Orthodontics and Pediatric Dentistry, Preparation for NBDE Part II

  • Category: Orthodontics & Pediatric Dentistry
  • Aim: Revising for NBDE Part II
  • Questions: 25
  • Hint: No
  • Mutiple Opportunites: No
  • Time Limit: No
  • Answer Explaining: Yes

Orthodontics and Pediatric Dentistry

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Question 1

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.
Question 1 Explanation: 
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 2

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.
Question 2 Explanation: 
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 3

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.
Question 3 Explanation: 
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 4

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
Question 4 Explanation: 
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 5

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
Question 5 Explanation: 
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 6
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
Question 6 Explanation: 
B. The cranial base includes, from anterior to posterior, the ethmoid, sphenoid, and occipital bones.
Question 7

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
Question 7 Explanation: 
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 8
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
Question 8 Explanation: 
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 9

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
Question 9 Explanation: 
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 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
Question 10 Explanation: 
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
The following teeth are erupted in an S-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
Question 11 Explanation: 
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 12
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
D
None of the above
Question 12 Explanation: 
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 13

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.
Question 13 Explanation: 
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 14
During an emergency denial visit in which a tooth is to he extracted due to extensive pulpai 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.
Question 14 Explanation: 
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

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.
Question 15 Explanation: 
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 16

An adult patient with a Class II molar relationship and a cephalometric ANB angle of 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
Question 16 Explanation: 
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 17

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.
Question 17 Explanation: 
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 18
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.
Question 18 Explanation: 
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 19
Congenitally missing teeth are the result of failure in which stage of development?
A
Initiation
B
Morphodifferentiation
C
Apposition
D
Calcification
Question 19 Explanation: 
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 20
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
Question 20 Explanation: 
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 compromised by injury or infection.
Question 21
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
Question 21 Explanation: 
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 22
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.
Question 22 Explanation: 
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 23
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.
Question 23 Explanation: 
C. Since M = Fd, doubling the force would double the moment, or tendency to rotate, tip, or torque.
Question 24
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
Question 24 Explanation: 
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 25
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
Question 25 Explanation: 
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.
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