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61 cases total
Caries & restorative care
17% of the exam · 0 of 5 rated
- Multiple Lesions in a Precooperative 2-Year-Old15 minA 26-month-old is referred by the pediatrician for 'brown spots' on the front teeth. The child falls asleep with a bottle of juice and has never seen a dentist. The family lives two hours away and has no transportation of its own. The child is healthy and not in pain.beginner
- Early Childhood Caries in a 3-Year-Old20 minA 3-year-old presents with extensive cavitated lesions on maxillary incisors and primary molars. The parent reports night-time bottle use, frequent carbohydrate snacks, and pain during meals. Medical history is noncontributory.intermediate
- Molar Incisor Hypomineralization (MIH)20 minA 7-year-old presents with cold sensitivity and food avoidance. Exam shows demarcated yellow-brown opacities and early posteruptive enamel breakdown on first permanent molars, with mild incisor opacities.intermediate
- Proximal Lesions on Bitewings in a 13-Year-Old20 minA 13-year-old returns for a recall after two years without care. The patient drinks two energy drinks a day and is about to start fixed orthodontic treatment. Bitewings show several proximal lesions.intermediate
- Restoring Carious Primary Incisors in a 4-Year-Old20 minA 4-year-old is scheduled for comprehensive care under general anesthesia for early childhood caries. The parent asks that the front teeth 'look natural' because the child is teased at preschool.intermediate
Trauma, emergencies & surgery
16% of the exam · 0 of 12 rated
- Complicated Crown Fracture of an Immature Incisor20 minA 9-year-old is seen 3 hours after being struck by a baseball. #8 is fractured with a pinpoint red spot in the dentin. The fragment was not found. The child is healthy.intermediate
- Delayed Eruption of a Central Incisor15 minA 7.5-year-old's #8 has not erupted, although #9 erupted a year ago. The parent is worried about the gap. The child is healthy.intermediate
- Injuries Inconsistent with the History15 minA 3-year-old is brought by the mother's boyfriend for a 'fall on the playground' 3 days ago. He gives different details when asked twice. The child is quiet and watchful.intermediate
- Intruded Primary Incisor in a 2-Year-Old15 minA 2-year-old fell against a coffee table an hour ago. The parent says #E 'went up into the gum.' The child cried immediately, did not lose consciousness, and has not vomited. Immunizations are up to date.intermediate
- Wheezing During a Restorative Visit15 minA 7-year-old with moderate persistent asthma is having two restorations placed under nitrous oxide and local anesthesia. Ten minutes in, the child becomes anxious, coughs, and wheezes audibly. The child's inhaler was left in the car.intermediate
- Avulsed Permanent Incisor in an 8-Year-Old25 minAn 8-year-old presents 30 minutes after bicycle trauma with avulsion of tooth #8. The parent stored the tooth in tap water initially before transferring it to milk. The child is alert with minor lip laceration and no loss of consciousness.advanced
- Avulsed Permanent Incisor Stored in Water25 minA 10-year-old presents after a collision during a soccer game. Tooth #8 was completely knocked out approximately 60 minutes ago. The caregiver placed it in tap water shortly after the injury; the initial dry time is uncertain. The patient has hypothyroidism and juvenile idiopathic arthritis. The caregiver does not have the medication list available.advanced
- Facial Cellulitis from Odontogenic Infection22 minA 5-year-old presents with progressive right mandibular swelling, fever, and reduced oral intake over 24 hours. Parent reports prior toothache in tooth S and worsening overnight facial swelling.advanced
- Infected Primary Molar and Accidental Successor Removal20 minA healthy 6-year-old is scheduled to have #K extracted under local anesthesia. It is nonrestorable, with a furcation abscess. The child is calm, and the parent is in the waiting room.advanced
- Lateral Luxation of a Permanent Incisor20 minAn 11-year-old fell from a skateboard 90 minutes ago. #9 is displaced palatally and the child cannot close the front teeth together. There was no loss of consciousness.advanced
- Soccer Trauma with Avulsion and a Through-and-Through Lip Wound25 minA healthy 10-year-old presents 50 minutes after a collision during a soccer game. Tooth #8 was avulsed. The caregiver recovered the intact tooth, left it dry for approximately five minutes, then placed it in milk. The upper lip is bleeding, and the caregiver reports that the wound “goes all the way from the mouth to the skin.”advanced
- The Premolar Came Out with the Primary Molar20 minA healthy 6-year-old is scheduled to have #T extracted under local anesthesia. It is nonrestorable, with a furcation abscess. The child is calm, and the parent is in the waiting room.advanced
Behavior & pain guidance
14% of the exam · 0 of 5 rated
- Local Anesthetic Dosing for a Small Child10 minA 5-year-old weighing 18 kg needs SSCs on #A, #B, #I, and #J and a pulpotomy on #J in one visit. Your assistant has set out 2% lidocaine with 1:100,000 epinephrine. The child is healthy.beginner
- Nitrous Oxide for an Anxious 7-Year-Old15 minA 7-year-old needs two restorations and an SSC. At the last visit the child cried during the injection and refused further care. The child is healthy, but had a cold last week and still has a stuffy nose.beginner
- Pain Management After Extractions in an Adolescent15 minA 15-year-old will have four premolars extracted for orthodontic reasons. The patient's parent asks for 'something strong, like the hydrocodone my older son got.' The adolescent has asthma that is well controlled and is otherwise healthy.beginner
- Parent Requests General Anesthesia for a 3-Year-Old20 minA 3-year-old screams and pushes away at the exam. Radiographs could not be taken. The parent says, 'Just put him to sleep and fix everything.' The child is healthy (ASA I) and snores at night.intermediate
- Desaturation During Moderate Sedation20 minA 4-year-old (16 kg) receives oral midazolam for restorative treatment under moderate sedation. Twenty minutes after the dose, during treatment, the pulse oximeter alarms at 89% and the capnograph waveform flattens.advanced
Diagnosis, pathology & imaging
10% of the exam · 0 of 7 rated
- Fever and Painful Mouth Ulcers in a Toddler15 minA 20-month-old has had fever (39 °C), irritability, and refusal to eat or drink for 2 days. The parent noticed 'blisters' in the mouth this morning. The child attends daycare and is otherwise healthy.beginner
- Jaw Pain and Clicking in a 15-Year-Old15 minA 15-year-old competitive gymnast has had right jaw pain for 3 months, worse in the morning and during exam weeks. The jaw 'clicks' on opening. The patient takes no medications.intermediate
- Persistent Painless Lower-Lip Swelling16 minA 10-year-old presents with a recurrent, painless bluish swelling on the lower labial mucosa for two months. Parent reports intermittent enlargement and spontaneous reduction after accidental lip biting.intermediate
- Bone Loss Around First Molars in an Adolescent20 minA 14-year-old is referred by an orthodontist who noticed bone loss on the pretreatment panoramic radiograph. The patient reports no symptoms. An older sibling 'lost teeth young.' The patient is healthy and takes no medications.advanced
- Early Loss of Primary Teeth in a 3-Year-Old20 minA 3-year-old has lost two lower primary incisors in the past six months without trauma. The parent brought one of the teeth: the root is fully intact. The child has had frequent ear infections.advanced
- Premature Primary Incisor Loss with Intact Roots20 minA 3-year-old presents after mandibular primary incisors #O and #P exfoliated spontaneously. The caregiver brings the teeth; both have nearly complete, unresorbed roots. There is no reported trauma.advanced
- Radiolucency Around an Unerupted Premolar20 minAn 11-year-old has a routine panoramic radiograph for orthodontic assessment. The patient has no pain or swelling. #K was restored with a pulpotomy and SSC at age 6.advanced
Prevention & health promotion
10% of the exam · 0 of 4 rated
- First Dental Visit at 12 Months15 minA 12-month-old comes for a first visit. The child breastfeeds on demand through the night, has a bottle of formula at daycare, and the family drinks bottled water. Two older siblings had dental treatment under general anesthesia.beginner
- Fluoride Supplements for a Family on Well Water10 minThe parent of a 4-year-old asks whether the child needs fluoride drops. The family lives rurally and drinks well water. The child had two small lesions restored last year and drinks juice twice a day.beginner
- White-Spot Lesions During Orthodontic Treatment15 minA 13-year-old is 8 months into fixed orthodontic treatment. The orthodontist asks you to see the patient for 'white marks around the brackets.' The patient brushes once a day and snacks after school.beginner
- Smooth, Shiny Wear on the Palatal Surfaces20 minA 16-year-old track athlete comes for a recall. The upper front teeth 'look see-through' and are sensitive to cold. The patient drinks sports drinks during training and has lost weight this year. The parent waits outside.intermediate
Growth & developing dentition
8% of the exam · 0 of 8 rated
- Anterior Crossbite in Mixed Dentition18 minA 9-year-old presents with a single-tooth anterior crossbite involving #9. Parent is concerned about esthetics and potential trauma to lower incisors.intermediate
- Anterior Crossbite with a Forward Mandibular Shift18 minAn 8-year-old in mixed dentition presents because “the upper front teeth bite behind the lower teeth.” The caregiver asks whether treatment can wait until all permanent teeth erupt.intermediate
- Early Loss of a Primary Second Molar: Space Maintenance18 minA 6-year-old had extraction of tooth T two weeks ago due to non-restorable caries. The parent asks if treatment is needed now because the area is asymptomatic.intermediate
- Ectopic Eruption of a Permanent First Molar15 minA 6.5-year-old's routine bitewings show the upper right first molar 'stuck' under the primary second molar. The child has no pain. The left first molar has erupted fully.intermediate
- Missing Canine Bulge in an 11-Year-Old15 minAn 11-year-old's primary canines are still firm. On palpation, there is no labial bulge over the right permanent canine. The lateral incisors are small and peg-shaped.intermediate
- Thumb Sucking with Open Bite and Crossbite15 minAn 8-year-old still sucks a thumb at night and while watching TV. The parent has tried bitter nail polish without success. The child says, 'I want to stop but I forget.'intermediate
- Ectopic First Molar beside a Stainless Steel Crown20 minA 7-year-old presents for a routine examination. Tooth #A, the maxillary right second primary molar, has a stainless steel crown placed for extensive caries. The child has no pain.advanced
- Submerged Primary Molar with No Successor20 minA 10-year-old's lower left primary second molar 'looks like it is sinking.' The child's older sister was missing two premolars. The child is healthy.advanced
Pulpal diagnosis & therapy
8% of the exam · 0 of 6 rated
- Abscessed Primary Second Molar in a 5-Year-Old15 minA 5-year-old has a 'pimple' on the gum by a lower back tooth. There was a toothache two months ago that went away. The child is healthy and afebrile. The parent wants to keep the tooth if possible.intermediate
- Deep Caries in a Primary Molar with Brief Provoked Pain18 minA 5-year-old has deep occlusoproximal caries in tooth #T, the mandibular right second primary molar. The caregiver reports brief pain when food enters the cavity or with cold drinks. Pain resolves quickly, with no spontaneous pain or nighttime waking.intermediate
- Deep Caries in a Primary Molar: Vital Pulp Therapy20 minA 6-year-old has deep dentinal caries on tooth L with provoked pain to cold/sweets that resolves quickly. No spontaneous/night pain, swelling, or sinus tract. Tooth is restorable.intermediate
- Lingering Pain in a Young Permanent Molar15 minA 10-year-old has had pain in the lower right back tooth for a week. Cold drinks cause pain that lingers for a minute, and the pain woke the child last night. The child is healthy.intermediate
- Necrotic Immature Incisor After Old Trauma20 minAn 8-year-old presents with swelling above an upper front tooth. The child fell 9 months ago and was not seen by a dentist. #9 has darkened.advanced
- Primary Incisor with Spontaneous Pain and Uncertain Restorability20 minA 4-year-old presents with extensive caries in tooth #E, the maxillary right primary central incisor. The caregiver reports spontaneous pain and nighttime waking and would prefer to retain the tooth if treatment has a reasonable prognosis.advanced
Special health care needs
8% of the exam · 0 of 7 rated
- Adolescent with Cerebral Palsy and Seizures20 minA 17-year-old with spastic quadriplegic cerebral palsy and epilepsy comes with a parent. The patient uses a wheelchair, communicates with an eye-gaze device, and has a gastrostomy tube. The parent asks who will see the patient after age 18.intermediate
- Gingival Inflammation and Mobility in Down Syndrome15 minA 12-year-old with Down syndrome has loose lower front teeth and bleeding gums. The child had a ventricular septal defect repaired in infancy without residual defects, and has hypothyroidism. The parent brushes for the child once a day.intermediate
- Antibiotic Prophylaxis for a Child with Heart Disease15 minA 6-year-old had tetralogy of Fallot repaired at age 1 with a transannular patch. Three months ago the child had a transcatheter pulmonary valve (Melody valve) placed. The child needs a pulpectomy and an SSC. The parent reports a hive-like rash after amoxicillin last year.advanced
- Autism Spectrum Disorder with Urgent Restorative Needs30 minA 6-year-old with autism spectrum disorder presents after two unsuccessful prior dental visits. Parent reports sensory triggers (sound/touch), transition difficulty, and escalating avoidance behaviors. Multiple untreated carious lesions are visible.advanced
- Autism with Dental Pain and Limited Examination Tolerance25 minA 6-year-old with autism has multiple visible carious lesions and intermittent dental pain. The patient communicates using short phrases and a visual communication board. Bright lights and unfamiliar sounds cause distress. The caregiver reports that preparation and familiar routines help with some medical visits. The medication list, airway history, and prior sedation experience have not yet been reviewed.advanced
- Dental Evaluation Before Leukemia Treatment20 minA 7-year-old was just diagnosed with acute lymphoblastic leukemia. The oncology team asks for a dental evaluation; chemotherapy starts in 10 days. Today's counts: ANC 800/mm³, platelets 45,000/mm³.advanced
- Extractions for a Child with Hemophilia A20 minA 9-year-old with severe hemophilia A needs two primary molars extracted and several restorations. The child receives prophylactic factor VIII infusions at home three times a week and has had no inhibitors.advanced
Practice, ethics & safety
5% of the exam · 0 of 4 rated
- A Grandparent Brings a Child for Treatment10 minA grandmother brings her 6-year-old grandson for treatment of two lesions. She says the parents are divorced, the mother 'never answers the phone,' and she takes care of him most days. The child has a toothache in one tooth.beginner
- A Parent Texts a Photo of a Broken Tooth at Night10 minAt 10 PM, a parent of a patient texts your personal cell phone a photo of their 10-year-old's broken front tooth after a fall, asking whether to go to the emergency room. Your office uses a HIPAA-compliant teledentistry platform.beginner
- A Parent Brings a Study on Fluoride and IQ15 minA parent refuses fluoride varnish for their high-risk 3-year-old, showing a news story about a study linking fluoride to lower IQ. The parent asks, 'Why would you put something toxic on my child's teeth?'intermediate
- The Wrong Tooth Was Extracted15 minDuring a busy afternoon, an associate extracted #T instead of #K in a 5-year-old under local anesthesia. The error is noticed when the assistant checks the radiograph. The parent is in the waiting room.intermediate
Advocacy & family education
4% of the exam · 0 of 3 rated
- Establishing a Dental Home Through an Interpreter10 minA pediatrician refers a 2-year-old who has never seen a dentist. The family arrived in the country a year ago and speaks limited English. An older cousin offers to translate.beginner
- Repeated Missed Appointments and Untreated Disease15 minA 5-year-old with severe early childhood caries has missed four appointments in six months, including a scheduled general anesthesia date. Today the child presents with facial swelling. The single mother works two jobs and relies on buses.intermediate
- Your City Council Votes on Water Fluoridation10 minYour city council will vote next month on whether to stop community water fluoridation. A council member who is a parent of one of your patients asks for your professional opinion and invites you to testify.intermediate