Ortho/Peds

Question 1

Which of the following is true regarding
crowding of the dentition?
A. Crowding of the primary dentition usually resolves
as the permanent teeth erupt.
B. Spacing in the primary dentition usually indicates
spacing will be present in the adult.
C. Approximately 15% of adolescents have crowding
severe enough to consider extraction of
permanent teeth as part of treatment.
D. Lower incisor crowding is more common in
African-American than white populations.

Answer 1

C. According to data available, approximately 15%
of adolescents have severe crowding that would

require major amounts of expansion or extrac-
tions to resolve. The other statements are false:

crowding in the primary dentition is very rare and

would indicate crowding will occur in the per-
manent dentition; spacing in the primary

dentition is normal; and African-Americans
generally have less crowding than whites.

Question 2

Bones of the cranial base include which of the
following?
A. Maxilla, mandible, and cranial vault
B. Ethmoid, sphenoid, and occipital
C. Palatal, nasal, and zygoma
D. Frontal and parietal

Answer 2

B. The cranial base includes, from anterior to poste-

rior, the ethmoid, sphenoid, and occipital bones.

Question 3

According to Scammon’s growth curves, which
of the following tissues has a growth increase
that can be used to help predict timing of the
adolescent growth spurt?
A. Neural tissues
B. Lymphoid tissues
C. Reproductive tissues

Answer 3

3.C. Reproductive tissues grow at the same time as
the adolescent growth spurt, and the appearance
of secondary sexual characteristics can be used
to help predict the timing of growth.

Question 4

Children in the primary dentition most often
present with \_\_\_\_\_.
A. An increased overbite
B. A decreased overbite
C. An ideal overbite
D. A significant open bite

Answer 4

B. Young children often present with minimal over-
bite or anterior edge-to-edge relationship. Habits

such as thumb-sucking increase the likelihood
that less overbite will be present.

Question 5

An adult patient with a Class II molar
relationship and a cephalometric ANB angle of
2 degrees has which type of malocclusion?
A. Class II dental malocclusion
B. Class II skeletal malocclusion
C. Class I dental malocclusion
D. Class II skeletal malocclusion

Answer 5

A. The molars are Class II but the skeletal

relationship described by a normal ANB meas-
urement is normal, so the malocclusion is dental

in origin.

Question 6

Which of the following reactions is least likely to
be observed during orthodontic treatment?
A. Root resorption
B. Devitalization of teeth that are moved
C. Mobility of teeth that are moved
D. Development of occlusal interferences

Answer 6

B. Root resorption is common during orthodontic
treatment, although lesions often repair on the
root surface. Mobility of teeth is also common as
the PDL reorganizes and widens during tooth
movement. It is uncommon for teeth to become
devitalized as a result of orthodontic movement

unless they have also been substantially compro-
mised by injury or infection.

Question 7

Doubling the force applied at the bracket of a
tooth would have what effect on the moment
affecting tooth movement?
A. The moment would decrease by 50%.
B. The moment would not change.
C. The moment would double.
D. The moment would increase by 4 times.

Answer 7

C. Since M = Fd, doubling the force would double

the moment, or tendency to rotate, tip, or torque.

Question 8

Class II elastics are used by stretching an elastic
between which of the two following points?
A. From the posterior to the anterior within the
maxillary arch
B. From the posterior to the anterior within the
mandibular arch
C. From the posterior of the maxillary arch to the
anterior of the mandibular arch
D. From the posterior of the mandibular arch to the
anterior of the maxillary arch

Answer 8

D. Class II elastics work in the direction that would
be used to correct a Class II malocclusion, to pull
the mandibular teeth forward and the maxillary
teeth distally.

Question 9

When Class III elastics are used, the maxillary
first molars will _____.
A. Move distally and intrude
B. Move mesially and extrude
C. Move mesially and intrude
D. Move only mesially; there will be no movement in
the vertical direction

Answer 9

B. Class III elastics are worn from the maxillary
first molars to the mandibular canines. The force

system created by Class III elastics will produce
mesial movement and extrusion of the maxillary
first molars.

Question 10

Which of the following depicts the usual order of
extraction of teeth if serial extraction is chosen
as the treatment to alleviate severe crowding?
A. Primary second molars, primary first molars,
permanent first premolars, primary canines
B. Primary canines, primary first molars, permanent
first premolars
C. Primary first molars, primary second molars,
primary canines
D. Primary canines, permanent canines, primary first
molars, permanent first premolars

Answer 10

B. Primary canines are extracted to encourage
alignment of the crowded incisors. However, the
incisors align and upright, borrowing space
otherwise needed for eruption of the permanent
canine. Primary first molars are then extracted to
encourage eruption of the first premolar so it may
be extracted to make room for the permanent
canine to erupt.

Question 11

A 7-year-old has a 4-mm maxillary midline
diastema. Which of the following should be
done?
A. Brackets should be placed to close it.
B. A radiograph should be taken to rule out the
presence of a supernumerary tooth.
C. Nothing should be done. It will close on its own.
D. Nothing should be done. Treatment should be
deferred until the rest of the permanent dentition
erupts.

Answer 11

B. When a large diastema greater than 2 mm is
present, it will probably not close on its own.
Diagnostic tests, such as a radiograph, should be

accomplished to rule out the presence of a super-
numerary tooth, usually a mesiodens.

Question 12

Reduction of overbite can be accomplished most
readily by which of the following tooth
movements?
A. Intruding maxillary incisors
B. Uprighting maxillary and mandibular incisors
C. Using a high-pull headgear to the maxillary molars
D. Using a lip bumper

Answer 12

A. Intruding incisors would decrease overbite while
uprighting teeth and using a high-pull headgear
could make overbite correction more difficult. A lip
bumper would likely have little effect on overbite.

Question 13

Congenitally missing teeth are the result of
failure in which stage of development?
A. Initiation
B. Morphodifferentiation
C. Apposition
D. Calcification

Answer 13

A. Initiation and proliferation are the only possibilities
for congenitally absent teeth, the bud and cap
stages, respectively. In the histodifferentiation
stage, the teeth are present; failure in this stage
results in structural abnormalities of the enamel
and dentin. Failure in the morphodifferentiation
stage results in size and shape abnormalities.

Question 14

During an emergency dental visit in which a
tooth is to be extracted due to extensive pulpal
involvement, a moderately mentally challenged
5-year-old child becomes physically combative.
The parents are unable to calm the child. What
should the dentist do?
A. Discuss the situation with the parents.
B. Force the nitrous oxide nosepiece over the child’s
mouth and nose.
C. Use the hand over mouth exercise (HOME).
D. Use a firm voice control.

Answer 14

A. For any child patient, it is imperative to discuss
any kind of physical restraint with the parent to

obtain an informed consent. An informed con-
sent includes recommended treatment, reason-
able alternatives to that treatment, and the risk of

no treatment. If the dentist wants to use a firm

voice control, it is recommended that a discus-
sion take place beforehand, as well.

Question 15

Which of the following is the definition of
conscious sedation?
A. A minimally depressed level of consciousness that
retains the patient’s ability to independently and
continuously maintain an airway and respond
appropriately to physical stimulation or verbal
command.
B. A significantly depressed level of consciousness
that retains the patient’s ability to independently
and continuously maintain an airway and respond
appropriately to physical stimulation or verbal
command.
C. A minimally depressed level of consciousness that
retains the patient’s ability to independently and
continuously maintain an airway.
D. A significantly depressed level of consciousness
that retains the patient’s ability to independently
and continuously maintain an airway.

Answer 15

A. Conscious sedation is defined as a minimally
depressed level of consciousness as opposed to
deep sedation or general anesthesia. Remember
that there are four stages of anesthesia (analgesia→ delirium → surgical anesthesia → respiratory
paralysis) and only in the first stage (analgesia) is
the patient conscious. The patient should be able
to maintain an airway and respond to stimulation
and command.

Question 16

The enamel rods in the gingival third of primary
teeth slope occlusally instead of cervically as in
permanent teeth, and the interproximal contacts
of primary teeth are broader and flatter than
permanent teeth.
A. The first statement is true and the second
statement is true.
B. The first statement is true and the second
statement is false.
C. The first statement is false and the second
statement is true.
D. The first statement is false and the second
statement is false.

Answer 16

A. Both of these statements are true. As a result of
these differences, there are modifications in
preparation design for Class II amalgams.
Beveling the gingival seat of Class II amalgams

are not recommended. There is a greater con-
vergence from cervical to occlusal of the buccal

and lingual walls of Class II amalgam prepara-
tions because of the broad and flat contact areas.

Question 17

Formocresol has been shown to have a very
good success rate when used as a medicament
for pulpotomy procedures. Why is there
continued interest to find another medicament
that performs as well as or better than
formocresol?

A. Application of formocresol is a clinically time-
consuming procedure.

B. Formocresol is toxic and there is possible
bloodborne spread to vital organs.
C. It has been demonstrated that formocresol may
cause spontaneous abortion.
D. It has been demonstrated that formocresol may
cause failure to develop adequate lung capacity in
children.

Answer 17

B. There have been concerns regarding the blood-
borne spread of formocresol at least since 1983,

when a study was published describing the tis-
sue changes induced by the absorption of

formocresol from pulpotomy sites in dogs. Ferric
sulfate and mineral trioxide aggregate (MTA)

have been demonstrated to be reasonable alter-
natives to formocresol.

Question 18

The following teeth are erupted in an 8-year-old patient. What is the space maintenance of choice?

3 A B C 7 8 9 10 H I __ 14
30 T S R 26 25 24 23 M L K 19

A. Band-loop space maintainer
B. Lower lingual holding arch
C. Nance holding arch
D. Distal shoe space maintainer

Answer 18

A. A band-loop space maintainer would work well
in this case because the maxillary first bicuspid

normally erupts prior to the loss of either the sec-
ond primary molar or the primary cuspid.

Question 19

The mother of a 5-year-old patient is concerned
about the child’s thumb-sucking habit. Six
months ago, the patient had 5-mm overjet and a
3-mm anterior open bite. Today, the patient has
10% overbite and 3.5-mm overjet. The mother
says that the child only sucks his thumb every
night when falling to sleep. Of the following,
which is the best advice?
A. Refer to a speech pathologist.
B. Recommend tongue thrust therapy.
C. Recommend a thumb-sucking appliance.
D. Counsel the parent regarding thumb-sucking, and
recall the patient in 3 months.

Answer 19

D. The patient’s overbite/overjet improved from the
previous examination and therefore it is likely that

the patient’s digit-sucking habit had decreased sig-
nificantly. The mother did state that the patient

only sucks his thumb while falling asleep. When
digit-sucking occurs for a limited time per day, not
only is tooth movement normally associated with
digit-sucking unlikely, it is possible for teeth to
return to a more normalized position. Remember
that the risk of malocclusion as related to habitual
activity is a function of amount of time per day the
habit is practiced, the duration of the habit in terms
of weeks and months, and the intensity of the

habit. Because the occlusion seems to be improv-
ing and because the habit has significantly

decreased, the best treatment is to counsel the
parent regarding thumb-sucking, and recall the
patient in 3 months.

Question 20

Orthodontic closure of a midline diastema in a
patient with a heavy maxillary frenum _____.
A. Is accomplished prior to the frenum surgery.
B. Is accomplished after the frenum surgery.
C. After orthodontic closure, frenum surgery is
typically not indicated.
D. After frenum surgery, orthodontic closure is
typically not indicated.

Answer 20

A. Orthodontic closure of a midline diastema is
accomplished prior to the periodontal surgery. If
a frenectomy is performed prior to orthodontic
treatment, it is possible that scar tissue could
form in the area, which may impede orthodontic
tooth movement.

Question 21

Your patient is 4 years old. Tooth E was
traumatically intruded and approximately 50%
of the crown is visible clinically. What is your
treatment of choice?
A. Reposition and splint
B. Reposition, splint, and primary endodontics
C. Reposition, splint, and formocresol pulpotomy
D. None of the above

Answer 21

D. Unless it can be determined that the primary
tooth is impinging on the permanent successor,

intruded primary teeth are left alone in the hopes
that they will spontaneously re-erupt. On the
other hand, intruded permanent teeth have a
poorer prognosis. If there is an open apex, an
intruded permanent tooth should be closely
monitored for spontaneous eruption. An intruded
permanent tooth with a closed apex should be
repositioned orthodontically, and a calcium
hydroxide pulpectomy should be performed 2
weeks following the injury.

Question 22

Your patient is 4 years old. The maxillary right
primary central incisor was traumatically
avulsed 60 minutes ago. What is the treatment of
choice?
A. Replant, splint, primary endo
B. Replant, splint, formocresol pulpotomy
C. Replant, no splint, primary endo
D. None of the above

Answer 22

D. Replanting primary teeth has a poor prognosis,
but could be considered if within 30 minutes.
A primary tooth that is replanted will likely
require splinting. The patient should be placed
on antibiotics, restricted to a soft diet, and have
a primary endodontic procedure accomplished.

Question 23

A young permanent incisor with an open apex
has a pinpoint exposure due to a traumatic
injury that occurred 24 hours previously. The
best treatment is _____.
A. Place calcium hydroxide on the pinpoint
exposure
B. Open the pulp chamber to find healthy pulp tissue
and perform a pulpotomy
C. Initiate a calcium hydroxide pulpectomy
D. Initiate conventional root canal treatment with
gutta-percha

Answer 23

B. Because the exposure site is likely significantly
contaminated from the injury that occurred
24 hours previously, direct pulp capping with
calcium hydroxide is contraindicated. A calcium
hydroxide pulpectomy should not be the
automatic procedure accomplished because
continued root elongation and closure of the
pulp canal will likely not occur. A calcium

hydroxide pulpotomy is preferable for a trauma-
tized tooth with an open apex with either a large

exposure or a small exposure of several hours or
days postinjury. Clinically, the tooth should be
anesthetized and, under sterile conditions, and
the clinician should open the pulp chamber in
search of healthy pulp tissue. It is likely that vital
tissue will be present within 24 hours of the
injury.

Question 24

A permanent incisor with an open apex is
extruded 4 mm following an injury 15 minutes
ago. What is the treatment of choice?
A. No immediate treatment, monitor closely for
vitality.
B. Reposition, splint, monitor closely for vitality.
C. Reposition, splint, initiate calcium hydroxide
pulpotomy.
D. Reposition, splint, initiate calcium hydroxide
pulpectomy.

Answer 24

B. An extruded permanent incisor with an open

apex should be repositioned, splinted, and mon-
itored closely for loss of vitality. Because of the

open apex, the tooth may remain vital and con-
tinue development; therefore, immediate pulp

treatment is contraindicated.

Question 25

Which of the following is the most likely cause of pulpal necrosis following trauma to a tooth? A. Ankylosis B. Calcific metamorphosis C. Pulpal hyperemia D. Dilaceration

Answer 25

C. The other three answers may occur as the result of trauma but do not cause loss of vitality. Pulpal hyperemia causes increased intrapulpal pressure and swelling, which may result in an interruption of the pulp’s blood supply. Without an adequate blood supply, the pulp becomes necrotic. This process can take time, and symptoms (either radiographic or clinical) may not present for weeks or even months. Typically, follow-up examination and radiographs are indicated at 1-, 2-, and 6-month intervals following a traumatic incident.

Question 26

``` Which of the following types of malocclusions is most common? A. Class I malocclusion B. Class II malocclusion C. Class III malocclusion D. Open bite malocclusion ```

Answer 26

A. Class I is the most common malocclusion, at about 50% of the U.S. population, compared to Class II (15%) and Class III (about 1%).

Question 27

According to Scammon’s growth curves, which of the following tissues has a growth increase that can be used to help predict timing of the adolescent growth spurt? A. Neural tissues B. Lymphoid tissues C. Reproductive tissues

Answer 27

C. Reproductive tissues grow at the same time as the adolescent growth spurt and the appearance of secondary sexual characteristics can be used to help predict the timing of growth.

Question 28

Of the following, which is the least reliable way to predict the timing of the peak of the adoles- cent growth spurt for an individual? A. Plotting changes in height over time on a growth curve B. Following eruption timing of the dentition C. Taking a hand–wrist radiograph to assess skeletal development D. Observing changes in secondary sex characteristics

Answer 28

B. Although developmental indicators generally cor- relate well with each other, using dental age to predict timing of growth is the least reliable of the methods offered.

Question 29

In a patient with incomplete cleft palate, which of the following aspects is most likely to remain open? A. The anterior aspect B. The middle aspect C. The posterior aspect D. The right aspect

Answer 29

C. Fusion of the palate proceeds from anterior to posterior, so any disturbance that occurs during that time will stop fusion at that point, leading to an opening posteriorly.

Question 30

``` Children in the primary dentition most often present with _____. A. An increased overbite B. A decreased overbite C. An ideal overbite D. A significant open bite ```

Answer 30

B. Young children often present with minimal overbite or anterior edge-to-edge relationship. Habits such as thumb-sucking increase the likelihood that less overbite will be present.

Question 31

During the mixed dentition, a 1-mm diastema develops between the maxillary incisors. Which of the following is most likely? A. The diastema will need orthodontic intervention to be closed B. The diastema will resolve once the canines erupt C. The diastema will only resolve when all of the permanent teeth erupt D. The diastema will continue to widen as permanent teeth erupt

Answer 31

B. Small diastemas between the maxillary incisors of 2 mm or less will generally close on their own as more permanent teeth, specifically the canines, erupt. Presence of a midline diastema before canine eruption is referred to as “the ugly duckling stage.”

Question 32

A patient with the maxillary first permanent molar mesiobuccal cusp sitting distal to the buccal groove of the mandibular first molar has which type of malocclusion? A. Class I B. Class II, division 1 C. Class II, division 2 D. Class III

Answer 32

7. D. If the mandibular molar buccal groove is mesial to the mesiobuccal cusp of the maxillary molar, the relationship is described as Angle Class III.

Question 33

An adult patient with a Class II molar relation- ship and a cephalometric ANB angle of ``` 2 degrees has which type of malocclusion? A. Class II dental malocclusion B. Class II skeletal malocclusion C. Class I dental malocclusion D. Class II skeletal malocclusion ```

Answer 33

A. The molars are Class II, but the skeletal relationship described by the ANB (the A-P angular difference between the maxilla and mandible) measurement is normal, so the malocclusion is dental in origin.

Question 34

In a patient who displays excessive maxillary incisor at rest, has an excessive lower face height, and has a deep overbite, which of the following would be the preferred method of overbite correction? A. Eruption of posterior teeth to rotate the mandible open B. Intrusion of maxillary incisors C. Intrusion of mandibular incisors D. Flaring of maxillary and mandibular incisors

Answer 34

B. All of the choices are possible solutions to correct a deep overbite. Erupting posterior teeth would increase the already excessively long lower face height, whereas intrusion of maxillary incisors would improve the excessive maxillary incisor show at rest.

Question 35

In tooth movement, the formation of a hyalin- ized zone on the pressure side is due to _____. A. The application of light, continuous forces B. The application of heavy forces C. The normal forces of mastication D. Abnormal swallowing patterns

Answer 35

B. Heavy forces cause compression of the PDL with | hyalinization.

Question 36

Which of the following reactions is least likely to be observed during orthodontic treatment? A. Root resorption B. Devitalization of teeth that are moved C. Mobility of teeth that are moved D. Development of occlusal interferences

Answer 36

B. Root resorption is common during orthodontic treatment, although lesions often repair on the root surface. Mobility of teeth is also common as the PDL reorganizes and widens during tooth movement. It is uncommon for teeth to become devitalized as a result of orthodontic movement unless they have also been substantially compro- mised by injury or infection.

Question 37

Root resorption is correlated to the pattern of stress distribution in the PDL and type of tooth movement. A. True B. False

Answer 37

A. Although somewhat controversial, it is believed that types of tooth movements that concentrate force in small areas of the PDL are more likely to result in root resorption during orthodontic treat- ment.

Question 38

Putting a force through which of the following points would cause pure translation of a tooth without rotation, tipping, or torque? A. Center of rotation B. Center of resistance C. Center of the bracket D. Apex of the root

Answer 38

B. The center of resistance is defined as the point at which force application will cause pure translation of a tooth.

Question 39

Doubling the force applied at the bracket of a tooth would have what effect on the moment affecting tooth movement? A. The moment would decrease by 50%. B. The moment would not change. C. The moment would double. D. The moment would increase by four times.

Answer 39

C. Since M = Fd, doubling the force would double the | moment, or tendency to rotate, tip, or torque.

Question 40

Two equal and opposite forces that are not collinear applied to a tooth are called which of the following? A. The center of resistance B. The center of rotation C. Root movement D. A couple

Answer 40

D. This is the definition of a couple. A couple results | in a rotational tendency or pure moment.

Question 41

A wire extending from the molars to the inci- sors is activated to intrude the incisors. What is the side effect on the molars? A. The molars will tip forward and intrude B. The molars will rotate mesiobuccally C. The molars will tip distally and extrude D. The molars will rotate distobuccally

Answer 41

C. The sum of the forces and moments on an appli- ance must equal zero. If the incisors intrude, the molars will extrude. These two forces form a couple with a moment in one direction. The molars will experience a couple in the opposite direction, which will cause them to tip distally.

Question 42

Class II elastics are used by stretching an elas- tic between which of the two following points? A. From the posterior to the anterior within the maxillary arch B. From the posterior to the anterior within the mandibular arch C. From the posterior of the maxillary arch to the anterior of the mandibular arch D. From the posterior of the mandibular arch to the anterior of the maxillary arch

Answer 42

D. Class II elastics work in the direction that would be used to correct a Class II malocclusion, to pull the mandibular teeth forward and the maxillary teeth distally.

Question 43

What makes it possible for nickel-titanium archwires to exhibit superelastic behavior? A. This behavior is based on a reversible transformation within the austenitic phase. B. This behavior is based on a reversible transformation between the austenitic and martensitic phases. C. This behavior is based on a reversible transformation within the martensitic phase. D. This behavior is based on an irreversible transformation within the martensitic phase.

Answer 43

B. Nickel-titanium archwires can exist in more than one phase: austenitic and martensitic phases. Superelastic behavior of these wires is attributed to the reversible transformation between these two phases.

Question 44

What is a second-order bend? A. A bend to position a tooth buccolingually B. A bend to provide angulation of a tooth in mesiodistal direction (tip) C. A bend to provide correct angulation of a tooth in labiolingual direction (torque) D. A bend to rotate a tooth

Answer 44

B. A second-order bend is placed to provide angu- lation of a tooth in the mesiodistal direction, also called tip. A first-order bend is placed in an arch- wire to position a tooth in the labiolingual direc- tion (in-out bend) and/or to rotate a tooth as seen in the occlusal plane. A bend to provide angulation in the labio-lingual direction is called a third-order bend (torqueing bend).

Question 45

When Class III elastics are used, the maxillary first molars will _____. A. Move distally and intrude B. Move mesially and extrude C. Move mesially and intrude D. Move only mesially; there will be no movement in the vertical direction

Answer 45

B. Class III elastics are worn from the maxillary first molars to the mandibular canines. The force sys- tem created by Class III elastics will produce mesial movement and extrusion of the maxillary first molars.

Question 46

An adolescent patient presents to your office with a skeletal and dental Class II malocclusion and a deep bite. Which of the following would be a proper treatment plan for this patient? A. Reverse-pull headgear, extrusion arch, and full fixed appliances B. Reverse-pull headgear, intrusion arch, and full fixed appliances C. Extraction of maxillary first premolars, extrusion arch, and full fixed appliances D. Extraction of maxillary first premolars, intrusion arch, and full fixed appliances

Answer 46

D. This patient, if still growing, may be treated with a growth modification approach using headgear (either cervical or high-pull, not reverse-pull) to correct the Class II malocclusion. Since deep overbite is present, a cervical headgear should be used because this type of headgear will extrude the molars which, in turn, will aid in reducing overbite; however, this was not one of the choices. If the patient is a nongrowing patient, the second approach to treat Class II malocclusion is Class II camouflage, which includes extraction of maxillary first premolars to correct the malocclusion. An intrusion arch along with full fixed appliances should be used to correct the deep bite.

Question 47

When using a cervical-pull headgear, the forces generated on the maxillary first molar cause this tooth to move in which of the following ways? A. Mesially and to extrude B. Distally and to extrude C. Mesially and to intrude D. Distally and to intrude

Answer 47

B. The line of force generated by a cervical headgear will cause the maxillary first molar to move distally, usually also tip distally, and to extrude. A high-pull headgear would cause the molar to move distally and intrude.

Question 48

Which of the following depicts the usual order of extraction of teeth if serial extraction is chosen as the treatment to alleviate severe crowding? A. Primary second molars, primary first molars, permanent first premolars, primary canines B. Primary canines, primary first molars, permanent first premolars C. Primary first molars, primary second molars, primary canines D. Primary canines, permanent canines, primary first molars, permanent first premolars

Answer 48

B. Primary canines are extracted to encourage alignment of the crowded incisors. However, the incisors align and upright, borrowing space oth- erwise needed for eruption of the permanent canine. Primary first molars are then extracted to encourage eruption of the first premolar so it may be extracted to make room for the permanent canine to erupt.

Question 49

Closure of a 2-mm maxillary midline diastema should be accomplished orthodontically in an 8-year-old in which of the following circum- stances? A. If the lateral incisors are missing B. If the space creates an esthetic concern and the child is being teased about it C. If there is also deep overbite present D. If mild crowding is also present

Answer 49

B. There is a high likelihood that a small diastema of 2 mm or less will close on its own over time as the permanent teeth erupt. However, if a child suffers psychological trauma because of esthetic concerns, the diastema can be closed. Parents should be informed of the reason for treatment and understand that there are some risks of per- forming orthodontic treatment that they are assuming.

Question 50

In a patient with missing permanent maxillary lateral incisors, the decision of whether to sub- stitute canines in the lateral spaces depends on all of the following except _____. A. The amount of crowding in the maxillary arch B. The interarch relationship between the maxillary and mandibular dentition C. The esthetic appearance of the permanent canines D. The type of orthodontic appliance used to align the teeth

Answer 50

D. Excessive crowding may influence the decision in favor of canine substitution. However, esthetic concerns may deter a decision to substitute canines for lateral incisors. Patients with a Class II interarch relationship requiring maxillary extrac- tions anyway may be better served to substitute canines for laterals rather than extracting healthy first premolars.

Question 51

All of the following may be indications to con- sider extraction of permanent teeth in an ortho- dontic patient except _____. A. Excessive crowding B. Class II interarch relationship C. Flat lip profile D. Anterior open bite

Answer 51

C. Excessive crowding may necessitate extractions. Also, extraction of maxillary premolars may be indicated to camouflage a Class II molar relation- ship. Anterior open bites may be improved by uprighting anterior teeth to increase overbite. Flat lips will not be improved by extraction of perma- nent teeth but other considerations may still necessitate extraction even in those patients.

Question 52

Advantages of fixed wire retention compared to a removable Hawley-type retainer include which of the following? A. Does not require the patient to remember to wear it. B. Is easier to clean. C. The design can be altered to achieve minor tooth movements. D. It can incorporate an acrylic bite plate to avoid relapse of overbite correction.

Answer 52

A. Fixed retention requires no patient cooperation to achieve retention. However, fixed retainers are more difficult to clean and cannot be modified to move teeth or control overbite relapse.

Question 53

``` The preferred surgical procedure to correct a Class II malocclusion due to a deficient mandible is which of the following? A. Maxillary impaction B. Maxillary setback C. Mandibular setback D. Mandibular advancement ```

Answer 53

D. Class II correction by surgery requires moving the mandible forward or the maxilla back. In a patient with a deficient mandible it is preferable to move the mandible forward. Moving the maxilla back significantly is difficult or impossible.

Question 54

Of the following, which is considered to be the least stable orthognathic surgical movement? A. Advancement of the mandible B. Advancement of the maxilla C. Superior movement (impaction) of the maxilla D. Inferior movement of the maxilla

Answer 54

D. Inferior movement of the maxilla, especially without bone grafting and rigid fixation, has been shown to relapse over time because of vertical occlusal forces generated by the masticatory musculature.

Question 55

Your patient exhibits enamel hypoplasia near the incisal edges of all permanent incisors and cuspids, except for the maxillary lateral inci- sors, which appear normal. At what age would ``` you suspect some kind of systemic problem? A. Prior to birth B. From birth to 1 year of age C. From 1 to 2 years of age D. From 2 to 3 years of age ```

Answer 55

B. All anterior permanent teeth begin calcification during the first 6 months, except for maxillary lat- eral incisors. The maxillary lateral incisor may be used as a key to timing; if this tooth is affected, the causative event is likely to have occurred at 1 year of age or older.

Question 56

Fluorosis is the result of excessive systemic flu- oride during which stage of tooth development? A. Initiation B. Morphodifferentiation C. Apposition D. Calcification

Answer 56

D. Localized infection, trauma, and excessive sys- temic fluoride ingestion may cause hypocalcifi- cation. Disturbances in apposition result in incomplete tissue formation. For example, an intrusive injury to a primary incisor may disrupt enamel apposition and result in an area of enamel hypoplasia.

Question 57

Why are implants not generally performed on a 12-year-old patient with congenitally missing lateral incisors? A. The patient would likely not be able to tolerate the surgical procedure. B. Waiting for the crowns is too much of an esthetic issue with most children that age. C. The gingival tissue will recede as the child gets older. D. The implants will appear to submerge as the child gets older.

Answer 57

D. Implants are osseointegrated and therefore behave as ankylosed teeth. As teeth erupt and alveolar bond formation occurs, an osseointe- grated implant will appear to submerge.

Question 58

On the health history form, the mother of a 6-year-old new patient notes that the child is moderately mentally challenged. The dentist should _____. A. Refer to a pediatric dentist B. Use a Tell-Show-Do technique of behavior management C. Use conscious sedation D. Use restraints after obtaining informed consent

Answer 58

B. Many mentally challenged individuals can be mainstreamed and treated as any other patient. Because a moderately challenged 6-year-old may ``` function as a preschool child, the normal man- agement techniques are likely applicable. The ``` correct answer for such a question will include some kind of normalization response.

Question 59

The functional inquiry questionnaire reveals that the mother has had negative dental experi- ences and remains very nervous regarding her dental care. How would this most likely influ- ence her 3-year-old child’s reaction to dentistry? A. Increase the likelihood of a negative behavior. B. Increase the likelihood of a positive response to dentistry. C. Will likely cause an initial positive reaction, which changes to a negative reaction with the slightest stress. D. Maternal anxiety has little effect on a child’s behavior in a dental setting.

Answer 59

A. Studies show that there is a high correlation between maternal anxiety and a child’s negative behavior in the dental office. This effect is greatest for children less than 4 years of age.

Question 60

Which of the following local anesthetic tech- niques is recommended for anesthetizing a pri- mary mandibular second molar which will be extracted? A. Buccal and lingual infiltration adjacent to the second primary molar B. Inferior alveolar nerve block C. Inferior alveolar nerve block and lingual nerve block D. Inferior alveolar, lingual, and buccal nerve block

Answer 60

D. Inferior alveolar, lingual, and buccal nerve blocks are required to adequately anesthetize this area when performing deep restorations, pulp ther- apy, and extractions. Some studies have shown that local infiltration anesthesia for primary molars is effective, but this is primarily reserved for restorative procedures because there is an increased probability for anesthesia failure using local infiltration for pulp therapy and extraction procedures.

Question 61

In the primary dentition, the mandibular fora- men is located where in relation to the plane of occlusion? A. Higher than the plane of occlusion B. Much higher than the plane of occlusion C. Lower than the plane of occlusion D. The same level as the plane of occlusion

Answer 61

C. In the primary dentition patient, the mandibular foramen is located lower than the plane of occlu- sion. Therefore, mandibular block injections for these patients are made somewhat lower than as is done for the adult patient.

Question 62

``` What is the minimum alveolar concentration of nitrous oxide (Vol %)? A. 50 B. 75 C. 95 D. 105 ```

Answer 62

D. Minimum alveolar concentration is a measure of potency. It is the concentration required to pro- duce immobility in 50 Vol % of patients responding to surgical incision. A minimum alveolar concentra- tion of 105 Vol % indicates that nitrous oxide alone does not produce profound surgical anesthesia at a normal atmospheric pressure.

Question 63

Following the administration of a local anes- thetic, most patients can be maintained in con- scious sedation at _____. A. 20%–40% nitrous oxide B. 20%–40% oxygen C. 50% nitrous oxide D. 10% nitrous oxide

Answer 63

A. The total flow rate is 4 to 6 L/min for most chil- dren. The practitioner can check the bag and make adjustments if necessary. The mainte- nance dose of nitrous oxide during an operative procedure is typically about 30%. In other words, a standard maintenance dose would usually be 4 L oxygen and 2 L of nitrous oxide. Of course,after a lengthy administration, it is wise to reduce the concentration due to tissue saturation and nausea.

Question 64

Your patient is 9 years old. The mandibular left first primary molar has a large, carious lesion on the distal and on the occlusal and the tooth has greater mobility than what you would nor- mally expect. You should _____. ``` A. Take a radiograph of the area B. Perform a pulpotomy C. Perform a pulpectomy D. Extract the tooth and consider space maintenance ```

Answer 64

A. It is difficult to know which treatment is indicated without more information than is presented in the question. The tooth could be mobile due to furcation involvement, internal or external root resorption, exfoliation, or a combination of all the above. Obtaining more clinical information by taking a radiograph is necessary before any further treatment is rendered.

Question 65

Why are rounded internal line angles desirable in the preparation of amalgam restorations in primary teeth? A. They increase retention B. They conserve tooth structure C. They increase resistance D. They decreases internal stresses in the restorative material

Answer 65

D. Due to the small size of primary molars and, therefore, small restorations as well, it is helpful to reduce stresses within the restorative material. It has been demonstrated that rounded internal line angles aid in reducing stress when com- pared to sharp internal line angles. Many of the burs recommended for use in primary molars have a rounded end to help achieve softened internal line angles.

Question 66

Your patient is 7 years old and has a very large, carious lesion on tooth T. What radiolog- ical factors should be used in determining the ``` best treatment of choice between pulpotomy and primary endodontics? A. Furcation involvement B. External root resorption C. Internal root resorption D. Two of the above E. All of the above ```

Answer 66

A. The treatment decision in this case should be made on the presence or absence of furcation involvement. Absence of furcation involvement generally indicates a vital pulp. Of course, it is nec- essary to have vital tissue to perform a pulpotomy. Presence of furcation involvement generally indi- cates progression to a nonvital pulp. If furcation involvement is present, a pulpectomy would be the treatment of choice in the absence of external or internal root resorption.

Question 67

``` Which pulpotomy medicament demonstrates better success rates than formocresol? A. Mineral trioxide aggregate B. Calcium hydroxide C. Resin-modified glass ionomer cement D. Fifth-generation bonding agents ```

Answer 67

A. Mineral trioxide aggregate (MTA) pulpotomies have shown very good promise and generally show higher success rates than formocresol pulpotomies. However, at this time MTA is very expensive and is not used as often as formocre- sol or ferric sulfate.

Question 68

The pulp tissue of primary teeth _____. 1. In general, is smaller proportionately than permanent pulps in relation to tooth crown size. 2. Is closer to the outer surface of the tooth than the permanent teeth. 3. Follows the general surface contour of the crown. 4. Has the mesial pulp horn closer to the surface than the distal pulp horn. A. Only 1, 2, and 4 are correct. B. Only 2, 3, and 4 are correct. C. Only 1, 3, and 4 are correct. D. 1, 2, 3, and 4 are correct.

Answer 68

B. The pulp chambers of primary teeth are propor- tionately larger compared to the size of the crown. This is significant because there is a higher risk of accidental pulp exposures on pri- mary teeth. In particular, the mesial-buccal pulp horn of the first primary molar is close to the external surface of the tooth.

Question 69

The following teeth are erupted in an 8-year-old patient. What is the space maintenance of choice? ``` 3 ABC 7 8 9 10 H I __ 14 30 T S R 26 25 24 23 M L K 19 A. Band-loop space maintainer. B. Lower lingual holding arch. C. Nance holding arch. D. Distal shoe space maintainer. ```

Answer 69

C. In space maintenance, the clinician must always be mindful of the exfoliation sequence of teeth. In this situation, the authors would normally exfoli- ate prior to the eruption of the second permanent premolar, tooth #13. If a band loop space main- tainer were used, there may be no anterior abutment if there is a normal exfoliation sequence. This could result in mesial tipping of the perma- nent molar and space loss. A Nance holding arch or a palatal holding arch would be an appropriate choice.

Question 70

``` The following teeth are erupted in a 4-year-old patient. What is the space maintenance of choice? A B C D E F G H I J __ S R Q P O N M L K A. Band-loop space maintainer. B. Lower lingual holding arch. C. Nance holding arch. D. Distal shoe space maintainer. ```

Answer 70

D. The only possibility within these choices is the distal shoe space maintainer. Some clinicians find that a removable “kiddie” acrylic partial can also be successful. These kiddie partials extend distally to the point where the mesial of the first permanent molar would be. Some advocate plac- Sample Exam Answer Key ▼ 405 ing a 1-mm-deep labial-lingual groove in the cast on the alveolar ridge on the mesial of the first permanent molar. This results in extra acrylic at the tissue–acrylic interface that causes pressure. This may aid in keeping the unerupted first permanent molar in position.

Question 71

If the fluoride level in the drinking water is greater than 0.6 ppm at any age, no supplemen- tal systemic fluoride is indicated. If the patient is less than 12 months old, no supplemental systemic fluoride is indicated, whatever the water fluoride level. A. The first statement is true and the second statement is true. B. The first statement is true and the second statement is false. C. The first statement is false and the second statement is true. D. The first statement is false and the second statement is false.

Answer 71

B. The systemic fluoride “Rule of 6s” states: a. If fluoride level is greater than 0.6 ppm, no supplemental systemic fluoride is indi- cated. b. If the patient is less than 6 months old, no sup- plemental systemic fluoride is indicated. c. If the patient is greater than 16 years old, no supplemental systemic fluoride is indicated. Therefore, the statement, “If the patient is less than 12 months old, no supplemental systemic fluoride is indicated” is false.

Question 72

A 1-year-old patient has his first dental exami- nation. The dentist reviews with the parent when to expect the next teeth to erupt, teething, oral hygiene tips for toddlers, and discusses fluoride issues with bottled water and tooth- paste. The term that describes this proactive ``` approach to dental care is _____. A. Risk assessment B. Probability counseling C. Anticipatory guidance D. Preventive support counseling ```

Answer 72

C. Anticipatory guidance is counseling patients and parents regarding the child’s home oral healthcare that is age-appropriate and is focused on prevention. Subjects to discuss with parents include: a. Oral hygiene b. Oral development c. Fluoride d. Diet and nutrition e. Oral habits f. Trauma and injury prevention

Question 73

Most natal and neonatal teeth are primary teeth. They should be extracted. A. The first statement is true and the second statement is true. B. The first statement is true and the second statement is false. C. The first statement is false and the second statement is true. D. The first statement is false and the second statement is false.

Answer 73

B. Most natal and neonatal teeth are primary teeth (90%); very few are supernumerary teeth (10%). Most are mandibular incisors (85%). Extraction of primary teeth should be accomplished only if they are extremely mobile and there is danger of aspiration. Most commonly, natal and neonatal teeth are left in position.

Question 74

The “willful failure of parent or guardian to seek and follow-through with treatment neces- sary to ensure a level of oral health essential ``` for adequate function and freedom from pain and infection” is a definition of _____. A. Munchausen syndrome by proxy B. Emotional abuse C. Parental corruption D. Neglect ```

Answer 74

D. Munchausen syndrome by proxy is a condition in which a person, usually a parent, presents factitious symptoms and illnesses in a child, which may result in extensive testing and/or hospitalizations. Examples of emotional abuse include denial of affection, isolation, extreme threats, and corruption. A parent who knowingly and willingly does not seek care for a child who has pain, infection, or inadequate function is guilty of neglect.

Question 75

Where do lesions commonly occur in the pri- mary form of acute herpetic gingivostomatitis? ``` A. Buccal mucosa B. Tonsils, hard and soft palate C. Tongue D. Gingiva E. All of the above ```

Answer 75

E. The location of lesions of primary herpetic gin- givostomatitis is on mucous membrane, including tonsils, hard and soft palates, buccal mucosa, tongue, palate, and gingiva. Children with this disease can be very sick and require close super- vision and support. They typically have a very significant fever, can become dehydrated, and the process lasts up to 2 weeks. Treatment may consist of: a. Topical anesthetics such as 0.5% dyclonine hydrochloride and viscous lidocaine b. Coating solutions such as diphenhydramine elixir and kaolin-pectin compound c. Antivirals such as acyclovir d. Analgesics such as acetaminophen and ibuprofen

Question 76

Localized aggressive periodontitis in the pri- mary dentition is seen most commonly in the primary molar area. It is most common in Asian children. A. The first statement is true and the second statement is true. B. The first statement is true and the second statement is false. C. The first statement is false and the second statement is true. D. The first statement is false and the second statement is false.

Answer 76

B. Localized aggressive periodontitis in the primary ``` dentition, previously known as localized prepu- bertal periodontitis (LPP) is most common in the ``` primary molar area and occurs most commonly in African-American children. Treatment includes debridement and antibiotic therapy.

Question 77

Your patient is 8 years old. Tooth #8 was avulsed and you replanted it within 30 min- utes. What is the best splint to use? A. Rigid fixation for 7 days B. Rigid fixation for 2 months C. Nonrigid fixation for 7 days D. Nonrigid fixation for 2 months

Answer 77

C. The appropriate splint for an avulsed tooth is a nonrigid splint, which is left in place for about 7 to 14 days. A 0.016 × 0.022 stainless steel ortho- dontic wire, a 0.018 round stainless steel wire, and a monofilament nylon (20- to 30-lb test) line are considered nonrigid. Long-term rigid splint- ing of replanted teeth increases risk of replace- ment root resorption (ankylosis). Rigid splinting is indicated for root fractures and remains in place for 2 to 3 months. A 0.032–0.036 stainless steel wire is considered a rigid splint.

Question 78

Your patient is 8 years old. Teeth #8 and #9 have approximately 50% of their crowns erupted. One month ago, the patient fell from a skateboard and hit teeth #8 and #9 on the side- walk. The radiograph today shows open apices of these teeth, normal PDL, and no apparent periapical radiolucency. The patient has no reaction to electrical pulp tests. What is your treatment of choice? A. Calcium hydroxide pulpotomy B. Formocresol apexification technique C. Calcium hydroxide apexification technique D. Reappoint for exam and radiographs in 6 weeks

Answer 78

D. If a tooth is incompletely erupted or is being ortho- dontically treated, the tooth may be normal even if there is little sensitivity to electrical pulp tests. Certainly, in the absence of other symptoms, treat- ment is contraindicated.

Question 79

A permanent incisor with a closed apex is traumatically intruded. What is the treatment of choice? A. Gradual orthodontic repositioning and calcium hydroxide pulpectomy B. Surgical repositioning and calcium hydroxide pulpectomy C. Gradual orthodontic repositioning and conventional endodontic therapy D. Surgical repositioning and conventional endodontic therapy

Answer 79

A. Rapid root resorption, pulp necrosis, and ankylosis are common sequelae to intruded permanent teeth with mature apices. Treatment includes: a. Gradual repositioning orthodontically (2–3 weeks) b. Stabilize for 2 to 4 weeks c. Calcium hydroxide pulpectomy 2 weeks after injury

Question 80

Which of the following is the most likely cause pulpal necrosis following trauma to a tooth? A. Ankylosis B. Calcific metamorphosis C. Pulpal hyperemia D. Dilaceration

Answer 80

C. The other three answers may occur as the result of trauma but do not cause loss of vitality. Pulpal hyperemia causes increased intrapulpal pressure and swelling, which may result in an interruption of the pulp’s blood supply. Without an adequate blood supply, the pulp becomes necrotic. This process can take time, and symptoms (either radiographic or clinical) may not present for weeks or even months. Typically, follow-up examination and radiographs are indicated at 1-, 2-, and 6- month intervals following a traumatic incident.

Question 81

curve of Spee

Answer 81

sagittal, antero-posterior

Question 82

curve of Wilson

Answer 82

left and right, frontal

Question 83

Dolichocephalic –

Answer 83

long narrow face

Question 84

growth of mandible mechanism

Answer 84

both intramembranous and endochondral.

Question 85

Scammon Growth curve: Neural tissue grows until what age?

Answer 85

5 y/o (this was the number on the test, but on book it is about 6-7)

Question 86

Which tissue show most growth in first 6 years and then plateau? lymph, neural, genital

Answer 86

neural

Question 87

Which system is most fully developed at birth? a. muscle system b. neural system c. gonadal system

Answer 87

b. neural system

Question 88

Which grows faster, maxilla or mandible?

Answer 88

Maxilla grows earlier and faster (b/c it is closer to brain)

Question 89

What is the best radiograph for showing prediction about ossification?

Answer 89

Wrist hand radiograph

Question 90

``` Majority of the tissues in FACE are derived from? A) ectoderm b) mesoderm c) ectoderm and mesoderm d) endoderm ```

Answer 90

ectoderm

Question 91

Eruption sequence of pediatrics?

Answer 91

Central-Central, Lateral-Lateral, 1M-1M, Canine-Canine, 2M-2M

Question 92

Overjet in permanent teeth should be?

Answer 92

2-3mm

Question 93

The space for the eruption of permanent mandibular second and third molars is created by the A. apposition of the alveolar process. B. apposition at the anterior border of the ramus. C. resorption at the anterior border of the ramus. D. resorption at the posterior border of the ramus.

Answer 93

C. resorption at the anterior border of the ramus.

Question 94

Additional space for successive eruption of permanent maxillary molars is provided by A. interstitial bone growth. B. appositional growth at the maxillary tuberosity. C. continuous expansion of the dental arch due to sutural growth. D. an increase in palatal vault height due to alveolar growth.

Answer 94

B. appositional growth at the maxillary tuberosity.

Question 95

Low occlusal plane leads to what? decreased biting force, tongue biting, excessive bite force

Answer 95

decreased biting force

Question 96

Arch length:

Answer 96

Distal 2nd PM to distal 2nd PM or Mesial M1 to Mesial of M1

Question 97

Arch width:

Answer 97

Inter-canine space

Question 98

Class 2 and 3 malocclusions: convex or concave?

Answer 98

2 - convex, 3 - concave

Question 99

QUESTION: What do you do to camouflage class 2?

Answer 99

Extract upper premolar

Question 100

Facial profile of class 2 malocclusion?

Answer 100

Convex

Question 101

Normal class 1 occlusion has maxillary MB cusp in

Answer 101

buccal groove of mandibular molar.

Question 102

What’s the occlusion when MB cusp of max 1st molar is distal to buccal groove of mand 1st molar?

Answer 102

CLASS III

Question 103

Distalized occlusion w/ upright central anterior and deep bite:

Answer 103

Class II div II

Question 104

What's the difference between primary class II and permanent class II? Shallow grooves, broad contacts

Answer 104

broad contacts

Question 105

Class III is due to what?

Answer 105

Maxillary retrusive & mandibular protrusion

Question 106

Most common type of occlusion in primary teeth:

Answer 106

Flush terminal plane

Question 107

Highest percentage of occlusion in the US? class I, class II, class III

Answer 107

1

Question 108

What Percentage of population have class I normal occlusion?

Answer 108

30%

Question 109

Most common patients to have anterior tooth fractures or trauma?

Answer 109

Class II div I

Question 110

Most likely to cause fracture in children?

Answer 110

Class II division I

Question 111

Class III patient: which of the following is not helpful in establishing whether pt has retrognathic maxilla or prognathic mandible? photographs, study models, ceph analysis, clinical exam

Answer 111

study models

Question 112

``` A child who has a distal step in the primary dentition generally develops which of the following molar relationships in the permanent dentition? A. Class I B. Class II C. Class III ```

Answer 112

B. Class II

Question 113

What happens to the permanent molar occlusion in the presence of a flush terminal plane and mandibular primate spaces? A. Erupts end-to-end; early mesial shift into Class I occlusion B. Erupts end-to-end; late mesial shift into Class I occlusion C. Erupts with Class II tendency D. Erupts with Class III tendency

Answer 113

A. Erupts end-to-end; early mesial shift into Class I occlusion

Question 114

Class II after which primary conformation

Answer 114

is formed with distal step.

Question 115

Class I can be formed with which primary conformation

Answer 115

flush terminal or mesial step

Question 116

``` Which of the following will most likely lead to a class 2 malocclusion on a patient distal step terminal flush plane mesial step ```

Answer 116

distal step

Question 117

Where are the primate spaces?

Answer 117

MAX: between LATERAL & CANINE; MAND: between CANINE & 1st MOLAR

Question 118

What makes space for mandibular teeth when they erupt?

Answer 118

Primate space

Question 119

What is the purpose of primary teeth?

Answer 119

Space holder of permanent teeth

Question 120

Premature loss of which tooth will cause mesial drift of permanent tooth?

Answer 120

Primary 2nd | molar

Question 121

The space difference between primary canine, first & second molar and the succedaneous teeth:

Answer 121

Leeway space ``` Leeway space (of Nance) = sum of primary tooth M/D widths is greater than sum of permanent successors (C + 2 PM). When primary teeth fall out, there is extra space to help relieve crowding. If nothing done, then 1st molars drift forward. - Usually 1.8 (total) mm in maxillary, 3.6(total) mm in mandible ```

Question 122

``` The late mesial shift of a permanent first molar is primarily the result of closure of which of the following spaces? A. Canine B. Leeway C. Primate D. Extraction ```

Answer 122

Leeway

Question 123

What will account for the anterior space for the perm. mandibular incisors? a. Flaring of the max incisors b. Primate space c. Leeway space

Answer 123

b. Primate space | - Because this is the space between the canines and the central incisors; Leeway is for posteriors

Question 124

What allows for more space for eruption of permanent lower incisors? Allow them to protrude buccally Use primate space Use early mesial shift (which actually is primate space) Leeway space (aka late mesial shift).

Answer 124

Use primate space

Question 125

Premature loss of which would lead to arch length deficiency?

Answer 125

Primary canine

Question 126

If a mandibular primary canine is prematurely lost, what would happen? Incipient malocclusion Insufficient arch size in anterior region When laterals erupt, canine’s root are resorbed When canine is shed, midline will shift in the direction of the lost tooth.

Answer 126

Insufficient arch size in anterior region

Question 127

Child lost both his primary mandibular canines prematurely, what does this lead to?

Answer 127

Lack of arch space

Question 128

Primary tooth lost prematurely, what does that do to permanent tooth?

Answer 128

Delayed eruption of perm - If the kids’ primary molar is lost, the eruption is delayed. If the pt loses primary after age 7, eruption is accelerated

Question 129

Which of the following dimensions are compared in the transitional dentition analysis? A. Arch width to arch length B. Leeway space to freeway space C. Leeway space to size of tooth D. Space available to space required E.The arch perimeter of the primary and transitional dentition

Answer 129

Space available to space required

Question 130

Moyers predict MD canine & premolars using a table, with the

Answer 130

sum of all 4 primary lower incisors.

Question 131

A dentist will perform a Moyers' mixed dentition analysis. Which of the following teeth will be measured to predict the size of the unerupted canines and premolars? A. Maxillary incisors B. Mandibular incisors C. Primary molars and canines D. Maxillary incisors for the maxillary arch E. Mandibular incisors for the mandibular arch

Answer 131

Mandibular incisors

Question 132

What happens with intercanine distance after mixed dentition? a. increased b. decreased c. stable, no change

Answer 132

increased

Question 133

What does the Moyers probability chart predict when a transitional dentition analysis is performed? a. The widths of mandibular anterior teeth b. The space available for permanent canine and premolars c. The width of permanent canines and premolars d. The space needed for alignment of permanent mandibular central and lateral incisors

Answer 133

The space available for permanent canine and premolars

Question 134

Tanaka predict MD canine & premolars width using

Answer 134

1/2 of sum of all 4 lower incisors

Question 135

Ugly duckling phase:

Answer 135

diastema between maxillary centrals (#8 & #9) - Maxillary central incisors can also be quite distally inclined when they first erupt - When maxillary centrals erupt, they move labially & have diastema. When permanent canines erupt, centrals move mesially to close diastema.

Question 136

The ugly duckling phase refers to?

Answer 136

Mixed dentition

Question 137

Ugly duckling stage ortho

Answer 137

Wait for canines before doing ortho on centrals

Question 138

Pt has minor crowding in the anterior mandibular region that has displaced the centrals. How you fix it?

Answer 138

Do stripping. - Ortho stripping (IPR, ContacEZ) = filing down the teeth, usually for 1-3 mm crowding

Question 139

How do posterior cross bites develop

Answer 139

Most posterior cross-bites appear to be unilateral. Usually, due to bilaterally underdeveloped maxilla with a shifting of the mandible to one side during closure.

Question 140

Anterior permanent tooth most likely to erupts in crossbite?

Answer 140

Maxillary laterals

Question 141

What head gear would you use to correct a class III?

Answer 141

Reverse pull headgear (also called protraction facemask)

Question 142

Which headgear is used for pt who needs to bring maxilla towards protrusive?

Answer 142

Reverse pull/facemask (protraction headgear)

Question 143

patient with maxillary arch constriction of 3 mm and a posterior crossbite, what will you see? Normal midline Midline shift towards the unaffected side Midline shift toward the affected side

Answer 143

Midline shift toward the affected side

Question 144

Patient has 3 mm palatal constriction, what is most likely complication?

Answer 144

Bilateral crossbite

Question 145

Hawley appliance is used for correction of skeletal crossbites.

Answer 145

False

Question 146

Unilateral posterior crossbites in kids are usually due to a ________; treat w/ ________

Answer 146

Unilateral posterior crossbites in kids are usually due to a MANDIBULAR SHIFT; treat w/ MAXILLARY EXPANSION

Question 147

Pt w/unilateral posterior crossbite § True unilateral maxillary constriction & functional crossbite § Mandibular shift § Bilateral constriction - If true unilateral maxillary constriction à fix using unequal W arch or asymmetrical maxillary expansion

Answer 147

§ Mandibular shift If true unilateral maxillary constriction à fix using unequal W arch or asymmetrical maxillary expansion

Question 148

What is indicated for the tx of unilateral posterior cross bite?

Answer 148

Elastics from lingual of max mol to Buccal of mand molar | - A single tooth cross bite can be adjusted by placing cross elastics from maxillary lingual to mandibular buccal.

Question 149

When to fix cross bite in a child?

Answer 149

ASAP/correct immediately

Question 150

What kind of appliance for posterior cross bite and when?

Answer 150

Quad Helix (with digit sucking) or Palatal Expander, correct immediately

Question 151

Most common cause of anterior crossbite:

Answer 151

thumbsucking, lack of interdental arch space, mouth breathing

Question 152

If patient has their nose always stuffed (chronic nasal congestion) & they breathe through their mouth, what happens? Anterior open bite, posterior open bite, constriction on arches

Answer 152

- Mouth breather à anterior open bite

Question 153

Mouth breathers have a facial feature:

Answer 153

incompetent lip, convex profile, narrow palatal vault, bilateral crossbite

Question 154

Anterior crossbite is done by all except: functional shift vs lower third of face is hypertrophied

Answer 154

functional shift

Question 155

QUESTION: Leveling of mandibular teeth à

Answer 155

OPEN BITE (treats the overbite)

Question 156

``` 8-year-old child, there is a recession in a mandibular incisor with posterior crossbite, which of the following treatment options is the least acceptable? a. oral hygiene instruction b. graft c. correction of cross bite d. observation ```

Answer 156

d. observation

Question 157

10-year-old child loses primary first molar, what is the space maintenance appliance needed?

Answer 157

None, since premolar erupting at this | age

Question 158

10 y/o patient has crown on first primary molar and second primary molar is going to be extracted due to caries. What should be done in order to maintain space? a. Nothing b. band loop c. distal shoe

Answer 158

Nothing - because premolar is about to erupt

Question 159

Can tx all with appliances except .

Answer 159

crepitus

Question 160

distal shoe for what

Answer 160

when exo primary M2 with unerupted perm M1

Question 161

Nance or Band/Crown Loop for what

Answer 161

mx problem when perm M1 present

Question 162

Lower lingual holding arch

Answer 162

md problem when perm M1 and perm incisors are present

Question 163

band/crown loop for what

Answer 163

primary M1 exo

Question 164

``` Loss of a primary right 1st molar in a 3-year-old child requires placement of a: a. band and loop b. distal shoe c. removable acrylic appliance d. none of the above ```

Answer 164

a. band and loop

Question 165

Lower 1st molar come out too early, what do you do?

Answer 165

Band and Loop

Question 166

Child lost primary 2nd molar:

Answer 166

distal shoe

Question 167

QUESTION: Most common space maintainer -

Answer 167

band and loop

Question 168

Patient has a stainless steel crown on tooth #L (primary man 1st M), it’s going to be EXT, but what else will be needed?

Answer 168

Do band- | and-loop for space maintenance

Question 169

Characteristics of a band and loop space maintainer include all of the following except? Potential for decalcification if the cement is lost provide space maintenance provides food trap if not properly soldered provides occlusal stop to prevent opposing dentition from supraerupting If leakage from cement, it can lead to recurrent decay

Answer 169

provides occlusal stop to prevent opposing dentition from supraerupting

Question 170

What does band and loop NOT do?

Answer 170

Does NOT create a vertical stop

Question 171

What primary reason for restoring primary teeth?

Answer 171

To maintain arch space

Question 172

What tooth is the most important to keep for space maintenance:

Answer 172

Primary 2nd molar

Question 173

What is the most common tooth that involves space management in primary teeth?

Answer 173

2nd molar

Question 174

How to do measure the projected arch length space for permanent teeth?

Answer 174

Arch length: Distal 2nd PM to distal 2nd PM or Mesial M1 to Mesial of M1

Question 175

How to do measure the projected arch widthspace for permanent teeth?

Answer 175

inter-canine space

Question 176

Lower 1st primary molar tooth has lower permanent premolar underneath, what will determine when the premolar will come in? a. How fast roots of 1st primary molar resorbs b. age of patient c. how much of root of premolar is formed

Answer 176

c. how much of root of premolar is formed

Question 177

What race has most deep bites?

Answer 177

White - Severe deep bite is nearly twice as prevalent in whites as blacks or Hispanics, while open bite > 2 mm is 5x more prevalent in blacks than in whites or Hispanics

Question 178

The best age to correct a thumb sucking habit is:

Answer 178

during primary dentition. Kids are easier to desensitize (5-6 years) - Mild displacement of the primary incisor teeth is often noted in a 3-4 y/o thumbsucker, but if sucking stops at this stage, normal lip and cheek pressures soon restore the teeth to their usual positions. - If the habit persists after the permanent incisors begin to erupt, orthodontic treatment may be necessary to overcome the resulting tooth displacements.

Question 179

Teeth erupt through bone when _____ formed, erupt through gingiva when _____ formed.

Answer 179

2/3 | 3⁄4

Question 180

Permanent teeth erupt where relative to primary teeth

Answer 180

lingual & inferior

Question 181

What stage does supernumerary or hypodontia anomalies occur? Initiation stage, histodifferentiation, proliferation

Answer 181

Initiation

Question 182

Post emergence eruption is mostly result of: root development, bone growth

Answer 182

root development - Phase begins as tooth emerges through gingiva & moves into occlusal contact.

Question 183

The primary tooth is missing/extracted. The perm tooth root is 1/3 formed. What is driving the eruption of the perm tooth?

Answer 183

the fact that the root is 1/3 formed

Question 184

When does tooth (crown) start to emerge in the oral cavity? a. When root starts to form b. Only after crown has been formed c. After complete root formation d. After 3⁄4 root has been formed

Answer 184

After 3⁄4 root has been formed

Question 185

How long for the root to complete formation after eruption?

Answer 185

2.5 - to 3.5 years

Question 186

Apical root closes---

Answer 186

2 1⁄2 - 3 1⁄2 years after eruption

Question 187

Calcification of premolar tooth at birth?

Answer 187

NO

Question 188

Pt has 12 primary teeth & 12 permanent teeth, what the patient’s age?

Answer 188

8.5 yrs old

Question 189

Which direction do succedaneous anterior teeth erupt?

Answer 189

Lingual

Question 190

If a child’s permanent mandibular incisors are erupting but their primary mandibular incisors are still there, where would they erupt?

Answer 190

they would erupt lingually

Question 191

Passive labial bow -

Answer 191

treats overjet

Question 192

Active labial bow –

Answer 192

for incisor retraction

Question 193

Edgewise bracket -

Answer 193

for intrusion motion (ortho brace bracket)

Question 194

QUESTION: Ortho case: Patient’s upper central were little flared & needed to be uprighted more, what appliance do you use?

Answer 194

Rectangular Arch | Wire

Question 195

Advantage of rectangular orthodontic wires –

Answer 195

Control crown and root movement

Question 196

Center of tooth when ortho is tipping it? Middle of root, apex, 0.5 of apex

Answer 196

Middle of root,

Question 197

Force put on crown, where is center of translation or rotation? Halfway down root, CEJ, past apex

Answer 197

Halfway down root

Question 198

Ortho finger springs are used for?

Answer 198

to fix tipping of anterior mand and maxillary teeth

Question 199

How do you prevent rotation in ortho?

Answer 199

Anti-rotational clasp

Question 200

What is moderate crowding?

Answer 200

less than 4 mm is moderate (>4 = severe crowding)

Question 201

How to patient with 16mm of overjet: Ortho w/ surgery, premolar extraction route

Answer 201

Ortho w/ surgery,

Question 202

Patient needs ortho with partially erupted #17 and #32. Radiographically, both teeth had crowns with distal area that are susceptible pericoronitis. What do you do?

Answer 202

EXT both teeth surgically

Question 203

You need to ortho for kid with very poor oral hygiene. What treatment is best?

Answer 203

Removable

Question 204

Best time to fix lingually inclined incisors?

Answer 204

When canines erupt

Question 205

If a child has 3mm crowding on the lower and permanent canines haven’t erupted, what do you do?

Answer 205

Nothing

Question 206

Primary anterior tooth intruded 5mm. How would you treat it? • Extract • Splint • Ortho to bring it down

Answer 206

Ortho to bring it down

Question 207

Ortho uprighting of molar, what is the common problem & what should you do?

Answer 207

Occlusal interferences - need to adjust occlusion

Question 208

Why would you move a tooth (ortho) before doing perio? More likely to get bone loss after perio surgery Easier to move now Stable teeth are harder to access

Answer 208

More likely to get bone loss after perio surgery

Question 209

A light force applied to the periodontal ligament during orthodontic treatment is considered? a. intermittent b. direct c. continuous d. indirect

Answer 209

direct

Question 210

Which one of the following doesn’t happen in the PDL during ortho movement?

Answer 210

Chemical change in PDL

Question 211

Orthodontic movement- why widened PDL?

Answer 211

Due to tension - Compression (where tooth is moving toward) and tension side (where tooth is moving away from). First, widened PDL occurs on tension side in presence of light prolonged orthodontic forces, indicating tooth movement is soon to begin. - Compression side: osteoclasts are removing lamina dura - Tension side: Osteoblasts are laying down new bone

Question 212

Which of the following soft tissue elements (fibers) are commonly associated with relapse following orthodontic rotation of teeth:

Answer 212

Supracrestal - Supracrestal fibers, in particular transseptal fibers, have been implicated as a major cause of postretention relapse of ortho treatment.

Question 213

What causes rotation of a tooth after ortho therapy?

Answer 213

Transeptal fibers

Question 214

QUESTION: What fibers cause reversement of a rotated tooth after ortho treatment?

Answer 214

Transseptal fibers

Question 215

Finish ortho tx in a non-compliant patient, what you do for retention – fix retention, removable retention, supracrestal fiberotomy

Answer 215

supracrestal fiberotomy

Question 216

Ortho Case: 14 yr. old kid w/ pano; all PM’s congenitally missing except #28 (missing 7 of them); retained primary molar crowns over congenital missing PM’s 1. 4 primary teeth are ankylosed & 4 perm teeth are missing 2. Using a ceph, you gotta tell if facial profile is convex, straight, or concave 3. Given ANB = 6, What class is it? 4. Other ortho pt: explorer catches in a pit of #19? What would your tx be?

Answer 216

1. (BOTH FALSE) 2. convex 3. Class II 4. PRR

Question 217

Ortho Case: 15 yr. old kid. Upper & lower canines are ectopically erupted out of the arch; besides that, everything else was normal in this case. 1. How do u treat?

Answer 217

1. Extract 1st PM’s & bring canines into arch OR take out 4 canines & keep PM’s (take out canines)

Question 218

Permanent 1st molar ectopically erupting with slight resorption of primary teeth. Tooth most likely needs ortho, what would you use?

Answer 218

separating device (Can use elastic separators)

Question 219

Ectopic maxillary molar eruption needs what?

Answer 219

Ortho intervention

Question 220

Esthetic analysis, # of vertical proprotions in the face?

Answer 220

Five - Vertically by 5 lines (4 planes) - Horizontally by 3 lines (2 planes)

Question 221

What does a bigger SNA means?

Answer 221

Maxilla is more protrusive - SNA-SNB=ANBà maxilla to mandible relationship range is 1-5

Question 222

QUESTION: Female w/ ANB angle = 60, what skeletal classification?

Answer 222

Class II (protrusive maxilla or retrognathic mandible)

Question 223

ANB = -4: Class

Answer 223

III

Question 224

ANB is -6 degrees, what’s the facial profile? Class

Answer 224

III

Question 225

SNA 76 AND SNB 78, what’s the facial profile?

Answer 225

76-78 = ANB = -2 so pt is Class III

Question 226

SNA AND SNB 78, what’s the facial profile?

Answer 226

78-78 = ANB = 0 so pt is Class III

Question 227

SNA 82 AND SNB 80, what’s the facial profile?

Answer 227

82-80 = ANB = 2 so pt is Class I

Question 228

Frankfort’s horizontal plane =

Answer 228

porion (upper external auditory meatus) to orbitale (inferior border of orbit)

Question 229

Fox plane is parallel to

Answer 229

Camper’s line (alar of nose – mid tragus line) – for anterior-posterior plane - Fox plane is parallel to interpuppillary line – for anterior plane

Question 230

Fox plane landmarks:

Answer 230

Lower ala upper tragus and interpupillary distance