Cases

Day 2. Wasn't too bad. My xrays weren't horrible. Basically they were simple cases, just
needed to know the drugs, and my subjective treatment plan.

I had the mexican girl case, with similar questions.

Denture patients, Ortho patients, Pedo patients, Alcoholics, Diabetics, Asthmatic, Sickle
Cell patient, Smokers (be careful with these. I had a patient that quit already and they
asked me what therapy I would give him to stop smoking...?!)

cases
man with a pmh of rheumatic fever and takes pen v k 250mg daily
does he need to be antibiotically prophylaxed? Yes

pt with anb of 6
do they have class II or bimaxillary protrusion?

child asthmatic patient no propranolol for the asthmatics

Day 2
16 year old hispanic female on albuterol for asthma...OH fair...
not enough space for canines on Max and mand
Does ectopic eruption on canines cause resorption of lateral?can but usually wont;
will erupt lingually

explorer catches on stained deep groove...Tx?

Composite
Preventive resin restoration
Seal ant
No treatment

What's do u do if her oral health declines after placement of braces declines?

What angles classification?
Clearly class 1

In looking at her facial pictures, What ISN'T true

Incompetent lips
Prognathism
Some other stuff

Asked how would u regain space. extract 1st pms with brackets bands
Removable appliance

Do u do frenectomy before or after place braces/ ortho treatment?

0
Talked about what to tell girl she had asthma I said bring inhaler was correct it and the
other statement was that no2 was contraindicated I said false because its not for
asthma patients

Albuterol is least likely to cause?

Increased salivation
Maybe tachycardia was an option... Don't remember

Kid pays soccer and uses inhaler.. notices white situation on the soft palate mouth
Candidiasis

Patient presented like 40 had ankylosis of primary molars

It asked if only 4 permanent premolars were missing but if you count it on pan you
see it was far more than that missing (true or false )

Explained person with ankyloglossia tongue tied; tongue attached to floor of mouth
almost to tip of tongue

Asked why they had bilateral posterior

open bite I put because the pm failed to erupt

Truck driver, no insurance or soFixed prosth patient but he had like hella bridges but
they looked terrible one was a maryland bridge...1!
cantilever it asked what was the benefit of the cantilever something about resistance,
retention or stability

Dude had extensive class 5 on all maxillary anterior include root caries on teeth

Asked what was the least likely contribution to the root caries or something like that
Would you extract all maxillary teeth and place a denture?

It asked if I would remove bridges what would b my largest concern I said the lack of
coronal structure was my concern
One image asked what was above a tooth and I put that it was not a pathological
condition but anatomical it was the zygomatic process because you could see it
bilaterally

Anytime the things says patient had a history of endocarditis do prophylaxis! If the
person has cardiac issue of regurgitation give them prophylaxis! Know the dosages
Amoxicillin 2g (4 x 500mg) 1 hr before trtmnt; 50mg/kg for kids

Substernal Pain traveling down left arm?

Angina?
MI
acid reflex etc

Which is affects platelet function the least

Ibuprofen
Celebrex (anti arthritic agent inhibits COX-2 but spares COX-1 so minimal effect on
platelet function)
Aspirin

Mandibular prosth patient hasn't been to dentist in years!

The mandible prosth he had looked terrible I wrote the main issue with it was
esthetics

Smoker for like 30 years asked what phase he was in when he admitted he was
smoking? Precontemplation

Asked what I should have him do about quitting??? They were like multiple things
like acupuncture, counseling, bupropion and NRT

It asked how would you ask the patient I said "would you like to start the steps to
quit"
Patient was a war vet single doesn't go to doctor lives alone I wrote he had signs of
Post traumatic stress disorder

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Case 1.
14 year old female wanted to correct crowding.
her maxillary and mandibular canines were JACKED!!!!! they were stacked. this case
became an othro case.
Which teeth should be extracted to provide room. 1st premolars ????
What caused this? arch deficiency
profile question
ANB of 6- class 2
also asked for angles classification.. LOOK A1 1ST MOLARS don't be fooled
If she stopped caring for her teeth whats the cheapest way to help? reinforce OHI
will you need consent? Yes
will you explain everything about the treatment plan, including that she may need a
gingivectomy after the braces are removed? yes

Case 2.
old man alcohol abuser and smoker who has spontaneous pain at night
Chantix is a med that is given to help stop smoking
he has been sober for 18 months, is he cured? I said no, because he can relapse
anytime (idk)????
he had liver disease so it asked about which LA could u give him. I put Articaine
because it can metablized in the plasma and liver., The other LA were all amides.
asked about would you prescribe lortab, and other strong drugs? I picked ibuprofen
600mg because he's an abuser

case 3
older white woman who wanted her bridge re-done
no real healthy issues
had chronic periodontitis
localized bleeding, and moderate gingivitis
she had her 3rs removed when she was 20 and the PAN has a RO lesion in the place
where 17 would have been, It asked what could it be. I picked recurrent cyst because
the other choices didn't make sense. she also stated that the doctor told her one of her
3rds was associated with "some" cyst, well we know that that is dentigerous that's why I
choice recurrent. Now that I think of it, I believe they had ameloblastoma. However, the
tooth had been extracted already. IDK look it up.
Asked about if you extract the anteriors how would you treat. sorry cant remember the
choices

case 4
old man with every disease and taking every medication
asked about his ASA classification. I chose ASA 2. he had hypertension, diabetes, didn't
specifiy whether or not it was controlled or uncontrolled. Hept C.ASA3 if hepC
Asked if his A1C level was 8. something is that good? no

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43. Picture of amalgam tattoo (Day 2 case)

Day 2

Mexican girl
Nothing looked wrong except not enough space for canines on Max and mand
Does ectopic eruption on canines cause resorption of lateral? No usually erupt
buccally?
explorer catches on the tooth do u place amalgam compomer composite sealant? I’d do
sealant if not ½ way to enamel. If it is, do comp
What's do u do if her oral health declines after placement of braces declines? Like what
was cheapest? I said reinforce oral hygiene other was fluoride make a 6 month recall
And asked if u should extract 1st pms I said yes
It asked if u start treatment before perio treatment I said no
Do u do fenectomy before or after place braces/ ortho treatment?
Talked about what to tell girl she had asthma I said bring inhaler was correct it and the
other statement was that no2 was contraindicated I said false because its not for asthma
patients

?????Albuterol is least likely to cause I wrote increase salivation

Kid pays soccer and notices build up of something in mouth I wrote candidsis due to
the use of the asthma p1`ump don't know if that's right

Patient presented like 40 had ankylosis of primary molars

It asked how many pm were missing it was like that is the first statement true or false
Explained person with ankyloglossia known as tongue tie congenital oral anomaly
where tongue tip is attached to lingual frenum
Asked by they had bilateral open bite I put because the pm failed to erupt of exist

Removable prosth patient but he had like hella bridges but they looked terrible one was
a cantilever it asked what was the benefit of the cantilever something about resistance,
retention or stability
It asked if I would remove bridges what would b my largest concern I said the lack of
coronal structure? was my concern
One image asked what was above a tooth and I put that it was not a pathological
condition but anatomical it was like they zygomatic process I think
It asked if I would extract all the mans teeth I said no

Anytime the things says patient had a history of endocarditis do prophylaxis! If the
person has cardiac issue of regurgitation give them prophylaxis! If patient had knee
replacement within the last 2 years prophylaxis??? ;

Pain down left harm? Angina, acid reflex etc

Patient was on hypertension and aspirin medicine would you worry about clotting

What test coumadin??? INR

Mandubular prosth patient hasn't been to dentist in years!

The mandible prosth he had looked terrible I wrote the main issue with it was esthetics

Smoker for like 30 years asked what phase he was in when he admitted he was
smoking? Presomething I don't really remember choices
Asked what I should have him do about quitting??? They were like multiple things like
acupuncture, counseling, smoking cessation drugs and some drug with the letter b or d
I put that but I have no clue!
It asked how would you ask the patient I said "would you like to start the steps to quit"
other choices sounded good to though

Patient was a war vet single doesn't go to doctor lives alone I wrote he had signs of Post
traumatic stress disorder

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My Pics included, stafne bone defect, a child whose gingiva was severely inflamed due
to leukemia, I had the AOT picture, a luekoedema pic, an erosive lichen planus pic and
a fusion pic. That's all the ones I can think of.
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Other stuff from cases:

1. maxillary teeth are supraerupted into occlusal plane where man eden. what would
you treatment – crowns, bring back into occlusal line for RPD.
2. Showed a shitty picture of decay near CEJ of #13 had huge MO already– asked what
would be ideal treatment ?

a. extraction

b. build up and crown

c. crown lengthen, build up, crown

d. endo, build up, crown.

**needed endo and crown lengthening if it was gonna get a crown, but there would’ve
hardly been enough root left in the bone after lengthening – think it was just a really bad
picture.

3. Chantix is also an antidepressant = xerostomia

4. Was asking about treatment on teeth that didn’t look like they had anything wrong
with them, but the pictures sucked so couldn’t tell what was going on.

--#3, huge MOD. asymptomatic, cold tested with no response, what would you do?
looked like the canals may have calcified from the pic. or just really blurry

a. endo

b. ext

c. no tx

d. fluoride

5. Patient starts wheezing on exhale – would prefer all expect?

a. steroid inhaler

b. beta 2 agonist inhaler

c. give them oxygen

d. put them in a comfortable postion.

6. What to do if kid on an Adderall - during appts . Keep things short and sweet. How
does Adderall affect kid = loss of appetite, dry mouth.

7. Extracting #1 – give informed consent that you may damage #2.

8. Give epi to a person on propranolol during injection – what would happen? Increased
BP(hypertensive crisis) and anaphylaxis

9. Give patient and parent home care instructions.

10. Root/cervical caries on multiple posterior teeth, poor hygiene, what do you place.

a. amalgam*????

b. resin

c. glass ionomer

11. Warfarin – need Prothrombin Test

12. Kids and cross bite + shift – what is it, how can you fix it.

13. Question asked what is on the distal of #10? Looked like old composite, cause it
was a pretty clean looking outline. Could have been decay, couldn’t make out much
from the xray.

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Cases

Know about xerostomia and problems that are associated with it (caries, salivary gland
infxn, inc plaque and calculus)

1. Patient who ate bet nuts; makes your teeth stained

2. Patient who was in alcohol and drug abuse program

???3. 13 year old child who had bilaterally protrusive malocclusion

4. Female patient who had class 2 division 1 and wanted a “pretty smile”

a. #8 and #9 rotated

5. Patient had crown #8 that came out

Day2 :

I had every case from 09-10. Every question was asked, I’m just going to add on the extra questions I had to each
case or add the reworded version.
Case 1

Long face, female, does not want to have those spaces between teeth – needs to close them (she does
not have Lateral Incisors) Good oral hygiene.

1). What treatment for flare out of Central Incisors? a). With removable dentures b). Braces c). Face-
gares

Case 2

AA man in his 40s. not currently taking any medications, or has allergies to anything. Doesn’t receive
regular medical or dental health.I forget the CC. But under patient info it states: Patient didnt get regular
treatment. Now that he has insurance he can afford to get regular treatment. He wants to get his teeth
fixed because he wants to keep all teeth that are worth saving. Tells the dentist that he has some mild
anxiety towards going to the clinic. Had an emergency rct on #18 2 months earlier that was completed
successfully.

AA man 46 yrs afraid of dentist, #3 and #6 crown decayed completely – lost.

1). Low blood pressure, low pulse - Syncope when have anesthesia

-The vitals of the patient show very low blood pressure and pulse. what is most likely to happen? A)
cardiovascular collapse, B) Thyroid storm C) Syncope D)some else that wasn’t right.

2). Fix #8,#9 esthetic edge/yellow stain. What treatment to #8, #9? (little bit cheeped off enamel of #8) a).
polished to smooth b). composite c). bleach

- Fix #8,9 the patient doesn’t like how the two front teeth aren’t on the same level. What would be the best
treatment? A). place a composite restoration on both teeth to put them on the same level. B). Place PFM
crowns on both teeth. C). Smoothen out the distal portion of the incisal edge of number 8. D). Place a
porcelain veener on the both 8 and 9. The thing about this question is that the distal edge of number 8
does look off angle, but the problem is that the chip is on the mesial of 8 not the distal. (it’s a really small
chip too). #8 does look a little off colored on the distal facial side but they didn’t ask about what to do
about it.

3). What treatment for #3, #6 space? a). bridge #2-6

- Same question as above, patient also has number #4 and does have decay.

-how would you treatment plan #4 if it were to get an RCT/ what is the most acceptable treatment
plan after the RCT? Take a look at the x-rays and you’ll see decay at/near the level of the alveolar
bone. Choices were A) post and core B) amalgam core C) post and crown and crown D) Crown
lengthening, post and core, and crowing

-Patient tells you that his anxiety started only in his adult years. Hes 40 something now. What
could be the cause of the anxiety? A) how the dentist approached the patient B) how the front
office staff treated him C) His past dental experiences D) the cost of getting dental work done E)
people at work telling him their experiences in the dental office
-Look at #31 select what you see A) large buccal lesion B) Occlusal decay C) APP D) something
else

4). Caries small/occlusal (brown spots on pits) on #31 can be seen on a). picture clinically b). xray c).
from chart

5). #12 has big caries lesion on mesial up to the bone level. What treatment needed? a). crown
lengthening b). post&core – next step because crown only can be on “sound tooth structure” (ferrule
rule = 1mm circular in prep increase strength in …10? Times - check this)

Case 3

I think that case was about some man that used to smoke and something about him trying to quit smoking
and trying the nicotine patches and other stuff and it not working. Hes only smokes 4-5 cigs a day.

- The best treatment to try to get this patient to stop smoking would be? A) some weird drug B) Nicotine
cream C) Nicotine nasal spray D) behavior counseling E)varenciline ( which is a anti smoking drugs but
works on the nicotine receptors too )

63 yrs old man … Picture teeth radiograph

1). #14 bone lost mesialy, overhang amalgam. Why? a). forget to put wedge

-what would be the most likely reason to of the amalgam overhang and the cause of the light contact
between teeth to teeth? A) using weak amalgam, B)something dumb C) a wedge was not placed when
the tooth was restored

2). From #20 big amalgam restoration – you can see on xray pin goes out of tooth distally. Patient
complained that floss shred all the time between #20 and #19. What should you do? a). explain patient
current situation b). tell pt. that previous dentist performance as bellow standard of dentistry c). extract
tooth #20 d). try to cut pin with hand piece

3). Can see well defined circular radiolucency under root tips of # 30, #31, #32. Diagnosis? a). PA cyst
b). OKC c). ameloblastoma

-same question as above. What seems to be the most likely reason of the radiolucency apical to tooth
31? A) PA cyst B) Odontogenic cyst C) ameloblastoma D) normal anatomy ok so for this one you need to
take a look at the other side of the Pan , and if you do you can see that this RL is in the same location
and just doesn’t look anything of the pathology mentioned. it looks just like this! I put normal anatomy cus
it’s the submandibular gland fossa. PS in the Pan on the exam you can also clearly see the mental

foramen on both sides.

Case 4

53 yrs old Porcelain-fused-to-metal PFM bridge #8-10. On PAN can see 3rd molars are impacted.

1). Why discoloration of bridge white color/translucency. Every explanation is possible EXECPT? a).
metal to thick b). not enough reduction in cervical third of #10 c). opack layer is too much thick

-same question, it asked why the discoloration of the cervical third of the #10. A)not enough labial
reduction b)opaque layer too thick C)metal too thick D) something else . Anyways in the clinical picture
you can see that the cervical third near the gingiva is clearly more white than the rest of the crown.

2). On clinical picture you can see wear off mandibular incisors. What is a reason for that? a).
occlusional habite (bruxism) b). thin dentin/enamel 3). Opposing bridge (reason for that in the next
question, if it’s just opposite bridge why all canines are flat?)

-whats the reason for shape of the lower incisor insical thirds? A) thin enamel B) erosion C) oral habit D)
something else

3). Why is that shape of canine – no cusp, flat occlusialy? a). bruxism

-whats the reason for the shape of the canine?in the picture the cusp tip is kinda cut in half. I
dunno that looked weird to me but it’s the same idea I went with Bruxism other answer choices
didn’t make sense.

4). Should we do 3rd molar extraction for the reason that #1 is close to sinus or #32 is close to mandibular
canal? NO (53yrs, 3rd molars are not bothering him)
5). 3rd molars are #1 disto-bucal and #32 is horizontal angulation of impaction. Plus partial bone
coverage. (check in book impaction angulations) TRUE

-some question about a tooth number 3 needing to be extracted and why separate the tooth when
extracting it.

-#3 needs to be extracted, because of its close proximity to the sinus , it is always indicated to
separate teeth It was a 2 part true or false question. – the tooth was very baldly decayed and
there was no clinical crown. Something similar to this minus the anatomical crown on the mesial.

6). What would be the reason to extract #1? a). to place implant, if #2 in future would be lost and pt.
need a bridge.

7). If you do pulpal thermal test on his posterior teeth you may have Negative/False result. Why? a). Age
b). pulpal obliteration/ calcification see xray

Case 5

On clinical picture you can see adult complete dentition (no missing teeth) in position central incisors
touching edge-to-edge. On back, posterior teeth disarticulated.

1). Why discolored pre-molar? Amalgam stain

2). What movement of condyle in TMJ must be for that position? a). rotation b). translation c). both - for
protrusive you do both

-what movement of the condyle is going on in the picture with the lady biting edge to edge? A) both
condyles are rotating ( how is that possible? Lol) B) the right condyle rotating while the left translates C)
the left condyle rotates while the right condyle translates D) both condyles on translating.

-what kind of position if the patient demonstrating in the edge to edge picture? A) maximum
intercuspation B) Centric relation C) Incisor guidance D) Centric position.

3). What clinical picture is demonstrating? a). free way space [the space between the max and mand occl
surfaces when at physiological rest] b). maximum intercuspation c). central occlusion d).incisor guidance
(I don’t know the answer – I put “a” but may be “b” or “d” also, check it)
4). On xray radiograph you may see circular radiolucency on middle root (close to apex) on #9.
Asymptomatic, no pain. Diagnosis? a). lateral periodonal cyst b). radicular cyst c). medial palatine cyst

5). What is the main test needed to be done for diagnosis? a). Thermal vitality test b). EPT c). percussion

Case 6

68 year old female wanting to get some work done. Shes taking certain medication but you have to
realize that Fosamax is a bisphosphonate! This case mainly tests you on the principles of what you can
and cant you to people taking bisphophnates or have an increased risk of ORN.They might switch out the
drug name you become familiar with bisphosphonates

68 yrs female came for your appointment with old dentures (both max/mand), that didn’t fit her anymore.
She had history of using Fosamax medication (biphosphonate drug to protect bones). She is after cancer
surgery, radiation, chemo therapy… On xray all teeth are missing except#6,7,8,9,10 and 25,26,27

1). What is possible diagnosis for her psychotic condition? Depression

-what is the most probable condition that this patient by have? A) Bipolar B) Anxiety C) Depression

-if this patient is on bisphosphonates, which of the following treatments can you render without increased risk of
systemic complications A) extraction of all hopeless teeth B) Scale and root planing C) something that you
shouldn’t be doing D) RCT

-An expect question? I forget the other choices but the except was that “the patient can proceed to get her
extractions done after being off Fosamax for 1 week”

2). If she is after breast cancer chem./radiation + biphosfonate drug Fosamax, what treatment for her you
CAN do if needed? a). extraction b). root canal c). alveolar plasty/surgery d). implants (you can’t touch
bone – risk of osteonecrosis)

3). After Fosamax was stoped for 1 week can you do extraction? NO, Fasle

4). What treatment is good for her? Root planning + cleaning, prophy

-what is the most ideal treatment for this patient? Choices were between A)coronal scaling and removable
dentures for both max and mand. B) coronal scaling and implant placement in edentulous areas C) Scaling and root
planing and something else…I went with this because the patient had moderate to severe bone loss and needing
not only coronal and root scaling but also needed root planing on the exposed root surfaces.

Case 7

Kid 5 yrs. 9 month fall 3 month ago. Tooth #F fall down. You can see on clinical picture new erupting
tooth is appeared. She has a FISTULAR, bump above #E.

1). Tooth #E has luxation. What treatment? Extraction

2). Does age of patient is identical for dental age? Yes, pt.’s age = dental age
3). What would be a treatment? Sealant on all permanent 1st molars

Prophylaxis, fluoride

4). What would be a treatment for posterior crossbite? Bilateral expansion

5). On biteweens you can see small insipient proximal caries on mesial of #19 (between #K and #19)
What is a treatment? a). composite b). don’t do anything c). disk between teeth

Case 8

This was a Mexican lady that has TMJ problems; I believe she was allergic to penicillin to look out for the
premedication question. she cant speak English well and has a loss of hearing from an accident. In my case the
lady did have posterior teeth messing in the in her clinical picture. and there was a picture of the her biting edge to
edge .

Mexican female. Has deafness because of accident. Parents help her in transportation and financially.
She complain in TMJ pain

1). What would be the easiest to improve? a). OHI oral hygiene b). financial limitation c). deafness
because of accident d). pain from TMJ

-the question was stated differently than above, Mine asked all of these would complicate the treatment of
this patient except, A)poor oral care, B)financial limitations C) English problems and deafness of patient
D) Pain from TMJ

2). On Xray radiograph you can see #21 is good, normal angulation, no carries, #19 distaly tipped, a big
carries lesion, # 14 is supererrupting. What treatment would you recommend? a). build up #19 carries
b). build up #21

3). What is next treatment after that? Build up with post and core in only ONE root canal True or
False (I don’t know, check)

-when having to build up the molar with you put the coret matrial in one canal the mesial canal (false).
Doing this makes the canal stronger (double false)

3). What is LEAST possible when you are upringting #19? a). roots of #19 move facialy b). encorrage of
anterior teeth or #21

-what is the least possible movement when up righting #18? A) roots move forward B) anchorage will
come from the premolar and anterior teeth C) tooth can extrude and cause occlusal interference

4). When you are upringting #19 what if possible to happend? Occlusial interfearance

5). What is LEAST possible treatment for supererrupting #14? a). Intrusion b). crown c). RCT d). caries
txn

6). If you do EXTRUSION of tooth #13? crown-to-root ratio increase and prognosis decrease
Case 9

A little girl with CLEFT on clinical picture of Maxillary you can see all teeth lined up normally in ONE line,
except #6 & #7, also #10 & #11 are parallel to each other (one behind other).

1). What is reason for strange position of laterals #7 and #10? CLEFT

2). On Cephalometric picture what is LEAST possible diagnosis? a) maxillary prognatism b). class1
c).class2 div 2 d). class3

3). What arrow point on xray? HYOID

Case 10

Man 46 yrs also with CLEFT palate, fixed when he was a kid, by surgery. On clinical picture he has
Angular Chelulitis on corner of his mouth. He’s complaining that his dentures are moving and discomfort
him and lesion in corner bother him.

1). What is treatment for Angular Chelulitis? Clotrimasol cream 2%

-the red inflammation that has formed under the maxillary denture is because of a ? A) bacteria B) fungus
C) protozoan D) something else

2). On PAN two opacity left/right under his mandible? HYOID

3). He is missing #7 and #10 and bone here (because of cleft) look like resorbed up to10 mm. What
would you recommend treatment? a). extract #8, #9 and do bridge #6-11 b). saving #8, #9 (not xtraction)
to preserve a bone/alveolar ridge (not sure – I choose ”b”)

4). Implants for #7 and

I had a case where I needed to identify the hyoid bone on a pan then find it in the lateral ceph they
provided. This is how it looked. Its basically under the angle of the mandible in a lateral ceph. Don’t get
clowned I thought for a second it might be the clavicle lol The other arrows pointed near the vertebrae to
confuse you!!
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