NBDE Diagnosis and Treatment Planning 5

Question 1

A 50-year-old patient presents with a chief complaint of sensitivity to cold that lingers for 30 seconds on tooth #19. The tooth is otherwise asymptomatic, and periapical radiographs are normal. What is the most likely pulpal diagnosis?

Accepted Answer

Symptomatic irreversible pulpitis

Answer

Lingering cold sensitivity (pain persisting after stimulus removal) indicates symptomatic irreversible pulpitis, indicating the pulp cannot heal and endodontic therapy is needed.

Question 2

A radiograph shows a diffuse, poorly defined radiopacity replacing the normal trabecular pattern of the posterior mandible in an elderly patient. The area is asymptomatic. What is the most likely diagnosis?

Accepted Answer

Florid cemento-osseous dysplasia

Answer

Florid cemento-osseous dysplasia presents as diffuse, bilateral, asymptomatic sclerotic masses replacing trabecular bone, most commonly in middle-aged Black women.

Question 3

A patient scheduled for a complicated extraction has a blood pressure reading of 185/110 mmHg at the start of the appointment. What is the most appropriate management?

Accepted Answer

Defer treatment, refer to physician, and reschedule after blood pressure is controlled

Answer

A blood pressure of ≥180/110 mmHg (Stage 3 hypertension) contraindicates elective dental surgery; the patient must be referred for medical management before rescheduling.

Question 4

Which finding on a clinical examination is most diagnostic of a vertical root fracture in a posterior tooth?

Accepted Answer

Probing depth >6 mm on a single isolated narrow pocket

Answer

An isolated narrow, deep periodontal defect (sinus tract or narrow probing defect along the root surface) is pathognomonic of a vertical root fracture.

Question 5

A 25-year-old patient presents requesting whitening but has tetracycline staining that is moderate-to-severe (banding visible). What is the most realistic treatment planning discussion with the patient?

Accepted Answer

Bleaching has limited effect; porcelain veneers or crowns may be needed for adequate results

Answer

Moderate-to-severe tetracycline staining responds poorly to bleaching alone, and porcelain veneers or full-coverage crowns are often required to achieve an acceptable esthetic outcome.

NBDE - National Board Dental Examination Practice Test

NBDE - National Board Dental Examination Practice Test

NBDE Diagnosis and Treatment Planning 5