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The crowns of the incisors when viewed from the incisal A.

are wider mesiodistally than buccolingually in both arches B. are wider buccolingually than mesiodistally in both arches C. are wider mesiodistally in the maxilla, and wider buccolingually in the mandible D. are wider mesiodistally in the mandible and wider mesiodistally in the maxilla

The correct answer is C. This is known as an arch trait, as it is true for both incisors of each arch. Both incisors of the maxilla are wider mesiodistally. Both incisors of the mandible are wider buccolingually. The maxillary central, in particular, is known for the greatest assymetry in this regard. It is much wider mesiodistally than buccolingually, and that difference, expressed as a ratio, is greatest for that incisor. It is also the largest incisor, in both dimensions, in absolute size.

A rule regarding congenitally missing teeth is: A. A mandibular tooth is more likely to be missing than its maxillary counterpart A distal tooth of a type is more likely to be missing than the mesial tooth of the B. same type A mesial tooth of a type is more likely to be missing than a distal tooth of the C. same type D. None of the above is true

The correct answer is B. In any set of teeth (incisor, premolar, molar), the distal tooth is more likely to be congenitally missing than the mesial. So lateral incisors are missing more than centrals, second premolars are missing more than first premolars, and third molars are more commonly missing than first or second. Of all of these, the MOST commonly missing is the maxillary lateral incisor. Note that choice A is therefore incorrect.

In centric occlusion, the mesiolingual cusp of the maxillary first molar will contact: the mesial marginal ridge of the mandibular first premolar and distal marginal A. ridge of the second premolar the distal marginal ridge of the mandibular first molar and distal marginal ridge of B. the second molar the distal marginal ridge of the mandibular second premolar and mesial marginal C. ridge of the first molar D. the central fossa of the mandibular first molar

The correct answer is D. The mesiolingual cusp of a maxillary molar is a holding cusp. The general rule for maxillary holding cusps is as follows: a maxillary holding cusp contacts the distal marginal ridge of its mandibular counterpart and the mesial marginal ridge of the mandibular tooth distal to its counterpart, EXCEPT FOR THE MESIOLINGUAL CUSPS OF THE MOLARS, WHICH CONTACT THE CENTRAL FOSSAE OF THEIR COUNTERPARTS. This should be the central fossa of the counterpart, the mandibular first molar.

The premolar which is most often double rooted is the: A. maxillary first B. maxillary second C. mandibular first D. mandibular second

The correct answer is A. Maxillary first premolars are almost always double rooted. When single rooted, they always have two separate root canals. The level of division of the two roots varies, from complete division up to the crown, to only a small separation apically. The mandibular first premolar is most often singlerooted, and the mandibular second premolar is almost always single rooted (double roots are rarer than in the mandibular first). The maxillary second premolar is most often single rooted. The extreme likelihood that the maxillary first premolar will have two roots has implications for both endodontics and exodontia of this tooth. It is also reported that some small percentage (5% in one study) are actually triple rooted.

The central fossa of a maxillary first molar is NOT bordered by which cusp? A. Mesiobuccal B. Mesiolingual C. Distobuccal D. Distolingual

The correct answer is D. The central fossa, containing a central pit, is located within the main cusp triangle (trigon) of the maxillary first molar. The three major cusps: MB, ML, and DB, surround the fossa and form the trigon, or primitive cusp triangle. The DL cusp (talon) is not part of the trigon, does not surround the central fossa, and is the smallest cusp of the tooth (excluding the Carabelli cusp or trait).

In the primary mandibular first molar, the most noticeable cusps are: A. MB and DB B. MB and ML C. DB and DL D. MB and DL

The correct answer is B. The primary mandibular first molar is a highly unusual tooth. Although it technically contains four cusps, in typical molar fashion it has a great variety in the prominence of those cusps. The MB and ML cusp are most prominent, and the mesial section of the crown comprises two-thirds of the crown area. Both the DB and DL cusps are much reduced. The range of cusp size, in decreasing order is: MB, ML, DB, DL. The ML cusp is notable for a pointy, cone-like shape.

The mesiobuccal cusp of the mandibular third molar occludes with which maxillary tooth surfaces? The mesial marginal ridge of the third molar and distal marginal ridge of the A. second molar The distal marginal ridge of the third molar and mesial marginal ridge of the B. second molar C. The mesial marginal ridge of the third molar only D. The central fossa of the maxillary third molar

The correct answer is A. The mesiobuccal cusp of a mandibular molar is a holding (supporting) cusp. The general rule of occlusion of mandibular holding cusps is as follows: the holding cusps of the mandibular teeth occlude on the mesial marginal ridge of their maxillary counterpart, and the distal marginal ridge of the maxillary tooth mesial to their counterpart, EXCEPT distobuccal cusps of mandibular molars occlude with central fossae of their counterparts, the distal cusp of the mandibular first molar occludes with the distal triangular fossa of its counterpart, and the first premolar occludes only with the mesial marginal ridge of its counterpart (but not the canine). In this case, the maxillary counterpart is the maxillary third molar, and the tooth immediately mesial to it is the maxillary second molar.

Tooth #23 replaces which primary tooth? A. K B. L C. M D. N E. O

The correct answer is D. Both 23 and N are mandibular left incisors. Remember that A through J are maxillary, while K through T are mandibular. The mandibular replacements are 20 for K, 21 for L, 22 for M, 23 for N, 24 for O, 25 for P, 26 for Q, 27 for R, 28 for S, and 29 for T. Remember that permanent molars 17, 18, 19, 30, 31, and 32 do not replace primary teeth.

Which cusp of the maxillary molar is NOT part of the trigon (primitive cusp triangle)? A. Mesiolingual B. Mesiobuccal C. Distolingual D. Distobuccal

The correct answer is C. In evolution, three cusps of the maxillary molar are considered to be the primary cusp triangle, and the original three cusps of the evolving molar. They form the trigon, and are the MB, ML, and DB cusps. The fourth cusp, the DL, is the smallest, is considered to be a minor cusp, and is known evolutionarily as the talon, or talon cusp. This cusp is less conspicuous as you go from first to second to third maxillary molar.

Which is the most common supernumerary tooth? A. Mesiodens B. Second lateral incisor C. Third mandibular D. Fourth maxillary molar

The correct answer is A. A mesiodens is a supernumerary located midline in the maxilla. It has a wide variety in morphology and is usually extracted. It is the most common and frequently causes a diastema between the central incisors. The other relatively common supernumeraries are the second maxillary lateral incisor, third mandibular premolar, and fourth maxillary molar.

The mesiobuccal cusp of the mandibular first molar occludes with which maxillary tooth surfaces? The mesial marginal ridge of the first molar and distal marginal ridge of the A. second premolar The distal marginal ridge of the first molar and mesial marginal ridge of the B. second molar C. The embrasure between the first and second molars D. The distal triangular fossa of the first molar

The correct answer is A. The mesiobuccal cusp of a mandibular molar is a holding (supporting) cusp. The general rule of occlusion of mandibular holding cusps is as follows: the holding cusps of the mandibular teeth occlude on the mesial marginal ridge of their maxillary counterpart, and the distal marginal ridge of the maxillary tooth mesial to their counterpart, EXCEPT DISTOBUCCAL CUSPS OF MANDIBULAR MOLARS OCCLUDE WITH CENTRAL FOSSAE OF THEIR COUNTERPARTS, THE DISTAL CUSP OF THE MANDIBULAR FIRST MOLAR OCCLUDES WITH THE DISTAL TRIANGULAR FOSSA OF ITS COUNTERPART, AND THE FIRST PREMOLAR OCCLUDES ONLY WITH THE MESIAL MARGINAL RIDGE OF ITS COUNTERPART (BUT NOT THE CANINE). In this case, the maxillary counterpart is the maxillary first molar, and the tooth mesial to it is the second premolar.

Extreme bruxism over time may cause masseteric hypertrophy. It can be noted on the face as: A. Swelling in the area of the temporal fossa B. Swelling in the lateral mandibular ramus area C. Swelling on the medial surface of the jaw D. Loss of muscle substance near the ramus E. Loss of muscle mass above and below the lips

The correct answer is B. Masseteric hypertrophy means gain in muscle substance of the masseter muscle. The masseter is located on the lateral part of the ramus and angle, and its growth in thickness can be seen as a squareness of the lower face on frontal view. People who brux (express tension by clenching their teeth) often develop this larger-thannormal size masseter. It can sometimes be confused with parotid swelling, although the parotids are slightly higher in location. Remember that the medial pterygoid is medial, not lateral, to the ramus. Loss of muscle substance would be atrophy rather than hypertrophy.

The mucosa found on the surface of the dorsum of the tongue is known as: A. lining mucosa B. masticatory mucosa C. specialized mucosa D. none of the above

The correct answer is C. Specialized mucosa is found on the dorsum of the tongue and contains taste buds and various papillae, including circumvallate, foliate, fungiform, and filiform. Masticatory mucosa consists of the gingiva and covering of the hard palate. Most of the other areas of the oral cavity are lined by lining mucosa. The characteristics of masticatory mucosa are keratinization, thin or absent submucosa, and tight binding of the lamina propria to underlying periosteum. Lining mucosa is generally nonkeratinized, with a thin lamina propria. Near the teeth, the gingiva and lining mucosa (alveolar mucosa) meet at the mucogingival junction.

The premolar with a root cross section and pulp chamber shape at the cervical line which is most similar to that of a canine is the: A. mandibular first B. mandibular second C. maxillary first D. maxillary second

The correct answer is A. You could answer this on general principal, that the mandibular first premolar is the most canine-like premolar tooth in almost every way. However, in detail, the mandibular first premolar has a round root cross section and a roundish pulp chamber at the cervix. The second premolar has a generally more flattened shape in the mesiodistal direction and a correspondingly oval pulp chamber. It may be constricted at the center with a corresponding hourglass shape. The maxillary first premolar root is flatttened mesiodistally, as is the pulp chamber. It is usually constricted at the center, indicating the two roots and two canals found in the tooth. The second maxilllary premolar, with one root, is less likely to be constricted into an hourglass shape.

Which ligament of the temporomandibular joint inserts into the ramus and angle of the mandible? A. Temporomandibular B. Stylomandibular C. Sphenomandibular D. Lateral

The correct answer is B. The origins and insertions of the TMJ ligaments are as follows: The stylomandibular ligament arises from the spine of the temporal bone known as the styloid process and inserts on the lower ramus and angle of the mandible. The sphenomandibular ligament arises from a spine on the sphenoid bone and runs forward and downward to insert on the lingula and deep ramus of the mandible. The lateral ligament is also known as the temporomandibular ligament. It descends from the lower border and tubercle of the zygoma to the posterior lateral condyle. Its fibers merge with those of the articular capsule.

The tissue located between the inner and outer enamel epithelium is known as: A. stellate reticulum B. dental sac C. dental papilla D. enamel organ

The correct answer is A. The stellate reticulum is an ectodermal tissue located between the inner and outer enamel epithelium. The stellate, or star-like, appearance of the tissue is caused by the arrangement of few cells within a network, separated by intracellular fluid. The inner enamel epithelium will differentiate into ameloblasts and form enamel. The outer enamel epithelium eventually merges with the gingiva as the tooth erupts. A small cell layer between the inner enamel epithelium and stellate reticulum is referred to as the stratum intermedium. Its presence is necessary for proper ameloblast function. The dental sac is mesodermal and forms cementum and the periodontal ligament. The dental papilla is mesodermal and forms pulp and dentin. The enamel organ consists of inner and outer enamel epithelium, stellate reticulum and stratum intermedium and forms enamel. It is ectodermal in origin.

The central portion of the articular disc of the TMJ is best described as: A. convex and avascular B. convex and vascular C. concave and avascular D. concave and vascular

The correct answer is C. The articular disc of the TMJ is composed of fibrous connective tissue. Some sources state that chondrocytes are found within it, so it is sometimes referred to as fibrous connective tissue with an underlying base of fibrocartilage. Its shape is biconcave, somewhat like that of an erythrocyte, with a raised outer portion and depressed middle. The central portion is avascular, and only the periphery, especially the posterior periphery is vascularized.

Which ligament of the temporomandibular joint merges with the fibers of the articular capsule? A. Lateral B. Stylomandibular C. Sphenomandibular D. None of the above

The correct answer is A. The lateral ligament, also known as the temporomandibular ligament, is found extending downward from the lateral surface of the zygoma. The zygoma is formed from the contact of the zygomatic section of the temporal bone and the temporal portion of the zygomatic bone. The ligament is roughly triangular in shape, and on its medial side is found the articular capsule and joint. Fibrous connective tissue composes both the ligament and capsule, and there is a fibrous connection between them.

Which characteristic is NOT typical of lining mucosa? A. Nonkeratinized B. Lines the surface of the hard palate C. Freely moveable D. Contains a well developed submucosa E. Epithelium thin

The correct answer is B. Lining mucosa covers most of the oral cavity except for the hard palate and gingival areas. It is usually loose, freely movable, and has a well-developed submucosa. The lamina propria is often highly glandular. The epithelium is thin and nonkeratinized. Epithelial ridges and rete pegs are uncommon and short.

Severing the left lateral pterygoid will cause the mandible to move in what direction if the patient attempts to protrude? A. Posteriorly B. Closure (elevation) C. Right D. Left E. Downward (depression)

The correct answer is D. If you like rules, the rule is that if a lateral pterygoid is injured, the mandible moves toward the injured side. If you wish to understand this rule better, imagine two intact lateral pterygoids protruding the mandible normally. Now cut the left lateral pterygoid, and imagine that the left side stays in place but the right side continues to protrude. In effect, the mandible will rotate around the axis of the left side. The left side stays in place while the right side rotates left. Lateral pterygoids have little effect on closing.

Incisal contact between the maxillary and mandibular incisors is seen normally: A. in centric occlusion B. in working movements C. in protrusive movements D. in retrusive movements E. never

The correct answer is C. Posterior contact is normal during centric occlusion and maintains the vertical dimension of occlusion. In a normal dentition, however, the incisors are slightly out of contact during centric occlusion. When the mandible moves forward (protrusion), the incisal edges of the mandibular anteriors meet the lingual surfaces of their maxillary counterparts as the teeth separate during opening. (Try it in your mouth!). Note that during retrusion (moving the mandible from centric occlusion to a more distal position), no such contact occurs. During working (lateral) movements, only posterior teeth and canines contact (group function), or canines contact alone (canine/cuspid protected guidance).

As you go from mandibular first to second to third molars, overall root length: A. increases, then decreases B. increases C. decreases D. decreases, then increases

The correct answer is C. While the mandibular third molar is often so variable that it is hard to make useful predictions about it, these generalities apply to mandibular first, second, and third molars as you move distally in the arch: 1) they decrease in mesiodistal length, and 2) their roots decrease in length. Third-molar roots may resemble normal molars or may be missing roots or have additional roots. Roots are often partially or totally fused. In some cases they form a cone-like, fused mass, making exodontia much simpler in these cases. In all cases, however, their roots are shorter than those of their second-molar counterparts, which are always smaller than those of the first molars.

The most common number of mammelons on an incisor is: A. 1 B. 2 C. 3 D. 4

The correct answer is C. Mammelons are bumps on the incisal edge of incisors. They are most commonly found on central incisors of both arches, and if found on the laterals, they are less prominent than those found on the centrals. There are normally three, but this is variable. The three are termed mesial, central, and distal. They are often worn off on adult teeth through years of occlusion.

In extraction of maxillary central incisors, the root anatomy guides the dentist to use a motion that is primarily: A. buccal-lingual luxation B. mesio-distal luxation C. rotation D. all of the above

The correct answer is C. One of the best reasons to know standard and unusual root shapes for the various maxillary and mandibular teeth is to use the correct motion on the forceps when performing extractions. In general, rounded roots are primarily rotated, including the maxillary central incisors and maxillary canines. All double and triple rooted teeth cannot be rotated and must be luxated in the buccal and lingual directions. Mesialdistal motion is normally ruled out because of the existence of adjacent teeth. It is used in rare cases where there is no mesial and distal adjacent tooth. The maxillary central is invariably single rooted with a rounded root, and can almost always be rotated without breaking the crown off of the root.

As the tooth bud develops into a tooth, the ameloblasts and odontoblasts: A. become farther apart B. become closer together C. stay approximately the same distance apart D. are always immediately next to each other

The correct answer is A. Early in tooth bud formation, the tissues of the enamel organouter enamel epithelium, stellate reticulum, stratum intermedium, and inner enamel epithelium-form adjacent to the dentin-forming tissues of the dental papilla. In fact, at this stage, the ameloblasts and future odontoblasts are in contact along the length of the tooth bud. The dentin production begins first, and predentin is laid down by odontoblasts. This predentin production induces the ameloblasts to begin enamel production by cells of the inner enamel epithelium. Thus, dentin is produced above the odontoblasts while enamel is formed below the inner enamel epithelium. Both dentin and enamel are deposited between these two layers, and the former site of the junction of the two layers becomes the DEJ, or dento-enamel junction. By tooth completion, the enamel organ is at the surface of the gingiva while the odontoblasts are producing dentin for the tooth root. Thus, these cell layers are very far apart at this point.

The major function of contact points in the dentition is to: A. protect the incisal surface B. protect the periodontium C. protect the alveolar mucosa D. protect restorations from poor retention E. none of the above

The correct answer is B. Contacts ensure that food does not get lodged between teeth and into the sulcus. Food, debris, and plaque in that area will lead to inflammation, tissue destruction, and bone loss. Contacts do not protect the incisal surface, as they are below (cervical to) that area. They do protect the gingiva (see above), but not especially the alveolar mucosa, which is more cervical and basically below the tooth region. The alveolar mucosa begins at the mucogingival junction. Contact is not involved in restoration retention. All restorations must be retained by retention within the individual tooth itself.

The premolar most likely to have a three-cusped appearance when viewed from the occlusal is the: A. maxillary first B. maxillary second C. mandibular first D. mandibular second

The correct answer is D. The premolars are usually considered to be two-cusped teeth (bicuspids). The exception to the rule, to a small extent, is the mandibular second premolar. Often, the lingual cusp area is divided into a mesiolingual cusp and a distolingual cusp. This gives the tooth a three-cusped appearance. A two-cusped variety also exists, with a large lingual cusp instead of the two smaller ones. In the three-cusped variety, a lingual groove separates the two lingual cusps. Note that the two-cusped and three-cusped varieties are not grossly different in size, as the single lingual cusp is about the same size as a mesioloingual and distolingual combined. The other premolars exist primarily in doublecusped varieties only.

At the cervical line, a cross section of the mandibular canine would show: A. a round shape B. an oval shape wider on the lingual than the labial C. a triangular shape with a distinctly wider labial surface D. an oval shape with a slightly wider labial surface

The correct answer is D. The mandibular and maxillary canines exhibit similar cross sectional shapes at the cervical line. The mandibular canine cross section is oval and flattened mesiodistally. It is generally slightly wider at the labial end than at the lingual. The pulp cavity at this point is lens-shaped, double convex.

In performing a left working movement: A. Only the left lateral pterygoid contracts B. Only the right lateral pteyrgoid contracts C. Both lateral pterygoids contract D. Neither lateral pterygoid contracts

The correct answer is B. In a left working movement, the mandible moves toward the left. The left side is then known as the working side and the right side as the nonworking (balancing) side. The lateral pterygoids pull the mandibular condyles forward, so the pull of both together results in protrusion. For only a left-sided movement, the left lateral pterygoid does not contract and the left condyle stays in a relatively unchanging position (it does rotate slightly). The right lateral pterygoid contracts and pulls the right side of the mandible outward, and then it turns left, as the left side of the mandible is stationary. Remember that the right lateral pterygoid moves the mandible left, and the left lateral pterygoid moves the mandible right.

Which is the first primary tooth to erupt? A. Mandibular central B. Mandibular lateral C. Maxillary central D. Maxillary lateral

The correct answer is A. If you see enough small children in your practice, you'll often notice that a 6-month-old child will have only two teeth: the two mandibular centrals. These are commonly the first teeth to erupt, and most commonly do so at 6 months. Mandibular laterals are often seen at about 9 months. Maxillary centrals and maxillary laterals average about 8 months. First molars then precede canines in both arches, and second molars are last in both arches. The last primary is usually the maxillary second molar at about 24 months. These times may vary considerably. Know the most common order: central, lateral, first molar, canine, second molar.

Which pair of angles of a maxillary first molar are acute when the tooth is viewed from the occlusal? A. MB and ML B. DB and DL C. MB and DB D. ML and DL E. None of the above

The correct answer is E. If you view the maxillary first molar from the occlusal, its shape is that of a rhombus, or equal-sided parallelogram. In any parallelogram, one pair of opposite corners will be obtuse, while the other pair of opposite corners will be acute. In the maxillary first molar, the opposite pair of MB and DL are acute, while the pair ML and DB are obtuse.

Of the following anterior teeth, the one most likely to be double rooted is the: A. Maxillary lateral B. Mandibular lateral C. Maxillary canine D. Mandibular canine

The correct answer is D. Although none of the teeth listed is commonly double rooted, the mandibular canine is the most likely of this group. Maxillary laterals ( choice A) are highly variable and are often the most variable teeth in the mouth. However, their variability does not usually include double-rooted appearance. Mandibular centrals and laterals (choice B) often have proximal root grooves. If these grooves are deep, there may be an appearance of becoming double rooted, but they rarely are. Maxillary canines (choice C) are invariably single rooted. Mandibular canines are occasionally double rooted. The point of separation into two roots may be toward the cervical of the root, or almost at the apex. This double-rooted possibility is significant for both exodontia and endodontics.

When extracting maxillary teeth, the root tip most likely to be forced into the maxillary sinus is that of a: A. canine B. first premolar C. second premolar D. first molar E. second molar

The correct answer is D. Anatomically, roots of the maxillary first molar are closest to the sinus, which dips downward in this area. Periapical x-rays of the area sometimes reveal that the roots of the first molar border right on the sinus margin. Although the first molar is the MOST likely tooth to have a root enter the sinus, roots of the second premolar and second molar can occasionally end up there as well.

Which cell type of the enamel organ is widely separated by liquid between the cells? A. Outer enamel epithelium B. Stellate reticulum C. Stratum intermedium D. Inner enamel epithelium

The correct answer is B. Both the inner and outer enamel epithelium are solid lines of cells with no space between the cells in each line. Between these two layers of cells we find the stratum intermedium, close to the inner enamel epithelium; and the stellate reticulum, filling the space between the stratum intermedium and outer enamel epithelium. The stratum intermedium is generally a few layers of squamous epithelium. The stellate reticulum is a reticulum (net-like network) of widely separated cells (think of stars in the sky). These cells are surrounded by a clear liquid matrix and are connected by cell processes.

The premolar with the buccal cusp most distally placed relative to the lingual is the: A. maxillary first B. maxillary second C. mandibular first D. mandibular second

The correct answer is A. An unusual aspect of the maxillary first premolar is the mesialdistal placement of the cusps. The buccal cusp is off center toward the distal, while the lingual cusp is off center toward the mesial. If you look at the tooth from the lingual, therefore, you will always see two distinct cusp tips, one slightly to the mesial or distal of the other. This placement, when viewed occlusally, is said to give the tooth a twisted appearance. This situation is not found in the second premolar, where the cusps are almost equal in size and straight in alignment.

Alveolar bone is composed of: A. compact bone B. spongy bone C. bundle bone D. all of the above E. none of the above

The correct answer is D. The alveloar bone is similar to most bone in the body in having a compact outer layer of lamellar bone and an inner layer of spongy bone. This spongy bone contains marrow space, usually of the yellow (fatty) type, although some red marrow exists. Collagen fibers of the periodontal ligament insert into the outer cortical compact layer, and are known as Sharpey's fibers. Compact bone with Sharpey's fibers is also known as bundle bone.

The class of teeth considered to have a long axis which is most vertical in a buccolingual direction (as viewed from the mesial or distal) is the: A. incisors B. canines C. premolars D. molars

The correct answer is C. Premolars do not vary far from a vertical line when viewed from the mesial or distal. Both maxillary and mandibular incisors tip their roots greatly toward the lingual, and canines less so. Mandibular molar roots lean buccally while maxillary molar roots lean palatally.

When assigning types of mandibular motion to the compartments of the TMJ, it is generally agreed that which compartment is associated with which motion type? A. Anterior: rotation, posterior: translation B. Anterior: translation, posterior: rotation C. Superior: rotation, inferior: translation D. Superior: translation, inferior: rotation

The correct answer is D. First, eliminate choices A and B, as the disc divides the joint compartment into upper (superior) and lower (inferior) compartments only. In the upper compartment, the upper surface of the disc acts as a cushion as the mandibular condyle slides forward. This cushion slides against the articular eminence in the movement of the condyle in a forward and downward direction. When rotating about an axis during opening, the condyle slides against the lower surface of the disc which conforms to the shape of the condylar head. So we say that translation occurs in the upper compartment and rotation in the lower.

Osteons, Haversian systems, and concentric bone layers: A. are not found in alveolar socket bone B. are found in the outer layer of alveolar bone C. are found in the inner layer of alveolar bone D. are found throughout alveolar bone

The correct answer is B. The alveloar bone is similar to most bone in the body in having a compact outer layer of lamellar bone and an inner layer of spongy bone. This spongy bone contains marrow space, usually of the yellow (fatty) type, although some red marrow exists. Haversian systems, with concentric rings of bone with osteocytes and canaliculi, which surround a canal with artery, vein, and nerve, are found only in compact (lamellar) bone. These systems do not exist within the inner spongy layers of bone, whether we are looking at alveolar bone or any other bone in the body.

If vertical dimension of occlusion is VDO, and vertical dimension of rest is VDR, and freeway space is FS, then: A. VDO + VDR = FS B. VDO + FS = VDR C. VDR + FS = VDO D. None of the above

The correct answer is B. The vertical dimension of occlusion (VDO) is a vertical measurement on the front of the face when the teeth are in full occlusion (centric occlusion). When the face is at rest, the teeth are slightly apart, and the vertical dimension of the front of the face is slightly longer. This is the vertical dimension of rest (VDR). The distance between the teeth at this point is the freeway space (FS). So when we take the smaller VDO and add the few millimeters of the FS, we get the slightly longer VDR. VDR is generally 2 to 5 mm more than VDO.

The primary mandibular central incisor usually exfoliates between which ages? A. 4-5 years B. 6-7 years C. 8-9 years D. 10-11 years E. 12-13 years

The correct answer is B. Eruption and exfoliation questions are common in this section. The mandibular primary centrals are often the first teeth lost, most commonly at age 6. Often they exfoliate as the permanent first molars are erupting. For mandibular primaries, the centrals exfoliate at year 6-7, the laterals at year 7-8, the canine at year 9-10, the first molar at year 10-11, and the second molar at age11-12. Remember that all exfoliation questions are approximations of average ages. The wrong answers must be fairly far off the mark.

Which incisor is most commonly found doubled (supernumerary)? A. Maxillary central B. Maxillary lateral C. Mandibular central D. Mandibular lateral

The correct answer is B. As is often the case, the maxillary lateral incisor is the answer for weirdest or most variable tooth. In this case, it is the most common supernumerary (doubled incisor), as it is also the most common missing, oversized, or undersized incisor. Note that the most distal tooth (lateral incisor, second premolar, third molar) in a set is always more likely to be missing or have a supernumerary. Note also that the most common supernumerary is the mesiodens. This tooth is found in the maxillary midline. It is not, however, considered an additional central. It has a morphology unique to itself and different from centrals.

Alveolar bone is composed of: A. cortical bone only B. cancellous bone only C. cortical bone surrounding cancellous bone D. cancellous bone surrounding cortical bone

The correct answer is C. Alveolar bone is a combination of cortical (compact) bone and trabecular (spongy) bone. The cortical bone is on the outside surface, both next to the tooth root and also continuous with the cortical bone of the maxilla and mandible. The cortical bone adjacent to the tooth root is sometimes referred to as lamina dura. Nerves and blood vessels travel primarily through the more porous cancellous bone between the two cortical plates. Note that alveolar bone can be lost rapidly either in periodontal disease or following tooth extraction.

Which muscle of mastication both strongly elevates and strongly retrudes the mandible? A. Masseter B. Medial pterygoid C. Lateral pterygoid D. Temporalis E. Anterior digastric

The correct answer is D. The temporalis is a strong, broad, flat muscle which can both elevate (close) and retrude (pull back) the mandible. This is due to the fact that it contains both vertical and nearly horizontal muscle fibers. The vertical fibers pull the mandible straight upward (elevation), while the horizontal fibers pull straight backward (retrusion). The most anterior fibers of the temporalis are the vertical. As you move posteriorly, they become first diagonal, and then horizontal. NBDE questions in the past have referred to this muscle as being an elevator in the anterior and an elevator/retruder in the posterior.

The primary crown most UNLIKE any permanent tooth is the: A. central incisor B. lateral incisor C. canine D. first molar E. second molar

The correct answer is D. The primary first molars, both maxillary and mandibular, are unique in morphology and bear little resemblance to any permanent teeth. Primary incisors and canines resemble their permanent counterparts closely, except in certain proportional ways. Likewise, primary second molars are notable for closely resembling their permanent FIRST molar counterparts. The primary maxillary first molar is a little like a premolar in shape, but generally has one minor and two major cusps. It is both small and squat in appearance. The mandibular primary first molar is four-cusped but has a distinctly larger development of the mesial end. The MB and ML cusps generally comprise two-thirds of the area of the crown.

In a noncarious, unrestored, and fully erupted tooth, dentin continues to form at the border of the pulp and dentin. This dentin is known as: A. primary dentin B. secondary dentin C. tertiary dentin D. reparative dentin E. none of the above

The correct answer is B. Dentin forms the bulk of both the crown and root of the tooth. In the crown, it underlies the outer enamel. In the root, it underlies a thin layer of cementum. The original dentin of the crown and root is primary dentin and is the most regular in structure. The pulp continues to form dentin later in life at the dentin-pulp border. This results in smaller pulp chambers with age. This dentin is secondary dentin, and is less regular in structure than is primary dentin. Reparative dentin is formed as a defense against caries, irritation, deep restorations, etc. It is the least regular in structure, and is alo known as sclerotic dentin. There is no tertiary dentin.

Enamel is formed from which embryonic germ layer? A. Endoderm B. Mesoderm C. Ectoderm D. None of the above

The correct answer is C. Of the tissues comprising the tooth structure, only enamel is formed from ectoderm. It is made by ameloblasts, which are ectodermal derivatives. Cementum, produced by cementoblasts, and dentin, produced by odontoblasts, are both mesodermal derivatives (choice B). Note also that pulpal tissue is mesodermal. No tooth structural tissue is endodermal (choice A).

The shape of the pulp chamber in cross section cut at the cervical line in the mandibular central incisor is: A. oval (flattened mesiodistally) B. oval (flattened bucco-lingually) C. round D. figure eight

The correct answer is A. Only maxillary incisors have roundish pulp chamber cross sections when cut at the cervical line. This is true for both maxillary centrals and laterals. In general, mandibular incisors and both arch canines will have ovalish pulp chambers, flattened mesiodistally. (Imagine squashing a round pulp from both the mesial and distal sides at once, resulting in a squashed oval, pointing to the buccal and lingual). Remember that the shape of a pulp chamber is usually related to the shape of the surrounding root.

The Carabelli cusp (trait) is found attached to which cusp? A. Mesiobuccal B. Mesiolingual C. Distobucal D. Distolingual

The correct answer is B. The Carabelli cusp (trait) is a variable cusp or extension of the mesiolingual cusp of the maxillary first molar. Its expression varies from that of a full cusp, at its largest, to a small protuberance at its smallest. Its expression varies among various races and ethnic groups. Some anatomists describe it as a cusp, making the maxillary first molar a five-cusped tooth. Others consider it a variety or trait of a four-cusped tooth. It is sometimes missing, and a groove or pit is found in the normal Carabelli cusp region of the mesiolingual cusp.

Which periodontal fibers are most in line with the long axis of the root? A. Alveolar crestal B. Apical C. Horizontal D. Oblique

The correct answer is B. If we arbitrarily call the long axis of the root vertical, only the apical periodontal fibers are nearly parallel (vertical). The apical fibers run vertically from the apex of the alveolar bone socket to the root apex cementum. More coronally, the next fibers, the oblique, run obliquely (slanted) from near apical cementum to more coronal alveolar bone. Horizontal fibers run horizontally from cementum to bone, which is thus perpendicular to the root axis. The most coronal alveolar fibers run obliquely from coronal cementum, apically slanted toward the alveolar crest of bone.

Which of the following permanent teeth is NOT succedaneous? A. Maxillary lateral incisor B. Mandibular first molar C. Maxillary second premolar D. Mandibular canine E. Maxillary canine

The correct answer is B. Succedaneous refers to a tooth that succeeds another tooth; that is, a tooth that replaces a previous tooth. Remember that permanent incisors and canines replace primary incisors and canines (choices A, D, and E). Permanent premolars replace primary molars (choice C). Thus, all the permanent teeth mentioned so far are succedaneous. Permanent molars are not succedaneous as they do not replace primary teeth. The permanent first molar develops distal to all primary teeth, and later the second and third molars do likewise. Molars do not replace any primary teeth and are therefore not succedaneous.

Which premolar exhibits H, Y, and U occlusal patterns? A. Maxillary first B. Maxillary second C. Mandibular first D. Mandibular second

The correct answer is D. The mandibular second premolar has a variety of occlusal appearances due mostly to its two-cusped or three-cusped nature. There is a slightly larger buccal cusp area, and then either an approximately equal-sized lingual cusp, or a pair of lingual cusps, known as the mesiolingual and distolingual cusps. Together, these two form an area slightly smaller than the buccal cusp. In the event of the three cusps, an occlusal Y groove pattern is common. On the two-cusped variety, either an H (more common) or U (less common) pattern may be found.

The inclinations of the root tips of the mesiobuccal and distobuccal roots of the maxillary first molar are, respectively: A. mesial, mesial B. mesial, distal C. distal, mesial D. distal, distal E. straight, straight

The correct answer is C. A characteristic curve of the two buccal root tips of the maxillary first molar toward each other is sometimes referred to as a pliers-handled appearance or pincer appearance. In effect, the roots grow apically and then turn toward each other, forming a U shape. This shape helps explain the stability of the tooth, especially when combined with the tripod-like arrangement of the palatal root. Note that the same roots of the second maxillary molar often both point distally, distinguishing one molar from the other. These roots in the second molar are also more parallel than those in the first molar.

Which muscle of mastication controls movement of the articular disc of the TMJ? A. Medial pterygoid B. Lateral pterygoid C. Temporalis D. Masseter

The correct answer is B. The lateral pterygoid muscle has two heads. The superior head arises from the greater wing of the sphenoid bone, and the inferior head from the lateral plate of the lateral pterygoid bone. They extend posteriorly to the mandibular condyle, TMJ capsule, and TMJ disc. Fibers from the upper head enter the capsule and merge with the fibrous connective tissue of both the capsule and disc. This is related to the function of the muscle in protruding the mandible, and pulling the disc with the condyle during protrusion, depressing (opening), and lateral movements. No other muscle enters the TMJ.

The mesiolingual cusp of the mandibular first molar contacts: A. the lingual embrasure between the maxillary first molar and second premolar B. the distal marginal ridge of the maxillary second molar C. the central fossa of the maxillary first molar D. the lingual groove of the maxillary first molar E. the lingual embrasure between the maxillary first molar and second molar

The correct answer is A. Lingual cusps of mandibular teeth are guiding cusps, not holding cusps. Therefore, they do not occlude on marginal ridges or central fossae. The general rule for mandibular lingual cusps is that they occlude in the lingual embrasures between their maxillary counterparts and the teeth mesial to their counterparts, EXCEPT for the distolingual cusps of the mandibular molars, which occlude in the lingual grooves of their maxillary counterparts. In this question we are not dealing with the exception of the distolingual cusps of mandibular molars, so in this case, the mandibular first molar mesiolingual cusp contacts the lingual embrasure between its counterpart (the maxillary first molar) and the tooth mesial to it (the maxillary second premolar).

In a mandibular canine, which surface is usually most parallel to the long axis of the tooth? A. Buccal B. Lingual C. Mesial D. Distal

The correct answer is C. Reviewing the surfaces, the lingual surface of the canine contains the bulbous cingulum. The surface of the lingual is thus slanted at roughly 45 degrees from the long axis (as represented by the root). Likewise, the facial surface slants inward as you go from cervical to incisal. The distal surface slants lingually as the tooth narrows coronally. Our answer is mesial. The mesial surface is vertical overall, with no large bulge. Notice that the distal is always more rounded and bulbous than the mesial, which is relatively straight and, if extended, would roughly parallel the root.

Mesial-occlusal-distal (MOD) cavity preparations are most difficult in which of the following teeth? A. Permanent mandibular first premolar B. Permanent maxillary second molar C. Primary mandibular second molar D. Primary mandibular first molar

The correct answer is D. MOD preparations can be difficult because tooth structure must be removed from three tooth surfaces. The remaining tooth structure can be weak, and pulp horns may be exposed. They are especially hard in small teeth with large pulp horns. The primary mandibular first molar is a good example. It has a very narrow distal end, is small overall, and has very high mesial pulp horns. Additionally, little tooth structure remains after the MOD is cut. Permanent mandibular first premolars are small, but not like the primaries. They should have a slanted occlusal floor, but an MOD is possible. Permanent maxillary second molars are generally large and would be the best of this group for making an MOD preparation. The primary mandibular second molar, while small, is larger than the first molar, and has the same shape as a permanent first molar, making it not as difficult to perform an MOD preparation.

The primary maxillary first molar is often said to have a premolar shaped crown. This tooth will invariably have how many roots? A. One B. Two C. Three D. Four

The correct answer is C. Despite a somewhat premolar-shaped crown, the primary maxillary first molar is consistent in root form with all maxillary molars, primary or permanent, in having three roots. They are the mesiobuccal, distobuccal, and palatal. Premolars will routinely have either one or two roots. Primary molars lack a common root trunk, and have widespread roots which allow space for the developing premolar crown underneath.

Synovial fluid-producing tissue in the TMJ: A. is found throughout all surfaces B. is not found within the joint C. is found only on articular surfaces D. is found only on non-articular surfaces

The correct answer is D. The TMJ is a synovial joint, similar to most other movable joints. It is different in having a fibrous articular disc. The surface of the disc is fibrous connective tissue, and the surface of the articulating surfaces of the glenoid fossa are fibrous connective tissue overlying hyaline cartilage. These surfaces are not covered with synovial tissue; however, their smooth functioning is dependent on the production of synovial fluid elsewhere in the joint. This production occurs in all non-articulating surfaces of the joint, which are lined with synovial tissue.

Which teeth exhibit isomorphy with each other? A. Primary maxillary first and second molars B. Primary maxillary second and primary mandibular second molars C. Primary mandibular first molars and primary maxillary first molars D. Primary maxillary second molars and permanent maxillary first molars E. None of the above

The correct answer is D. Isomorphy refers to a close similarity in morphology and crown shape between two teeth. The most notable examples of isomorphy are the primary second molars with the permanent first molars IN BOTH ARCHES. Thus, by looking at a primary second molar in either arch, you can very accurately predict the morphology of the permanent first molar in that same arch. Isomorphy does not exist between primary first and second molars, as both first molars are very unusual in shape and both second molars closely resemble permanent first molars.

The distobuccal cusp of the maxillary first molar occludes in: A. the mesial marginal ridge of the mandibular second molar B. the distal marginal ridge of the mandibular first molar C. the central groove of the mandibular first molar D. the facial embrasure between the mandibular first and second molars E. the distobuccal groove of the first mandibular molar

The correct answer is E. Buccal cusps of maxillary teeth are guiding cusps, not holding cusps. Therefore, they do not occlude on marginal ridges or central fossae. The general rule for maxillary buccal cusps is that they occlude in the facial embrasures between their mandibular counterparts and the teeth distal to their counterparts, EXCEPT for the mesiobuccal cusps of the molars, which occlude in the buccal grooves of their mandibular counterparts, and the distobuccal cusp of the first molar, which opposes the distobuccal groove of the mandibular first molar. In this question we are dealing with the exception of the distobuccal cusps of the maxillary first molar, which occludes with the distobuccal groove of its mandibular counterpart, the mandibular first molar.

The distal contact point and height of contour of the maxillary lateral incisor is located: A. at the incisal edge B. in the incisal third C. in the middle third D. in the cervical third

The correct answer is C. As is generally the case, the distal contact of this tooth is more cervical than is the mesial contact. On the mesial side, where it contacts the central incisor, the contact will be near the junction of incisal and middle thirds. However, on the distal side, it is slightly more cervical, usually around the middle of the middle third. This is the contact with the maxillary canine. On the canine, this height of contour is at the junction of the incisal and middle third.

The buccal cusp of the maxillary first premolar occludes in: A. the mesial marginal ridge of the mandibular first premolar B. the distal marginal ridge of the mandibular second premolar C. the mesial marginal ridge of the mandibular second premolar D. the facial embrasure between the mandibular first and second premolars E. the facial embrasure between the mandibular first premolar and canine

The correct answer is D. Buccal cusps of maxillary teeth are guiding cusps, not holding cusps. Therefore, they do not occlude on marginal ridges or central fossae. The general rule for maxillary buccal cusps is that they occlude in the facial embrasure between their mandibular counterpart and the tooth distal to their counterpart, EXCEPT for the mesiobuccal cusps of the molars, which occlude in the buccal groove of their mandibular counterpart, and the distobuccal cusp of the first molar, which opposes the distobuccal groove of the mandibular first molar. In this question, the contact is the embrasure between first and second mandibular premolars.

The most common arrangement of canals in the roots of a permanent mandibular first molar is: A. two mesial, two distal B. two mesial, one distal C. one mesial, two distal D. one mesial, one distal E. none of the above

The correct answer is B. Although some variation exists, the most common arrangement of canals in the mandibular first molar is two canals in the mesial root (MB and ML), and one in the distal. The largest is normally the distal, followed by the MB, then the ML. Approximately 25% of mandibular first molars will have four canals: MB, ML, DB, and DL.

The lingual fossa is normally deepest on which incisor? A. Maxillary central B. Maxillary lateral C. Mandibular central D. Mandibular lateral

The correct answer is B. The maxillary lateral is noted for its variability, and one area of great variety is the lingual fossa. It is normally more pronounced than that of any other incisor and often contains a pit, from narrow and shallow to deep and extensive. Extremely deep pits may give a dens-in-dente appearance. In operative dentistry the maxillary lateral is the only incisor in which you will occasionally see lingual pit amalgams. The lingual surface is often marked by a lingual marginal groove and tubercles on the cingulum. In general, expect any type of unusual variety to be most commonly found on maxillary laterals.

Sharpey's fibers in the periodontal ligament: A. enter only alveolar bone B. enter only cementum C. are collagenous in composition D. enter cancellous bone to form bundle bone

The correct answer is C. Sharpey's fibers is an older name for the collagenous bundles of the periodontal ligament which connect the tooth to the tooth socket. The two tissues entered by these fibers are cementum on the tooth, and the cortical bone plate of the alveolar bone. When they enter the cortical plate, the resulting bone, when viewed under the microscope, is termed bundle bone. The fibers do not penetrate the bone enough to reach the cancellous inner layers of the alveolar bone.

The mesial and distal heights of contour of the maxillary canine are, respectively: A. incisal third, incisal third B. junction of incisal/ middle third, junction of incisal/middle third C. junction of incisal/middle third, middle third D. middle third, middle third E. middle third, cervical third

The correct answer is C. One way to eliminate answers is to note that the labial view of the maxillary canine is not symmetrical. The mesial cusp ridge is shorter than the distal cusp ridge. This means that the distance from the cusp tip to the mesial contact is shorter than that from the cusp tip to the distal contact. Another way to look at it is that the distal cusp ridge dips lower (more cervical). Therefore, the distal height of contour will be more cervical than the mesial. The mesial height of contour is at about the junction of incisal and middle thirds, while the distal is at the middle of the middle third. Do not consider choice E, even though it follows the pattern discussed above. These contacts (middle, cervical) are too cervical for an anterior tooth.

A mandibular permanent first molar is more likely to have a partially bifurcated: A. mesial root B. distal root C. both roots are equally likely to be bifurcated D. neither root is bifurcated

The correct answer is A. One of the distinctions between the mandibular first-molar mesial and distal roots is the deep root concavity seen running the length of the mesial surface of the mesial root. The distal root, by comparison, will have no similar concavity or a very slight depression. This concavity will sometimes express itself as a partial split (bifurcation) of some small section of the apical end of the mesial root into two roots. This feature is rare to unknown on the distal root. Other differences include the greater likelihood of the mesial root having a pronounced distal curvature.

In a left working movement: A. the left side moves laterally, and the right side medially B. the left side moves medially, and the right side laterally C. both sides move medially D. both sides move laterally

The correct answer is A. In a left working movement, the mandible shifts to the left. From a central position, the left side of the mandible is moving away from center (laterally). The right side of the mandible, although also moving left, is moving toward the center (medially). The left TMJ purely rotates when the right is rotating and translating mechanically. Note that it is impossible for both sides of the mandible to move either laterally or medially at the same time.

The faciolingual dimension of a mandibular first molar, when compared to the mesiodistal dimension, is: A. smaller B. larger C. the same D. larger or smaller, depending on the tooth

The correct answer is A. Mandibular first molars are the largest teeth in the mouth, in mesiodistal dimension. While they are also large buccolingually, they are invariably larger mesiodistally by about 0.5 to 1.0 mm. This is in contrast to the maxillary first molar, which is slightly larger buccolingually than mesiodistally, usually by about 1.0 mm. The mandibular second molar is about equal in both directions and is thus more symmetrical than the first molar.

Which position is achieved entirely by soft tissue, without guidance from teeth? A. Postural (physiologic rest) B. Centric occlusion C. Centric relation D. Protruded contact

The correct answer is A. In postural rest position, the mandible stays a comfortable distance from the maxilla, with the teeth slightly separated. The freeway space between the teeth is often 2-5 mm. There is no tooth contact, and the position is determined and maintained by the muscles of occlusion and related tendons and ligaments. Centric occlusion involves full tooth contact. Centric relation is normally a few millimeters distal to centric occlusion and is achieved by moving distal from centric occlusion. This procedure involves tooth contact. Protruded contact involves contacting guidance of the maxillary and mandibular teeth during protrusion.

The earliest succedaneous tooth in the mouth to erupt is the: A. Primary mandibular central incisor B. Primary mandibular lateral incisor C. Permanent mandibular first molar D. Permanent maxillary first molar E. Permanent mandibular central incisor

The correct answer is E. The question depends entirely on the definition of succedaneous. A succedaneous tooth succeeds (replaces) another tooth. So only permanent teeth can be succedaneous. Note, however, that permanent molars are never succedaneous, as they erupt distal to all primary teeth (choices C and D). Only permanent incisors, canines, and premolars can be succedaneous (refer to choices A and B). Of all succedaneous teeth, the permanent mandibular central incisor is usually first, appearing at about age 6, close to the eruption of the nonsuccedaneous permanent mandibular first molar.

In the permanent mandibular third molar, when viewed from the occlusal: A. the mesial end is larger than the distal B. the distal end is larger than the mesial C. the mesial and distal ends are the same size D. it is impossible to generalize about mandibular third molars

The correct answer is A. Beware of choice D. Although mandibular third molars are notoriously variable in both crown and root form, there are some good generalizations. Almost invariably, the mesial (trigonid) end of the crown is wider, larger, and more distinct than the distal (talonid). The most common pattern is a four-cusp tooth, with MB and ML being the largest cusps and the whole occlusal surface tapering toward the distal.

The lamina propria is: A. epithelial tissue B. connective tissue C. adipose tissue D. muscle tissue

The correct answer is B. The lamina propria is a loose connective tissue located within the mucosal layer, just underneath the epithelium. In the oral cavity, it will be found below the outer layer of stratified squamous epithelium. The lamina propria in the oral cavity often forms wedge-like extensions into concavities in the epithelium, known as connective tissue papillae. The corresponding epithelial extensions into the connective tissue are known as rete pegs.

In a left lateral (working movement): A. the left mandibular teeth are the working side and move to the left B. the left mandibular teeth are the working side and move to the right C. the left mandibular teeth are the balancing side and move to the left D. the left mandibular teeth are the balancing side and move to the right

The correct answer is A. By definition, a working movement occurs when the mandibular teeth on one side move laterally across the surfaces of the maxillary teeth toward their own side. In other words, in a left working movement, left mandibular cusps move laterally left across the cusps of the maxillary left teeth. The other side is known as the nonworking (balancing) side. In this case, the balancing side is the right side. In a left working movement, the balancing side also moves left, as the mandible cannot move both left and right at the same time.

The buccal cusp of the mandibular canine occludes with which maxillary tooth surfaces? The mesial marginal ridge of the first premolar and distal marginal ridge of the A. canine The mesial marginal ridge of the canine and distal marginal ridge of the lateral B. incisor C. The embrasure between the canine and first premolar D. None of the above

The correct answer is D. The buccal cusp of a mandibular canine is not considered to be a holding (supporting) cusp. Therefore, the general rule of occlusion of mandibular holding cusps does not apply. The canine, as an anterior tooth, will normally be slightly out of contact between its maxillary counterpart and the tooth immediately mesial to it. In this case, the maxillary counterpart is the maxillary canine, and the tooth mesial to it is the lateral incisor.

The buccal cusp of the mandibular first premolar contacts which surfaces on maxillary teeth? The mesial marginal ridge of the first premolar and distal marginal ridge of the A. canine The mesial marginal ridge of the second premolar and distal marginal ridge of the B. first premolar The distal marginal ridge of the first premolar and the mesial marginal ridge of the C. canine D. None of the above

The correct answer is D. While theoretically it may appear that the correct answer is choice A, most authors state that there is no contact with the maxillary canine distal marginal ridge, and the canine remains slightly out of contact but near the area of the buccal cusp of the mandibular first premolar. The general rule of occlusion of mandibular holding cusps is as follows: the holding cusps of the mandibular teeth occlude on the mesial marginal ridge of their maxillary counterpart, and the distal marginal ridge of the maxillary tooth mesial to their counterpart, EXCEPT DISTOBUCCAL CUSPS OF MANDIBULAR MOLARS OCCLUDE WITH CENTRAL FOSSAE OF THEIR COUNTERPARTS, THE DISTAL CUSP OF THE MANDIBULAR FIRST MOLAR OCCLUDES WITH THE DISTAL TRIANGULAR FOSSA OF ITS COUNTERPART, AND THE FIRST PREMOLAR OCCLUDES ONLY WITH THE MESIAL MARGINAL RIDGE OF ITS COUNTERPART (BUT NOT THE CANINE).

The Carabelli cusp (trait) is found on which molar tooth? A. Maxillary first B. Mandibular first C. Maxillary second D. Mandibular second

The correct answer is A. The Carabelli cusp (trait) is a variable cusp or extension of the mesiolingual cusp of the maxillary first molar. Its expression varies from that of a full cusp, at its largest, to a small protuberance at its smallest. Its expression varies among various races and ethnic groups, including an increased incidence in people of Asian descent. Some anatomists describe it as a cusp, making the maxillary first molar a five-cusped tooth. Others consider it a variety or trait of a four-cusped tooth. It is sometimes missing, and a groove or pit is found in the normal Carabelli cusp region of the mesiolingual cusp.

Which permanent mandibular molar is most likely to be marked by supplemental occlusal grooves, crenulations, and unpredictable placement of pits? A. First molar B. Second molar C. Third molar D. All molars about equally

The correct answer is C. The question may be answered on general principle, in that the third molars are often the most unpredictable teeth in either arch. The specific patterns referred to here are the pit-groove patterns. In third molars, you will often find supplemental grooves at right angles to the main grooves, and additional pits and fissures not normally seen in first and second molars. The crenulated pattern refers to a highly grooved overall occlusal surface with grooves running in all directions, leaving a lacy, nook-and-cranny occlusal surface.

Functions attributed to the ligaments of the temporomandibular joint include all of the following EXCEPT: A. increasing stability of the joint B. aiding in forward movement of the condyle C. increasing the strength of the joint D. limiting extreme motion of the joint E. All of the above are ligament functions

The correct answer is B. The ligaments, being fibrous connective tissue in composition, play no role in movement of the condyle. Muscular tissue is necessary for this movement, specifically fibers from the upper head of the lateral pterygoid muscle. There is disagreement among anatomy sources as to the function or role of the ligaments. None give the ligaments an extremely important function, but most claim that they help limit motion of the mandible beyond a certain point, or act as barriers to excessive forward or downward motion. Others give the ligaments a general strengthening function which adds stability to the joint. Most importantly, the Dental Boards usually agree with the general notion of adding strength, stability, and limits of movement to the joint.

Which of the following is a function of pulpal tissue? A. Sensory B. Formation of dentin C. Nutritive D. Defensive E. All of the above

The correct answer is E. It should be noted that the MAJOR function of pulp is the production of dentin, as dentin is the major structural tissue of both crown and root. Any question on the dental boards that asks for the "most important" function will have dentin formation as the answer. However, the pulp is also sensory (clearly). All sensory fibers in the pulp carry pain sensation, regardless of whether the original stimulus is hot, cold, or touch. The nutritive function of pulp consists of providing materials to the dentin through the odontoblastic processes. The defensive function of the pulp consists of a limited ability to produce a defensive inflammatory response, and the formation of reparative dentin when the tooth is damaged.

Cervical bulges are found on which surfaces of primary anterior teeth? A. Mesial and distal B. Buccal and lingual C. Lingual only D. Buccal only

The correct answer is B. Primary teeth are notable for cervical bulges; that is, extension of the crown at the cervical line. In the primary anteriors, these bulges extend over both the buccal and lingual surfaces, as though the cervical line was a tightened belt and was tightened further to make the crown overhang in both front and back. In the primary molars, by contrast, the cervical bulge is buccal only.

Which of the following permanent teeth is MOST likely to be missing a distolingual cusp? A. Mandibular first molar B. Maxillary first molar C. Maxillary third molar D. Maxillary second molar

The correct answer is C. The mandibular first molar is invariably a five-cusped tooth, with MB, ML, DB, DL, and distal cusps. Maxillary first and second molars are normally four-cusped teeth. The distolingual cusp is usually less pronounced on the second molar. It is often absent on the maxillary third molar. This is an arch trait: the gradual diminishment in size of the distolingual cusp as you go posteriorly in the maxilla. In the lower arch, the mandibular second premolar can also be viewed as possibly lacking a distolingual cusp. This tooth is either two- or three-cusped. The two-cusped variety has a single buccal cusp and a single lingual cusp, while the three-cusped version has a buccal cusp and paired mesiolingual and distolingual cusps. However, both varieties are common, so it is common to find this tooth lacking the distolingual cusp as well, although that answer is not listed here.

As you go from mandibular first to second to third molars, mesiodistal crown length: A. increases, then decreases B. increases C. decreases D. decreases, then increases

The correct answer is C. While the mandibular third molar is often so variable that it is hard to make useful predictions about it, these generalities apply to mandibular first, second, and third molars as you move distal in the arch: 1) they decrease in mesiodistal length, and 2) their roots decrease in length. Third-molar crowns may resemble normal molars or may be missing whole cusps. In rare cases they are roundish or ovoid, but they are always smaller than their second-molar counterparts, which are always smaller than the first molars. Note that buccolingual length is always shortest in the third molar but about equal in the first and second.

When compared to that of permanent teeth, primary teeth color tends to be: A. whiter B. darker C. similar in shade D. variable, depending on the individual tooth

The correct answer is A. As a general rule, primary teeth are whiter than their permanent counterparts. This shade difference is often noticed by parents. It is common for parents to notice, for example, that newly erupted permanent mandibular incisors are a few shades darker or more yellowish than the primary maxillary incisors that may remain as the mandibular permanent incisors erupt. In the mixed dentition (normal, unstained, not heavily carious, and no tetracycline effects), you can often pick out the primary versus permanent teeth by color alone.

When compared to that of permanent teeth, the ratio of mesio-distal diameter to crown height of primary teeth is: A. greater B. less C. the same D. variable, depending on the individual tooth

The correct answer is A. Primary teeth are often said to have a short or squat appearance of their crowns compared to those of permanent teeth. This is because these teeth are often relatively wide mesiodistally and short incisocervically. This results in a LARGE ratio of mesiodistal diameter to incisocervical crown height. This ratio is smaller in the permanent teeth, which lack the short, squat appearance of primaries. One example: for maxillary central incisors, the primary tooth ratio is 1.083 (the tooth is just slightly bigger mesioincisally than in crown height), while for the corresponding permanent incisor it is .809 (the mesiodistal diameter is only 80% of the crown height).

When primary mandibular incisors are retained too long and the permanent incisors erupt with the primaries still in place, the permanents usually erupt in what position relative to the primaries? A. Mesially B. Distally C. Lingually D. Buccally

The correct answer is C. This is a fairly common occurrence. A child of about 6 years will often present to the dental clinic with a parent, and the parent will be concerned about a double row of teeth. In these cases, the permanent mandibular incisors are erupting before the primaries have completely exfoliated. An x-ray usually confirms partial resorption of the primary roots, and the primaries are allowed to exfoliate. No further treatment is usually indicated. In rare cases where the permanents erupt buccally, extraction of the primaries and tooth movement of the permanents is in order, however this is highly unusual.

The mesial height of contour of the mandibular central incisor is: A. near the incisal edge B. at the junction of the incisal and middle thirds C. in the middle third D. at the junction of the middle and cervical thirds

The correct answer is A. Mandibular central incisors contact at the most incisal point found on any tooth. The contact is located just below the incisal edge. On the distal surface, it is still incisal and near the edge, but is slightly more cervical than the contact found on the mesial side of the tooth.

The TMJ structure consists of: A. One synovial compartment B. An upper synovial and lower nonsynovial compartment C. Two synovial compartments D. Two nonsynovial compartments

The correct answer is C. The TMJ has an upper and lower compartment, separated by the articular disc, which is composed of fibrous connective tissue. Both the upper and lower compartments are synovial; that is, they produce synovial fluid. Synovial fluid aids in lubricating the articular surfaces of the joint, and is found in many movable joints. Note that the synovial membrane lines the inside of the joint but not the actual articulating surfaces. These surfaces are fibrous connective tissue over hyaline cartilage.

The lingual cusp of the mandibular first premolar contacts: A. the mesial marginal ridge of the maxillary first premolar B. the distal marginal ridge of the maxillary second premolar C. the central fossa of the maxillary second premolar D. the lingual embrasure between the maxillary first and second premolars E. the lingual embrasure between the maxillary first premolar and canine

The correct answer is E. Lingual cusps of mandibular teeth are guiding cusps, not holding cusps. Therefore, they do not occlude on marginal ridges or central fossae. The general rule for mandibular lingual cusps is that they occlude in the lingual embrasures between their maxillary counterparts and the teeth mesial to their counterparts, EXCEPT for the distolingual cusps of the mandibular molars, which occlude in the lingual grooves of their maxillary counterparts. In this question we are not dealing with the exception of the distolingual cusps of mandibular molars, so in this case, the mandibular first premolar lingual cusp contacts the lingual embrasure between its counterpart (the maxillary first premolar) and the tooth mesial to it (the maxillary canine).

Which characteristic most distinguishes permanent mandibular central incisors from lateral incisors? A. Mesiodistal length B. Buccolingual length C. Root length D. Rotation of the crown around the root axis E. None of the above

The correct answer is D. The mandibular central and lateral incisors can be viewed as almost twins. They are similar in dimension both mesiodistally and buccolingually. (The lateral may be slightly, but not significantly, larger). Their roots are similar in length, although the lateral may have a more pronounced distal inclination. The crowns are of similar anatomy. However, the lateral has a twisted or rotated crown, as if you took a central and then slightly rotated the crown around the long axis of the root. The root may appear to face forward, while the incisal edge is curved in keeping with the normal curve of cusp tips of the mandibular arch.

The formation of dual teeth with combined enamel and dentin crowns but with only one root is known as: A. gemination B. dilaceration C. concrescence D. dens-in-dente E. taurodont

The correct answer is A. Gemination is a form of fusion, where a single root attempts to form two crowns, and these crowns share dentin and enamel. A dilaceration is a sharply bent root, especially near the apex. Concrescence is joining of two teeth by cementum union. Taurodonts are teeth, usually molars, with short roots relative to crown size, and large pulpal chambers, giving rise to a bull-like appearance. Dens-in-dente refers to a tooth-within-atooth appearance and is due to invagination, usually in a maxillary lateral incisor.

The lingual surfaces of most maxillary teeth of a patient are worn down so that dentin is visible through the remaining enamel on the lingual side. This is due to the dissolving of the mineral of the enamel by strong acid. This loss of tooth structure can be termed: A. attrition B. abrasion C. erosion D. internal resorption

The correct answer is C. Erosion is the chemical dissolving of tooth structure. It can be caused by a number of factors, including sucking on lemons and other acidic fruit, excessive intake of acidic beverages (cola), or excessive vomiting, as in bulimia. Bulimics often exhibit normal facial surfaces with severely eroded lingual surfaces. This is due to the effect of strong mineral acid from the stomach (hydrochloric acid at pH 2). Attrition (choice A) is the mechanical wearing of teeth due to physiologic processes, including chewing and bruxism. Abrasion (choice B) is the mechanical wearing away of tooth structure due to some outside object, such as toothbrush abrasion at the cervical lines of teeth due to hard sideways brushing, or from habitually holding bobby pins or nails with the teeth. Internal resorption (choice D) is the loss of dentin from pathologic dissolving by processes inside the pulp chamber. It can follow tooth trauma.

The Golgi apparatus in odontoblasts producing dentin can be expected to be: A. absent B. less developed than in an average cell C. developed to the same degree as that of an average cell D. more highly developed than that of an average cell

The correct answer is D. Remember that the function of Golgi apparatus is to modify and package proteins produced for export by the cell. In this way, an odontoblast would be similar to any other protein-producing secretory cell. Proteins produced by ribosomes on the rough ER will enter the ER and travel to the Golgi apparatus. Here, within the flattened sacs of the Golgi, the collagen and other fibers will be modified and packaged to be sent to the edge of the cell for secretion as dentin matrix. So the large production demands of producing collagen and other proteins for predentin should result in odontoblasts having large, numerous, and active Golgi bodies.

When you move the mandible from centric occlusion (maximum intercuspation) to protruded contact (edge-to-edge) position: A. vertical dimension decreases B. horizontal overlap increases C. vertical overlap increases D. None of the above

The correct answer is D. As you move from centric occlusion to edge-to-edge position, the mandibular teeth separate from the maxillary and a space is created between the two arches. Try this yourself, as you protrude and slide the mandible forward. The anterior teeth act as a guide as you slowly separate from occlusal contact until only incisal edges of incisors contact. At this point, the increased space between the arches adds to vertical dimension. There is no vertical overlap (overbite; choice C) nor is there any horizontal overlap (overjet; choice B) at this point. So protrusion to edge-to-edge increases vertical dimension while decreasing both vertical and horizontal overlap.

In centric occlusion, the mesiolingual cusp of the maxillary second molar will contact: A. the central fossa of the mandibular second molar B. the central fossa of the mandibular first molar the distal marginal ridge of the mandibular first molar and mesial marginal ridge of C. the second molar the distal marginal ridge of the mandibular second premolar and mesial marginal D. ridge of the first molar

The correct answer is A. The mesiolingual cusp of a maxillary second molar is a holding cusp. The general rule for maxillary holding cusps is as follows: a maxillary holding cusp contacts the distal marginal ridge of its mandibular counterpart and the mesial marginal ridge of the mandibular tooth distal to its counterpart, EXCEPT for the mesiolingual cusps of the molars, which contact the central fossae of their counterparts. This should be the central fossa of the counterpart, the mandibular second molar.

The most common arrangement of canals in the roots of a permanent maxillary first molar is: A. ML, MB, DL, DB B. ML, MB, and DB only C. ML, MB, and palatal D. MB, DB, and palatal E. none of the above

The correct answer is D. Most often, the maxillary first molar has three canals: a mesiobuccal, a distobuccal, and a palatal. The palatal is usually largest and widest. Occasionally (30%) the first molar may have a fourth canal, located within the mesiobuccal root, slightly lingual to the mesiobuccal canal. When found, it is the smallest and thinnest of all canals in the tooth.

Which ligament of the temporomandibular joint inserts into the lingula of the mandible? A. Temporomandibular B. Stylomandibular C. Sphenomandibular D. Lateral

The correct answer is C. The origins and insertions of the TMJ ligaments are as follows: The sphenomandibular ligament arises from a spine on the sphenoid bone and runs forward and downward to insert on the lingula and deep ramus of the mandible. The stylomandibular ligament arises from the spine of the temporal bone known as the styloid process and inserts on the lower ramus and angle of the mandible. The lateral ligament is also known as the temporomandibular ligament. It descends from the lower border and tubercle of the zygoma to the posterior lateral condyle. Its fibers merge with those of the articular capsule.

Which two tissues are formed by the same part of the tooth bud? A. Enamel and dentin B. Dentin and cementum C. Dentin and pulp D. Pulp and cementum E. None of the above

The correct answer is C. The three sections of the tooth bud are the enamel organ, the dental sac, and the dental papilla. The enamel organ, not surprisingly, produces enamel and contains the inner enamel epithelium, stratum intermedium, stellate reticulum, and outer enamel epithelium. The dental papilla, a mesodermal derivative, produces both dental pulp and dentin. The dental sac, also mesodermal, produces both cementum and the periodontal ligament.

The most numerous cell type of the dental pulp is the: A. neuron B. fibroblast C. leukocyte D. macrophage E. ameloblast

The correct answer is B. The dental pulp is a connective tissue characterized by multiple collagen fibers running in all directions, and large numbers of fibroblasts, which produce the fibers. There are also capillaries, neurons, lymphatic channels, and different types of leukocytes, including macrophages, neutrophils, and eosinophils. However, the predominant cell type is the fibroblast. Note that the pulp is lined by the dentin-forming odontoblasts, but there are no ameloblasts, which form enamel.

Collagen fibers inserting into compact bone of the alveolar socket are called: A. Tomes processes B. Sharpey's fibers C. Von Ebner lines D. Contour lines of Owen E. None of the above

The correct answer is B. The fibers of the periodontal ligament are collagenous and insert into the compact, lamellar outer layer of the tooth socket. This is similar to fibers of a tendon inserting into bone. The appearance of the bone with the collagen fibers causes it to be named bundle bone. The fibers themselves are called Sharpey's fibers. Tomes processes (choice A) are projections of ameloblasts into developing enamel. Von Ebner lines (choice C) are found in dentin and show the incremental laying down of dentin tissue. Lines of Owen (choice D) are found in dentin as well, and are exaggerated Von Ebner lines found in areas of trauma during dentin formation.

In centric occlusion, the distolingual cusp of the maxillary third molar will contact: A. the central fossa of the mandibular second molar B. the central fossa of the mandibular third molar the distal marginal ridge of the mandibular first molar and mesial marginal ridge of C. the second molar the distal marginal ridge of the mandibular second molar and mesial marginal ridge D. of the first molar E. None of the above

The correct answer is E. The distolingual cusp of a maxillary third molar is theoretically a holding cusp, however it is often missing on this tooth. The general rule for maxillary holding cusps is as follows: a maxillary holding cusp contacts the distal marginal ridge of its mandibular counterpart and the mesial marginal ridge of the mandibular tooth distal to its counterpart, EXCEPT FOR THE MESIOLINGUAL CUSPS OF THE MOLARS, WHICH CONTACT THE CENTRAL FOSSAE OF THEIR COUNTERPARTS. This should be the distal marginal ridge of the mandibular third molar and no mesial marginal ridge, because there is no tooth distal to the third molar. So the answer is either the cusp does not exist, or it contacts only the distal marginal ridge of the mandibular third molar.

The submucosa of gingival masticatory mucosa is: A. similar in thickness to that of lining mucosa B. much thicker than that of lining mucosa C. found between the epithelium and lamina propria D. thin or absent

The correct answer is D. The gingival masticatory mucosa is characterized by keratinization, thin or absent submucosa, and a firm, direct binding of the lamina propria to the periosteum. In general, the submucosa is thicker in the lining mucosa. Note that submucosa, when present, is always found beneath lamina propria, and is never between epithelium and lamina propria. If all four tissues are present in a digestive mucosa, the order from the outside will be: epithelium, lamina propria, muscularis mucosae, submucosa.

The appearance of a second root in a canine is: A. never found B. found more often in the maxillary than the mandibular C. found more often in the mandibular than the maxillary D. found about equally in both arches

The correct answer is C. Two roots are a fairly rare occurrence in canines, but are occasionally found in the mandibular canine. They are almost unknown in the maxillary. If they are found in the mandibular canine, they will be buccal and lingual, similar to those found in premolars.

The shape of the pulp chamber in cross section cut at the cervical line in the maxillary central incisor is: A. oval (flattened mesiodistally) B. oval (flattened bucco-lingually) C. round D. figure eight

The correct answer is C. Only maxillary incisors have roundish pulp chamber cross sections when cut at the cervical line. Laterals are egg-shaped with the widest portion labial, not round. This is true for both maxillary centrals and laterals, which are egg-shaped with the widest portion of the labial not round. In general, mandibular incisors and both arch canines will have oval-shaped pulp chambers, flattened mesiodistally. (Imagine squashing a round pulp from both the mesial and distal sides at once, resulting in a squashed oval, pointing to the buccal and lingual). Remember that the shape of a pulp chamber is usually related to the shape of the surrounding root.

The mesiobuccal cusp of the maxillary second molar occludes in: A. the buccal groove of the second mandibular molar B. the facial embrasure between the mandibular first and second molars C. the central groove of the mandibular second molar D. the distal marginal ridge of the mandibular first molar E. the buccal groove of the mandibular third molar

The correct answer is A. Buccal cusps of maxillary teeth are guiding cusps, not holding cusps. Therefore, they do not occlude on marginal ridges or central fossae. The general rule for maxillary buccal cusps is that they occlude in the facial embrasures between their mandibular counterparts and the teeth distal to their counterparts, EXCEPT for the mesiobuccal cusps of the molars, which occlude in the buccal grooves of their mandibular counterparts, and the distobuccal cusp of the first molar, which opposes the distobuccal groove of the mandibular first molar. In this question we are dealing with the exception of the mesiobuccal cusps of maxillary molars, which occlude with the buccal grooves of their mandibular counterparts. In this case, the maxillary second molar mesiobuccal cusp contacts the mandibular second molar buccal groove (its counterpart).

Which of the following fiber sets does NOT attach to cementum? A. Alveolar crestal B. Dento-gingival C. Circular D. Oblique

The correct answer is C. The attachment fibers are usually divided into two groups, the gingival group and the periodontal group. Gingival fibers attach tissues, not including alveolar bone. For example, circular fibers run only within gingiva, encircling the tooth. Dento-gingival fibers run from cementum to gingiva. Dento-periosteal fibers run from cementum to periosteum. Periodontal fibers run from alveolar bone to cementum, and include alveolar crestal, oblique, horizontal, and apical.

As compared to those of the permanent mandibular first molar, the roots of the second molar are: A. more mesially inclined B. straighter C. more distally inclined D. very similar in inclination to the first molar

The correct answer is C. In the permanent mandibular first molar, the mesial root is usually slightly curved distally, and the distal root is straighter but pointing toward the distal. In the second molar, both roots are usually significantly inclined toward the distal and curved distally at the end. They tend to resemble each other more than the two roots of the first molar do. They are also closer together. The roots in the first molar are more widely spread.

Protrusive movement causes the condyle of the mandible to move: A. backward and downward B. backward and upward C. forward and downward D. forward and upward

The correct answer is C. Protrusive movement is defined as moving the mandible outward, away from the head. If you are in centric occlusion, you will protrude to move toward an edge-to-edge position. The lateral pterygoid moves both condyles forward when it contracts, so the initial protrusive movement is forward. When the condyle contacts the articular eminence in the glenoid fossa, it cannot move directly forward anymore and begins to glide downward along the surface of the fossa.

In occlusion, guiding cusps are defined as: A. lingual cusps of maxillary and mandibular arches B. bucccal cusps of maxillary and mandibular arches C. buccal cusps of the maxillary arch and lingual cusps of the mandibular arch D. lingual cusps of the maxillary arch and buccal cusps of the mandibular arch

The correct answer is C. In occlusion, cusps are defined as either holding (supporting) cusps or guiding cusps. Holding cusps, in central occlusion, make contact with the opposing arch, establish vertical dimension of occlusion, and support the forces of occlusion. They are the lingual cusps of the maxillary arch and buccal cusps of the mandibular. When the teeth are in centric occlusion, these cusps are in contact. The other cusps (guiding) are not. The other cusps are either lingual to the contact (lingual cusps of the mandibular arch) or buccal to the contact (buccal cusps of the maxillary arch).

The buccal cusp of the maxillary second premolar occludes in: A. the mesial marginal ridge of the mandibular first premolar B. the distal marginal ridge of the mandibular second premolar C. the mesial marginal ridge of the mandibular second premolar D. the facial embrasure between the mandibular first and second premolars E. the facial embrasure between the mandibular second premolar and first molar

The correct answer is E. Buccal cusps of maxillary teeth are guiding cusps, not holding cusps. Therefore, they do not occlude on marginal ridges or central fossae. The general rule for maxillary buccal cusps is that they occlude in the facial embrasure between their mandibular counterpart and the tooth distal to their counterpart, EXCEPT for the mesiobuccal cusps of the molars, which occlude in the buccal grooves of their mandibular counterparts, and the distobuccal cusp of the first molar, which opposes the distobuccal groove of the mandibular first molar. In this question, the contact is the embrasure between second mandibular premolar (the counterpart) and the first molar (the tooth distal to the counterpart).

Which of the following permanent teeth is MOST likely to be missing a distolingual cusp? A. Mandibular first molar B. Maxillary first molar C. Mandibular second premolar D. Maxillary second molar

The correct answer is C. The mandibular first molar is invariably a five-cusped tooth, with MB, ML, DB, DL, and distal cusps. Maxillary first and second molars are normally four-cusped teeth. The distolingual cusp is usually less pronounced on the second molar. It is often absent on the maxillary third molar, but that answer is not listed. The mandibular second premolar is either a two- or three-cusped tooth. The two-cusped variety has a single buccal cusp and a single lingual cusp, while the three-cusped version has a buccal cusp and paired mesiolingual and distolingual cusps. However, both varieties are common, so it is common to find this tooth lacking the distolingual cusp.

When compared to the buccal roots of the maxillary first molar, the buccal roots of the maxillary second molar are: A. more parallel, with a pliers-like appearance B. less parallel, lacking a pliers-like appearance C. more parallel, with both having a mesial tip orientation D. more parallel, with both having a distal tip orientation

The correct answer is D. A characteristic curve of the two buccal root tips of the maxillary first molar toward each other is sometimes referred to as a pliers-handled appearance or pincer appearance. In effect, the roots grow apically and then turn toward each other, forming a U shape. This shape helps explain the stability of the tooth, especially when combined with the tripod-like arrangement of the palatal root. Note that the same roots of the second maxillary molar often both point distally, distinguishing one molar from the other. These roots in the second molar are also more parallel than those in the first molar. In buccal view they seem to sway distally, with the palatal root in the midline and slightly mesially tilted.

Rests of Malassez are composed of: A. ectodermal derivatives B. former enamel epithelium cells C. former root sheath of Hertwig cells D. all of the above

The correct answer is D. The epithelial rests of Malassez are found in the periodontal ligament and are leftovers from the root formation process. The root is originally outlined by the epithelial root sheath of Hertwig, which is composed of the inner and outer enamel epithelium tissues, without a stellate reticulum in between. The root sheath induces formation of odontoblasts, which then produce root dentin. Pieces of the root sheath, which do not disappear, remain as the epithelial rests of Malassez. These small groups of tissue are ectodermal in origin, as the original enamel epithelium is ectodermal.

In the Posselt envelope of motion, protruded contact position (PCP) is: A. achieved with the posterior teeth in occlusion B. an extreme border position C. the same as edge-to-edge D. the same as an Angle Class II relationship

The correct answer is B. The Posselt envelope of motion is a tracing of the extreme border movements of the mandible. It shows how far the mandible can protrude, retrude, open, and close, and all motions connecting these points. Protruded contact position is caused by protruding the mandible as far as possible. This will normally push the mandible past edgeto-edge, until the mandible appears to be in a Class III relationship. As the mandible protrudes, anterior tooth contact causes separation of the teeth out of occlusion.

The marrow space inside alveolar bone surrounding teeth: A. does not exist B. is usually red marrow C. is usually hematopoietic marrow D. is usually yellow marrow

The correct answer is D. Two types of marrow space are found within bone, red (hematopoietic), which is the source of blood cells; and yellow (fatty), which does not produce blood cells. The alveloar bone is similar to most bone in the body in having a compact outer layer of lamellar bone and an inner layer of spongy bone. This spongy bone contains marrow space, usually of the yellow (fatty) type, although some red marrow exists, especially in the ramus and condyle of the mandible.

As compared to the cross section of the maxillary central incisor at the cervical line, the cross section of the mandibular central is: A. more flattened mesiodistally B. more flattened faciolingually C. rounder D. almost identical

The correct answer is A. As a general rule, maxillary incisors have round root sections and round pulp chamber cross sections. Mandibular incisors have more oval ones, and are flattened mesiodistally. This is in keeping with the general root shape of each. Maxillary incisor roots are round, and mandibular ones are flattened to a greater degree. Note that in both arches, as the pulp moves coronally it will flatten buccolingually, in keeping with the coronal shape of all incisors.

Based on root morphology, the tooth most likely to be successfully rotated during exodontia is the: A. Maxillary central B. Mandibular central C. Mandibular lateral D. Mandibular canine

The correct answer is A. During extraction, rotation can be used on teeth with rounded conical roots. Two primary examples are maxillary centrals (especially) and maxillary laterals. Rotation may also be used somewhat with maxillary canines. If roots are flattened mesiodistally, then buccal-lingual movement is used instead of rotation, as rotation may cause crown fracture. Mandibular centrals, laterals, and canines ( choices B, C, and D) are all flattened mesiodistally, and therefore are usually not rotated during extraction. Mandibular canines also may occasionally have two roots (buccal and lingual), which will prohibit rotation.

The mesiolingual cusp of the mandibular third molar contacts: A. the lingual embrasure between the maxillary second molar and third molar B. the distal marginal ridge of the maxillary second molar C. the central fossa of the maxillary second molar D. the lingual groove of the maxillary third molar E. the buccal embrasure between the maxillary second molar and third molar

The correct answer is A. Lingual cusps of mandibular teeth are guiding cusps, not holding cusps. Therefore, they do not occlude on marginal ridges or central fossae. The general rule for mandibular lingual cusps is that they occlude in the lingual embrasures between their maxillary counterparts and the teeth mesial to their counterparts, EXCEPT for the distolingual cusps of the mandibular molars, which occlude in the lingual grooves of their maxillary counterparts. In this question we are not dealing with the exception of the distolingual cusps of mandibular molars, so in this case, the mandibular third molar mesiolingual cusp contacts the lingual embrasure between its counterpart (the maxillary third molar) and the tooth mesial to it (the maxillary second molar).

Hypocalcified enamel rods which enter into enamel from the DEJ are known as: A. enamel spindles B. enamel tufts C. enamel lamellae D. none of the above

The correct answer is B. There are a number of somewhat confusing anomalies at the dentinoenamel junction. Enamel spindles are odontoblastic processes and dentinal tubules which extend a short way into enamel. Enamel lamellae, on the other hand, extend from enamel into dentin. They are pieces of uncalcified organic enamel material. Enamel tufts are hypocalcified enamel rods. They are individual entities; however, they appear as groups (tufts) when a group of them are viewed laterally.

The distal cusp of the mandibular first molar occludes with which maxillary tooth surfaces? The mesial marginal ridge of the first molar and distal marginal ridge of the second A. molar The distal marginal ridge of the second molar and mesial marginal ridge of the first B. molar C. The embrasure between the first and second molars D. The distal triangular fossa of the first molar

The correct answer is D. The distal cusp of the mandibular first molar is a holding cusp. The general rule of occlusion of mandibular holding cusps is as follows: the holding cusps of the mandibular teeth occlude on the mesial marginal ridge of their maxillary counterpart, and the distal marginal ridge of the maxillary tooth mesial to their counterpart, EXCEPT DISTOBUCCAL CUSPS OF MANDIBULAR MOLARS OCCLUDE WITH CENTRAL FOSSAE OF THEIR COUNTERPARTS, THE DISTAL CUSP OF THE MANDIBULAR FIRST MOLAR OCCLUDES WITH THE DISTAL TRIANGULAR FOSSA OF ITS COUNTERPART, AND THE FIRST PREMOLAR OCCLUDES ONLY WITH THE MESIAL MARGINAL RIDGE OF ITS COUNTERPART (BUT NOT THE CANINE). Note that mesiobuccal cusps of mandibular molars and buccal cusps of premolars contact marginal ridges.

Damage to the right lateral pterygoid results in: A. the mandible turning right on protrusion B. inability to elevate the mandible C. the mandible turning left on protrusion D. none of the above

The correct answer is A. As a rule, the mandible will move toward the side of injury when the lateral pterygoid is damaged. In this case, the right condyle will not move because of the muscle damage. The left condyle moves forward, but because there is no movement on the right side, the left condyle moves out and rotates to the right, with the nonmoving right condyle acting as a pivot point. Damage to the lateral pterygoid will not affect elevation (closing), because the lateral pterygoid is not an elevator. The elevators are the temporalis, medial pterygoid, and masseter.

The distobuccal cusp of the mandibular third molar occludes with which maxillary tooth surfaces? The mesial marginal ridge of the third molar and distal marginal ridge of the second A. molar B. The central fossa of the third molar C. The mesial marginal ridge of the third molar only D. The distal marginal ridge of the third molar only

The correct answer is B. The distobuccal cusp of a mandibular molar is a holding (supporting) cusp. The general rule of occlusion of mandibular holding cusps is as follows: the holding cusps of the mandibular teeth occlude on the mesial marginal ridge of their maxillary counterpart, and the distal marginal ridge of the maxillary tooth mesial to their counterpart, EXCEPT distobuccal cusps of mandibular molars occlude with central fossae of their counterparts, the distal cusp of the mandibular first molar occludes with the distal triangular fossa of its counterpart, and the first premolar occludes only with the mesial marginal ridge of its counterpart (but not the canine). In this case, the maxillary counterpart is the maxillary third molar, and the cusp should occlude in the central fossa of this tooth. Remember that the mandibular third molar is located one-half tooth mesial to the maxillary.

A mandibular permanent first molar is likely to have a deep root concavity running apically down: A. both roots B. the mesial root C. the distal root D. neither root

The correct answer is B. One of the distinctions between the mandibular first-molar mesial and distal roots is the deep root concavity seen running the length of the mesial surface of the mesial root. The distal root, by comparison, will have no similar concavity or a very slight depression. Other differences include the greater likelihood of the mesial root having a distal curvature, and the greater likelihood of the mesial root being partly split by a partial furcation running partway up from the apical end.

Odontoblasts laying down dentin matrix would be expected to contain large numbers of welldeveloped: A. nuclei B. lysosomes C. rough ER D. smooth ER E. mitochondria

The correct answer is C. This is a case of a best answer with a reasonable second-best answer. The best answer is rough endoplasmic reticulum. The rough ER contains numerous ribosomes, and is known for producing proteins for export. Collagen fibers of the dentin matrix would be good examples of protein made for export (outside of the cell). The secondbest answer is probably mitochondria, in that the synthesis of collagen would be energyconsuming. Odontoblasts are single nuclei cells (unlike osteoclasts, which are multinucleated). Note that smooth ER lacks ribosomes, and that the digestive enzyme activity of lysosomes would not be needed for this process.

When a fourth canal is found in the permanent maxillary first molar, it is found in the: A. mesiobuccal root B. distobuccal root C. palatal root D. mesiolingual root

The correct answer is A. Note that the three-rooted maxillary first molar does not have a mesiolingual root. The maxillary first molar most often has three roots: mesiobuccal, distobuccal, and palatal. The palatal root is largest, and its canal is largest and widest. In the case of a fourth canal, it is invariably found in the mesiobuccal root. The distobuccal and palatal roots are invariably one-canalled.

In centric occlusion, the lingual cusp of the maxillary first premolar contacts: the mesial marginal ridge of the mandibular first premolar and distal marginal ridge A. of the second premolar the distal marginal ridge of the mandibular first premolar and mesial marginal ridge B. of the second premolar the mesial marginal ridge of the mandibular first molar and distal marginal ridge of C. the second premolar the distal marginal ridge of the mandibular second premolar and mesial marginal D. ridge of the first molar

The correct answer is B. The lingual cusp of a maxillary premolar is a holding cusp. The general rule for maxillary holding cusps is as follows: a maxillary holding cusp contacts the distal marginal ridge of its mandibular counterpart and the mesial marginal ridge of the mandibular tooth distal to its counterpart, EXCEPT FOR THE MESIOLINGUAL CUSPS OF THE MOLARS, WHICH CONTACT THE CENTRAL FOSSAE OF THEIR COUNTERPARTS. This should be the distal marginal ridge of the mandibular first premolar and mesial marginal ridge of the second premolar.

The mandibular incisors of a patient are worn down so that dentin is visible on the incisal edge. This is due to grinding of these edges against the natural maxillary incisors. This loss of tooth structure can be termed: A. attrition B. abrasion C. erosion D. internal resorption

The correct answer is A. Attrition is the mechanical wearing of teeth due to physiologic processes, including chewing and bruxism. Abrasion (choice B) is the mechanical wearing away of tooth structure due to some outside object, such as toothbrush abrasion at the cervical lines of teeth due to hard sideways brushing, or from habitually holding bobby pins or nails with the teeth. Erosion (choice C) is the chemical dissolving of tooth structure. It can be caused by a number of factors, including sucking on lemons and other acidic fruit, excessive intake of acidic beverages (cola), or excessive vomiting, as in bulimia. Bulimics often exhibit normal facial surfaces with severely eroded lingual surfaces.

The distobuccal cusp of the maxillary second molar occludes in: A. the mesial marginal ridge of the mandibular second molar B. the buccal groove of the mandibular second molar C. the central groove of the mandibular third molar D. the facial embrasure between the mandibular first and second molars E. the facial embrasure between the mandibular second and third molars

The correct answer is E. Buccal cusps of maxillary teeth are guiding cusps, not holding cusps. Therefore, they do not occlude on marginal ridges or central fossae. The general rule for maxillary buccal cusps is that they occlude in the facial embrasures between their mandibular counterparts and the teeth distal to their counterparts, EXCEPT for the mesiobuccal cusps of the molars, which occlude in the buccal grooves of their mandibular counterparts, and the distobuccal cusp of the first molar, which opposes the distobuccal groove of the mandibular first molar. In this question, we are NOT dealing with the exception of the mesiobuccal cusps of the maxillary molars or the distobuccal cusp of the maxillary first molar, so this cusp should follow the general rule and occlude with the facial embrasure between its mandibular counterpart (the mandibular second molar) and the mandibular molar distal to it (the mandibular third molar).

The distolingual cusp of the mandibular second molar contacts: A. the lingual embrasure between the maxillary first molar and second molar B. the lingual groove of the maxillary second molar C. the central fossa of the maxillary second molar D. the lingual groove of the maxillary first molar E. the lingual embrasure between the maxillary second molar and third molar

The correct answer is B. Lingual cusps of mandibular teeth are guiding cusps, not holding cusps. Therefore, they do not occlude on marginal ridges or central fossae. The general rule for mandibular lingual cusps is that they occlude in the lingual embrasures between their maxillary counterparts and the teeth mesial to their counterparts, EXCEPT for the distolingual cusps of the mandibular molars, which occlude in the lingual grooves of their maxillary counterparts. In this question we are dealing with the exception of the distolingual cusps of mandibular molars, so in this case, the mandibular second molar distolingual cusp contacts the lingual groove of its counterpart (the maxillary second molar).

The embrasures which surround the contact points of anterior teeth are: A. mesial, distal, lingual, buccal B. mesial and distal only C. buccal and lingual only D. buccal, lingual, cervical, gingival E. incisal, cervical, buccal, lingual

The correct answer is E. The best way to answer the question is to imagine that the embrasures are spaces surrounding a small point of contact between two incisors. This small contact point will have space above it, below it, in front of it, and in back of it. These spaces in dental anatomy will be, respectively, incisal, cervical (gingival), buccal (facial), and lingual (palatal). Note that there is no space mesial or distal to the contact point. Immediately mesial or distal to the contact would be tooth structure.

The most highly mineralized oral or dental tissue is: A. enamel B. dentin C. bone D. cementum

The correct answer is A. Enamel is the most mineralized and hardest tissue in the human body. Most estimates place the mineral content of enamel at about 95 to 98%. Dentin, though highly mineralized, still has more organic content than does enamel. Most estimates place the mineral content of dentin at about 80%. Cementum is least mineralized, and is most similar to bone. There are varying estimates of its mineral content, but most place it at about 60 to 65%.

The anterior tooth with the most pronounced lingual ridge is the: A. Maxillary central incisor B. Mandibular lateral incisor C. Maxillary canine D. Mandibular canine

The correct answer is C. A lingual ridge runs from the incisal edge down the center of the lingual surface of the crown, toward the cervical end of the crown. It splits the lingual surface in half, and usually has a depression on either side (lingual fossae) which separate the lingual ridge from the mesial and distal marginal ridges. Lingual ridges are found on canines, but not on incisors (choices A and B). The lingual ridge is more pronounced on the maxillary canine than on the mandibular (choice D). This is in keeping with a general rule that the lingual anatomy of the maxillary canine is much more pronounced than that of the mandibular.

Oblique ridges are found on which molar teeth? A. Maxillary first and second B. Mandibular first and second C. Maxillary and mandibular first D. Maxilary and mandibular second E. First and second molars in both arches

The correct answer is A. Oblique ridges are characteristic of maxillary molar teeth. They connect the mesiolingual and distobuccal cusps. The oblique ridge is also considered to be the distal end of the trigon, the major cusp area of the maxillary molar, composed of the ML, MB, and DB cusps. The DL cusp is often reduced and is referred to as the talon (as opposed to the trigon). The trigon is evolutionarily the primitive cusp triangle of the molar crown. Oblique ridges are not found on mandibular molars or on any other teeth.

The anterior tooth with the most pronounced lingual ridge is the: A. Maxillary central incisor B. Mandibular lateral incisor C. Maxillary canine D. Mandibular canine

The correct answer is C. A lingual ridge runs from the incisal edge down the center of the lingual surface of the crown, toward the cervical end of the crown. It splits the lingual surface in half, and usually has a depression on either side (lingual fossae) which separate the lingual ridge from the mesial and distal marginal ridges. Lingual ridges are found on canines, but not on incisors (choices A and B). The lingual ridge is more pronounced on the maxillary canine than on the mandibular (choice D). This is in keeping with a general rule that the lingual anatomy of the maxillary canine is much more pronounced than that of the mandibular.

Which of the following is NOT a periodontal fiber? A. Oblique B. Transseptal C. Apical D. Horizontal

The correct answer is B. Periodontal fibers must run from the cementum of the tooth into alveolar bone. The main periodontal fiber types are alveolar crestal, horizontal, oblique, and apical, named for either their position or alignment. The transseptal fiber is classified with the gingival group, as it does not enter alveolar bone. Instead, as the name suggests, it travels from one tooth to another tooth, crossing over the alveolar crest. It attaches directly from the cementum of one tooth into the cementum of another, but does not attach to bone.

A patient presents for examination with both mandibular first molars distal to the maxillary first molars. This occlusion is known as: A. Class I, distocclusion B. Class II, mesiocclusion C. Class II, distocclusion D. Class III, mesiocclusion E. Class III, distocclusion

The correct answer is C. The normal (Class I) jaw relationship will result in the mandibular first molar being located one cusp (one-half tooth) mesial to the maxillary first molar. If the mandibular molar is located distal to the maxillary, it indicates a small mandible (micrognathy) or another problem causing the maxillary teeth to be too far mesial and the mandibular too far distal. This is distocclusion is Angles Class II. Mesiocclusion is Angles Class III, where the mandibular first molar is more than one-half tooth mesial to the maxillary first molar.

Which tooth below is MOST likely to be caries-resistant? A. Maxillary first premolar B. Mandibular second premolar C. Mandibular lateral incisor D. Mandibular second molar E. Maxillary central incisor

The correct answer is C. Look for a mandibular anterior tooth to be your answer here. You will often notice clinically that partially edentulous patients often retain mandibular anteriors despite loss of most other teeth. This is due to the following three factors: 1) they have few significant pits or fissures; 2) they are bathed in saliva most of the time, which resists plaque buildup; and 3) they are cleaned by the normal movements of the tongue. Other teeth cannot fit all three of these categories. Note that mandibular canines are often the last teeth left. This is because, although the mandibular incisors are rarely lost to caries, they are often lost to periodontal disease, partially due to their short roots and easy calculus buildup.

The major blood supply of the PDL is from: A. pulpal vessels B. gingival vessels C. periosteal vessels D. periapical vessels

The correct answer is C. All of the vessels listed supply blood to the PDL, as all of them are in the vicinity of the PDL and all anastomose or send branches there. Out of this group, however, the MAJOR source is vessels branching from the periosteum surrounding the alveolar bone. Note that both lymphatics and nerves follow the path of the blood vessels in the PDL.

The distobuccal cusp of the mandibular second molar occludes with which maxillary tooth surfaces? The mesial marginal ridge of the second molar and distal marginal ridge of the first A. molar The distal marginal ridge of the second molar and mesial marginal ridge of the third B. molar C. The embrasure between the first and second molars D. The central fossa of the maxillary second molar

The correct answer is D. The distobuccal cusp of a mandibular molar is a holding (supporting) cusp. The general rule of occlusion of mandibular holding cusps is as follows: the holding cusps of the mandibular teeth occlude on the mesial marginal ridge of their maxillary counterpart, and the distal marginal ridge of the maxillary tooth mesial to their counterpart, EXCEPT distobuccal cusps of mandibular molars occlude with central fossae of their counterparts, the distal cusp of the mandibular first molar occludes with the distal triangular fossa of its counterpart, and the first premolar occludes only with the mesial marginal ridge of its counterpart (but not the canine). In this case, the maxillary counterpart is the maxillary second molar, and the mandibular cusp will occlude in its central fossa.

The maxillary molar most likely to have fused roots is the: A. first B. second C. third D. fused roots are rare for all three molars

The correct answer is C. While all three maxillary molars commonly have three roots, the roots and their arrangement differ distinctively from one to the other. Most notable in the first molar is the pliers-like appearance of the two buccal roots. The mesiobuccal hooks distally and the distobuccal hooks mesially. The second molar does not have this curvature, and the two buccal roots are more parallel, with both roots inclined distally. The third molar often has three fused roots forming a cone-like structure, or sometimes all distally inclined. These factors are important in exodontia of maxillary molars. Maxillary third molars, in particular, can sometimes be elevated out distally in a rotating manner because of the fused cone-like distally facing roots.

In centric occlusion, the lingual cusp of the maxillary second premolar contacts: the mesial marginal ridge of the mandibular first premolar and distal marginal ridge A. of the second premolar the distal marginal ridge of the mandibular first premolar and mesial marginal ridge B. of the second premolar the mesial marginal ridge of the mandibular first molar and distal marginal ridge of C. the second premolar the distal marginal ridge of the mandibular second premolar and mesial marginal D. ridge of the first molar

The correct answer is D. The mesiolingual cusp of a maxillary second premolar is a holding cusp. The general rule for maxillary holding cusps is as follows: a maxillary holding cusp contacts the distal marginal ridge of its mandibular counterpart and the mesial marginal ridge of the mandibular tooth distal to its counterpart, EXCEPT FOR THE MESIOLINGUAL CUSPS OF THE MOLARS, WHICH CONTACT THE CENTRAL FOSSAE OF THEIR COUNTERPARTS. This should be the distal marginal ridge of the mandibular second premolar and mesial marginal ridge of the first molar.

Of the following premolars, the one which can never be rotated during extraction is the: A. maxillary first B. maxillary second C. mandibular first D. mandibular second

The correct answer is A. For the most part, rotation of a tooth during extraction works best on teeth with rounded roots, such as the maxillary central incisor and maxillary canine. It can be used in conjunction with buccal-lingual luxation on teeth with single ovalish roots. It can never be used on double-rooted teeth. Of the premolars above, the maxillary first is always double rooted. Of the others, the maxillary second is sometimes double rooted and sometimes single. For the mandibular premolars, the mandibular first is the most likely to have a single ovalish, but close to round, root. It is theMOST likely premolar on which rotation may be part of the extraction.

In centric occlusion, the distolingual cusp of the maxillary second molar will contact: A. the central fossa of the mandibular second molar the distal marginal ridge of the mandibular first molar and mesial marginal ridge of B. the second molar the distal marginal ridge of the mandibular second molar and mesial marginal ridge C. of the first molar the distal marginal ridge of the mandibular second molar and mesial marginal ridge D. of the third molar

The correct answer is D. The distolingual cusp of a maxillary second molar is a holding cusp. The general rule for maxillary holding cusps is as follows: a maxillary holding cusp contacts the distal marginal ridge of its mandibular counterpart and the mesial marginal ridge of the mandibular tooth distal to its counterpart, EXCEPT FOR THE MESIOLINGUAL CUSPS OF THE MOLARS, WHICH CONTACT THE CENTRAL FOSSAE OF THEIR COUNTERPARTS. This should be the distal marginal ridge of the mandibular second molar and mesial marginal ridge of the third molar.

Which premolar, when viewed from the facial, has a longer mesial cusp ridge than distal cusp ridge? A. Maxillary first B. Maxillary second C. Mandibular first D. Mandibular second

The correct answer is A. The question depends on the fact that the maxillary first premolar has an asymmetric positioning of its two cusps. Rather than having the buccal and lingual cusps in a straight line, the buccal cusp is displaced slightly distally, and the lingual cusp is displaced slightly mesially. This gives the occlusal view of the tooth a slightly twisted appearance. Cusp ridges run from the cusp tip to the proximal edge of the tooth at the marginal ridge. Therefore, if you look facially at the maxillary first premolar, you will see the buccal cusp shifted toward the distal. This makes the cusp tip farther from the mesial, and thus there will be a longer mesial cusp ridge on this tooth.

Guiding cusps normally contact: A. mesial marginal ridges B. distal marginal ridges C. central fossae D. embrasures

The correct answer is D. In occlusion, cusps are defined as either holding (supporting) cusps or guiding cusps. Holding cusps, in central occlusion, make contact with the opposing arch, establish vertical dimension of occlusion, and support the forces of occlusion. They are the lingual cusps of the maxillary arch and buccal cusps of the mandibular. When the teeth are in centric occlusion, these cusps are in contact. The other cusps (guiding) are not. The other cusps are either lingual to the contact (lingual cusps of the mandibular arch) or buccal to the contact (buccal cusps of the maxillary arch). Holding cusps generally occlude in the marginal ridge and central fossa areas of the opposing arch. Guiding cusps generally lie in embrasures between teeth, or between cusps of the lingual or buccal surfaces of the opposing arch.

Dentinal tubules which enter into enamel are known as: A. enamel spindles B. enamel tufts C. enamel lamellae D. none of the above

The correct answer is A. There are a number of somewhat confusing anomalies at the dentinoenamel junction. Enamel spindles are odontoblastic processes and dentinal tubules which extend a short way into enamel. Enamel lamellae, on the other hand, extend from enamel into dentin. They are pieces of uncalcified organic enamel material. Enamel tufts are hypocalcified enamel rods. They are individual entities; however, they appear as groups (tufts) when a group of them are viewed laterally.

Dens-in-dente is most commonly noted in which tooth? A. Maxillary central B. Maxillary lateral C. Maxillary canine D. Mandibular central E. Mandibular lateral

The correct answer is B. The maxillary lateral is the most highly variable tooth in the mouth. It can be normal incisor-shaped, peg-shaped, or congenitally missing, or have a wide variety of invaginations, from small pits to deep pits to dens-in-dente, or tooth-within-a-tooth. This is the case when the invagination is so deep that the radiographic appearance appears to show a small tooth inside the maxillary lateral.

The contact of the permanent mandibular incisor with the canine occurs at which level of the lateral? A. Incisal third B. Junction of incisal and middle thirds C. Middle third D. Gingival third

The correct answer is A. Mandibular incisors are widest near the incisal tip, and their contacts (both central and lateral) are always near the incisal edge. The mandibular canine contact with the lateral incisor is thus in the incisal third. In the canine, the contact is also in the incisal third, but not as incisal as in the lateral. The distal contact of the canine is also in the incisal third, but near the junction of the incisal and middle thirds.

Which of the following oral muscles is NOT innervated by CN V? A. Masseter B. Buccinator C. Medial pterygoid D. Lateral pterygoid E. Mylohyoid

The correct answer is B. The general rule for innervation by CN V (the trigeminal) is that it innervates the muscles of mastication (temporalis, lateral pterygoid, medial pterygoid, masseter), the mylohyoid, the anterior digastric, and the two tensors (tensor tympani and tensor veli palatini). Note that the buccinator is not included. The buccinator is in the group of muscles of facial expression, which are all innervated by CN VII (the facial nerve).

The heights of contour of the mandibular first premolar, when viewed from the mesial, are located within which third? A. buccal in occlusal third, lingual in middle third B. both in middle third C. both in occlusal third D. buccal in cervical third, lingual in occlusal third E. both in cervical third

The correct answer is D. As a general rule, the buccal heights of contour of the premolars are located within the cervical thirds. The lingual heights of contour will normally be more occlusal. On the mandibular first premolar, it is especially occlusal, within the occlusal third.

In a distal view of a permanent maxillary first molar, how many roots should be visible? A. 1 B. 2 C. 3 D. 4

The correct answer is C. This may not be as obvious as it seems. Rule out 4, as the molar only has three roots: the palatal, mesiobuccal, and distobuccal. However, how should they look in a distal view? The palatal root will clearly be visible as the only root on the palatal side. It is massive, and often hooked. On the buccal end, a distal view should easily show the full length of the distobuccal root, so we have two roots so far. What about the mesiobuccal? In this case we can see this root mostly because it is larger than the distobuccal, so some, but not all, of the mesiobuccal root is blocked by the distobuccal. We should, however, see some small sections of it outside of the profile of the distobuccal root.

Which of the following is the most coronally located periodontal fiber group? A. Alveolar crestal B. Apical C. Horizontal D. Oblique

The correct answer is A. We can eliminate choice B, as the apex is at the opposite end from the crown. The apical fibers are, of course, most apical, and run from the apex of the alveolar bone socket to the root tip. The oblique fibers are slightly more coronal. They run from the cementum near the apical end, obliquely coronally to alveolar bone. The horizontal fibers are more coronal and run horizontally from cementum to alveolar bone around mid-root. The alveolar crestal fibers are most coronal, and run from the most coronal part of the root to the alveolar crest of bone.

Which ligament of the temporomandibular joint originates from a thin, pointed extension of the temporal bone? A. Temporomandibular B. Stylomandibular C. Sphenomandibular D. Lateral

The correct answer is B. The bony origins of the three TMJ ligaments are primarily from three different bones. The stylomandibular ligament originates from a thin, bony extension of the temporal bone, known as the styloid process. The spine of the sphenoid bone is the major origin of the sphenomandibular ligament. The lateral ligament (temporomandibular ligament) has its origin from the zygomatic process. This process is a fusion of the temporal and zygomatic bones.

The inner enamel cuticle, found on the surface of the enamel of an erupting tooth crown, is: A. also known as Nasmyth's membrane B. also known as the stratum intermedium C. cellular D. formed by odontoblasts

The correct answer is A. As the tooth crown nears eruption, the ameloblasts produce their final product, known as the inner enamel cuticle. This material is acellular, and is firmly adherent to the enamel surface as the tooth erupts. Its older name is Nasmyth's membrane. This cuticle has on its outside a second acellular layer formed from the keratinized remnants of the dental sac. This adherent double layer may persist for some time after the tooth erupts but is eventually worn away, leaving the enamel exposed in the oral cavity.

In the maxillary arch, the narrowest incisal or occlusal embrasure is located: A. between first premolar and canine B. between canine and lateral incisor C. between lateral incisor and central D. between central incisors

The correct answer is D. The best way to answer the question is to imagine contact points and proximal-incisal angles for the anterior teeth. A small incisal embrasure will be located wherever the contact points are high (incisal) and where proximal-incisal line angles are almost perpendicular. The best example of this arrangement is the central incisors. Their mesial incisal line angles are very square, and the contact is in the incisal third of the tooth. As you go further distally, the line angles become more rounded, especially for canines. These rounded line angles at the incisal, as well as the more apical contacts, dropping to the middle third as you reach the distal of the canine, ensure much larger incisal embrasures.

The shape of the pulp chamber in cross section cut at the cervical line in the maxillary canine is: A. oval (flattened mesiodistally) B. oval (flattened bucco-lingually) C. round D. figure eight

The correct answer is A. Only maxillary incisors have roundish pulp chamber cross sections when cut at the cervical line. This is true for both maxillary centrals and laterals. In general, mandibular centrals and both arch canines will have ovalish pulp chambers, flattened mesiodistally. (Imagine squashing a round pulp from both the mesial and distal sides at once, resulting in a squashed oval, pointing to the buccal and lingual). Remember that the shape of a pulp chamber is usually related to the shape of the surrounding root.

Which two molars can be considered to be five-cusped teeth? A. Maxillary first and second B. Mandibular first and second C. Maxillary and mandibular first D. Maxillary and mandibular second

The correct answer is C. Most maxillary molars are considered four-cusped teeth. However, in some cases, the Carabelli cusp (trait) can be large enough to be considered a fifth cusp on a maxillary first molar. The maxillary second molar is usually four-cusped. The mandibular first molar is normally five-cusped with an ML, MB, DL, and DB cusp and a fifth distal cusp. The mandibular second lacks the distal cusp and is normally a four-cusp tooth.

Tooth #B is replaced by tooth #: A. 2 B. 3 C. 4 D. 5 E. 6

The correct answer is D. Remember that primary molars are succeeded by permanent premolars. The permanent molars erupt distal to all primary teeth and do not replace them. So the maxillary replacements are 4 for A, 5 for B, 6 for C, 7 for D, 8 for E, 9 for F, 10 for G, 11 for H, 12 for I, and 13 for J. 1, 2, 3, 14, 15, and 16 do not replace primary teeth.

The largest cusp of a maxillary first molar is the: A. mesiobuccal B. mesiolingual C. distobuccal D. distolingual E. Carabelli

The correct answer is B. The three largest cusps (trigon, or primitive cusp triangle) of the maxillary first molar are the MB, ML, and DB cusps. The DL cusp is smallest, and is known as the talon cusp (or talon). This cusp is also the one which is even less conspicuous as you go from first to second to third molar. Note also that the DB cusp decreases in relative size as you go from first to second and third molar. The order of size of the cusps in this tooth, then, is from largest to smallest: ML, MB, DB, DL, Carabelli.

Which structure is involved in pulling the disc of the TMJ forward? A. Stylomandibular ligament B. Medial pterygoid muscle C. Mandibular condyle D. TMJ meniscus E. Lateral pterygoid muscle

The correct answer is E. The lateral pterygoid connects from the greater wing of the sphenoid and the lateral surface of the lateral pterygoid plate to the mandibular condyle, articular disc, and capsule. It is the only muscle that attaches to these structures. The stylomandibular ligament, sometimes given a vague protective function, extends from the styloid process to the lingula of the mandible. The medial pterygoid muscle is an elevator with no direct attachment to the TMJ. The mandibular condyle is separated from the glenoid (temporal) fossa by the articular (TMJ) disc. The condyle does not pull the disc. The disc is also called the meniscus; they are the same thing.

Because of the staining effect, tetracycline is not given to children younger than approximately what age? A. 2 years B. 5 years C. 8 years D. 11 years E. 14 years

The correct answer is C. This may not seem like dental anatomy, but it is actually a calcification question. In order to avoid tetracycline staining or any other intrinsic stain of enamel, we must avoid all ages where tooth crown calcification is occurring. The last tooth to calcify (and erupt) is the third molar. Most third molars erupt at 17 to 21 years, but calcification of enamel occurs mostly at about age 8. So pregnant mothers and children age 8 and younger are not given tetracycline.

At the cervical line, a cross section of the maxillary lateral incisor would show: A. a round shape B. an oval shape wider on the lingual than the labial C. a triangular shape with a distinctly wider labial surface D. an oval shape with a slightly wider labial surface E. mesiodistal flattening

The correct answer is A. The maxillary lateral incisor exhibits an almost round root cross section shape at the cervical line. It is not flattened mesiodistally or labiolingually. The pulp chamber mimics the root shape by being round at this point as well. It is very similar in both root shape and pulp shape to those of the maxillary central. Note that as the pulp enters the coronal section, it will begin to widen mesiodistally (flatten buccolingually) in keeping with the crown shape.

The epithelial root sheath of Hertwig is composed of: A. inner enamel epithelium and stellate reticulum B. stellate reticulum only C. inner and outer enamel epithelium D. all of the tissues listed above E. none of the above

The correct answer is C. Only the original inner and outer enamel epithelium take part in root formation. There is no stellate reticulum in between them, as would be found in the original enamel organ. The root form is originally outlined by the epithelial root sheath of Hertwig, which then induces formation of odontoblasts, which then produce root dentin. Pieces of the root sheath, which do not disappear, remain as the epithelial rests of Malassez. These small groups of tissue are ectodermal in origin, as the original enamel epithelium is ectodermal.

The mesiolingual cusp of the mandibular second molar contacts: A. the lingual embrasure between the maxillary first molar and second molar B. the distal marginal ridge of the maxillary second molar C. the central fossa of the maxillary second molar D. the lingual groove of the maxillary second molar E. the lingual embrasure between the maxillary second molar and third molar

The correct answer is A. Lingual cusps of mandibular teeth are guiding cusps, not holding cusps. Therefore, they do not occlude on marginal ridges or central fossae. The general rule for mandibular lingual cusps is that they occlude in the lingual embrasures between their maxillary counterparts and the teeth mesial to their counterparts, EXCEPT for the distolingual cusps of the mandibular molars, which occlude in the lingual grooves of their maxillary counterparts. In this question we are not dealing with the exception of the distolingual cusps of mandibular molars, so in this case, the mandibular second molar mesiolingual cusp contacts the lingual embrasure between its counterpart (the maxillary second molar) and the tooth mesial to it (the maxillary first molar).

In centric occlusion, the distolingual cusp of the maxillary first molar will contact: the mesial marginal ridge of the mandibular first premolar and distal marginal ridge A. of the second premolar the distal marginal ridge of the mandibular second premolar and mesial marginal B. ridge of the first molar the distal marginal ridge of the mandibular first molar and mesial marginal ridge of C. the second molar the distal marginal ridge of the mandibular second molar and mesial marginal ridge D. of the first molar

The correct answer is C. The distolingual cusp of a maxillary molar is a holding cusp. The general rule for maxillary holding cusps is as follows: a maxillary holding cusp contacts the distal marginal ridge of its mandibular counterpart and the mesial marginal ridge of the mandibular tooth distal to its counterpart, EXCEPT FOR THE MESIOLINGUAL CUSPS OF THE MOLARS, WHICH CONTACT THE CENTRAL FOSSAE OF THEIR COUNTERPARTS. This should be the distal marginal ridge of the mandibular first molar and mesial marginal ridge of the second molar.

In rare cases, a permanent mandibular first molar may have a complete supernumerary third root. This root is usually: A. a second mesial root B. a second distal root C. a buccal root D. a lingual root

The correct answer is B. Despite the fact that the mandibular first molar has a distinct mesial root concavity on the mesial side of the mesial root, and that this root sometimes furcates partially upwards from the mesial, complete additional whole roots are usually second distal roots. Buccal and/or lingual additional roots are not found.

Cervical bulges are found on which surfaces of primary molar teeth? A. Mesial and distal B. Buccal and lingual C. Lingual only D. Buccal only

The correct answer is D. Cervical bulges are overhangs of the crown sticking out above the cervical line of the primary teeth. In primary anteriors, the cervical bulge is found on both the buccal and lingual surfaces. In the molars, it is found only on the buccal. The most conspicuous cervical bulge in the primary molars is that of the primary mandibular first molar. It is often described as being potbelly when seen from the proximal view. The other molars are not as exaggerated in this area, but still show a pronounced buccal cervical bulge.

A patient is congenitally missing the maxillary lateral incisors and mandibular second premolars. This individual is said to have the condition known as: A. anodontia B. oligodontia C. hypodontia D. hyperdontia

The correct answer is C. Anodontia (choice A) refers to the complete absence of tooth formation. In oligodontia (choice B), most but not all teeth are missing. Both of these conditions are often associated with ectodermal dysplasia. Hypodontia refers to a small number of congenitally missing teeth. This is fairly common, and is not usually associated with a systemic disease or disturbance.

Which incisor is most commonly congenitally missing? A. Maxillary central B. Maxillary lateral C. Mandibular central D. Mandibular lateral

The correct answer is B. The maxillary lateral and the third molars show more variability than any other teeth. Besides a wide variety of unusual morphologies (peg lateral, etc.), the maxillary lateral incisor is fairly commonly congenitally missing. In these patients, the canines drift mesially toward the centrals. Also commonly congenitally missing are third molars and premolars.

An example of a guiding (nonsupporting) cusp is: A. distolingual of #30 B. mesiobuccal of #18 C. distolingual of #14 D. lingual of #5 E. palatal of #13

The correct answer is A. Note that the holding (supporting, occluding) cusps of the posterior dentition are the lingual (palatal) cusps of the maxillary teeth and the buccal (facial) cusps of the mandibular teeth. Buccals of maxillary teeth and linguals of mandibular teeth are guiding cusps. Choice A is the lingual of a mandibular first molar, so it is not a holding cusp, and is a guiding cusp. Choice B is a buccal of a mandibular molar and is a holding cusp. Choice C is a lingual cusp of a maxillary molar and is a holding cusp. Choice D is the lingual of a maxillary premolar and is a holding cusp. Choice E is the palatal (lingual) of a maxillary premolar and is a holding cusp.

At the cervical line, a cross section of the maxillary canine would show: A. a round shape B. an oval shape wider on the lingual than the labial C. a triangular shape with a distinctly wider labial surface D. an oval shape with a slightly wider labial surface

The correct answer is D. The maxillary canine, at the cervix, will have a cross section which is oval and flattened mesiodistally. It is generally slightly wider at the labial end than at the lingual. The pulp cavity at this point is lens-shaped, double convex. It is similar in crosssectional shape to the mandibula canine.

Canaliculi and Haversian systems: A. are found in acellular cementum B. are found in cellular cementum C. are found in both types of cementum D. are not found in cementum

The correct answer is D. Cementum is often described as the dental tissue which most resembles bone. It has a similar mineral content, and has an organic matrix primarily composed of collagen fibers. However, the Haversian systems, concentric tissue layers, lacunae, canaliculi, etc., found in bone are not found in cementum. Remember that these features are not always found in bone. Only compact bone (rather than trabecular bone) has these features. Remember also that acellular cementum could not have such features as Haversian systems, because Haversian systems contain osteocytes (cells) within bony lacunae. However, neither acellular nor cellular cementum actually has these features.

The distobuccal cusp of the mandibular first molar occludes with which maxillary tooth surfaces? The mesial marginal ridge of the second molar and distal marginal ridge of the first A. molar B. The central fossa of the first molar The mesial marginal ridge of the first molar and the distal marginal ridge of the C. second premolar D. The embrasure between the first and second molars

The correct answer is B. The distobuccal cusp of a mandibular molar is a holding (supporting) cusp. The general rule of occlusion of mandibular holding cusps is as follows: the holding cusps of the mandibular teeth occlude on the mesial marginal ridges of their maxillary counterparts, and the distal marginal ridges of the maxillary tooth mesial to their counterparts, EXCEPT distobuccal cusps of mandibular molars occlude with central fossae of their counterparts, the distal cusp of the mandibular first molar occludes with the distal triangular fossa of its counterpart, and the first premolar occludes only with the mesial marginal ridge of its counterpart (but not the canine). In this case, the maxillary counterpart is the maxillary first molar, and the cusp should occlude in the central fossa of this tooth.

When viewed from the buccal, the tooth closest to vertical in the mesiodistal angulation of its main axis is the: A. maxillary central incisor B. maxillary lateral incisor C. maxillary canine D. maxillary first premolar

The correct answer is A. Another way of asking the question is: which tooth does not lean toward the mesial or distal? The maxillary central incisor is almost straight vertically, estimated to be about 2 degrees from vertical. The lateral tends to lean slightly mesially, the canine even more in a distal direction, and the first premolar slightly in a distal direction. Do not confuse this leaning with the buccolingual leaning (when viewed from the mesial or distal). These measurements differ significantly for the teeth listed, with the premolar being most vertical.

Which premolar has a lingually inclined occlusal table? A. Maxillary first B. Maxillary second C. Mandibular first D. Mandibular second

The correct answer is C. The mandibular first premolar is very canine-like in form, with a much reduced lingual cusp, almost resembling a cingulum. The occlusal table thus inclines apically from buccal to lingual, as in a downward slope. This is important in operative dentistry, as the occlusal preparation for this tooth also is slanted to the lingual. All other premolars are essentially flat in their occlusal table, or possibly very slightly lingually leaning if the buccal cusp is slightly higher than the lingual. However, only the mandibular first premolar has this trait so pronounced that it is very different from the other three.

The most prominent cingulum is found on which incisor? A. Maxillary central B. Maxillary lateral C. Mandibular central D. Mandibular lateral

The correct answer is B. The maxillary lateral is often the most distinct in almost any anatomical form. Its cingulum is usually more notable relative to its size than that of the central. It should be noted that maxillary cingula are almost always more prominent than their mandibular counterparts. In addition to the prominent cingulum, the maxillary lateral often features a deep lingual fossa, deep lingual pits, and tubercles on the cingulum.

The mesiobuccal cusp of the mandibular second molar occludes with which maxillary tooth surfaces? The mesial marginal ridge of the second molar and distal marginal ridge of the first A. molar The distal marginal ridge of the second molar and mesial marginal ridge of the third B. molar C. The embrasure between the first and second molars D. The central fossa of the maxillary second molar

The correct answer is A. The mesiobuccal cusp of a mandibular molar is a holding (supporting) cusp. The general rule of occlusion of mandibular holding cusps is as follows: the holding cusps of the mandibular teeth occlude on the mesial marginal ridge of their maxillary counterpart, and the distal marginal ridge of the maxillary tooth mesial to their counterpart, EXCEPT distobuccal cusps of mandibular molars occlude with central fossae of their counterparts, the distal cusp of the mandibular first molar occludes with the distal triangular fossa of its counterpart, and the first premolar occludes only with the mesial marginal ridge of its counterpart (but not the canine). In this case, the maxillary counterpart is the maxillary second molar, and the tooth immediately mesial to it is the maxillary first molar.

The mesiobuccal cusp of the maxillary third molar occludes in: A. the mesial marginal ridge of the mandibular second molar B. the distal marginal ridge of the mandibular second molar C. the mesial marginal ridge of the mandibular third molar D. the facial embrasure between the mandibular second and third molars E. the buccal groove of the third mandibular molar

The correct answer is E. Buccal cusps of maxillary teeth are guiding cusps, not holding cusps. Therefore, they do not occlude on marginal ridges or central fossae. The general rule for maxillary buccal cusps is that they occlude in the facial embrasure between their mandibular counterpart and the tooth distal to their counterpart, EXCEPT for the mesiobuccal cusps of the molars, which occlude in the buccal grooves of their mandibular counterparts, and the distobuccal cusp of the first molar, which opposes the distobuccal groove of the mandibular first molar. In this question we are dealing with the exception of the mesiobuccal cusps of maxillary molars, which occlude with the buccal groove of their mandibular counterpart. In this case, the maxillary third molar mesiobuccal cusp contacts the mandibular third molar buccal groove.

Which incisor commonly exhibits the most variety in anatomy in both crown form and root form? A. Maxillary central B. Maxillary lateral C. Mandibular central D. Mandibular lateral

The correct answer is B. It is commonly said that the third molars and the maxillary lateral incisor are the most variable teeth in the mouth. The common forms of maxillary lateral variation include the peg lateral, with an ice cream cone-shaped crown; the deep lingual pit, with a deep (often carious) invagination; and the dens-in-dente, a deep lingual invagination giving a "tooth-within-a-tooth" appearance on x-ray. By contrast, variations in the other incisors are minor and less pronounced.

The greatest curvature of the cervical line interproximally is found on the: A. Mesial of the maxillary central B. Mesial of the maxillary lateral C. Distal of the maxillary central D. Distal of the maxillary lateral

The correct answer is A. When viewed from the proximal, all incisors show a distinct curvature of the cervical line as the line curves markedly upward (toward the incisal). It then returns to a much lower (apical) level on both the facial and lingual. It is most noticeable on the mesial of the central incisor. This is one of those most, biggest, longest, shortest type questions common in this section.

The distal inclination in roots of the permanent mandibular first molar is: A. more pronounced in either root, depending on the tooth B. usually more pronounced in the mesial root C. usually more pronounced in the distal root D. usually equal in both roots

The correct answer is B. In the mandibular first molar, one of the major distinctions between roots is the greater distal curvature of the mesial root. The distal root, by contrast, is usually more straight, without significant curvature. Another distinction is the deep root concavity seen running the length of the mesial surface of the mesial root. The distal root, by comparison, will have no similar concavity or a very slight depression. This concavity will sometimes express itself as a partial split (bifurcation) of some small section of the apical end of the mesial root into two roots. This feature is rare to unknown on the distal root.

Which premolar is considered to be most molar-like in form? A. Maxillary first B. Maxillary second C. Mandibular first D. Mandibular second

The correct answer is D. The maxillary premolars are considered to be much more alike than are the mandibular premolars. They are most premolar-like in form, with fairly similar sized buccal and lingual cusps and greater overall symmetry. The mandibular premolars, by contrast, are significantly different from each other. The first premolar is very canine-like with a small lingual cusp and relatively large buccal cusp. The mandibular second premolar, while more premolar-like than the first, has attributes of molars as well. The chief molar-like attribute of the mandibular second is the tendency toward three cusps rather than two. The most common form of this tooth has a large buccal cusp with two smaller lingual cusps making up the rest of the crown. The two lingual cusps are the mesiolingual and distolingual and are separated by a lingual groove. There is a less common two-cusped variety which is less molar-like in form.

How many teeth (out of 32) in the normal dentition oppose only ONE other tooth? A. None B. 1 C. 2 D. 4 E. 6

The correct answer is D. Because of the shift of the mandibular teeth in a mesial direction due to the smaller size of the anterior teeth, most teeth have two opposing teeth. That is, they oppose their counterpart in the other arch, and a tooth either mesial or distal to that counterpart. There are two classes of exceptions. One of the exceptions is the mandibular central incisors. These two teeth (#24 and #25) oppose only the maxilary centrals (#8 and #9). The other exception is the maxillary third molars (#1 and #16), which oppose only the mandibular third molars. Note that the mandibular third molars oppose both the maxillary second and third molars.

In extraction of maxillary first premolars, the root anatomy guides the dentist to use a motion that is primarily: A. buccal-lingual luxation B. mesiodistal luxation C. rotation D. all of the above

The correct answer is A. One of the best reasons to know standard and unusual root shapes for the various maxillary and mandibular teeth is to use the correct motion on the forceps when performing extractions. In general, rounded roots are primarily rotated, including the maxillary central incisors and maxillary canines. All double- and triple-rooted teeth cannot be rotated and must be luxated in the buccal and lingual directions. Mesial-distal motion is normally ruled out because of the existence of adjacent teeth. It is used in rare cases where there is no mesial and distal adjacent tooth. The maxillary first premolar is invariably double rooted with a buccal and lingual root, and can never be rotated without breaking the crown off of the root.

The mesiobuccal cusp of the maxillary first molar occludes in: A. the mesial marginal ridge of the mandibular second molar B. the distal marginal ridge of the mandibular first molar C. the central groove of the mandibular first molar D. the facial embrasure between the mandibular first and second molars E. the buccal groove of the first mandibular molar

The correct answer is E. Buccal cusps of maxillary teeth are guiding cusps, not holding cusps. Therefore, they do not occlude on marginal ridges or central fossae. The general rule for maxillary buccal cusps is that they occlude in the facial embrasure between their mandibular counterpart and the tooth distal to their counterpart, EXCEPT for the mesiobuccal cusps of the molars, which occlude in the buccal grooves of their mandibular counterparts, and the distobuccal cusp of the first molar, which opposes the distobuccal groove of the mandibular first molar. In this question we are dealing with the exception of the mesiobuccal cusps of maxillary molars, which occlude with the buccal groove of their mandibular counterpart. In this case, the maxillary first molar mesiobuccal cusp contacts the mandibular first molar buccal groove.

The glenoid (articular) fossa in which the mandibular condyle articulates is a depression within which cranial bone? A. Sphenoid B. Zygomatic C. Temporal D. Parietal E. A combination of more than one bone

The correct answer is C. The names for the fossa include mandibular, articular, glenoid, and temporal. This is due to the location of the fossa wholly within the temporal bone. The anterior border of the fossa is the articular eminence of the temporal bone, and the posterior border is the tympanic section of the temporal bone. Slightly more posterior is the mastoid process and associated styloid process. So the entire eminence is a temporal bone feature.

The epithelium of the mucous membrane of the mouth is: A. simple squamous B. stratified squamous C. simple columnar D. stratified columnar E. cuboidal

The correct answer is B. Squamous cells are flattened, pancake-like cells, and when in layers are known as stratified. The stratified squamous cells lining the mucosa of the oral cavity are similar to those lining the outer skin, although less keratinized. They do, however, flake off continuously into the mouth. Simple squamous tissue would be too thin and not allow for the constant flaking and replacement. Columnar epithelium is found in both the respiratory system and other organs of the digestive system.

The attrition at the contact point between teeth is known to cause: A. Reduced embrasures interproximally B. Diastemas C. Longer clinical crowns D. Shorter clinical crowns

The correct answer is A. Over time, posterior teeth lose small amounts of enamel as the contact points wear against each other during chewing. The contacts become slightly broader, the teeth themselves become slightly closer, through drifting, and the embrasures between the teeth become slightly smaller. Diastemas ( choice B) are not created, because the teeth drift to close any space created by the attrition. The process is at a microscopic level; the wear is very gradual, as is the accompanying drifting, so that contact is not lost. This process does not affect crown length (choices C and D), which is occluso-cervical in direction. It only affects the mesio-distal dimension.

In comparison to those of permanent molars, the common root trunks of primary molars are proportionately: A. larger B. smaller C. relatively equal D. variable, depending on the tooth

The correct answer is B. The common root trunk refers to that area of root apical to the crown but coronal to the bifurcation or trifurcation of the roots. It can be viewed as the combined root area from which the individual roots emerge. It is characteristic of primary molars that they have little or no common root trunk. That is, the roots appear to furcate almost immediately below the crown. This is due to the fact that the primary molar roots must flare widely in order to leave room for the developing crowns of the succedaneous premolars.

In centric occlusion, the mesiolingual cusp of the maxillary third molar will contact: A. the central fossa of the mandibular second molar B. the central fossa of the mandibular third molar the distal marginal ridge of the mandibular first molar and mesial marginal ridge of C. the second molar the distal marginal ridge of the mandibular second molar and mesial marginal ridge D. of the third molar

The correct answer is B. The mesiolingual cusp of a maxillary third molar is a holding cusp. The general rule for maxillary holding cusps is as follows: a maxillary holding cusp contacts the distal marginal ridge of its mandibular counterpart and the mesial marginal ridge of the mandibular tooth distal to its counterpart, EXCEPT FOR THE MESIOLINGUAL CUSPS OF THE MOLARS, WHICH CONTACT THE CENTRAL FOSSAE OF THEIR COUNTERPARTS. This should be the central fossa of the counterpart, the mandibular third molar.

Which of the following is NOT considered an important reason for restoring proximal contact in dental restorations? A. Contact protects the periodontal tissue B. Contact prevents food impaction C. Contact increases retention of the restorations D. Contact prevents tooth drifting

The correct answer is C. Contact is re-established in proximal areas when Class II restorations are completed. This restoration of contact at the correct contact level prevents food from wedging in between teeth and causing buildup of plaque and debris. This, in turn, protects the periodontal ligament, because the chief etiology of periodontal bone loss is calculus and plaque accumulation. Stability of the arch is maintained and tooth drifting is also minimized. Without contact, teeth may drift mesially or distally into the space left by the faulty restoration. Proximal contact is NOT considered to be related to filling material retention. This is because each restoration's retention is supposed to depend solely on the retentive properties of that individual tooth, tooth preparation, and material. In other words, retention stands alone within the individual tooth. Adjacent teeth are never considered as part of restoration retention.

Which cusp on the primary mandibular first molar is highest and sharpest? A. Mesiobuccal B. Distobuccal C. Mesiolingual D. Distolingual

The correct answer is C. The primary first mandibular molar is a highly unusual tooth. It is molar-like in form, with two roots (mesial and distal), but has a very pronounced mesial development of the crown. The mesial section comprises two-thirds of the crown, and the distal portion is much reduced. The mesiolingual cusp is the highest and sharpest, although the mesiobuccal is overall largest as viewed from the occlusal. It is followed in size by the ML, DB, and DL cusps.

The masseteric sling is composed of the masseter and the: A. medial pterygoid B. lateral pterygoid C. anterior digastric D. temporalis

The correct answer is A. The masseteric sling is a powerful pair of muscles which wrap underneath the angle and ramus of the mandible and act to both support and close (elevate) the mandible. On the lateral surface of the mandible we find the masseter, while on the medial surface we find the medial pterygoid. Although the temporalis ( choice D) also strongly elevates, it is not part of this structure. The lateral pterygoid ( choice B) attaches to the condyle and TMJ disc, and pulls the condyles forward and laterally. The lateral pterygoid is not part of the masseteric sling.

Which cusp becomes smaller and less conspicuous as you go from maxillary first to second to third molar? A. Mesiobuccal B. Mesiolingual C. Distobuccal D. Distolingual

The correct answer is D. The MB, ML, and DB cusps of the maxillary molars are the largest, and form the primary cusp triangle, or trigon, of the tooth. The distolingual cusp is the smallest, and is not part of the trigon. It is sometimes referred to as the talon or talon cusp. It is most noticeable in the first molar, less noticeable in the second, and often absent in the third molar. The maxillary third molar therefore often does not have the rhomboid appearance of a maxillary molar, and the occlusal aspect will appear triangular or heartshaped instead.

Which type of dentin is most regular in structure? A. Primary dentin B. Secondary dentin C. Reparative dentin D. All have the same regular structure

The correct answer is A. All dentin is formed by odontoblasts located at the border of the pulp and dentin. It consists of tubules surrounding odontoblastic processes, as well as intertubular dentin. In primary dentin, the tubules are regular in pattern. In secondary dentin, formed later in life, tubules are less regular, less numerous and more wavy. Reparative dentin (sclerotic dentin) forms in response to caries, heat, deep fillings, etc. It is least regular and most wavy, and tubules are least numerous.

The largest root of the maxillary first molar is the: A. mesiobuccal B. distobuccal C. palatal D. varies depending on the individual tooth

The correct answer is C. The palatal or lingual root of the maxillary first molar is the most massive by far. It is normally straight but palatally inclined, giving the three roots a tripodlike appearance. The mesiobuccal root (choice A) is second in size, and the distobuccal (choice B) is smallest. The mesiobuccal is often curved distally and the distobuccal curved mesially. This pliers-like appearance is not found in the maxillary second and third molars.

Which of the following will cause reduction of the size of the pulp chamber in mid-life? A. Formation of primary dentin B. Formation of secondary dentin C. Internal resorption D. External resorption E. Pulp fibrosis

The correct answer is B. Primary dentin (choice A) surrounds the pulp chamber when the tooth is first formed and erupts. It is the initial dentin that makes up the base of both the crown and root. If the young tooth has a given size pulp chamber, further dentin formation, secondary dentin, later in life, will begin to fill the chamber with dentin, making it smaller. Internal resorption (choice C) is loss of dentin, resulting in a larger pulp chamber. External resorption (choice D) involves the exterior of the root and does not change the pulp chamber size. Pulp fibrosis (choice E) would change the histology of the cells in the chamber, but not the chamber's size.