The Boards

Les Quan’s ABE Study and

Test Taking Guide, 2010

Diplomate, American Board of Endodontics - 2006

Chair – Mentoring/Website Committee of the C.O.D.

• Achieving the highest level of knowledge

and skill possible

• Continually pursuing new knowledge and

experience

• Fully understanding and applying new

research and advances to the practice of

endodontics, and

• Ensuring the highest possible quality of

care of the patient.

My excuses……..

• In 1984 Diplomates in the Specialty

consisted of grandfathered individuals

• No additional formal training

• The 2 endodontists who I admired most

where grandfathers

• I was totally occupied with building a

practice!

My answer today

• Board Certification is the process by

which an endodontist in the United States,

documents by written, practical and/or

simulator based testing a mastery of the

basic knowledge and skills that define

an area of dental specialization.

Based on Practicing Diplomates

3 Ghosts5 ghosts5 Ghosts

28 Endodontists, 915,855 population

One MoreGhosts

Ghosts

37 28 Endodontists,X

One More

Only FIVE

Diplomates!

I was recently speaking to a board member of the

American Association of Endodontists. We agreed that

many endodontists have been deeply affected by the

recession. He told me he knew of some practices down

15% or more. Endodontics has almost never seen a

downturn—let alone one this significant!

What happened?

I believe many endodontists take their

relationships with referring dentists for

granted.

Roger Levin, October 2009

Food for

Thought

The Boards

Timing

Recommendations

Start of Residency

Graduation &

ABE Written Exam

1 Year

Portfolio

One year timeline is now available

residency

Getting Started

Know all the rules!

Get the CD from ABE

1. The Written Examination contains 200

questions.

2. Questions are multiple choice, consisting

of a stem with four or five foils

3. It is a PASS – NO PASS exam

4. 98% pass rate (2008)

5. Each question is statistically evaluated

Written Examination - Grading

My older age wasn’t held

against me!

Where do you start

studying when you

graduated from dental

school 30 years ago?

…and the VAHLB 20

years ago?

Where I started from…..

1. What are the rules?

2. What do I need to relearn?

3. Assemble resources

4. Get the information into long

term memory, efficiently

What to study?

The Written Examination

Phase I of the certifying examination of the American Board of Endodontics is a four

hour written examination consisting of 200 multiple choice questions, divided evenly

between morning and afternoon sessions. According to the ABE, the questions are

designed to test recall as well as the ability to apply knowledge, interpret information,

and solve problems. Subject areas include anatomy, biochemistry, embryology,

general and oral pathology, microanatomy, immunology, inflammation,

microbiology, pharmacology, vascular and neurophysiology, pulpal and

periradicular pathobiology, radiology, oral medicine, biostatistics, clinical

endodontics, dental materials related to endodontics, related dental disciplines,

and classic and current literature. Although there is no one single text or review

course that can totally prepare one for a written exam, a number of excellent review

courses are offered during the year and are strategically scheduled near the times

when board examinations are given.

Because of the contemporary and constantly developing nature of a number of critical

areas, particular study should be also directed towards HIV and hepatitis

immunology and virology; management of diabetes, hypertension, thyroid

disease, and renal failure; antibiotics, analgesics, and local anesthetics; basic

concepts of cellular and molecular biology; anaerobic bacteria and current

genus and species identification; differential diagnosis of radiolucent and

radiopaque lesions; wound healing; and guided tissue and bone regeneration.

American Association of Oral and

Maxillofacial Surgeons

$2,470

American Association of Oral and

Maxillofacial Surgeons – Cont’d

$1,140

ABE “Approved”

Knowledge Base of Endodontics

Dr. Quan’s

Knowledge Base of Endodontics

Review Courses

• Loma Linda

• Michigan

• Albert Einstein - Pennsylvania

Review Courses - Ranked

1. Albert Einstein

2. Michigan

3. Loma Linda

I went to them all, and got a

“feel” for what I didn‘t know

•Pulp and Periradicular

Biology

•Local Anesthesia and

Analgesic Control of

Postoperative Pain

•Differential diagnosis and

Histopathology of

Periapical Tissues

•Mechanisms of

Endodontic Pain

•Management of the

Medically Compromised

Patient

•Pharmacology of Pain

•Facial Space Infections of

Odontogenic Origin

•Periapical Inflammatory

Responses and their

Regulation

Albert Einstein

•Biology of the Pulp

•Immunology

•Endodontic Microbiology

•The Medically Compromised

Patient

•Differential Diagnosis of

Periradicular Lesions

Odontogenic Origin

•Clinical Pharmacology

•Pain

•New Developments in

Instrumentation

•Endodontic Surgery

Michigan

•Pulp Biology

•Host-Pathogen

Relationships: Balance of

•Extra-Radicular Living and

Non Living Agents

•Endodontic Pain Control

•Orafacial Infections

•Infractions and Vertical

Fractures

Loma Linda

•Pulp and Periradicular

Biology

•Local Anesthesia and

Analgesic Control of

Postoperative Pain

•Differential diagnosis and

Histopathology of

Periapical Tissues

•Mechanisms of

Endodontic Pain

•Management of the

Patient

•Pharmacology of Pain

Odontogenic Origin

•Periapical Inflammatory

Responses and their

Regulation

•Biology of the Pulp

•Immunology

•Endodontic Microbiology

•The Medically

Compromised Patient

•Differential Diagnosis of

Periradicular Lesions

Odontogenic Origin

•Clinical Pharmacology

•Pain

•New Developments in

Instrumentation

•Endodontic Surgery

•Pulp Biology

•Host-Pathogen

Relationships: Balance of

•Extra-Radicular Living

and Non Living Agents

•Endodontic Pain Control

•Orafacial Infections

•Infractions and Vertical

Fractures

MICHIGAN PENNSYLVANIA LOMA LINDA

Covered Topics

• Many identical topics to study

• UNIQUE EXCEPTIONS!

• “New developments in Instrumentation”,

Dr James Johnson (resource disk)

• “Differential Diagnosis and Histopathology

of Periradicular Lesions” , Dr. Gordon

Pringle (resource disk)

Review Courses 2009-2010

1. COD/Columbia

• March 12-14, 2010

2. Bender, Seltzer & Grossman

• Later this year

What I studied first

The Sciences

Dental Decks

• 1-800-457-7126

• Deckscorp.com

• Part One and Two NDB exam

– Radiology

– Endodontics

– Oral Pathology

– Dental Anatomy and Occlusion

– Microbiology & Pathology

– Anatomic Sciences

Gray’s Anatomy Flashcards

Head and

Neck - Only

Websites

Quick Review

Sources!

LINKED

(Included on Resource Disk)

Sample website

Free PowerPoint Lectures

(Included on Resource Disk)

WABeresfordTOOTH TISSUES: Pulp

DENTINE

ENAMEL

CEMENTUM

PERIODONTAL

LIGAMENT/

ALVEOLAR BONE

GINGIVA

DENTAL PULP: Functions

Service tissue keeping its Odontoblasts alive

for slow defensive responses in the dentine

Providing antimicrobial defense for the

dentine and itself

Providing sensory feedback from the dentine,

but for what purposes?

DENTINE

ENAMEL

CEMENTUM

PERIODONTAL

LIGAMENT/

ALVEOLAR BONE

GINGIVA

Service tissue keeping its Odontoblasts alive for slow

defensive responses in the dentine

Providing antimicrobial defense for the dentine and itself

Providing sensory feedback from the dentine, but for

what purposes?

WABeresfordTOOTH TISSUES: Pulp & its roles

PULP CHAMBER

CORONAL PULP HORN

ACCESSORY

ROOT CANAL

APICAL FORAMEN

PULP REGIONS

ODONTOBLAST

PULP PROPER/

PULP CORE

Cell-poor

ZONE OF WEIL

- peripheral pulp

PULP ELEMENTS - Mucoid connective tissue

MATRIX -

Ground substance

Reticular fibers

Collagen I

fibers Elastic fibers

Blood vessels

Nerves

Lymphatics

CELLS -

Odontoblasts

Fibroblasts

Macrophages

Mast cells

Leukocytes

PULP INNERVATION

Nerves: sensory (V) to

ODONTOBLASTS

DENTINAL TUBULES

Blood vessels

Nerves:

autonomic

Sub-odontoblastic plexus

in cell-poor zone of Weil

PULP ELEMENTS - Mucoid connective tissue

MATRIX - Ground

substance Reticular

fibers Collagen I fibers

Elastic fibers

Blood vessels

Nerves

Lymphatics

CELLS -

Odontoblasts

Fibroblasts

Macrophages

Mast cells

Leukocytes

& Denticles & Fibrosis with aging

DENTICLES/ PULP STONES

Hard mineralized bodies found in

the pulp or the dentine

TWO TYPES:

1 TRUE - constructed of dentine

by ectopic odontoblasts & showing

dentinal tubules

2 FALSE - mineralized connective

tissue, etc, (not made of dentine)

Both may show layering/lamellar patterns

from incremental growth

DENTICLES/ PULP STONES:

further classification by place

Hard mineralized bodies found in the pulp

or the dentine

THREE SUBTYPES:

1 FREE - in the pulp

2 IMBEDDED - enclosed in the

dentine as this has slowly grown

inwards

3 ATTACHED - partly imbedded

TOOTH GERM: Pulp development

DENTAL LAMINA

DENTAL PAPILLA

DENTAL SAC/FOLLICLE

DENTAL ORGAN

MESENCHYME

ALVEOLAR BONE

TOOTH TISSUES: Sources

DENTAL LAMINA

DENTAL PAPILLA

DENTAL SAC/FOLLICLE

DENTAL ORGAN

MESENCHYME

ALVEOLAR BONE

DENTINE

ENAMEL

CEMENTUM

A BONE

DENTAL LAMINA

DENTAL PAPILLA

mesenchyme

DENTAL SAC/FOLLICLE

DENTAL ORGAN

ALVEOLAR BONE

DENTINE

ENAMEL

CEMENTUM

A BONE

Ameloblasts

Odontoblasts

CT cells

Cementoblasts

Fibroblasts

Osteoblasts & ‘clasts

DENTAL LAMINA

DENTAL PAPILLA

DENTAL SAC/FOLLICLE

DENTAL ORGAN

ALVEOLAR BONE

DENTINE

ENAMEL

CEMENTUM

SUPPORTING

LAMINA DURA

Spongy bone

TOOTH GERM

DENTAL LAMINA

Outer dental epithelium

Stellate reticulum

Inner dental epithelium

Stratum intermedium

DENTAL PAPILLA

DENTAL SAC/FOLLICLE

Vessels Nerves

HERTWIG’S

SHEATH grows to

lengthen root

PULP differentiates

Epithelial diaphragm

FURTHER ROOT FORMATION

Odontoblast recruitment site

Text Books

My Texts

1. Inflammation 5th edition, Trowbridge/Emling

2. Dental Pulp, Hargreave/Goodis

3. Pathways of the Pulp, 8th Edition, Cohen/Burns

4. Endodontics, 5th edition, Ingle/Bakland

5. Dental Management of the Medically

Compromised Patient, 6th Edition, Little, et al

I didn‘t read every chapter!

Inflammation Trowbridge/Emling

Important text. The whole

book is informative

Dental Pulp

Hargreaves/Goodis

• The BEST of the Bunch!

Dental Pulp

Hargreaves/Goodis

• History of Pulp Biology

• Development of the Pulpodentin complex

• Dentin Formation and Repair

• Pulpodentin complex

• Pulp as a Connective Tissue

• The Circulation of the Pulp

• Nerve Supply of the Pulpodentin Complex and

Response to Injury

• Pain Mechanisms of the Pulpodentin Complex

• Pharmacologic Control of Pain

• Histology of Pulpal Inflammation

Dental Pulp – CONT’D

Hargreaves/Goodis

• Molecular Mediators of Pulpal Inflammation

• Pulpal Infections Including Caries

• Calcium Hydroxide and Vital Pulp Therapy

• Repair of Pulpal Injury by Dental Materials

• Permanent Restorations and the Dental Pulp

• Pulpal Effects of Thermal and Mechanical Irritants

• Interrelationship of the Dental Pulp and Apical

Periodontitis

• Root Resorption

• Differential Diagnosis of Odontalgia

• The Dental Pulp in Systemic Disorders

2nd EDITION

April 2010

Release

Ingle’s Endodontics6

Ingle, Bakland, Baumgartner

• Chapters 5, 7, 8, 12, 13

• Current Edition - 2008

Pathways of the Pulp 9th ed.

Cohen/Hargreaves

Chapters: 3,12,13,15

• Non Odontogenic Toothache

• Structure and Function of the Dentin- Pulp

Complex

• Pathobiology of Primary Apical Periodontitis

• Endodontic Microbiology & Tx. of Infections

Chapters:16,17,18

• Endodontic and Periodontic Interrelationships

• Dental Traumatic Injuries

• Analgesics in Endodontics

Pathways of the Pulp 9th ed.

Cohen/Hargreaves

Dental Management of the Medically

Compromised Patient

Little, Falace, et al

Grey pages – Dental Management

Summary

• Entire Book is good

Medical Emergencies in the

Dental Office

• Malamed & Darby Home Study

Course*

*(resource disk)

Lecture

• Dental Management of the

Medically Compromised Patient

*(resource disk)

Donald Falace

Dental Management of the

Patient

Donald Falace, DMD

Professor and Division Chief

Oral Diagnosis and Oral Medicine

Objectives of the Course

• Help you identify patients with various types of medical problems who might be at risk for having problems as a result of dental treatment

• Help you to plan and deliver dental treatment in such a way as to avoid or minimize the chances of an adverse event or outcome occurring, thus protecting your patients from injury, disease or adversity.

• Help you to avoid litigation, anxiety, sleepless nights and heartache.

What do we do in the course of providing

dental treatment that can affect the

physical and emotional health and well

being of a patient?

• Instill fear

• Inflict pain

• Inject local anesthetic

solutions

• Inject potent

vasoconstrictors

• Cause bleeding

• Dictate body position

• Expose to radiation

• Expose to dental

materials

• Prescribe medicines

• Alter oral function

• Alter appearance

Risk Assessment?

Can we provide dental treatment to this patient without endangering their (or our) health and well being?

Yes. No problems are anticipated, and treatment

can be delivered in the usual manner.

Yes. The potential for problems exists, however,

modifications can be made in the delivery of treatment that reduces risk to an acceptable level.

No. Potential problems exist that are serious

enough to make it inadvisable to provide elective dental treatment.

Physical/Emotional

-stability

-control

-tolerance

-reserve

Dental Procedure

-invasiveness

-trauma

-blood loss

-duration

Risk Assessment

Most Common Medical

Emergencies in Dental Practice

• Syncope

• Mild Allergic Reaction

• Angina Pectoris

• Postural Hypotension

• Seizures

• Asthmatic Attack

• Hyperventilation

• Epinephrine Reaction

• Insulin Shock

• Cardiac Arrest

• Anaphylaxis

• Myocardial Infarction

Many of these events are preventable, or at least the chances

of them occurring can be lessened

Reference Sources: Basic

Medical Information

• Little,J, Falace,D, Miller,C, Rhodus,N: Dental Management of the Medically Compromised Patient, 6th ed, Mosby, 2002 (~$55)

• The Merck Manual (~$35)

• Harrison’s Principles of Internal Medicine (~$125)

• Cecil’s Textbook of Internal Medicine (~$139)

• Internet (PubMed, Medline, eJournals, Google scholar, MD Consult)

Reference Sources: Drug

Information• Drug Information Handbook

for Dentistry (Lexicomp) ~$45

• Physician’s Desk Reference

– PDR ~ $95

– OTC drugs

– Nutritional supplements

– Herbal medications

• Facts and Comparisons

• Drug Information for the Health Care Provider (USPDI)

• Internet

Internet Based Websites for Drug

Information

• Med center library website (Micromedix)

• Google scholar

• www.ada.org

• www.drugs.com

• www.factsandcomparisons.com

• www.fda.gov/cder/drug/default.htm

• www.lexi.com

• www.nlm.nih.gov

• www.rxlist.com

Clinical Examination

• General appearance

• Behavior

• Vital signs

• Head and neck

• Oral tissues

• Radiographs

Laboratory Tests

• Determine coagulation status (von Willebrand’s, hemophilia)

• Determine level of anticoagulation (coumadin)

• Screening for blood glucose (periodontal disease, burning mouth)

• Screen for infectious disease (hepatitis C, AIDS)

• Screening for liver function (hepatitis C, cirrhosis)

• Screening for kidney function (renal failure)

• Complete blood count with differential [CBC with diff] (burning mouth, unexplained oral lesions)

Medical Consultation

• Purpose:

– Verify or clarify information

– Determine risk for doing dental

treatment on the patient

– Determine if any changes are

required in the delivery of

dental treatment

• Be brief and to the point

• Letter, FAX, phone call

• Response should attached to or

recorded in the patient’s chart

Phone Consultation

• Often the physician will not be available to talk to you directly

• You may instead talk with a nurse or receptionist who will convey what the physician has said or who will tell you what is in the chart

• It is mandatory to document this conversation, to include to whom you spoke and what was said

• Direct, written confirmation of this consult is advisable for medico-legal reasons

• Suggestion: Write a brief summary of the conversation and FAX it to the physician; include a statement to the effect that if they disagree with the summary, they should FAX their correction to you within 24 hours; your FAX should be attached to the chart

ABC’s of

Problem

Identification

Antibiotics

Anesthesia

Anxiety

Allergy

Bleeding

Chair position

Devices

Equipment

Emergencies

• Are there any potential problems related to the provision of dental care?

– If not, proceed with treatment in the usual manner

– If yes, then…

Answer this question….

• Are there any potential problems related to the

provision of dental care? If yes, then…

• How do I need to modify treatment

to avoid those problems?

Examples of Treatment Modifications

• Pre-op:

– prophylactic antibiotics

– sedative

– food intake

• Intra-op:

– upright chair position

– minimize or avoid epinephrine

– nitrous oxide

– hemostasis measures

• Post-op:

– analgesics

– anti-fibrinolytic agent

– antibiotics

Answer this question….

• Are there any potential problems related to the provision of dental care?

– If not, proceed with treatment in the usual manner

– If yes, then…

• How do I need to modify treatment to avoid those problems?

• Are there any oral manifestations related to the disease or it’s treatment?

Manifestations

• Dry mouth

(xerostomia)

• Oral

ulcerations/lesions

• Burning

mouth/tongue

• Bleeding

• Gingival hyperplasia

• Fungal/bacterial

infections

Getting the information

into long term memory

Learning Aids

http://www.memorize-it.com/

Why Memorize·It?

Repetition plays a vital role in the retention of

information. The Dana Foundation study on

Better Teaching Through Brain Biology says

"Without this step of converting new learning

to long-term memory through repetition and

elaboration, students are unlikely to be able

to use it for a lifetime".

If you've ever used flashcards before and have

something you need to learn quickly, then

Memorize·It is for you.

The whole idea of learning is centered around

repetition.

The more you practice something, the better you

get and the more you know about it.

flashcardstation.com

Purchase, download and sell flashcards on

every subject imaginable.

You can have my decks…

1. ABE Glossary of Endodontic Terms

2. Medically Complicated Patients

3. Memory Words

4. Sample Questions and Answers

5. Trowbridge – Q and A

6. Drug interactions

7. SBE Prophylaxis Guidelines

8. Quan’s Endodontic Sequence

My Decks

Hardcopy and

Electronic formats

(Included on

Resource Disk)

Other information sources

Colleagues for Excellence

•Advances in Endodontic Surgery and Contemporary Endodontic Treatment

•Bisphosphonate-Associated Osteonecrosis of the Jaw

•Antibiotics and the Treatment of Endodontic Infections

•Endodontic Case Difficulty Assessment and Referral

• Disassembly of Endodontically Treated Teeth

•Coronal Leakage and Restoration of Endodontically Treated Teeth

•Taking the Pain out of Restorative Dentistry and Endodontics

•Treatment Planning: Comparing the Restored Endodontic Tooth and the

Dental Implant

•Endodontic Considerations in the Management of Traumatic Dental Injuries

•The Cracked Tooth

•Rotary Instrumentation: An Endodontic Perspective

•Obturation of Root Canal Systems

Colleagues for

Excellence Newsletter

Series

AAE Fact Sheets

The AAE has published nearly 20

official position statements and

treatment guidelines on various

clinical topics

www.aae.org

Free Clinical Resources

Glossary of Endodontic Terms

Glossary of Endodontic

Important!

Guide to Clinical Endodontics

Avulsed teeth and trauma

guidelines

SBE Regimens

3. Memory Words

8. Quan’s Endodontic sequence

My Decks

21 Years of Literature

(25 years, NOW!)

Literature

Review

Literature on the Written Exam

Exam questions cited both

Publication and Year,

Approximate number of Literature

Questions - 25

November 2005

Literature Review

Compilations

• San Antonio Guide

• VA QuickHit 2005*

• Literature index cards

• Quan’s ABE Study Guide

*Included on Resource Disk

Literature Review

Compilations

Literature Review

Compilations

Literature Review

Compilations

Index Card Literature Review

Literature Review

Compilations

2010 Review Syllabus

Outline – ABE Orals Study Guide

1. RADIOGRAPHIC EXAM

2. SUBJECTIVE AND OBJECTIVE EXAM

3. DIAGNOSIS

4. ETIOLOGY

5. PATHOGENESIS

6. APPLICATION OF BIOLOGIC PRINCIPLES

7. TREATMENT

8. COMPLICATIONS TO TREATMENT

9. MEDICAL COMPLICATIONS & MEDICAL EMERGENCIES

10. PROGNOSIS

11. WHAT I DO & WHY I DO IT

Effect of manual instrumentation on root canal bacteria

Mechanical instrumentation is the core method for bacterial reduction in the infected root

canal.

Byström & Sundqvist (43), Byström A, Sundqvist G., 9181 - Bacteriologic evaluation of

the efficacy of mechanical root canal instrumentation in endodontic therapy. measured

the reduction in bacterial counts cultured from infected canals by instrumentation with

hand stainless-steel instruments under irrigation with physiological saline solution.

Fifteen root canals with necrotic pulps and periapical lesions were instrumented at five

sequential appointments. The access cavity was sealed between the appointments with

a bacteria-tight temporary filling, but the canals were left empty with no antibacterial

dressing.

This procedure caused a substantial reduction in bacterial numbers, usually 100–1000-

fold, but achieving bacteria-free root canals proved difficult. After five

appointments, seven of the 15 root canals still contained cultivable bacteria (43).

Byström A, Sundqvist G., 9181 - Bacteriologic evaluation of the efficacy of mechanical

root canal instrumentation in endodontic therapy.

The relatively limited antibacterial efficiency of mechanical preparation was also reported

by Ørstavik et al. (44). Ørstavik 1991 - Effects of extensive apical reaming and calcium

hydroxide dressing on bacterial infection during treatment of apical periodontitis: a pilot

study. In fact, Cvek et al. (45) Cvek, 1976 - Antimicrobial effect of root canal debridement

in teeth with immature root. A clinical and microbiologic study. had already compared the

antibacterial effect of biochemical root canal cleansing in permanent non-vital maxillary

incisors with immature apices with those with mature roots.

Literature Review

Other resources

Literature Review

Other resources

University of Oregon

http://www.ohsu.edu/sod/endo/endo_literature.html

Current

thru 2008

OSHU Classic Literature•History of endodontics

•Tooth morphology

•Anatomy of the pulp and periapex

•Diagnostic procedures - pulp histology

•Radiographic Interpretation

•Endodontic Length Determination

•Vertical Root Fractures

•Pulpal Histopathology

•Pulpal Physiology

•Pulpal Response to Caries and Dental Procedures

•Mechanical Properties of Endodontic Instruments

•Endodontic Instrumentation Techniques

•Pulp Capping and Pulpotomies

•Endodontic Irrigation and Chelation

•Interappointment Medicaments and Temporary Fillings

•Endodontic Obturation; Methods and Materials

•Endodontic Sealers

•Prognosis of Nonsurgical Endodontic Treatment

•Endodontic Retreatment

•Restoration-Endodontically Treated Teeth

•Diagnosis of Non-Odontogenic Pain

•Focal Infection, Bacteremias, Anachoresis and the Hollow Tube Theory

•Pediatric Endodontics

•Use of Apical Barriers in Endodontics

•Apexification and Apexogenisis

•Endodontic Trauma; Pathogenesis and Treatment

•Use of Antibiotics in Endodontics

•Endodontic Surgery: Prognosis and Treatment Planning

•Endodontic Surgery: Technique

•Endodontic Surgery: Materials

•Prediction/Treatment of Endodontic Pain

•Procedural Misadventures

•Use of Analgesics in Endodontics

•Endodontic/Periodontal Interrelationships

•Local Anesthetics : I

•Local Anesthesia : II

•Endodontic Microbiology/Immunology

•Pulpal and Periapical Disease

•Tooth Lightening: Internal and External

•Internal and External Resorption

•Orthodontic/Endodontics (Extrusion)

•Intentional Replantations/Transplantation

•Endodontic and Intraosseous Implants

•Medically compromised patients

OHSU Classic Literature – Cont’d

Literature Review

Other resources

Navy - Bethesda

http://www.bethesda.med.navy.mil/Careers/Postgraduate_Dental_School/

http://www.bethesda.med.navy.mil/Careers/Postgraduate_Dental_School/Endodontics/L

iterature/index.aspx

Good questions for each topic

My thoughts……..Cont’d

Literature Review

Other resources

JOE Online Study Guide

JOE Online Study

GuideSuccess and Failure in Endodontics:

Root Canal Anatomy:

Root Canal Debridement:

Lasers in Endodontics:

Obturation of the Root Canal System:

Pulpal and Periradicular Diagnosis:

Endodontic Surgery:

Procedural Accidents

Endodontic-Periodontal Interrelationships:

Management of the Immature Apex Tooth:

Uses of Calcium Hydroxide:

Traumatic Injuries:

Vital Pulp Therapy:

Treatment of the Primary Tooth:

Bleaching in Endodontics:

Endodontic Radiology:

Single-Visit Endodontics:

Endodontic Retreatment:

Temporary Restorations:

JOE Online Study

GuideCoronal Microleakage:

Post Space Preparation:

Orthodontic Extrusion:

Glucocorticoids in Endodontics:

Microbiology in Endodontics:

Pain and Anxiety Control:

Immunologic Reactions and Endodontics:

Restoration of the Endodontically Treated Tooth

Sinus Tracts:

Relationship Between Systemic Diseases and Endodontics:

Medical Emergencies and Drugs:

Periradicular Lesions Not of Endodontic Origin:

Veterinary Endodontics:

Endodontics

The BIG picture

Volumes 1 thru 16

Highly recommended – great information

Endodontic Topics

The Philosophy behind

Endodontic Topics

Clinical dentistry based on the scientific

evidence

One topic per issue, the most qualified

scientists will present relevant and cutting edge

information on the chosen topic

5 year cycle of topics

Volumes 1 thru 16 included

on the resource disc

Endodontic Topics

Where I went from there…..

Test taking skills

30 years of catching up

www.pearsonvue.com

The test rules

• Four hours will be allotted to complete the

examination

• It is a computer-based Written Examination

• The Written Examination contains 200

questions

• Responses are recorded directly into the

computer.

• NOT PENCIL & PAPER!

The test rules

• Request two forms of identification (ID)

• Check IDs

• Capture electronic signature and verify that

signatures match

• Capture electronic fingerprint

• Capture digital photograph

• Distribute Candidate rules document

• Show Candidate where to store belongings

• Offer Candidate erasable note board and pen

• Admit

The test rules

• Personal items, such as cellular

phones, hand-held

computers/personal digital

assistants (PDAs) or other electronic

devices, pagers, watches, wallets,

purses, hats, bags, coats, books and

notes, are not allowed in the testing

The test rules

• The Pearson Professional Center test

administrator will provide you with

an erasable note board and a marker

before you enter the testing room.

You may not remove these items

from the testing room at any time

during the exam, and you must

return all items to the test

administrator after the exam.

The test rules

• You may not write on the erasable

note board until after the exam has

been started.

• If you need to clean your note board

during the exam, raise your hand and

the test administrator will assist you.

The test rules

• Earplugs are available

from the test administrator

on request.

The test rules

• The Pearson test administrator will

log you in to your assigned

workstation, verify that you are

taking the correct exam and start the

exam. Please remain in your

assigned seat. Eating, drinking,

smoking and making noise that

creates a disturbance for other

Candidates are prohibited during the

The test rules

• To ensure a high level of

security throughout your

testing experience, you will

be monitored at all times.

Both audio and video will be

recorded.

The test rules

• To request an unscheduled break,

raise your hand to get the test

administrator’s attention. The

administrator will set your testing

workstation to the break mode and

restart the exam for you when you

return. The exam clock will NOT stop

while you are away.

The test rules

• You must leave the testing room for

all breaks. When you leave the

testing room, you will be

fingerprinted, and you will be

fingerprinted again before you re-

enter the testing room

The test rules

• If you do not follow the above rules,

if you tamper with the computer or if

you are suspected of cheating,

appropriate action will be taken. This

may include invalidation of your

exam results.

The test rules

• You may not write on the erasable

note board until after the exam has

been started. If you need to clean

your note board during the exam,

raise your hand and the test

administrator will assist you.

Practicing for the test

Take the NMR practice test,

so you are comfortable with

test mechanics

Recommendation:

Practicing for the test

the Classic Way

Written Practice Tests

• Pathways of the Pulp, Challenge – A self assessment exam

• Inflammation, Self tests for each chapter

• Loma Linda and Einstein Courses -Review Questions*

• Medical Emergencies n the Dental Office, Malamed, Post-test Questions

Sit down and take them all together, 3 weeks before

actual exam, time yourself

After exam thoughts……

My thoughts…

• I don’t know if I passed, but I was not feeling overwhelmed by the exam

• Questions were fair

• If I failed: I’d study the same cards, notes and old exams

• Additional areas of study: Know “Paget’s and Von Wildebrand diseases”

• Oral Pathology Diseases: more familiarity with names, histology and radiographic descriptions

• How do x-rays work? KVP, grayscale, maximum annual dosages.

• End Renal disease? Know medical conditions and drugs used to treat.

• Pharmacology of Drugs. Drug interactions

• Emergency medical conditions: how to treat them

• Diagnosis: How do EPT, CO2 and Endo-ice work physiologically, which is the best and worst?

• CaOH literature: how much, how long, how does it work? Is it needed?

• MTA – pH, physical properties, when does it leak after setting?

• Good to know last Two years of JOE’s. 2004 literature was asked a lot!

• Nerve pathways.

• Mechanisms of Pain

• pKa , what makes anesthetic

“Faster” vs. “Longer Duration”?

• Lipid vs. protein binding?

• Articaine vs. Lidocaine?

• Know traumatic injuries, types and

treatment

• GG ISO size?

I passed!

Assembling your study materials

what you don’t have on disk!

•Textbooks

•Gray’s Anatomy Flash Cards

•Some AAE materials

•Dental Decks

Written part 1 section of DVD

The Case Portfolio

Know the Rules

Table of Contents

•Helpful Hints

•Pet Peeves

•Submission Deadlines

•Portfolio Preparation

•Required Cases for Submission

Narrative

Radiographs & Images

Radiographs

Digital Images

Laboratory and Biopsy Reports

Recall

•The Case History Report Form Instructions and Information

•Instructions for the Case History Report Form

To Create a Case History Report Form

Tool Bar

Tab Button

Select Buttons

Spell Check

Allowed Space

Changes

Addendum Page

Table of Contents-cont’d

•Back Up Copies

•Printing

•Case History Report Form Required Information

•The Case History Report Form

•The Case History Evaluation Form Instructions

• Category Evaluation

• The Case History Evaluation Form

• How Cases are Graded

• Case Grading Chart

• Case History Portfolio Submission ChecklistSubmission of the Portfolio

• Examination Scoring

• Candidate Notification

• Appeal Process for an Adverse Decision

• Certification Process Timeline

Table of Contents - Cont’d

Follow the directions!

1. No grammar and spell check!

2. Type up and edit as a WORD

document.

3. Quan’s WORD template is

recommended

4. Adhere to their CHECKLIST

Fifteen Cases

• One year Follow-up

• Types of cases

– Diagnosis (1)

– Emergency (1)

– Medically compromised (1)

– Nonsurgical RCT (5)

– Retreatment (2)

– Surgical RCT (2)

– Other (3)

Case History Peeves

•Acceptable: High technical skill required.

•Excellent: Required the highest level of

knowledge and technical skill.

•Unacceptable: The knowledge and technical

skills required were within the scope of the

general dentist.

•Deficient: Routine diagnostic and technical

difficulty requiring average skills.

Specialist Quality Cases

94% pass rate

FALL 2009

84% pass rate

Spring 2009

Case History Peeves

Case History Peeves Listed

Cases in the portfolio that don‘t meet the

criteria for the category; for example in the

medically compromised category, a case in

which no significant modification of

treatment was done.

• Be specific with clinical findings – do not

leave anything for the examiner to interpret.

Example: tooth #14 felt different‘. Different

to what stimulus? This may be something

the patient would say and so would be

appropriate only for the chief complaint.

• Make sure it is clear which tooth you are

referring to.

We cannot assume it is the tooth listed in

the case heading, particularly if other teeth

may be contributing to the problem.

• Be consistent with terminology. If you

use the term ‗palatal‘ for tooth #3, do not

use the term ‗lingual‘ for tooth #14.

In this example, palatal is a better term

and should be used throughout the

portfolio

• • If you do something that differs from your

normal treatment protocol, provide the

rationale.

Example: lidocaine was used singularly for

14 cases in your portfolio, and articaine was

used for 1 case. Why?

• Make sure radiographs reveal the entire

periapical lesion and the entire periapical

region of the involved tooth

AAE Endodontic Case

Difficulty Assessment Form

AAE Endodontic Case

LEVELS OF DIFFICULTY

MINIMAL DIFFICULTY Preoperative condition indicates

routine complexity (uncomplicated). These types of cases

would exhibit only those factors listed in the MINIMAL

DIFFICULTY category. Achieving a predictable treatment

outcome should be attainable by a competent practitioner

with limited experience.

AAE Endodontic Case

MODERATE DIFFICULTY Preoperative condition is

complicated, exhibiting one or more patient or treatment

factors listed

in the MODERATE DIFFICULTY category. Achieving a

predictable treatment outcome will be challenging for a

competent, experienced practitioner.

AAE Endodontic Case

HIGH DIFFICULTY Preoperative condition is exceptionally

complicated, exhibiting several factors listed in the

MODERATE DIFFICULTY category or at least one in the

HIGH DIFFICULTY category. Achieving a predictable

treatment outcome will be challenging for even the most

experienced practitioner with an extensive history of

favorable outcomes.

Case Selection Tips

• Show what you can do!

• Moderate to High Difficulty

Report

Template

Spell and

Grammar

Complete

The Complete Set

Quan’s Case Portfolio

1. The entire, 15 case, portfolio in

digital format

2. Includes the “Routine

Abbreviations and Procedure

Descriptions

3. “Word” template with spell and

grammar check

Quan’s Case Portfolio

/www.gradware.com

1-877-333-1676gradware.com

Case Portfolio Template

Oral Exam

Guidelines

Orals – The Rules

What does this mean?

Case Based Format

1. Interpretation of Radiographs

2. Request for Additional Information

3. Differential Diagnosis/Diagnosis

4. Etiology

5. Pathogenesis

Ten Topics- supported by the literature

2009 ABE

Case Based Format – CONT”D

6. Alternate Treatments, Treatment of

Choice

7. Biological Implications

8. Medical History

9. Complications/Management of

Complications

10. Prognosis

Ten Topics- supported by the literature

2009 ABE

Orals – The Rules

•An oral exam is different than a

written exam

• NOT multiple choice!

•You know THE correct answer or

you DON’T !

Orals – The Rules

• Three sessions, one after another

• They come to you

• 2 against 1

• 30 minute sessions

• Taped

• Paper and pencil provided

• 10 sections of 3 questions each

Orals – The Rules

•Questions are in a specific order

•You start by being given x-rays and

possibly photos

•They were not of high good quality

96% pass rate

FALL 2009

81% pass rate

SPRING 2009

Orals – Peeves

Use references when indicated or asked for.

References are to be used to justify your

comments.

Unlike the Written Exam, during the Orals

there are almost no instances where we ask

for a specific author.

Orals – Peeves

Failure to use any literature citations to

support an answer or using too many

references from the 60‘s and 70‘s when more

relevant and current literature is available.

Orals – Peeves

A Candidate should be able to quote the

classic literature from our specialty, at a

minimum, to support a position

Orals – Peeves

The Directors must complete all ten

sections of their scripted scenario in the

allotted time. Talking slower doesn‘t help

A Candidate that can‘t completely

answer a question should say so and

then move on.

Trying to control the pace

Orals – Peeves

Do not dwell on the question and then try

and answer the question later on. Let it go.

On the other hand, do not filibuster.

Be concise with your answers. Brevity is a

virtue.

Trying to control the pace

My Orals Strategy

Be able to support with

literature citations everything

that I do clinically

Study Aids

3. DIAGNOSIS

4. ETIOLOGY

5. PATHOGENESIS

7. TREATMENT

10. PROGNOSIS

3. DIAGNOSIS

4. ETIOLOGY

5. PATHOGENESIS

7. TREATMENT

10. PROGNOSIS

RADIOGRAPHIC EXAM

SUBJECTIVE AND OBJECTIVE EXAM

Subjective and Objective Exam

Fascial Space Infections

DIAGNOSIS

Differential Diagnosis of Odontalgia

ETIOLOGY

Pulpal Irritants

PATHOGENESIS

Pathogenesis of Apical Periodontitis & Causes of Endodontic Failures

Endodontic Pathogens

Eradication of endodontic infection by instrumentation and irrigation

solutions

3. DIAGNOSIS

4. ETIOLOGY

5. PATHOGENESIS

7. TREATMENT

10. PROGNOSIS

APPLICATION OF BIOLOGIC PRINCIPLES

ChemoMechanical Debridement – Irrigation

Ca(OH)2 - Interappointment

Ca(OH)2

Size of Apical Instrumentation

Dens Evaginitis

Pulp Protection – Current concepts

3. DIAGNOSIS

4. ETIOLOGY

5. PATHOGENESIS

7. TREATMENT

10. PROGNOSIS

TREATMENT

AAE Guide to Clinical Endodontics

AAE Trauma Guidelines

Vital Pulp Therapy

Tooth Morphology

Restoration of the Endodontically Treated Tooth

Management of Traumatic Injuries

Local Anesthetics Injections and Local Anesthetic Pharmacology

Magnification & Illumination

Root End Filling Materials

Flap Design

Root End Instrumentation

Obturation

Adhesive Dentistry and Endodontics (Coronal Leakage)

3. DIAGNOSIS

4. ETIOLOGY

5. PATHOGENESIS

7. TREATMENT

10. PROGNOSIS

COMPLICATIONS TO TREATMENT

Systemic Complications

MEDICAL COMPLICATIONS & MEDICAL

EMERGENCIES

PROGNOSIS

Outcome Studies

Retreatment: - Treatment Options for Negative

Outcomes with NSRCT, NS ReTX, and Surgical RetX.

3. DIAGNOSIS

4. ETIOLOGY

5. PATHOGENESIS

7. TREATMENT

10. PROGNOSIS

What do you do and

What do you do and why?

Creation of Memory Words

Memory Words

Detrails of the study

gfuide and how it is

formatted

Neumonics

3. Memory Words

8. Quan’s Endodontic Sequence

My Decks

Sample Question &

Answers

Sample Question &

Answers

My Practice Questions FIVE

ABE tolerated but NOT

approved

Practice #1

Practice #2

Practice #3

Practice #4

Practice #5

The QuestionsABE Self Assessment Case Scenario #1

You are looking at a Periapical of #29 and clinical photos of the area.

see PAGE # 1

Describe everything that you see?

Radiograph? Periapical area of #29? Adjacent teeth?

Clinical observations from photos?

21 year old, Asian female, in good health but who reports a prior

allergic reaction to aspirin with rash and dizziness, when she took some

three years ago. Tooth #29 is asymptomatic, non-vital to CO2. The rest

of the quadrant is vital to all tests and is normal on clinical exam.

What other radiographs, test results or clinical findings do you require

to make a diagnosis? See PAGES #2 and #3. Which show #20 also

has dens evaginatus.

#20 is non vital to CO2 and asymptomatic, the rest of lower left

quadrant is vital and normal clinically.

Which population group does Dens Evaginatus occur most frequently ?

What is the prevalence of Dens Evaginatus in this racial group?

Bilaterally?

The Answers

I have the all the

answers and

references!

lesquan@sbcglobal.net

Preparation Hints

• Create your own:

“How I do endo and Why I do it.”

• Create “Short” Oral Reports

• Use Memorize-it Decks

• Factor in Jet Lag affecting your

performance

Orals Folder Part 3

Post Orals

• Histopathology of periapical lesions

• What cell types are present in any

given clinical situation?

• Vertical cracks

• Most frequent causes?

• Microbiology in cracks

• External Resorption

Post Orals – Cont’d

• Heathersay 2004

• Intermediate cementum

• Incidence of oral cancers

• Inflammation and Immunology

Classes of Immunoglobulins

Types of Immune responses

• Classes of Hypertension

Normal

Pre-hypertension

Stage I

Stage 2

• Review immunology and inflammation basics

• Pulpal anatomy

• Tooth anatomy - layers

• Tooth development

• Each case had Medical Issues

Post orals – Cont’d

If there is a next time……

• Relearn prior flashcard lists - subject selection was good.

• Some subjects I just did not study at all.

• It is a question and answer by memory test. It was a fairly

relaxed conversation with my peers (5 of 6 examiners)

Memorize your support research so you can respond

flawlessly under stress.

• Try not to get flustered if you don’t know every answer, you

are not supposed to! They are trying to quickly determine

the depth and breadth of your knowledge, so they keep

asking questions until you run out of answers.

The Resource DiskPractice questions and answers (111 Pages)

Personal Memorize flash cards (Six Inch Stack)–Endodontic Glossary

–Immunology Questions

–SBE regimens & Antibiotics

–Space Abscesses

–Miscellaneous

PowerPoint Lectures (32) individual

Website List (43) individual

Medical Emergencies (9 pages) home study course

Reprints in PDF (9) Miscellaneous Important articles

Differential Dx. and Histology of Periradicular

Lesions (7 pages)

New Developments in Instrumentation (80 pages)

Index Card Literature Review (2 Inch tall stack)

QuickHitLit – Quan Literature Review

Navy Literature Review

San Antonio Guide

OHSU Literature review

Quan’s Orals Study Guide (filed in “ABE Part 3 Oral

Exam” folder)

Resource Disk – Cont’d

Assembling your study materials

1. Order 3”X 5” index cards – Avery

2. 5” X 7” Blank Index Cards

3. Print Hardcopy of “Resource Disk”

4. Acquire recommended texts

Les (Quando) Quan

―Appointed‖

Ambassador to China

The first and only

Ambassador of the

American Board of

Endodontics

Good Luck!

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