INBDE-10-11-20

DENTIN

INBDE STUDY GUIDE

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INTEGRATED NATIONAL BOARD DENTAL EXAMINATION (INBDE)

STUDY GUIDE Ricky J. Rubin, D.M.D., M.P.A., FAGD

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INTEGRATED NATIONAL BOARD DENTAL EXAMINATION (INBDE) The INBDE is a 500 multiple-choice examination scored as PASS or FAIL. The INBDE is 12 hours and 30 minutes and is taken over a period of 1-1/2 days. • Day 1: examinee has 8 hours and 15 minutes to answer 360 questions. • Day 2: examinee has 4 hours and 15 minutes to answer 140 questions.

The INBDE emphasizes the decision making process relevant to the safe practice of dentistry by integrating the basic sciences with dental and clinical science.

The INBDE presents multiple choice questions accompanied by a Patient Box that contains patient case information. The information in the Patient Box is information that would be available to the dentist and dental hygienist during the patient visit. Examinees will need to extrapolate the relevant information from the Patient Box and apply that information with their didactic and clinical knowledge to correctly answer the exam questions.

INBDE CONTENT Molecular, Biochemical, Cellular and systems-level development, structure and function General and Disease-Specific Pathology to assess patient risk Pharmacology Biology of Microorganisms in Physiology and Pathology Behavior Sciences, Ethics, and Jurisprudence Genetics, Congenital and Developmental Diseases and Conditions and clinical features to assess patient risk Research Methodology and Analysis and Informatic Tools Cellular and Molecular Bases of Immune and Non-Immune Host Defense Mechanisms Physics and Chemistry to Explain the characteristics and technological application of biomaterials Physics and Chemistry to Explain Biology and Pathobiology

INBDE PERCENTAGE 12.2% 11.8 10.6% 10.6% 10.6% 10.6% 9.8% 9.0% 8.0% 6.8% 100%

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INTRODUCTION: THE DENTIN INBDE STUDY METHOD: Below is a sample PATIENT BOX that will be presented to you on the INBDE. Each patient box contains specific patient information. You will be asked several questions covering multiple disciplines related to the information provided in the patient box to test your dental knowledge and ability to apply your knowledge to practical situations you may encounter as a dental professional.

The underlying format of the DENTIN study guide covers all of the required information you will need to correctly understand and answer the INBDE patient box questions. Because it is difficult to predict the exact information contained in the patient boxes, DENTIN has provided you with the core foundational knowledge and material in this study guide that will enable you to successfully answer any INBDE question and pass the exam.

The core INBDE material in this high-yield study guide contains over 2,100 prior and potential INBDE SUCCESS STATEMENTS that have been carefully selected based on the material’s clinical importance, relevance, and practical application.

To efficiently and effectively maximize your study time, DENTIN has reviewed thousands of pages of detailed dental information and carefuly developed over 2,100 INBDE success statements contained in this study guide. The statements are meticulously organized by subject and each statement includes the correct answer in the statement, so you are learning the important information with the correct response.

The DENTIN INBDE study guide is an amazing high-yield and effective study aid to successfully pass the INBDE. As long as you invest the time and effort to study the INBDE success statements in this study guide, YOU WILL PASS THE INBDE. BEST OF LUCK! DENTIN. INBDE PATIENT BOX PATIENT Male, 68 years old CHIEF COMPLAINT “I have a bump on my gum near my bottom right tooth” BACKGROUND AND/OR PATIENT HISTORY Prosthetic Heart Valve Smokes E-cigarettes Medications: Warfarin (Coumadin) Penicillin allergy CURRENT CLINICAL FINDINGS #28 periapical radiolucency; no response to #2 endo ice or electric pulp test.

White coating on tongue that wipes off.

BP: 130/80

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TABLE OF CONTENTS ANATOMICAL SCIENCES Tongue ............................................................................................................................................ 1-26 Salivary Glands ............................................................................................................................. 27-56 Soft and Hard Plates, Throat, Sinuses.......................................................................................... 57-73 Muscles of Mastication ................................................................................................................. 74-88 Muscles of Facial Expression ....................................................................................................... 89-93 Hyoid Muscles ............................................................................................................................ 94-103 Neck Muscles and Neck Triangles ........................................................................................... 104-113 Cranial Nerves........................................................................................................................... 114-162 Lymphatic System .................................................................................................................... 163-188 Osteology and TMJ................................................................................................................... 189-212 Embryology and Histology ........................................................................................................ 213-285

DENTAL ANATOMY AND OCCLUSION Dental Anatomy and Occlusion ................................................................................................ 286-441 Maxillary Canine........................................................................................................................ 442-467 Mandibular Canine .................................................................................................................... 468-487 Maxillary Lateral Incisor ............................................................................................................ 488-503 Mandibular Lateral Incisor ........................................................................................................ 504-510 Maxillary Central Incisor............................................................................................................ 511-513 Mandibular Central Incisor ........................................................................................................ 514-519 Maxillary First Premolar ............................................................................................................ 520-532 Mandibular First Premolar ........................................................................................................ 533-539 Maxillary Second Premolar ....................................................................................................... 540-544 Mandibular Second Premolar ................................................................................................... 545-549 Maxillary First Molar .................................................................................................................. 550-578 Mandibular First Molar .............................................................................................................. 579-596 Mandibular Second Molar ........................................................................................................ 597-609 Maxillary Second Molar ............................................................................................................ 610-623 Third Molars .............................................................................................................................. 624-634 Primary (Deciduous) Teeth ........................................................................................................ 635-650

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MICROBIOLOGY AND PATHOLOGY Biology of Microorganisms and Disease .................................................................................. 651-895 Odontogenic and Bone Lesions ............................................................................................... 896-944 Endocrine Pathology ................................................................................................................. 945-953 Musculoskeletal and Skin Pathology ........................................................................................ 954-967 Bacterial and Viral Oral Pathology ............................................................................................ 968-978 Blood Pathology ....................................................................................................................... 979-997 Oral White Lesions .................................................................................................................. 998-1008 Pigmented Lesions ............................................................................................................... 1009-1017 Comprehensive Oral Pathology Review ....................................................................... Pages: 155-266

IMMUNOLOGY Immunology .......................................................................................................................... 1018-1064

BIOCHEMISTRY, PHYSIOLOGY, AND NUTRITION Biochemistry, Physiology, and Nutrition ............................................................................... 1065-1303

PHARMACOLOGY Pharmacokinetics ................................................................................................................. 1304-1341 Respiratory Drugs ................................................................................................................. 1342-1352 Anticoagulants and Salicylates (Aspirin) ............................................................................... 1353-1374 Antihistamines and Proton Pump Inhibitors ......................................................................... 1375-1382 Opioid Analgesics ................................................................................................................. 1383-1393 Antibiotics and Antifungals ................................................................................................... 1394-1414 Antivirals and Viruses ............................................................................................................ 1415-1430 Local Anesthetics.................................................................................................................. 1431-1471 Anti-anxiety Agents and General Anesthesia ....................................................................... 1472-1491 Anti-hypertensive (Beta Blockers)......................................................................................... 1492-1503 Diuretics ................................................................................................................................ 1504-1507 ACE Inhibitors and Statins .................................................................................................... 1508-1513 Anti-Anginal Drugs ................................................................................................................ 1514-1516 Anti-Convulsant Drugs .......................................................................................................... 1517-1519 Hypoglycemics and Endocrine Imbalance Drugs ................................................................. 1520-1539

PROVISION OF DENTAL CARE Periodontics .......................................................................................................................... 1540-1598 Endodontics .......................................................................................................................... 1599-1670 Oral Surgery .......................................................................................................................... 1671-1726 Orthodontics and Pediatric Dentistry.................................................................................... 1727-1793 Biomaterials, Operative Dentistry, and Prosthodontics ........................................................ 1794-1889

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PROFESSIONAL ETHICS, PATIENT MANAGEMENT, OSHA Ethical and Legal Principles; Informed Consent .................................................................. 1890-1908 Special Needs and Medical Emergencies ............................................................................ 1909-1945 Research Method, Variables, and Statistics ......................................................................... 1946-1996 Oral Health Indices and Prevention ...................................................................................... 1997-2077 OSHA and Infection Control ................................................................................................. 2078-2110

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ANATOMICAL SCIENCES TONGUE 1.

HYPOGLOSSAL NERVE (CN XII) provides MOTOR to ALL TONGUE INTRINSIC & EXTRINSIC MUSCLES EXCEPT “PALATOGLOSSUS” which is innervated by the VAGUS NERVE (PHARYNGEAL PLEXUS).

2.

EXTRINSIC TONGUE MUSCLES are named based on their ORIGIN.

3.

During contraction, the tongue muscle that PROTRUDES the tongue is GENIOGLOSSUS.

MUSCLES OF MASTICATION 74.

The MASSETER originates from the ZYGOMATIC ARCH (cheekbone) and inserts on and covers the LATERAL SURFACE OF THE RAMUS (ANGLE) OF THE MANDIBLE.

75.

All muscles of mastication are innervated by TRIGEMINAL NERVE (MANDIBULAR DIVISION-V3).

76.

BLOOD SUPPLY to the muscles of mastication comes from the PTERYGOID BRANCH of the MAXILLARY ARTERY.

77.

The muscle of mastication that INSERTS into the CORONOID PROCESS is TEMPORALIS.

78.

Mandibular movements produced by the LATERAL PTERYGOIDS are OPENING (DEPRESSION), PROTRUSION, and LATERAL EXCURSION (side-to-side).

OSTEOLOGY AND TEMPEROMANDIBULAR JOINT 189. TMJ is a GINGLYMOARTHRODIAL JOINT with ROTATIONAL and TRANSLATIONAL movement.

190. During TRANSLATION (SLIDING), the disk and condyle move FORWARD and BACKWARD in the upper joint space.

191. During ROTATION (HINGE), the mandible is ELEVATED and DEPRESSED.

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DENTAL ANATOMY AND OCCLUSION 286. GINGIVAL FIBERS attach tooth CEMENTUM to GINGIVA, while PDL FIBERS attach tooth CEMENTUM to BONE. 287. The PDL is 0.2mm wide, but DECREASES in THICKNESS to 0.1mm in older adults due to the deposition of CEMENTUM and BONE. 288. A permenant tooth’s CERVICAL LINE has the GREATEST CURVATURE DEPTH on the MESIAL.

MAXILLARY CANINE

442. The permenant ANTERIOR tooth with the GREATEST CERVICAL PROMINENCE and GREATEST FACIO-LINGUAL CROWTH WIDTH is the MAXILLARY CANINE. 443. The permenant tooth with the GREATEST OVERALL LENGTH and LONGEST ROOT (not crown) in the oral cavity is the MAXILLARY CANINE. 444. The maxillary canine has a DISTAL BULGE and greatest F-L dimension of all anteriors.

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MAXILLARY CENTRAL INCISOR 511. The maxillary central incisor ROOT is the only maxillary tooth at its cervix that is the same thickness both M-D and F-L, making its canal cervix ROUND. 512. The maxillary central incisor has the most frequent root and canal morphology that has ONE ROOT WITH ONE CANAL (just like the maxillary lateral).

513. The average inciso-cervical length of a maxillary central incisor is 10-11mm and 8-9mm mesiodistally.

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MICROBIOLOGY AND PATHOLOGY 651. All cells in the immune system were derived from PRIMITIVE CELLS IN BONE MARROW. 652. Cellular movement to the site of inflammation in response to chemical signals is CHEMOTAXIS. 653. The cells FIRST TO RESPOND to an inflammatory reaction via chemotaxis are NEUTROPHILS (WBCs).

654. IMMUNE COMPLEX is formed by the combination of an ANTIBODY and ANTIGEN. 655. An amorphous gelatinous structure that surrounds the entire bacterium to prevent phagocytosis, contains antigens, and mediates cellular adhesion is the CAPSULE.

ODONTOGENIC AND BONE LESIONS 896. Oral manifestations associated with TRISOMY 21 (DOWN SYNDROME) include bullshaped molars (TAURODONTISM), some missing teeth (HYPODONTIA), increased gingivitis and periodontal disease, and DECREASED CARIES. 897. Patient with DOWN SYNDROME (TRISOMY 21) would most likely present with the CLASS III malocclusion (protruded mandible).

898. The MOST common site for oral cancer is the LATERAL BORDER OF THE TONGUE. 899. Inflammation and fissuring at the corners of the mouth (labial commissures) caused by CANDIDA ALBICANS, RIBOFLAVIN (B2) DEFICIENCY, or ILL-FITTING DENTURE (DECREASED VERTICAL DIMENSION) is called ANGULAR CHEILITIS (PERLECHE).

900. A 28-year old pregnant patient presents with a pedunculated, raspberry-like, BENIGN softtissue growth on her INTERDENTAL PAPILLAE. The lesion is ulcerated, smooth, red, and bleeds easily. The lesion is due to local tissue irritation or injury, but can also occur during due to progesterone changes. This lesion accurately describes a PYOGENIC GRANULOMA (PREGNANCY TUMOR).

901. An asymptomatic SWELLING that appears as a HEART-SHAPED radiolucency in the ANTERIOR MAXILLARY MIDLINE due to the position of the nasal spine is a NASOPALATINE DUCT CYST (INCISIVE CANAL CYST).

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ENDOCRINE PATHOLOGY 945. Clinical features like GOITER, EXOPTHALMOS, WEIGHT LOSS, and GRAVE’S DISEASE Exophthalmos) are associated with HYPERTHYROIDISM. 946. The MOST common cause of HYPERTHYROIDISM is an AUTOIMMUNE DISORDER. 947. High basal metabolism associated with HYPERTHYROIDISM is due to EXCESSIVE THYROXIN (T4) PRODUCTION. 948. PARATHYROID ADEMOMA is the most common cause of HYPERPARATHYROIDISM.

BACTERIAL AND VIRAL ORAL PATHOLOGY 968. The cardinal symptoms of fever, sore throat, and STRAWBERRY TONGUE associated with SCARLET FEVER are caused by group A Streptococcus.

969. During the intra-oral examination, you detect spontaneous and painful bleeding on probing, and a gray pseudomembranous film on the punched-out interdental papillae. The patient has a fetid odor and there is no clinical attachment loss. This evaluation is consistent with NECROTIZING ULCERATIVE GINGIVITIS (NUG).

970. The bacteria primarily responsible for NECROTIZING ULCERATIVE GINGIVITIS (NUG) are Spirochetes, (Treponema denticola), Fusobacterium and Prevotella intermedia.

971. The most important oral lesion to help clinically diagnose ERYTHEMA MULTIFORME is HEMORRAGIC CRUSTING OF THE LIP. 972. A SEVERE and potentially fatal bullous form of ERYTHEMA MULTIFORME that clinically presents as painful BULL’S-EYE (TARGET)-SHAPED LESIONS of the mucous membranes of the eyes, oral mucosa, and genitalia is STEVENS-JOHNSON SYNDROME.

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ORAL WHITE LESIONS 998. A white lesion that CANNOT BE SCRAPED OFF is LEUKOEDEMA. 999. A BENIGN, WHITE, corrugated, thick but SOFT folding of the BUCCAL MUCOSA bilaterally is WHITE SPONGE NEVUS. 1000. A 55-year old woman presents with asymptomatic, inter-connected SLENDER-FINE, LACE-LIKE WHITE LINES (WHICKHAM STRIAE) on her BUCCAL MUCOSA just above the occlusal plane that does not wipe off. Her benign oral condition is consistent with LICHEN PLANUS. 1001. A benign, HYPERKARATOTIC WHITE LINE along the BUCCAL MUCOSA at the level of the occlusal plane caused by traumatic irritants like CHEEK BITING, CLENCHING, BRUXING, or ORTHODONTICS is LINEA ALBA. 1002. The single BEST method to diagnose LINEA ALBA is by its UNIQUE CLINICAL APPEARANCE.

PIGMENTED LESIONS 1009. A painless, BLUE-BLACK or GRAY benign iatrogenic lesion visible clinically and radiographically on the mandibular gingiva or buccal mucosa is an AMALGAM TATOO (FOCAL ARGYROSIS).

1010. The MOST COMMON PIGMENTED LESION is an AMALGAM TATOO (FOCAL ARGYROSIS).

1011. Small (pinhead) REDDISH-PURPLE hemorrhagic dots on the PALATE when tiny capillaries bleed and leak blood into the oral mucosa due to trauma, infectious diseases, vitamin C or K deficiency, and certain medications are PETECHIAE. 1012. A 65-year old female presents with asymptomatic, abnormally dilated superficial veins (reddish-purple) on the tongue’s VENTRAL and LATERAL surfaces called LINGUAL VARICOSITIES.

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IMMUNOLOGY 1018. All cells in the immune system were derived from PRIMITIVE CELLS IN BONE MARROW. 1019. Cellular movement to the site of inflammation in response to chemical signals is CHEMOTAXIS. 1020. The cells FIRST TO RESPOND to an inflammatory reaction via chemotaxis are NEUTROPHILS (WBCs).

1021. IMMUNE COMPLEX is formed by the combination of an ANTIBODY & ANTIGEN. 1022. A condition where the immune system identifies its own cells and tissues as foreign, and signals antibodies to attack is an AUTOIMMUNE REACTION.

BIOCHEMISTRY, PHYSIOLOGY, AND NUTRITION 1065. A person with Phenylketonuria (PKU) is most likely deficient in the NONESSENTIAL amino acid TYROSINE. 1066. A person with Phenylketonuria (PKU) should limit FOODS HIGH IN PROTEIN and ASPARTAME in their diet due to their high PHENYLALANINE content.

1067. A SIMPLE CARBOHYDRATE formed by hydrolysis of glucose + fructose is SUCROSE. 1068. GLUCOSE, FRUCTOSE, & GALACTOSE are MONOSACCHARIDES, the simplest form of carbohydrates.

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PHARMACOLOGY PHARMACOKINETICS 1304. DOSE-RELATED adverse drug reactions include TOXICITY & SIDE-EFFECTS, NOT a drug allergy.

1305. DRUG EFFICACY (CEILING EFFECT) is a drug’s ability to produce a desired therapeutic effect REGARDLESS OF DOSAGE and is NOT RELATED to drug potency.

1306. If a drug has a half-life of 4 hours. Upon discontinuing the drug 94% will be eliminated in 16 hours.

1307. If 100mg of a drug with a half-life of 60 minutes is taken, after 60 minutes of being administered, 50mg remains. After 120 minutes 25mg remains, and after 180 minutes, 12.5mg remains.

1308. The time required to reduce the concentration of a drug in the body by exactly 50% is: HALF-LIFE (T ½.)

RESPIRATORY DRUGS (BRONCHODILATORS) 1342. The BRONCHODILATOR and drug of choice for ACUTE ASTHMA is ALBUTEROL. 1343. INHALED CORTICOSTEROIDS like Budesonide (Pulmicort) or Fluticasone (Flovent) are the drugs of choice for CHRONIC ASTHMA. 1344. A patient taking THEOPHYLLINE for CHRONIC ASTHMA or COPD should not be prescribed ERYTHROMYCIN for a bacterial infection due to an increased chance of SERUM TOXICITY. 1345. Drugs that are CONTRAINDICATED with asthmatics taking THEOPHYLLINE include aspirin, NSAIDs, barbiturates, narcotics, and erythromycin.

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ANTI-COAGULANTS AND ASPIRIN (SALICYLATES) 1353. The most common anticoagulant administered via injection (parenterally) to a hospitalized patient is HEPARIN. 1354. Warfarin inhibits blood clotting by affecting the coagulation pathway to PREVENT FIBRIN FORMATION. It prevents the conversion of inactive vitamin K to its active form.

1355. An alcoholic taking WARFARIN may present clinically with PALATAL PETECHIAE. 1356. ASPIRIN’s MECHANISM OF ACTION is to INHIBIT PROSTAGLANDIN SYNTHESIS

by INHIBITING the enzyme CYCLOXYGENASE.

ANTIHISTAMINES AND PROTON-PUMP INHIBITORS (PPIs) 1375. ANTIHISTAMINES mechanism of action BLOCKS natural histamine in the body at H1 & H2 receptor sites to treat MILD ALLERGIC REACTIONS. 1376. An ALLERGIC REACTION is a drug effect that is UNPREDICTABLE and NOT DOSERELATED. 1377. The MOST COMMON H1 antihistamine that treats mild allergic reactions and seasonal allergies by blocking vasodilation, bronchi constriction, and capillary permeability is BENEDRYL (Diphenhydramine).

OPIOID ANALGESICS (NARCOTICS) 1383. The MOST COMMON OPIOD used in dentistry is CODEINE, prescribed as TYLENOL 3 when combined with Acetaminophen to treat MODERATE pain.

1384. OPIOIDS work by BLOCKING BRAIN PAIN RECEPTORS without loss of consciousness.

1385. The cardinal sign of an OPIOID OVERDOSE (HEROIN, MORPHINE, CODEINE) is PINPOINT PUPILS (MIOSIS).

1386. The most appropriate analgesic for HEROIN ADDICTS are NSAIDs because they do not alter consciousness.

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ANTIBIOTICS AND ANTIFUNGALS 1394. The penicillin derivative when combined with clavulanic acid that is MOST EFFECTIVE against bacteria that produce the beta-lactamase enzyme is AMOXICILLIN. 1395. PENICILLINS kill bacteria by competitively inhibiting TRANSPEPTIDASE ENZYME to disrupt bacteria cell-wall synthesis. Penicillins are BACTERIOCIDAL. BOTH STATEMENTS TRUE. 1396. The antibiotic of choice in DENTISTRY for non-penicillinase producing oral infections in a pregnant woman who denies allergies is PENICILLIN VK.

ANTIVIRALS AND VIRUSES 1415. ANTIVIRAL DRUGS treat viral infections by INHIBITING VIRAL DNA SYNTHESIS. 1416. The drug of choice to treat COLD SORES caused by HSV-1 is ACYCLOVIR (ZOVIRAX) or VALTREX. 1417. HEPATITIS A, C, D, E are RNA viruses, while HEPATITIS B is a DNA virus.

1418. Potential oral pathology caused by opportunistic infections in an HIV + individual are HAIRY LEUKOPLAKIA, ORAL CANDIDIASIS, and KAPOSI’S SARCOMA.

LOCAL ANESTHETICS 1431. Allergic reactions to amides are RARE, but if they occur, are most likely caused by the PRESERVATIVE (SODIUM BISULFATE or SODIUM METABISULFATE) in the anesthetic solution.

1432. The purpose of SODIUM BISULFITE in an anesthetic that contains a vasoconstrictor is to serve as a PRESERVATIVE BY PREVENTING OXIDATION. 1433. An ALKALIZING AGENT added to local anesthetics is SODIUM HYDROXIDE, which makes the anesthetic solution BASIC.

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ANTI-ANXIETY AGENTS AND GENERAL ANESTHESIA 1472. BARBITURATES are contraindicated in patients with respiratory disease, during pregnancy and alcoholics.

1473. Two main classes of anti-anxiety agents, BENZODIAZEPINES and BARBITURATES, both produce SEDATION to relieve anxiety, but DO NOT PRODUCE ANALGESIA. 1474. Benzodiazepines and Barbiturates produce their calming effects by DEPRESSING THE CNS LIMBIC SYSTEM & RETICULAR FORMATION via the central inhibitor neurotransmitter (neurons) gamma-amino-butyric acid (GABA).

1475. BARBITURATES are ABSOLUTELY contraindicated in patients with a family history of PORPHYRIA (enzyme deficiency) since they induce P450 enzymes which contain heme.

ANTI-HYPERTENSIVES BETA BLOCKERS 1492. BETA BLOCKERS TREAT: HEART ATTACK, ANGINA, CARDIAC ARRHYTHMIAS, MIGRAINES, GLAUCOMA, HYPERTHYROIDISM, and STAGE FRIGHT. 1493. NON-SELECTIVE BETA BLOCKERS are CONTRAINDICATED in patients with ASTHMA or REACTIVE AIRWAY DISEASE. 1494. A patient with asthma or COPD should NOT take a non-cardioselective beta blocker like Propranolol to treat hypertension because it can block the dilation effects of drugs like Albuterol which can lead to bronchoconstriction.

1495. To prevent a severe vasopressor response, TRY TO AVOID EPINEPHRINE with patients taking non-selective beta blockers like Propranolol or Timolol.

DIURETICS 1504. DIURETICS decrease BLOOD PRESSURE & BLOOD VOLUME by promoting sodium and water excretion.

1505. THIAZIDES ARE THE MOST WIDELY USED diuretics to treat hypertension, specifically HYDROCHLOROTHIAZIDE (HCTZ) in patients with NORMAL KIDNEY FUNCTION. 1506. DIURETICS-the first therapy of choice for HYPERTENSION (high BP).

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ACE INHIBITORS AND STATINS 1508. ANGIOTENSIN-CONVERTING ENZYME INHIBITORS (ACE INHIBITORS) such as Lisinopril treat HYPERTENSION and CHF by “inhibiting” the conversion of inactive Angiotensin I→Angiotensin II to lower blood pressure.

1509. A relatively common oral side effect of ACE inhibitors such as Lisinopril is DYSGEUSIA (altered taste sensation).

1510. The effectiveness of ACE inhibitors is decreased if the patient takes NSAIDs (IBUPROFEN).

ANTI-ANGINAL DRUGS 1514. Nitroglycerin/Nitrostat (Amyl Nitrate) is the single most effective drug of choice for an ACUTE ANGINA PECTORIS ATTACK. 1515. Nitroglycerin is fast-acting and effective within 2-4 minutes if administered SUBLINGUALLY for angina attacks (must be present in the dental emergency kit).

1516. Alcohol (Ethanol) combined with NITROGLYCERIN can cause dangerously low blood pressure (hypotension).

ANTI-CONVULSANT DRUGS 1517. The anti-seizure medication mainly used to treat TRIGEMINAL NEURALGIA in dentistry is Carbamezepine (Tegretol).

1518. Multiple Sclerosis is a complex and progressive autoimmune disorder that damages the myelin sheaths of nerve cells. A potential early symptom of MS in a person under 60years of age is TRIGEMINAL NEURALGIA.

HYPOGLYCEMICS (ANTI-DIABETICS) AND ENDOCRINE IMBALANCE DRUGS 1520. HYPOGLYCEMIA is the most serious and common complication of INSULIN INJECTION therapy for Diabetes Mellitus Type 1 causing sweating, weakness, confusion, slurred speech, & blurred vision, but NOT shortness of breath.

1521. In the event of a hypoglycemic reaction (insulin shock), promptly administer concentrated glucose (orange juice) or simple carbohydrate source to relieve mild hypoglycemia.

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1522. If untreated, hypoglycemia can lead to a seizure or unconsciousness, in which case a GLUCAGON INJECTION should be administered.

1523. The first-line oral hypoglycemic of choice to treat DIABETES MELLITUS TYPE 2 (Non-Insulin Dependent) when exercise and diet have failed is METFORMIN (GLUCOPHAGE).

PROVISION OF DENTAL CARE PERIODONTICS 1540. The best indicator of a FAILED DENTAL IMPLANT is MOBILITY due to failed osseointegration.

1541. OSSEOUS SURGERY is used to treat periodontal disease, and REQUIRES raising a GINGIVAL FLAP and SUTURES. 1542. The goal of OPEN FLAP DEBRIDEMENT is to gain ACCESS and VISUALIZATION to the underlying supporting BONE and ROOT SURFACES for effective scaling and rootplaning.

1543. A periodontal procedure that uses BARRIER MEMBRANES to direct and promote the growth of new clinical attachment of periodontal tissues to reduce probing depths and arrest periodontal disease is GUIDED TISSUE REGENERATION (GTR).

PROVISION OF DENTAL CARE ENDODONTICS 1599. A highly-effective root canal irrigant due to its antimicrobial action, substantivity, low toxicity, and because it does not interfere with the bond strength of resin cement to root dentin and a fiber post is 2% CHLORHEXIDINE GLUCONATE (CHX).

1600. The least effective endodontic treatment for primary teeth with extensive caries is the DIRECT PULP CAP. Pulp-capping should be limited to small exposures produced by mechanical means or pin-point caries. BOTH TRUE. 1601. The most widely used endodontic irrigant that is bactericidal, dissolves organic pulp and collagen, but does not remove the smear layer is NaOCl (SODIUM HYPOCHLORITE).

1602. CBCT 3D imaging should be used only when the patient’s history and clinical exam demonstrate the patient benefits outweigh the potential risks. CBCT should not be used routinely for endodontic diagnosis or for screening purposes in the absence of clinical signs and symptoms. BOTH TRUE.

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PROVISION OF DENTAL CARE ORAL SURGERY 1671. Indications for a posterior maxillary sinus augmentation (lift) prior to placing a dental implant include severe alveolar resorption due to SINUS PNEUMATIZATION, atrophy, or trauma.

1672. Arterial blood supply to the maxillary sinus is derived from the INFRAORBITAL, MAXILLARY, and PSA. 1673. SINUS PNEUMATIZATION leaves a thin layer of bone in the posterior maxilla’s OCCLUSAL and LATERAL WALLS. 1674. DEGENERATIVE TMJ ANKYLOSIS is most commonly caused by TRAUMA or FRACTURE to the TMJ.

PROVISION OF DENTAL CARE ORTHODONTICS AND PEDIATRIC DENTISTRY 1727. The most common chronic condition of rampant caries in the primary dentition due to intake of dietary sugars, nighttime feeding, and inadequate oral hygiene is EARLY CHILDHOOD CARIES (ECC).

1728. The most effective orthodontic appliance to retract or retrude protruding or flared maxillary incisors into proper arch alignment is the HAWLEY REMOVALBE APPLIANCE WITH CLASPS AND LABIAL BOW. 1729. The two major causes of orthodontic relapse are CONTINUED UNFAVORABLE GROWTH and SOFT TISSUE REBOUND. 1730. The most common congenitally missing permenant teeth (besides 3rd molars) are MAXILLARY LATERAL INCISORS and MANDIBULAR SECOND PREMOLARS.

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PROVISION OF DENTAL CARE BIOMATERIALS, OPERATIVE DENTISTRY, AND PROSTHODONTICS 1794. Pit and fissure SEALANTS are generally comprised of FILLED BIS-GMA RESIN, an ideal material for occlusal surfaces due to their high wear resistance.

1795. The tooth preparation reduction for metal-ceramic restorations is 1.5-2.0mm to allow for 0.5mm metal thickness and 1.0-1.5mm thickness of porcelain.

1796. The most effective etching solution to prepare the enamel surface for dental sealants is 35%-50% PHOSPHORIC ACID. 1797. HYDROCOLLOIDS like ALGINATE are aqueous and HYDROPHILLIC (water-loving), while ELASTOMERS like POLYVINYL SILOXANES are non-aqueous and HYDROPHOBIC.

PROFESSIONAL ETHICS AND PATIENT MANAGEMENT ETHICAL AND LEGAL PRINCIPLES, DENTAL PRACTITIONER RESPONSIBILITY AND INFORMED CONSENT 1890. A hygienist’s professional obligation to be HONEST and TRUTHFUL and provide full patient disclosure best describes the ethical principal VERACITY. 1891. Written communication that falsely defames one’s character is LIBEL. 1892. Verbal communication that falsely defames one’s character is SLANDER. 1893. A hygienist’s responsibility and duty to DO NO HARM and protect patients during the course of treatment is NON-MALEFICENCE. 1894. The duty of a dental professional TO DO GOOD with the primary obligation to provide the highest quality of care and service within one’s capacity to patients and the public is BENEFICENCE.

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SPECIAL NEEDS AND MEDICAL EMERGENCIES 1909. In PARKINSON’S DISEASE neurons in the BASAL GANGLIA to DEGENERATE, causing DECREASED DOPAMINE production.

1910. CARBIDOPA-LEVODOPA (Sinemet) is the current MOST EFFECTIVE drug combination to treat PARKINSON’S DISEASE by replenishing dopamine.

1911. The opioid and CNS stimulant that can produce PARKINSON-LIKE EFFECTS due to altered dopamine levels is METHAMPHETAMINE (crystal meth).

1912. A 13-year-old child during a routine prophylaxis had a sudden lapse of consciousness that began with a blank stare and ended quickly within 10-15 seconds with complete and immediate recovery. This child most likely had an ABSENCE (PETITE MAL) SEIZURE.

RESEARCH METHODS, VARIABLES, AND STATISTICS 1950. The ARITHMETIC AVERAGE of scores, and MOST COMMON measure of central tendency is the MEAN. 1951. If 10 hygienists scored a total of 950 points out of 1000 possible points on the NBDE after using the DENTIN study guide, then the MEAN score is 950/10 = 95%.

1952. The measure of central tendency that would locate the midpoint of sample data using a DATA MATRIX is the MEDIAN. 1953. The DIFFERENCE between high and low scores on a data matrix that is affected by OUTLIERS is the RANGE.

ORAL HEALTH INDICES AND PREVENTION 1997. The BEST caries index to use when an epidemiologist’s main purpose of research is to determine caries susceptibility rather than immediate treatment needs is the DFMT. 1998. The PRIMARY goal in any oral health preventive program is PLAQUE CONTROL. 1999. The only index that is REVERSIBLE & IRREVERSIBLE because it measures both gingivitis and periodontitis is the PERIODONTAL DISEASE INDEX (PDI).

2000. The BEST dental index to detect EARLY signs of GINGIVITIS is the SULCULAR BLEEDING INDEX (SBI).

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OSHA AND INFECTION CONTROL 2078. The MOST EFFECTIVE methods to prevent infection and disease transmission are HAND WASHING and PRACTICING UNIVERSAL PRECAUTIONS. 2079. HANDS should be thoroughly washed IMMEDIATELY after removing gloves to prevent microbial growth on the hands due to the warm temperature and moisture within the glove.

2080. The MOST common antimicrobial agent present in hand sanitizers for disinfection is ALCOHOL.

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ORAL PATHOLOGY AND DISEASES BENIGN EPITHELIAL TUMORS PAPILLOMA

PAPILLOMA –the most common BENIGN neoplasm of EPITHELIAL TISSUE ORIGIN caused

by HUMAN PAPILLOMA VIRUS (HPV). It appears as a pedunculated (foot-shaped), or sessile WHITISH cauliflower-like mass on the tongue (posterior border), lips, gingiva, or soft palate. A papilloma is soft in the oral cavity, but on exposed areas of the lips, are usually rough and scaly.

•

Papilloma-a vital benign cauliflower-like, white lesion with a verrucuous & pedunculated (foot-shaped) surface. Easy to diagnose. HPV lesion is not covered by normal mucosa and is a disease of epithelium. Non-ulcerated, small, slow growing, usually non-painful. Lateral border of tongue, hard or soft palate are common areas. MUST EXCISE SURGICALLY and recurrence is rare.

•

Microscopic Features: finger-like projections of stratified squamous epithelium supported by thin cores of vascular fibrous C.T. Epithelium may show hyperkeratosis or parakeratosis.

Histogenesis: squamous epithelium.

VERRUCA (Warts)-similar to a papilloma, but is NOT pedunculated caused by a viral infection. Do excision & biopsy, especially children who have this on their finger and place their finger in their mouth and spread the infection orally.

KERATOCANTHOMA-a non-painful crater-formed lesion (VIRAL) growing for 2-3 months in the SKIN that looks like squamous cell or basal cell carcinoma, and can heal by itself, but must still do biopsy. Can last up to 6 months. It is usually only in the skin and very rarely inside the mouth.

MULTIPLE ENDOCRINE NEOPLASIA SYNDROMES (MEN SYNDROME) – groups of syndromes characterized by tumors of various endocrine glands that occur in association with a variety of other pathologic features. The most important aspect of MEN syndrome is medullary carcinoma of the THYROID due to its ability to metastasize and cause death. Thus, detecting mucosal neuromas may alert the clinician for early diagnosis and treatment. MEN is classified into 3 groups:

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4 TYPES OF MELANOMA: 1. Superficial Spreading Melanoma-the MOST COMMON form of malignant melanoma (65%), & most common cutaneous melanoma in Caucasians. The lesion is TAN, BROWN, BLACK, or ADMIXED on sun-exposed skin (especially BLACK). The cancer begins at one focus in the skin at the dermo-epidermal junction (DEJ). It initially grows in a horizontal plane, along and just above & below the dermo-epidermal junction (this is the “radial” growth phase of melanoma which predominates), and is clinically macular or only slightly elevated. The “vertical” growth phase is characterized by an increase in size, change in color, nodularity, and at times ulceration.

2. Nodular Melanoma-much less common (~13% of cutaneous melanomas). THERE IS NO “RADIAL” GROWTH PHASE (it exists only in the “vertical” growth phase). NM presents as a sharply defined nodule with degrees of pigmentation (may be pink (amelanotic melanoma) or black, and occurs more often on the back, head, and neck of men.

3. Lentigo Malignant Melanoma-even less common (~10% of cutaneous melanomas), and is most common in the ELDERY population. The lesion may grow for years in the “radial” growth phase before developing into the more aggressive “vertical” growth phase. This radial growth phase is known as lentigo maligna (melanotic freckle of Hutchinson), while the vertical growth phase is known as lentigo maligna melanoma.

4. Acrolentiginous Melanoma-occurs on the hands and feet with a reputation for being ignored by the patient, resulting in the development of metastic disease.

NEVUS (MOLES)-nearly all moles are normal. Atypical (Dysplastic) nevi-unusual moles are generally larger than normal moles, and are flat or have a flat part, with irregular borders with variable shades of color (especially brown, but can be a Blue Nevus). The presence of dysplastic nevi may mark a greater risk of malignant melanoma developing on apparently normal skin.

NEVUS

ACQUIRED NEVI (MOLES) – small, usually dark, skin growths that develop from pigmentproducing cells (melanocytes) in the skin. Fairly common on the skin and intra-orally (much more common than congenital nevi both intra-orally and extra-orally). When present, they are usually on the HARD PALATE, or may be on the gingiva and lips. Acquired nevi are microscopically classified into 5 subtypes: 1. Intramucosal Nevus- MOST COMMON nevus in the oral cavity. Nevus cells are located in the C.T. or lamina propria of the oral mucosa. Under palpation, these nevi appear SOLID and SLIGHTLY RAISED over the mucosa surface.

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ODONTOGENIC ABNORMALITIES ABRASION – abnormal, PATHOLOGIC WEARING AWAY (LOSS) of tooth structure.

1. Toothbrush Abrasion-most often results in V-shaped wedges at the cervical margins in canines & premolars. Caused by using a hard bristle toothbrush and/or horizontal brushing strokes with a gritty dentifrice.

2. Occlusal Abrasion-results in flattened cusps on all posterior teeth & worn incisal edges due to chewing or biting on hard foods or objects, and chewing tobacco.

ATTRITION –physiologic wearing away of enamel and dentin due to NORMAL function or mainly excessive GRINDING/GRITTING/CLENCHING teeth together (BRUXING). The most noticeable effects are POLISHED FACETS (flat incisal edges that usually develop on the linguoincisal of maxillary canines & central incisors, and facioincisal of mandibular canines). Discolored tooth surfaces, and exposed dentin.

ATTRITION (BRUXING/GRINDING)

EROSION – CHEMICAL loss of tooth structure from NON-MECHANICAL MEANS such as drinking acidic liquids (soda) or eating acidic foods. Common in BULIMCS due to regurgitated stomach acids. Affects smooth surfaces and occlusal surfaces of teeth.

EROSION

INTRINSIC STAINING: can be caused by the following except DIABETES MELLITUS. • Dentinogenesis imperfecta-causes a translucent or opalescent hue, usually gray to bluish-brown.

• Erythroblastosis fetalis- causes intrinsic stain that is bluish-black, greenish-blue, tan, or brown.

• Porphyria-causes intrinsic stain that is RED or BROWN. • Fluorosis-causes white opacities, or light brown to brownish-black.

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BENIGN MIGRATORY GLOSSITIS (GEOGRAPHIC TONGUE) OR (ERYTHEMA MIGRANS) A HARMLESS, USUALLY PAINLESS (maybe slight burning), COMMON condition due to desquamation of FILIFORM papillae (no taste buds). One or more irregular-shaped patches on the tongue exist. The center area is redder than the rest of the tongue, and edges of the patch are whitish color. These patches appear and remain for a short time, heal, then reappear at another site. The patches usually do not respond to treatment, but disappear spontaneously. Geographic Tongue often occurs with Fissured Tongue.

GEOGRAPHIC TONGUE

FISSURED TONGUE (“SCROTAL TONGUE”) –a DEEP, usually asymptomatic (maybe painful if infected with Candida Albicans) MEDIAN FISSURE with laterally radiating grooves that vary in number, but are usually symmetrically arranged across the DORSUM (TOP) OF THE TONGUE. Rare in children, but incidence increases with age. Found in Melkersson-Rosenthal Syndrome (along with Cheilitis Granulomatosum & Facial Nerve Paralysis).

FISSURED TONGUE

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STOMATITIS NICOTINA (“PIPE-SMOKER’S PALATE” OR NICOTINIC STOMATITIS): the initial clinical response is generalized palatal erythroplakia then becomes a white hyperkeratotic area with small red dots. Related to pipe smoking (tobacco), occurs ONLY ON THE PALATE, and mainly affects males. The palate is initially red & inflamed, then develops a diffuse, grayish-white, thickened, multi-nodular popular appearance with a small red “spot” in the center of each tiny nodule. This “spot” corresponds to orifices of palatal salivary gland ducts.

Treatment: None, except to stop smoking. Not usually premalignant.

• Found ONLY in the palate (palate is leathery white and full of keratin (hyperkeratosis with RED DOTS (inflamed minor salivary glands). The only lesion produced by tobacco that is not cancerous. Usually a white, generalized area with red dots on the hard palate that are PAINLESS & non-indurated. White areas with multiple red dots (inflamed salivary glands in the palate).

NICOTINIC STOMATITIS (PIPE-SMOKER’S PALATE)

LICHEN PLANUS – oral lesion mainly on the BUCCAL MUCOSA appearing as white or grayish-white striae arranged in a lace-like pattern (Wickman’s Striae) often bilaterally & symmetrically distributed, and usually asymptomatic, but may sometimes cause a burning sensation. A fairly common inflammatory disease, of unknown cause, but may be autoimmune.

It usually affects the skin, mouth, or both. May also be on the tongue, lips, hard palate, & gingiva, but MAINLY BUCCAL MUCOSA. • Microscopic Features: hyperparakeratosis with thickening of the granular cell layer, development of a “saw-tooth” appearance of rete pegs, degeneration of the basal cell layer, and infiltration of inflammatory cells into the sub-epithelial layer of C.T. LICHEN PLANUS

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ODONTOGENIC TUMORS AMELOBLASTOMA-tumors of odontogenic epithelial origin and MOST COMMON EPITHELIAL (ECTODERMAL) ODONTOGENIC TUMOR! (its occurrence equals the frequency of all other odontogenic tumors combined). Consists entirely of odontogenic epithelium that shows the differentiation of the familiar, histologic layers of the enamel organ at sites. Enlargement of the tumor may expand the buccal, lingua cortical plates of bone, or palatal bone plates. Root resorption of teeth adjacent to the tumor is common, and in many cases an UNERUPTED, MANDIBULAR 3rd MOLAR is associated with the radiolucent defect. Ameloblastomas are slow-growing, locally invasive tumors that usually run a benign course (do not infiltrate). Often asymptomatic, a painless swelling or expansion of the jaw is the usual clinical presentation. Ameloblastomas occur in three different clinical-radiographic situations with different treatments & prognosis: AMELOBLASTOMA

AMELOBLASTOMA-often associated with unerupted teeth mainly in the posterior body and angle of the mandible (but can be in the maxilla). Looks like a multi-loculated “SOAPBUBBLE” appearance on a panorex. BENIGN TUMOR of ODONTOGENIC ORIGIN that is usually painless. Can cause severe facial/jaw abnormalities due to its growth potential which destroys surrounding bone. Treatment: SURGICAL EXICISION. • Histogenesis: may arise from rests of the dental lamina, epithelial lining of a dentigerous cyst, basal cells of the oral epithelium (mucosa), developing enamel organ, and possibly remnants of Hertwig’s sheath. Consists entirely of odontogenic epithelium that shows the differentiation of the histologic layers of the enamel organ at sites.

• Clinical Features: most often seen in adolescents in the mandibular (retro) molar area. THE MOST AGGRESSIVE ODONTOGENIC TUMOR that is usually benign, but often shows a highly expansive and locally invasive mode of growth.

• Ameloblastoma Radiographic Features: multi-locular or uni-locular RADIOLUCENT lesion on vital teeth with a “soap bubble” appearance when the radiolucent loculations are large & honeycombed when the loculations are small. Has irregular-scalloped margins. Appears similar to a Central Giant Cell Granuloma in the mandible.

• Microscopic Features: various microscopic patterns of the tumor include the follicular (most common pattern of multiple islands with reverse polarity) & plexiform (also the most common pattern of large anastomosing cords), cystic, acanthomatous (extensive squamous

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STUDY HARD TEST WITH CONFIDENCE

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