Correct Answer is: B

Rationale

CAL is determined as follows:

When the gingival margin is coronal to the CEJ, you subtract (from the probing depth) the distance from the CEJ to the gingival margin. If the gingival margin is apical to the CEJ, CAL is equal to the probing depth plus the distance from the CEJ to the gingival margin.

Correct Answer is: A

In dentistry, maintaining a more natural body positioning for performing dental procedures while also considering patient positioning, instrument and equipment design, as well as the layout of the environment in which the dental procedures are performed. The most common ergonomic mistake is in malpositioning of the body of the seated operator.

Correct Answer is: E

Rationale

Margaret indicated that she smokes ½ pkg cigarettes per day, she did not indicate that she wanted nutritional counseling, nor is there enough information to determine if she would be a candidate for it.

Correct Answer is: C

Rationale

Asking about tobacco use, advising users to quit, assessing readiness to quit, assisting with the quitting process based on readiness to quit, and arranging follow-up are the Five A’s. The Five A’s were developed as a guideline for clinical practitioners to address all the steps necessary to provide effective intervention with a tobacco-using patient.

Correct answer: B

Rationale

Fostering an understanding with the patient during the teachable moment increases communication regarding the patient’s disease state and how smoking can exacerbate periodontal disease.

Correct answer: A

Rationale

Margaret is experiencing no thought of stopping tobacco use. This is the stage of change that needs education on why quitting is best for her health.

Correct Answer: D

Rationale

The nicotine nasal spray has the fastest absorption rate of all the alternatives listed. Therefore it delivers nicotine most quickly to the brain. The nicotine passes through the nose’s capillaries to cross the blood-brain barrier.

Correct Answer: D

Rationale

An amalgam mix that is crumbly will not stick together to produce a good restoration. An amalgam mix that is firm will not be pliable enough to produce a good restoration.

Correct Answer is:        C

Rationale

Resin-based composites provide excellent esthetics and may be used successfully in posterior teeth.

Correct Answer is:        E

Rationale

Nicotine withdrawal symptoms are the strongest the first 2 days after stopping tobacco use and diminish over approximately 4 weeks.

Correct Answer is: E

Rationale

Glass ionomer cement for cementation of stainless steel crowns is not resin-modified.

Correct Answer is: D

A. Abfraction – consists of the ongoing flexion, tension, and compression forces exerted in the cervical area of a tooth from mastication, and occlusal trauma can result in cracking and eventual loss of cervical tooth structure.
B. Abrasion – the loss of tooth structure associated with toothbrush stiffness and bristle configuration; toothbrushing force, method, and frequency; and duration of brushing.
C. Erosion – the loss of tooth structure as a result of a chemical process.
D. Attrition – the term used to refer to tooth structure wear on the incisal and occlusal surfaces that occurs from normal tooth use, the mechanical tooth-to-tooth wear of the dentition from normal tooth contact.

Correct Answer is:        C

Rationale

Dental sclerosis is the reduction of the dentinal tubule lumen as a result of the deposition of intratubular dentin.

Correct Answer is:        D

Rationale

Periodontal surgery is likely to increase the probability of dentinal hypersensitivity due to the exposure of dentin that was once covered by soft tissue. The other behavior modification strategies will decrease dentinal hypersensitivity.

Correct Answer is:        B

 Rationale 

Both statements are false. The statements given in the question refer to extrinsic erosion, not intrinsic erosion. Intrinsic erosion is caused by acid regurgitation associated with medical and psychologic disorders such as morning sickness and bulimia.

Correct Answer is:        A

Rationale

Both statements are true. Mild hypersensitivity can usually be managed by the patient, at home, using good oral hygiene with a sensitivity-protection dentifrice. Severe hypersensitivity associated with cervical tooth loss usually requires the placement of a Class V restoration.

Correct Answer is:        B

Rationale

The only selection from the above listed choices that is indicative to selective polishing is cigarette smoke stain

Correct Answer is:        E

Rationale

 There is no relationship between tooth bleaching and an increase in hypertension

Correct Answer is:        B

Rationale

 Through use of intermittent strokes and pressure, the heat generated by the friction between the tooth and abrasive-filled rubber cup is reduced.

Correct Answer: A

Rationale

Epilepsy and emphysema are contraindications for nitrous oxide–oxygen analgesia.

Correct Answer is:        A

Rationale

 The existence of incipient caries is not a cause of gingival recession. Factors that contribute to gingival recession include the use of a hard toothbrush, abfraction (which causes loss of cervical tooth structure followed by recession), and occlusal trauma, which can alter the attachment level of the gingiva.

Correct Answer is:        C

Rationale

 Mrs. Chow having dentinal hypersensitivity would not significantly benefit from using an oral irrigation system. She would benefit from daily fluoride mouth rinse, a soft toothbrush, and low-abrasive fluoridated toothpaste for sensitive teeth.

Correct Answer is: C
A. The use of a 5% sodium fluoride varnish – she would benefit from fluoride varnish therapy.
B. Use of a desensitizing agent such as potassium nitrate- she would benefit from the use of a desensitizing agent.
C. In-office oral irrigation of 0.12% chlorhexidine – An in-office oral irrigation procedure with 0.12% chlorhexidine is not an evidence-based intervention for the treatment of dentinal hypersensitivity.
D. Placement of Class V restorations – she would benefit placement of a Class V restoration.

Correct Answer is:        C

Rationale

Stage II, the delirium or excitement stage of light anesthesia, is characterized by hyperresponsiveness to stimuli, exaggerated inspirations, and loss of consciousness.

Correct Answer is:        E

Rationale

The ideal minimal amount of nitrous oxide–oxygen needed to relax the patient is the point at which the patient reports one or all of the listed symptoms.

Correct Answer is:        B

Rationale

To meet the patient’s need for valuing health and wellness, communicate satisfaction when evaluation or therapy has occurred. Recognize that even small accomplishments may be major to the recovering patient. Expect the patient to have periods of recurrence of eating disorder behaviors. Support the recovery, not the illnesses.

Correct Answer is:        D

Rationale

Respiratory condition is the exception. The most common physiologic effect of anorectic behavior is hormonal abnormalities. Cardiovascular, gastrointestinal, renal, and hematologic systems may be compromised in patients with anorexia.

Correct Answer is:        A

Rationale

Lanugo, a fine downy hair usually found on the lower half of the face and upper body, is a common physical finding in anorectics not bulimics. In bulimia nervosa the presence of a callus on the knuckle(s) can occur from repeated self-induced vomiting is common. It has been estimated that 8% to 29% of the population may exhibit this type of callus. Commissure lesions; dry, cracked lips; and intraoral trauma may be evident, along with parotic enlargement.

Correct Answer is:        C

Rationale

Dental erosion, is the most common dental finding in the patient with an eating disorder who engages in vomiting. It has also been associated with vomiting as a result of gastric disturbances (such as hiatal hernia, duodenal or peptic ulcers, previous pregnancies, and cancer-related chemotherapy), high–citric acid fruit intake, or habitual eating or sucking on chewable vitamin C tablets or sweet-and-sour type candies, Antabuse therapy for alcoholism, medications containing hydrochloric acid, and exposure to industrial acids.

Correct Answer is:        A

Rationale

Dental erosion is synonymous with perimylolysis

Correct Answer is:        C

Rationale

Persons who regularly vomit may exhibit parotid gland enlargement. This subsides with abstinence from vomiting. Vomiting can also result in diminished taste acuity.

Correct Answer is:        B

Rationale

Soft tissue curettage is primarily indicated for edematous suprabony pockets where shrinkage and reduction in inflammation will result in a shallow pocket or to reduce  inflammation

Correct Answer is:        B

Rationale

Used needles:

• must not be bent or broken before disposal
• must not be recapped.
• In dentistry, if recapping or disassembly is unavoidable, a the scooping techniques must be undertaken and appropriate safety devices should be used.

Correct Answer is:        A

Rationale

Standard precautions (which replaced universal precautions in 1996) is “a set of precautions designed to prevent transmission of HIV, Hepatitis B virus (HBV), and other blood borne pathogens when providing first aid or health care. Under standard precautions, blood and certain body fluids of all patients are considered potentially infectious for HIV, HBV and other blood borne pathogens”

Correct Answer is: A

Rationale

It is necessary for handpiece to be completely filled with water when the insert is placed in the handpiece as this will provide total submersion of the stack which helps prevent trapping of air bubbles. If air is trapped, the handpiece may become warm, or even hot; overheating can occur along with possible insert damage.

Correct Answer is: A

Rationale

Just like your hand scalers, ultrasonic insert tips wear with use. Worn insert tips can significantly diminish your scaling efficiency:

• 1 millimeter of tip loss results in a 25% loss of efficiency
• 2 millimeters of tip loss results in a 50% loss of efficiency

How does a worn insert affect scaling? When an insert tip is worn, the “sweep” of the instrument is reduced, therefore the insert tip doesn’t travel as far on its’ optimal path. The clinical result of a worn insert can be to:

• Put more pressure on the insert, which can dampen the vibration
• Turn up the power on the generator, often to high levels for which the tip may not be designed
• Both of these actions can result in inefficient scaling, inferior tip performance, and more discomfort for you and your patient

Correct Answer is:        B

Rationale

Alginates have poor dimensional stability and they lack the ability to reproduce fine details. Other drawbacks include difficulty in disinfecting and poor tear strength. It must be poured within 15 min from being made and during that time it must be kept in a humid environment.

Correct Answer is:        B

Rationale

Compressed air will clear the moisture created by the breath on the mirror when taking intra-oral photographs

Correct Answer is:        A

Rationale

It is noted on the intra-oral examination that Mrs. Chow has maxillary tori. Patients with tori – consider using bisecting angle technique instead of paralleling technique for improved comfort

Correct Answer is:        B

Rationale

 Hyperventilation is breathing in excess of what the body needs. This is sometimes called overbreathing. There are many factors that can lead to hyperventilation. This condition most commonly results from anxiety, panic, nervousness, or stress. It often takes the form of a panic attack.

Some symptoms include:

• a pounding and racing heartbeat
• problems with balance, lightheadedness, or vertigo
• numbness or tingling in the hands, feet, or around the mouth
• chest tightness, fullness, pressure, tenderness, or pain
• headache
• gas, bloating, or burping
• twitching
• sweating
• vision changes, such as blurred or tunnel vision

Correct Answer is:        C

Rationale

Since the hygienist moves frequently around the head of the patient during treatment, they will ask the patient to rotate the head or tilt the chin during treatment to attain a line of sight that is perpendicular to the tooth surface. After reclining the chair, ask the patient to scoot to the end of the headrest. This is especially important if using a flat headrest — reaching or leaning over the “dead” headrest space can lead to a myriad of musculoskeletal dysfunctions

Correct Answer is:        A

Rationale

The bitewing x-ray is commonly used to detect decay. It shows the crowns of the upper and lower teeth at the same time, and shows good detail. Normally 4 films are taken. Unfortunately, the bone is often not visible, which limits the usefulness of bitewings in periodontics. Vertical bitewings are films that show both upper and lower teeth, but the view extends farther down the root, generally giving an excellent image of the bone to help confirm a periodontal diagnosis.

Correct Answer is:        B

Rationale

The therapeutic endpoint is the restoration of gingival health, a reduction in pocket depth, and a gain in or maintenance of a stable clinical attachment level.

Correct Answer is:        C

Rationale

Correct Answer is:        A

Rationale

Both the statement and the reason are correct and related to one another

Correct Answer is: A

Rationale

Both the above statements are true

Correct Answer is:        A

Rationale

Any/all hand instruments are appropriate. Patients with communicable diseases or at high risk for infection should not use power-driven scalers because of the high production of potentially infective aerosols.

Correct Answer is: A

Rationale

Both the above statements are true

Correct Answer is:        B

Rationale

Autoimmunity occurs when innate mechanisms that normally prevent the immune system from attacking self-antigens fail and activated T cells and antibodies begin to attack the individual’s own tissues.

Correct Answer is:        A

Rationale

Management of autoimmune diseases typically includes pharmacotherapy beginning with anti-inflammatory medications and progressing to immunosuppressive drugs. The goals of medication therapy used to treat autoimmune diseases include reduced pain, improved function, slowed rate of disease progression, and limiting tissue destruction.

Correct Answer is:        B

Rationale

Clients with autoimmune disease must be placed on 2-3 month maintenance intervals because of their compromised immune system.

Correct Answer is: B

A. Antibiotic therapy – Candidiasis is more frequently associated with antibiotic therapy.
B. Sjogren’s syndrome – Xerostomia is related to Sjögren’s syndrome, an autoimmune process that often includes rheumatoid arthritis and results in the destruction of the salivary glands.
C. Mucoceles – Mucoceles are not associated with the condition of xerostomia
D. Benign tumors of the parotid gland – Benign tumors of the parotid gland do not always produce xerostomia. Salivary function may or may not be affected by benign tumor growth.
E. Peutz-jeghers syndrome – Freckle-like lesions of the hands, perioral skin, and oral mucosa and intestinal polyposis are characteristic of Peutz-Jeghers syndrome.

Correct Answer is:        C

Rationale

Correct Answer is:        D

Rationale

Correct Answer is:        B

Rheumatoid arthritis affects women three times more frequently than men.

Correct Answer is: E

Rationale

Pilocarpine is the most commonly used sialogogue in the treatment of xerostomia. Artificial saliva is used palliatively in xerostomia to temporarily restore moisture in the oral cavity. Topical fluoride is used to relieve dentinal hypersensitivity and aids in the prevention of dental caries. Atropine is used to lessen secretions and thus would not be used to treat xerostomia.

Correct Answer is: D

Rationale

3 MO, 4 DO & MO, 5 DO, 31 MO, 30 DO & MO, 29 DO has decay

Correct Answer is:        D

 All of the above are some self-help advice that can help ease the symptoms of lichen planus

Correct Answer is: A

A. Dorsal – the lesion is located on the top or the dorsal of the tongue
B. Ventral – the bottom surface of the tongue
C. Lateral – lateral surfaces are the sides of the tongue
D. Median – median refers to toward the midline
E. Distal – away from midline

Correct Answer is:        C

Rationale

Because Anna is allergic to penicillin, the correct dosage is Clindamycin 600 mg 1 hour prior to appointment. Amoxicillin is a derivative of penicillin. The other choices are not the correct dosages

Correct Answer is:        C

Rationale

The right bitewing is cone cut in the bottom right area- not aligning the PID over the film correctly

Correct Answer is:        B

Rationale

Due to the lichen planus, the sonic-ultrasonic scaler would be an efficient way to remove stain so that the lichen planus would not be disturbed nor would the water spray irritate it.

Correct Answer is: A

A. Blood pressure – both the systolic and diastolic levels are high, follow up is necessary
B. Height – can’t be modified
C. Pulse – is within normal limits
D. Medications- none
E. Weight – is within normal limits, or even a bit high, but won’t affect treatment

Correct Answer is:        E

Rationale

Fluoride is contraindicated in people who have mucosal disease

Correct Answer is:        A

Rationale

No more than 1 mm of discernable movement is the definition of Class I mobility

Correct Answer is:        B

Rationale

Calculus is evident in the bitewing radiograph and the arrow is pointing to it.

Correct Answer is:        A

Rationale

Presence of lacy lesions in the oral cavity suggests a diagnosis of Lichen Planus in this patient. It commonly affects young adults. The characteristic skin lesion is pruritic, plane topped, polygonal, purplish papule covered with scanty scales. Buccal mucosa, lips and genitalia are commonly involved. Treatment includes antihistamines for pruritus and topical steroids for localized lesions. Systemic steroids may be given for widespread disease after ruling out contraindications.

Correct Answer is:        D

A combination therapy with steroids and Dapsone gives a better result than 1 drug used alone.

Correct Answer is: C

A. Concrescence – fusion of teeth that occur after root has formed -adjacent roots fuse by deposition of cementum – thought to result from trauma
B. Enamel pearls – small masses of excess enamel often found at the bifurcation or trifurcation area and are formed by a small, misplaced group of ameloblasts.
C. Ankyloglossia – also known as tongue-tie, is a congenital oral anomaly that may decrease mobility of the tongue tip and is caused by an unusually short, thick lingual frenulum, a membrane connecting the underside of the tongue to the floor of the mouth.
D. Dens in Dente – “tooth within a tooth”- developmental variation when the outer surface of the tooth crown turns itself inward before mineralization- permanent maxillary lateral most affected
E. Dilaceration – a tooth that has a sharp bend or curve in the root or crown.

Correct Answer is:        D

Rationale

Three rounded protuberances, which are present on the cutting edges of incisors. Usually they are worn off early in the life of the tooth. However, when an anterior open bite is present — that is, the anterior teeth are not in contact when the bite is fully closed — mamelons may remain into adulthood

Correct Answer is:        A

Rationale 

Both the above statement and the reason are correct and related

Correct Answer is:        A

Rationale

Sensory Innervation

Sensory innervation carries touch, pain, pressure and temperature sensations.

Correct Answer is:        A

Both statements are true

Correct Answer is:        C

Rationale

The genioglossus muscle forms the bulk of the tongue and allows it to move freely. draws entire tongue anteriorly to protrude tip or press tip against alveolar ridges and teeth.

The superior longitudinal muscle shortens tongue, turns tip upward, assists in turning lateral margins upward

The inferior longitudinal muscle shortens tongue, pulls tip downward, assists in retraction

Correct Answer is:        A

Rationale

Both statements are true

Correct Answer is:        C

Rationale

Bullae are large vesicles that are relatively deep-seated and less prone to rupture. Examples occur in pemphigus and as the result of traumatic injuries. Macules are flat areas that are differentiated from surrounding tissues by color; they may vary in size, shape and color. Examples are petechiae, ecchymosis, freckles and melanosis.

Papules are small (pinhead to 5 mm) superficial elevated area of tissue, which may appear flattened, rounded, or pointed; color may vary. Examples are found in lichen planus and traumatic hyperplasia. (skin tag is also an example)

Correct Answer is: A

A. Filiform papilla – Plentiful hair like papillae covering the dorsal surface of the tongue that generally have a whitish color, although they often are stained extrinsically from food, tobacco, or medication
B. Fungiform papilla – flat, broad papillae that appear as red, mushroom-shaped elevators and are scattered among the filiform papillae. They house taste buds for sweet, sour, or salty stimuli.
C. Circumvallate papilla – a series of large papillae located in a V-formation on the posterior dorsal surface. They contain taste buds that respond to bitter stimuli only.
D. Foliate papilla – folds or “ruffles” of tissue on the posterior lateral border of the tongue; contain taste buds.

Correct Answer is: A

A. Fissured tongue – excessive fissures in dorsum of the tongue
B. Macroglossia – large tongue; may result from inflammatory condition.
C. Bifid tongue – tongue with anterior cleft; also called forked
D. Median rhomboid glossitis – an area on the tongue devoid of papilla
E. Glossopyrosis – burning sensation of the tongue

Correct Answer is:  B

Rationale

The knee is the most common total joint replacement

Correct Answer is:        D

Rationale

In patients with prosthetic joint implants, a January 2015 ADA clinical practice guideline, based on a 2014 systematic review states, “In general, for patients with prosthetic joint implants, prophylactic antibiotics are not recommended prior to dental procedures to prevent prosthetic joint infection.” According to the ADA Chairside Guide, for patients with a history of complications associated with their joint replacement surgery who are undergoing dental procedures that include gingival manipulation or mucosal incision, prophylactic antibiotics should only be considered after consultation with the patient and orthopedic surgeon; in cases where antibiotics are deemed necessary, it is most appropriate that the orthopedic surgeon recommend the appropriate antibiotic regimen and, when reasonable, write the prescription

Correct Answer is: C

Rationale

Intraoral x-rays are the most common type of x-ray. There are several types of intraoral x-rays. Each shows different aspects of teeth.

• Bite-wings show details of the upper and lower teeth in one area of the mouth. Each bite-wing shows a tooth from its crown to the level of the supporting bone. Bite-wing x-rays detect decay between teeth and changes in the thickness of bone caused by gingivitis. Bite wing x-rays can also help determine the proper fit of a crown or other restorations. It can also show wear or breakdown of fillings.
• Periapical x-rays show the whole tooth — from the crown, to beyond the root where the tooth attaches into the jaw. Each periapical x-ray shows all teeth in one portion of either the upper or lower jaw. Periapical x-rays detect any unusual changes in the root and surrounding bone structures.
• Occlusal x-rays track the development and placement of an entire arch of teeth in either the upper or lower jaw.

Extraoral x-rays are used to detect dental problems in the jaw and skull. There are several types of extraoral x-rays.

• Panoramic x-rays show the entire mouth area — all the teeth in both the upper and lower jaws — on a single x-ray. This x-ray detects the position of fully emerged as well as emerging teeth, show impacted teeth, and help diagnosis tumors.
• Tomograms show a particular layer or “slice” of the mouth and blur out other layers. This x-ray examines structures that are difficult to clearly see because other nearby structures are blocking the view.
• Cephalometric projections show an entire side of the head. This x-ray looks at the teeth in relation to the jaw and profile of the individual. Orthodontists use this x-ray to develop each patient’s specific teeth realignment approach.
• Sialogram. This test uses a dye, which is injected into the salivary glands so they can be seen on x-ray film (Salivary glands are a soft tissue that would not be seen with an x-ray.) Dentists might order this test to look for salivary gland problems, such as blockages, or Sjogren’s syndrome.
• Dental computed tomography (CT) is a type of imaging that looks at interior structures in 3-D (three dimensions). This type of imaging is used to find problems in the bones of the face such as cysts, tumors, and fractures.
• Cone Beam CT is a type of x-ray that creates 3-D images of dental structures, soft tissue, nerves, and bone. It helps guide tooth implant placement and evaluates cysts and tumors in the mouth and face. It also can detect problems in the gums, roots of teeth, and jaws. Cone beam CT is similar to regular dental CT in some ways. They both produce accurate and high quality images. However, the way images are taken is different. The cone-beam CT machine rotates around the patient’s head, capturing all data in one single rotation. The traditional CT scan collects “flat slices” as the machine makes several revolutions around the patient’s head. This method also exposes patients to higher level of radiation. A unique advantage of cone beam CT is that it can be used in a dentist’s office. Dental computed CT equipment is only available in hospitals or imaging centers.
• Digital imaging is a 2-D type of dental imaging that allows images to be sent directly to a computer. The images can be viewed on screen, stored, enhanced and enlarged or printed out. Digital imaging has several other advantages compared with traditional x-rays. Also, if necessary, images can be sent electronically to another dentist or specialist for a second opinion or to a new dentist. Digital imaging also uses less radiation than x-rays.

Correct Answer is: D

Rationale

Status asthmaticus is a severe asthmatic attack that does not respond to treatment with an adequate dose of commonly used bronchodilators. This condition may produce bronchospasms for hours or days without remission and often requires hospitalization.

Correct Answer is:        A

Rationale

Decreased lung function can be triggered by many factors in the dental environment including anxiety, supine positioning, tooth enamel dust, and aerosols commonly created by dental procedures.

Correct Answer is:        C

Rationale 

During treatment of individuals with asthma, a local anesthetic without epinephrine or levonordefrin should be used because some people with asthma are sensitive to the sulfite preservatives present in these local anesthetic solutions.

Correct Answer is:        D

Rationale

An individual experiencing an asthma attack generally is more comfortable in an upright position. Lying flat often exacerbates symptoms.

Correct Answer is:        A

Rationale

 Aspirin has been associated with precipitation of asthma attacks in some patients.

Correct Answer is:        A

Rationale

Both statements are true. In untreated periodontitis, oral pathogens continuously stimulate cells of the oral tissues and periodontium to release a mixture of cytokines (immune system proteins that act as chemical messengers to stimulate inflammation in the respiratory epithelium) and other biologically active molecules. This release of cytokines increases a person’s susceptibility to establishment by respiratory pathogens.

Correct Answer is:        C

Rationale

Dyspnea is defined as difficult, labored breathing. Although status asthmaticus does involve difficulty in breathing; it is better defined as a severe asthmatic attack that does not respond to treatment with an adequate dose of commonly used bronchodilators.

Correct Answer is:        A

Rationale

At about 4½ weeks in utero the buccopharyngeal membrane ruptures and it is at this point that the tongue begins to develop as a swelling that arises out of the back part of the pharyngeal arches

Correct Answer is: A

A. Filiform papilla – Plentiful hair like papillae covering the dorsal surface of the tongue and have not taste function but only provide sensory function, or the ability to know that something is on the tongue
B. Fungiform papilla – flat, broad papillae that appear as red, mushroom-shaped elevators and are scattered among the filiform papillae. They house taste buds for sweet, sour, or salty stimuli.
C. Circumvallate papilla – a series of large papillae located in a V-formation on the posterior dorsal surface. They contain taste buds that respond to bitter stimuli only.
D. Foliate papilla – folds or “ruffles” of tissue on the posterior lateral border of the tongue; they contain taste buds.
E. Vallate papilla – synonymous with Circumvallate papilla

Correct Answer is:        B

Rationale

Patients with Down syndrome may present with some the following dental manifestations:

• Delayed eruption of both primary and permanent dentitions
• 35-55% microdontia, clinical crowns are short, conical, small, roots complete
• Enamel hypocalcification and hypoplasia common
• Down Syndrome patients 50% more likely to have congenitally missing teeth
• 1/3 more caries resistant than their non-Down Syndrome siblings
• Gingivitis develops earlier and more rapidly and extensively, perhaps because of an abnormality in host defenses.
• V-shaped palate, incomplete development of the midface complex, soft palate insufficiency
• High incidence of laryngeal-tracheal stenosis, also upper airway obstruction and sleep apnea common

Correct Answer is:        A

Rationale

Patients with Down syndrome may present with some of the following dental manifestations:

• Delayed eruption of both primary and permanent dentitions
• 35-55% microdontia, clinical crowns are short, conical, small, roots complete
• Enamel hypocalcification and hypoplasia common
• Down Syndrome patients 50% more likely to have congenitally missing teeth
• Gingivitis develops earlier and more rapidly and extensively, perhaps because of an abnormality in host defenses.
• Scalloped, fissured tongue with bifid uvula, cleft lip/palate, enlarged tonsils/adenoids

Correct Answer is:        B

Rationale 

Typically, the nucleus of each cell contains 23 pairs of chromosomes, half of which are inherited from each parent. Down syndrome occurs when an individual has a full or partial extra copy of chromosome 21.

Correct Answer is: C

Rationale

 Down syndrome is usually caused by an error in cell division called “nondisjunction.”  Nondisjunction results in an embryo with three copies of chromosome 21 instead of the usual two.  Prior to or at conception, a pair of 21st chromosomes in either the sperm or the egg fails to separate.  As the embryo develops, the extra chromosome is replicated in every cell of the body.  This type of Down syndrome, which accounts for 95% of cases, is called trisomy 21.

Correct Answer is:        B

Rationale

 Clients with Intellectual and development disabilities should be encouraged to perform their own oral hygiene. Depending on the level of cognitive and/or motor involvement and the individual’s personality characteristics, patients can be taught to perform adequate oral hygiene homecare. Just like people without Intellectual and development disabilities, there is great variance in the capabilities of persons with Intellectual and development disabilities. All should be assessed as individuals without preconceived notions about what they can and cannot do.

Correct Answer is: A

Rationale

The maxillary second molars are the most common teeth to manifest microdontia in a person with Down syndrome. The lateral incisors, canines, first molars, and central incisors follow.

Correct Answer is: D

Rationale

The second premolars, followed by the lateral incisors, are the most frequently missing permanent teeth in persons with Down syndrome.

Correct Answer is:        B

Rationale

Tooth loss occurs in about 50% of individuals with Down syndrome; this finding is attributed to the high prevalence of periodontal disease in this population.

Correct Answer is: A

Rationale

Congenital heart disease is the most common and serious medical condition in persons with Down syndrome. Most cardiovascular malformations associated with Down syndrome are acutely or chronically life threatening. Cardiac problems are present in 40% to 50% of newborns with Down syndrome.

Correct Answer is:        D

Rationale

There are many OSA problems in patients with Down syndrome due to a flattened midface, a narrowed nasopharyngeal area, low tone of muscles of the upper airway, an enlarged tongue, tonsils and adenoids.

Correct Answer is:        A

Rationale 

Both statements are true. These are the definitions of dental and dental hygiene diagnoses, as defined by Darby ML, Walsh MM: Dental hygiene: theory and practice, ed 3, St Louis, 2009, Saunders.

Correct Answer is: E

Rationale

Uvula – a conic projection from the posterior edge of the middle of the soft palate

Correct Answer is:        C

Rationale 

The palate is formed between the sixth and ninth weeks of pregnancy. A cleft palate happens if the tissue that makes up the roof of the mouth (palatal shelves) does not join together completely during pregnancy.

The lip forms between the fourth and seventh weeks of pregnancy. As a baby develops during pregnancy, body tissue and special cells from each side of the head grow toward the center of the face and join together to make the face. This joining of tissue forms the facial features, like the lips and mouth. A cleft lip happens if the tissue that makes up the lip does not join completely before birth. This results in an opening in the upper lip. The opening in the lip can be a small slit or it can be a large opening that goes through the lip into the nose.

Correct Answer is:        C

Rationale

Orofacial clefts are one of the most common craniofacial congenital defects because the disorder affects nearly 6800 births annually. The presence of an orofacial cleft is most strongly associated with other factors because clefts associated with syndromes are rare.

Correct Answer is: A

Rationale

According to several references, African Americans have the lowest prevalence of orofacial clefts.

Correct Answer is: B

A. Cleft lip only – more prevalent in males
B. Cleft palate only- more prevalent in females
C. Cleft lip and palate – more prevalent in males
D. No predominance – Females are predominately likely to have only cleft palate without a cleft lip. Males are more likely to have a cleft lip and cleft palate.

Correct Answer is:        B

Rationale

In current literature, maternal alcohol consumption has not been associated with the occurrence of a nonsyndromic orofacial cleft.

Correct Answer is:        B

Rationale

The development of the upper lip occurs during the fourth week of embryologic development.

Correct Answer is:        E

Rationale

The development of the palate is complete by the twelfth week of embryologic development.

Correct Answer is:        D

Rationale

Palatal development must progress from the anterior to the posterior. Formation of the anterior and posterior palate cannot develop simultaneously.

Correct Answer is:        B

Rationale

Orofacial clefts do not affect the mandible; as a result, orthognathic surgery to correct an orofacial cleft will not involve the mandible.

Correct Answer is:        B

Rationale

Due to orofacial clefts, tooth development can be altered. Alterations may include hypomineralized enamel, or enamel hypoplasia.

Correct Answer is:        C

Rationale

Complete bilateral cleft lip and palate is the most severe type of cleft because it affects both sides and the anterior and posterior palate.

Correct Answer is:        A

Rationale

Cleft uvula is the mildest form of cleft palate, occurs when the
posterior portion of secondary palate does not fuse

Correct Answer is: A

Rationale

The 1^st branchial arch forms the body of the tongue, the 2nd, 3rd, and 4th branchial arches forms the base of the tongue?

Correct Answer is: A

A. Misplaced sebaceous glands – Fordyce granules
B. Misplaced group of ameloblasts – enamel pearl
C. Calcified dental tissue – Odontoma
D. When the outer surface of the tooth crown turns itself inward – Dens in Dente
E. Deposition of excessive amounts of secondary cementum. – hypercementosis

Fordyce granules

Correct Answer is:        A

Rationale

Chronic periodontitis is a presumed risk factor for nonhemorrhagic stroke. Hemorrhagic strokes are usually caused by anatomic abnormalities (e.g., aneurysms) that lead to the rupture or bursting of blood vessels.

Correct Answer is:        A

Rationale

 The word bacteremia is a combination of “bacteria” and “-emia” (in the blood).

Correct Answer is: E

A. Infrabony pocket- the junctional epithelium is located apical to the crest of the alveolar bone.
B. Horizontal pocket – horizontal is a term used for bone loss, not a pocket type
C. Pseudopocket – pseudopocket is not associated with movement of the junctional epithelium, it is defined as a pocket, adjacent to a tooth, resulting from gingival hyperplasia and edema but without apical migration of the epithelial attachment.
D. Vertical pocket- vertical is a term used for bone loss, not a pocket type
E. Suprabony pocket – the junctional epithelium is located coronal to the crest of the alveolar bone.

Correct Answer is:        C

Rationale 

The free gingiva is the marginal gingiva surrounding the tooth creating a cuff or collar extending coronally about 1.5 mm ( probing)
-Ends in knife-edged tip next to tooth surface
-Forms the gingival wall of the sulcus
-Demarcated from the adjacent attached gingiva by a shallow linear depression, the free gingival groove

Correct Answer is:        A

Rationale

 The col is a craterlike area of the interproximal oral mucosa joining the lingual and buccal interdental papillae.

Correct Answer is:        A

Rationale

 Healthy gingiva generally have a sulcus depth that may range anywhere from 1 to 3mm. Sulcus depths greater than 3mm occur in patients that have varying degrees of periodontal disease

Correct Answer is:        E

Rationale

For patient comfort and adequate stain removal, a combination of hand and ultrasonic scaling is indicated along with a rubber cup polish. Ultrasonic scaling should always be followed by hand scaling

Correct Answer is:        B

Rationale

Mr. Brown has 1-3 mm of recession on his mandibular anteriors with 3-4mm periodontal pocketing throughout, indicating mild periodontitis as the CAL would be greater than the healthy level of 3mm

Correct Answer is:        A

Rationale

The mental fossa is defined as a depression on anterior aspect of mandible above the mental ridge. It appears as a diffuse radiolucency around the roots of the incisors.

Correct Answer is:        C

Rationale

The definition of the genial tubercle is a small eminence of bone found on the lingual side of the mandible at the midline that serves as attachment site for the genioglossus and geniohyoid muscles.

Correct Answer is:        D

Rationale

The lingual foramen is a small opening situated on the lingual (tongue) side surface of the anterior mandible through which small blood vessels pass. The lingual foramen is usually situated in the midline of the internal surface of the mandible at the level of or superior to the mental spines.

Correct Answer is:        B

Rationale

The mandibular canal is the canal within the mandible that transmits the inferior alveolar nerve and vessels. Its posterior opening is the mandibular foramen

Correct Answer is: A

Rationale

The external oblique ridge is a smooth ridge on the buccal surface of the body of the mandible that extends from the anterior border of the ramus downward and forward with diminishing prominence. It marks the attachment of the buccinator muscle and its stability provides a reliable landmark for designing dentures or subperiostal implants.

Correct Answer is:  B

Rationale

Smoking has been shown to significantly increase the risk of tooth loss from periodontal disease. The effect appears to be dose-related, with heavy smokers exhibiting a significantly greater risk of tooth loss from periodontal disease compared to nonsmokers and lighter smokers.

Correct Answer is: B

Rationale

Mr. Brown is a smoker, and as a result his capacity for healing is diminished. Smoking has been shown to significantly increase the risk of tooth loss from periodontal disease. The effect appears to be dose-related, with heavy smokers exhibiting a significantly greater risk of tooth loss from periodontal disease compared to nonsmokers and lighter smokers. One hypothesis for the increased periodontal changes noted in smokers is that the periodontal pockets of smokers tend to be more anaerobic compared to nonsmokers. An anaerobic environment could conceivably promote the growth of Gram-negative periodontal pathogens in the subgingival plaque.

Correct Answer is: C

A. Decay – although decay is common in the lingual pit of the maxillary lateral incisors, in the above image, and definitive circular demarcation is visible indicating a restoration as opposed to decay
B. Food debris – debris would likely be lodged interproximal and not on the lingual surfaces of the teeth
C. Composite restorations – Composite resins exhibit a decrease in luminosity when exposed to tobacco smoke. The effect of tobacco-smoke on the color parameters of esthetic restorative materials is attributed to the brown pigments from tobacco leaves, present on the particulate phase of tobacco smoke known as tar. Therefore, one can speculate that the staining potential might be worsened with cigarettes with elevated content of tar.
D. Amelogenesis imperfect – Amelogenesis imperfecta is a disorder of tooth development. This condition causes teeth to be unusually small, discolored, pitted or grooved, and prone to rapid wear and breakage.