MOSBY HYGIE Diag

Question 1

1. Body temperature exceeding 37.5°C (99.1°F) but less
   than 41.0°C (105.8 °F) is termed
   A. anoxia.
   B. pyrexia.
   C. hyperthermia.
   D. hypothermia.

Answer 1

ANS: B
Pyrexia (B), or fever, is an elevated body temperature
exceeding 37.5°C (99.1°F) but less than 41.0°C
(105.8°F) and is an indication of active infection. Patients
should not be treated in the clinical setting when fever is
present to avoid transmission of infectious agents. Anoxia
(A) is an oxygen deficiency or reduction of oxygen in
tissue, which can lead to cyanosis. Hyperthermia (C)
is an extremely dangerous condition when temperature
is above 41.0°C (105.8°F), requiring immediate
medical attention. Hypothermia (C) is abnormally low
body temperatures below 35.5°C (96.0°F) and can be
caused by exposure to cold temperatures, hemorrhage,
starvation, or physiologic shock.

Question 2

2. The first stage of physical assessment begins before
   the patient is seated. At this time, it can be determined
   that the patient does not have a communicable disease.
   A. Both statements are true.
   B. Both statements are false.
   C. The first statement is true, and the second
   statement is false.
   D. The first statement is false, and the second
   statement is true.

Answer 2

ANS: C
The first statement is true, and the second statement
is false (C). The first stage of physical assessment
begins before the patient is seated by observing
the patient’s gait, skin color, voice, and other
physical characteristics to determine overall status.
Unfortunately, physical appearance cannot be the sole
determinant of infectious status, and taking a thorough
medical history and vital signs will add additional
important information for patient assessment. Choices
A, B, and D do not correctly reflect the statements

Question 3

4. When the medical history includes a history of
   myocardial infarction, which assessment is used to
   determine when it is safe to provide oral care?
   A. Six months have passed since the event.
   B. Three months have passed since the event.
   C. The patient has functional capacity to run a short
   distance and climb a flight of stairs.
   D. The patient has the functional capacity to run a
   long distance and climb two flights of stairs.

Answer 3

ANS: C
The American College of Cardiology (ACC) and the
American Heart Association (AHA) have determined
that meeting four metabolic equivalents for functional
capacity (i.e., can run a short distance, climb a flight
of stairs, etc.) is the best method for determining
safe provision of noncardiac procedures (C). Former
guidelines to wait 3 to 6 months (A, B) before
providing dental care were supplanted with the ACC/
AHA guidelines in 2007. It is not necessary that the
patient have the functional capacity to run a long
distance or climb two flights of stairs (D).

Question 3

3. The technique of using the sense of touch to obtain
   information is termed
   A. palpation.
   B. percussion.
   C. auscultation.
   D. observation

Answer 3

ANS: A
Palpation (A) is an examination using the sense of
thorough tissue manipulation or application of pressure
on the area with fingers or the hand. Percussion (B)
is the act of tapping or striking a surface or tooth with
the fingers or an instrument. Auscultation (C) is the
use of sound in patient assessment such as clicking or
popping of the temporomandibular joint (TMJ) during
mouth opening. Observation (D) is visual examination
in a systematic order to note appearance, movement, or
function.

Question 4

5. Which of the following categories in the American
   Society of Anesthesiologists (ASA) risk classification
   describes a healthy client with no systemic disease?
   A. ASA I
   B. ASA II
   C. ASA III
   D. ASA IV
   E. ASA V

Answer 4

ANS: A
The ASA I (A) category is defined as “a healthy
patient without systemic disease.” ASA II (B) is
defined as “patient with mild systemic disease that
does not interfere with daily activities.” ASA III (C) is
defined as “a patient with severe systemic disease that
requires significant accommodations to treatment.”
ASA IV (D) is defined as “a patient with severe
systemic disease that is a constant threat to life.” ASA
V (E) is only used during an emergency appointment

Question 5

6. Which ASA risk classification is appropriate for the
   patient who has a history of myocardial infarction but
   can perform vigorous, intense activity (10 metabolic
   equivalent [MET] functional capacity)?
   A. ASA I
   B. ASA II
   C. ASA III
   D. ASA IV
   E. ASA V

Answer 5

ANS: B
The ASA II (B) risk category describes mild systemic
disease that does not interfere with daily activities. The
“10 metabolic equivalent functional capacity” describes
being able to play doubles tennis and perform strenuous
exercise. These activities would describe mild disease
level and recovery from the cardiac event. The ASA
I (A) risk category refers to a healthy patient without
systemic disease. The ASA III (C) risk category refers
to a patient with a severe systemic disease. The ASA
IV (D) risk category refers to a patient with a severe
systemic disease that is a constant threat to life. The
ASA V (E) risk category refers to a moribund patient
who is not expected to survive without surgery

Question 6

7. When the health history reveals that the patient has
   had a prior unpleasant dental experience that has led
   to dental phobia, which of the following is the MOST
   likely potential emergency situation?
   A. Exercise-induced asthma
   B. Tonic-clonic seizure
   C. Vasovagal syncope

Answer 6

ANS: C
Vasovagal syncope (C), or fainting, is the most common
dental emergency situation triggered by anxiety and
dental fears. Exercise-induced asthma (A) could also
be induced by stress or by allergy to dental office
environmental substances, but this reaction is not as
common as syncope. Although tonic-clonic seizures (B)
may be triggered by stress, failure to take antiseizure
medications would be a more common finding.

Question 7

8. According to the Fourth Report on the Diagnosis,
   Evaluation, and Treatment of High Blood Pressure in
   Children and Adolescents, at which age should a child’s
   blood pressure be measured at health care appointments?
   A. >3 years
   B. >6 years
   C. >10 years
   D. >12 years

Answer 7

ANS: A
The most recent guidelines call for the measurement
of blood pressure in children older than age 3 years
(A) when presenting at any health care facility; an
appropriate-sized cuff that accommodates the child’s
arm size should be used. Children who are >6 years
(B), >10 years (C), or >12 years (D), should have
blood pressure measurements taken at healthcare
appointments.

Question 7

9. All of the following medical conditions are associated
   with hypertension EXCEPT one. Which one is the
   EXCEPTION?
   A. Heart failure
   B. Hyperthyroidism
   C. Diabetes mellitus
   D. Type I hypersensitivity reaction

Answer 7

ANS: D
When an individual experiences a type I
hypersensitivity reaction (D), blood pressure falls,
and this condition is referred to as anaphylactic
shock. Heart failure (A), hyperthyroidism (B), and
diabetes mellitus (C) are all related to complications
of hypertension.

Question 8

10. Under which category does a blood pressure reading
    of 126/86mm Hg fall?
    A. Prehypertension
    B. Normal blood pressure
    C. Stage 1 hypertension
    D. Stage 2 hypertension

Answer 8

ANS: A
Prehypertension (A) occurs with levels from
120/80mm Hg to less than 139/89mm Hg. Normal
blood pressure is less than 120/80mm Hg (B).
Stage 1 hypertension (C) occurs with levels
from 140/90mm Hg to 159/99mm Hg. Stage 2
hypertension (D) is 160/100mm Hg and higher.

Question 9

11. When evaluating respiration, the clinician should
    observe all of the following factors EXCEPT one.
    Which one is the EXCEPTION?
    A. Rate of respiration
    B. Depth of respiration
    C. Quality of respiration
    D. Patient position during respiration
    E. Patient pulse rate during respiration

Answer 9

ANS: E
The patient’s pulse rate is not evaluated at the same
time as respiration (E). Assessment of respiration includes the rate (A), depth (B), and quality (C).
Normal respiration is noiseless, and sounds during
respiration indicate a degree of airway obstruction.
Patients who have difficulty breathing (orthopnea) in
the supine position (D) may have medical conditions
such as congestive heart failure that require treatment
modification.

Question 10

12. When nasal congestion is present, which oral
    procedure would MOST compromise the airway?
    A. Ultrasonic scaling
    B. Periodontal probing
    C. Taking dental images
    D. Periodontal scaling
    E. Intraoral or extraoral examination

Answer 10

ANS: A
Of these procedures, the water lavage produced in
ultrasonic scaling (A) will have the most effect on
the airway, since breathing through the nose is more
difficult. Periodontal probing (B), taking dental
images (C), periodontal scaling (D), or intraoral or
extraoral examination (E) will affect patient comfort
and efficiency of the procedure, and adaptations
may need to be made but are less likely to affect the
airway compared with ultrasonic scaling

Question 11

13. The patient is a 10-year-old who presents with a body
    temperature of 100.5°F. Treatment considerations for
    this patient include
    A. having the patient rinse with mouthwash before
    providing treatment.
    B. questioning the parent about recent exposure to
    others with infectious conditions.
    C. immediately referring the patient to a physician to
    minimize exposure to other patients

Answer 11

ANS: C
The best course of action would involve immediate
referral to a physician (C) for further medical evaluation
and to minimize further exposure to others. Elevated
temperature in children often indicates development
of a contagious “childhood illness” (measles, mumps,
chickenpox) in which elevation of body temperature
is an initial symptom. Although a preprocedural rinse
(A) reduces microbial contamination, it would not be
sufficient to reduce the risk of infection from someone
with an actively infectious disease. Questioning
the parent about exposure to others with infectious
conditions (B) may not obtain important information if
the parent is unaware of exposure.

Question 12

14. During a medical emergency, the pulse should be
    taken from which artery?
    A. Radial
    B. Carotid
    C. Brachial
    D. Femora

Answer 12

ANS: B
The cardiopulmonary resuscitation (CPR) guidelines
recommend that during a medical emergency, the
pulse should be taken from the carotid artery (B). The
radial artery (A) is used to take the pulse in normal
treatment situations, whereas the brachial artery
(C) or the femoral artery (D) would only be used if
trauma would not allow access to the carotid artery

Question 13

16. Your client presents with a blood pressure (BP)
    of 165/102mm Hg, right arm, sitting. Treatment
    considerations include all of the following EXCEPT
    one. Which one is the EXCEPTION?
    A. Provide routine oral services
    B. Delay treatment until BP is controlled
    C. Keep appointment duration short
    D. Provide referral for medical evaluation of BP
    within 1 month
    E. Use a stress-reduction protocol and good pain control

Answer 13

ANS: B
Treatment does not need to be delayed; delay
of treatment is NOT recommended unless BP
measurements are 180/110mm Hg or greater (B).
Oral procedures can be provided safely (A) provided
the client is not overstressed, generally in a short
appointment, and has good pain control (C, E). The
client should be advised to see a physician within
1 month for assessment of BP (D).

Question 14

15. All of the following are risk factors in the
    development of type II diabetes mellitus (T2DM)
    EXCEPT one. Which one is the EXCEPTION?
    A. Obesity
    B. Smoking
    C. Genetics
    D. Middle age
    E. Sedentary lifestyl

Answer 14

ANS: B
Smoking is a risk factor for periodontitis, not T2DM
(B). Obesity (A) is strongly correlated to T2DM,
or insulin-resistant diabetes. There is a genetic
component (C) to T2DM, which places some
populations such as African Americans and Latinos
and subpopulations such as the Pima Indians at
higher risk for developing the disease. T2DM has
traditionally been termed “adult-onset diabetes”
because the majority of persons developing this
disease are middle-aged or older adults (D), although
this is changing as the prevalence of obesity increases.
A sedentary lifestyle (E) is strongly linked to T2DM.

Question 15

17. Blood pressure (BP) classifications in pediatric
    individuals are based on all of these factors EXCEPT
    one. Which one is the EXCEPTION?
    A. Age
    B. Gender
    C. Height
    D. Weight

Answer 15

ANS: D
Weight (D) is not used in the statistical calculations
for categories such as normal, prehypertension,
stage 1 hypertension, and stage 2 hypertension. The
factors used by the Fourth Report on the Diagnosis,
Evaluation, and Treatment of High Blood Pressure
in Children and Adolescents are age (A), gender (B),
and height (C), with seven height levels quantifying
various levels according to year of age. Routine BP
readings are recommended in children age 3 years
and older.

Question 16

18. Indurated, movable retroauricular lymph nodes
    suggest examination of which area for etiology?
    A. Scalp behind ear
    B. Auricular tragus
    C. Zygomatic region
    D. Maxillary posterior teeth

Answer 16

ANS: A
The scalp behind the ear (A) drains into the
retroauricular lymph nodes. The auricular tragus
is drained by the anterior auricular glands or
preauricular glands (B). The zygomatic region (C)
is drained by the buccal, malar, mandibular, and
submandibular glands. Maxillary posterior teeth (D)
are primarily drained by the submandibular lymph nodes, and maxillary third molars are drained by the
superior deep cervical lymph nodes.

Question 17

19. Submandibular lymph nodes are best examined by
    A. rolling the node over the inferior border of the
    mandible.
    B. pushing the node superiorly to contact the
    mylohyoid muscle.
    C. asking the patient to swallow as the nodes are
    palpated bilaterally.

Answer 17

ANS: A
To determine whether abnormal nodes are present,
they must be pressed against a hard surface.
Of the choices provided, only rolling the node
over the inferior border of the mandible (A)
allows this technique. Neither pushing the node
superiorly to contact the mylohyoid muscle (B)
nor asking the patient to swallow while palpating
the nodes bilaterally (C) would identify indurated
submandibular nodes.

Question 18

20. All of the following techniques will detect the
    presence of cysts or lymphadenopathy during the
    extraoral examination of the neck EXCEPT one.
    Which one is the EXCEPTION?
    A. Taking medical history
    B. Rolling the nodes over a hard surface
    C. Visual observation as the head is turned to the side
    D. Palpation of areas where the lymphatic system is
    present

Answer 18

ANS: A
The medical history (A) would not reveal the
presence of cysts or lymphadenopathy, since patients
are usually unaware of having enlarged lymph nodes.
Rolling the nodes over a hard surface (B), visual
observation as the head is turned to the side (C), and
palpation (D) are all methods used to detect indurated
structures in the head and neck area.

Question 19

21. The presence of cystic acne indicates the probable
    finding of which microorganism?
    A. Staphylococcus aureus
    B. Neisseria gonorrhoeae
    C. Treponema pallidum
    D. Streptococcus sanguis

Answer 19

ANS: A
Cysts and boils are associated with S. aureus (A),
a common skin microorganism. N. gonorrhoeae (B)
and T. pallidum (C) are associated with infection of
mucosal surfaces, not skin. S. sanguis (D) is associated
with oral ecosystems and is not found on skin.

Question 20

22. A periodontal infection surrounding tooth #24 would
    be related to which condition?
    A. Enlargement of submental nodes
    B. Induration of submandibular nodes
    C. Formation of a mucocele in the lower lip
    D. Prominent sublingual ductal mucosa

Answer 20

ANS: A
Mandibular anterior teeth, including tooth #24, drain
into the submental lymph node (A). Submandibular
nodes (B) receive drainage from maxillary teeth and
posterior mandibular teeth. A mucocele (C) occurs
from an injury that traumatizes the salivary gland
duct. Sublingual ducts (D) are not affected by toothrelated infections in the local area.

Question 21

23. An objective abnormal finding during the head and
    neck examination that can be identified by a health
    care professional is called a symptom. A patient report
    of pain is a good example of a symptom.
    A. Both statements are true.
    B. Both statements are false.
    C. The first statement is true, and the second
    statement is false.
    D. The first statement is false, and the second
    statement is true.

Answer 21

ANS: D
The first statement is false, and the second statement is
true (D). The definition of a sign is an objective finding
identified by the health care professional, whereas the
definition of a symptom is a subjective finding reported
by the patient. A patient report of pain is subjective and
is a symptom. Both signs and symptoms are valuable
patient assessment tools. Choices A, B, and C do not
correctly address the question.

Question 22

24. During examination of the temporomandibular joint
    (TMJ), all of the following are issues to be considered
    EXCEPT one. Which one is the EXCEPTION?
    A. Noises
    B. Tenderness
    C. Deviations of movement
    D. Crowding of mandibular incisors

Answer 22

ANS: D
The alignment of incisors (D) is used to determine
the possibility of occlusal misalignment and not to
examine the TMJ. Malocclusion may be a factor in TMJ
assessment if the molar or jaw relationship is abnormal.
Noises such as clicking or popping (A), tenderness (B),
and movement deviations (C) are all characteristics that
should be assessed during TMJ examination.

Question 23

25. When the oral cavity exhibits a reduction of saliva, all
    of the following are potential findings EXCEPT one.
    Which one is the EXCEPTION?
    A. Caries
    B. Candidiasis
    C. Coated tongue
    D. Periodontal disease

Answer 23

ANS: D
Periodontal disease (D) is a multifactorial disease
unrelated to xerostomia, which is the clinical term for
dry mouth. Caries (A) and a coated tongue (C) may
be results of chronic dry mouth. Candidiasis (B) may
occur when reduced saliva flow allows opportunistic
fungi to flourish.

Question 23

26. Examination of breath odors is a component of all of
    the following conditions EXCEPT one. Which one is
    the EXCEPTION?
    A. Alcoholism
    B. Carcinoma
    C. Tobacco use
    D. Diabetes mellitus

Answer 23

ANS: B
Carcinoma (B) presents as a nonhealing ulceration or
red-to-white nodule and is not associated with breath
odor. Alcoholism (A) may be suspected by the smell
of alcohol on the breath. Uncontrolled diabetes (D)
may present as a sweet odor of the breath. Tobacco
use (C) is often identified by breath odors.

Question 24

27. Which area of the tongue has the
    greatest predisposition to development of
    carcinoma?
    A. Dorsal surface
    B. Lateral borders
    C. Ventral surface
    D. Area of foramen cecum

Answer 24

ANS: B
The most common location of oral carcinoma on the
tongue is the lateral border area (B). The tongue’s
dorsal (A) and ventral (C) surfaces and the area
of foramen cecum (D) are less likely to undergo
malignant changes.

Question 25

28. Palpation of the lymph nodes during the head
    and neck examination reveals all of the following
    conditions EXCEPT one. Which one is the
    EXCEPTION?
    A. Metastatic lesions
    B. Fibrous hyperplasia
    C. Acute inflammation
    D. Latent tuberculosis (TB) infection

Answer 25

ANS: D
Latent TB infection (D) is not detectable from
lymphadenopathy. TB bacteria are contained in lung
tissue, not in the lymph nodes of the head and neck.
Chronically inflamed lymph nodes may form fibrous
hyperplasia (B) or fibrous connective scar tissue, and
acutely inflamed nodes (C) may fill with fluid, producing
edema. Malignant tissue of epithelium metastasizes
(A) via the lymphatic system and can be detected by
indurated, fixed lymph nodes of the head and neck.

Question 26

29. During oral examination, the patient is asked to
    occlude the teeth and swallow. What is the reason
    for this?
    A. Assessment for fremitus
    B. Assessment for centric occlusion
    C. Assessment for mouth breathing
    D. Assessment for reverse swallowing

Answer 26

ANS: D
The patient is asked to occlude the teeth and swallow
to determine whether tongue thrusting is a habit
from reverse swallowing (D). The tongue should go
backward during the swallow and should not protrude
through the front teeth. Assessment for fremitus (A)
requires the tapping of teeth while feeling digitally
for tooth movement. Assessment for centric occlusion
(B) does not involve swallowing while teeth are in
occlusion. Assessment for mouth breathing (C) is
done by visually examining the mouth while open

Question 27

30. A lesion that is attached by a stemlike or stalklike
    base is described as
    A. sessile.
    B. diffuse.
    C. papillary.
    D. corrugated.
    E. pedunculated

Answer 27

ANS: E
A pedunculated (E) lesion is attached by a stemlike or
stalklike base to the tissue surface. Sessile (A) lesions
have a broad flat base. Diffuse (B) lesions have borders
that are not well defined. Papillary (C) lesions are
clusters of small, nipplelike projections or elevations.
Corrugated (D) lesions have a wrinkled surface.

Question 28

31. All of the following are evidence-based risk factors
    for periodontal disease EXCEPT one. Which one is
    the EXCEPTION?
    A. Age
    B. Tobacco use
    C. Retained biofilm
    D. Compromised immune system
    E. Diabetes controlled with insulin

Answer 28

ANS: E
Uncontrolled diabetes is associated with increased
infection, but individuals with diabetes controlled
with medications such as insulin (E) have no greater
risk for periodontal disease than do individuals
without diabetes. According to surveys of oral
health in populations, the risk for periodontal
disease increases with age (A). Tobacco use (B) is a
documented risk factor associated with periodontal disease. Retained biofilm (C) becomes more
pathogenic the longer it is undisturbed and may
cause periodontal inflammation and infection. Any
condition that reduces the host response (D) increases
the risk of periodontal disease.

Question 29

32. Periodontal disease is associated with the following
    obligate, anaerobic, gram-negative bacteria EXCEPT
    one. Which one is the EXCEPTION?
    A. Streptococcus mutans
    B. Tannerella forsythensis
    C. Porphyromonas gingivalis
    D. Aggregatibacter actinomycetemcomitans

Answer 29

ANS: A
S. mutans (A) is a gram-positive, not a gram-negative,
facultative anaerobic bacterium associated with dental
caries. T. forsythensis (B), P. gingivalis (C), and
A. actinomycetemcomitans (D) are all gram-negative,
obligate, anaerobic bacteria that have strong links to
periodontal disease.

Question 30

33. Which drug has been associated with improved
    periodontal tissue health?
    A. Nifedipine (Procardia)
    B. Cyclosporine (Sandimmune)
    C. Phenytoin (Dilantin)
    D. Doxycycline (Atridox)

Answer 30

ANS: D
Doxycycline (Atridox) (D), an antibacterial drug
in the tetracycline classification, has been shown
to suppress and kill periodontal microorganisms.
Nifedipine (Procardia) (A), cyclosporine
(Sandimmune) (B), and phenytoin (Dilantin) (C) all
are associated with gingival hyperplasia, which makes
the periodontal area difficult to clean and predisposes
an individual to periodontal inflammation.

Question 31

34. Which factor is the STRONGEST predictor of future
    clinical attachment loss?
    A. Bleeding on probing
    B. Prior periodontal infection
    C. Lack of bleeding on probing
    D. Bone loss on dental images

Answer 31

ANS: B
A history of prior periodontal disease (B) is the strongest
predictor of future clinical attachment loss. Individuals
are never cured of periodontal disease, and frequent
maintenance is needed to prevent recurrence. Bleeding
on probing (A) is an indicator of active inflammation but
does not necessarily predict progression of inflammation
into the periodontal ligament. Lack of bleeding on
probing (C) is an indicator of low risk of future clinical
attachment loss. Bone loss on dental images (D)
indicates past disease activity but is not predictive of
future clinical attachment loss.

Question 32

35. Current salivary genetic deoxyribonucleic acid (DNA)
    tests for periodontal disease (PD) are prognostic tests.
    These tests can be used to diagnose PD.
    A. Both statements are true.
    B. Both statements are false.
    C. The first statement is true, and the second
    statement is false.
    D. The first statement is false, and the second
    statement is true

Answer 32

ANS: C
The first statement is true, and the second statement
is false (C). The DNA test identifies inflammatory
markers such as interleukin-1 in saliva and may
indicate increased susceptibility to PD. However, the test is used only as a prognostic test and not for
diagnosis of PD. Some individuals with a positive test
have not developed PD, and others without the DNA
indicator have developed PD. Choices A, B, and D do
not correctly address the question.

Question 33

39. Periodontal screening and recording (PSR), a procedure for
    periodontal screening, has all of the following components
    EXCEPT one. Which one is the EXCEPTION?
    A. The probe has a 0.5mm ball tip.
    B. Teeth are examined by sextants.
    C. The highest score is recorded for each sextant.
    D. The probe is walked into the mesial areas of the
    indicator tooth.

Answer 33

ANS: D
During the PSR procedure, the probe is walked
around the entire tooth, not just the mesial areas of
the indicator tooth (D). The six areas assessed are the
distobuccal, buccal, mesiobuccal, distolingual, lingual,
and mesiolingual areas. A special probe with a 0.5-mm
ball tip (A) is used during the procedure. All teeth are
examined by sextants (B), and the highest score for
each sextant is recorded (C) and used to determine
whether full periodontal charting is needed.

Question 34

36. Examination of the periodontium reveals localized
    probe depths between 4 and 5 millimeters (mm),
    but the tissue do not bleed on probing. All of the
    following factors should be considered in any
    determination of this finding EXCEPT one. Which
    one is the EXCEPTION?
    A. History of tobacco use
    B. Clinician probing technique
    C. Periodontal disease not in active state
    D. Type of probe used in obtaining readings
    E. Type of microorganisms within periodontal sulcus

Answer 34

ANS: D
The type of probe used to obtain readings (D) or lack
of bleeding on probing should not factor into the
readings. Research shows that tobacco use (A) may
constrict vasculature of the periodontium, in which
case tissues do not bleed easily. When clinicians do
not use sufficient pressure in their probing technique
(B), it may result in inaccurate readings or failure to
reach the base of the ulcerated junctional epithelium
where bleeding originates. Periodontal disease is
characterized by exacerbation and remission. During
remission, the disease is not in an active state (C), so
the stable tissue may not bleed although increased
probing depths are present due to past disease.
Not all microorganisms (E) are capable of causing
periodontal infection or inflammation, and anaerobic,
gram-negative bacteria are more strongly related to
active infection and bleeding.

Question 35

37. All of the following are components of a periodontal
    examination EXCEPT one. Which one is the
    EXCEPTION?
    A. Adequate lighting
    B. Nutritional evaluation
    C. Nabors periodontal probe
    D. Compressed air to dry tissues
    E. Digital examination for fremitus

Answer 35

ANS: B
Nutritional evaluation (B) is not part of a thorough
periodontal examination, although it may be indicated
in some cases. Adequate lighting (A) is important for
accurate observation of tissue color and consistency
during periodontal examination. A specific probe to
measure furcation involvement during periodontal
examination is the Nabors probe (C). Compressed
air to dry tissues (D) improves observation of tissue.
Tooth movement during occlusion, or fremitus (E), is
one procedure used to identify mobile teeth.

Question 36

38. Which of the following instruments is used to assess
    implants for peri-implantitis?
    A. Plastic probe
    B. Williams probe
    C. Florida probe
    D. Periodontal endoscope
    E. Marquis probe with colored bands

Answer 36

ANS: A
A plastic probe (A) is used to prevent damage to
the titanium implant surface, and it can help assess
implants for peri-implantitis. The Williams probe
(B), the Florida probe (C), and the Marquis probe with colored bands (E) are all metal probes that
may scratch the titanium implant post and are
not recommended for the assessment of existing
implants. The periodontal endoscope (D) is used for
subgingival calculus detection on normal tooth roots.

Question 37

41. During periodontal examination, the probe tip is
    placed on the tooth or root surface and walked into
    which area of the periodontium?
    A. Marginal epithelium
    B. Junctional epithelium
    C. Keratinized epithelium
    D. Parakeratinized epithelium

Answer 37

ANS: B
During periodontal examination, the probe tip is
placed on the tooth or root surface and walked into
the sulcus to the base of the junctional epithelium
(B). The probe depth is measured from the margin of
the gingival epithelium (A) to the base of the pocket.
Keratinized epithelium (C) is the outer surface of
the buccal and lingual gingiva and is part of the
masticatory mucosa. Parakeratinized epithelium (D)
is a component of the keratinized masticatory mucosa.

Question 38

43. A 4-mm probe depth of the junctional epithelium at
    the cementoenamel junction (CEJ) is referred to as a
    A. true pocket.
    B. pseudopocket.
    C. gingival pocket.
    D. periodontal pocket.

Answer 38

ANS: B
A pseudopocket (B) is formed by edema of the
gingival margin but without loss of connective
tissue fibers or apical migration of the junctional
epithelium. A true pocket (A) is another term for a
periodontal pocket. A gingival pocket (C) is another
term for pseudopocket, with no connective tissue loss.
A periodontal pocket (D) is characterized as apical
migration of the junctional epithelium.

Question 39

40. A tooth with a 2-mm recession of gingival margin has
    a 3-mm probe depth. What is the degree of clinical
    attachment loss?
    A. 2mm
    B. 3mm
    C. 5mm
    D. 6mm

Answer 39

ANS: C
The attachment loss is determined by measuring the
space from the cementoenamel junction (CEJ) to the
junctional attachment. In the example provided, a
2-mm loss is caused by recession, and a 3-mm pocket
depth caused by apical migration of the junctional
epithelium. The two numbers are added together to
get the total clinical attachment loss of 5mm (C).
Choices A, B, and D are not the correct degrees of
clinical attachment loss.

Question 40

42. Gingival crevicular fluid comes from which tissue?
    A. Crevicular epithelium
    B. Junctional epithelium
    C. Sulcular connective tissue

Answer 40

ANS: C
Gingival crevicular fluid is a serumlike fluid
secreted from the capillaries in connective tissue (C) underlying the sulcus. As inflammation increases in
the sulcus, the capillaries become more permeable,
and more gingival crevicular fluid is released to
flush the periodontal pathogens out of the sulcus.
The junctional epithelium (B) is the barrier between
the epithelium of the sulcus and the underlying
connective tissue and does not secrete gingival
crevicular fluid. Fluid is not secreted by the crevicular
epithelium (A) because there are no blood vessels
within epithelium.

Question 41

44. Generalized aggressive periodontitis affects
    permanent first molars, incisors, or both. Localized
    aggressive periodontitis affects most teeth.
    A. Both statements are true.
    B. Both statements are false.
    C. The first statement is true, and the second
    statement is false.
    D. The first statement is false, and the second
    statement is true.

Answer 41

ANS: B
Both statements are false (B). The generalized form
of aggressive periodontitis affects most teeth. The
localized form is confined mostly to the permanent
first molars, incisors, or both. Choices A, C, and D do
not correctly address the question

Question 42

45. The alveolar mucosa is separated from the alveolar
    gingiva at which anatomic landmark?
    A. Vestibule
    B. Free gingival groove
    C. Junctional epithelium
    D. Mucogingival junction

Answer 42

ANS: D
The mucogingival junction (D) separates the alveolar
gingiva from the alveolar mucosa. The vestibule (A)
is the space between the lips and the gingiva. The free
gingival groove (B) separates the free gingiva from
the attached gingiva. The junctional epithelium (C)
is the most inferior portion of the sulcular epithelium
and attaches the tooth to the underlying connective
tissue.

Question 43

46. In which area of the gingiva is a mucogingival
    junction (MGJ) absent?
    A. Lingual to the lower anterior teeth
    B. Buccal to maxillary third molars
    C. Buccal to mandibular third molars
    D. Lingual to maxillary anterior teeth

Answer 43

ANS: D
The area between the marginal gingiva and palatal
mucosa (lingual to maxillary anterior teeth) (D) does
not have an MGJ or alveolar mucosa. The gingiva in
this area is bound directly to the periosteum of the hard palate. All other areas of the periodontium—
lingual to the lower anterior teeth (A), buccal to
the maxillary third molars (B), and buccal to the
mandibular third molars (C)—have an MGJ and
alveolar mucosa.

Question 44

48. Which is a non–plaque-induced gingival lesion?
    A. Allergic gingivitis
    B. Puberty-associated gingivitis
    C. Pregnancy-associated gingivitis
    D. Leukemia-associated gingivitis
    E. Ascorbic acid–deficiency gingivitis

Answer 44

ANS: A
Allergic gingivitis (A) is caused by an immunologic
response to an allergen, not plaque biofilm. Gingivitis
associated with puberty (B), pregnancy (C), leukemia
(D), and ascorbic acid deficiency (E) are all classified
as plaque-induced gingivitis modified by systemic
factors

Question 45

47. Which feature differentiates periodontitis from gingivitis?
    A. Bleeding on probing
    B. Clinical attachment loss
    C. Fibrotic gingival consistency
    D. Probe depth greater than 3mm

Answer 45

ANS: B
A diagnosis of periodontitis requires clinical
attachment loss (B), with apical migration of the
junctional epithelium, bone loss, or both. Bleeding
on probing (A) may occur in both gingivitis and
periodontitis. Probing depth (D) alone, even
if greater than 3mm, may simply indicate a
pseudopocketing caused by inflammation. Fibrotic
gingival consistency (C) relates to overgrowth of
connective tissue but does not necessarily indicate
clinical attachment loss

Question 46

49. Cratered and missing gingival papillae are indicative
    of all of the following EXCEPT one. Which one is the
    EXCEPTION?
    A. Loss of col
    B. Necrotizing ulcerative gingivitis (NUG)
    C. Proximal infrabony osseous defect
    D. Chronic use of toothpicks

Answer 46

ANS: B
Although individuals with chronic NUG may have
cratered papillae, not all cases of NUG (B) result
in this defect. Cratered or missing papillae are
associated with a proximal infrabony osseous defect
(C), which causes the col area to disintegrate (A), and
with pressure on interdental papillae from chronic use
of toothpicks (D).

Question 47

50. Which palpation method is used to examine the floor
    of the mouth?
    A. Digital
    B. Circular
    C. Bidigital
    D. Bimanual

Answer 47

ANS: D
The bimanual (D) method is the best method to
examine the floor of the mouth. Digital (A), circular
(B), and bidigital (C) palpation methods would not
provide information on the pathologic processes
inferior to the floor of the mouth.

Question 48

51. A yellow nodule in the vestibule, lateral to tooth #18,
    is discovered during a clinical examination. Which
    examination method would be used to gain more
    information?
    A. Digital examination
    B. Histologic sample
    C. Circular compression
    D. Radiographic examination
    E. Antibody assay

Answer 48

ANS: E
Antibody assay (E) is a blood test used to determine if
antibodies to a specific pathogen or tissue. This type
of test is often used to diagnose autoimmune disease
but would not be used to diagnose an oral lesion.
Histologic sample (B) or biopsy, is the microscopic
examination (D) that can help determine whether the
lesion has alveolar bone involvement or is confined
to soft tissue only. Digital examination by palpation
(A) determines consistency of the lesion, and circular
compression (C) determines whether the nodule is
movable or attached to the underlying tissue. This
information is vital to the formulation of a differential
diagnosis

Question 49

52. During intraoral examination, a pedunculated, solid lesion
    of normal color with a smooth surface texture is observed
    along the line of occlusion on the buccal mucosa. Which
    would be the FIRST choice in a differential diagnosis?
    A. Papilloma
    B. Mucocele
    C. Irritation fibroma
    D. Kaposi sarcoma

Answer 49

ANS: C
Irritation fibroma (C) is the most common intraoral
neoplasm. It is commonly associated with chronic
trauma such as the line of occlusion from biting
the buccal mucosa. A papilloma (A) is papillary in
surface consistency, often described as cauliflowerlike, and may be white or the color of normal
mucosa, depending on the amount of keratinization.
A mucocele (B) is bluish or the color of normal
mucosa. A mucocele is a lesion that forms when
a damaged minor salivary gland causes retention
of saliva. Kaposi sarcoma (D), which is a vascular
malignancy associated with patients with human
immunodeficiency virus (HIV), presents as a purplish
bruise on the palate and may become exophytic as it
enlarges.

Question 50

53. During examination for abnormalities of the extraoral
    or intraoral structures, which of the following is
    essential?
    A. Bilateral comparison
    B. Radiographic images
    C. Records of prior oral examinations
    D. Determination of body temperature

Answer 50

ANS: A
Comparing both sides of the face or the oral cavity
(A) may help rule out pathologic processes or identify
developmental differences. Radiographic images (B)
are necessary if a clinical examination cannot identify
the probable source of an abnormality. Records of
prior examinations (C) may be useful to get historical
information but are not essential. Elevated body
temperature (D) would be more indicative of an
infectious disease than abnormalities of intraoral and
extraoral structures.

Question 51

54. Which of the following poses an increased risk for
    root caries?
    A. Increased salivation
    B. Decreased salivation
    C. Consumption of acidic foods
    D. Back-and-forth toothbrushing technique

Answer 51

ANS: B
Lack of saliva (B) increases the risk for caries of
any type. Acidic food consumption (C) is linked to
erosion, not caries. Increased salivation (A) assists
remineralization and is not a risk factor for caries.
Toothbrushing is the primary form of mechanical
disruption of biofilm, and the back-and-forth
toothbrushing technique (D) has not been linked to
caries risk

Question 52

55. A patient who displays the typical signs of traumatic
    occlusion is likely to have radiographic and clinical
    signs that demonstrate all of the following characteristics
    EXCEPT one. Which one is the EXCEPTION?
    A. Tooth mobility
    B. Horizontal bone loss
    C. Widening of periodontal ligament space
    D. Angular or vertical bone destruction

Answer 52

ANS: B
Horizontal bone loss (B) is associated with the slow
bone loss seen in chronic periodontal disease. Tooth
mobility (A) is often associated with excessive
occlusal forces. Widening of the periodontal ligament
space (C) is usually the first radiographic sign of
occlusal trauma. Angular or vertical bone destruction
(D) is found when excessive occlusal forces occur in
the presence of inflammation, causing rapid bone loss

Question 53

56. All of the following statements about smoking and
    periodontal disease are true EXCEPT one. Which one
    is the EXCEPTION?
    A. Smoking cessation is beneficial to periodontal heath.
    B. Tobacco users have higher levels of pathogenic
    bacteria compared with nonsmokers.
    C. Smokers frequently display more inflammation and
    bleeding on probing compared with nonsmokers.
    D. A positive correlation exists between the amount
    smoked and the severity of periodontal disease.

Answer 53

ANS: C
Smokers may have less bleeding on probing and
inflammation compared with nonsmokers (C) because
of the vasoconstrictive properties of nicotine and
a suppressed immune response to plaque biofilm.
Smoking cessation is extremely beneficial to
periodontal health (A) because tobacco use puts
patients at high risk for development of periodontal
disease. Tobacco users have higher levels of pathogenic
bacteria compared with nonsmokers (B), even with
good oral hygiene. A positive correlation exists
between the amount smoked and the severity of
periodontal disease (D), with heavy smokers displaying
more severe exacerbations of periodontal disease.

Question 54

57. When a patient is identified as being at high risk
    for caries during oral examination, which of the
    following strategy is NOT recommended by the
    American Dental Association (ADA) for primary
    prevention of caries?
    A. Sealants
    B. Fluoride varnish
    C. Nutritional counseling
    D. Xylitol gum chewed after meals

Answer 54

ANS: D
Although research indicates that xylitol gum chewed
after meals (D) reduces caries activity, it has not
received a recommendation from the ADA. According to the 2011 ADA clinical practice recommendations,
only sealants (A), fluoride (B), and dietary practices
(C) are primary caries-preventive strategies.

Question 55

58. Components of the intraoral examination of the floor
    of the mouth include assessment of all of the following
    EXCEPT one. Which one is the EXCEPTION?
    A. Salivary flow
    B. Swallowing pattern
    C. Color of the mucosa
    D. Ability to lift the tongue to the palate
    E. Surface texture of the mucosa

Answer 55

ANS: B
The swallowing pattern (B) is examined while teeth
are clenched. The flow of saliva (A), the color (C)
and surface texture (E) of the mucosa, and the ability
to lift the tongue to the palate (D) are all part of the
examination of the floor of the mouth.

Question 56

60. Blood in the sputum of an individual infected with TB
    represents
    A. droplet infection.
    B. breakage of blood vessels as a result of violent
    coughing.
    C. aerosol of TB organism transmitted to the
    circulatory system.
    D. TB bacteria infecting and damaging blood
    vessels

Answer 56

ANS: B
Violent coughing may cause the blood vessels in
the pharyngeal area to rupture (B), mixing blood
with sputum. Droplet infection (A) is the method of
transmission of TB and is not associated with blood in
sputum. Aerosol of the TB organism is the method of
transmission (C), which may cause the TB organism
to be transmitted in the circulatory system, but does
not produce blood in sputum. TB bacteria cannot
directly infect or damage blood vessels (D) and do not
cause blood in sputum.

Question 57

59. Symptoms of active TB include all of the following
    EXCEPT one. Which one is the EXCEPTION?
    A. Flulike symptoms
    B. Unexplained weight gain
    C. Cough that produces blood
    D. Persistent cough for more than 3 weeks

Answer 57

ANS: B
Weight loss, not weight gain (B), is associated with
active disease. The Centers for Disease Control and
Prevention (CDC) associate flulike symptoms (A),
cough that produces blood (C), persistent cough for
more than 3 weeks (D) with active TB.

Question 58

61. All of the following are examples of an elevated
    lesion EXCEPT one. Which one is the EXCEPTION?
    A. Macule
    B. Bulla
    C. Vesicle
    D. Pustule
    E. Nodule

Answer 58

ANS: A
A macule (A) is a flat lesion distinguished by a
color different from that of surrounding tissues.
All of the other lesions are raised lesions. A bulla
(B) is a circumscribed elevated lesion more than
5 mm in diameter and is usually filled with serous
fluid. Vesicles (C) are small elevated lesions
less than 1 cm in diameter and contain serous
fluid. Pustules (D) are raised lesions of various
sizes that are filled with purulent exudates. A
nodule (E) is a solid palpable lesion up to 1 cm in
diameter.

Question 59

62. Which term characterizes an outward growth?
    A. Ulcer
    B. Fissure
    C. Induration
    D. Exophytic
    E. Coalescence

Answer 59

ANS: D
An exophytic (D) lesion is defined as an
outgrowing lesion. An ulcer (A) is a break
or depression in the surface continuity of the
epithelium. A fissure (B) is a cleft or groove in
tissue. An induration (C) is an abnormal hardening
of tissue, often associated with cancerous growths.
Coalescence (E) is the process of joining together,
with loss of borders.

Question 60

63. A radiographically evident lesion or mass that extends
    beyond the boundaries of one distinct area and has
    many parts is called
    A. sclerotic.
    B. scalloped.
    C. unilocular.
    D. multilocular.

Answer 60

ANS: D
A multilocular (D) lesion is a radiographically
evident lesion extending beyond the boundaries
of one distinct area and has many parts. The
radiographic image of a sclerotic (A) lesion shows
a definite radiopaque border because of the highest
density, and such a lesion is usually a longstanding
one. Radiolucent lesions with scalloped (B) borders
extending between the roots of multiple teeth
are seen in some types of cysts and neoplasms.
Unilocular (C) is a radiographically descriptive
term of the appearance of a single, rounded
compartment.

Question 61

64. A cytologic smear of the oral mucosa is a technique
    used to histologically examine
    A. surface cells.
    B. biopsy specimen.
    C. keratinized tissue.
    D. erythematous nodules.

Answer 61

ANS: A
The cytologic smear examines only surface cells
(A) removed for microscopic examination. A biopsy
specimen (B) removes all cell layers for microscopic
preparation and examination. Keratinized tissue
(C) will not always identify a pathologic process,
as surface keratin covers potential abnormal tissues
underneath. Erythematous nodules (D) are examined
when the tissue is removed and glass slides of shaved
tissue are made for dye preparation and microscopic
examination.

Question 62

65. Given a history of bruxism and the dental
    examination revealing flat occlusal surfaces, which
    muscle would be expected to be prominent when
    examining the face?
    A. Facial
    B. Masseter
    C. Buccinator
    D. Pterygomandibular

Answer 62

ANS: B
The masseter (B) muscle is overworked and
hypertrophies with chronic bruxism. The facial (A),
buccinator (C), and pterygomandibular (D) muscles
are not activated during occlusion.

Question 63

66. The presence of extra teeth beyond the normal
    complement is known as
    A. anodontia.
    B. hypodontia.
    C. hyperdontia.
    D. macrodontia.

Answer 63

ANS: C
Hyperdontia (C) refers to the presence of extra teeth
beyond the normal complement, or supernumerary
teeth. Anodontia (A) refers to the total absence
of teeth. Hypodontia (B) refers to the absence of
some teeth so that a normal complement is lacking.
Macrodontia (D) refers to larger-than-normal teeth.

Question 64

68. A tooth with a normal crown but wide and elongated
    pulp extending into the root is an example of
    A. taurodontism.
    B. dentin dysplasia.
    C. dens evaginatus.

Answer 64

ANS: A
A tooth with a normal crown but wide and elongated
pulp extending into the root is an example of
taurodontism (A). Dentin dysplasia (B) is a
developmental disturbance of dentin covered by
normal enamel. Dens evaginatus (C) is a cusplike
elevation of enamel in the central groove or lingual
ridge of the buccal cusp of posterior teeth

Question 65

67. Which of the following is a supernumerary tooth?
    A. Dens in dente
    B. Mesiodens
    C. Macrodont
    D. Peg latera

Answer 65

ANS: B
The most common supernumerary tooth is the
mesiodens (B), found at the midline of the maxillary
arch. Dens in dente (A) are an invagination of the
pulp canal, literally a “tooth within a tooth.”
A macrodont (C) is a larger-than-normal tooth.
A peg lateral (D) is a smaller-than-normal tooth, or a
microdont.

Question 66

69. A cervical stress-related defect manifesting as a
    wedge-shaped defect is called an
    A. erosion.
    B. attrition.
    C. abrasion.
    D. abfraction.

Answer 66

ANS: D
Occlusal stress forces at the CEJ are speculated to be
a cause of abfraction (D), which results in a wedgeshaped defect. Erosion (A) is dissolution of tooth
structure caused by chemical contact. Attrition (B)
is loss of tooth structure from tooth-to-tooth contact.
Abrasion (C) results from abrasive substances.

Question 67

70. The MOST effective means for detecting occlusal
    caries is the
    A. use of a thin explorer.
    B. use of transillumination.
    C. use of air and visual inspection.
    D. use of laser detection technology.

Answer 67

ANS: C
Use of visual inspection after drying the enamel
surface with air (C) is considered the most effective
method for detecting occlusal caries. Use of a
thin explorer (A) may damage enamel integrity.
Transillumination (B) is used to detect interproximal
caries in anterior teeth, not for detection of occlusal caries. Laser detection technology (D), such as
Diagnodent, requires calibration, and the efficacy
of this technology has not been proven by extensive
research.

Question 68

71. In an assessment of the deciduous dentition, tooth
    #E is the
    A. maxillary right canine.
    B. maxillary right central incisor.
    C. mandibular right lateral incisor.
    D. mandibular right central incisor.

Answer 68

ANS: B
Deciduous teeth are designated by the alphabet,
beginning at the maxillary right second molar. The
maxillary right central incisor (B) is tooth #E. The
maxillary right canine (A) is tooth #C, the mandibular
right lateral incisor (C) is tooth #Q, and the
mandibular right central incisor (D) is tooth #P.

Question 69

72. The relationship of occlusal surfaces that provide for
    maximal intercuspation when teeth are occluded is
    A. centric occlusion.
    B. class I occlusion.
    C. anterior open bite.
    D. end-to-end occlusion.

Answer 69

ANS: A
Centric occlusion (A) refers to the relationship
of occlusal surfaces that provide for maximal
intercuspation when teeth are occluded. Class I
occlusion (B) reflects the location of the maxillary
canines and that the first molar relationships are
in normal occlusion but there is malpositioning of
individual or groups of teeth. Anterior open bite
(C) is when the anterior teeth are not in contact but
posterior teeth are in normal occlusion. End-toend occlusion (D) occurs when the molars are in a
cusp-to-cusp relationship rather than an intercuspal
relationship.

Question 70

73. According to Black’s classification, occlusal caries on
    cusp tips is an example of what class of caries?
    A. I
    B. II
    C. III
    D. IV
    E. VI

Answer 70

ANS: E
Class VI caries (E) occurs on the incisal edges of
anterior teeth or the cusp tips of posterior teeth. Class
I caries (A) occurs in pits and fissures. Class II caries
(B) occurs on the proximal surfaces of posterior teeth.
Class III caries (C) occurs on the proximal surfaces
of anterior teeth. Class IV caries (D) occurs on the
incisal edge of anterior teeth.

Question 71

75. Directing a strong light through tooth surfaces for
    diagnostic information is an example of
    A. percussion.
    B. transillumination.
    C. visual examination procedure.
    D. auscultation.

Answer 71

ANS: B
Transillumination (B) involves the direction of
light through a tissue to see shadows and is a
useful diagnostic tool for detection of proximal
caries in anterior teeth. Percussion (A) is a
diagnostic procedure in which a tooth is tapped
to gauge pain or other response from the patient.
The visual examination (C) is used for detection
of abnormal findings by direct observation.
Auscultation (D) involves the use of sounds to
obtain information.

Question 71

74. Signs of occlusal trauma include all of the following
    EXCEPT one. Which one is the EXCEPTION?
    A. Fremitus
    B. Wear facets
    C. Pain in tooth with percussion
    D. Narrowing of periodontal ligament
    E. Pain in tooth with tooth-to-tooth contact

Answer 71

ANS: D
Widening of periodontal ligament, not narrowing
(D), is a sign of occlusal trauma. Fremitus (A),
which is the movement of teeth during occlusion,
the presence of wear facets (B), pain when teeth are
percussed (C), or pain when teeth are in occlusal
contact during chewing (E) are additional signs of
occlusal trauma.

Question 72

76. An examination of the occlusion reveals a normal
    canine-to-molar relationship and crowded mandibular
    anterior teeth. This is described as
    A. normal occlusion.
    B. class I occlusion.
    C. class II occlusion.
    D. class III occlusion.

Answer 72

ANS: B
Class I, or mesognathic, occlusion (B) involves
a normal canine-to-molar relationship, but some
other tooth position is incorrect. In a normal
occlusion (A), all teeth relationships are correct.
In class II, or retrognathic, malocclusion (C), the
maxilla is prominent, and the mandible is posterior
to its normal relationship. Class III, or prognathic,
malocclusion (D) involves a prominent, protruded
mandible, and the maxilla is usually in a normal
position.

Question 73

77. Hypoplasia of the enamel is associated with which
    congenital condition or disease?
    A. Aplasia
    B. Syphilis
    C. Cleft palate
    D. Tetracycline ingestion

Answer 73

ANS: B
Transmission of syphilis (B) from mother to fetus
after the 16th week of gestation may alter the
development of specific teeth germs, leading to
notched incisors and mulberry molars. Aplasia (A) is
the lack of development of salivary glands, leading to
dry mouth. Cleft palate (C) is a congenital condition
involving the development of the palate but does not
affect enamel formation. Tetracycline ingestion (D)
during tooth formation results in staining of dentin,
not enamel

Question 74

78. Grooves or pits in enamel corresponding with
    the stage of tooth development is a condition
    described as
    A. attrition.
    B. hypoplasia.
    C. hyperplasia.
    D. hypercalcification.

Answer 74

ANS: B
Hypoplasia (B) is the most common abnormality of
tooth development and mineralization. It presents
as defective enamel with pits or grooves in enamel,
and patterns often are linear, corresponding to the
time of tooth development. Attrition (A) is a wearing
away of tooth surfaces from tooth-to-tooth contact Hyperplasia (C) is the abnormal increase in the
number of normal cells, resulting in thickening or
enlargement of a tissue or organ but is not a term used
to describe teeth. Hypercalcification (D) may occur in
areas of enamel and dentin if severe fluorosis occurs,
causing changes in tooth color, not in the surface
integrity of enamel

Question 75

79. In class II, division 1 occlusion, which teeth are
    protruded?
    A. All of mandibular anterior teeth
    B. Some of mandibular anterior teeth
    C. All of maxillary anterior teeth
    D. Some of maxillary anterior teeth

Answer 75

ANS: C
In class II, division I malocclusion, the mandible
is retruded and all maxillary anterior incisors (C)
are protruded or flared. In class II malocclusion, all
mandibular anterior teeth (A) are retruded. In class
II, division II malocclusion, some maxillary anterior
teeth (B) are protruded, and some maxillary anterior
teeth (D) are retruded, and the entire mandibular arch
is retruded.

Question 76

80. Attrition of tooth surfaces is influenced by which
    habit?
    A. Bruxism
    B. Sucking on lemons
    C. Reverse swallowing
    D. Wearing of a bite guard or mouthpiece

Answer 76

ANS: A
Bruxism (A) is a parafunctional habit of grinding
teeth, which may result in excessive wear on the
occlusal and incisal tooth surfaces. Sucking on
lemons (B) may result in acidic erosion of enamel but
usually occurs on the facial rather than occlusal or
incisal surfaces. Reverse swallowing (C) may result
in protrusion of anterior teeth. Wearing a bite guard
or mouthpiece (D) separates tooth surfaces to prevent
excessive wear.

Question 76

81. White spot lesions are described as
    A. hypercalcified areas.
    B. subsurface demineralization.
    C. spread of demineralization along dentinal tubules.

Answer 76

ANS: B
White spot lesions are caused by initial enamel
demineralization without breakthrough to enamel
surface (B). Hypercalcified areas (A) would
not be clinically detectable. In phase II caries,
demineralization spreads along the dentinal
tubules (C).

Question 77

82. Factors that increase the risk for development of
    early childhood caries includes all of the following
    EXCEPT one. Which one is the EXCEPTION?
    A. Milk taken at bedtime
    B. Prolonged breastfeeding
    C. High levels of lactobacilli
    D. Pacifier dipped into honey
    E. High levels of Streptococcus salivarius

Answer 77

ANS: E
Streptococcus mutans is the bacterial species
associated with caries, not S. salivarius (E). Milk
taken at bedtime (A), prolonged breastfeeding (B),
high levels of lactobacilli (C), and pacifiers dipped in
honey (D) may all be risk factors for early childhood
caries.

Question 78

83. Which teeth are generally affected first in early
    childhood caries?
    A. Maxillary molars
    B. Mandibular anterior teeth
    C. Mandibular molars and maxillary anterior teeth

Answer 78

ANS: C
Primary mandibular molars along with maxillary
anterior teeth (C) are generally affected first in cases
of early childhood caries. Maxillary molars (A) are
usually not affected in the early disease process, and
likewise mandibular anterior teeth are not affected
until later in the disease process (B).

Question 79

84. Parafunctional habits include all of the following
    EXCEPT one. Which one is the EXCEPTION?
    A. Bruxism
    B. Clenching
    C. Thumbsucking
    D. Mouth breathing

Answer 79

ANS: D
A parafunctional habit is any habit that moves the
mandible or rocks teeth beyond normal function.
Mouth breathing (D) is not associated with tooth
movement. Bruxism (A), clenching (B), and
thumbsucking (C) all may affect tooth movement

Question 80

85. Blood pressure levels are determined by which mode
    of examination?
    A. Olfaction
    B. Palpation
    C. Auscultation
    D. Observation

Answer 80

ANS: C
Auscultation (C) is defined as the act of listening
to sounds for information, for example, the use of a
stethoscope for detection of blood pressure. Olfaction
(A) involves using the sense of smell for detection
of certain conditions, for example, “juicy fruit”
smell being associated with ketoacidosis in severe
hyperglycemia. Palpation (B) is the use of the sense of
touch for detection of certain conditions, for example,
palpating the lymph nodes for pathology. Observation
(D) is visual inspection to determine abnormalities

Question 81

86. An epithelium-lined sac is referred to as a
    A. cyst.
    B. bulla.
    C. nodule.
    D. granuloma.

Answer 81

ANS: A
A cyst (A) is an epithelium-lined, fluid-filled sac. A
bulla (B) is a fluid-filled blister without an epithelial
lining. A nodule (C) is a solid elevated lesion. A
granuloma (D) is a lesion filled with immature
vascular connective tissue.

Question 82

87. Screening is a type of examination procedure that
    includes all of the following characteristics EXCEPT
    one. Which one is the EXCEPTION?
    A. Includes a brief examination for a specific
    purpose
    B. Is used as a component of triage
    C. Encompasses intraoral and extraoral examinations
    only
    D. Is used to survey a group for prevalence of a
    specific condition

Answer 82

ANS: C
Screening encompasses more than only intraoral and
extraoral examinations (C), although they are some of
the components of screening. A screening examination
includes a brief examination for a specific purpose (A), is
used as a component of triage (B), and is used to survey a
group for prevalence of a specific condition (D)

Question 83

88. The pulp testing device is an example of which
    method of tooth examination?
    A. Thermal
    B. Electrical
    C. Percussion
    D. Auscultation

Answer 83

ANS: B
The pulp testing device, or vitalometer, produces an
electrical wave (B) that is transmitted through enamel
to the pulp, and living pulp tissues may or may not
respond with a sensation. Typically, nonvital teeth
have no response to the electrical stimuli, whereas
vital teeth respond with sensation, although falsepositives may occur. Ideally, more than one type
of testing should be used to verify pulpal status
before performing any nonreversible procedures.
Thermal (A) testing involves use of cold and heat
for a response to test nerve vitality. Percussion (C)
involves tapping on teeth with a metal instrument to
test patient response. Auscultation (D) is a listening
technique that is not used for pulp testing

Question 84

89. Which statement BEST describes a dental office
    worker who presents with a positive Mantoux skin
    test and no symptoms of active TB?
    A. Not contagious and may continue working
    B. Not contagious but cannot work for 3 weeks
    C. Contagious and cannot work for at least 3 weeks
    D. Contagious and may not work until the disease is
    treated and controlled

Answer 84

ANS: A
Because no symptoms are present in this employee,
the CDC considers this individual noninfectious, and
he or she may continue working in the dental office
(A). Some persons exposed to the TB bacteria may
develop antibodies that cause a positive Mantoux skin
test, although the disease is not active. In the absence
of symptoms, the employee is not contagious (C, D),
and his or her noninfectious status carries with it no
restrictions on work (B).

Question 85

90. Which of the following terms refers to a lesion
    limited to a focal area?
    A. Diffuse
    B. Localized
    C. Confluent
    D. Generalized

Answer 85

ANS: B
A localized (B) lesion is limited to one place. A diffuse
(A) lesion is spreading from one area to another.
Confluent (C) lesions run together or are joined.
Generalized (D) lesions are spread over a large area.

Question 86

91. Signs of a positive Mantoux skin test include all
    of the following EXCEPT one. Which one is the
    EXCEPTION?
    A. Redness
    B. Induration
    C. Size of skin reaction
    D. Changes within 12 to 24 hours
    E. Changes within 48 to 72 hour

Answer 86

ANS: D
The Mantoux skin test is an example of a type
IV hypersensitivity, or delayed hypersensitivity,
reaction; that is, a change within 12 to 24 hours (D)
is extremely unlikely. Redness (A), induration or
hardness (B), the size of the skin reaction (C), and
changes to the site within 48 to 72 hours (E) are all
included in the CDC guidelines for skin test results
indicating exposure to the TB bacillus.

Question 87

92. If a client has been diagnosed with active TB
    and reports taking appropriate medication for
    treating the infection, how long should the
    clinician wait before providing preventive oral
    services?
    A. 1 week
    B. 2 weeks
    C. 3 weeks
    D. 6 months

Answer 87

ANS: C
The CDC suggests that a client with active TB who
has been taking medication is no longer contagious
if anti-TB drugs are taken for at least 3 weeks (C).
Waiting 1 (A) or 2 (B) weeks would not be sufficient
to ensure that the infection would not be spread;
waiting 6 months (D) would be erring on the side of
caution.

Question 88

93. Screening questions on the health history
    concerning active TB are recommended by which
    health-related agency?
    A. National Institutes of Health (NIH)
    B. U.S. Food and Drug Administration (FDA)
    C. Centers for Disease Control (CDC)
    D. National Institute for Occupational Safety and
    Health (NIOSH)

Answer 88

ANS: C
The CDC (C) is the governmental agency formulating
guidelines for TB prevention and safety practices
in health care locations. The NIH (A) is primarily
responsible for research and does not develop
guidelines to prevent the spread of TB. The FDA (B)
regulates safe manufacturing and processing of food,
drugs, and medical devices, not TB prevention and
safety practices. The NIOSH (D) is the part of the
CDC responsible for conducting research and making
recommendations on workplace safety

Question 89

94. Nonvital teeth may have all of the following
    characteristics EXCEPT one. Which one is the
    EXCEPTION?
    A. Tooth sensitivity
    B. Apical radiolucency
    C. Intrinsic discoloration
    D. Increased susceptibility to fracture

Answer 89

ANS: A
Nonvital teeth have no living nerve, so they are not
sensitive (A). Radiolucency at the apex of a tooth (B)
indicates inflammation or necrosis of the pulp, so pulp
testing should be performed. Intrinsic discoloration
(C) is an indication to examine for pulp vitality.
Nonvital teeth have no active blood supply and
become brittle over time, with increasing susceptibility
to fracture (D), which is why endodontically treated
teeth are often covered with full crowns.

Question 90

95. Which of the following terms refers to tissue or
    mucosa having a blue color?
    A. Cyanotic
    B. Melanotic
    C. Leukoplakia
    D. Erythroplakia

Answer 90

ANS: A
Mucosa or tissue having a bluish color are said to
be cyanotic (A). Melanotic (B) tissue has excessive
melanin pigmentation and is of a darker hue than
expected. Leukoplakia (C) refers to white plaque
on skin or the mucosa that cannot be scraped off.
Erythroplakia (D) refers to a reddish colored area of
tissue or mucosa.

Question 91

97. Excessive space between two adjacent teeth in the
    same arch is called
    A. diastema.
    B. open bite.
    C. wear facet.
    D. primate space.

Answer 91

ANS: A
A diastema (A) is defined as excessive space between
adjacent teeth in the same arch. An open bite (B) is
an open area between opposing arches of teeth. A
wear facet (C) involves a wear pattern on the incisal
or occlusal surfaces of a tooth. Primate space (D) is
the normal space between primary teeth allowing for
skeletal growth and the larger size of permanent teeth.

Question 91

96. Which of the following lymph node findings would
    have the MOST negative prognosis?
    A. Palpable, tender, movable
    B. Palpable, nontender, movable
    C. Palpable, indurated, nonpainful

Answer 91

ANS: C
Lymph nodes that are indurated, nonmovable, and
nonpainful (C) have the least favorable prognosis
because of the high possibility of malignancy. Rapidly
dividing cancer cells invading the lymph node form
an indurated or hard mass that infiltrates into the
underlying connective tissue making the lymph node
nonmovable or “fixed.” Cancer is often nonpainful
until it is widespread. Palpable, tender, movable
lymph nodes (A) are indicative of active infection.
Palpable, nontender, movable lymph nodes (B) are
indicative of past infection and healed scar tissue.

Question 92

98. Static occlusion can be identified with which tool?
    A. Study casts
    B. Radiographs
    C. Use of percussion
    D. Examination for fremitus

Answer 92

ANS: A
Static occlusion is the relationship between the maxillary
and mandibular arches when the jaw is closed and
stationary. Study casts (A), placed together, help identify
static occlusion. Radiographs (B) will not identify static
occlusion due to the positioning of the bite block or
sensor. Percussion (C) is a test performed by tapping on
teeth with a dental instrument, but it is not a test used to
determine occlusion. An examination for fremitus (D)
is performed by having the patient tap his or her teeth
together and observe movement to determine loss of
periodontal support and is unrelated to static occlusion.

Question 93

99. Malpositioned teeth, overhanging margins of
    restorations, and abnormal tooth morphology may
    cause increased accumulation of dental plaque in
    specific areas. These factors may be the primary
    etiologic factor in periodontal disease.
    A. Both statements are true.
    B. Both statements are false.
    C. The first statement is true, and the second
    statement is false.
    D. The first statement is false, and the second
    statement is true.

Answer 93

ANS: C
The first statement is true, and the second statement is
false (C). Malpositioned teeth, overhanging margins
of restorations, and abnormal tooth morphology allow
increased accumulation of dental plaque in those
areas if extraordinary plaque control measures are
not taken, but they contribute to, rather than cause, periodontal disease. The plaque biofilm is the primary
etiologic agent in periodontal disease. Choices A, B,
and D do not correctly address the question.

Question 94

100. When the incisal edges of maxillary incisors are
     within the incisal half of mandibular incisors, the
     condition is referred to as
     A. open bite.
     B. deep overbite.
     C. normal overbite.
     D. moderate overbite.

Answer 94

ANS: D
Moderate overbite (D) is defined as the incisal edge
of maxillary teeth being within the incisal half of
mandibular incisors. In open bite (A), the incisal
edges of maxillary incisors are not in contact with
the incisal edges of mandibular incisors. Deep or
severe overbite (B) occurs when maxillary incisors
completely cover mandibular incisors and the incisal
edges touch the mandibular gingival margin. Normal
overbite (C) occurs when maxillary incisors contact
the first third of the incisal edges of mandibular teeth.

Question 95

102. Formation of biofilm involves a series of stages.
     Which of the following is the beginning stage?
     A. Formation of pellicle
     B. Differentiation of bacteria into species
     C. Initial multiplication of bacterial species
     D. Aggregation of bacteria into organized colonies

Answer 95

ANS: A
The first step in biofilm formation is when a
pellicle forms on the tooth surface (A). The
initial multiplication of bacterial species (C), the
aggregation of bacteria into organized colonies (D),
and the differentiation of bacteria into species (B) are
the next steps in biofilm formation and maturation.

Question 95

101. Formation of which connective tissue may cause the
     pulp chambers and canals to narrow over time?
     A. Mantle dentin
     B. Primary dentin
     C. Sclerotic dentin
     D. Secondary dentin

Answer 95

ANS: D
Secondary dentin (D) forms within the pulp and canals
and narrows the inner surfaces of the tooth to protect
the pulp in response to the lifelong process of attrition.
Mantle dentin (A) is the first product laid of primary
dentin produced during odontogenesis. Primary dentin
(B) is the first type of dentin formed and makes up
the majority of the tooth. Sclerotic dentin (C) is the
calcification of open dentinal tubules and does not
affect the size of the pulp chamber or canals

Question 96

103. Populations at high risk of contracting TB include
     all of the following EXCEPT one. Which one is the
     EXCEPTION?
     A. Dental health care workers
     B. Individuals with HIV infection
     C. Immigrants from developing countries
     D. Individuals living in environments where active
     TB exists

Answer 96

ANS: A
Dental health care workers (A) are not among the groups
listed as being at high risk for TB infection by the CDC.
Groups listed as being at high risk for TB infection are
individuals with HIV infection (B), immigrants from
developing countries (C), and individuals living in
environments where active TB exists (D