American Board of Dental Public Health (ABDPH) Diplomate Examination

Correct: For patients with special healthcare needs who rely on Augmentative and Alternative Communication (AAC), the most effective strategy is to integrate their existing communication tools into standard behavior guidance techniques like Tell-Show-Do. This approach respects the patient’s autonomy, reduces anxiety by providing a predictable environment, and allows for two-way communication, which is essential for obtaining informed consent and assessing the patient’s comfort level during the oral examination.

Incorrect: Using standardized office symbols instead of the child’s personal device is less effective because the child is already trained on and familiar with their own system’s layout and vocabulary. Having the caregiver operate the device exclusively removes the child’s agency and can hinder the development of a direct rapport between the dentist and the patient. Deferring the use of communication aids until after radiographs are taken is counterproductive, as the radiographic process often requires the highest level of communication and cooperation to be successful.

Takeaway: Effective pediatric dental management of patients using AAC requires the seamless integration of the patient’s personal communication tools into behavior guidance protocols to ensure patient autonomy and clinical cooperation.

Correct: Systemic acyclovir (15 mg/kg five times daily for 7 days) is the evidence-based treatment for primary herpetic gingivostomatitis in children when started within 72 hours of onset, as it significantly reduces the duration of symptoms like fever and pain.

Correct: Sectioning a primary molar is the safest surgical approach when encountering resistance due to divergent roots or dense bone. This technique allows the clinician to remove each root along its own path of withdrawal, which significantly reduces the amount of force transmitted to the underlying permanent tooth bud and the surrounding alveolar bone, preserving the integrity of the developing successor.

Incorrect: Applying increased apical force is dangerous in pediatric patients because it can lead to the displacement of the primary tooth or surgical instruments into the follicle of the permanent tooth. Cowhorn forceps are contraindicated for primary molars because their beaks are designed to engage the furcation, where the permanent premolar bud is located, risking its injury or accidental extraction. Buccal bone guttering is unnecessarily invasive for a primary tooth extraction and can lead to significant post-operative discomfort and potential loss of alveolar bone height.

Takeaway: When surgical resistance is encountered in pediatric extractions, sectioning the tooth is the preferred method to protect the developing permanent successor and minimize alveolar trauma.

Correct: The presence of Grade 4+ tonsils (kissing tonsils) combined with clinical signs such as a high-arched palate, mouth breathing, and restless sleep are significant indicators of potential Obstructive Sleep Apnea (OSA) or sleep-disordered breathing. According to the American Academy of Pediatric Dentistry (AAPD) guidelines, the pediatric dentist plays a crucial role in screening for these conditions during the oral examination. The most appropriate and safest next step is to refer the patient to a medical professional, such as a pediatrician or ENT specialist, for a definitive diagnosis (often via polysomnography) and management.

Incorrect: Orthodontic expansion is a valid adjunct treatment for some airway issues but should not be initiated before a medical diagnosis of the underlying cause of obstruction. Lateral cephalometric radiographs provide only a two-dimensional view of a three-dimensional space and are not the gold standard for diagnosing airway obstruction or OSA. Recommending nasal strips or a ‘wait and see’ approach is inappropriate given the severity of Grade 4+ tonsils and the potential systemic health consequences of untreated sleep-disordered breathing in a developing child.

Takeaway: A comprehensive pediatric oral examination must include an airway assessment, and findings suggestive of significant obstruction or sleep-disordered breathing require a formal medical referral.

Correct: According to the American Academy of Pediatric Dentistry (AAPD) and the American Dental Association (ADA), children at high risk for dental caries should receive professional fluoride varnish applications at least every 3 to 6 months. This frequency is necessary to maximize the remineralization of non-cavitated lesions and provide a protective effect against the high-risk factors identified in the patient’s assessment, such as visible decalcification (white spot lesions) and dietary habits.

Incorrect: Limiting application to 6-month intervals is the standard for low-risk patients, but it is insufficient for high-risk individuals. The risk of fluorosis from professional varnish is minimal when applied correctly, as it is a topical treatment with rapid setting. Annual application is inadequate for high-risk caries management regardless of systemic fluoride intake. Monthly application is not the standard evidence-based protocol and may not provide additional benefit over the 3-month interval while increasing costs and patient burden.

Takeaway: High-risk pediatric patients require professional fluoride varnish applications at 3- to 6-month intervals to effectively manage caries risk and promote remineralization.

Correct: The viability of the periodontal ligament (PDL) cells is the single most important factor in determining the healing outcome of a replanted tooth. If the PDL cells are preserved through short extra-oral dry time or appropriate storage media, they prevent the bone from coming into direct contact with the root surface, thereby preventing replacement resorption (ankylosis) and promoting a functional ligamentous attachment.

Incorrect: Rigid splinting for an extended period (8 weeks) is contraindicated because it restricts the physiological micro-movement of the tooth, which is necessary to prevent ankylosis; current guidelines recommend flexible splinting for only 2 weeks. Mechanical debridement of the root surface or the application of phosphoric acid are both detrimental as they destroy the PDL cells and the cementoblast layer, which directly leads to bone-to-root contact and subsequent replacement resorption.

Takeaway: The preservation of viable periodontal ligament cells through minimal extra-oral dry time is the primary clinical determinant for preventing ankylosis and ensuring successful soft tissue and bone healing after tooth avulsion.

Correct: Extensive clinical evidence and systematic reviews support that stainless steel crowns (SSCs) are the most durable and successful restorative option for primary molars with multi-surface lesions. This is especially true for children at high risk for caries, where the full-coverage nature of the SSC protects the remaining tooth structure from further decay and provides superior longevity compared to amalgam, composite, or glass ionomer restorations.

Incorrect: Resin-modified glass ionomer cements are effective for smaller restorations but lack the structural integrity for large multi-surface restorations compared to SSCs. While bonding agents are important, the material’s physical properties and the patient’s risk profile are more significant predictors of long-term success. Although composite resin allows for conservative preparation, it has a higher failure rate in multi-surface primary molar applications due to polymerization shrinkage, moisture control challenges, and susceptibility to recurrent decay in high-risk patients.

Takeaway: For multi-surface carious lesions in primary molars, especially in high-caries-risk patients, stainless steel crowns offer the highest long-term success rate and durability compared to any intracoronary restorative material.

Correct: In pediatric patients undergoing chemotherapy, the timing of dental extractions is critical due to the impact of bone marrow suppression on healing and infection risk. The most appropriate approach is to perform necessary extractions at least 7 to 10 days before the anticipated nadir (the point where blood counts are at their lowest, typically 7-14 days after starting chemotherapy). This timeframe allows for the formation of a stable fibrin clot and initial epithelialization while the patient still has sufficient neutrophils (ANC > 1,000/mm3) and platelets (> 75,000/mm3) to facilitate healing and prevent systemic dissemination of oral bacteria.

Incorrect: Delaying the extraction until the chemotherapy cycle has begun or until the nadir is reached is dangerous, as the patient’s ability to mount an immune response and heal the surgical site is severely compromised, leading to a high risk of life-threatening septicemia. Managing a tooth with a chronic periapical abscess via pulpotomy is inappropriate because pulpal therapy has a lower success rate in immunosuppressed patients and leaves a potential source of infection. Extractions are not contraindicated in hematologic patients; rather, they must be timed carefully relative to the bone marrow’s functional status.

Takeaway: Surgical dental interventions in pediatric oncology patients should be completed at least 7 to 10 days before the chemotherapy-induced nadir to ensure the bone marrow can support adequate wound healing and immune defense.

Correct: Children with behavioral challenges such as ASD or ADHD are at a significantly higher risk for dental trauma due to impulsivity, coordination deficits, or sensory processing issues. From a public health perspective, the most effective intervention involves individualized risk assessment and anticipatory guidance for parents. Custom-fitted mouthguards are the gold standard because they provide superior retention, comfort, and protection compared to over-the-counter versions, which is particularly important for children with sensory sensitivities who may otherwise refuse to wear protective gear.

Incorrect: Stock or boil-and-bite mouthguards often have poor fit and can interfere with breathing or speaking, leading to very low compliance rates in children with behavioral challenges. Pit and fissure sealants are an effective public health measure for preventing dental caries but provide no protection against mechanical orofacial trauma. Pharmacological behavior management is intended for clinical dental procedures and is not a safe or appropriate strategy for managing behavior during general physical activities or sports.

Takeaway: Effective prevention of dental trauma in high-risk pediatric populations requires a combination of caregiver education and the use of high-compliance, custom-fitted protective equipment.