Dental MCQ
Protecting the pulp · Operative Dentistry · INBDE Patient Cases

Pulp Protection INBDE Patient Cases

By Dr. Isaac Sun, DDS

7 ADA INBDE-format patient cases on pulp protection. Each case is a shared patient box (chief complaint, history, medications, allergies, exam) followed by linked multiple-choice questions with full distractor explanations. Practice the way the real exam is structured.

7 patient cases35 linked questionsADA INBDE formatFull distractor explanations

Seven ADA INBDE-format patient cases on pulp protection: a deep lesion in a reversibly inflamed tooth managed with an indirect pulp cap and a sealed liner, a small pinpoint exposure of a healthy vital pulp capped directly with MTA after hemostasis, insulating a deep amalgam with a glass ionomer base over thin dentin, the error of leaving zinc oxide eugenol under a composite because eugenol inhibits resin polymerization, recognizing irreversible pulpitis as past the operative boundary and referring for root canal therapy, distinguishing caries-infected from caries-affected dentin in selective stepwise excavation, and choosing between calcium hydroxide and MTA for a direct pulp cap. Topics include liners and bases, direct and indirect pulp capping, calcium hydroxide and MTA, and biocompatibility in deep preparations.

Case Coverage Map
What each case is testing
A deep cavity that's almost into the nerve:
Reversible pulpitis, the indirect pulp cap, caries-affected versus infected dentin, a therapeutic liner, and the bacteria-tight seal.
A pinpoint exposure during caries removal:
Direct pulp cap indications, MTA as the material of choice, hemostasis before capping, moisture-setting, and the sealing restoration.
Insulating a deep amalgam:
When a base is needed, thermal conductivity of metal, glass ionomer as a base, the liner-versus-base distinction, and the goal of protecting vitality.
A sedative filling that won't let the bonding set:
Eugenol inhibiting resin polymerization, removing ZOE before bonding, RMGI as a resin-compatible liner, ZOE's sedative role, and restorative care of a vital tooth.
Throbbing that keeps her up at night:
Irreversible pulpitis, why capping is contraindicated, referral for root canal therapy, the vital-pulp boundary of operative dentistry, and avoiding a doomed cap.
How much decay to take out:
Caries-infected versus caries-affected dentin, selective/stepwise excavation, the risk of unnecessary exposure, and sealing affected dentin to remineralize.
Picking the pulp-cap material:
Calcium hydroxide versus MTA, the shared reparative-dentin effect, MTA's superior durable seal, calcium hydroxide's tunnel defects and dissolution, and the decisive role of the seal.
Patient case: A deep cavity that's almost into the nerve
0 of 5 answered, 0 correct
Patient
Female, 26 years old
Chief Complaint
"This back tooth is sensitive to cold and sweets, but it stops fast."
Background and/or Patient History
  • Large carious lesion on a lower molar, radiographically very close to the pulp
  • Brief, sharp sensitivity to cold and sweet that resolves quickly; no spontaneous or night pain
  • No swelling, no percussion pain
Allergies
NKDA
Medications
  • None
Current Findings
  • Deep lesion approaching but not exposing the pulp; tooth vital and responsive
  • Symptoms consistent with reversible pulpitis
  1. Question 1
    Moderate
    The symptom pattern (brief, stimulus-evoked sensitivity that resolves) is consistent with:
  2. Question 2
    Moderate
    To avoid exposing this vital pulp, the appropriate approach is:
  3. Question 3
    Hard
    The dentin deliberately left over the pulp should be the:
  4. Question 4
    Moderate
    A protective material placed on the deepest dentin to encourage reparative dentin would be:
  5. Question 5
    Moderate
    What most determines whether the pulp stays healthy after this restoration?

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Patient case: A pinpoint exposure during caries removal
0 of 5 answered, 0 correct
Patient
Male, 19 years old
Chief Complaint
Routine restoration; small exposure encountered during excavation.
Background and/or Patient History
  • During removal of deep caries, a tiny pinpoint pulp exposure occurred
  • Tooth was asymptomatic before treatment; no history of spontaneous pain
  • Bleeding at the exposure was small and easily controlled
Allergies
NKDA
Medications
  • None
Current Findings
  • Small mechanical/carious pulp exposure in a vital, previously asymptomatic tooth
  • Hemostasis achieved promptly with a sodium hypochlorite pellet
  1. Question 1
    Moderate
    Given a small exposure of a healthy, vital pulp with controlled bleeding, the appropriate procedure is:
  2. Question 2
    Moderate
    The preferred material for this direct pulp cap is:
  3. Question 3
    Moderate
    Controlling bleeding before capping matters because persistent bleeding would indicate:
  4. Question 4
    Moderate
    MTA is well suited to a pulp exposure in part because it:
  5. Question 5
    Moderate
    After capping, what should be placed to give the best long-term pulpal prognosis?

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Patient case: Insulating a deep amalgam
0 of 5 answered, 0 correct
Patient
Male, 58 years old
Chief Complaint
Replacement of a failed deep filling on a molar.
Background and/or Patient History
  • Deep preparation on a molar to receive an amalgam restoration
  • Remaining dentin over the pulp is thin
  • Patient reports the old tooth was sensitive to hot and cold drinks
Allergies
NKDA
Medications
  • Atorvastatin
Current Findings
  • Deep preparation with thin remaining dentin; pulp not exposed
  • Planned restoration is amalgam (a metallic, thermally conductive material)
  1. Question 1
    Moderate
    A base is indicated under this deep amalgam mainly to provide:
  2. Question 2
    Moderate
    A suitable base material here that also bonds to tooth and releases fluoride is:
  3. Question 3
    Moderate
    Why is thermal insulation more of a concern under amalgam than under composite?
  4. Question 4
    Easy
    If a thin therapeutic layer were also wanted on the deepest dentin for its biologic effect, it would be a:
  5. Question 5
    Easy
    The combined liner-and-base approach in a deep preparation is ultimately aimed at:

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Patient case: A sedative filling that won't let the bonding set
0 of 5 answered, 0 correct
Patient
Female, 44 years old
Chief Complaint
Definitive composite after a temporary sedative filling.
Background and/or Patient History
  • A temporary zinc oxide eugenol (ZOE) sedative restoration was placed two weeks ago to calm a sensitive tooth
  • The tooth is now comfortable, and a definitive composite is planned
  • The dentist is deciding how to handle the ZOE before bonding
Allergies
NKDA
Medications
  • None
Current Findings
  • Symptoms resolved; tooth vital and asymptomatic
  • Existing ZOE base in the preparation
  1. Question 1
    Moderate
    Leaving ZOE in contact with the bonding surface is a problem because eugenol:
  2. Question 2
    Moderate
    The appropriate step before bonding the composite is to:
  3. Question 3
    Moderate
    A resin-compatible liner/base to use under the composite instead of ZOE is:
  4. Question 4
    Moderate
    ZOE was a reasonable choice for the earlier temporary because it:
  5. Question 5
    Easy
    Now that the tooth is asymptomatic and vital, the overall plan is best described as:

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Patient case: Throbbing that keeps her up at night
0 of 5 answered, 0 correct
Patient
Female, 37 years old
Chief Complaint
"It throbs on its own and wakes me up; hot drinks make it worse."
Background and/or Patient History
  • Deep caries on a molar with spontaneous, lingering, throbbing pain
  • Pain lingers well after a hot or cold stimulus is removed and wakes her at night
  • Considering whether a pulp cap could save the appointment
Allergies
NKDA
Medications
  • Ibuprofen as needed
Current Findings
  • Lingering pain to thermal stimulus and spontaneous night pain
  • Findings consistent with irreversible pulpitis
  1. Question 1
    Moderate
    Spontaneous, lingering, throbbing pain that wakes the patient indicates:
  2. Question 2
    Moderate
    For irreversible pulpitis, a direct or indirect pulp cap is:
  3. Question 3
    Moderate
    The appropriate definitive care for this tooth is:
  4. Question 4
    Easy
    Pulp protection (liners, bases, capping) in operative dentistry applies only to:
  5. Question 5
    Moderate
    Recognizing this case as past the operative boundary is important because it prevents:

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Patient case: How much decay to take out
0 of 5 answered, 0 correct
Patient
Male, 31 years old
Chief Complaint
Asymptomatic deep lesion found on a checkup radiograph.
Background and/or Patient History
  • Deep proximal lesion on a premolar; tooth vital and asymptomatic
  • On excavation, the dentist finds a soft outer layer and a firmer deeper layer near the pulp
  • No spontaneous pain at any point
Allergies
NKDA
Medications
  • None
Current Findings
  • Soft, wet, discolored outer dentin overlying firmer, deeper dentin close to the pulp
  • Vital, asymptomatic tooth
  1. Question 1
    Moderate
    The soft, outer dentin laden with bacteria is termed:
  2. Question 2
    Hard
    The firmer, deeper dentin near the pulp is:
  3. Question 3
    Moderate
    Removing only the infected layer while preserving affected dentin over the pulp is the principle behind:
  4. Question 4
    Moderate
    The risk of aggressively removing all the deep affected dentin here is:
  5. Question 5
    Moderate
    For the affected dentin left in place to remineralize and the pulp to stay healthy, the essential requirement is:

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Patient case: Picking the pulp-cap material
0 of 5 answered, 0 correct
Patient
Female, 23 years old
Chief Complaint
Small pulp exposure managed; material selection in question.
Background and/or Patient History
  • A small exposure of a healthy vital pulp is to be capped
  • The dentist is weighing calcium hydroxide against MTA
  • Long-term durability of the seal is a priority
Allergies
NKDA
Medications
  • None
Current Findings
  • Small exposure, vital healthy pulp, bleeding controlled
  • Candidate for either capping material
  1. Question 1
    Moderate
    Both calcium hydroxide and MTA can be used because they share the ability to:
  2. Question 2
    Moderate
    Given the priority on a durable seal, MTA is generally preferred because it:
  3. Question 3
    Hard
    A specific long-term shortcoming of calcium hydroxide is that it can:
  4. Question 4
    Moderate
    Calcium hydroxide remains a reasonable choice in part because it is:
  5. Question 5
    Moderate
    Whichever material is chosen, the prognosis still depends most on:

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Keep studying
Pulp Protection core recall

Refresh the anatomy facts these cases depend on: nerve numbers, foramina, functions, and lesion findings.

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