Ortho/Peds Flashcards
Which of the following is true regarding
crowding of the dentition?
A. Crowding of the primary dentition usually resolves
as the permanent teeth erupt.
B. Spacing in the primary dentition usually indicates
spacing will be present in the adult.
C. Approximately 15% of adolescents have crowding
severe enough to consider extraction of
permanent teeth as part of treatment.
D. Lower incisor crowding is more common in
African-American than white populations.
C. According to data available, approximately 15%
of adolescents have severe crowding that would
require major amounts of expansion or extrac-
tions to resolve. The other statements are false:
crowding in the primary dentition is very rare and
would indicate crowding will occur in the per-
manent dentition; spacing in the primary
dentition is normal; and African-Americans
generally have less crowding than whites.
Bones of the cranial base include which of the following? A. Maxilla, mandible, and cranial vault B. Ethmoid, sphenoid, and occipital C. Palatal, nasal, and zygoma D. Frontal and parietal
B. The cranial base includes, from anterior to poste-
rior, the ethmoid, sphenoid, and occipital bones.
According to Scammon’s growth curves, which
of the following tissues has a growth increase
that can be used to help predict timing of the
adolescent growth spurt?
A. Neural tissues
B. Lymphoid tissues
C. Reproductive tissues
3.C. Reproductive tissues grow at the same time as
the adolescent growth spurt, and the appearance
of secondary sexual characteristics can be used
to help predict the timing of growth.
Children in the primary dentition most often present with \_\_\_\_\_. A. An increased overbite B. A decreased overbite C. An ideal overbite D. A significant open bite
B. Young children often present with minimal over-
bite or anterior edge-to-edge relationship. Habits
such as thumb-sucking increase the likelihood
that less overbite will be present.
An adult patient with a Class II molar
relationship and a cephalometric ANB angle of
2 degrees has which type of malocclusion?
A. Class II dental malocclusion
B. Class II skeletal malocclusion
C. Class I dental malocclusion
D. Class II skeletal malocclusion
A. The molars are Class II but the skeletal
relationship described by a normal ANB meas-
urement is normal, so the malocclusion is dental
in origin.
Which of the following reactions is least likely to
be observed during orthodontic treatment?
A. Root resorption
B. Devitalization of teeth that are moved
C. Mobility of teeth that are moved
D. Development of occlusal interferences
B. Root resorption is common during orthodontic
treatment, although lesions often repair on the
root surface. Mobility of teeth is also common as
the PDL reorganizes and widens during tooth
movement. It is uncommon for teeth to become
devitalized as a result of orthodontic movement
unless they have also been substantially compro-
mised by injury or infection.
Doubling the force applied at the bracket of a
tooth would have what effect on the moment
affecting tooth movement?
A. The moment would decrease by 50%.
B. The moment would not change.
C. The moment would double.
D. The moment would increase by 4 times.
C. Since M = Fd, doubling the force would double
the moment, or tendency to rotate, tip, or torque.
Class II elastics are used by stretching an elastic
between which of the two following points?
A. From the posterior to the anterior within the
maxillary arch
B. From the posterior to the anterior within the
mandibular arch
C. From the posterior of the maxillary arch to the
anterior of the mandibular arch
D. From the posterior of the mandibular arch to the
anterior of the maxillary arch
D. Class II elastics work in the direction that would
be used to correct a Class II malocclusion, to pull
the mandibular teeth forward and the maxillary
teeth distally.
When Class III elastics are used, the maxillary
first molars will _____.
A. Move distally and intrude
B. Move mesially and extrude
C. Move mesially and intrude
D. Move only mesially; there will be no movement in
the vertical direction
B. Class III elastics are worn from the maxillary
first molars to the mandibular canines. The force
system created by Class III elastics will produce
mesial movement and extrusion of the maxillary
first molars.
Which of the following depicts the usual order of
extraction of teeth if serial extraction is chosen
as the treatment to alleviate severe crowding?
A. Primary second molars, primary first molars,
permanent first premolars, primary canines
B. Primary canines, primary first molars, permanent
first premolars
C. Primary first molars, primary second molars,
primary canines
D. Primary canines, permanent canines, primary first
molars, permanent first premolars
B. Primary canines are extracted to encourage
alignment of the crowded incisors. However, the
incisors align and upright, borrowing space
otherwise needed for eruption of the permanent
canine. Primary first molars are then extracted to
encourage eruption of the first premolar so it may
be extracted to make room for the permanent
canine to erupt.
A 7-year-old has a 4-mm maxillary midline
diastema. Which of the following should be
done?
A. Brackets should be placed to close it.
B. A radiograph should be taken to rule out the
presence of a supernumerary tooth.
C. Nothing should be done. It will close on its own.
D. Nothing should be done. Treatment should be
deferred until the rest of the permanent dentition
erupts.
B. When a large diastema greater than 2 mm is
present, it will probably not close on its own.
Diagnostic tests, such as a radiograph, should be
accomplished to rule out the presence of a super-
numerary tooth, usually a mesiodens.
Reduction of overbite can be accomplished most
readily by which of the following tooth
movements?
A. Intruding maxillary incisors
B. Uprighting maxillary and mandibular incisors
C. Using a high-pull headgear to the maxillary molars
D. Using a lip bumper
A. Intruding incisors would decrease overbite while
uprighting teeth and using a high-pull headgear
could make overbite correction more difficult. A lip
bumper would likely have little effect on overbite.
Congenitally missing teeth are the result of failure in which stage of development? A. Initiation B. Morphodifferentiation C. Apposition D. Calcification
A. Initiation and proliferation are the only possibilities
for congenitally absent teeth, the bud and cap
stages, respectively. In the histodifferentiation
stage, the teeth are present; failure in this stage
results in structural abnormalities of the enamel
and dentin. Failure in the morphodifferentiation
stage results in size and shape abnormalities.
During an emergency dental visit in which a
tooth is to be extracted due to extensive pulpal
involvement, a moderately mentally challenged
5-year-old child becomes physically combative.
The parents are unable to calm the child. What
should the dentist do?
A. Discuss the situation with the parents.
B. Force the nitrous oxide nosepiece over the child’s
mouth and nose.
C. Use the hand over mouth exercise (HOME).
D. Use a firm voice control.
A. For any child patient, it is imperative to discuss
any kind of physical restraint with the parent to
obtain an informed consent. An informed con-
sent includes recommended treatment, reason-
able alternatives to that treatment, and the risk of
no treatment. If the dentist wants to use a firm
voice control, it is recommended that a discus-
sion take place beforehand, as well.
Which of the following is the definition of
conscious sedation?
A. A minimally depressed level of consciousness that
retains the patient’s ability to independently and
continuously maintain an airway and respond
appropriately to physical stimulation or verbal
command.
B. A significantly depressed level of consciousness
that retains the patient’s ability to independently
and continuously maintain an airway and respond
appropriately to physical stimulation or verbal
command.
C. A minimally depressed level of consciousness that
retains the patient’s ability to independently and
continuously maintain an airway.
D. A significantly depressed level of consciousness
that retains the patient’s ability to independently
and continuously maintain an airway.
A. Conscious sedation is defined as a minimally
depressed level of consciousness as opposed to
deep sedation or general anesthesia. Remember
that there are four stages of anesthesia (analgesia→ delirium → surgical anesthesia → respiratory
paralysis) and only in the first stage (analgesia) is
the patient conscious. The patient should be able
to maintain an airway and respond to stimulation
and command.
The enamel rods in the gingival third of primary
teeth slope occlusally instead of cervically as in
permanent teeth, and the interproximal contacts
of primary teeth are broader and flatter than
permanent teeth.
A. The first statement is true and the second
statement is true.
B. The first statement is true and the second
statement is false.
C. The first statement is false and the second
statement is true.
D. The first statement is false and the second
statement is false.
A. Both of these statements are true. As a result of
these differences, there are modifications in
preparation design for Class II amalgams.
Beveling the gingival seat of Class II amalgams
are not recommended. There is a greater con-
vergence from cervical to occlusal of the buccal
and lingual walls of Class II amalgam prepara-
tions because of the broad and flat contact areas.
Formocresol has been shown to have a very
good success rate when used as a medicament
for pulpotomy procedures. Why is there
continued interest to find another medicament
that performs as well as or better than
formocresol?
A. Application of formocresol is a clinically time-
consuming procedure.
B. Formocresol is toxic and there is possible
bloodborne spread to vital organs.
C. It has been demonstrated that formocresol may
cause spontaneous abortion.
D. It has been demonstrated that formocresol may
cause failure to develop adequate lung capacity in
children.
B. There have been concerns regarding the blood-
borne spread of formocresol at least since 1983,
when a study was published describing the tis-
sue changes induced by the absorption of
formocresol from pulpotomy sites in dogs. Ferric
sulfate and mineral trioxide aggregate (MTA)
have been demonstrated to be reasonable alter-
natives to formocresol.
The following teeth are erupted in an 8-year-old patient. What is the space maintenance of choice?
3 A B C 7 8 9 10 H I __ 14
30 T S R 26 25 24 23 M L K 19
A. Band-loop space maintainer
B. Lower lingual holding arch
C. Nance holding arch
D. Distal shoe space maintainer
A. A band-loop space maintainer would work well
in this case because the maxillary first bicuspid
normally erupts prior to the loss of either the sec-
ond primary molar or the primary cuspid.
The mother of a 5-year-old patient is concerned
about the child’s thumb-sucking habit. Six
months ago, the patient had 5-mm overjet and a
3-mm anterior open bite. Today, the patient has
10% overbite and 3.5-mm overjet. The mother
says that the child only sucks his thumb every
night when falling to sleep. Of the following,
which is the best advice?
A. Refer to a speech pathologist.
B. Recommend tongue thrust therapy.
C. Recommend a thumb-sucking appliance.
D. Counsel the parent regarding thumb-sucking, and
recall the patient in 3 months.
D. The patient’s overbite/overjet improved from the
previous examination and therefore it is likely that
the patient’s digit-sucking habit had decreased sig-
nificantly. The mother did state that the patient
only sucks his thumb while falling asleep. When
digit-sucking occurs for a limited time per day, not
only is tooth movement normally associated with
digit-sucking unlikely, it is possible for teeth to
return to a more normalized position. Remember
that the risk of malocclusion as related to habitual
activity is a function of amount of time per day the
habit is practiced, the duration of the habit in terms
of weeks and months, and the intensity of the
habit. Because the occlusion seems to be improv-
ing and because the habit has significantly
decreased, the best treatment is to counsel the
parent regarding thumb-sucking, and recall the
patient in 3 months.
Orthodontic closure of a midline diastema in a
patient with a heavy maxillary frenum _____.
A. Is accomplished prior to the frenum surgery.
B. Is accomplished after the frenum surgery.
C. After orthodontic closure, frenum surgery is
typically not indicated.
D. After frenum surgery, orthodontic closure is
typically not indicated.
A. Orthodontic closure of a midline diastema is
accomplished prior to the periodontal surgery. If
a frenectomy is performed prior to orthodontic
treatment, it is possible that scar tissue could
form in the area, which may impede orthodontic
tooth movement.
Your patient is 4 years old. Tooth E was
traumatically intruded and approximately 50%
of the crown is visible clinically. What is your
treatment of choice?
A. Reposition and splint
B. Reposition, splint, and primary endodontics
C. Reposition, splint, and formocresol pulpotomy
D. None of the above
D. Unless it can be determined that the primary
tooth is impinging on the permanent successor,
intruded primary teeth are left alone in the hopes
that they will spontaneously re-erupt. On the
other hand, intruded permanent teeth have a
poorer prognosis. If there is an open apex, an
intruded permanent tooth should be closely
monitored for spontaneous eruption. An intruded
permanent tooth with a closed apex should be
repositioned orthodontically, and a calcium
hydroxide pulpectomy should be performed 2
weeks following the injury.
Your patient is 4 years old. The maxillary right
primary central incisor was traumatically
avulsed 60 minutes ago. What is the treatment of
choice?
A. Replant, splint, primary endo
B. Replant, splint, formocresol pulpotomy
C. Replant, no splint, primary endo
D. None of the above
D. Replanting primary teeth has a poor prognosis,
but could be considered if within 30 minutes.
A primary tooth that is replanted will likely
require splinting. The patient should be placed
on antibiotics, restricted to a soft diet, and have
a primary endodontic procedure accomplished.
A young permanent incisor with an open apex
has a pinpoint exposure due to a traumatic
injury that occurred 24 hours previously. The
best treatment is _____.
A. Place calcium hydroxide on the pinpoint
exposure
B. Open the pulp chamber to find healthy pulp tissue
and perform a pulpotomy
C. Initiate a calcium hydroxide pulpectomy
D. Initiate conventional root canal treatment with
gutta-percha
B. Because the exposure site is likely significantly
contaminated from the injury that occurred
24 hours previously, direct pulp capping with
calcium hydroxide is contraindicated. A calcium
hydroxide pulpectomy should not be the
automatic procedure accomplished because
continued root elongation and closure of the
pulp canal will likely not occur. A calcium
hydroxide pulpotomy is preferable for a trauma-
tized tooth with an open apex with either a large
exposure or a small exposure of several hours or
days postinjury. Clinically, the tooth should be
anesthetized and, under sterile conditions, and
the clinician should open the pulp chamber in
search of healthy pulp tissue. It is likely that vital
tissue will be present within 24 hours of the
injury.
A permanent incisor with an open apex is
extruded 4 mm following an injury 15 minutes
ago. What is the treatment of choice?
A. No immediate treatment, monitor closely for
vitality.
B. Reposition, splint, monitor closely for vitality.
C. Reposition, splint, initiate calcium hydroxide
pulpotomy.
D. Reposition, splint, initiate calcium hydroxide
pulpectomy.
B. An extruded permanent incisor with an open
apex should be repositioned, splinted, and mon-
itored closely for loss of vitality. Because of the
open apex, the tooth may remain vital and con-
tinue development; therefore, immediate pulp
treatment is contraindicated.
Which of the following is the most likely cause of
pulpal necrosis following trauma to a tooth?
A. Ankylosis
B. Calcific metamorphosis
C. Pulpal hyperemia
D. Dilaceration
C. The other three answers may occur as the result
of trauma but do not cause loss of vitality. Pulpal
hyperemia causes increased intrapulpal pressure
and swelling, which may result in an interruption
of the pulp’s blood supply. Without an adequate
blood supply, the pulp becomes necrotic. This
process can take time, and symptoms (either
radiographic or clinical) may not present for
weeks or even months. Typically, follow-up
examination and radiographs are indicated at 1-,
2-, and 6-month intervals following a traumatic
incident.
Which of the following types of malocclusions is most common? A. Class I malocclusion B. Class II malocclusion C. Class III malocclusion D. Open bite malocclusion
A. Class I is the most common malocclusion, at
about 50% of the U.S. population, compared to
Class II (15%) and Class III (about 1%).
According to Scammon’s growth curves, which
of the following tissues has a growth increase
that can be used to help predict timing of the
adolescent growth spurt?
A. Neural tissues
B. Lymphoid tissues
C. Reproductive tissues
C. Reproductive tissues grow at the same time as
the adolescent growth spurt and the appearance
of secondary sexual characteristics can be used
to help predict the timing of growth.
Of the following, which is the least reliable way
to predict the timing of the peak of the adoles-
cent growth spurt for an individual?
A. Plotting changes in height over time on a growth
curve
B. Following eruption timing of the dentition
C. Taking a hand–wrist radiograph to assess
skeletal development
D. Observing changes in secondary sex
characteristics
B. Although developmental indicators generally cor-
relate well with each other, using dental age to
predict timing of growth is the least reliable of the
methods offered.
In a patient with incomplete cleft palate, which
of the following aspects is most likely to remain
open?
A. The anterior aspect
B. The middle aspect
C. The posterior aspect
D. The right aspect
C. Fusion of the palate proceeds from anterior to
posterior, so any disturbance that occurs during
that time will stop fusion at that point, leading to
an opening posteriorly.
Children in the primary dentition most often present with \_\_\_\_\_. A. An increased overbite B. A decreased overbite C. An ideal overbite D. A significant open bite
B. Young children often present with minimal overbite
or anterior edge-to-edge relationship. Habits such as
thumb-sucking increase the likelihood that less
overbite will be present.
During the mixed dentition, a 1-mm diastema
develops between the maxillary incisors. Which
of the following is most likely?
A. The diastema will need orthodontic intervention
to be closed
B. The diastema will resolve once the canines
erupt
C. The diastema will only resolve when all of the
permanent teeth erupt
D. The diastema will continue to widen as
permanent teeth erupt
B. Small diastemas between the maxillary incisors
of 2 mm or less will generally close on their own
as more permanent teeth, specifically the
canines, erupt. Presence of a midline diastema
before canine eruption is referred to as “the ugly
duckling stage.”
A patient with the maxillary first permanent
molar mesiobuccal cusp sitting distal to the
buccal groove of the mandibular first molar
has which type of malocclusion?
A. Class I
B. Class II, division 1
C. Class II, division 2
D. Class III
- D. If the mandibular molar buccal groove is mesial
to the mesiobuccal cusp of the maxillary molar,
the relationship is described as Angle Class III.
An adult patient with a Class II molar relation-
ship and a cephalometric ANB angle of
2 degrees has which type of malocclusion? A. Class II dental malocclusion B. Class II skeletal malocclusion C. Class I dental malocclusion D. Class II skeletal malocclusion
A. The molars are Class II, but the skeletal
relationship described by the ANB (the A-P angular
difference between the maxilla and mandible)
measurement is normal, so the malocclusion is
dental in origin.
In a patient who displays excessive maxillary
incisor at rest, has an excessive lower face
height, and has a deep overbite, which of the
following would be the preferred method of
overbite correction?
A. Eruption of posterior teeth to rotate the
mandible open
B. Intrusion of maxillary incisors
C. Intrusion of mandibular incisors
D. Flaring of maxillary and mandibular incisors
B. All of the choices are possible solutions to correct
a deep overbite. Erupting posterior teeth would
increase the already excessively long lower face
height, whereas intrusion of maxillary incisors
would improve the excessive maxillary incisor
show at rest.
In tooth movement, the formation of a hyalin-
ized zone on the pressure side is due to _____.
A. The application of light, continuous forces
B. The application of heavy forces
C. The normal forces of mastication
D. Abnormal swallowing patterns
B. Heavy forces cause compression of the PDL with
hyalinization.
Which of the following reactions is least likely
to be observed during orthodontic treatment?
A. Root resorption
B. Devitalization of teeth that are moved
C. Mobility of teeth that are moved
D. Development of occlusal interferences
B. Root resorption is common during orthodontic
treatment, although lesions often repair on the root
surface. Mobility of teeth is also common as the
PDL reorganizes and widens during tooth
movement. It is uncommon for teeth to become
devitalized as a result of orthodontic movement
unless they have also been substantially compro-
mised by injury or infection.
Root resorption is correlated to the pattern of
stress distribution in the PDL and type of tooth
movement.
A. True
B. False
A. Although somewhat controversial, it is believed
that types of tooth movements that concentrate
force in small areas of the PDL are more likely to
result in root resorption during orthodontic treat-
ment.
Putting a force through which of the following
points would cause pure translation of a tooth
without rotation, tipping, or torque?
A. Center of rotation
B. Center of resistance
C. Center of the bracket
D. Apex of the root
B. The center of resistance is defined as the point at
which force application will cause pure translation
of a tooth.
Doubling the force applied at the bracket of a
tooth would have what effect on the moment
affecting tooth movement?
A. The moment would decrease by 50%.
B. The moment would not change.
C. The moment would double.
D. The moment would increase by four times.
C. Since M = Fd, doubling the force would double the
moment, or tendency to rotate, tip, or torque.
Two equal and opposite forces that are not
collinear applied to a tooth are called which of
the following?
A. The center of resistance
B. The center of rotation
C. Root movement
D. A couple
D. This is the definition of a couple. A couple results
in a rotational tendency or pure moment.
A wire extending from the molars to the inci-
sors is activated to intrude the incisors. What
is the side effect on the molars?
A. The molars will tip forward and intrude
B. The molars will rotate mesiobuccally
C. The molars will tip distally and extrude
D. The molars will rotate distobuccally
C. The sum of the forces and moments on an appli-
ance must equal zero. If the incisors intrude,
the molars will extrude. These two forces form a
couple with a moment in one direction. The molars
will experience a couple in the opposite direction,
which will cause them to tip distally.
Class II elastics are used by stretching an elas-
tic between which of the two following points?
A. From the posterior to the anterior within the
maxillary arch
B. From the posterior to the anterior within the
mandibular arch
C. From the posterior of the maxillary arch to the
anterior of the mandibular arch
D. From the posterior of the mandibular arch to the
anterior of the maxillary arch
D. Class II elastics work in the direction that would
be used to correct a Class II malocclusion, to pull
the mandibular teeth forward and the maxillary
teeth distally.
What makes it possible for nickel-titanium
archwires to exhibit superelastic behavior?
A. This behavior is based on a reversible
transformation within the austenitic phase.
B. This behavior is based on a reversible
transformation between the austenitic and
martensitic phases.
C. This behavior is based on a reversible
transformation within the martensitic phase.
D. This behavior is based on an irreversible
transformation within the martensitic phase.
B. Nickel-titanium archwires can exist in more than
one phase: austenitic and martensitic phases.
Superelastic behavior of these wires is attributed
to the reversible transformation between these
two phases.
What is a second-order bend?
A. A bend to position a tooth buccolingually
B. A bend to provide angulation of a tooth in
mesiodistal direction (tip)
C. A bend to provide correct angulation of a tooth
in labiolingual direction (torque)
D. A bend to rotate a tooth
B. A second-order bend is placed to provide angu-
lation of a tooth in the mesiodistal direction, also
called tip. A first-order bend is placed in an arch-
wire to position a tooth in the labiolingual direc-
tion (in-out bend) and/or to rotate a tooth as seen
in the occlusal plane. A bend to provide angulation
in the labio-lingual direction is called a third-order
bend (torqueing bend).
When Class III elastics are used, the maxillary
first molars will _____.
A. Move distally and intrude
B. Move mesially and extrude
C. Move mesially and intrude
D. Move only mesially; there will be no movement
in the vertical direction
B. Class III elastics are worn from the maxillary first
molars to the mandibular canines. The force sys-
tem created by Class III elastics will produce
mesial movement and extrusion of the maxillary
first molars.
An adolescent patient presents to your office
with a skeletal and dental Class II malocclusion
and a deep bite. Which of the following would be
a proper treatment plan for this patient?
A. Reverse-pull headgear, extrusion arch, and full
fixed appliances
B. Reverse-pull headgear, intrusion arch, and full
fixed appliances
C. Extraction of maxillary first premolars, extrusion
arch, and full fixed appliances
D. Extraction of maxillary first premolars, intrusion
arch, and full fixed appliances
D. This patient, if still growing, may be treated with a
growth modification approach using headgear
(either cervical or high-pull, not reverse-pull) to
correct the Class II malocclusion. Since deep overbite is present, a cervical headgear should be
used because this type of headgear will extrude
the molars which, in turn, will aid in reducing
overbite; however, this was not one of the
choices. If the patient is a nongrowing patient, the
second approach to treat Class II malocclusion is
Class II camouflage, which includes extraction of
maxillary first premolars to correct the
malocclusion. An intrusion arch along with full
fixed appliances should be used to correct the
deep bite.
When using a cervical-pull headgear, the forces
generated on the maxillary first molar cause this
tooth to move in which of the following ways?
A. Mesially and to extrude
B. Distally and to extrude
C. Mesially and to intrude
D. Distally and to intrude
B. The line of force generated by a cervical headgear
will cause the maxillary first molar to move distally,
usually also tip distally, and to extrude. A high-pull
headgear would cause the molar to move distally
and intrude.
Which of the following depicts the usual order of
extraction of teeth if serial extraction is chosen
as the treatment to alleviate severe crowding?
A. Primary second molars, primary first molars,
permanent first premolars, primary canines
B. Primary canines, primary first molars,
permanent first premolars
C. Primary first molars, primary second molars,
primary canines
D. Primary canines, permanent canines, primary
first molars, permanent first premolars
B. Primary canines are extracted to encourage
alignment of the crowded incisors. However, the
incisors align and upright, borrowing space oth-
erwise needed for eruption of the permanent
canine. Primary first molars are then extracted to
encourage eruption of the first premolar so it may
be extracted to make room for the permanent
canine to erupt.
Closure of a 2-mm maxillary midline diastema
should be accomplished orthodontically in an
8-year-old in which of the following circum-
stances?
A. If the lateral incisors are missing
B. If the space creates an esthetic concern and the
child is being teased about it
C. If there is also deep overbite present
D. If mild crowding is also present
B. There is a high likelihood that a small diastema of
2 mm or less will close on its own over time as
the permanent teeth erupt. However, if a child
suffers psychological trauma because of esthetic
concerns, the diastema can be closed. Parents
should be informed of the reason for treatment
and understand that there are some risks of per-
forming orthodontic treatment that they are
assuming.
In a patient with missing permanent maxillary
lateral incisors, the decision of whether to sub-
stitute canines in the lateral spaces depends on
all of the following except _____.
A. The amount of crowding in the maxillary arch
B. The interarch relationship between the maxillary
and mandibular dentition
C. The esthetic appearance of the permanent
canines
D. The type of orthodontic appliance used to align
the teeth
D. Excessive crowding may influence the decision in
favor of canine substitution. However, esthetic
concerns may deter a decision to substitute
canines for lateral incisors. Patients with a Class II
interarch relationship requiring maxillary extrac-
tions anyway may be better served to substitute
canines for laterals rather than extracting healthy
first premolars.
All of the following may be indications to con-
sider extraction of permanent teeth in an ortho-
dontic patient except _____.
A. Excessive crowding
B. Class II interarch relationship
C. Flat lip profile
D. Anterior open bite
C. Excessive crowding may necessitate extractions.
Also, extraction of maxillary premolars may be
indicated to camouflage a Class II molar relation-
ship. Anterior open bites may be improved by
uprighting anterior teeth to increase overbite. Flat
lips will not be improved by extraction of perma-
nent teeth but other considerations may still
necessitate extraction even in those patients.
Advantages of fixed wire retention compared to
a removable Hawley-type retainer include
which of the following?
A. Does not require the patient to remember to
wear it.
B. Is easier to clean.
C. The design can be altered to achieve minor
tooth movements.
D. It can incorporate an acrylic bite plate to avoid
relapse of overbite correction.
A. Fixed retention requires no patient cooperation to
achieve retention. However, fixed retainers are
more difficult to clean and cannot be modified to
move teeth or control overbite relapse.
The preferred surgical procedure to correct a Class II malocclusion due to a deficient mandible is which of the following? A. Maxillary impaction B. Maxillary setback C. Mandibular setback D. Mandibular advancement
D. Class II correction by surgery requires moving the
mandible forward or the maxilla back. In a
patient with a deficient mandible it is preferable
to move the mandible forward. Moving the maxilla
back significantly is difficult or impossible.
Of the following, which is considered to be the
least stable orthognathic surgical movement?
A. Advancement of the mandible
B. Advancement of the maxilla
C. Superior movement (impaction) of the maxilla
D. Inferior movement of the maxilla
D. Inferior movement of the maxilla, especially
without bone grafting and rigid fixation, has been shown to relapse over time because of vertical
occlusal forces generated by the masticatory
musculature.
Your patient exhibits enamel hypoplasia near
the incisal edges of all permanent incisors and
cuspids, except for the maxillary lateral inci-
sors, which appear normal. At what age would
you suspect some kind of systemic problem? A. Prior to birth B. From birth to 1 year of age C. From 1 to 2 years of age D. From 2 to 3 years of age
B. All anterior permanent teeth begin calcification
during the first 6 months, except for maxillary lat-
eral incisors. The maxillary lateral incisor may be
used as a key to timing; if this tooth is affected, the
causative event is likely to have occurred at 1 year
of age or older.
Fluorosis is the result of excessive systemic flu-
oride during which stage of tooth development?
A. Initiation
B. Morphodifferentiation
C. Apposition
D. Calcification
D. Localized infection, trauma, and excessive sys-
temic fluoride ingestion may cause hypocalcifi-
cation. Disturbances in apposition result in
incomplete tissue formation. For example, an
intrusive injury to a primary incisor may disrupt
enamel apposition and result in an area of
enamel hypoplasia.
Why are implants not generally performed on a
12-year-old patient with congenitally missing
lateral incisors?
A. The patient would likely not be able to tolerate
the surgical procedure.
B. Waiting for the crowns is too much of an
esthetic issue with most children that age.
C. The gingival tissue will recede as the child gets
older.
D. The implants will appear to submerge as the
child gets older.
D. Implants are osseointegrated and therefore
behave as ankylosed teeth. As teeth erupt and
alveolar bond formation occurs, an osseointe-
grated implant will appear to submerge.
On the health history form, the mother of a
6-year-old new patient notes that the child is
moderately mentally challenged. The dentist
should _____.
A. Refer to a pediatric dentist
B. Use a Tell-Show-Do technique of behavior
management
C. Use conscious sedation
D. Use restraints after obtaining informed consent
B. Many mentally challenged individuals can be
mainstreamed and treated as any other patient.
Because a moderately challenged 6-year-old may
function as a preschool child, the normal man- agement techniques are likely applicable. The
correct answer for such a question will include
some kind of normalization response.
The functional inquiry questionnaire reveals
that the mother has had negative dental experi-
ences and remains very nervous regarding her
dental care. How would this most likely influ-
ence her 3-year-old child’s reaction to dentistry?
A. Increase the likelihood of a negative behavior.
B. Increase the likelihood of a positive response to
dentistry.
C. Will likely cause an initial positive reaction,
which changes to a negative reaction with the
slightest stress.
D. Maternal anxiety has little effect on a child’s
behavior in a dental setting.
A. Studies show that there is a high correlation
between maternal anxiety and a child’s negative
behavior in the dental office. This effect is greatest
for children less than 4 years of age.
Which of the following local anesthetic tech-
niques is recommended for anesthetizing a pri-
mary mandibular second molar which will be
extracted?
A. Buccal and lingual infiltration adjacent to the
second primary molar
B. Inferior alveolar nerve block
C. Inferior alveolar nerve block and lingual nerve
block
D. Inferior alveolar, lingual, and buccal nerve block
D. Inferior alveolar, lingual, and buccal nerve blocks
are required to adequately anesthetize this area
when performing deep restorations, pulp ther-
apy, and extractions. Some studies have shown
that local infiltration anesthesia for primary molars
is effective, but this is primarily reserved for
restorative procedures because there is an
increased probability for anesthesia failure using
local infiltration for pulp therapy and extraction
procedures.
In the primary dentition, the mandibular fora-
men is located where in relation to the plane of
occlusion?
A. Higher than the plane of occlusion
B. Much higher than the plane of occlusion
C. Lower than the plane of occlusion
D. The same level as the plane of occlusion
C. In the primary dentition patient, the mandibular
foramen is located lower than the plane of occlu-
sion. Therefore, mandibular block injections for
these patients are made somewhat lower than as
is done for the adult patient.
What is the minimum alveolar concentration of nitrous oxide (Vol %)? A. 50 B. 75 C. 95 D. 105
D. Minimum alveolar concentration is a measure
of potency. It is the concentration required to pro-
duce immobility in 50 Vol % of patients responding
to surgical incision. A minimum alveolar concentra-
tion of 105 Vol % indicates that nitrous oxide alone
does not produce profound surgical anesthesia at a
normal atmospheric pressure.
Following the administration of a local anes-
thetic, most patients can be maintained in con-
scious sedation at _____.
A. 20%–40% nitrous oxide
B. 20%–40% oxygen
C. 50% nitrous oxide
D. 10% nitrous oxide
A. The total flow rate is 4 to 6 L/min for most chil-
dren. The practitioner can check the bag and
make adjustments if necessary. The mainte-
nance dose of nitrous oxide during an operative
procedure is typically about 30%. In other words, a
standard maintenance dose would usually be
4 L oxygen and 2 L of nitrous oxide. Of course,after a lengthy administration, it is wise to reduce
the concentration due to tissue saturation and
nausea.
Your patient is 9 years old. The mandibular left
first primary molar has a large, carious lesion
on the distal and on the occlusal and the tooth
has greater mobility than what you would nor-
mally expect. You should _____.
A. Take a radiograph of the area B. Perform a pulpotomy C. Perform a pulpectomy D. Extract the tooth and consider space maintenance
A. It is difficult to know which treatment is indicated
without more information than is presented in
the question. The tooth could be mobile due to
furcation involvement, internal or external root
resorption, exfoliation, or a combination of all the
above. Obtaining more clinical information by
taking a radiograph is necessary before any further
treatment is rendered.
Why are rounded internal line angles desirable
in the preparation of amalgam restorations in
primary teeth?
A. They increase retention
B. They conserve tooth structure
C. They increase resistance
D. They decreases internal stresses in the
restorative material
D. Due to the small size of primary molars and,
therefore, small restorations as well, it is helpful
to reduce stresses within the restorative material.
It has been demonstrated that rounded internal
line angles aid in reducing stress when com-
pared to sharp internal line angles. Many of the
burs recommended for use in primary molars
have a rounded end to help achieve softened
internal line angles.
Your patient is 7 years old and has a very
large, carious lesion on tooth T. What radiolog-
ical factors should be used in determining the
best treatment of choice between pulpotomy and primary endodontics? A. Furcation involvement B. External root resorption C. Internal root resorption D. Two of the above E. All of the above
A. The treatment decision in this case should be made
on the presence or absence of furcation
involvement. Absence of furcation involvement
generally indicates a vital pulp. Of course, it is nec-
essary to have vital tissue to perform a pulpotomy.
Presence of furcation involvement generally indi-
cates progression to a nonvital pulp. If furcation
involvement is present, a pulpectomy would be the
treatment of choice in the absence of external or
internal root resorption.
Which pulpotomy medicament demonstrates better success rates than formocresol? A. Mineral trioxide aggregate B. Calcium hydroxide C. Resin-modified glass ionomer cement D. Fifth-generation bonding agents
A. Mineral trioxide aggregate (MTA) pulpotomies
have shown very good promise and generally
show higher success rates than formocresol
pulpotomies. However, at this time MTA is very
expensive and is not used as often as formocre-
sol or ferric sulfate.
The pulp tissue of primary teeth _____.
1. In general, is smaller proportionately than
permanent pulps in relation to tooth crown
size.
2. Is closer to the outer surface of the tooth than
the permanent teeth.
3. Follows the general surface contour of the
crown.
4. Has the mesial pulp horn closer to the surface
than the distal pulp horn.
A. Only 1, 2, and 4 are correct.
B. Only 2, 3, and 4 are correct.
C. Only 1, 3, and 4 are correct.
D. 1, 2, 3, and 4 are correct.
B. The pulp chambers of primary teeth are propor-
tionately larger compared to the size of the
crown. This is significant because there is a
higher risk of accidental pulp exposures on pri-
mary teeth. In particular, the mesial-buccal pulp
horn of the first primary molar is close to the
external surface of the tooth.
The following teeth are erupted in an 8-year-old patient. What is the space maintenance of choice?
3 ABC 7 8 9 10 H I \_\_ 14 30 T S R 26 25 24 23 M L K 19 A. Band-loop space maintainer. B. Lower lingual holding arch. C. Nance holding arch. D. Distal shoe space maintainer.
C. In space maintenance, the clinician must always
be mindful of the exfoliation sequence of teeth.
In this situation, the authors would normally exfoli-
ate prior to the eruption of the second permanent
premolar, tooth #13. If a band loop space main-
tainer were used, there may be no anterior
abutment if there is a normal exfoliation sequence.
This could result in mesial tipping of the perma-
nent molar and space loss. A Nance holding arch
or a palatal holding arch would be an appropriate
choice.
The following teeth are erupted in a 4-year-old patient. What is the space maintenance of choice? A B C D E F G H I J \_\_ S R Q P O N M L K A. Band-loop space maintainer. B. Lower lingual holding arch. C. Nance holding arch. D. Distal shoe space maintainer.
D. The only possibility within these choices is the
distal shoe space maintainer. Some clinicians find
that a removable “kiddie” acrylic partial can also
be successful. These kiddie partials extend distally
to the point where the mesial of the first
permanent molar would be. Some advocate plac-
Sample Exam Answer Key ▼ 405
ing a 1-mm-deep labial-lingual groove in the cast
on the alveolar ridge on the mesial of the first
permanent molar. This results in extra acrylic at the
tissue–acrylic interface that causes pressure. This
may aid in keeping the unerupted first permanent
molar in position.
If the fluoride level in the drinking water is
greater than 0.6 ppm at any age, no supplemen-
tal systemic fluoride is indicated. If the patient
is less than 12 months old, no supplemental
systemic fluoride is indicated, whatever the
water fluoride level.
A. The first statement is true and the second
statement is true.
B. The first statement is true and the second
statement is false.
C. The first statement is false and the second
statement is true.
D. The first statement is false and the second
statement is false.
B. The systemic fluoride “Rule of 6s” states:
a. If fluoride level is greater than 0.6 ppm,
no supplemental systemic fluoride is indi-
cated.
b. If the patient is less than 6 months old, no sup-
plemental systemic fluoride is indicated.
c. If the patient is greater than 16 years old, no
supplemental systemic fluoride is indicated.
Therefore, the statement, “If the patient is less
than 12 months old, no supplemental systemic
fluoride is indicated” is false.
A 1-year-old patient has his first dental exami-
nation. The dentist reviews with the parent
when to expect the next teeth to erupt, teething,
oral hygiene tips for toddlers, and discusses
fluoride issues with bottled water and tooth-
paste. The term that describes this proactive
approach to dental care is \_\_\_\_\_. A. Risk assessment B. Probability counseling C. Anticipatory guidance D. Preventive support counseling
C. Anticipatory guidance is counseling patients and
parents regarding the child’s home oral healthcare
that is age-appropriate and is focused on
prevention. Subjects to discuss with parents
include:
a. Oral hygiene
b. Oral development
c. Fluoride
d. Diet and nutrition
e. Oral habits
f. Trauma and injury prevention
Most natal and neonatal teeth are primary
teeth. They should be extracted.
A. The first statement is true and the second
statement is true.
B. The first statement is true and the second
statement is false.
C. The first statement is false and the second
statement is true.
D. The first statement is false and the second
statement is false.
B. Most natal and neonatal teeth are primary teeth
(90%); very few are supernumerary teeth (10%).
Most are mandibular incisors (85%). Extraction of
primary teeth should be accomplished only if they
are extremely mobile and there is danger of
aspiration. Most commonly, natal and neonatal
teeth are left in position.
The “willful failure of parent or guardian to
seek and follow-through with treatment neces-
sary to ensure a level of oral health essential
for adequate function and freedom from pain and infection” is a definition of \_\_\_\_\_. A. Munchausen syndrome by proxy B. Emotional abuse C. Parental corruption D. Neglect
D. Munchausen syndrome by proxy is a condition in
which a person, usually a parent, presents factitious
symptoms and illnesses in a child, which may result
in extensive testing and/or hospitalizations.
Examples of emotional abuse include denial of
affection, isolation, extreme threats, and corruption.
A parent who knowingly and willingly does not seek
care for a child who has pain, infection, or
inadequate function is guilty of neglect.
Where do lesions commonly occur in the pri-
mary form of acute herpetic gingivostomatitis?
A. Buccal mucosa B. Tonsils, hard and soft palate C. Tongue D. Gingiva E. All of the above
E. The location of lesions of primary herpetic gin-
givostomatitis is on mucous membrane, including
tonsils, hard and soft palates, buccal mucosa,
tongue, palate, and gingiva. Children with this
disease can be very sick and require close super-
vision and support. They typically have a very
significant fever, can become dehydrated, and
the process lasts up to 2 weeks. Treatment may
consist of:
a. Topical anesthetics such as 0.5% dyclonine
hydrochloride and viscous lidocaine
b. Coating solutions such as diphenhydramine
elixir and kaolin-pectin compound
c. Antivirals such as acyclovir
d. Analgesics such as acetaminophen and
ibuprofen
Localized aggressive periodontitis in the pri-
mary dentition is seen most commonly in the
primary molar area. It is most common in
Asian children.
A. The first statement is true and the second
statement is true.
B. The first statement is true and the second
statement is false.
C. The first statement is false and the second
statement is true.
D. The first statement is false and the second
statement is false.
B. Localized aggressive periodontitis in the primary
dentition, previously known as localized prepu- bertal periodontitis (LPP) is most common in the
primary molar area and occurs most commonly
in African-American children. Treatment
includes debridement and antibiotic therapy.
Your patient is 8 years old. Tooth #8 was
avulsed and you replanted it within 30 min-
utes. What is the best splint to use?
A. Rigid fixation for 7 days
B. Rigid fixation for 2 months
C. Nonrigid fixation for 7 days
D. Nonrigid fixation for 2 months
C. The appropriate splint for an avulsed tooth is a
nonrigid splint, which is left in place for about
7 to 14 days. A 0.016 × 0.022 stainless steel ortho-
dontic wire, a 0.018 round stainless steel wire,
and a monofilament nylon (20- to 30-lb test) line
are considered nonrigid. Long-term rigid splint-
ing of replanted teeth increases risk of replace-
ment root resorption (ankylosis). Rigid splinting
is indicated for root fractures and remains in
place for 2 to 3 months. A 0.032–0.036 stainless
steel wire is considered a rigid splint.
Your patient is 8 years old. Teeth #8 and #9
have approximately 50% of their crowns
erupted. One month ago, the patient fell from a
skateboard and hit teeth #8 and #9 on the side-
walk. The radiograph today shows open apices
of these teeth, normal PDL, and no apparent
periapical radiolucency. The patient has no
reaction to electrical pulp tests. What is your
treatment of choice?
A. Calcium hydroxide pulpotomy
B. Formocresol apexification technique
C. Calcium hydroxide apexification technique
D. Reappoint for exam and radiographs in 6 weeks
D. If a tooth is incompletely erupted or is being ortho-
dontically treated, the tooth may be normal even if
there is little sensitivity to electrical pulp tests.
Certainly, in the absence of other symptoms, treat-
ment is contraindicated.
A permanent incisor with a closed apex is
traumatically intruded. What is the treatment
of choice?
A. Gradual orthodontic repositioning and calcium
hydroxide pulpectomy
B. Surgical repositioning and calcium hydroxide
pulpectomy
C. Gradual orthodontic repositioning and
conventional endodontic therapy
D. Surgical repositioning and conventional
endodontic therapy
A. Rapid root resorption, pulp necrosis, and ankylosis
are common sequelae to intruded permanent
teeth with mature apices. Treatment includes:
a. Gradual repositioning orthodontically (2–3
weeks)
b. Stabilize for 2 to 4 weeks
c. Calcium hydroxide pulpectomy 2 weeks after
injury
Which of the following is the most likely cause
pulpal necrosis following trauma to a tooth?
A. Ankylosis
B. Calcific metamorphosis
C. Pulpal hyperemia
D. Dilaceration
C. The other three answers may occur as the result of
trauma but do not cause loss of vitality. Pulpal
hyperemia causes increased intrapulpal pressure
and swelling, which may result in an interruption
of the pulp’s blood supply. Without an adequate
blood supply, the pulp becomes necrotic. This
process can take time, and symptoms (either
radiographic or clinical) may not present for weeks
or even months. Typically, follow-up examination
and radiographs are indicated at 1-, 2-, and 6-
month intervals following a traumatic incident.
curve of Spee
sagittal, antero-posterior
curve of Wilson
left and right, frontal
Dolichocephalic –
long narrow face
growth of mandible mechanism
both intramembranous and endochondral.
Scammon Growth curve: Neural tissue grows until what age?
5 y/o (this was the number on the test, but on book it is about 6-7)
Which tissue show most growth in first 6 years and then plateau? lymph, neural, genital
neural
Which system is most fully developed at birth?
a. muscle system
b. neural system
c. gonadal system
b. neural system
Which grows faster, maxilla or mandible?
Maxilla grows earlier and faster (b/c it is closer to brain)
What is the best radiograph for showing prediction about ossification?
Wrist hand radiograph
Majority of the tissues in FACE are derived from? A) ectoderm b) mesoderm c) ectoderm and mesoderm d) endoderm
ectoderm
Eruption sequence of pediatrics?
Central-Central, Lateral-Lateral, 1M-1M, Canine-Canine, 2M-2M
Overjet in permanent teeth should be?
2-3mm
