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Sample NDSE Practice Questions
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1A 28-year-old presents with spontaneous, lingering pain in tooth 36 that is worsened by heat and relieved by cold. The tooth responds exaggeratedly to thermal testing and is not tender to percussion. Which diagnosis best fits?
A.Reversible pulpitis
B.Symptomatic irreversible pulpitis
C.Pulp necrosis
D.Symptomatic apical periodontitis
Explanation: Spontaneous, lingering pain with heat sensitivity and relief by cold is classic for symptomatic irreversible pulpitis, where inflammatory exudate increases intrapulpal pressure that cold can transiently relieve. The pulp is vital but cannot recover, so root canal therapy or extraction is indicated.
2During non-surgical root canal therapy, which irrigant combination is most effective for dissolving organic pulp tissue while also removing the inorganic smear layer?
A.Saline followed by hydrogen peroxide
B.Chlorhexidine alone
C.Sodium hypochlorite alternated with EDTA
D.Sodium hypochlorite followed by chlorhexidine
Explanation: Sodium hypochlorite dissolves organic (pulpal) tissue and is antimicrobial, while EDTA chelates calcium to remove the inorganic smear layer. Alternating them addresses both organic and inorganic components of the canal wall.
3An 11-year-old falls and avulses an immature permanent maxillary central incisor with an open apex. The tooth is replanted within 20 minutes. What is the most appropriate long-term goal of management?
A.Extraction and space maintenance
B.Immediate root canal therapy before splinting
C.Apexification with calcium hydroxide
D.Revascularization of the pulp
Explanation: An immature tooth with an open apex replanted within a short extra-alveolar time has the potential for pulpal revascularization, so the pulp is left in place and monitored. Endodontic intervention is reserved for signs of necrosis or infection-related resorption.
4Which apical anatomical landmark represents the narrowest portion of the canal and the ideal apical limit for cleaning, shaping, and obturation?
A.Apical constriction (minor diameter)
B.Apical foramen
C.Cementodentinal junction
D.Anatomic apex
Explanation: The apical constriction, or minor apical diameter, is the narrowest part of the canal and is the recommended apical termination point for instrumentation and obturation. Working beyond it risks overextension and periapical irritation.
5A patient reports persistent pain after a completed root canal on tooth 16. A CBCT reveals an untreated second mesiobuccal (MB2) canal. This finding most directly illustrates the importance of which biomedical-science concept in endodontics?
A.Pharmacokinetics of local anesthetics
B.Pulpal immunology
C.Variability of root canal morphology
D.Biofilm resistance to antibiotics
Explanation: Missed canals, especially MB2 in maxillary first molars, reflect the well-documented anatomical variability of root canal systems. Knowledge of complex morphology and the use of magnification and CBCT improve detection and treatment success.
6During apical microsurgery, which root-end filling material is favored for its biocompatibility, hydrophilic setting, and ability to stimulate hard-tissue formation?
A.Amalgam
B.Mineral trioxide aggregate (MTA)
C.Cavit
D.Zinc oxide-eugenol paste
Explanation: MTA sets in the presence of moisture, seals well, is highly biocompatible, and promotes cementogenesis and hard-tissue healing, making it a preferred root-end filling in apical surgery. Its sealing ability and tissue response exceed older materials.
7A patient with symptomatic irreversible pulpitis of a mandibular molar remains painful despite a successful inferior alveolar nerve block. Which supplemental technique is most reliably effective?
A.Topical benzocaine application
B.Long buccal infiltration
C.Mental nerve block
D.Intraosseous injection
Explanation: Inflamed mandibular molars frequently fail to anesthetize fully with an IAN block alone; an intraosseous injection delivers anesthetic directly into cancellous bone adjacent to the tooth and is the most reliable supplemental technique. Intraligamentary injection is a secondary option.
8Which radiographic feature most strongly suggests external cervical resorption rather than internal resorption?
A.The radiolucent defect moves relative to the canal on parallax (SLOB) radiographs
B.The pulp canal outline is uniformly ballooned
C.The lesion is centered exactly over the canal on all angles
D.The defect has perfectly smooth, symmetric borders
Explanation: External resorption defects shift position relative to the root canal when the horizontal angulation changes (parallax/SLOB rule), and the canal outline usually remains traceable through the lesion. Internal resorption stays centered on the canal and balloons its outline.
9What is the principal rationale for placing an intracanal calcium hydroxide dressing between visits in a tooth with apical periodontitis?
A.It induces immediate radiographic bone fill within days
B.It chemically bonds to dentin to seal the canal permanently
C.It anesthetizes the periapical tissues
D.Its high pH provides antimicrobial action and helps dissolve residual necrotic tissue
Explanation: Calcium hydroxide releases hydroxyl ions, creating a high alkaline pH that is bactericidal and aids in dissolving residual organic debris between appointments. It is an interim medicament, not a permanent obturation material.
10A tooth previously treated with root canal therapy shows a new periapical radiolucency and a sinus tract two years later. Cleaning, shaping, and obturation appear adequate radiographically. Which is the most appropriate next step?
A.Prescribe long-term antibiotics only
B.Immediate extraction
C.Nonsurgical retreatment to disinfect a likely persistent or missed canal infection
D.Observe with no treatment for another two years
Explanation: Post-treatment apical periodontitis usually reflects persistent intracanal infection, often from inadequately disinfected anatomy. Nonsurgical retreatment to re-access and disinfect the canal system is the recommended first-line approach before surgery or extraction.
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