boot camp Flashcards

Question

Famciclovir

Answer 1

Famciclovir (Famvir®) is an antiviral medication used to treat the symptoms of recurrent herpes labialis and can be recommended for this patient.

Answer 2

Fluconazole (Diflucan®) is an azole antifungal medication used for both the prevention and treatment of various fungal and yeast infections

Answer 3

Lamivudine (Epivir®) is a nucleoside reverse transcriptase inhibitor (NRTI), which is a class of antiretroviral medications commonly used to prevent and treat HIV/AIDS.

Answer 4

Isoniazid (Tubizid®) is an antibiotic used to prevent and treat tuberculosis, a serious bacterial infection caused by Mycobacterium tuberculosis.

Answer 5

Protein binding is associated with the duration of action: the lower the protein binding, the shorter the duration of action. less protein binding allows the anesthetic to be more readily removed from the nerve. This refers to how much of the anesthetic attaches to proteins in your body. The more it binds, the slower it may be removed, which usually means a longer duration of action pKa is associated with the diffusion of the local anesthetic across the lipid bilayer. Lower pKa increases diffusion into tissues, and therefore more rapid onset of action.pKa Value: This is a measure of acidity. A lower pKa means the anesthetic can more easily penetrate tissues, leading to a quicker onset of action. Since local anesthetic X has lower protein binding and lower pKa than Y, it will have a shorter duration of action and a more rapid onset of action

Answer 6

Represent probability and indicate the chance that any observed difference between groups is due to randomness. A p-value close to 0 the observed differnce--> unlikely to be random, p-value near 1 --> suggests no significant difference between groups other than what might occur by chance. In this case methamphetamine has the p-value closest to 0, indicating the strongest association with caries rate. Generally, a p-value that is less than 0.05 indicates that the results are statistically significant.

Answer 7

Down syndrome, with the most common example being an atrioventricular septal defect (AVSD). involves communications between the left and right atria and ventricles, allowing blood to move in unwanted directions. It may lead to a number of complications, such as pulmonary edema. Nearly all cases of congenital AVSD necessitate heart surgery in order to close the defects

Answer 8

An atrioventricular node block describes a partial or complete block in electric impulse transmission between the atria and ventricles. This condition is not commonly noted as a congenital heart defect in individuals with Down syndrome.

Answer 9

Patent ductus arteriosus (PDA) is a congenital defect where the fetal communication between the aorta and pulmonary artery fails to close completely, reducing cardiovascular efficiency. While PDA has a higher prevalence among individuals with Down syndrome,

Answer 10

When utilizing a full thickness mucoperiosteal flap, the flap should always end on the bone. Full thickness flaps allow access to underlying osseous structures during surgical procedures (e.g., surgical extractions, removal of osseous tori)

Answer 11

partial thickness flaps are supraperiosteal and are used in mucogingival surgeries

Answer 12

Incisions along the edentulous ridge should be made at a 90-degree angle to the bone for a full thickness flap. This allows for optimal bone visibility and access, adequate blood supply to the flap, and trauma limitation to soft tissues. Additionally, this enables primary closure of the wound.

Answer 13

Incisions must be made over intact bone, not over bony defects, eminences, or vital structures. This reduces the risk of dehiscence, compromised blood flow, and delayed bone healing.

Answer 14

The base of the flap should be narrower than the free margins The base of the flap should always be wider than the free margins. A wider base ensures adequate blood supply to the flap

Answer 15

diagnosis of herpes simplex virus (i.e., cold sores) A history of herpes simplex virus (HSV), recent stressors, intraoral vesicular lesions all . This is a recurrent HSV-1 infection reemerging from the trigeminal nerve. Intraorally, herpes simplex occurs mainly on keratinized tissues (e.g., vermillion border of lips, hard palate, attached gingiva) in immunocompetent patients. However, in some cases, lesions can be seen on nonkeratinized tissues. Stress, menstruation, sunlight, or fevers may influence cold sore outbreaks. The condition is often self-limiting and should resolve within two weeks.

Answer 16

An odds ratio (OR) measures the association between two factors in a population. If OR = 1, the exposure does not affect the odds of the disease If OR > 1, the exposure is associated with higher odds of the disease If OR < 1, the exposure is associated with lower odds of the disease

Answer 17

Anterior repositioning splints are designed to protrude the mandible, which can be useful in sleep apnea patients to open the airway. These splints can also aid in recapturing an anteriorly displaced articular disc. This patient is experiencing an ‘open lock’ which is caused by posterior displacement of the articular disc and inability to close the mouth, thus this splint would not help this patient and could further worsen TMD symptoms.

Answer 18

Obesity is associated with a higher risk of cancers of the liver and prostate. Chronic inflammation, changes to the gut microbiome, and alterations in fatty acid metabolism in obesity are linked to carcinogenesis

Answer 19

is an organization responsible for regulating the safety of workers. They provide training, outreach, safety standards, and education to both employers and workers. Regulation within dental offices falls under the responsibility of this organization due to multiple occupational exposures to injuries, diseases, and chronic illnesses.

Answer 20

common symptom impeded eruption of permanent teeth. A radiograph should be taken to confirm the clinical finding. A radiograph should be taken to confirm the clinical finding.

Answer 21

the predominant bacteria in dental plaque, a colorless or white, sticky bacterial biofilm that adheres to all surfaces of the mouth. It commonly appears on the gingival margins or interproximal areas of the teeth.

Answer 22

The critical pH is the value below which a substance will become soluble. The critical pH of dentin and cementum are 6.2 and 6.7, respectively. This is below both the critical pH values of dentin and cementum only, the patient will most likely suffer from root decay.

Answer 23

is often infected by mandibular second or third molars. These teeth have roots that extend below the attachment of the mylohyoid muscle at the mylohyoid line, allowing infections to spread into this space.

Answer 24

is often infected by teeth that have roots above the attachment of the mylohyoid to the mylohyoid line (i.e., mandibular incisors, canines, premolars, or first molars).

Answer 25

EpiPen® is the brand name of an auto-injectable device that delivers epinephrine. used for the emergency treatment of anaphylaxis. A 0.3 mL EpiPen® delivers a single dose of 0.3 mg epinephrine, which is equal to 1 g/1000 mL or a concentration of 1:1000. The recommended concentration for children under approximately 66 pounds is 0.15 mg or a concentration of 1:2000.

Answer 26

condition in which the body’s blood sugar or glucose level is lower than normal result lightheadedness agitation confusion coma even death. Patients with diabetes type two have some risk for hypoglycemic episodes injection of excess medication delaying or skipping meals, or increasing exercise without adjusting food intake or dosage of medication

Answer 27

1 mg intramuscular glucagon should be used in conscious patients if they are not responsive to an initial oral source of glucose. Intramuscular glucagon is indicated in any hypoglycemic patient that is unconscious.

Answer 28

null hypothesis --> in a statistical study --> proposes that there is no significant difference between the outcomes of different groups. Investigators will aim to disprove the null hypothesis through experimentation and statistical analysis. determine whether the difference between two groups or characteristics is statistically significant and to reject the null hypothesis is by using the confidence interval. If the confidence interval does not include the null hypothesis mean (zero), the results are statistically significant, and the null hypothesis can be rejected. In this specific case, the confidence interval of (-3.41, 16.41) includes the null hypothesis mean of 0. Thus, the results are not significant, and the null hypothesis cannot be rejected.

Answer 29

Nitrous oxide at 30-40% is optimal sedation for dental procedures, offering relaxation, comfort, and slight analgesia while maintaining high levels of patient cooperation.

Answer 30

measures the association between two factors in a population. It represents the odds that an outcome will occur given exposure compared to the odds an outcome will occur without the exposure. OR = 1: the exposure does not affect the odds of the outcome OR > 1: the exposure is associated with increased odds of the outcome OR < 1: the exposure is associated with decreased odds of the outcome

Answer 31

is a degenerative joint disease, in which the cartilage in joints breaks down.

Answer 32

Factor V Leiden, an inherited disorder characterized by a mutation in the factor V protein. This mutation ultimately increases the risk of venous thromboembolism. Patients with Factor V Leiden are in a prothrombotic state. Factor V Leiden is associated with osteonecrosis, which manifests in the oral cavity as idiopathic osteonecrosis of the jaw (ONJ). Patients with Factor V Leiden are in a hypercoagulable state, and thrombotic occlusion of blood vessels that supply the jaw can lead to ischemic bone destruction and osteonecrosis. ONJ can progress following tooth extraction and alveolar osteitis (dry socket)

Answer 33

A hypercoagulable state, also known as thrombophilia, is a condition where the blood is more prone to forming clots than usual, increasing the risk of thrombosis

Answer 34

Proper hygiene is an essential part of implant health maintenance. The accumulation of plaque and calculus on implants differs from that on natural dentition. There is less accumulation and tenacity of calculus, and removal is best achieved using a plastic scaler. Additionally, a plastic scaler will avoid creating microdefects in the titanium implant that are caused by metal-on-metal contact and can impact the longevity of the implant.

Answer 35

In a class I occlusion, the distobuccal cusp of the right mandibular first molar occludes in the central fossa of the maxillary first molar. A protrusive movement of the mandible (the mandible sliding anteriorly) will translate this tooth directly anterior, resulting in this cusp passing the mesial marginal ridge of the maxillary first molar.

Answer 36

Sickle cell anemia is an inherited condition affecting the shape of red blood cells. Sickle cell is inherited in an autosomal recessive pattern. If both of the parents are carriers, they each carry one affected allele but are generally asymptomatic. If both parents are carriers, their children have a 25% chance to carry no gene (AA), a 50% chance to be carriers (Aa), and a 25% chance to have sickle cell anemia (aa).

Answer 37

, also known as dichotomous variables, are variables that can only take on two possible values or categories. Examples include yes/no outcomes, heads/tails in a coin flip, and win/loss in a competition. In this case, oral cancer can either be present or absent during the screening process and can only take on those two distinct categories.

Answer 38

are numeric variables that are obtained by counting and taking values from a set of distinct whole values.

Answer 39

Continuous variables are numeric variables that are obtained by measuring and can, therefore, assume any value within a certain set of real numbers. The value given for a continuous variable can be as small as the instrument of measurement allows. However, the presence or absence of oral cancer is not measured on a numerical score.

Answer 40

Ordinal variables are organized by ordering or ranking of groups. In the case of oral cancer screening, the presence or absence of the disease is not affected by rank since there is no clear order of the outcome.

Answer 41

rare congenital condition that consists of four different heart defects: pulmonary trunk stenosis, right ventricular hypertrophy, a ventricular septal wall defect, and an overriding aorta. Patients generally have a full repair of TOF when they are infants. Patients with repaired TOF will require antibiotic prophylaxis before dental treatments if the patient has a prosthetic valve, residual shunts, or valvular regurgitation. It is unknown how this patient’s TOF was repaired, so it is best to consult with the patient’s pediatric cardiologist before proceeding with treatment, with or without the use of antibiotics.

Answer 42

This is a condition in which enamel mineral content is deficient--> making the enamel softer and more porous. Appearence white or opaque spots on the teeth, especially on anterior teeth. Hypomineralization occurs due to disruptions in the enamel formation process during tooth development. Fluorosis or trauma during development are causes of hypomineralization.

Answer 43

indicated as a major connector in a removable partial denture primarily when there is insufficient room for a lingual bar. The lingual bar is a common connector used in mandibular partial dentures, but it requires adequate space to be effective and comfortable. If the anatomy of the patient’s mouth (such as the presence of a high floor of the mouth or other structures) does not allow for this space, a lingual plate can provide a suitable alternative.

Answer 44

group of over 100 viruses, many of which are sexually transmitted as they spread via skin to skin contact. Many HPV subtypes can be asymptomatic or cause benign warts on the skin and mucosa. Others can be cancerous. There are two high risk HPV types: HPV 16 HPV 18. Strains are associated with many cancers oropharynx, larynx, cervix, vagina, penis, anus in both men and women.

Answer 45

Epstein Barr virus is associated with an increased risk of nasopharyngeal carcinoma and Burkitt’s lymphoma.

Answer 46

Schistosomiasis is an infection caused by parasitic flatworms. This infection is associated with bladder cancer but not with cervical cancer.

Answer 47

Cytomegalovirus is usually a subclinical infection (in healthy adults) and causes sore throat and fever. It does not increase the risk of cervical cancer.

Answer 48

Crepitus is a grinding sound within the TMJ and is often associated with more advanced TMD or degeneration. The sound results from bone-to-bone contact of the mandibular condyle with the articular portion of the temporal bone. Generally, this results from damage to the articular disc and can result in damage to the articular cartilage, mandibular condylar head, mandibular fossa, and articular eminence

Answer 49

Locking is another sign of advanced TMJ dysfunction, usually resulting from articular disc displacement without reduction. Anterior dislocation of the disc relative to the head of the mandibular condyle is most common and results in a “closed lock” that prevents full mouth opening. An “open lock” may also occur when the articular disc is posteriorly displaced, resulting in the inability to close the mouth

Answer 50

Fruity breath, often smelling like nail polish remover or sweet like fruit, is a symptom of high levels of ketones in the blood, which can indicate a medical condition, most commonly diabetic ketoacidosis (DKA). It's a sign that the body is burning fat for fuel instead of glucose, due to a lack of insulin. This can be a serious medical condition, especially in people with diabetes.

Answer 51

Potentially life-threatening complication typically associated with type 1 diabetes, but in some cases is associated with uncontrolled type 2 diabetes mellitus that typically presents with the following symptoms: Fatigue Stomach pain/nausea Thirst Fruity smelling breath Confusion Excessive urination Kussmaul's breathing patterns (rapid, deep breaths)

Answer 52

breathing pattern characterized by rapid, deep, and sometimes labored breaths. sign of metabolic acidosis, a condition where the body has too much acid in the bloodstream. The body attempts to compensate for the acidosis by expelling carbon dioxide, a primary acid, through rapid, deep breaths.

Answer 53

Bisphosphonates are a class of medications that inhibit osteoclast-mediated bone resorption.

Answer 54

The symptoms are consistent with mumps, which is a paramyxovirus infection -->inflammation of many different organs but most commonly affecting the parotid gland and the testes, as seen in this patient. Orchitis, or inflammation of the testes, is the second most common finding. Parotid inflammation, or parotitis, is apparent in more than half of all cases and is more often bilateral. Stensen’s duct is the opening of the parotid gland and, therefore, would be most likely involved in this case.

Answer 55

The ducts of Rivinus are several small ducts associated with the sublingual gland.

Answer 56

is the major duct associated with the sublingual glands

Answer 57

Also known as atopic dermatitis --> long-lasting inflammatory skin condition characterized dry itchy inflamed skin. triggered by allergens, irritants stress cause rash that may weep crack crust. While there's no cure, various treatments can help manage symptoms and prevent flare-ups.

Answer 58

thinning hair eczema, hypodontia, and conical-shaped teeth. Higher suceptibility to dental caries The first-line treatment for patients with ectodermal dysplasia would be orthodontic treatmen

Answer 59

bacteriostatic antibiotics --> bind to and inhibit the 30S ribosomal subunit in bacteria and consequently inhibit protein synthesis.

Answer 60

bactericidal antibiotics that inhibit DNA synthesis by binding to topoisomerase II (gyrase) and topoisomerase IV in order to block replication and separation of replicated DNA, respectively.

Answer 61

Bactericidal antibiotics that consist of beta-lactam and inhibit bacterial cell wall synthesis. Both of these antibiotics inhibit the transpeptidase enzyme involved in the final step of peptidoglycan formation, an important component of the bacterial cell wall. The peptidoglycan becomes deficient, resulting in a weakened cell wall and bacterial death.

Answer 62

Nooninvasive tool for dentists Use --> addressing caries. It is a topical liquid containing silver water ammonia fluoride. Silver --> is an effective antibacterial agent Fluoride --> important in the remineralization process of these lesions. Silver diamine fluoride (SDF) --> it promotes the remineralization of tooth structure (dentin and enammel).

Answer 63

When SDF is applied, caries will appear black because the silver chemically reacts with the oxidizable proteins in the carious dentin.

Answer 64

accuracy of a diagnostic test in determining disease, known as true positives. If the tests or measurements used in the study are not sensitive enough, they may not accurately detect or measure fluoride absorption, leading to inaccurate results. The sensitivity of the test is crucial to ensure that the study accurately captures the fluoride absorption levels being investigated.

Answer 65

Accuracy of a diagnostic test --> determining disease, known as --> true positives. If the tests --> are not sensitive enough, they may not accurately detect or measure fluoride absorption, leading to --> inaccurate results.

Answer 66

Molar is orthodontically moved from a mesially tilted position --> to a vertical position. During this movement, the tooth is extruded in the coronal direction. Molar is upright into occlusion --> the vertical dimension of occlusion increases, and there is a wedge effect --> that opens the bite in the anterior. This type of movement decreases overbite.

Answer 67

congenital heart defect --> where a single, large blood vessel arises from the heart instead of the two normal vessels: the aorta pulmonary artery. This means oxygen-rich and oxygen-poor blood mix, --> reduced oxygen levels in the body and requiring surgical correction

Answer 68

Congenital heart defect where --> aorta and pulmonary artery are switched, meaning the aorta is connected to the right ventricle and the pulmonary artery to the left ventricle This leads to a --> separation of the oxygenated and deoxygenated bloodstreams, resulting --> in limited oxygen reaching the body

Answer 69

Tricuspid atresia is a congenital heart defect where the tricuspid valve, which normally sits between the right atrium and right ventricle, doesn't form at all or is underdeveloped. This lack of a valve or underdeveloped valve prevents blood from flowing properly from the right atrium to the right ventricle and then to the lungs.

Answer 70

Congenital heart defect where the pulmonary veins, which normally return oxygenated blood from the lungs to the left atrium, instead drain into the right atrium or other veins. This abnormal connection means oxygen-rich blood from the lungs doesn't reach the left side of the heart and is subsequently pumped to the body, leading to a lack of oxygenated blood circulation.

Answer 71

Characterized persistent burning sensation in the mucosa, including the tongue. It has an unknown etiology lacks clinical signs diagnosed by exclusion. OJO Other conditions that can cause the mouth to burn and must be excluded include xerostomia, chronic candidiasis allergic reaction.

Answer 72

Aphthous stomatitis, also known as canker sores, is characterized by small, painful ulcers in the mouth. It can cause pain and burning in the mouth, but the patient’s lack of ulcers indicates this is not the diagnosis.

Answer 73

Lichen planus is a mucocutaneous disease generally seen on the buccal mucosa and/or tongue. There are several manifestations of lichen planus. These include reticular lichen planus, which appears as white, lace-like lesions (i.e., Wickham striae), and the erythematous type (i.e., atrophic lichen planus). Lichen planus may cause burning in the mouth, but it also occurs with signs on an intraoral exam.

Answer 74

Wickham striae are fine, white or grayish white lines or streaks that appear on the surface of papules and oral mucosal lesions, particularly in lichen planus. They are a characteristic, diagnostic feature of this condition.

Answer 75

Atrophic lichen planus is a rare form of lichen planus characterized by pale papules or plaques with a central area of tissue thinning (atrophy). It's a subtype of lichen planus, a chronic inflammatory condition affecting the skin and/or mouth. Atrophic lichen planus is distinguished by its annular (ring-like) appearance and the loss of elastic fibers in the affected areas.

Answer 76

pericoronal cysts --> attached to unerupted teeth. They are most often found --> on the coronal tooth structure of impacted mandibular third molar teeth

Answer 77

Genetic disorder affecting --> bone and dental development. Dental features delayed exfoliation of primary teeth delayed eruption of permanent teeth multiple multiple Other characteristic features of CCD hypoplastic or absent clavicles prominent forehead wide nasal bridge short stature flat feet.

Answer 78

Dental features of ectodermal dysplasia include missing, pointed, or globe-shaped teeth.

Answer 79

also known as Treacher Collins syndrome, primarily impacts facial bone development. It is associated with craniofacial anomalies, including malocclusion, tooth agenesis, and discolored enamel.

Answer 80

is defined by data that is being compared from different individuals. One group is usually the control group or gold standard, and the other groups are divided into different interventions. In this case, since the subjects are divided into different preoperative medication groups, the outcomes will be compared between the individuals.

Answer 81

addictive central nervous system stimulant. This drug has harmful effects on the oral cavity. Methamphetamine contains highly acidic chemicals, which erode teeth and cause significant xerostomia. This, in conjunction with teeth grinding and a lack of oral hygiene, leads to severe attrition and decay. Methamphetamine users also commonly present with anxiety and mood disturbances, as seen in this case

Answer 82

is a condition in which stomach acid passes through the esophagus and into the oral cavity. This can result in significant erosion and possible tooth decay. However, anxiety and trembling are findings more commonly associated with methamphetamine use, not with GERD. Additionally, erosive damage and decay are generally present on posterior teeth and the lingual surfaces of teeth.

Answer 83

condition in which there is inflammation and destruction of the salivary glands. This results in reduced saliva, which buffers acids and protects teeth from decay. This is less common in males and is not associated with tremors and anxiety

Answer 84

characterized by a red, diamond-shaped, flat, or raised lesion on the dorsum of the tongue. This is caused by the loss of the filiform papillae and can be accompanied by a burning sensation. This condition is frequently associated with a fungal infection, Candida albicans, and can result in an unpleasant burning sensation. No treatment is required, but antifungals can be prescribed if the lesion is symptomatic.

Answer 85

geographic tongue, is characterized by atrophic patches surrounded by white, keratotic margins. The lesions can move across the tongue, vary in intensity, and spontaneously disappear.

Answer 86

mucocutaneous disease typically on the buccal mucosa and/or tongue. It can cause non-wipeable, lace-like, white lines (i.e., Wickham striae) or red and erosive or ulcerative pathologies

Answer 87

The patient is suffering from burning due to median rhomboid glossitis, which can be alleviated with an antifungal treatment. Nystatin, an antifungal medication, would be suitable to relieve the patient's symptoms.

Answer 88

is an antiviral medication that is used to treat herpes simplex virus (HSV) and varicella-zoster virus (i.e., chickenpox) infections

Answer 89

is a broad-spectrum antimicrobial agent often used in periodontal and oral surgery procedures. It can be used to treat gingivitis and is a potent chemical plaque-controlling agent when used long-term.

Answer 90

Epivir is a nucleoside reverse transcriptase inhibitor (NRTI) used to treat human immunodeficiency virus (HIV)

Answer 91

Narrow ridges with a large amount of resorption increase the complexity of complete denture fabrication, making 0° non-anatomic denture teeth the ideal choice. Resorbed ridges provide less denture retention, and utilizing a sharper cuspal inclination increases lateral forces during mastication, which can lead to dislodgement.

Answer 92

20° Semi-anatomic denture teeth with shallow 20° cusps are utilized in complete dentures on semi-resorbed ridges.

Answer 93

22° Semi-anatomic denture teeth with 22° cusps are utilized in partial dentures, implant overdentures, or complete dentures on healthy ridges with moderate resorption.

Answer 94

Denture teeth with fully anatomic anatomy have 30° cusps and are utilized in partial dentures, implant overdentures, or complete dentures on healthy ridges with minimal resorption

Answer 95

had a previous root canal treatment; therefore retreatment or extraction is required to clean out the infection. If no treatment is performed, it will likely turn into a sinus tract. sinus tract is a channel in the bone that connects the infection to the oral cavity. This allows the infection to drain.

Answer 96

Severe diffuse cellulitis --> spreads rapidly and is acute in nature. It occurs --> after an infection of the roots of mandibular teeth that spread into the submandibular, sublingual, and submental spaces.

Answer 97

painful and restricted mouth opening due to muscle spasms. This can occur in severe infections of mandibular teeth that spread to the masticatory spaces.

Answer 98

includes communicating truthful information to the patients and to insurance companies. Since the dentist changed the date of service, they are not being truthful to the insurance company

Answer 99

A lower lingual holding arch is a fixed bilateral space maintainer for the mandible. It is used to preserve the primary molar and canine space.

Answer 100

A Nance appliance is a fixed bilateral space maintainer for the maxilla, used to prevent mesial drift of the permanent molars.

Answer 101

Capsaicin causes the depletion of substance P, a neurotransmitter responsible for increased sensitization. It decreases the ability of nerve fibers to send pain signals to the brain. It has been used in patients with postherpetic neuralgia and trigeminal neuralgia

Answer 102

is a neurotoxin that causes cytotoxicity and chromosomal damage.

Answer 103

has been shown to be a neurotoxin and can cause damage to nerves.

Answer 104

Nitric oxide is a gas that leads to the relaxation of vascular smooth muscles and subsequently arteriolar and venous dilation.

Answer 105

being the most common oral fungal species after Candida. Oral Aspergillus infections manifest as a black or yellow necrotic ulcerative lesion on the palate or posterior tongue

Answer 106

Blastomyces is a spore-forming, dimorphic fungus responsible for fungal pneumonia in immunocompromised patients

Answer 107

is known to cause cryptococcosis, a rare invasive fungal infection. This infection can lead to fungal pneumonia or meningitis in immunocompromised hosts

Answer 108

are components --> added to a composite that can affect its properties. Typically, smaller filler particles result in a composite with less strength.

Answer 109

result in a composite with less water retention, more abrasion resistance, and a smoother finish.

Answer 110

is a type I hypersensitivity or an "immediate allergic" reaction. This reaction is caused by --> immunoglobulin E (IgE). IgE causes --> mast cell degranulation and histamine release --> resulting in * itchy skin * rash * swelling * nausea * difficulty breathing. Mneumonic GAMED: IgG- "G"eneric- most common antibody IgA- w"A"aaaaaa- like a baby crying; found in breast milk, tears, saliva, and sweat IgM- i"M"mediate- first antibody made upon pathogen invasion by B cells IgE- sn"E"eze- associated with allergies and mast cells IgD- "D"ifferentiation- helps the B lymphocyte differentiate

Answer 111

The sphenomandibular ligament is one of the two accessory ligaments of the temporomandibular joint (TMJ), the other being the stylomandibular ligament. The accessory ligaments are so named because they are not directly attached to the joint. The sphenomandibular ligament originates from the spine of the sphenoid and inserts into the lingula of the mandible. Functionally, the sphenomandibular ligament is responsible for limiting inferior movement of the joint.

Answer 112

Consecutive sampling involves selecting all subjects who meet the study criteria until an adequate sample size is obtained. It is a type of non-probability sampling or non-random sampling, which means that sampling errors and bias may be present. For early studies, however, this is a good sampling technique because it is efficient and relatively inexpensive.

Answer 113

can be transmitted via blood products, leading to acute or chronic inflammation of the liver. It remains a significant health concern in the medical setting due to its high transmissibility. The virus may be transmitted either percutaneously through needlesticks or through contact with mucosal surfaces or open wounds. If surfaces are not properly disinfected following patient care, this virus can live on a surface for up to one week. The risk of percutaneous transmission of Hepatitis B is 30%.

Answer 114

is a monoclonal antibody used to treat osteoporosis and certain bone cancers. It is a RANKL inhibitor, which decreases bone resorption and increases bone density. Denosumab is administered subcutaneously and has a higher risk of MRONJ compared to oral bisphosphonates.

Answer 115

The only nerves involved in taste have special visceral afferent (SVA) fibers and are the facial, glossopharyngeal, and vagus nerves. trigeminal nerve carries general somatic afferent (GSA) that supplies sensation to the skin of the face and special visceral efferent (SVE) fibers that innervate the muscles of mastication

Answer 116

the object is located between the radiograph source and the center of rotation in a panoramic radiograph. A ghost image of the patient’s earring would not be present in a periapical radiograph.

Answer 117

appears as a radiopaque, dome-shaped structure with a rounded edge.

Answer 118

appears radiographically as a radiopaque mass embedded in the mucoperiosteum with an intact sinus wall.

Answer 119

class II preparations, it is important to ensure that the matrix is burnished against the adjacent tooth and sealed around the outline form of the preparation. After the composite is cured and the matrix band is removed, the proximal contact should be flossed and visually inspected.

Answer 120

Cefazolin (Kefzol®) is an intravenous cephalosporin antibiotic. Although this medication is in a different class, intravenous delivery is unnecessary in this case as the patient can take oral antibiotics.

Answer 121

Metronidazole (Flagyl®) is an antibiotic that works most effectively against gram-negative and positive anaerobic bacteria. However, its narrow spectrum of activity limits its efficacy as a monotherapy antibiotic for prophylaxis of infective endocarditis as the most common offending organisms are streptococcus and staphylococcus (gram-positive, aerobic species).

Answer 122

is a common abrasive agent added to toothpaste to help remove plaque debris surface stains. It does not have antimicrobial or anti-inflammatory properties, so it does not directly address plaque or gingivitis.

Answer 123

is a commonly used tooth desensitizer that functions via hyperpolarization of interdental nerves, increasing the stimulus threshold for pain and temperature signaling.

Answer 124

is the primary source of fluoride in most dentifrice products. Its antimicrobial properties are less strong compared to those of stannous fluoride.

Answer 125

**Tertiary prevention** reduces the severity of disease in a symptomatic patient. For example, this patient presents with maxillary cant and mandibular deviation. The recommended treatment option (i.e., orthognathic surgery) corrects facial symptoms to improve appearance and is an example of tertiary prevention. **Primordial prevention** counters the development of risk factors on a community-wide scale. Expanding access to dental care and education in rural areas is an example of such prevention. ***Primary prevention*** hinders disease development. It is typically delivered to healthy patients to thwart the onset of disease. Examples include habit control and fluoride varnish. **Secondary prevention** is early disease detection. The target prevention recipient is a healthy-appearing patient with subclinical forms of a disease. Early diagnosis and interceptive orthodontics are secondary prevention measures.

Answer 126

of a tooth is the specific point where --> the application of a force results in uniform resistance to displacement. It is typically near the middle third of the root in a periodontally healthy tooth. OJO When the horizontal bone level around a tooth decreases due to periodontal disease --> that tooth’s center of resistance shifts towards the apical third of the root.

Answer 127

side effect of radiation therapy, certain medications, and aging.

Answer 128

antidepressant and nerve pain medication and is often used to treat depression. Common side effects include xerostomia, nausea, vomiting, drowsiness, weakness, and headaches.

Answer 129

diuretic medication used to treat hypertension. Common side effects include increased urination or frequency of urination, headaches, dizziness, muscle cramps, and xerostomia

Answer 130

especially in higher doses, can cause methemoglobinemia, which is a blood disorder in which an abnormal amount of methemoglobin is produced. Of note, benzocaine may also be associated with methemoglobinemia.

Answer 131

Inflamed tissue has a lower pH than normal, which favors the ionized form of local anesthetics. Since only the non-ionized form of local anesthetics can penetrate a neuronal membrane, they are less effective in inflamed tissue.

Answer 132

The maximum dose of 2% lidocaine with vasoconstrictor (1:200,000 epinephrine) is 7.0 mg/kg, not to exceed 500 mg. This patient weighs 80 k Importantly, if the anesthetic used was 2% lidocaine with 1:100,000 epinephrine, then the limiting factor would be the vasoconstrictor. Even though the absolute maximum dosage of lidocaine would still be 500 mg, the maximum epinephrine dosage (0.2 mg for a healthy patient) would be reached at 11 carpules, resulting in 374 mg of lidocaine.

Answer 133

The maximum dose of lidocaine without vasoconstrictor for adults and the maximum pediatric dose of lidocaine with vasoconstrictor is 4.4 mg/kg. For an 80 kg patient, 352 mg would be the amount of lidocaine if this incorrect dosage is used.

Answer 134

This patient has a recent history of a myocardial infarction in the last 3 months, which is classified as ASA IV. For patients with severe cardiac disease of ASA III or IV, the maximum dose of epinephrine that can be administered is 0.04 mg. To calculate the epinephrine in one 1.8 mL carpule of 4% articaine with 1:100,000 epinephrine: 1:100,000 means there is 1 g of epinephrine in 100,000 mL of articaine 1/100,000 = 0.00001 g/mL = 0.01 mg/mL Therefore, in one 1.8 mL carpule, there is 0.018 mg of epinephrine. 2 carpules = 3.6 mL with a total of 0.036 mg epinephrine 3 carpules = 5.4 mL with a total of 0.054 mg epinephrine Given the maximum dose of 0.04 mg, this patient can be administered 2 carpules of 4% articaine with 1:100,000 epinephrine.

Answer 135

Clindamycin is a broad spectrum antibiotic associated with gastrointestinal upset and pseudomembranous colitis.

Answer 136

is not associated with gastrointestinal upset and pseudomembranous colitis

Answer 137

Tetracycline is associated with liver damage

Answer 138

is associated with aplastic anemia.

Answer 139

is a form of --> severe cellulitis associated with the floor of the mouth. common causes of Ludwig's angina odontogenic infections especially infections of lower second and third molars with roots below the mylohyoid muscle. Extraoral signs bilateral lower face swelling in the upper neck and the mandible regions. Intraorally elevation of the floor of the mouth dysphagia or difficulty swallowing saliva. As the condition worsens, the airway can become compromised, and spaces on both sides of the tongue can harden. The floor of the mouth elevates, pushing the tongue posteriorly and blocking the oropharynx.

Answer 140

The patient complains of biting his cheek when trying to eat and talk. The patient was recently delivered his complete denture and there is clinical evidence of bilateral linea alba. The patient is likely experiencing excessive vertical dimension of occlusion (VDO). Excessive VDO occurs when --> the teeth are brought into premature contact during mastication and swallowing. This results in occlusion of the teeth while the patient’s cheeks are strained, catching the cheeks into the bite.

Answer 141

This may lead to a --> shift in skeletal jaw growth causing a malocclusion or the shift in alignment of the maxillary and mandibular teeth. A growth spurt typically causes more mandibular growth than maxillary growth and may result in a malocclusion.

Answer 142

known as the dependent or response variable, is the outcome that is measured following the manipulation of the explanatory variable. In this study, the outcome that is measured is the reported pain level by the patients following orthognathic surgery.

Answer 143

what will happen at each visit is the best initial option for managing patients who suffer from post-traumatic stress disorder (PTSD). Communication of expectations is a conservative and effective first-line technique. If the patient knows what to expect at each visit, a potentially triggering event may be avoided. The best initial technique for treating a patient with a history of PTSD is to thoroughly explain what will happen at each visit.

Answer 144

play a critical role in defending against extracellular bacterial infections. They produce cytokines that promote inflammation and stimulate the recruitment of immune cells to infection sites. When dysregulated, Th17 cells can contribute to the development and progression of several autoimmune diseases, including rheumatoid arthritis (RA). These cells are found abundantly in the synovial fluid of patients with RA and contribute to joint inflammation and damage.

Answer 145

activate and stimulate cytotoxic T cells and macrophages. They are important in the defense against intracellular pathogens and are often involved in delayed-type hypersensitivity reactions.

Answer 146

stimulate --> B cells to produce antibodies and activate eosinophils and mast cells. They are involved in allergic responses and defense against specific parasites.

Answer 147

Rheumatoid arthritis (RA) is --> autoimmune disease in which the patient’s immune system attacks healthy cells. This causes pain swelling stiffness loss of function in the joints. RA primarily affects synovial joints (e.g., knees, shoulder), which are free-moving joints enclosed in a capsule These are different from fibrous joints (e.g., sutures of the skull), which are held together by dense connective tissue.

Answer 148

The latest research has shown that the development of rheumatoid arthritis is linked to both genetic and environmental factors.

Answer 149

Cartilage covers the ends of bones in the synovial joints. The chronic inflammation in rheumatoid arthritis destroys this cartilage over time.

Answer 150

Rheumatoid arthritis is a systemic condition; it tends to affect multiple joints on both sides of the body symmetrically.

Answer 151

is a high-speed suction unit used in dental procedures to remove fluids, debris, and other substances from the patient’s mouth. The powerful suction capacity allows quick and effective removal of aerosols generated during dental procedures. HVEs are essential for infection control, as they offer the most protection from aerosols during the restorative appointment.

Answer 152

Air filtration system Air filtration systems consist of filters, air purifiers, and pressure systems that help remove contaminants (e.g., aerosols) in dental offices. Although helpful, they are not as effective as a HVE in removing aerosols.

Answer 153

Personal protective equipment consists of gloves masks gowns, protective eyewear. Although they help filter out aerosols, they only protect the person wearing them (e.g., the provider), whereas HVEs protect both the patient and the provider.

Answer 154

are thin, flexible, latex or nitrile sheets that cover specific areas of the mouth during dental procedures. They isolate the saliva, blood, and fluids of the teeth in treatment but do not isolate aerosols

Answer 155

Tooth 14 previously underwent root canal treatment but may still harbor residual bacteria, have an untreated canal, or possess an inadequate apical seal. As a result, a chronic apical abscess developed. Clinical signs of a chronic apical abscess sinus tract that can be traced to the periapical radiolucency with gutta-percha mild discomfort upon percussion.

Answer 156

Acute apical abscess Patients with an acute apical abscess present with severe pain that has a rapid onset and swelling without a sinus tract. Oftentimes, a periapical radiolucency is not yet visible on a radiograph, as the infection has not had sufficient time to resorb the surrounding bone

Answer 157

Patients with asymptomatic apical periodontitis do not have pain or a sinus tract. Radiographically this diagnosis manifests as a periapical radiolucency.

Answer 158

Condensing osteitis radiographically appears as a diffuse radiopaque lesion around the apex of a tooth, typically without a sinus tract. Condensing osteitis is caused by low-grade, chronic periapical inflammation and is most commonly asymptomatic.

Answer 159

can immediately but temporarily stabilize ill-fitting dentures. Depending on the material used, these relines can last from three days to 18 months. The benefit of this method is that the patient does not have to go any period without the denture, as there is no lab processing

Answer 160

Denture adhesive is a soluble material that can enhance denture stability, retention, and performance. They are meant for well-made dentures but cannot compensate for a denture that no longer fits due to ridge resorption.

Answer 161

are indicated to correct an ill-fitting denture. The indirect method involves taking a new impression with the existing denture and sending it to the laboratory to add new base material to the intaglio of the denture.

Answer 162

can correct ill-fitting dentures but is more often used when the denture base fractures, is thin, or is perforated. It is more expensive to the patient and not an immediate solution, and this patient is interested in a new denture within the next year.

Answer 163

is a condition where the heart chambers become stiff over time. Although the heart is able to pump blood normally during systole, the ability to relax the chambers during diastole is diminished. The most common cause of this condition is amyloidosis, which causes a build up of protein in the cardiac tissue. These proteins eventually replace the normal tissue and cause stiffness in the heart.

Answer 164

is a generalized scarring in the liver that impairs normal functioning and is life-threatening in later-stages. It is typically caused by excessive alcohol consumption and/or viral hepatitis. It is not the most commonly associated finding with amyloidosis

Answer 165

is a generalized scarring in the liver --> that impairs normal functioning and is life-threatening in later-stages. It is typically caused by excessive alcohol consumption and/or viral hepatitis. It is not the most commonly associated finding with amyloidosis

Answer 166

Pulmonary fibrosis is a restrictive lung disease that causes scarring of the lung tissue and impairs normal lung function. Although this disease can be caused by many toxins, pollutants, medications, and radiation, most causes are unknown. That is why many diagnoses refer to the disease as idiopathic pulmonary fibrosis

Answer 167

Granuloma deposits characterize a disease called sarcoidosis, commonly confused with amyloidosis. Sarcoidosis is an inflammatory disease that involves the growth of granulomas in different parts of the body, but most commonly the lungs. In some cases, granulomas can form in amyloidosis, but not very commonly.

Answer 168

characterize disease called sarcoidosis commonly confused with amyloidosis. Sarcoidosis is an inflammatory disease that involves the growth of granulomas in different parts of the body, but most commonly the lungs. In some cases, granulomas can form in amyloidosis, but not very commonly.

Answer 169

Forensic dentists may be called in these cases and can obtain dental records without patient consent or a subpoena when it is necessary to: Identify a deceased person Determine the cause of death or source of injury Determine the age of remains Testify in malpractice cases Perform other duties according to state law

Answer 170

Tonsillitis can result in enlarged tonsils that can cause snoring due to airway obstruction. The obstruction and narrowing of the airway passage leads to the vibration of oropharyngeal structures, heard as snoring

Answer 171

Laryngitis and pharyngitis can cause a hoarse voice in a child, but tonsillitis on its own does not cause a hoarse voice. Tonsillitis does not directly affect the vocal cord

Answer 172

Acid reflux Children with acid reflux under the age of 12 often have a dry cough, asthma, and trouble swallowing. It is not related to tonsillitis.

Answer 173

Enlarged tonsils and tonsillitis can lead to painful swallowing, which may lead to less frequent swallowing. This can be perceived as hypersalivation; however, there is no actual increase in saliva production due to tonsillitis. Therefore, this is not a direct result of tonsillitis.

Answer 174

The patient recently had a fever, pharyngitis, exudative tonsillitis, and enlarged cervical lymph nodes. This presentation is most consistent with streptococcal pharyngitis (i.e., strep throat), which is an infection caused by the bacteria

Answer 175

Hand-foot-and-mouth disease is usually seen in young children and is caused by the coxsackievirus. A rash is seen on the palms of the hands and soles of the feet, and patients also develop painful oral ulcers. The patient is not a young child and did not have any rash initially when he had a sore throat.

Answer 176

is a disease caused by the Epstein-Barr virus and presents with similar symptoms, such as a fever, sore throat, and swollen lymph nodes and tonsils. However, the symptoms would not have resolved after antibiotic administration, and the disease course would be protracted with extreme fatigue and hepatosplenomegaly.

Answer 177

can cause an infection in adults called shingles, which causes a painful rash along a dermatome that does not cross the midline. VZV does not typically present with painless subcutaneous nodules, and its associated rash would be limited to a dermatomal pattern rather than being widespread

Answer 178

These are classic symptoms of rheumatic fever (RF), a known complication of streptococcal pharyngitis that can develop one to five weeks after infection. Symptoms of RF include the J♡NES (JONES) criteria: Joints - migratory joint pain ♡ (carditis) - heart inflammation Nodules - painless lumps on the skin Erythema marginatum - ring-like rash Sydenham chorea - involuntary movements of face and limbs

Answer 179

An allergy to amoxicillin (Amoxil®) typically presents with a maculopapular rash, raised hives, ocular pruritus, and edema of the lips. More importantly, the symptoms appear soon after taking the medication and not five weeks later.

Answer 180

occurs when bacteria enter the bloodstream and travel to the heart. The bacteria attach to damaged heart valves or tissue and cause life-threatening inflammation. This patient does not have any cardiac conditions and is not at risk for endocarditis.

Answer 181

is a skin condition that often follows infection or drug exposure, characterized by erythematous “targetoid” lesions. This is an unlikely diagnosis because painless nodules are not a clinical feature of EM. Further, the onset of the patient’s symptoms occurred much later after taking amoxicillin, while most lesions in EM appear within 72 hours after the exposure.

Answer 182

E0: No caries or radiolucency E1: Caries in the outer half of enamel E2: Caries in the inner half of the enamel but not into the dentin D1: Caries into the first third of the dentin D2: Caries into the middle third of the dentin D3: Caries into the inner third of the dentin Tooth 4 has a distal interproximal lesion limited to the outer half of the enamel, which is placed into the E1 category.

Answer 183

The muscles of respiration include both primary and accessory muscles. Primary muscles, like the diaphragm and parasternal intercostals, play a central role in ventilation. Accessory muscles, such as the external intercostals, assist in breathing during periods of increased demand or when the primary muscles are compromised.

Answer 184

The diaphragm is a dome-like structure that separates the abdomen from the thorax and is used as the primary muscle of respiration

Answer 185

Contraction of the platysma tenses the skin of the neck, deepens facial folds, and depresses the mandible. This muscle is used to convey emotions such as surprise or disgust.

Answer 186

The rhomboids play a crucial role in stabilizing the shoulder girdle and scapula, contributing to upper limb movement

Answer 187

The patient is experiencing pain in the preauricular area which spreads to adjacent structures, has functional limitations of mandibular opening, and is demonstrating bilateral reciprocal joint clicking. This patient's presentation is suggestive of temporomandibular joint (TMJ) pathology. Innervation to the TMJ is provided auriculotemporal nerve masseteric nerve deep temporal nerve; all three nerves are branches of the third division of the trigeminal nerve. The auriculotemporal nerve provides the majority of sensory innervation to the TMJ and is likely primarily responsible for this patient’s pain

Answer 188

is a branch of the facial nerve. This nerve provides motor innervation to the occipitalis muscle and posterior auricular muscles and provides sensation to the auricle. However, it is not the most likely implicated nerve for the patient's facial pain.

Answer 189

is a small branch of the zygomatic nerve, which originates from the second division of the trigeminal nerve. This nerve provides sensory innervation to the skin overlying the temporal bone. This nerve does not provide sensation to the temporomandibular joint

Answer 190

The posterior superior alveolar nerve is a branch of the second division of the trigeminal nerve. This nerve provides sensory innervation to the second and third maxillary molars and all but the mesiobuccal root of the maxillary first molar. This branch also provides innervation to the overlying gingiva of these teeth as well as adjacent buccal mucosa, but it does not innervate the temporomandibular joint

Answer 191

is a type of non-random sampling that invites participants who are easy to contact. This method is often used for new or pilot studies and includes people who are willing to participate. However, this sampling design may lead to a lack of population representation or bias. In this case, invitations to participate were only sent to dental school faculty, who are easily located and contacted.

Answer 192

Stratified random sampling involves obtaining a random sample from a population and then stratifying it into subgroups with similar characteristics. Then, a sample group is created by selecting a member from each subgroup. In this study, the participants are neither divided into subgroups nor randomly selected.

Answer 193

Cluster sampling is a method of selecting samples that divides a population into mutually exclusive and collectively exhaustive subgroups. This means that these subgroups have no overlap in similarities and include all of the possible options within the population. In cluster sampling, several whole subgroups are selected for inclusion in the study. In this study, the participants are not divided into subgroups.

Answer 194

Systematic sampling is a type of sampling that involves selecting a random individual from a population list and then selecting subsequent participants from that list at random set intervals. This study did not involve a sampling list or interval.

Answer 195

The Centers for Disease Control and Prevention (CDC) recommends that dental unit water used in nonsurgical procedures measure less than or equal to 500 colony-forming units of heterotrophic bacteria per milliliter of water (≤ 500 CFU/mL). This is the standard set for drinking water by the Environmental Protection Agency (EPA).

Answer 196

The normal curve during acid introduction to the oral cavity is shown above, also known as the Stephan curve. At a near-neutral plaque pH, the consumption of acidic foods or foods that are metabolized by oral bacteria and produce acidic byproducts will cause a drop in the pH, often below the critical pH of enamel of 5.5. For this patient, the initial drop to the critical pH occurs in the first 5 minutes and it neutralizes back to a pH of 7 in 40 minutes. It typically requires between 30-60 minutes for the pH to neutralize and return to baseline. Demineralization of hydroxyapatite occurs below the critical pH of enamel. The Stephan curve and plaque pH are affected by a variety of outside factors, including: * Frequency of meals * Time between meals * Type and consistency of food * Amount and quality of saliva * Drinking water after meals The production and quality of saliva can affect the recovery time. Chewing sugar-free gum, such as xylitol gum, stimulates saliva production and decreases the time for the plaque pH to return to baseline. On the other hand, patients with dry mouth or xerostomia may experience a longer recovery time due to reduced bicarbonate buffering in saliva

Answer 197

During cardiopulmonary resuscitation (CPR), the goal is to perform 100-120 chest compressions per minute. Some recommend following the beat of the song Staying Alive by Bee Gees in order to maintain this rhythm. The steps of CPR are as follows: Put the heel of your dominant hand at the center of the person’s chest. Put your other hand over your dominant hand, then interlock your fingers. Start chest compressions, aiming for 100-120 compressions per minute. Once 30 compressions are completed, open the person’s mouth. Add two rescue breaths, watching for chest rise. Continue the 30 compressions, with 2 breaths each cycle until a professional arrives.

Answer 198

Botox injections consist of botulinum toxin, a product of the bacterium Clostridium botulinum that prevents the release of acetylcholine from the axon endings at the neuromuscular junction. When acetylcholine binds to receptors on the cell membrane of the muscle fiber, it causes depolarization and subsequently leads to muscle contraction. Therefore, the inhibition of acetylcholine release results in muscle paralysis, which can last from three to twelve months.

Answer 199

The temporalis is a primary muscle of mastication. Its primary functions are to elevate the mandible, perform lateral excursive movements, and retrude the mandible posteriorly.

Answer 200

The digastric muscle is a suprahyoid muscle that is considered an accessory muscle of mastication. The digastric muscles are partially responsible for depressing the mandible.

Answer 201

The medial and lateral pterygoid muscles are the primary muscles of mastication. The medial pterygoid muscle is responsible for mandibular elevation, protrusion, and contralateral excursion. The lateral pterygoid muscle is responsible for depression, protrusion, and contralateral excursion.

Answer 202

develops from the remnant of the reduced enamel epithelium and most commonly occurs with third molars and maxillary canines. It is exclusively pericoronal, associated with the crown of an unerupted tooth.

Answer 203

is a cyst that typically appears on a radiograph as a corticated, unilocular, or multilocular radiolucency in the posterior mandible. They can be pericoronal, periapical, or in a lateral root position.

Answer 204

is an odontogenic tumor that typically appears on a radiograph as a corticated radiolucency in the posterior mandible. They can be pericoronal, interradicular, or periapical and often cause rapid cortical expansion, tooth displacement, and root resorption.

Answer 205

is a mixed odontogenic tumor that can be either compound or complex. Radiographically, a complex odontoma appears as a conglomerate mass of enamel and dentin that bears no anatomic resemblance to a tooth. A compound odontoma appears as numerous miniature teeth. They are not exclusively pericoronal.

Answer 206

The patient's clinical presentation suggests the presence of acute necrotizing ulcerative gingivitis (ANUG), a rapidly destructive, non-communicable, microbial disease of the gingiva. It usually occurs in the context of an impaired host immune response. This condition is characterized by the sudden onset of inflammation, pain, and "punched-out" crater-like lesions on the gingiva. A biopsy would only present as non-specific inflammation; therefore, it would not help diagnose ANUG. Without a diagnosis, treatment cannot be prescribed.

Answer 207

is a commonly recommended antibiotic for the management of ANUG. It is highly effective against gram-negative bacteria, which are associated with the condition.

Answer 208

Rinses such as chlorhexidine (Paroex®) are often prescribed in conjunction with debridement to manage ANUG.

Answer 209

is used in cases of ANUG. This involves gently removing supragingival plaque and necrotic pseudomembranous tissue with moist gauze, as well as ultrasonic scalers and irrigation to remove supragingival calculus.

Answer 210

Drug-induced immune hemolytic anemia is a rare presentation of anemia and has been found to be associated with penicillins like amoxicillin and cephalosporins. The anemia is caused by the drug triggering the immune system to attack its own red blood cells, which can present with cyanosis, indicated by this patient’s blue tint of her lips. Discontinuing the drug usually resolves the anemia.

Answer 211

is associated with a risk for Clostridium difficile colitis, also known as pseudomembranous colitis. The risk seems to be higher in the elderly, recently hospitalized, and those with weakened immune systems.

Answer 212

is associated with a risk for QT prolongation in patients, which can cause arrhythmias, especially in those on vasoconstrictors. If a patient is allergic to amoxicillin and pre-procedure antibiotics are indicated, azithromycin can be prescribed as an alternative.

Answer 213

is a hormone released by the kidney to stimulate the formation of red blood cells in response to low oxygen levels or hypoxia. It can be elevated in patients with cyanotic heart disease.

Answer 214

is a milk-based, bioactive agent that buffers calcium and phosphate ions. It provides enamel supersaturation to minimize demineralization, promote remineralization, and inhibit cariogenic activity. Additionally, CPP-ACP is beneficial for hypomineralized enamel, mild fluorosis, white spot lesions, erosion, and tooth sensitivity.

Answer 215

The DMF (decayed-missing-filled) index is used to determine caries risk in a patient. For the DMFS index, the total surface count is determined. If 32 teeth are examined, 148 surfaces are included. If third molars are not included, 128 surfaces should be considered.

Answer 216

Posterior crossbites often develop unilaterally with a functional shift of the mandible. Posterior crossbites during primary or mixed dentition are usually due to constriction of the palate, where the posterior teeth are occluding on cusp tips. This forces the mandible to deviate to one side to maintain a cusp-to-fossa relationship.

Answer 217

are not associated with posterior crossbites. Rather, this bite trends towards anterior crossbite due to lack of overjet and is instead associated with the risk of teeth fracturing and sensitivity.

Answer 218

Odontogenic keratocysts (OKCs) are rare, benign, and locally aggressive developmental cysts that most often affect the posterior mandible. OKCs are commonly associated with Gorlin-Goltz syndrome, also known as nevoid basal cell carcinoma syndrome, an inherited condition comprising the principal triad of basal cell carcinomas, multiple jaw keratocysts, and skeletal anomalies. Gorlin-Goltz syndrome and the development of OKCs are associated with defects in a gene that is highly associated with the dysfunction of basal cells, causing tumor growth (e.g., basal cell carcinomas, OKCs).

Answer 219

are antigen-presenting cells of the immune system whose function is to process antigen material and present it on the cell surface to T cells. Dysfunction of dendritic cells may be involved in the development of Langerhans cell histiocytosis.

Answer 220

Fibroblasts are cells that synthesize extracellular matrix and collagen. Dysregulation of these cells is implicated in the disease process of central ossifying fibroma.

Answer 221

Osteoblasts are cells that specialize in producing bone. Dysfunctions of osteoblasts are most heavily implicated in osteoblastomas

Answer 222

The periapical radiograph reveals a radiopacity on the distal of the implant abutment. This indicates excess coronal cement at the restoration site. Cement residue creates an environment that supports bacterial growth and biofilm accumulation. This can cause inflammation (i.e., peri-implant mucositis), which can lead to destruction of hard and soft tissues surrounding the implant (i.e., peri-implantitis).

Answer 223

is the portion of the implant that is placed into the bone. There is no clinical or radiographic evidence of a broken fixture.

Answer 224

Bone quality is assessed during implant planning, and it is classified into four distinct types. As types progress from type 1 to 4, the amount of cortical bone decreases, and the amount of trabecular bone increases. While type 4 is not the ideal bone type for implant placement, it would more likely affect primary and secondary implant stability and would not contribute to bone loss

Answer 225

may contribute significantly to bone loss, as it can affect the crown's emergence profile. A bulbous crown can create a large food trap that may result in gingival inflammation and bone loss over time. The angulation of this implant appears to be within normal limits

Answer 226

The periodontal ligament (PDL) is a connective tissue located between the cementum of the tooth and the alveolar bone. Sharpey’s fibers of the PDL anchor the tooth to the bone. Sharpey’s fibers consist of four main groups that have unique orientations within the PDL: alveolar crest fibers, horizontal fibers, oblique fibers, and apical fibers. In multirooted teeth, interradicular fibers are also present. With excessive forces, Sharpey’s fibers create a space between tooth and bone by increasing in number and diameter, allowing for the accommodation of chewing forces. This is often observed radiographically as a widened PDL space

Answer 227

Heavy occlusal forces cause alveolar bone resorption and reduced bone density. This can result in the mobility of teeth.

Answer 228

aid in the remodeling of the cementum. They are not active during heavy occlusal forces but rather aid in the resorption of cementum that occurs during inflammatory periodontal conditions like periodontitis.

Answer 229

The rests of Malassez are stem cells found in the PDL. They play a role in cementum repair and, when stimulated, are responsible for forming cysts. They are not responsible for accommodating occlusal forces

Answer 230

is a set of physical, developmental, and cognitive abnormalities that occur in a child when the mother consumes alcohol during pregnancy. Alcohol is a teratogen that can impair the normal growth and development of the fetus. Common characteristics of FAS include microcephaly and overall growth deficiency. A. Central nervous system impairment B. Cleft lip D. Midface deficiency Other manifestations of FAS include problems with the central nervous system, midface deficiency, cleft lip or a thin upper lip, short palpebral fissures, and a long philtrum.

Answer 231

The patient presents with extreme pain and a non-restorable tooth 19. The best treatment option to get the patient out of pain is an extraction. The patient’s platelet level is most concerning because a low value puts him at a higher risk of spontaneous bleeding. Normal platelet counts range from 150,000 to 450,000 platelets per microliter of blood. A low platelet count is termed thrombocytopenia. The minimum platelet count at which oral surgery can be done is 50,000/uL, but this patient’s count is 42,000uL. This patient also has a diagnosis of idiopathic thrombocytopenic purpura that is uncontrolled. The patient should see his physician to manage his thrombocytopenia. The patient will likely require some form of perioperative management to prevent bleeding.

Answer 232

Less than 5% of mandibular first premolars have two roots. Mandibular first premolars typically have one root with one canal. The prevalence of mandibular first premolars with two roots is relatively low, and it is considered an uncommon anatomical variation.

Answer 233

Dental water lines should be flushed to prevent stagnant moisture which can be conducive to bacterial proliferation. Bacterial biofilms can form within minutes, so it is important to flush water lines multiple times daily. This is not limited to only surgical procedures, since it is important to have a clean and healthy working environment at all times

Answer 234

Bacterial biofilms form within minutes of water becoming stagnant. Several bacteria secrete extracellular polymeric substances that bind to the sides of the water tubing and allow for bacteria proliferation.

Answer 235

Dental water lines should be flushed at the beginning of the day for at least 2 minutes and for 20 seconds between patients

Answer 236

Bacterial loads in the dental water supply should be less than 500 colony forming units/mL

Answer 237

Calculus is mineralized plaque composed of bacteria. Calculus consists of about 20% organic matrix, which is not mineralized and contains microorganisms. Despite mineralization, viable bacteria are still present in calculus. Mineralization may decrease the viable bacteria; therefore, calculus has less viable bacteria than plaque.

Answer 238

Supragingival calculus is mineralized from the saliva.

Answer 239

Subgingival calculus is mineralized from the gingival crevicular fluid

Answer 240

Calculus is composed of predominantly anaerobic microorganisms, which also play a role in the pathogenesis of periodontal disease. Therefore, plaque and calculus cause the inflammation that leads to periodontitis.

Answer 241

Proximate cause is classified under negligence according to Tort law. Under this principle, it can be argued that a dentist’s negligence was the proximate cause of a plaintiff’s injury. The negligent action was not placing a gauze curtain during extraction which led to the patient aspirating the tooth.

Answer 242

When a cotton plier falls on a patient's chest, it is not an example of negligence, but it should be avoided during a procedure.

Answer 243

A file breaking during a root canal is not considered negligence because it is a potential risk associated with root canal treatment, provided that the dentist operated at the standard of care, obtained appropriate informed consent, and explained the treatment outcome to the patient.

Answer 244

While dental implants are not recommended and have a low rate of success in patients with uncontrolled diabetes, it is not negligence if the dentist provided proper informed consent before the procedure

Answer 245

Vasovagal syncope occurs when a person faints in response to stress and emotional distress such as with the sight of an anesthetic syringe. After confirming that the airway, breathing, and circulation are stable, the use of ammonia salts can be the next line of treatment. Inhaled ammonia salts act by irritating the membranes in the nose, triggering an inhalation reflex and a regain of consciousness.

Answer 246

is given to patients experiencing anaphylaxis or circulatory collapse. Syncope does not fall into either category, so epinephrine is not warranted.

Answer 247

is given to patients experiencing hypoglycemia. The patient does not show any signs of hypoglycemia such as tachycardia, excessive sweating, or irritability

Answer 248

is used in dentistry to reverse the effects of local anesthesia. However, this would only reverse the anesthetic, or "numbness", effect and would not be a remedy for the patient losing consciousness.

Answer 249

Accuracy is the degree to which a measurement represents the true value of an outcome. In other words, it is a measure of how close the final results of an experiment are to the correct or accepted value. In this case, confirming that 80% of the results are correct through histological analysis can be regarded as a demonstration of accuracy.

Answer 250

is a measure of the consistency among a set of results. However, the precision of a dataset does not describe how correct the results are. Precision is a term best used to describe quantitative outcomes. Since this study uses a qualitative dataset, precision may not be the most relevant measure.

Answer 251

is a measure of how likely it is that an experiment will produce the same results when repeated. Reliability can be improved by increasing the sample size. As there is no mention of consistency throughout repeated trials, reliability cannot be confirmed.

Answer 252

is the extent to which the study effectively measures what it is designed to measure, or how well a dataset represents the phenomenon being assessed. Validity can be improved by having more controlled variables, using appropriate methods of measurement, and reducing experimental bias. However, it does not describe the correctness of a study’s results. Since the methods of data collection and analysis were not fully described, validity cannot be confirmed

Answer 253

Restorability depends on several factors, such as: Structural integrity Periodontal involvement Endodontic involvement Relation to the overall oral environment Patient’s ability to maintain dentition Parafunctional habits Finances Restorability is an important first step because it determines the subsequent diagnostic aids and treatment plans to restore or replace the tooth.

Answer 254

testing is important to determine if the tooth needs pulp therapy. However, assessing restorability is a more crucial first step; if the broken tooth is non-restorable, the dentist would not need to perform endodontic treatment

Answer 255

Crown preparation is important if it is determined that a crown can restore the tooth. However, the dentist first needs to determine if the tooth is restorable.

Answer 256

Temporization is an important step to protect the tooth from further damage and to provide some relief to the patient. However, determining restorability is the priority; if the broken tooth is non-restorable, the dentist may not need to temporize the tooth and may extract it instead. This could save both time and cost for the patient

Answer 257

Consecutive sampling involves selecting all subjects who meet the study criteria until an adequate sample size is obtained. It is a type of non-probability sampling or non-random sampling, which means that sampling errors and bias may be present. For early studies, however, this is a good sampling technique because it is efficient and relatively inexpensive. In this case, consecutive patients (all who are eligible to obtain and read the leaflet) were sampled on a Monday morning with no randomization.

Answer 258

sampling includes volunteers who agree to participate in the study. This type of sampling requires less work on the part of the researcher because they do not have to come up with a sample. However, it can lead to biased results and the researcher has little control over who is included in the sample. In this case, the patients are not volunteering to be a part of the sample but were chosen

Answer 259

The clinical photos depict classic signs of an --> autoimmune blistering disease (AIBD). These lesions may be identified desquamative erythematous gingiva erosions ulcerations of the mucosa sloughing of tissue and atrophy. Mucous membrane pemphigoid (MMP) is an example of an AIBD caused by an autoantibody-mediated attack on hemidesmosomes. Common symptoms widespread blisters ulcerations in mucocutaneous areas such as the oral cavity. The ocular involvement is another finding specific to MMP. INBDE Pro-Tip: A positive Nikolsky sign is highly specific for pemphigus vulgaris (PV) but can also occur in MMP. MMP and PV should be differentiated by the other clinical or histological features presented in the question stem, as the oral lesions may be clinically indistinguishable:

Answer 260

: Manifests in the mouth as bleeding gingiva, erosions, ulcerations, and sloughing tissue. Extraoral involvement often occurs at the mucosa of the eyes and anogenital region. Involvement of the skin tends to be mild and less painful. Additionally, permanent progressive scarring is a feature of MMP, which accounts for the high risk of blindness in these patients

Answer 261

: Manifests in the mouth as widespread, shallow, painful, ragged ulcerations. Extraoral manifestations often involve the skin and can be severe and painful

Answer 262

Erysipelas Erysipelas is a group A streptococcal infection of the dermis characterized by a raised, well-demarcated, red rash on the face. It can also affect the extremities or trunk.

Answer 263

Erythema multiforme is an acute, immune-mediated condition characterized by target-like lesions, erosions, and bullae on the skin. This condition is caused by viral infections as well as certain medications and drugs.

Answer 264

Pemphigus vulgaris is an AIBD caused by an autoantibody attack on desmosomes. Pemphigus manifests in the mouth as widespread ragged ulcerations, painful blisters, and ulcers on the skin. This patient's ocular mucosal involvement and lack of cutaneous involvement make diagnosing pemphigus vulgaris less likely.

Answer 265

The intrinsic temporomandibular (TMJ) ligaments do not prevent muscle fatigue and they do not help in easing tension from the surrounding muscles of mastication. They mainly function to stabilize the joint and prevent extreme movement.

Answer 266

By limiting movement and keeping the condyle in place, the temporomandibular ligaments passively guide the condyles

Answer 267

The ligaments provide stability to the condyle during movemen

Answer 268

Glucocorticoids help prevent intravascular contents from leaking into inflamed tissues through several mechanisms. Primarily, they work by tightening endothelial cell-cell junctions and reducing prostaglandin synthesis.

Answer 269

Glucocorticoids decrease the expression of adhesion proteins on endothelial cells of blood vessels, which enables white blood cells (WBCs) to exit vessels and enter tissues. Decreasing these proteins prevents the slow-rolling and exiting process of these WBCs, preventing them from entering the inflamed tissues.

Answer 270

Glucocorticoids suppress vasodilation through several mechanisms, such as decreased prostaglandin synthesis. This reduction of blood flow is an important anti-inflammatory mechanism, as it limits the ability of white blood cells to reach the area of inflammation.

Answer 271

exert anti-inflammatory effects by decreasing white blood cell extravasation, inhibiting vasodilation, decreasing capillary permeability, and suppressing inflammatory cytokine production.

Answer 272

Creatine phosphokinase-MB (CPK-MB) is a cardiac marker used to assist diagnoses of an acute myocardial infarction. It has relative specificity for cardiac tissue, but can still become elevated in non-cardiac conditions, such as skeletal muscle injury. Since CPK-MB normalizes 48-72 hours after myocardial ischemia, it is useful in determining re-infarction if levels rise again after declining

Answer 273

Cardiac troponins (e.g. troponin I and troponin C) are --> sensitive and specific markers of myocardial damage, assist diagnoses of acute myocardial infarction. first-line test for evaluating patients with suspected acute myocardial infarction. Time --> two weeks to normalize, they are not suitable for reassessing re-infarctions that occur during that window

Answer 274

D-dimers are a fibrin degradation product present in the blood after a blood clot is degraded by fibrinolysis. It is commonly used to diagnose thromboses and thrombotic disorders. It is not a preferred test to diagnose myocardial infarctions.

Answer 275

are proteins found in heart muscle cells that are released into the bloodstream when the heart is injured or damaged, such as during a heart attack. Measuring these proteins in the blood helps doctors detect and assess the extent of heart damage

Answer 276

Precontemplation Contemplation Preparation Action Maintenance A readiness to change and a determination to take action have been expressed. This is consistent with preparation. A key step in preparation to quit smoking is choosing a quit date. This provides time to prepare and solidifies the commitment.

Answer 277

The patient’s lesion is in a high-risk area for malignancy and has features consistent with --> squamous cell carcinoma (SCC), the most common oral malignancy. appear as red white mixed lesions thick or nodular persistent ulceration or erosion. It most commonly occurs posterior lateral tongue floor of the mouth. Smoking is a known risk factor in the development of oral squamous cell carcinoma. Tobacco --> can cause an epigenetic alteration of oral epithelial cells, inhibit host immune functions, cause --> oxidative stress on tissues, all contributing to the development of oral SCC.

Answer 278

Median rhomboid glossitis Median rhomboid glossitis is a red, diamond-shaped lesion caused by atrophy of the filiform papillae of the tongue. This is caused by the fungus Candida albicans and can result in an unpleasant burning sensation.

Answer 279

Epstein-Barr virus (EBV) can cause oral hairy leukoplakia, which can appear as white, non-wipeable patches on the tongue. EBV is an opportunistic infection due to a weakened immune system, often associated with human immunodeficiency virus. Leukoplakic lesions caused by EBV are unlikely to be ulcerated and indurated

Answer 280

The patient's lesion is consistent with a diagnosis of oral squamous cell carcinoma. Squamous cells are found in the epidermis, which consists of the following five layers from top to bottom: Stratum corneum Stratum lucidum Stratum granulosum Stratum spinosum Stratum basale Oral squamous cell carcinoma originates in the stratum spinosum. This is the layer in which --> squamous cells are developed from --> keratinocytes. These squamous cells become dysplastic to form a squamous cell carcinoma. As the cancer progresses, it can infiltrate deeper layers of tissues and spread to adjacent structures.

Answer 281

Squamous cell carcinoma is a cancer of the squamous cells in the epithelium. It is the most common malignancy in the oral cavity and, like most cancers, can metastasize and spread to other areas of the body. The most common site for oral squamous cell carcinoma (OSCC) to metastasize is the lungs bone the liver.

Answer 282

is the second most common site of metastasis for OSCC. Bone is the most common site of metastasis for breast cancer.

Answer 283

is the third most common site of metastasis for OSCC. The liver is also a site for distant metastasis for cancers such as melanoma or lung cancer.

Answer 284

to amoxicillin is a maculopapular rash. This is a red lesion with raised and flat sections on the skin, --> resulting from histamine release Other symptoms * raised hives * ocular pruritus, * edema of the lips, tongue, and face.

Answer 285

To ensure proper functioning, sterilization equipment such as autoclaves is tested with a spore test. These tests are biological indicator tests that assess whether or not the autoclave can kill highly resistant bacteria. According to the Centers for Disease Control and Prevention (CDC), they should be used on each autoclave and sanitized at least weekly

Answer 286

is a highly addictive sympathomimetic stimulant that can cause a multitude of issues, including cardiac, musculoskeletal, and neurological problems. Methamphetamines also significantly affect the oral cavity by decreasing salivation and causing severe xerostomia, which can lead to gingivitis, candidiasis, and glossitis. When combined with poor oral hygiene, methamphetamines can cause severe tooth decay. Severe caries associated with methamphetamine use is commonly termed “meth mouth.” Considering the patient's dental background and use of illegal substances, it’s recommended to perform a comprehensive examination of all the teeth using a full mouth series. This will allow for a thorough evaluation of the condition of each tooth in terms of cavities and periodontal health.

Answer 287

Denture adhesives are pastes, powders, or adhesive pads placed in a removable dental prosthesis to enhance retention. Many adhesives contain zinc, which can cause neuropathy if used excessively. Many cases of zinc overdose from chronic adhesive overuse have been linked to nerve damage, numbness, and tingling sensations.

Answer 288

This patient likely has von Willebrand disease (vWD) given the familial history of the disease and the autosomal dominant inheritance of the disorder. In vWD, there can be defective or decreased levels of von Willebrand factor. Von Willebrand factor normally helps platelets stick to damaged endothelium; it also binds to factor VIII to protect it from being cleared from circulation. Consequently, patients with vWD will sometimes present with an increased partial thromboplastin time (PTT), due to the increased clearance of factor VIII, and increased bleeding time, due to the reduced platelet-endothelial binding.

Answer 289

measures the quantity of platelets in the blood. Though vWD affects platelet function (as measured by bleeding time), there is little impact on platelet count outside the setting of severe disease or after major adverse bleeding events.

Answer 290

assay assesses the function of proteins in the extrinsic pathway. This test is commonly used in a calculation called the international normalized ratio (INR) to detect the therapeutic level of warfarin or the presence of liver disease. There is no effect on factor VII in vWD; therefore, PT is not abnormal in this condition.

Answer 291

results from an autoimmune attack on myelin and myelin-producing cells in the central nervous system. This is a T-cell mediated, type IV hypersensitivity reaction. Multiple sclerosis often causes with fatigue, muscle spasms, and vision problems.

Answer 292

A distal shoe is a unilateral space maintainer used when there is early loss of the primary second molar, and the first permanent molar has not erupted yet. A distal shoe consists of a unit attached to the primary first molar and a distal segment that extends into the soft tissue against the unerupted permanent first molar. At age 4, the permanent first molar is unlikely to be fully erupted, making a distal shoe the most viable treatment option.

Answer 293

A bluegrass appliance is a habit-reversal or habit-breaking appliance used for persistent tongue-thrusting or thumb-sucking habits in childhood or adolescence. It is not used for space maintenance.

Answer 294

is used to preserve the mandibular primary molar and canine space. It consists of steel bands on the permanent first molars and a steel wire that engages the lingual of the incisors to prevent mesial drift of the permanent first molars. The permanent first molars must be fully erupted before a LLHA can be placed.

Answer 295

is a bilateral space maintainer that consists of bands around the permanent maxillary first molars and a stainless steel loop with an acrylic button that engages the anterior portion of the palate.

Answer 296

In this scenario, the mandibular movement is representing a working movement toward the right. Movements on the left side of the arch are therefore nonworking. At resting occlusion, the buccal cusp of the left mandibular second premolar will be occluding with the mesial marginal ridge of the maxillary second premolar. When moving to the right, the left mandibular second premolar will move in an oblique (medial and anterior) direction and will contact the lingual cusp of the left maxillary first premolar.

Answer 297

The half-life of a drug is the time it takes for the body to clear half of the drug’s active substance. In the case of this drug, its half-life is 4 hours. In order to estimate how much drug will be eliminated in a certain time, we rely on the half-life. We know that the drug will eliminate half of its active substance every 4 hours, demonstrating first-order kinetics in which a constant fraction of the drug is eliminated per time. In order to estimate how much drug is eliminated at a certain time, we will divide the remaining amount of drug by two at every half-life (4 hours). We will then add that amount to the total drug already eliminated.

Answer 298

At 0 hours, all of the drug is available so 100% is still remaining and 0% is eliminated. At 4 hours, we are at the first half-life so you divide 100% by two and get 50%. That means we have 50% eliminated and 50% remaining. At 8 hours, we are at the second half-life so you divide the remaining 50% by two and get 25%. That 25% is added to the already eliminated 50%. Therefore, we have 75% eliminated and 25% remaining. At 12 hours, we are at the third half-life so you divide the remaining 25% by two and get 12.5%. This is added to the already eliminated 75%. This leaves 87.5% eliminated and 12.5% remaining. This trend continues with 93.75% or approximately 94% after 16 hours

Answer 299

Prednisone is a corticosteroid medication used to treat immune system disorders, blood disorders allergies. Its primary mechanism of action --> involves immunosuppression to decrease inflammation in conditions such as lupus. Prednisone behaves similarly to --> endogenous cortisol, resulting in the same adverse effects such as --> poor glycemic control. Therefore, a side effect of this medication would not be hypoglycemia, rather, hyperglycemia may be present. Patients who take prednisone can expect weight gain hypertension hyperglycemia altered mood.

Answer 300

Serotonin syndrome is a drug reaction caused by --> the combination or increased dosage of medications that increase serotonin availability. Signs and symptoms of serotonin syndrome include nausea tachycardia hypertension, potentially fever and seizures. St. John’s wort is prescribed for depression. Similar to other antidepressants, St. John’s wort increases the availability of serotonin by decreasing serotonin reuptake into nerve terminals. Tramadol (Ultram®) is an opioid that functions as a serotonin and norepinephrine reuptake inhibitor. In combination, St. John’s wort and tramadol (Ultram®) may result in serotonin syndrome. Other drugs that increase the levels of serotonin are also contraindicated with the use of St. John’s wort. Examples include serotonin reuptake inhibitor antidepressants (i.e. fluoxetine), irreversible monoamine oxidase inhibitor antidepressants (i.e. isocarboxazid), and opioids that affect serotonin levels (i.e. methadone, pethidine).

Answer 301

is a complication of aspirin when used in a child currently with or recovering from a viral illness. Reye’s syndrome does not result from the combination of St. John’s wort and tramadol (Ultram®)

Answer 302

The patient is taking adalimumab for her rheumatoid arthritis, which is a tumor necrosis factor (TNF) inhibitor. Adalimumab is a monoclonal antibody that binds to TNF-alpha, which is an inflammatory cytokine that contributes to joint inflammation and pain. Therefore, by targeting TNF-alpha, the medication inhibits the inflammatory cytokine and reduces inflammation, pain, and damage to the joints.

Answer 303

is a beta-2 agonist that acts on the smooth muscle of bronchioles and is used to help alleviate bronchoconstriction. It is used during acute episodes to induce smooth muscle relaxation and bronchodilation, thereby reducing airway obstruction.

Answer 304

is an oral anticoagulant that inhibits vitamin K. This results in decreased effectiveness of vitamin K-dependent factors II, VII, IX, and X. Since factor V is not dependent on the action of vitamin K, infusion of factor V will not reverse the action of warfarin, so this is the exception.

Answer 305

requires special treatment considerations, as these patients are prone to prolonged bleeding even after minor dental procedures. The international normalized ratio (INR) is the ratio of the patient’s prothrombin time compared to the normal prothrombin time of a healthy person. Prothrombin time is a blood test that measures how long the blood takes to clot, evaluating the efficacy of factors I, II, V, VII, and X. Those with a factor VIII deficiency will have a normal INR value, so this is not a useful tool pre-operatively.

Answer 306

Patients with hemophilia A are advised to avoid non-steroidal anti-inflammatory drugs (NSAIDs) after dental treatment, as these can further increase their risk of bleeding. NSAIDs block cyclooxygenase, leading to the inhibition of platelet aggregation and prolonged bleeding time

Answer 307

Angiotensin-converting enzyme inhibitors (ACE inhibitors) such as lisinopril increase bradykinin concentrations in the body, leading to the classic presentation of dry cough and/or bradykinin-mediated angioedema. ACE inhibitors are used to treat hypertension by blocking the conversion of angiotensin I to angiotensin II, preventing the hypertensive response prompted by the renin-angiotensin-aldosterone (RAAS) system.

Answer 308

n this scenario, the mandibular movement is representing a working movement toward the right. Movements on the left side of the arch are therefore nonworking. At resting occlusion, the buccal cusp of the left mandibular second premolar will be occluding with the mesial marginal ridge of the maxillary second premolar. When moving to the right, the left mandibular second premolar will move in an oblique (medial and anterior) direction and will contact the lingual cusp of the left maxillary first premolar.

Answer 309

This patient's presentation is consistent with herpangina caused by an infection with coxsackievirus A. Patients often present with a sore throat, trouble swallowing, and occasionally a fever. Small red macules that progress to ulcers are commonly present on the soft palate and tonsillar pillars. The virus is transmitted via the fecal-oral route or by respiratory droplets.

Answer 310

Recall bias occurs when there is a systematic change in study participants' ability to recall and report information. Case-control studies are retrospective. After participants are identified as having an outcome of interest, researchers acquire information by asking them to recall past information such as events, exposures, or medical records. Since participants may have difficulty remembering this information, case-control studies are most likely to be impacted by recall bias.

Answer 311

, participants with known exposure are tracked over time. It comprises a group of case reports of patients who have been given a similar treatment or exposure. This study type includes detailed reports of diagnosis, treatment, and follow-up. Since case series studies are prospective, they have a low risk of recall bias.

Answer 312

is a longitudinal, observational study that is designed in a manner opposite of a case-control study. In a cohort study, the researcher starts with a participant's exposure status and tracks them to see if they develop the disease of interest. Typically, this study type definitively establishes whether or not the patient received an exposure, which determines whether a participant enters the case or control arm of the study. Consequently, a cohort study design reduces the effects of recall bias

Answer 313

involves the introduction of an intervention, the effects of which are tracked to identify study outcomes. Because it is not a retrospective study, an experimental study is unlikely to be impacted by recall bias.

Answer 314

The sublingual artery runs through the floor of the mouth and could be damaged during interforaminal (i.e., anterior) mandibular implant placement. Damage to this artery may cause a sublingual hematoma, which can be life-threatening. These hematomas may resolve naturally, but they can also cause rapid hemorrhage, tongue enlargement, obstruction of the upper airway, or spread to the mediastinum. These advancements quickly lead to airway obstruction, hindering the patient’s ability to breathe. When these hematomas progress, they require immediate drainage in the operating room by an oral surgeon.

Answer 315

is found in the neck, arising from the brachiocephalic artery (i.e., right common carotid) and aortic arch (i.e., left common carotid). Due to its location, it is improbable that this artery would be damaged during implant placement.

Answer 316

could each be damaged during implant placement if the implant is too long or placed too close to the mandibular canal or mental foramen, respectively. Damage to either of these nerves would cause paresthesia or pain in the areas this nerve supplies. This damage is not considered life-threatening

Answer 317

not a risk during the extraction of mandibular teeth and, therefore, does not need to be included in an informed consent discussion. A tuberosity fracture is a risk for maxillary extractions only, primarily the most distal molars. The informed consent discussion of any extraction should include dental problems observed, proposed treatment, benefits and risks of that treatment, alternative treatments, and benefits and risks of alternative treatment, including not treating the condition.

Answer 318

The patient is most likely experiencing orthostatic hypotension, which is low blood pressure and dizziness caused by fast changes in position. The patient is taking lisinopril, a medication associated with an increased risk of orthostatic hypotension. Slow changes in chair position can help prevent episodes of orthostatic hypotension. If orthostatic hypotension does occur, the best treatment is to lean the dental chair back to place the patient in a supine position. This will increase blood flow back to the heart and brain and aid in increasing blood pressure.

Answer 319

. Sublingual nitroglycerin should be administered during an acute angina attack, in which there is partial blockage of the coronary arteries. Nitroglycerin releases nitric oxide, which dilates blood vessels, reduces the workload on the heart, and improves blood flow.

Answer 320

95%, [s,n][1.0,500]:[1.4-1.6] 95% - represents the level of confidence. Confidence intervals are commonly created with 90%, 95%, and 99% confidence. [s,n] - represents the standard deviation (s) and the sample size (n) [1.0, 500] - corresponds with the s and n values of the study In this case, the standard deviation (s) = 1.0 and the sample size (n) = 500 [1.4-1.6] - represents the confidence interval of the data. By definition, a 95% confidence interval represents the range of values for which we are 95% confident contains the true average. The true average in this case represents the average number of caries we would find if we sampled a random population of pediatric patients who had early fluoride application, which likely be between 1.4 and 1.6.

Answer 321

start with enamel loss, which can then lead to dentin exposure. Exposed dentinal tubules allow the pulp to be stimulated with a change in temperature or touch, which is perceived as sensitivity. The solution often involves sealing the tubules with desensitizers, such as GLUMA®, or placing a restoration over the exposed dentin.

Answer 322

A desensitizer does not act as a topical sedative. Desensitizers work by physically occluding dentinal tubules, not by anesthetizing the pulp.

Answer 323

A desensitizer does not stimulate reparative dentin formation. This describes the action of calcium-based liners, such as calcium hydroxide.

Answer 324

A longitudinal study follows the same sample or group of people over a period of time. The primary objective of this type of study is to investigate the potential association between a specific exposure or risk factor and the development of a particular outcome. Often, exposed and non-exposed subjects are followed prospectively to monitor the incidence of morbidity or mortality. Therefore, the relative risk of the exposure can be measured.

Answer 325

are observational studies where two groups with different outcomes are compared to investigate previous exposure to risks. This study is different from a longitudinal study since it involves two groups and is retrospective.

Answer 326

analyze data from a population at a single point in time. This study differs from a longitudinal study, which involves observation of a group over a period of time.

Answer 327

observing or analyzing subjects without manipulating variables. An observational study can collect data from the same subjects over time, but it can also be retrospective or cross-sectional. In other words, longitudinal studies may be observational, but not all observational studies are longitudinal

Answer 328

A previous history of trauma can lead to discoloration of affected teeth. Typically, teeth with a history of trauma will manifest with a gray hue due to the obliteration of the pulp and the breakdown of red blood cells within the pulp space.

Answer 329

Coffee consumption Long-term coffee consumption can cause teeth discoloration that is dark brown or black and would be present on all teeth.

Answer 330

Smoking history Smoking can lead to tooth discoloration, but it is generally more widespread and not localized to anterior teeth.

Answer 331

Sertraline is an antidepressant of the selective serotonin reuptake inhibitor class (SSRI). This drug selectively inhibits the reuptake of serotonin (5-HT) at the presynaptic neuronal membrane, leading to an increased synaptic concentration of serotonin in the central nervous system.

Answer 332

Although digestion, lubrication, and providing a buffer are all functions of saliva, they are not specifically functions of the immunoglobulin-A (IgA) in saliva. Salivary IgA is instead the predominant protein in the mucosal humoral response as it plays a key role in neutralizing pathogenic microorganisms such as bacteria and viruses. Therefore, salivary IgA functions more as an antiviral and antibacterial.

Answer 333

contains special enzymes that help to digest starches in food consumed. Specifically, saliva contains amylase, which breaks down starches or carbohydrates into sugars.

Answer 334

Tightness of the airway and difficulty breathing indicate a medical emergency. Emergent needs should be addressed before continuing with the dental procedure.

Answer 335

Administer epinephrine Management of acute episodes of congestive heart failure includes oxygen supplementation, chronotropes, and patient positioning. Epinephrine is a bronchodilator that can help relieve tightness in the airways and increase heart function.

Answer 336

The patient presents with erythematous ulcerations on the gingiva and buccal mucosa, which have been sensitive to spicy foods. She also reports additional skin lesions, and her symptoms have improved with corticosteroid treatment. Chronic candidiasis is a persistent or recurring infection with Candida. It should not be included in the differential, as it manifests with wipeable white plaques, does not cause intraoral ulcerations, and is not treated with corticosteroids. The use of corticosteroids can weaken the immune system and worsen the body’s ability to fight off candidiasis. The treatment for candidiasis is an antifungal.

Answer 337

Mucous membrane pemphigoid (MMP) and pemphigus vulgaris (PV) are autoimmune blistering conditions characterized by a type 2 hypersensitivity reaction, leading to symptomatic oral ulceration. MMP affects mucous membranes of the oral cavity, eyes, genitals, and respiratory tract. PV affects mucous membranes and skin. Corticosteroids are an effective treatment for MMP and PV. Both MMP and PV are Nikolsky-positive conditions that should be differentiated by other presenting clinical or histological features.

Answer 338

The patient is likely experiencing an autoimmune vesiculobullous condition, such as mucous membrane pemphigoid (MMP) or pemphigus vulgaris (PV). Diagnosis of both include biopsy and direct immunofluorescence. In MMP, immunofluorescence detects autoantibodies attacking the anchoring proteins of the mucous membrane (i.e., hemidesmosomes). In PV, immunofluorescence detects autoantibodies that target specific proteins involved in cell adhesion (i.e., desmosomes).

Answer 339

Exfoliative cytology Exfoliative cytology examines cells that are "shed" by the body naturally or by manually scraping them from the surface of the tissue. Although this is a non-invasive process, it is not diagnostic, and a traditional biopsy is required to form a diagnosis for this lesion.

Answer 340

An excisional biopsy is indicated in cases where the lesion is expected to be benign, and the diameter is approximately 1 cm or less. With an excisional biopsy, the entire lesion and surrounding area are removed. The patient does not present with malignant lesions but has widespread oral involvement, making excisional biopsy infeasible.

Answer 341

is used in research to separate and identify proteins, often those found in blood samples. Western blot is typically used to diagnose human immunodeficiency disorder (HIV) or Lyme disease, neither of which aligns with the patient's symptoms or presentation

Answer 342

The patient has a profoundly dry oral mucosa and major salivary glands that fail to produce saliva. This is referred to as xerostomia or dry mouth, which can increase the risk for caries, oral trauma, and opportunistic infections. One common opportunistic infection is candidiasis, which is caused by the fungi Candida. Because this opportunistic infection is caused by a fungus, only an antifungal medication such as clotrimazole (Mycelex®) would be effective. This medication is an azole antifungal medication that eliminates fungi by damaging the permeability barrier in the fungal cytoplasmic membrane.

Answer 343

Carbamazepine (Tegretol®) is an anticonvulsant medication used to prevent and control seizures. It would not be effective in dealing with fungal infections.

Answer 344

Cephalexin (Keflex®) is a cephalosporin antibiotic that eliminates bacteria. Because the most common opportunistic infection is from a fungus, this medication would not be effective.

Answer 345

Clonazepam (Klonopin®) is a benzodiazepine that is used to control seizures, epilepsy, and anxiety. It would not be effective in dealing with fungal infections.

Answer 346

Primary closure involves the reapproximation of all layers of a wound at the end of the surgery. While primary closure can be beneficial in reducing debris collection in the extraction socket, applying excessive tension to the mucosa can damage small blood vessels in the area. This would increase the risk of poor wound healing and should only be attempted when tension-free closure can be easily achieved. Patients undergoing radiation treatment should avoid surgery outside of emergencies because wound closure can lead to tissue dehiscence, infection, and osteoradionecrosis due to impaired wound healing. Ideally, extractions should be performed three to six weeks before radiation treatment.

Answer 347

Alveoloplasty will eliminate any sharp edges of bone, which decreases irritation and surface area of exposed bone and increases the chances of healing after extraction

Answer 348

It is important to wait for complete healing before initiating radiation treatment. Two to three weeks is a reasonable amount of time to allow for healing. However, this decision should be made alongside the patient’s primary care physician and oncologist.

Answer 349

located in the heart when activated exert effects on the sinoatrial (SA), atrioventricular (AV) nodes, and ventricular muscle to increase contractility and heart rate. A. Alpha-1 receptors Alpha-1 receptors located on smooth muscle cause vasoconstriction, urinary retention, and pupil dilation. B. Alpha-2 receptors Alpha-2 receptors on smooth muscle also cause vasoconstriction. D. Beta-2 receptors Beta-2 receptors on smooth muscle cause bronchodilation, vasodilation, and stop peristalsis.

Answer 350

Albuterol is a beta-2 adrenergic receptor agonist that causes bronchodilation and is used as an emergency inhaler to prevent and treat asthma.

Answer 351

Buspirone is a nonbenzodiazepine anxiolytic primarily used to treat anxiety disorders. Methadone is a long-acting opioid agonist commonly used to treat opioid drug dependence by preventing withdrawal symptoms. Both anxiolytics and opioids are central nervous system (CNS) depressants. These drugs reduce stimulation in certain regions of the brain, making them effective for treating conditions such as anxiety or pain. Palpitations are a more likely side effect of a CNS stimulant medication and are unlikely to be seen in this case.

Answer 352

Warfarin (Coumadin®) is a vitamin K antagonist that functions as an anticoagulant to decrease hepatic synthesis of clotting factors. Acetaminophen (Tylenol®) is an analgesic, but not a non-steroidal anti-inflammatory drug (NSAID). There is an important drug-drug interaction between warfarin (Coumadin®) and acetaminophen (Tylenol®) that will impact the pharmacodynamics of warfarin. The combination may result in a significant elevation of INR, termed supratherapeutic INR, and put patients at an increased risk of bleeding. If patients taking warfarin (Coumadin®) must take acetaminophen (Tylenol®), they should take a lower dose to minimize the risk of this drug-drug interaction.

Answer 353

Gout is a common inflammatory disorder characterized by sudden attacks of severe pain, swelling, redness, and tenderness in one or more joints. Gout most often affects the joints in the toes. It is caused by a build-up of uric acid crystals within joint spaces which precipitates the inflammatory reaction. Allopurinol is often used to treat gout and acts by inhibiting xanthine oxidase, an important enzyme in the production of uric acid.

Answer 354

is used to treat high cholesterol by inhibiting cholesterol absorption.

Answer 355

is an antimetabolite used as a chemotherapy drug and as an immunosuppressant. Common indications for methotrexate include cancer, rheumatoid arthritis, and psoriasis

Answer 356

Lupus is an autoimmune disease that can cause inflammation, swelling, pain, and damage to various body systems. Antibiotics are not part of the pharmaceutical drug therapies used by patients with lupus since it is not caused by bacteria. Although patients with lupus are immunocompromised and antibiotics may be needed to treat opportunistic infections, antibiotics are not used to treat lupus itself.

Answer 357

* This patient is presenting with a complaint of enlarging gums, which are firm to palpation on examination. These findings, coupled with the image of diffusely enlarged gingiva, are suggestive of gingival enlargement, a well-known complication of calcium channel blockers, including verapamil. **** Out of the presented options, the patient is most likely taking verapamil due to his history of hypertension. The treatment of this condition involves changing medications if possible and resectioning of the enlarged tissue. Medications that are likely to cause gingival enlargement include: Anticonvulsants: Phenytoin Ethosuximide Sodium valproate Calcium channel blockers: Nifedipine Verapamil Amlodipine Diltiazem Immunosuppressants: Cyclosporine The most common medications known to cause gingival enlargement are: **C**alcium channel blockers (i.e., verapamil, amlodipine, nifedipine)- anti-hypertension **D**ilantin® (phenytoin)- anticonvulsant **C**yclosporine- immunosuppressan

Answer 358

Omeprazole (Prilosec®) is a proton pump inhibitor used to treat peptic ulcer disease or gastroesophageal reflux disease (GERD). After prolonged use of proton pump inhibitors, discontinuation of the medication can cause a rebound of acid hypersecretion. This increased acid secretion leads to lower pH environments in the gastrointestinal tract and can lead to esophageal ulcers.

Answer 359

Of the following medications listed above, only ibuprofen is contraindicated during the third trimester of pregnancy. It is a nonsteroidal anti-inflammatory drug (NSAID) that acts to reduce pain and inflammation by inhibiting the enzyme cyclooxygenase (COX). These medications may cause serious adverse effects such as the premature closure of the fetal ductus arteriosus, especially if used after 20 weeks gestation (second to third trimester). This categorizes ibuprofen as category D during the third trimester.

Answer 360

The main concern in this patient’s medical history is significant for acute intermittent porphyria (AIP). AIP is a rare metabolic condition involving a deficiency in the hydroxymethylbilane synthase enzyme. This enzyme plays a role in the pathway converting toxic porphyrin precursors into the iron-containing porphyrin known as heme, which is the red pigment of human blood. Barbiturates are contraindicated in patients with acute intermittent porphyria because they enhance porphyrin synthesis, which will exacerbate the disease by increasing the accumulation of toxins.

Answer 361

In the event of a flood warning, the first thing that should be done is to turn off the central power unit and close the main gas valve to the facility. After this is done, if there is sufficient time, patient records, computers, and anything easily moved should be relocated to either a higher floor or away from the expected flooding area. In an emergency flooding situation, the building/facility should be evacuated if necessary and everyone present should relocate to higher ground.

Answer 362

The increased radiopacity at the root of tooth 21 is due to a bifurcated root. The X-ray beam must pass through two roots, resulting in increased radiopacity. This is an extremely rare finding in mandibular first premolars.

Answer 363

which two teeth appear to have split from one. There is one main crown with a cleft in the incisal third of the crown, causing one tooth to appear as two teeth. The number of teeth in the arch will be normal.

Answer 364

is the asymptomatic excess deposition of non-neoplastic cementum, most commonly found on the roots of vital posterior mandibular teeth. This thicker layer of cementum will give the teeth an enlarged, bulbous appearance on radiographic examination, which is not seen in this case

Answer 365

is the asymptomatic excess deposition of non-neoplastic cementum, most commonly found on the roots of vital posterior mandibular teeth. This thicker layer of cementum will give the teeth an enlarged, bulbous appearance on radiographic examination, which is not seen in this case

Answer 366

is a bony proliferation that occurs in response to inflammation and usually appears apical to non-vital teeth. It will appear as an area of irregular sclerosis adjacent to the apex of a root and its associated periapical radiolucency. Since the patient has no offending inflammatory source, condensing osteitis is unlikely.

Answer 367

Anesthetic cartridges in dentistry are color-coded based on their contents. According to the American Dental Association (ADA) standards, prilocaine 4% without epinephrine is in a cartridge labeled with a black stripe. Importantly, color coding can vary slightly by manufacturer, and practitioners should verify labels. The ADA guidelines are a standard reference but are not legally binding, and exceptions exist in packaging. Blue Bupivacaine 0.5% with 1:200,000 epinephrine (Marcaine®) is in a cartridge with a blue stripe. Gold Articaine 4% with 1:100,000 epinephrine (Septocaine®) is packaged in a cartridge with a gold stripe. This should not be confused with mepivacaine, which is packaged in a tan or brown-striped cartridge. Red Lidocaine 2% with 1:100,000 epinephrine is packed in a red-striped cartridge.

Answer 368

Maxillary second premolars most commonly have one root and two pulp horns. These horns are located in the buccal and lingual positions.

Answer 369

Edge-to-edge occlusion leads to --> increased occlusal forces on the facial surfaces of the teeth, which can lead to veneer delamination. Heavy occlusion on the anterior teeth, especially in excursive movements, is the most likely reason for failing veneers. Teeth 6, 23, and 24 were likely the anterior teeth bearing the most occlusal load, causing them to fail first.

Answer 370

Porcelain veneers do not have weak enamel bonding. They have a stronger bond to enamel than dentin. This makes it preferable to bond porcelain to enamel.

Answer 371

Over-tapered preparation Over-tapering the preparation can result in less retention form for the veneer preparation. If it were the main cause of failure for the veneers, the patient would likely see generalized veneer failure. Additionally, the preparations are described as adequate

Answer 372

Severe crowding of teeth describes when the edges of teeth overlap, usually when there is not enough arch space for them. This information is not given and would not cause the observed veneer failure.

Answer 373

Crouzon syndrome is an autosomal dominant disorder characterized by premature fusion of cranial sutures, which results in midface deficiency and distinct craniofacial features, including: Short and broad skull (i.e., brachycephaly) Bulging eyes (i.e., proptosis) Large forehead (i.e., frontal bossing) Hypertelorism (i.e., wide-set eyes) Underdeveloped upper jaw (i.e., maxillary retrognathia)

Answer 374

Crouzon syndrome primarily affects the craniofacial skeleton, particularly the midface, due to premature suture fusion. Midline organ defects are not a typical feature

Answer 375

The critical pH is the value below which a substance will become soluble. The critical pH of dentin and cementum are 6.2 and 6.7, respectively. According to the salivary pH graph provided, the patient’s oral cavity measured a baseline pH of roughly 6.0. This is below both the critical pH values of dentin and cementum only, indicating that a caries attack will be localized where the enamel is not present for protection. Therefore, the patient will most likely suffer from root decay.

Answer 376

are pre-fabricated silver crown forms that are adapted to individual teeth and cemented with a biocompatible luting agent. The patient is considered high caries risk and has a two-surface carious lesion on her lower left second primary molar. Stainless steel crowns are preferred for multi-surface lesions on primary teeth. The goal is to arrest the caries process on the tooth until the tooth naturally exfoliates around 10-12 years old.

Answer 377

and composite restorations are generally used for small lesions in primary teeth (e.g., occlusal restorations). Given the size of the lesion and the high caries risk status of the patient, the best method to avoid recurrent decay is crowning the tooth.

Answer 378

The periodontal ligament (PDL) is a connective tissue located between the cementum of the tooth and the alveolar bone. Sharpey’s fibers of the PDL anchor the tooth to the bone. Sharpey’s fibers consist of four main groups that have unique orientations within the PDL: alveolar crest fibers, horizontal fibers, oblique fibers, and apical fibers. In multirooted teeth, interradicular fibers are also present. With excessive forces, Sharpey’s fibers create a space between tooth and bone by increasing in number and diameter, allowing for the accommodation of chewing forces. This is often observed radiographically as a widened PDL space.

Answer 379

Heavy occlusal forces cause alveolar bone resorption and reduced bone density. This can result in the mobility of teeth

Answer 380

Cementoclasts aid in the remodeling of the cementum. They are not active during heavy occlusal forces but rather aid in the resorption of cementum that occurs during inflammatory periodontal conditions like periodontitis.

Answer 381

The rests of Malassez are stem cells found in the PDL. They play a role in cementum repair and, when stimulated, are responsible for forming cysts. They are not responsible for accommodating occlusal forces.

Answer 382

The patient presents with a wipeable white plaque on the dorsal surface of the tongue. The biopsy contains hyphae (the branching filaments that make up the mycelium of a fungus), indicating a likely diagnosis of an opportunistic infection from oral candidiasis, a fungal infection.

Answer 383

are the basic structural unit of most fungi, forming long, thread-like filaments

Answer 384

A mass of hyphae collectively forms the mycelium, which is the vegetative body of a fungus

Answer 385

Cross-sectional studies capture a snapshot of how variables are related at a single point in time, measuring the association between exposure and outcome at that specific moment. These studies provide valuable insights into how variables coexist but do not track changes over time. Longitudinal studies track associations over extended periods by observing changes in variables and outcomes across different time points. By following participants over time, longitudinal studies can identify patterns and suggest potential relationships, but they still focus on associations rather than definitive causation.

Answer 386

While longitudinal studies can provide insights into potential causal relationships by showing changes over time, they do not establish causation definitively. Causation typically requires more controlled experimental designs, such as randomized controlled trials, to rule out confounding factors.

Answer 387

Experimental outcomes are typically measured in controlled experimental studies, where researchers manipulate variables to observe effects. Cross-sectional and longitudinal studies, as observational designs, do not involve such manipulation

Answer 388

Mandibular tooth infections can lead to infections in three spaces: the sublingual, submandibular, and submental spaces. Infections in the submandibular space can easily spread to the sublingual space because the posterior border of the mylohyoid muscle is not bounded by fascia. The submandibular space is bordered by the mylohyoid muscle superiorly, and the sublingual space is bordered by the mylohyoid muscle inferiorly. The unbounded, shared border makes it easy for the infection to travel between the two spaces.

Answer 389

is a potential space located between the buccinator and platysma muscles. Buccal space infections are generally caused by bicuspid and molar infections. Although the infection can spread to the buccal space, it is much less likely due to the anatomical distance between the submandibular and buccal spaces.

Answer 390

is a potential space located between the levator anguli oris and the levator labii superioris muscles. Infections that spread into the canine space generally involve the maxillary incisors or canines.

Answer 391

The superficial temporal space is located between the skin and the temporalis muscle and is often infected by maxillary second or third molar infections.

Answer 392

The subgingival bacteria in an individual with active periodontal disease are primarily gram-negative anaerobes. The progression from gingival health to periodontitis typically involves a transition from gram-positive aerobes to more pathogenic gram-negative anaerobes within the periodontal environment. Gram-negative anaerobes, like Porphyromonas gingivalis, Tannerella forsythia, and Treponema denticola, thrive in the anaerobic conditions of the periodontal pocket and are closely associated with the pathogenesis of periodontitis.

Answer 393

Gram-positive aerobes require oxygen to survive and are typically found in healthier, less deep areas of the oral cavity. Since periodontitis involves deep periodontal pockets where oxygen is limited, gram-positive aerobes are not well-suited to this environment.

Answer 394

While some gram-positive anaerobes can exist in the subgingival area, they are generally more common in the early stages of gingival inflammation and are not the primary pathogens associated with periodontitis. Gram-negative bacteria tend to dominate in more advanced periodontal disease

Answer 395

In this case, the patient is being “forced” to go to the emergency room, which implies that the patient is going against their desires. This violates the principle of autonomy.

Answer 396

The ASA physical status classification system is used to assess the fitness of patients prior to surgery and is divided into six categories. The patient above has one systemic condition (well-controlled type II diabetes mellitus) and is managing it with the proper medication. Therefore, she is considered ASA II.

Answer 397

The p-value represents the probability of obtaining the observed results, assuming the null hypothesis is true. It quantifies how likely the results occurred purely due to chance. A low p-value, typically < 0.05, suggests that the observed data is unlikely to have occurred by chance alone. This indicates statistically significant evidence against the null hypothesis, allowing its rejection and the conclusion that there is an effect.

Answer 398

A lower p-value indicates more statistical significance. Typically, a p-value < 0.05 is considered statistically significant.

Answer 399

The p-value indicates the probability of obtaining the observed or more extreme results if the null hypothesis is true. It does not give the probability that the null hypothesis itself is true

Answer 400

Grinding teeth, or bruxism, can lead to several oral manifestations, including increased tooth mobility, temporomandibular joint (TMJ) pain, and tooth sensitivity. There is no evidence to suggest that bruxism can influence hormones. However, the reverse is true, where bruxism can be a habit that occurs in response to hormones and stress.

Answer 401

Prevalence refers to the total number of new and existing cases of a disease or condition in a population at a given time or over a defined period. The reported data describes the total number of cases (i.e., 1,000,000) of a condition and defines the timeframe (i.e., 2010-2019).

Answer 402

Incidence is the number of new cases of a condition that develop in a population over a specific time. This data does not specify whether these cases are new or existing.

Answer 403

Sensitivity measures a test's ability to identify true positives or individuals with a condition

Answer 404

Specificity Specificity measures a test's ability to identify true negatives or individuals without the condition

Answer 405

A lateral periodontal cyst is a true developmental odontogenic cyst that occurs near the lateral root surface of a vital tooth. It most commonly occurs in the mandibular canine-premolar region. These are generally incidental radiographic findings and are asymptomatic. A lateral periodontal cyst can cause root displacement. Since the findings align with these signs and symptoms, the diagnosis is most likely a lateral periodontal cyst.

Answer 406

The patient has a history of jaw pain. In addition, the temporomandibular joint condyles are seated anteriorly to the articular eminences. These findings are consistent with anterior temporomandibular joint (TMJ) dislocation, which often occurs when the jaw is opened too wide or experiences an abnormal interruption during the process of mouth opening. Of the therapeutic techniques listed, the only one that is not appropriate is performing gentle caudal pressure on the lower molars. To correct the dislocation, the TMJ will need to be repositioned or reduced. This involves a forceful downward push that should be performed by a healthcare professional. Gentle pressure will not help resolve or alleviate the issue.

Answer 407

Although not commonly used as a primary treatment for TMJ dislocation, diazepam has a muscle relaxant property and can be prescribed in certain cases to help relieve muscle spasms and tension associated with the TMJ

Answer 408

Occlusal equilibrium refers to the state of achieving a proper maximum intercuspation. This can be achieved by manual manipulation, stabilization appliances, or splints. These adjunctive treatments may help treat a TMJ joint dislocation

Answer 409

helps relax the muscles and reduce the inflammation associated with the dislocation.

Answer 410

Omeprazole (Prilosec®) is a proton pump inhibitor used to treat peptic ulcer disease or gastroesophageal reflux disease (GERD). After prolonged use of proton pump inhibitors, discontinuation of the medication can cause a rebound of acid hypersecretion. This increased acid secretion leads to lower pH environments in the gastrointestinal tract and can lead to esophageal ulcers.

Answer 411

Tamsulosin (Flomax®) is a selective alpha-1 antagonist that relaxes muscles in the prostate and the bladder. It is used to treat benign prostate hypertrophy and discontinuing tamsulosin would decrease urinary frequency

Answer 412

The main concern in this patient’s medical history is significant for acute intermittent porphyria (AIP). AIP is a rare metabolic condition involving a deficiency in the hydroxymethylbilane synthase enzyme. This enzyme plays a role in the pathway converting toxic porphyrin precursors into the iron-containing porphyrin known as heme, which is the red pigment of human blood. Barbiturates are contraindicated in patients with acute intermittent porphyria because they enhance porphyrin synthesis, which will exacerbate the disease by increasing the accumulation of toxins.

Answer 413

Humira® (adalimumab) is an immunosuppressant drug used to treat a number of autoimmune diseases, including rheumatoid arthritis. Specifically, it functions as a monoclonal antibody that binds to and inhibits tumor necrosis factor-alpha (TNF-α), thereby blocking inflammatory reactions. Other medical conditions treated by this drug include psoriatic arthritis, ankylosing spondylitis, Crohn’s disease, and ulcerative colitis.

Answer 414

Based on the clinical presentation and time of onset, this patient is most likely experiencing drug hypersensitivity. Drug hypersensitivity occurs when a medication causes an immunologic or inflammatory response, resulting in an allergic, exaggerated pharmacologic, or pseudoallergic reaction. Drug hypersensitivity is considered a delayed (i.e., type IV) hypersensitivity reaction. Type IV hypersensitivity reactions are T cell-mediated, in which the body’s CD4 and CD8 cells respond to antigens. The activation and recruitment of T cells to a specific antigen typically takes days, resulting in the delayed onset seen in a type IV hypersensitivity reaction.

Answer 415

Type I hypersensitivity reactions are mediated by preformed IgE antibodies, which cause mast cell and basophil degranulation in response to allergens. These cells release histamine and other vasoactive compounds. Drug allergies are an example of a type I hypersensitivity reaction, but symptom onset is typically within a few minutes

Answer 416

Type II hypersensitivity reactions are IgM and IgG-mediated and trigger complement activation, which leads to cell and tissue damage. The onset of a type II hypersensitivity reaction is typically hours.

Answer 417

Immune complex-mediated (i.e., type III) hypersensitivity reactions involve immune complexes deposited in tissues like the skin, kidneys, or joints, as seen in rheumatoid arthritis and systemic lupus erythematosus. The onset of a type III hypersensitivity reaction is typically hours to days

Answer 418

The patient has human immunodeficiency virus (HIV), which can be transmitted through the exchange of blood. Gloves are effective at preventing open skin, sores, or wounds the operator may have on their hands from becoming contaminated by a patient’s intraoral tissues or fluids. Gloves are required when directly handling potentially infectious materials and contaminated surfaces.

Answer 419

According to the Occupational Safety and Health Administration (OSHA), bending needles is permissible only if there is no feasible alternative or if such actions are required for a specific dental procedure. The dental assistant had no reason to bend the needle for disposal. Therefore, the OSHA protocols should be reviewed with the dental assistant to reiterate proper needle disposal techniques.

Answer 420

Cor pulmonale is a type of pulmonary heart disease that occurs when the right side of the heart becomes enlarged and strained due to chronic lung disorder. The condition involves the lungs and blood vessels, leading to pulmonary vascular resistance. The right ventricle of the heart has to work harder to pump blood through the lungs against this resistance, resulting in right-sided heart failure.

Answer 421

Left-sided heart failure occurs when the left ventricle of the heart is unable to pump blood effectively to the body. This is distinct from right-sided heart failure, which occurs when the right ventricle of the heart is unable to pump blood effectively to the lungs

Answer 422

Pulmonary hypertension is characterized by high blood pressure in the pulmonary arteries. Cor pulmonale is a consequence of long-term pulmonary hypertension, but it is not synonymous with pulmonary hypertension

Answer 423

Superior vena cava congestion occurs when the superior vena cava is compressed or obstructed, impairing the deoxygenated blood flow from the upper body back to the heart. Although superior vena cava congestion can contribute to right-sided heart failure, this condition is distinct from cor pulmonale, which involves the pulmonary system.

Answer 424

occurs when the median nerve is compressed at the wrist. The median nerve runs from the forearm to the palm and provides sensory innervation to the thumb, index finger, middle finger, and inner half of the ring finger. Numbness and tingling of the hand are common symptoms of carpal tunnel syndrome

Answer 425

The axillary nerve innervates the teres minor and deltoid muscles involved in the external rotation of the shoulder joint

Answer 426

The radial nerve innervates the triceps brachii which acts to extend the arm at the elbow.

Answer 427

The ulnar nerve provides sensory innervation to the pinky and outer half of the ring finger. When the ulnar nerve is compressed, numbness and tingling can be felt on these fingers rather than those affected by carpal tunnel syndrome.

Answer 428

For patients with prosthetic joints, it is most appropriate for the patient’s orthopedic surgeon to decide and prescribe a prophylactic antibiotic. In emergency situations, such as the patient with an abscess and swelling, treatment should not be delayed if the orthopedic surgeon cannot be contacted within a reasonable timeframe. It is the dentist’s responsibility to be informed of the American Academy of Orthopedic Surgeons (AAOS) and the American Dental Association (ADA) antibiotic prophylaxis guidelines. Since the patient's orthopedic surgeon provided a medical letter stating that the patient should take prophylactic antibiotics for dental treatment, it is reasonable for the dentist to provide azithromycin (Zithromax®) as a premedication.

Answer 429

At least 1 mm of buccal bone thickness is recommended for implant placement. Less than 1 mm may lead to physiological or pathological buccal bone loss surrounding the implant. This can lead to periodontal defects and implant failure. Key Takeaway: To ensure successful implant placement, it is necessary to have a minimum bone width of 1 mm buccal to the implant.

Answer 430

1) Low-level disinfectants, which are effective against most bacteria, some viruses, and some fungi. However, they are not tuberculocidal nor sporicidal. These are to be used on noncritical items (e.g., blood pressure cuffs) 2) Intermediate-level disinfectants, which include the same efficacy as low-level with the added benefit of being tubuerculocidal, but still are not sporicidal. These are generally used to disinfect surfaces and instruments that come into contact with intact skin, but not with mucous membranes or blood. 3) High-level disinfectants, which are effective against all microorganisms, including mycobacteria, except high levels of bacterial spores. A key application is that only high-level disinfectants can be used on semi-critical items.

Answer 431

Caries Management by Risk Assessment (CAMBRA) is a caries risk assessment tool separate and distinct from the American Dental Association (ADA) Caries Risk Assessment. This question specifically asks for the caries risk factors utilized by CAMBRA. CAMBRA categorizes patients into caries risk categories. A patient can be classified as having a “low,” “moderate,” “high,” or “extreme” risk for caries. This tool allows dentists to evaluate the causes of caries and address the risk factors through patient behavioral changes and minimally invasive care. CAMBRA considers the following in determining caries risk: Biological or environmental risk factors Protective factors Biological risk factors – clinical exam Disease indicators – clinical exam CAMBRA does not consider genetic factors when determining caries risk. INBDE Pro-Tip: CAMBRA and the ADA Caries Risk Assessment are two types of caries risk assessments. Use the one that the question stem specifies. If the question stem does not specify which risk assessment to use, default to the ADA Caries Risk Assessment.

Answer 432

Local anesthetics exist in two forms when injected: an ionized quaternary salt (BH+) and a tertiary or free base (B). The proportion of each is determined by the pKa of the anesthetic and the pH of the tissue. The un-ionized tertiary or free base (B) form is essential for the local anesthetic to diffuse intracellularly through the lipid membrane to block the Na+ channel. In basic environments, the un-ionized tertiary or free base (B) form of the anesthetic is favored, allowing for better penetration of the lipid membrane.

Answer 433

Beginning with file size #15, the color of the files cycles in the order of White-Yellow-Red-Blue-Green-Black as the size increases. The file size is indicated by its color and represents the diameter at the file tip.

Answer 434

Denture clicking when speaking indicates that the dentures have resulted in an excess vertical dimension of occlusion (VDO), or dentures cause the jaws to be “overly opened.” Excess VDO means that the denture has been set with too much vertical height, which causes the upper and lower jaws to be positioned too far apart when the teeth are together. This can lead to the denture teeth ‘clicking’ or hitting each other when the patient speaks. Other signs of excess VDO include strained appearance, complaints of fatigue and pain in the muscles that elevate the mandible, and inability to chew food properly. The denture teeth can be adjusted with acrylic burs to reduce the VDO so the teeth no longer interfere when speaking.

Answer 435

Anterior teeth that are unable to contact the wet/dry line will present with the patient having difficulty producing fricative sounds (e.g., “f" and “v") but will not present with clicking sounds upon speaking

Answer 436

Dentinogenesis imperfecta is a genetic condition that affects the development of dentin. It typically presents as teeth with a range of yellow to blue opalescence, cervical constriction, bulbous crowns, and pulpal obliteration. This patient presents with findings representative of dentinogenesis imperfecta. There are 3 types of dentinogenesis imperfecta: Type 1: Associated with osteogenesis imperfecta (brittle bones and blue sclera). Primary dentition affected more than permanent Type 2: Not associated with osteogenesis imperfecta. Both dentitions affected equally. Type 3: Shell teeth (large pulp chambers) with multiple pulp exposures. A. Amelogenesis imperfecta Amelogenesis imperfecta is also a genetic condition that affects tooth development, but it specifically results in defective enamel. It does not affect dentin and the pulp chambers.

Answer 437

Regional odontodysplasia refers to a phenomenon where several teeth in an area have abnormalities in their enamel, dentin, and pulp. Teeth are referred to as "ghost teeth" as they are radiolucent and thin on radiographs.

Answer 438

Tetracycline staining occurs when tetracycline exposure occurs at the same time as crown development and calcification. This results in permanent yellow/gray/brown discolored bands on the teeth.

Answer 439

can either follow an indolent course or can be aggressive and metastasize. The bone is the most common site for metastasis in prostate cancer. Those with bone metastasis often have severe pain in the lower spine and are at an increased risk of fractures. Bone is the most common metastatic site for prostate cancer.

Answer 440

Normally, the eruption of the permanent canines precedes that of the second molars. While both of these events occur between the ages of 11-13 years of age, adherence to the normal eruption sequence is critical. Alterations from the normal eruption sequence can lead to loss of space that inhibits the eruption of certain teeth. The primary canine and molars take up more space than the permanent canine and premolars. The extra space is referred to as the Leeway space, which closes upon the eruption of the permanent 2nd molars. In this question, the eruption of tooth 2 (second molar) prior to tooth 6 (canine) could potentially inhibit the eruption of tooth 6 or result in an ectopic eruption of tooth 6 due to early closure of the Leeway space.

Answer 441

The patient is in the mixed dentition phase. The bitewing images show that all first molars and the left mandibular canine have erupted. Since the patient does not have the maxillary canines or any of the first premolars, they are likely younger than 11 years old. Mandibular canines erupt between ages 9-10 years old, and tooth 27 is still erupting, suggesting that this patient is within that age range.

Answer 442

The patient recently had a fever, pharyngitis, exudative tonsillitis, and enlarged cervical lymph nodes. This presentation is most consistent with streptococcal pharyngitis (i.e., strep throat), which is an infection caused by the bacteria group A Streptococcus pyogenes.

Answer 443

Mononucleosis Mononucleosis is a disease caused by the Epstein-Barr virus and presents with similar symptoms, such as a fever, sore throat, and swollen lymph nodes and tonsils. However, the symptoms would not have resolved after antibiotic administration, and the disease course would be protracted with extreme fatigue and hepatosplenomegaly.

Answer 444

The patient recently had a fever, pharyngitis, exudative tonsillitis, and enlarged cervical lymph nodes. This patient most likely originally developed streptococcal pharyngitis (i.e., strep throat) due to a group A Streptococcus (GAS) infection. Five weeks following his treatment with amoxicillin, the patient developed pain in multiple joints, painless skin nodules, and an epidermal rash. These are classic symptoms of rheumatic fever (RF), a known complication of streptococcal pharyngitis that can develop one to five weeks after infection. Symptoms of RF include the J♡NES (JONES) criteria: Joints - migratory joint pain ♡ (carditis) - heart inflammation Nodules - painless lumps on the skin Erythema marginatum - ring-like rash Sydenham chorea - involuntary movements of face and limbs

Answer 445

Since the patient has difficulty retruding her tongue, the styloglossus muscle most likely has impaired function.

Answer 446

Periodontal scaling and root planing (SRP), also referred to as "deep cleanings" by patients, involves removing both supragingival and subgingival plaque and calculus. SRP is accomplished using scalers and curettes along the surface of the tooth’s enamel (coronal structure) and cementum (root structure). Since dentin is an internal anatomical feature of teeth, the scalers will not reach this area.

Answer 447

Dual-cure composite resins are both photo-activating and self-activating. They may be used instead of light-cure composite resin because of their potential for a deeper depth of cure. Dual-cure composites can polymerize in areas where light penetration is limited. Dual-cure composites can often cure to a depth of 4 to 6 mm, whereas conventional composites usually cure to depths of 2 to 3 mm.

Answer 448

Torque in orthodontics refers to the movement involved with moving the apex. Root torque occurs when the crown is relatively stationary and the root moves in the direction of the force. This requires the most force of the answer choices listed. Bodily movement requires the most force of all movements.

Answer 449

The infraorbital nerve is the final and largest branch of the maxillary nerve, or the second division of the trigeminal nerve (CN V2). Upon entering the orbit through the inferior orbital fissure, the maxillary nerve is referred to as the infraorbital nerve (ION). The ION runs anteriorly through the floor or the orbit in the infraorbital groove, passes through the infraorbital canal, and descends to reach the face through the infraorbital foramen. The ION provides sensation to the skin of the lower eyelid, conjunctiva, upper lip, and the lateral surface of the nose.

Answer 450

The buccal nerve stems from the anterior trunk of the mandibular branch of the trigeminal nerve (CN V3) before entering the oral cavity. It provides sensory innervation to most of the buccal mucosa, the lower buccal gingiva in the molar region, and the skin overlying the anterior portion of the buccinator muscle.

Answer 451

The facial nerve (CN VII) exits the skull through the stylomastoid foramen, located near the base of the ear. The facial nerve controls facial movement, transmits taste sensations to the front two-thirds of the tongue, and stimulates tear production from the lacrimal gland, among other functions.

Answer 452

The ophthalmic nerve is the first division of the trigeminal nerve (CN V1) and exits the skull through the superior orbital fissure. The ophthalmic nerve supplies sensory branches to structures of the eye, the nasal and sinus membranes, and skin of the eyebrow, eyelids, forehead, and nose, as well as certain areas of the dura mater and falx cerebri.

Answer 453

Human papillomavirus (HPV) is a virus that typically manifests as warts and papillomas on the hands, genitals, and mouth. HPV genotypes 16 and 18 are responsible for the majority of cervical cancers worldwide. They are also responsible for a significant proportion of oropharyngeal cancer. HPV 16 is the most oncogenic, accounting for almost half of all cervical cancers, and HPV 16 and 18 together account for approximately 70% of cervical cancers.

Answer 454

Human papillomavirus (HPV) genotypes 4, 40, 13, and 32 are not responsible for any of the major cancers.

Answer 455

Human papillomavirus (HPV) genotypes 6 and 11 are responsible for the majority of anogenital warts, not cervical cancer

Answer 456

Preserving tooth K will hold the current alignment of the dentition and maintain space for any eventual replacement of tooth 20. Loss of the second primary molar without a succedaneous tooth to take its place may lead to the mesial drifting of the permanent first molar.

Answer 457

In adolescents aged 12 to 19 years, the prevalence of dental caries from highest to lowest is as follows: Hispanic Americans > Black Americans > Asian Americans > White Americans

Answer 458

IgG is the most abundant antibody in the gingival crevicular fluid (GCF) in those with chronic periodontitis. IgG plays a crucial role in the long-term immune response in chronic diseases. IgG binds to pathogens, including viruses and bacteria, specifically targeting and eliminating periodontal pathogens in the GCF.

Answer 459

Dental records are a type of health record used to document the treatment course of a patient and are imperative to providing adequate patient care. Insurance claims or payment records, while important from a business perspective, are not a necessary portion of the dental record for patient care. Dental records should include: Documentation of clinical findings A listed diagnosis Informed consent documents Treatments rendered Medications given Physician contact information

Answer 460

According to the CDC, the human papillomavirus (HPV) vaccine is recommended for ages 11-12 years to protect against cancer-causing HPV infection. However, the vaccine is available to patients beginning at age 9. Between ages 9-14: two doses required, given 6 to 12 months apart After age 15: three doses are required, given over a 6 month period Since this patient is 25 years old, she will require 3 doses of the HPV vaccine.

Answer 461

Spirochetes are present in the mature plaque in gingivitis. The plaque biofilm begins with gram-positive cocci and rods at baseline, progresses to fusobacteria and filaments in the intermediate, and finally incorporates spirochetes in matured plaque.

Answer 462

Gram-positive rods are present at the initial stages of plaque biofilm formation rather than the later stages

Answer 463

Tetracycline is a bacteriostatic antibiotic that binds to and inhibits the 30S ribosomal subunit in bacteria and inhibits protein synthesis. Prolonged use of tetracyclines can lead to tooth enamel dysplasia, hepatotoxicity, photosensitivity, and Fanconi syndrome. Fanconi syndrome is a disorder of the kidneys where there is increased secretion of glucose, bicarbonate, uric acid, and potassium in the urine. It occurs as a result of kidney tubule dysfunction.

Answer 464

Vancomycin is a bactericidal glycopeptide antibiotic that disrupts cell wall synthesis. Side effects associated with its use include nephrotoxicity, ototoxicity, thrombocytopenia, and erythema multiforme.

Answer 465

Ciprofloxacin is a fluoroquinolone, a bactericidal antibiotic that inhibits DNA synthesis by binding to topoisomerase II (gyrase) and topoisomerase IV in order to block replication and separation of replicated DNA, respectively. Side effects include hepatotoxicity, photosensitivity, tearing of tendons, nausea, diarrhea, and rash. It does not cause enamel dysplasia or Fanconi Syndrome.

Answer 466

Amoxicillin is a bactericidal antibiotic that consists of beta-lactam and inhibits bacterial cell wall synthesis. Side effects associated with amoxicillin include stomach cramps, diarrhea, loss of appetite, joint pain, and vomiting. It does not cause Fanconi syndrome.

Answer 467

The investigation in the Colorado Brown Stain case was a public health assessment. This type of assessment collects and evaluates information about hazardous substances–fluoride, in this case–to determine if exposure could harm people. It considers the potential health effects of these substances on the population, both in the past and going forward.

Answer 468

The maxillary first premolar is characterized by its mesial marginal ridge groove. The mesial marginal ridge groove is a developmental groove that crosses the mesial marginal ridge. The groove follows the long axis of the tooth before becoming confluent with the mesial crown and root concavity. The mesial crown and root concavity is a unique developmental depression located cervically to the mesial marginal ridge groove. The mesial crown and root concavity are important in the context of restorations, as their contour is challenging to replicate. The mesial marginal ridge groove is present in approximately 97% of maxillary first premolars.

Answer 469

prilocaine

Answer 470

The patient has a draining sinus tract linked to an infected tooth 8. This is a chronic inflammatory response due to the chronic periapical lesion. Accumulation of inflammatory cells can lead to a clinical sinus tract. Lymphocytes (e.g., T cells, B cells, natural killer cells) are involved in the targeted immune response and play a significant role in chronic inflammatory response. Macrophages and lymphocytes have a bidirectional relationship in chronic inflammatory response. INBDE Pro-Tip: Cells that are predominant in acute and chronic infection: Acute: Neutrophils Chronic: Lymphocytes (e.g., T and B cells), monocytes, macrophages

Answer 471

Neutrophils are the dominant cell type in acute inflammation. Acute inflammation is characterized by rapid onset, short duration, and cardinal signs (e.g., pain, heat, redness, and swelling).

Answer 472

Eosinophils are immune cells that occur relatively infrequently and function mainly in allergic reactions and parasitic infections. They are not present in draining sinus tracts.

Answer 473

This patient wishes to understand the efficacy of a root canal treatment. Second only to meta-analysis/systematic review, an experimental study (i.e., randomized controlled trial) will provide the highest standard of evidence regarding the efficacy of an intervention. Experimental studies compare outcomes (e.g., pain, sensitivity) between an intervention group of patients (e.g., root canal treatment) and a control group of patients (e.g., no root canal treatment).

Answer 474

Transposition is a developmental phenomenon that causes the position of two adjacent teeth to interchange. The most common teeth to be transposed are the maxillary canine and 1st premolar, followed by the maxillary canine and lateral incisor.

Answer 475

An amphiarthrosis is a joint that exhibits only slight movement. Examples include the pubic symphysis and the intervertebral articulations.

Answer 476

A condyloid joint consists of an elliptical-shaped bone that fits into an elliptically-shaped cavity. This joint will allow for forward and backward, or side-to-side movements; it will not allow for rotational movement. An example includes metacarpophalangeal joints.

Answer 477

Microglossia is a condition in which the tongue is small in size relative to the rest of the oral cavity. Microglossia is rare and usually occurs in the context of other congenital conditions. Cleft lip and palate alone are not commonly associated with microglossia.

Answer 478

Ear infections The levator veli palatini and tensor veli palatini muscles are important to the function of the eustachian tube, which connects the oral cavity to the middle ear. Cleft lip and palate patients can have dysfunction of these muscles, leading to fluid buildup in the ear and making them more prone to ear infections. This often requires antibiotic treatment and may lead to hearing loss

Answer 479

Although endodontic sealers, like those made of zinc oxide eugenol, have antimicrobial properties and can prevent reinfection of the root canal, this is not their primary purpose

Answer 480

Maxillary first molars usually have three roots with four canals: one canal in each distobuccal and palatal root and two canals in the mesiobuccal root. INBDE Pro Tip: Reference percentages vary based on the source. Use these percentages when answering canal percentage questions for the INBDE. Note that percentages will not always add up to 100%.

Answer 481

Pulp canal obliteration (i.e., calcific metamorphosis) describes an apparent loss of the pulp chamber and obliteration of the canal space on a radiograph. Clinically, teeth with pulp canal obliteration are often discolored and lack incisal translucency. Traumatic injuries often cause this.

Answer 482

A bioceramic sealer is a material used in endodontic treatments to fill the small gaps between the core obturation material and the canal walls to minimize voids. Bioceramic sealers should be radiopaque to be visualized on radiographs and distinguishable from adjacent anatomical structures.

Answer 483

The “bump” on the patient’s gum matches the clinical presentation of a sinus tract or chronic apical abscess. This indicates that bacteria have destroyed the pulp and traveled into the bone. A path to drain the infection is created, resulting in a sinus tract. Teeth with sinus tracts are always deemed necrotic. The pulp would negatively respond to electric pulp testing (EPT) and thermal testing. Key Takeaway: The pulpal diagnosis for a tooth with a chronic apical abscess, or sinus tract, is pulpal necrosis.

Answer 484

Hemophilia A is an inherited sex-linked bleeding disorder characterized by deficient factor VIII. This results in insufficient clotting of the blood, leading to prolonged bleeding following injury. Patients with hemophilia A classically experience hemarthrosis (i.e., bleeding into the knee joint) after trauma, frequent nosebleeds, and bruising that can range from mild to severe and significantly affect treatment planning.

Answer 485

IX A deficiency of factor IX causes hemophilia B and is associated with prolonged bleeding and hemarthrosis

Answer 486

Factor XI deficiency is characteristic of the disorder hemophilia C, also referred to as Rosenthal syndrome or plasma thromboplastin antecedent. Individuals with hemophilia C tend to have more mild symptoms than individuals with hemophilia A and B

Answer 487

A complete blood count will assess the relative amount of cells in the blood. This test may be beneficial for detecting disorders like anemia that affect the cells in the blood, but it is not used to detect defects in the coagulation cascade, such as in hemophilia.

Answer 488

International normalized ratio (INR) is a calculation based on prothrombin time (PT) that is typically used to monitor patients who are on warfarin. This measures the extrinsic pathway, which is not affected in those with hemophilia.

Answer 489

Common Factors I, II, V, X, and XIII are involved in the common pathway. B. Extrinsic Factors III and VII are involved in the extrinsic pathway.

Answer 490

Hemophilia A causes a deficiency of factor VIII, which is involved in the intrinsic pathway of the coagulation cascade.

Answer 491

Epinephrine is a common vasoconstrictor used in local anesthetics. While it is a helpful adjunct to limit bleeding intraoperatively, epinephrine can produce rebound bleeding as the medication wears off. Thus, it is not advisable to use soaked gauze postoperatively in patients with hemophilia A who already have an increased risk of bleeding.

Answer 492

Gel foam is a gelatin matrix sponge that can be used as an adjunct for postoperative bleeding. It is placed in an extraction site and secured with sutures. It will be absorbed in four to six weeks.

Answer 493

Hemophilia A is an X-linked recessive disorder that presents with a factor VIII deficiency. Factor VIII is a clotting factor produced in the liver and is a component of the intrinsic pathway of the coagulation cascade. Defects in the intrinsic coagulation pathway present with an increased partial thromboplastin time (PTT). Since patients with hemophilia are at increased risk for adverse bleeding events during surgical procedures, it is most appropriate to further investigate the status of this patient's hemophilia before dental extractions. This can be done by checking the patient's PTT. INBDE Pro-Tip: The intrinsic pathway involves more clotting factors than the extrinsic pathway. Similarly, PTT contains more letters than prothrombin time (PT).

Answer 494

Implants to replace missing maxillary teeth, particularly posterior teeth, may require a sinus lift procedure. A sinus lift, or sinus augmentation, is a surgical procedure that raises the floor of the maxillary sinus to provide more vertical space for implant placement. A sinus lift is a logical consideration prior to placing an implant to replace missing tooth 14. The amount of bone from the alveolar ridge to the sinus floor can be measured on conventional radiographs or cone-beam computed tomography (CBCT). The provider can determine if a sinus lift is necessary by considering the vertical space available and the length of the implants, which varies from around 8 to 15 mm.

Answer 495

Consuming an acidic drink (e.g., soda, coffee) will cause the pH of plaque to decrease rapidly. Demineralization begins below the critical pH, where phosphate and calcium ions begin to dissolve from the tooth surface. The critical pH of enamel is 5.5. It takes approximately 30-45 minutes for the plaque pH to increase back to the critical pH. Key Takeaway: The pH returns to critical after consuming an acidic drink in approximately 30-45 minutes.

Answer 496

Gastroesophageal reflux disease is a common cause of tooth erosion. Tooth erosion and attrition can result in yellow occlusal and lingual surfaces.

Answer 497

A lack of intra-arch space can manifest as buccal or lingual displacement of teeth in the arch. In cases with severe crowding, this is an indication for the extraction of teeth to make space in the arch for alignment.

Answer 498

Interarch space is the vertical space between an edentulous ridge and the opposing dentition. This is an important consideration for planning implants and removable prosthodontics.

Answer 499

The mylohyoid muscle originates on the mylohyoid line of the mandible; it inserts at the hyoid bone, specifically at the mylohyoid raphe. The functions of the mylohyoid muscle include: Elevation of the hyoid bone Elevation of the tongue Depression of the mandible Elevation of the oral cavity floor Depression of the mandible is synonymous with opening the mouth. Therefore, the mylohyoid contributes to opening the mouth.

Answer 500

The temporalis contributes to closing the mouth. It is responsible for elevation, retrusion, and ipsilateral excursion of the mandible.

Answer 501

Histamine is a compound released by mast cells in response to certain allergens. When released, it can lead to various allergic reactions, including wheezing. Histamine binds to specific receptors on smooth muscle cells and causes them to tighten. This is known as bronchoconstriction. Bronchoconstriction narrows the airways and makes it difficult for air to pass through.

Answer 502

Medicaid is a federal and state-funded program that provides medical, hospital, and dental care for qualifying patients of all ages. However, dental coverage may be limited based on which state the individual lives in. The child is most likely to receive comprehensive dental benefits under the Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) benefit of Medicaid coverage. Dental services must minimally include treatment of pain and infections, dental restorations, and oral health maintenance for children younger than 21. The child is guaranteed comprehensive coverage in all fifty states.

Answer 503

Periodontitis is defined as microbially-associated, host-mediated inflammation that results in the loss of periodontal attachment of the tooth to the adjacent bone. Clinical periodontal assessment involves the following: Pocket depth measurement Bleeding on probing Clinical attachment level Radiographic assessment of alveolar bone volume Tooth mobility Calculus, or mineralized bacterial plaque, can form on teeth, leading to gingivitis. However, its presence does not always mean the progression to periodontitis. Therefore, it is not a reliable marker for periodontitis.

Answer 504

The HIPAA security rule mandates reasonable technological and physical safeguards to protect the confidentiality of patient health information, prevent unauthorized access and use, and ensure employee compliance with appropriate information use. While the security of this patient’s records was violated, the dentist’s decision indicates a violation of breach notification.

Answer 505

Privacy The HIPAA privacy rule sets national standards for protecting medical records and personal health information, grants patients rights to access and request copies of their records, and ensures safeguards to prevent unauthorized disclosure. While the privacy of this patient’s records was violated, the dentist’s decision most directly violates breach notification.

Answer 506

The patient is taking rosuvastatin (Crestor®), a statin medication used to reduce his cholesterol and treat hyperlipidemia. This medication competitively inhibits the enzyme HMG-CoA reductase. This conversion is a critical step in the production of cholesterols in the liver.

Answer 507

Angiotensin II receptor The inhibition of the angiotensin II receptor is the mechanism of action for angiotensin receptor blockers (ARBs) such as losartan. These medications promote vasodilation and reduce blood pressure.

Answer 508

The inhibition of calcium channels is the mechanism of action for calcium channel blockers such as nifedipine. These medications block calcium influx, which prevents the vasoconstriction of blood vessels and results in a reduction of blood pressure.

Answer 509

The most common bacterial agent involved in subacute bacterial endocarditis from a dental origin is Viridans streptococci. These are a group of alpha-hemolytic gram-positive bacterial species that are part of the normal mouth bacterial flora but may cause a transient bacteremia that leads to heart infection in at-risk individuals.

Answer 510

Streptococcus bovis is a gram-positive bacteria that can be found in the gastrointestinal tract. Although this bacteria is capable of causing infective endocarditis, it is not associated with a dental origin.

Answer 511

Staphylococcus aureus is commonly found within the nose or skin of individuals and is associated with skin and soft tissue infections. This bacteria is the most common cause of infective endocarditis overall. Since the question is asking about infection in the setting of dental procedures, Viridans streptococci is of more concern.

Answer 512

Enterococcus faecalis is the predominant bacteria associated with recurrent endodontic infections. These bacteria are present in the healthy human gastrointestinal system and are associated with a small fraction of infective endocarditis cases of susceptible individuals. Viridans streptococci are a more common oral pathogen responsible for infective endocarditis.

Answer 513

Bohn’s nodules are found at the hard-soft palate junction or on the facial or lingual surfaces of the alveolar ridge. They are thought to be from salivary gland remnants. They manifest as small, painless, white-yellow, firm papules. They are typically found in newborns and do not require treatment as they rupture and heal after a few weeks.

Answer 514

Erythematous, ulcerative lesion along the lips An erythematous, ulcerative lesion along the lips describes actinic cheilitis. This is a premalignant skin change that occurs due to sun damage

Answer 515

Translucent, pearly-white, keratin-filled cyst along the alveolar crest A translucent, pearly-white, keratin-filled cyst along the alveolar crest describes a gingival cyst. They are odontogenic, arise from the remnants of the dental lamina, and are common in newborns. They appear clinically similar to Bohn’s nodules and Epstein pearls but can be distinguished histologically and by their cellular origin. While Bohn’s nodules have minor salivary gland tissue remnants, gingival cysts are lined with epithelial cells.

Answer 516

The patient is taking 0.12% chlorhexidine gluconate (Peridex®), a broad-spectrum antibacterial mouth rinse commonly used to reduce inflammation caused by gingivitis. This rinse kills bacteria by binding to the phospholipid membrane and causing cell rupture, thus reducing the bacterial load that contributes to gingivitis. A rare adverse effect can include mouth ulceration, but this is not a common finding that would be expected in someone using the mouth rinse, so this is the exception.

Answer 517

Calculus buildup is a common side effect of chlorhexidine gluconate (Peridex®). This rinse promotes the mineralization of plaque and induces rapid biofilm formation.

Answer 518

Chlorhexidine gluconate (Peridex®) temporarily alters the taste perception of salt and bitterness. This usually lasts for a few hours following the use of the oral rinse.

Answer 519

One of the most common side effects of 0.12% chlorhexidine gluconate (Peridex®) is rapid brown-yellow staining of teeth, limiting the medication’s long-term use.

Answer 520

Since the research team receives funding directly from the company that makes the appliance, there is a conflict of interest. The conflict is that the primary interest, professional judgment on the validity of research, can be influenced by the secondary interest, financial gain. Consequently, the results are more likely to support the intervention being assessed, since the researchers are receiving financial support from the company.

Answer 521

It is not known how much funding the researchers receive. Additionally, larger funding does not necessarily lead to an increase in sample size or statistical significance. Statistical significance would be determined by the data collected in the study.

Answer 522

The company’s involvement in the study is described as a financial contribution, rather than as direct participation in the study itself. Researchers must maintain transparency in reporting conflicts of interest and personal biases that may affect study results. The company's intervention in the research would jeopardize the validity of the study results.

Answer 523

Receiving funding from the company that makes the appliance does not mean that the researchers will develop and adhere to a more rigorous methodology.

Answer 524

In a class I occlusion, tooth 13 will intercuspate with teeth 19 and 20. The buccal cusps of mandibular teeth occlude with fossa and marginal ridges of maxillary teeth. The buccal cusp of tooth 20 (mandibular second premolar) will contact the mesial marginal ridge of tooth 13 (maxillary second premolar) in class I occlusion. INBDE Pro-Tip: An easy way to answer occlusion questions is to draw out a picket fence diagram like the one presented above.

Answer 525

The lingual cusp of tooth 13 will contact the distal marginal ridge of tooth 20.

Answer 526

The lingual cusp of tooth 12 will contact the mesial marginal ridge of tooth 20.

Answer 527

The National Health Service Corps (NHSC) aids over 18,000 healthcare providers through scholarships and loan repayment. The NHSC strives to expand access to high-quality healthcare in communities facing significant shortages of health professionals. These community healthcare sites offer care to patients regardless of their ability to pay.

Answer 528

The ASPR is focused on preventing, preparing for, and responding to the health impacts of emergencies and disasters

Answer 529

The FDA evaluates foods, drugs, and medical devices based on efficacy and safety.

Answer 530

The NIH is responsible for biomedical and public health research.

Answer 531

Stability is the resistance to horizontal or rotational forces

Answer 532

Support is the resistance to vertical movement of the denture base toward the ridge.

Answer 533

The vertical dimension of occlusion (VDO) is determined with measurements from wax rims, facial esthetics, and phonetic tests. Denture teeth help provide the VDO at centric relation in removable prostheses.

Answer 534

It is often difficult to achieve adequate pulpal anesthesia in a tooth with symptomatic irreversible pulpitis due to the increased acidity of the inflamed pulp, which delays or prevents profound anesthesia. Lidocaine remains the preferred anesthetic for an inferior alveolar nerve block because while achieving profound pulpal anesthesia can still be challenging, its success rates are similar to other anesthetics without the risks or disadvantages associated with other local anesthetics

Answer 535

Articaine is superior to lidocaine for infiltrations, but it does not provide increased success rates for inferior alveolar nerve blocks compared to lidocaine. Additionally, there is controversy regarding whether or not it has a slightly higher risk of paresthesia when used for a block compared to lidocaine.

Answer 536

Mepivacaine is traditionally prepared without epinephrine. Without a vasoconstrictor, the duration of action will be too short for a root canal and should not be used unless the patient has a contraindication to epinephrine.

Answer 537

Bupivacaine is not superior to lidocaine in achieving pulpal anesthesia, and its slow onset makes it an impractical choice for a root canal. Because of its longer duration, it is often indicated for use at the end of an appointment to prolong anesthesia and pain control.

Answer 538

Root canal therapy removes the inflamed or infected pulp and involves cleaning and shaping the canal. This process uses a series of hand files or rotary instruments to remove the pulp and some of the dentinal walls. Ideally, dentin removal is minimal but is generally unavoidable, given the nature of accessing and instrumenting canals. This dentin removal can weaken the root structure and can make the tooth more susceptible to root fracture in the long term.

Answer 539

Amalgam restorations rely on a convergent tooth preparation for retention. Larger and deeper restorations can often act as a large wedge and create cracks and fractures in the tooth. These cracks are more likely to occur in the coronal surface of the tooth than the root.

Answer 540

Limited remaining coronal tooth structure primarily affects the retention of restorations. It does not make the tooth significantly more prone to root fractures.

Answer 541

Clinical trials are conducted in a series of phases. Each phase has a different purpose and helps researchers answer specific questions. Phase IV occurs after a drug is approved by the FDA and made available to the public. Researchers track the treatment's safety in the general population, seeking more information about its benefits and optimal use

Answer 542

In phase II of a clinical trial, a new drug or treatment is given to a medium-sized group of 100-300 people. The goal is to determine its effectiveness and to further study its safety

Answer 543

In phase III, the intervention is given to a large group of 1,000-3,000 people to confirm its effectiveness, monitor side effects, and compare it with standard or similar treatments. More information is collected that will allow the new drug or treatment to be used safely.

Answer 544

Substernal chest pain, a symptom of coronary artery disease called angina, is most likely caused by ischemia in the heart due to partial blockage of a coronary artery. Nitroglycerin helps to relieve angina symptoms by dilating the coronary arteries and improving blood flow to ischemic heart tissue. Since there is no relief of symptoms with nitroglycerin, the dentist must escalate medical management by assuming this is a myocardial infarction and contacting emergency medical services.

Answer 545

Aspirin prevents thrombosis by reducing platelet aggregation. Aspirin should be provided to patients presenting with new onset symptoms of chest pain after emergency medical services are called and nasal oxygen is provided. This patient has a history of symptomatic coronary artery disease, warranting the use of nasal oxygen and nitroglycerin first. Since the patient had no symptom relief, emergency medical services should be contacted

Answer 546

Young women are the most likely group of those listed to have a temporomandibular or orofacial pain complaint. Roughly 29% of women aged 18-44 complain of orofacial pain.

Answer 547

This patient most likely has sickle cell anemia, a genetic disease in which red blood cells have a sickle shape that decreases their ability to carry oxygen. These sickle-shaped blood cells get entrapped in capillaries and can cause enlarged bone marrow spaces. A potentially life-threatening complication of sickle cell disease is a splenic sequestration crisis, which occurs when red blood cells are captured and pool within the spleen. Management of this crisis may include the removal of the spleen (i.e., splenectomy), as seen in this patient. Another possible complication is a stroke or cerebrovascular accident, which occurs when blood flow to a portion of the brain is stopped.

Answer 548

Hemolytic anemia occurs when the body’s red blood cells are destroyed faster than they can be replaced. Although treatment can also involve the removal of the spleen, hemolytic anemia is not associated with cerebrovascular accidents.

Answer 549

Waldenstrom macroglobulinemia is a rare type of blood cell cancer characterized by an excess of abnormal white blood cells in the bone marrow. This cancer is not commonly associated with spleen removal.

Answer 550

Thalassemia is an inherited blood disorder that affects alpha or beta globin synthesis. It can vary widely in phenotypic expression, from asymptomatic to severe anemia that requires transfusions and produces many secondary disorders. This condition is not commonly associated with cerebrovascular accidents at a young age.

Answer 551

Albuterol is a beta-2 selective agonist that causes smooth muscle relaxation, leading to bronchodilation and allowing more oxygen to flow into the lungs. It is a short-acting beta agonist used in rescue therapy for acute asthma or chronic obstructive pulmonary disease (COPD) symptoms.

Answer 552

An example of an alpha-1 agonist is phenylephrine. These drugs have vasoconstrictive effects and are typically used for rhinitis or hypotension

Answer 553

Alpha-1 antagonists typically have the suffix “-osin” (e.g., tamsulosin). These drugs are used to treat many conditions, such as hypertension or the urinary symptoms of benign prostatic hyperplasia

Answer 554

Beta-blockers act non-selectively against the beta-1 and beta-2 receptors and are used clinically to treat multiple conditions, including hypertension. Beta-blockers have the suffix “-lol” (e.g., propranolol, nadolol).

Answer 555

Chronic bronchitis is one form of chronic obstructive pulmonary disease (COPD). It is mainly a clinical diagnosis in which patients will present with a chronic productive cough and may be overweight, cyanotic, and have peripheral edema (e.g., swollen extremities). Other symptoms associated with chronic bronchitis include wheezing and crackles due to excess mucus production and frequent respiratory infections. Smoking is the key risk factor for this condition.

Answer 556

Acute bronchitis is an inflammation of the airway that is typically caused by a virus and is self-limiting. Patients with acute bronchitis will have similar symptoms to those with COPD and asthma, but it is not a type of COPD due to its acute nature.

Answer 557

Emphysema is the other form of chronic obstructive pulmonary disease. Patients with emphysema have permanent enlargement and destruction of alveoli. They present with severe dyspnea, a quiet barrel-shaped chest, and an absent or infrequent cough. They are typically older and thin and have a long-standing history of tobacco use.

Answer 558

Refractory asthma is a condition where asthma symptoms or attacks persist even though the condition is being managed with medication. Refractory asthma is not a form of COPD

Answer 559

When placed in a supine position, patients with chronic obstructive pulmonary disease (COPD) can experience orthopnea (i.e., shortness of breath when lying down). To minimize patient discomfort and difficulty breathing, it is best to avoid a supine position.

Answer 560

If a patient uses an inhaler to manage COPD or asthma symptoms, it is important always to confirm that they have it with them at each visit. The inhaler should be kept within reach in case the patient has difficulty breathing.

Answer 561

Provide supplemental oxygen as needed If the oxygen saturation is low, it is appropriate to provide supplemental oxygen to patients with COPD during treatment. When using supplemental oxygen, it is important to remind the patient to take deep breaths so they do not lose their respiratory drive

Answer 562

Use a pulse oximeter throughout the appointment It is important to keep a close eye on oxygen saturation levels during appointments for patients with pulmonary disease. If the oxygen saturation drops below 90%, the patient will become hypoxic and begin to exhibit systemic signs and symptoms

Answer 563

Proper treatment planning for implant placement should be done to avoid long-term complications. The space requirement between two teeth adjacent to a planned implant is 7 mm. This accounts for a 4 mm implant diameter and allows for 1.5 mm of space between the implant and the adjacent teeth on either side. When the implant is placed too close to the adjacent teeth, complications can arise (e.g., damage to the adjacent periodontal ligament, infection, loss of the implant, loss of the adjacent tooth).

Answer 564

Abrasion is the non-carious loss of tooth structure caused by external mechanical wear. It classically results from overly rough brushing teeth with a toothbrush. In addition, oral habits (e.g., using toothpicks, chewing on pens, fingernail biting, lip or tongue piercings) can cause abrasion

Answer 565

Ellis class III fractures affect the enamel, dentin, and pulp, often requiring endodontic therapy before a permanent restoration. When less than half of the coronal tooth structure remains in anterior teeth, a post and core are typically placed, followed by a full-coverage crown for strength and durability. Zirconia is an ideal choice for anterior restorations due to its excellent esthetics and high mechanical strength, offering a long-lasting and visually appealing solution.

Answer 566

The curve of Spee describes the gradual curvature of the mandibular occlusal plane in the sagittal plane. Angle’s class II refers to a malocclusion, where the mesiobuccal cusp of the maxillary first molar is mesial to the buccal groove of the mandibular first molar. Angle’s class II can be further broken down into the following two divisions: Class II division 1 describes a class II molar relationship accompanied by proclined maxillary central incisors. Class II division 2 describes a class II molar relationship accompanied by retroclined maxillary central incisors. The curve of Spee in patients with class II division 2 occlusion is generally steeper or exaggerated, as the lower incisors are usually extruded in these cases.

Answer 567

The ophthalmic nerve (V1) is the first branch of the trigeminal nerve. It carries sensory information from the anterior scalp, forehead, upper eyelid, nose, frontal sinuses, and parts of the eye. It passes through the superior orbital fissure and gives rise to three main branches: lacrimal, frontal, and nasociliary nerves.

Answer 568

The infraorbital foramen is located below the eye and lateral to the nose. The foramen transmits the infraorbital artery, infraorbital vein, and the infraorbital nerve. The infraorbital nerve is the distal continuation of the V2 branch of the trigeminal nerve, also known as the maxillary nerve.

Answer 569

Post-exposure prophylaxis (PEP) is recommended in all confirmed cases of needlestick injury where the source person is HIV-infected. After a needlestick injury, affected tissues should be thoroughly cleansed with soap and water, and the appropriate personnel should be informed to document the needle stick and follow protocols. An HIV test should be conducted if both the source and exposed individuals consent. If the test reveals HIV infection in the source person, regardless of viral load, the exposed individual should commence PEP immediately. The risk of transmission of HIV through a needle stick or scalpel cut is 0.3%.

Answer 570

PEP utilizes a cocktail of drugs, including antiretroviral therapy and reverse transcriptase inhibitors.

Answer 571

Neuropraxia is the least severe traumatic peripheral nerve injury (PNI). This injury typically results from compression or mild traction of the nerve and involves segmental demyelination without damage to the axon or surrounding connective tissues. This results in a blockage of nerve conduction with temporary paresthesia or weakness, but a full recovery is anticipated as the myelin sheath heals.

Answer 572

Axonotmesis injuries are more severe than neurapraxia but less severe than neurotmesis. In axonotmesis, the axon of the nerve is damaged, but the connective tissue sheath around the nerve is generally intact.

Answer 573

Neurotmesis is the complete transection of a peripheral nerve. This injury results in complete motor and sensory deficits of the tissues innervated by the damaged nerve.

Answer 574

Wallerian degeneration describes a component of the recovery process that occurs after neuronal injury. This process involves the degeneration and disintegration of a nerve fiber distal to the site of injury.

Answer 575

Personal protective equipment (PPE) donning (i.e., putting on) and doffing (i.e., taking off) are critical processes that play a significant role in limiting exposure to pathogens. The correct order of PPE donning is: 1. Hand hygiene 2. Gown 3. Mask 4. Eye protection 5. Gloves

Answer 576

The periodontium consists of different zones and regions, each separated by unique types of tissue. The gingival margin is the peak of the gingiva (i.e., the apex of the non-attached gingiva). The mucogingival junction is the line between the attached gingiva and the unbound alveolar mucosa. The tissue between the gingival margin and the mucogingival junction consists entirely of keratinized gingiva. Keratinized gingiva is epithelium with specialized keratin-producing cells that make the tissue firm and durable.

Answer 577

The alveolar mucosa is located below the mucogingival junction and consists of non-keratinized tissue.

Answer 578

The attached gingiva is firmly adhered to the tooth root and describes the section of the keratinized gingiva between the gingival groove and mucogingival junction. The distance between the gingival margin and the mucogingival junction consists of both attached gingiva and free gingiva

Answer 579

Clinical attachment loss is measured from the cementoenamel junction to the base of the periodontal pocket. This does not extend to the mucogingival junction.

Answer 580

N95 respirators are similar to standard surgical masks in that they are used to avoid or reduce provider exposure to large respiratory droplets. However, N95 respirators offer a high level of protection against small aerosol particles when used correctly with a properly fitted seal. These masks are designed to filter out a minimum of 95% of aerosols and small particles. There are certain situations in which an N95 mask may be preferred over standard surgical masks, such as when treating patients with active tuberculosis infections or who have recently tested positive for COVID-19. Key Takeaway: N95 respirators have a filtration efficiency of 95% of particles.

Answer 581

The patient is taking nifedipine for her hypertension, which is an L-type calcium channel blocker that acts to lower her blood pressure. As opposed to L-type calcium channels, T-type calcium channels are not involved in myocardial contraction. Instead, they are involved in impulse generation for nerves and conduction and are not the intended targets for calcium channel blockers.

Answer 582

Nifedipine inhibits the entry of calcium ions through L-type calcium channels, which are found in vascular smooth muscle and myocardial cells.

Answer 583

Blocking L-type calcium channels will reduce intracellular calcium in vascular smooth muscle, which causes a decrease in contractility in these cells. This will dilate the coronary arteries and systemically reduce blood pressure.

Answer 584

Nifedipine belongs to the dihydropyridine class of L-type calcium channel blockers. While many other L-type calcium channel blockers will exert their action on the heart, dihydropyridine calcium channel blockers are vascular selective and do not significantly affect cardiac contractility.

Answer 585

Gram-negative anaerobes have been associated with peri-implantitis. The most commonly identified bacterial species are Prevotella, Fusobacterium, and Treponema (gram negative) and also Streptococcus (gram positive).

Answer 586

Gram-positive cocci like Staphylococcus aureus have been associated with peri-implantitis and implant loss but are not the predominant bacteria involved with peri-implantitis.

Answer 587

Gram-positive cocci and non-motile bacilli make up the microbial composition of biofilms on healthy implants.

Answer 588

There are also some cases of peri-implantitis induced by Gram-negative aerobic bacteria, but the main etiological factor is represented by Gram-negative anaerobic bacteria.

Answer 589

An asymptomatic midline neck mass that moves during swallowing is most likely a thyroglossal duct cyst. This developmental birth defect results from a persistent thyroglossal duct failing to atrophy as it should during normal development, leaving behind cystic structures. While the condition is often benign, surgical intervention may be necessary if swallowing or breathing becomes difficult or the cyst becomes infected.

Answer 590

Symptoms of a submandibular gland infection include fever and enlargement of the submandibular glands underneath the jaw. Salivary gland infections do not manifest with swelling on the midline of the neck.

Answer 591

Obstruction of Wharton’s duct (of the submandibular salivary glands) is characterized by swelling on the floor of the mouth due to saliva accumulation in the duct.

Answer 592

Ludwig’s angina is a serious medical condition involving the floor of the mouth, often caused by bacterial infection of facial spaces. Jaw and neck swelling can make speaking and breathing difficult, resulting in emergent medical needs.

Answer 593

Infective endocarditis is a possible complication that can arise after dental procedures in susceptible patients. Antibiotic prophylaxis is indicated in certain patients who are at a higher risk for developing infective endocarditis. According to the American Dental Association (ADA) and the American Heart Association (AHA), certain conditions and procedures require antibiotic prophylaxis while others do not. Patients specifically with unrepaired tetralogy of Fallot, or repaired tetralogy of Fallot with prosthetic valves or residual shunts, are at a much higher risk of developing infective endocarditis and should receive antibiotic prophylaxis before undergoing dental procedures.

Answer 594

Calcific aortic stenosis is a disease in which the aortic valves thicken and stiffen, limiting valve function and decreasing cardiac output. However, it is not an indication of antibiotic prophylaxis.

Answer 595

Mitral valve prolapse is a condition in which one or both leaflets of the mitral valve may not close properly when the heart is contracting, leading to the backward flow of blood into the left atrium. Mitral valve prolapse is generally asymptomatic to mild in nature and is not an indication for antibiotic prophylaxis.

Answer 596

The Hawthorne effect describes the phenomenon where participants in a study alter their behavior since they are aware they are being observed.

Answer 597

The halo effect describes the phenomenon where people are viewed positively due to previous experiences with a person or by transferring their positive feelings about one attribute of the person to another. In dentistry, there is another type of halo effect, specifically related to dental health. It occurs when a person from a non-fluoridated community consumes water or food with fluoride supplied by another community. This will result in a decrease in caries rate

Answer 598

Habituation refers to decreased responsiveness over time due to repeated exposures to the same stimulus

Answer 599

The horn effect refers to the bias that occurs when a person’s overall perception of someone is influenced by a single negative trait

Answer 600

The mandibular second molar is characterized by three developmental grooves: the central groove, buccal grove, and lingual groove. The buccal groove extends from the central groove buccally and separates the mesiobuccal and distobuccal cusps.

Answer 601

The lingual groove extends from the central groove and extends lingually, separating the mesiolingual and distolingual cusps.

Answer 602

The mandibular second molar does not have mesial and distal grooves.

Answer 603

Patients have a right to their healthcare records under the Health Insurance Portability and Accountability Act (HIPAA). Under HIPAA, providers have a 30-day limit to provide dental records upon written request. Even if the patient has an outstanding bill for dental services, the provider is still obligated to release the patient’s records. Failure to release the patient’s dental records can result in a complaint to the state dental licensing board and fines. Withholding records can antagonize the patient and potentially cause harm to the patient and the next provider as well. Withholding records can also irreparably damage the doctor-patient relationship.

Answer 604

he wet-dry line is the junction between the “dry” vermillion (i.e., colored portion) of the lips and the “wet” oral mucosa. It is used as a guideline to determine the incisal edge length for dental prosthetics. Typically, the patient will make a fricative sound (e.g., f, v, ph), and the contact of the central incisors to this wet-dry line will be observed.

Answer 605

The junction between the skin and the vermillion of the lips is the vermillion border, which is inferior to the wet-dry line.

Answer 606

The unattached and attached oral mucosa meet at the mucogingival junction, which is located inside the oral cavity.

Answer 607

The attached mucosa and the tooth meet at the junctional epithelium, which is located inside the oral cavity.

Answer 608

The maximum dose of 2% lidocaine with 1:100,00 epinephrine is 4.4 mg/kg for a pediatric patient. From the question box, we know the patient weighs 50 lbs. First, convert the patients weight to kg by using the conversion 1 lb = 0.45 kg. Remember, you won't have a calculator to solve. Heres an easy way to do it by hand. For maximum dose questions, we can use the following formula to plug in the relevant values and solve for the maximum milliliters that can be administered.

Answer 609

Of the teeth provided in the answer choices, the maxillary first molar has the palatal root in the closest proximity to the sinus floor. Molars tend to have short, wide roots, making them susceptible to the extrusion of obturation materials.

Answer 610

Relative risk is a measure of the ratio of the probabilities of an outcome between two groups. In this case, the relative risk of developing a non-functional oral habit with the use of sealants (intervention) is compared to no sealants (control). Since the relative risk is 3.3, this indicates that the risk of developing a non-functional oral habit is higher in those with sealants (exposed group) compared to those without. So according to the risk analysis, sealants are associated with a higher risk of non-functional oral habits.

Answer 611

If a patient aspirates a foreign body, they will likely become tachycardic (i.e., have an increased heart rate). This occurs because of the activation of the sympathetic nervous system and response to hypoxia (i.e., low oxygen levels). The heart rate climbs to send oxygenated blood to vital organs.

Answer 612

Symptoms of foreign body aspiration include the inability to talk due to choking or gagging, and coughing to clear the foreign body from the airway. If the foreign body cannot be cleared, patients may become cyanotic and develop bluish skin discoloration due to inadequate blood oxygenation

Answer 613

The superficial temporal artery is a terminal branch of the external carotid artery which provides the primary vascular supply to the retrodiscal tissue of the temporomandibular joint (TMJ). Additionally, the TMJ receives vascular supply from two branches of the maxillary artery: the anterior tympanic and the deep auricular arteries.

Answer 614

The middle meningeal artery is a branch of the maxillary artery that enters the skull and supplies the dura mater and the calvaria. Although the auriculotemporal nerve is the primary nerve supply of the TMJ and encircles the middle meningeal artery, this artery does not supply to the retrodiscal tissue of the TMJ.

Answer 615

The maxillary artery gives rise to two branches, the anterior tympanic and the deep auricular arteries, that provide the primary vascular supply to the TMJ. These arteries provide vascular supply to the anterior portion of the TMJ, not the retrodiscal tissue.

Answer 616

The facial artery arises from the external carotid artery and provides vascular supply to the muscles of facial expression and many of the structures of the face. The facial artery does not provide any vascular supply to the TMJ.

Answer 617

Ectodermal dysplasia is a group of genetic disorders that involve abnormalities of structures derived from the ectoderm layer of the embryo in development. Classic characteristics of ectodermal dysplasia include: Brittle hair Missing teeth Conical teeth Dysfunctional sweat glands

Answer 618

The ectoderm gives rise to the anterior two-thirds of the tongue, and the endoderm gives rise to the posterior third of the tongue. The tongue can be implicated in ectodermal dysplasia. However, if the tongue is affected, the patient would present with macroglossia, or a larger than normal tongue, not microglossia, a smaller than normal tongue.

Answer 619

The circular radiolucency within the root canal of tooth 11 can best be described as internal root resorption. This condition involves the loss of dentin from the canal walls, often resulting from chronic inflammation due to factors such as caries, trauma, or tooth fractures. Root canal treatment is the primary management approach, as it removes the affected tissue and prevents further resorption by eliminating the responsible cells.

Answer 620

Dens in dente, also known as dens invaginatus, is a tooth anomaly that occurs when the inner enamel epithelium is invaginated or folded inwards. Teeth with this condition tend to appear radiographically as a “tooth within a tooth,” manifesting as an internal radiolucency with a radiopaque border.

Answer 621

An enamel pearl is an enamel structure often found in the furcations of molars. Radiographically, they appear as round, smooth, radiopaque structures located on the root.

Answer 622

Internal root resorption, often linked to chronic inflammation from factors like caries, trauma, or tooth fractures, involves key cells called odontoclasts. The odontoclasts specifically target dentin, cementum, and internal structures of the tooth, degrading the tooth by using enzymes that break down minerals and proteins.

Answer 623

The American Academy of Endodontics (AAE) has an endodontic case difficulty assessment that places endodontic treatment cases into three categories based on various considerations: Minimal difficulty: Involves factors exclusively in the minimal difficulty category Moderate difficulty: Involves one or two factors in the moderate difficulty category High difficulty: Involves three or more factors in the moderate difficulty category or at least one factor in the high difficulty category Factors that are assessed for difficulty include: Patient considerations: Medical history, anesthesia problems, patient disposition, ability to open mouth, gag reflex, emergency condition Diagnostic/treatment considerations: Straightforward pulpal or periapical diagnoses, difficulty obtaining radiographs, position in the arch, isolation, crown and root morphology, canal appearance, resorption Additional considerations: Trauma history, history of endodontic treatment, perio-endo diagnosis INBDE Pro-Tip: Consider the characteristics of the patient and the qualities of the tooth in question. Rather than memorize every component of each category, remember these questions: Minimal: Is this case straightforward; could a provider with limited experience treat this? Moderate: Is this case more challenging, requiring a provider with more experience? High: Is this case extremely challenging for even the most experienced provider? In this case, tooth 11 has internal root resorption, which is a factor in the high-difficulty category. A. Minimal B. Moderate The patient has at least one high-difficulty factor (i.e., internal resorption), which places the treatment out of the minimal and moderate difficulty categories. Key Takeaway: Endodontic cases with high difficulty have three or more factors listed in the moderate difficulty category or at least one in the high difficulty category. A tooth with internal root resorption is placed in the high case difficulty for endodontic treatment.

Answer 624

According to the American Dental Association, a diastolic blood pressure reading of > 109 mmHg requires consultation with a physician before treatment because the patient is at a significantly increased risk of a major adverse cardiac event (e.g., myocardial infarction, stroke).

Answer 625

Topical fluoride varnish helps fight cavities. The following mechanisms are true of topical fluoride varnish: Inhibit tooth demineralization by decreasing calcium phosphate solubility Enhance tooth remineralization, creating a more acid-resistant surface Inhibit bacterial enzymes The solubility of calcium phosphate represents the rate at which calcium phosphate dissolves out of the tooth. Therefore, a decrease in calcium phosphate solubility means less calcium phosphate dissolves out of the tooth.

Answer 626

An increase in calcium phosphate solubility would indicate that demineralization is occurring. Fluoride inhibits demineralization and promotes remineralization

Answer 627

Fluoride ions replace the hydroxyl group (OH -) in hydroxyapatite to form fluorohydroxyapatite. They do not bond.

Answer 628

Shadowing present under and around the margin of the restoration indicates recurrent or secondary caries, as the brown, decayed dentin shows through the enamel.

Answer 629

If poor shade selection were involved in this case, the shadowy discoloration would be present on the entire restoration, not just at the margin. Shadowing and darkness are usually indicative of caries.

Answer 630

Although the margin of a restoration is likely where extrinsic staining can occur, the shadowing present under the restoration suggests that there is pathology beyond staining.

Answer 631

The most ideal time for treatment of a diastema alone is after the eruption of the permanent canines. Eruption of the canines often closes diastemas and sets the anterior arch width. Diastemas that are 2 mm in width or smaller may close spontaneously with the eruption of the permanent canines

Answer 632

Treatment of midline diastemas less than 2 mm before the permanent canines erupt is unnecessary and can lead to prolonged treatment. Prolonged orthodontic treatment should be minimized.

Answer 633

Eruption of the permanent molars and premolars will not affect midline diastemas as there is no anterior eruption pressure from these teeth to close the diastema.

Answer 634

The submandibular gland is one of the three major salivary glands and wraps around the mylohyoid muscle.

Answer 635

The digastric muscle is inferior to the submandibular gland.

Answer 636

The temporalis muscle is superior to the submandibular gland.

Answer 637

The buccinator muscle is superior to the submandibular gland.

Answer 638

Thyroid hormone has widespread effects throughout the body which include: increasing cardiac output, increasing ventilation rate, increasing metabolism, increasing the breakdown of carbohydrates and proteins, and inducing the production of growth factors. Adolescents with a deficiency in thyroid hormone often have stunted growth and delayed linear bone development.

Answer 639

High levels of cortisol can lead to weight gain, red striae of the abdomen, muscle weakness, fatigue, and hyperglycemia. High levels of cortisol is often referred to as Cushing's syndrome.

Answer 640

High levels of antidiuretic hormone can cause nausea, cramps, personality changes, memory problems, and depression. This occurs in people with cancer, heart failure, and abnormal function of the hypothalamus.

Answer 641

Low levels of testosterone can cause hypogonadism, decreased muscle mass, decreased body and facial hair, and infertility. It has less of an effect on height.

Answer 642

C-fibers are responsible for transmitting the dull, throbbing, aching pain typical of migraines. They are unmyelinated nerve fibers that are involved in the sensation of chronic pain.

Answer 643

A-delta fibers are myelinated and transmit fast, sharp pain, like the immediate pain felt from a cut. While these fibers contribute to the sharp, initial pain experienced at the onset of a headache, they play a lesser role in the dull, throbbing, and chronic pain that is more typical of migraines.

Answer 644

Following a tooth avulsion, the best attempt at saving the tooth until a dentist can be seen is to first rinse the tooth in milk, saline, or the patient's saliva, not water. Then, the tooth should be reimplanted into the socket. The goal is to preserve the periodontal ligament fibroblasts that were traumatically separated from their position in the oral cavity. If implantation cannot be done immediately, the descending order of preference for storage mediums is the following: Milk Hank’s balanced salt solution Saliva Saline Key Takeaway: The ideal method of protecting a tooth after avulsion is reimplantation into the socket until a dentist can be seen.

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