The patient does not have symptoms. All teeth shown in the radiograph respond to pulp testing, except the canine.
1. The radiolucent structure (arrow) at the apex of the canine is likely which of the following?
a. Maxillary fracture b. Apical pathosis c. Nasopalatine duct d. Nutrient canal
2. The radiographic appearance internally indicates which of the following? a. Two likely superimposed canals
b. Dentinogenesis imperfecta
c. Dense accumulations of linear calcifications d. Calcific metamorphosis
3. The recommended treatment and reason for the treatment is which of the following?
a. Root canal treatment; there is pulp pathosis.
b. Root end resection and root end filling; there is pathosis, but the pulp space is too small to attempt root canal treatment.
c. No treatment; there is no pathosis. d. Extraction is prescribed.
Questions 4 to 8 relate to the following illustration.
Tooth no. 30 (first molar) causes the patient prolonged pain to cold and episodes of spontaneous pain. The tooth responds to probing with an explorer into the carious lesion.
There is no pain to percussion or palpation and no swelling. Periodontal probing is within normal limits.
4. What is the pulpal diagnosis? a. Reversible pulpitis
b. Irreversible pulpitis c. Necrosis
d. Unknown, pending further information 5. What is the periapical diagnosis?
a. Normal
b. Acute apical periodontitis c. Chronic apical periodontitis d. Acute apical abscess
6. What is the likely appearance of the pulp histologically? a. Coronal pulp is necrotic; radicular pulp is inflamed. b. Coronal pulp is inflamed; radicular pulp is normal. c. The entire pulp is inflamed.
d. The entire pulp is necrotic.
7. What is the likely appearance of the periapex histologically? a. Normal structures
b. Acute inflammation; no bone resorption c. Acute inflammation; bone resorption d. Chronic inflammation; bone resorption
a. None. Schedule the patient for future evaluation. b. Complete canal preparation at this visit.
c. Remove the caries and place a sedative temporarily. d. Perform pulpotomy or partial pulpectomy.
A 50-year-old woman comes to the clinic complaining of sharp sensitivity with chewing on the lower left second molar. She reports a period of cold sensitivity 6 months prior but has not had any cold tenderness for several months. The third and first molars respond to pulp testing; the second molar does not respond. There is no pain to palpation, but the tooth is tender to percussion on the cusps and tender to biting on a bite stick. There is an isolated 6- mm probing defect on distal. (Photograph: The shallow occlusal alloy has been removed.)
9. What is the pulpal diagnosis for tooth no. 18? a. Normal
b. Hypersensitive c. Irreversible pulpitis d. Necrosis
10. What type of bacteria would likely be found in the pulp? a. Gram-positive aerobes
b. Gram-negative anaerobes c. Mixed flora
d. None
11. What is the likely cause of the patient's pain? a. Inflamed pulp
b. Apical abscess c. Cracked tooth d. Periodontal abscess
12. What additional tests are indicated? a. Cold test
b. Heat test c. Test cavity d. Transillumination
13. What type of permanent restoration is indicated? a. Occlusal amalgam
b. Occlusal bonded complete c. Pin-retained amalgam d. Full-cast crown
The patient reports "a bad toothache for 2 days. I can't bite on these lower, right, front teeth." There is pain on pressure and palpation in the region of the lateral incisor and canine. The premolar (small amalgam) is asymptomatic. The lateral and premolar respond to pulp testing; the canine does not respond. There is no swelling. There is an aphthous ulcer on the facial attached gingiva of the lateral. All probings are normal. The lateral and canine have moderate mobility.
14. Which tooth and tissue are the probable source of pain? a. Lateral incisor and pulp
b. Canine and pulp
c. Canine and periapical tissue
d. Lateral incisor, canine, and periapical tissue
15. What is the likely pulpal and periapical diagnosis for the lateral incisor? a. Irreversible; phoenix abscess
b. Normal; chronic apical periodontitis c. Necrosis; phoenix abscess
d. Reversible; normal
16. What is the likely pulpal and periapical diagnosis for the canine? a. Irreversible pulpitis; phoenix abscess
b. Normal; chronic apical periodontitis c. Necrosis; phoenix abscess
d. Necrosis; suppurative apical periodontitis
17. Which teeth (tooth) require(s) endodontic treatment? a. Lateral incisor only
b. Canine only
d. Neither at present
18. Which bacteria have been related to this pathosis? a. Gram-negative rods; anaerobic
b. Gram-positive rods, anaerobic c. Gram-negative cocci; aerobic d. Gram-positive cocci; aerobic
19. Of the following inflammatory cells, which would likely predominate periapically?
a. Lymphocytes
b. Polymorphonuclear neutrophilic leukocytes c. Plasma cells
d. Macrophages
20. Looking at the radiograph and clinical photograph, what is the likely cause of the pulpal and periapical pathosis?
a. Incisal attrition b. Cervical erosion c. Caries
d. Impact trauma
The patient reports severe, continuous pain in the mandibular, right quadrant. She states that the pain began when she was drinking iced tea last evening and the pain has not subsided. She slept poorly last night. Medical history is noncontributory.
Amalgams were place a few months earlier after removal of deep caries on both molars. She has increased pain on lying down. The pain is not relieved with analgesics. She cannot localize the pain to an individual tooth. Pulp testing shows response on the premolar and second molar. The first molar does not respond. Cold-water application causes intense, diffuse pain in the region. Percussion and palpation are not painful. Probings are normal.
21. Which tooth (teeth) is (are) the most likely cause of her pain? a. Premolar
b. First molar c. Second molar
d. First and second molars
a. Necrosis; chronic apical periodontitis b. Necrosis; phoenix abscess
c. Irreversible pulpitis; chronic apical periodontitis d. irreversible pulpitis; acute apical periodontitis
23. What is the pulpal and periapical diagnosis for the second molar? a. Irreversible pulpitis; normal
b. Irreversible pulpitis; acute apical periodontitis c. Irreversible pulpitis; acute apical abscess d. Normal; normal
24. What would be the minimal emergency treatment on the offending tooth (teeth)? a. Remove the amalgam and place a sedative dressing. Prescribe analgesics and antibiotics.
b. Do a complete canal preparation. Place a cotton pellet of formocresol. c. Reduce the occlusion and prescribe antibiotics.
d. Perform a pulpotomy and place a dry-cotton pellet.
25. Inferior alveolar injection is indicated. If the offending tooth (teeth) is (are) not anesthetized, what is the likely reason?
a. There is a decreased pH in the region favoring formation of cations. b. The anesthetic solution is diluted by the inflammatory fluids.
c. There may be morphologic changes in the nerves that originate in the inflamed areas; these nerves becomes more excitable.
d. Because of inflammation, there is increased circulation in the area; this carries away the anesthetic very rapidly.
The patient has no adverse signs or symptoms. Surgery was several years ago. There are no probing defects. The canine responds to pulp testing.
26. What diagnosis is likely? a. Chronic apical periodontitis
b. Foreign-body reaction c. Apical radicular cyst d. Scar tissue
27. What is the likely cause?
a. Continued irritation from an undébrided, unsealed canal b. Adverse reaction to corrosion of the amalgam
c. Coronal leakage
d. Perforation of both cortical plates. 28. What should the treatment plan be?
a. Replace the crown; retreat the canal.
b. Perform another surgery and place another root end material. c. Place the patient on antibiotics to resolve the lesion.
d. No treatment is needed.
A 58-year-old woman has swelling in the maxillary anterior area that has steadily increased for 2 days. She denies thermal sensitivity and tenderness to biting pressure. The swelling is between teeth nos. 9 (central incisor) and 10 (lateral incisor). There is normal mobility, and probing depths are 4 to 5 mm with the distofacial surface of tooth no. 9 probing 8 mm. There is no tenderness to percussion, but there is tenderness to palpation. Pulp tests reveal that teeth nos. 8, 9, 10, and 11 are responsive to electrical-pulp testing and to thermal stimulation with carbon dioxide snow (i.e., dry ice).
29. Based on this information, the clinical photograph, and the radiograph, what is the pulpal diagnosis for tooth no. 9?
a. Normal
c. Irreversible pulpitis d. Necrotic
30. Based on this information, the clinical photograph, and the radiograph, what is the pulpal diagnosis for tooth no. 10?
a. Normal
b. Reversible pulpitis c. Irreversible pulpitis d. Necrotic
31. What is the periradicular diagnosis for tooth no. 9? a. Normal
b. Chronic apical periodontitis
c. Chronic suppurative, apical periodontitis d. Acute apical periodontitis
e. Acute periodontal abscess
32. Which of the following is the most likely the cause of swelling associated with teeth nos. 9 and 10?
a. Pulp necrosis b. Periodontal disease
c. A developmental groove defect d. Vertical-root fracture
e. Peripheral giant-cell granuloma
33. Which of the following is most important in determining if this lesion is of periodontal origin or of pulpal origin?
b. A periapical radiograph
c. Periodontal mobility and mobility assessment d. Pulp testing
e. Periodontal probing
34. Treatment of this case requires which of the following? a. Periodontal scaling, root planing of the area, and drainage
b. Root canal débridement of tooth no. 9, followed by incision and drainage c. Analgesic treatment and antibiotic treatment until the involved tooth can be localized
d. Flap reflection to inspect the root for a vertical root fracture or lateral canal e. Surgical excision and biopsy
35. Which of the following statements is true regarding the effects of periodontal treatment procedures on the dental pulp?
a. Scaling and root-planing procedures remove cementum, expose dentinal tubules, which are invaded and result in pulp inflammation.
b. Citric acid application appears to produce pulpal inflammation when used in conjunction with reattachment procedures.
c. Hypersensitivity may result from scaling but is a sign of pulpal pathosis or inflammation or both.
d. Scaling and root-planing procedures may produce deposition of tertiary dentin.