National Board Dental Examination / Integrated National Board Dental Examination (INBDE) Patient Assessment, Diagnosis, and Treatment Planning Syllabus

What is the principle of the paralleling technique and why is it preferred?

The film/sensor is placed parallel to the long axis of the tooth and the central beam is directed perpendicular to both; it minimizes dimensional distortion and is the most accurate, preferred intraoral technique.

What is the purpose of a bitewing radiograph?

To detect interproximal caries, assess alveolar bone crest levels, and evaluate the fit of restorations by imaging the crowns of both arches in occlusion.

Which radiographic projection is used to localize an object buccolingually, and what rule governs it?

Two images at different horizontal/vertical angles using the SLOB rule (Same Lingual, Opposite Buccal): if the object moves the Same direction as the tube head/cone, it is Lingual; if Opposite, it is Buccal.

What anatomy is best displayed on a panoramic radiograph?

A broad view of both jaws, all teeth, the TMJs, maxillary sinuses, and the mandible; useful for impactions, cysts, fractures, and developmental assessment, but with lower detail than intraoral films.

On a periapical radiograph, what does a radiolucent area at the root apex typically indicate?

A periapical pathology such as a periapical granuloma, cyst, or abscess, usually from pulpal necrosis (apical periodontitis).

Identify these mandibular radiographic landmarks: a radiolucent oval below the premolars and a radiopaque line along the lower border.

The radiolucent oval is the mental foramen; the radiopaque line at the lower border is the inferior border of the mandible (cortical bone).

Distinguish radiolucent from radiopaque on a radiograph.

Radiolucent structures appear dark/black (low density, allow X-rays through, e.g., pulp, caries, cysts); radiopaque structures appear light/white (high density, absorb X-rays, e.g., enamel, bone, metal restorations).

What is the ALARA principle in radiation protection?

As Low As Reasonably Achievable: keep patient and operator radiation exposure to the minimum necessary, using protective measures and prescribing radiographs only when clinically justified.

List three key methods to reduce patient radiation dose in dental radiography.

Use the fastest film/digital sensors, use rectangular collimation and long position-indicating devices, use lead aprons/thyroid collars when appropriate, set proper exposure (higher kVp), and limit retakes.

What are deterministic versus stochastic effects of radiation?

Deterministic effects have a threshold dose and severity increases with dose (e.g., erythema, cataracts); stochastic effects have no threshold and probability (not severity) increases with dose (e.g., cancer, genetic mutations).

What is the most radiosensitive phase of the cell cycle, and which cells are most radiosensitive (per the Law of Bergonie and Tribondeau)?

Cells are most radiosensitive during mitosis (M phase); cells that are highly mitotic, undifferentiated, and have a long mitotic future (e.g., stem cells, reproductive cells) are most radiosensitive.

What is the maximum permissible dose (MPD) of occupational radiation exposure per year for operators?

50 mSv (5 rem) per year for occupationally exposed workers; the general public limit is 1 mSv (0.1 rem) per year.

How does a cold thermal pulp test help diagnose pulpal status?

A normal/healthy or reversibly inflamed pulp responds with sharp pain that subsides quickly; lingering pain after stimulus removal suggests irreversible pulpitis; no response suggests pulpal necrosis.

What does an electric pulp test (EPT) measure, and what does a positive response indicate?

It measures the presence of viable sensory nerve fibers in the pulp; a response indicates vital nerve tissue, but it gives no information about blood supply/health and can yield false readings.

How do percussion and palpation testing aid diagnosis?

Pain on percussion indicates inflammation of the periodontal ligament (apical periodontitis); pain on palpation of the apical mucosa indicates the inflammatory/infectious process has extended into surrounding bone/soft tissue.

Contrast reversible and irreversible pulpitis clinically.

Reversible pulpitis: short, sharp pain to stimuli that resolves quickly, no lingering pain, treat the cause; irreversible pulpitis: spontaneous and/or lingering pain after stimulus, often requires root canal therapy or extraction.

What three components form the classic 'diagnostic triad' for pulpal/periapical diagnosis?

Subjective symptoms (patient history/pain description), objective clinical tests (thermal, EPT, percussion, palpation), and radiographic findings.

What is a differential diagnosis and how is it formulated?

A ranked list of possible conditions that could explain the patient's findings, formulated by gathering history/exam/test data, then comparing characteristic features to narrow toward the most probable definitive diagnosis.

List the major caries risk factors used in caries risk assessment (CAMBRA).

Disease indicators (existing cavities/lesions), risk factors (high mutans/lactobacilli, frequent snacking, plaque, reduced saliva, deep pits/fissures), against protective factors (fluoride exposure, saliva, sealants, antibacterials).

Name modifiable and non-modifiable risk factors for periodontal disease.

Modifiable: smoking, poor plaque control, uncontrolled diabetes, stress, obesity; non-modifiable: genetics, age, and certain systemic/host factors.

How does diabetes mellitus influence periodontal disease, and what lab value reflects glycemic control?

Poorly controlled diabetes increases severity and progression of periodontitis (bidirectional relationship); glycemic control is reflected by HbA1c, with <7% generally indicating good control.

What is the standard sequencing order of phases in a comprehensive dental treatment plan?

1) Systemic/emergency (urgent) phase, 2) Disease control/preparatory phase (caries removal, perio therapy, extractions, endo), 3) Definitive/rehabilitative phase (restorations, prostho, ortho), 4) Maintenance/recall phase.

In treatment planning, why is the disease-control (Phase I) stage completed before definitive restorative work?

To eliminate active disease (caries, infection, periodontal inflammation) and stabilize the patient so that definitive restorations are placed in a healthy, predictable environment with better long-term prognosis.

What are the three components of evidence-based dentistry (EBD)?

The best available scientific/clinical evidence, the clinician's expertise and judgment, and the patient's needs/values/preferences.

Rank the levels of evidence in the EBD hierarchy from strongest to weakest.

Systematic reviews/meta-analyses of RCTs (strongest), then individual RCTs, cohort studies, case-control studies, case series/reports, and expert opinion (weakest).

What initial steps should be taken when a seated dental patient shows signs of vasovagal syncope (fainting)?

Position the patient supine with legs elevated (Trendelenburg), ensure airway, administer oxygen, apply a cold compress, and monitor vitals; recovery is usually rapid.

What is the first-line drug, dose, and route for managing anaphylaxis in a dental office?

Epinephrine 1:1000, 0.3-0.5 mg intramuscularly into the mid-anterolateral thigh (vastus lateralis), repeatable every 5-15 minutes as needed.

How do you distinguish a mild allergic reaction from anaphylaxis, and how does management differ?

Mild reaction: localized urticaria/itching, no airway/cardiovascular compromise, treat with antihistamine (e.g., diphenhydramine); anaphylaxis: rapid multi-system involvement with airway swelling, bronchospasm, hypotension, requiring immediate IM epinephrine plus oxygen and EMS.

What is the immediate management of suspected acute myocardial infarction or angina in the dental chair?

Stop treatment, position comfortably (upright if dyspneic), give oxygen, administer sublingual nitroglycerin (if BP adequate) for angina, give aspirin 162-325 mg chewed if MI suspected, monitor vitals, and activate EMS.

What is the management for an acute asthma attack in the dental office?

Stop treatment, position the patient upright, administer a short-acting beta-2 agonist (albuterol) inhaler, give supplemental oxygen, and activate EMS if no improvement; epinephrine may be used in severe refractory cases.

How do you recognize and treat hypoglycemia in a conscious versus unconscious diabetic patient?

Signs: shakiness, sweating, confusion, tachycardia. Conscious: give 15 g oral fast-acting carbohydrate (juice, glucose gel); unconscious: do NOT give oral glucose, administer IM glucagon or IV dextrose and activate EMS.

What are the steps and compression parameters of adult Basic Life Support (BLS/CPR)?

Check responsiveness, call for help/AED, then C-A-B: chest compressions at 100-120/min, depth 2-2.4 inches (5-6 cm) with full recoil, 30:2 compression-to-ventilation ratio, minimize interruptions, and use the AED as soon as available.