Day-of-test recap

Board takeaway

Allow about ten minutes. Read once, say the opening and closing aloud, then put it away. Print or save as PDF before you leave.

Start with the question. Pause, answer directly, give the reason, and stop when the question is answered. For a full case, work through findings → diagnosis → options → recommendation → follow-up.

My primary concern is [concern]. I would first establish [key finding]. Based on [findings], I recommend [plan] because [reason]. I would change the plan if [new finding].

1. The child before the tooth

Stable → risks → gaps → setting.

• Stable or emergency? Airway, breathing, circulation; spreading infection, significant bleeding, head injury, aspiration risk. Stabilize and escalate before routine dental treatment.
• What changes care? Medical control, medications/allergies, weight, airway/OSA, bleeding/infection risk, developmental abilities, cooperation, urgency, and family barriers.
• What is missing? Ask for the specific history, examination, image, laboratory result, or consultation that would change the decision, and say why you need it.
• What setting is safe? Office, sedation, or hospital/GA follows the child’s risk and treatment needs. A diagnosis or age alone does not choose the setting.

2. Caries and prevention

Risk → control → restore → reassess.

• Control the disease, not just the cavities: caregiver-assisted fluoride brushing, fewer sugar exposures, fluoridated water, professional prevention, and a dental home. Audit all fluoride sources before prescribing supplements.
• Active noncavitated lesion: remineralization, sealant or selected infiltration, and surveillance. An inactive lesion does not automatically need restoration.
• Cavitated lesion: assess the pulp and whether you can clean, arrest, or restore.
• 38% SDF: selected cavitated lesions without pulpal involvement; obtain consent for permanent dark staining. Recheck hardness/activity and reapply when indicated. Black alone does not prove arrest.
• ITR: interim disease control with a definite plan for reassessment and definitive care.
• SSC: consider for extensive primary-molar destruction, high failure risk, and after pulp therapy. Explain why full coverage fits.
• MIH: demarcated defects, sensitivity, breakdown, and difficult anesthesia. Protect and restore; coordinate any first-permanent-molar extraction with orthodontic and developmental assessment.
• Recall: individualize it; high-risk children often need prevention and review about every three months.

Full caries and prevention notes

3. Pulp therapy

Tooth → pulp → roots → restore → review.

Name the tooth and diagnosis first: primary or permanent? Vital or necrotic? Root maturity or resorption? Restorable?

• Preserving vitality lets the root keep developing.
• Purulence, necrosis, infection, or uncontrollable bleeding changes the plan. Five minutes of bleeding alone does not establish a primary-pulp diagnosis.
• Sensibility tests are unreliable in primary and immature teeth; one test does not establish the diagnosis.

Full pulp notes

4. Trauma

Child → tooth → injury → apex → time.

• Child first: check for head, soft-tissue, and bone injury; account for missing teeth and fragments. Record mechanism, timing, dry time, storage, occlusion, mobility, baseline findings, and appropriate images.

Primary teeth

• Avulsed primary tooth: never replant.
• Intruded primary tooth: generally allow spontaneous re-eruption regardless of direction; monitor the successor. Discoloration alone does not establish infection or mandate endodontics.

Permanent teeth

• Avulsed permanent tooth: replant promptly when appropriate; otherwise keep it moist in a suitable medium and get urgent care.
  • Handle the crown, not the root.
  • Include splinting, antibiotic/tetanus assessment, instructions, and long-term follow-up.
• After replantation:
  • Closed apex → start endodontics within two weeks.
  • Open apex → watch for revascularization; intervene with clinical/radiographic evidence of pulp necrosis and root-canal infection.
• Open-apex avulsion recall: clinical/radiographic reviews at 2 weeks, 1, 2, 3, and 6 months, 1 year, then annually for at least 5 years; infection-related resorption can progress rapidly.
• Mature lateral luxation: reposition, splint four weeks, and arrange endodontic evaluation at about two weeks; IADT recommends root canal treatment with anti-resorptive intracanal medication for complete roots.
  • This injury-specific plan is distinct from diagnosing necrosis on one negative test.
• Permanent traumatic pulp exposure: preserve suitable vital pulp; partial/full pulpotomy is favored over direct capping in the 2025 AAPD guideline.
  • Size, elapsed time, and bleeding observations inform assessment rather than acting as isolated exclusion rules.
• Splint times: avulsion/extrusion about two weeks; lateral luxation/root fracture about four weeks; cervical root fracture up to four months. Associated bone injury changes the plan.

Avulsed permanent tooth: dry time, then apex

Dry time is measured outside the mouth, separately from storage time. PDL cells are largely nonviable after about 30 minutes dry, so 60 minutes is a prognostic grouping boundary, not a safe waiting period or a replantation deadline. Splint 2 weeks (4 weeks with an alveolar or jaw fracture), and give antibiotic and tetanus advice.

Open-apex recall: 2 weeks, 1, 2, 3, and 6 months, then 1 year, then annually for at least 5 years. Infection-related resorption can progress quickly.

Extraction and follow-up

• Primary root tip fractured during extraction: remove it if easily accessible; a small deep fragment near the successor may be safer to leave. Explain, document, and monitor.
• Follow-up: one negative sensibility test after trauma does not prove necrosis. Combined injuries follow the more intensive schedule. Say what you are monitoring, not just “review.”

Full trauma and surgery notes

5. Behavior, sedation, and rescue

Connect → relieve pain → choose support → prepare to rescue.

Cooperation and support

• Start with communication: pain control, tell-show-do, praise, distraction, and sensory adaptations. Ask what has worked before. Communication impairment does not establish intellectual disability.
• Deferring care: nonurgent disease may allow desensitization or interim care with a documented plan. Pain, infection, or trauma may need prompt care with another technique.
• Protective stabilization: specific indication, informed consent, least restriction, monitoring, and documentation. Never punishment or convenience.

Sedation and analgesia

• Sedation/GA: justify patient selection, airway assessment, setting, fasting, trained personnel, monitoring, rescue, and recovery.
  • Be able to rescue from a deeper level than intended.
  • Dental deep sedation needs two trained people throughout, an independent observer who does not do dentistry, capnography, an ECG, and a defibrillator.
• Local anesthesia: calculate the maximum dose before injecting, counting all agents and the actual cartridge volume. Aspirate, inject slowly, monitor, and give numb-tissue instructions.
• Pain: definitive treatment plus an NSAID when appropriate; acetaminophen if NSAIDs are unsuitable, or both when indicated. Check individual and combined maximums. No codeine or tramadol under 12; further adolescent restrictions apply.

Rescue and discharge

• Emergency: stop, call for help, support airway/ventilation/circulation, monitor, and activate EMS as indicated. Suspected anaphylaxis: prompt IM epinephrine, 0.01 mg/kg of 1 mg/mL (maximum 0.3 mg prepubertal, 0.5 mg teen or adult).
• Discharge: stable airway and cardiovascular status, return to baseline, and written caregiver instructions. Reversal agents or long-acting drugs may require longer observation.

Full behavior and sedation notes

6. Infection, pathology, and imaging

Describe → differentiate → investigate → act → review.

Infection and prophylaxis

• Localized pulpal infection, well child: source control; no routine antibiotic.
• Spreading facial infection or systemic illness: prompt source control plus indicated antibiotics. Dysphagia, dyspnea, or rapid progression → emergency escalation.
• IE prophylaxis: only when a highest-risk cardiac condition and a qualifying procedure are both present.
  • A syndrome, murmur, pacemaker, or prosthetic joint alone is not an indication.
  • Amoxicillin is first choice; clindamycin is no longer recommended.

Lesions and imaging

• Oral lesion: describe location, size, color, surface, consistency, duration, symptoms, and change; give a focused differential. Still present about two weeks after removing the suspected cause → biopsy/referral; suspicious → sooner.
• Imaging: justify it by history, examination, risk, and a question whose answer changes care.
  • Review existing images first.
  • Risk-based bitewing intervals are planning guides, not automatic orders.
  • CBCT requires an unresolved treatment-changing question, the smallest appropriate field, and interpretation of the entire volume.
• Early periodontitis, unusual bleeding, or premature tooth loss: consider systemic disease and coordinate assessment rather than simply scaling or extracting.

Full diagnosis and infection notes

7. Growth and space

Stage → space → shift → sequence.

• Before a space maintainer: which tooth, time since loss, existing space, successor, dental age/root development, occlusion, hygiene, cooperation, and medical suitability.
• Second primary molar lost before the first permanent molar erupts: distal shoe only in a suitable patient.
• After eruption: conventional space maintenance as indicated.
• Lower lingual arch: account for permanent-incisor eruption.
• Every appliance needs surveillance.
• Space already lost: analyze and consider regaining. Crowding does not justify extraction without a long-term orthodontic plan.
• Crossbite: distinguish dental, skeletal, and functional. A functional shift may favor early correction; a skeletal discrepancy needs broader planning or referral.
• Eruption problems: asymmetry, ectopic teeth, ankylosis, and supernumeraries need localization and a timed intervention plan.
• TMD: establish the pain source and begin with reversible care. Painless clicking alone is different from pain, dysfunction, or a bite change.

Full growth and space notes

8. Medical risk and access

Home by one. Adapt. Coordinate. Keep the handoff connected.

• A syndrome name prompts assessment; it does not replace it.
• Adapt communication, scheduling, sensory environment, and caregiver support to the individual.
• Teledentistry supports the dental home but does not replace it.

Full access and special-needs notes

9. Numbers to know

Dose questions: kg × mg/kg → mg → mL using the actual concentration. Separate mg/kg/dose from mg/kg/day, and check the adult maximum, allergies, interactions, and organ function.

10. Consent, safety, and closing

Discuss → check understanding → document → verify → learn.

Close every full care plan with:

I would explain the diagnosis, the options including deferral or no treatment, and their benefits, risks, and prognosis; obtain informed consent and appropriate assent; document the discussion; provide prevention and postoperative instructions; and arrange follow-up to assess [outcome], with earlier return for [warning signs].

• Consent is a conversation: verify the decision-maker and use a qualified interpreter when needed. Revisit consent if the plan or material risks change.
• Suspected abuse: document injury type, character, and location; arrange prompt hospital assessment for suspected abusive bite injuries; report reasonable suspicion under applicable law.
  • For dental neglect, assess caregiver understanding and access barriers; caries alone does not establish neglect. If the child’s safety is clearly threatened during the visit, consult the proper authorities before dismissing the child and adult.
• Safety checks: two patient identifiers, tooth/site verification, time-out, standard precautions, instrument processing, medication checks, and emergency readiness. Assess fire risk: ignition source, fuel, and oxidizer. With cautery and supplemental oxygen, ≤30% at 4 L/min is a suggested fire-risk limit, not a prescribed flow; higher oxygen may be needed when desaturation risk outweighs fire risk.
• Record corrections: never erase the original. On paper, one line with initials and date; in an EHR, a separate correcting entry.
• Near misses: report them, identify contributing causes, and fix the workflow in a fair learning culture.

Full practice and safety notes

11. In the room

• Format: two successive one-hour OCE sessions, two examiners per session. Follow your assigned ABPD candidate instructions; confirm ID and arrival details; put prohibited items away.

• If you are unsure, do not invent a fact. Say:

  I would verify that exact dose or criterion before proceeding. The immediate safe action is [action].

• If new findings change the case, change the plan and explain why.

• Neutral examiner expressions are not feedback. Reset after each question.

Further review: study themes, AAPD topic notes, medical conditions, and case library. This sheet leaves out full drug regimens, rare-syndrome lists, and administrative policy detail to keep the exam-day read focused.

Sources

• AAPD primary VPT 2024, scope and research implications
• AAPD pulp best practice 2026, primary pulpotomy/LSTR
• AAPD permanent vital-pulp guideline 2025
• IADT 2020 avulsion: AAPD overview, immediate care, and endodontics and follow-up.
• IADT 2020 permanent-tooth fractures and luxations
• AAP/AAPD sedation guidance
• AAPD patient safety