I will Help Wreb Questions

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Prosthoman

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Please post any questions you have I will try to help you as much as I can in my best ability.

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I believe that if you have prosthetic joints and you have an immunodeficiency such as SLE or Rhematoid, you should premed. Correct me if I'm wrong.
 
hi everybody,
please can someone help me a question, i'll be taking the wreb next year but i want to get ready.

1) i have a pt with ideal #2-M caries. but, #31 is gone, and #32 barely occludes with the distal of #2. will this qualify? i read in my friend's candidate manual that you just need "some" contact with the opposing dentition.

thanks so much everybody!
g

That is correct, you must simply have some occlusal contact. I would tell you from a practical standpoint, however, that #2 is NOT an ideal tooth, even if the caries are ideal. By all means keep that patient if you need them but try to find a premolar or a 1st molar to work on. The more anterior the better in my opinion (and I've taken the exam twice!).
 
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I believe that if you have prosthetic joints and you have an immunodeficiency such as SLE or Rhematoid, you should premed. Correct me if I'm wrong.

Prosthetic joints are not indicated for premed in the newest AHA guidelines. In real practice you may want to premed simply to prevent adverse outcomes, but for the purpose of taking an exam the answer would be no.

Premed should be given for:

- Prior IE
- artifical heart valves
- certain congenital heart conditions (memorize the specific ones including prosthetic heart valves)
- a cardiac transplant that develops heart valve problems

That's it. Nothing about joints or immunodeficiency. You might be confusing RA with rheumatic fever?

The guidelines for testing purposes are very straight-forward and simple: http://www.americanheart.org/presenter.jhtml?identifier=3047051
 
Prosthetic joints are not indicated for premed in the newest AHA guidelines. In real practice you may want to premed simply to prevent adverse outcomes, but for the purpose of taking an exam the answer would be no.

Premed should be given for:

- Prior IE
- artifical heart valves
- certain congenital heart conditions (memorize the specific ones including prosthetic heart valves)
- a cardiac transplant that develops heart valve problems

That's it. Nothing about joints or immunodeficiency. You might be confusing RA with rheumatic fever?

The guidelines for testing purposes are very straight-forward and simple: http://www.americanheart.org/presenter.jhtml?identifier=3047051
You are right about the new AHA guideline, but the previous poster is also correct. Regarding prosthetic joints, the guideline is not set by AHA but by ADA and the American Academy of Orthopedic Surgeons. In 2003, an advisory statement was made between the two. According to the statement, patients with prosthetic joints and fall into the following groups should be pre-medicated: inflammatory arthropathies (including rheumatoid arthritis), type 1 diabetes, first two years after joint replacement, previous PJI, malnourishment and hemophilia. Regardless, there is no evidence suggest that these patients are at increased risk for dentally induced bacteremia. Hope that clears the confusion.
 
You are right about the new AHA guideline, but the previous poster is also correct. Regarding prosthetic joints, the guideline is not set by AHA but by ADA and the American Academy of Orthopedic Surgeons. In 2003, an advisory statement was made between the two. According to the statement, patients with prosthetic joints and fall into the following groups should be pre-medicated: inflammatory arthropathies (including rheumatoid arthritis), type 1 diabetes, first two years after joint replacement, previous PJI, malnourishment and hemophilia. Regardless, there is no evidence suggest that these patients are at increased risk for dentally induced bacteremia. Hope that clears the confusion.


You are 100% correct: http://www.ada.org/prof/resources/topics/topics_antibiotic_joint.pdf
My fault!
 
i just got my wreb scores. i passed everything except for operative. i got a 2.99. I got a lot of points taken off on my amalgam restoration. I had to take off a lot of anatomy in order for the restoration to occlude properly. basically should i appeal? im really freaking out right now and i need some advice. thank you
 
i just got my wreb scores. i passed everything except for operative. i got a 2.99. I got a lot of points taken off on my amalgam restoration. I had to take off a lot of anatomy in order for the restoration to occlude properly. basically should i appeal? im really freaking out right now and i need some advice. thank you

I posted in your other thread, but you can't appeal scores, only math errors. They won't even review your case for an appeal. Sorry!
 
they failed you for lack of anatomy?

i'd just retake the part you failed. i agree with gavin i dont think you'll get anywhere trying to appeal it.
 
I have a class III pt who has caries on the mesial of tooth #10. Its a V shape with the apex just hitting the DEJ. Will this qualify? I also have a hard time visualizing the radiolucency clinically...I was told by the director who coaches us for boards here that this is ideal, seeing it rx but not clinically. What do you all think? Is caries indicator solution allowed oN WREBS? Should we use it?
 
I have a class III pt who has caries on the mesial of tooth #10. Its a V shape with the apex just hitting the DEJ. Will this qualify? I also have a hard time visualizing the radiolucency clinically...I was told by the director who coaches us for boards here that this is ideal, seeing it rx but not clinically. What do you all think? Is caries indicator solution allowed oN WREBS? Should we use it?

Hi Buckey - let me tell you that the lesion you describe seems ideal. when i took my wreb exam i was freaking out since my lesions were "barely" visible, and they accepted all of them. i know a lot of my classmates were also concerned, but i didn't hear one rejection from the wreb examiners, so that points toward them giving the benefit of the doubt in most cases. the candidate guide does talk about caries indicator and if i remember correctly they don't want you to use RED indicator, every other kind is allowed, but again, read your candidate guide for this. I can't stress enough how important is to READ and RE-READ your candidate guide!!!
 
Thanks for the reply man. So today I bring a perio pt in for screening and she meets all the reqs but is lacking in supragingival calculus (obvious calculus) on the molars. Periodontist says for me to tell her to not brush or floss until the exam. Patient agreed. Wonder if she'll develop some good calculus..
 
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Thanks for the reply man. So today I bring a perio pt in for screening and she meets all the reqs but is lacking in supragingival calculus (obvious calculus) on the molars. Periodontist says for me to tell her to not brush or floss until the exam. Patient agreed. Wonder if she'll develop some good calculus..

Make sure you concentrate on the calculus that can be seen radiographically and also remember the minimum 5 clicks sub g calculus required.
 
Hi guys,
I have my exam in a few wks and im worried about my Class II on tooth #30. Its a DO, but part of the marginal ridge along with a bit of the occlusal is fractured off, but there is still visible decay. The lesion is about 1.5mm away from the pulp horn. Is it okay to submit a tooth that has a bit of the tooth structure missing? I have a digital xray so i can email it if anyone wants to see..thanks for your help!
 
I have a question regarding my Class II patient that I am still unsure of. My patient has 2 Class II unrestored lesions, one is #4 MO and the second is a #5 DO. These adjacent lesions have interproximal contact but #5 has a diastema on mesial. Is this a qualifying lesion? The thing that is throwing me off in the candidate guide is on page 23 D. "There must be at least one pre-existing interproximal contact between the surface(s) with the qualifying carious lesion(s) and an adjacent tooth. Can anyone help me with this? My test is Aug 10-13, 2012 at USC
 
Let me know if anyone needs advice or Qs answered. Just took the WREB a few weeks ago.

hi, can u help me with protho computer portion? we did not have implant class before and dr worthington's book does not have enough to do with the test. it seems like some clinical questions , not the book's. dr worthington's book is listed as reference for wreb this year.?
 
Hey guys im taking the written WREB in under two weeks.. kinda freaking since I have been out of school since 2011. Does anyone have any sample questions, and newer hints/tips? i have been study the green board buster book... Shoot me an email slevy007 @ gmail . com

Any help is greatly appreciated!!
 
This is a summary of some of the questions from early posters in this discussion.

Here are the stuff that you will be seeing in your exam:
1)--You will see one question about Prophylaxis:
make sure you know if a pt. is alleregic to Pen what you prescribe instead
2) In Perio endo lession ..which one you treat first ( endo always first)
3) the most important factor in patient treatment, is alway pt. himeslf
4) classification of Patient: Class I, II or II or Iv and V ( as far as systemic disease goes)
4) be able to classify perio ( periodontitis, mild, moderate, sever)
5) rememeber you never do everything, if something that you can't do you have to refer.
6) Implants, clean it with plastic materials Never use metal
7) know complete denture in side out. ...
Chick bitting
teeth arrangment
kind of teeth you use with natural tooth
problem if a denture patient is Wistle
know VDR, VDO, how to measure those on real pt.
pt. with tori, least invasive method
pt. with tori best tx for a pt with tori for denture
8) know the kennedy classifcation with Modification
9) know Angle classiffication
10) distinguish b/w Horizontal bone loss and vertical
11) distinguish b/w inflamed, healty, knift edge, bulbos gingiva
12) distinguish between mental foramen, and redioluency
13) know the major connector for both arches
14) make sure you know how to calculate attachment loss
Negative number means pt. has no ressesion
positive means, pt has ressesion
15) know how to calculate the attached gingiva from a reference point such as mucogingival junction and pocket depth
16) distinguish b/w Edametous
Firm
Fibros..
Perio preceed any ortho
17) know that females are allergic to Nickle...if a partial give allergic reaction that is usually from
18) distinguish Under extention of denture border..you will see 2 questions
usually give patient an ulceration
19) make sure when to Reline, if in the day of delivery of the framework you push the posterior part, anteriro lifts, then it is ok, however in the day of actual delivery of teh partial denture if that happens, denture needs a reline
20) Deep overbit in making denture
21) best teeth for complete denture
22) sequence in denture delivery
23) make sure you underestand what a group function is
24) order of treatment..
get rid of pain first,,then do cosmetic
25) know the prep for FGC
26) know the prep for Anterior Ceramic Crown
27) they will show you a rest prep for partial denture and ask you what is wrong with it ( choose the most rounded, nice and deep prep)
28) know parts of the partial denture, and which one is for direct retention and which is fir indirect reten.
29) if not enough space exist between the upper and lower denture what would you do ( usually in posteri..do a tuberasity reducton both )
30) if an elderly has osteoprosis and has a long edentulous space..best tx is removable partial denture.
here general stuff you need to konw:
Partial denture, classifcation, major connector, when relining,,what tooth to chose
denture know it in and out
perio:
Diagnos the patient perio disease
smooking is a risk factor
Calculas on the xray
Classification of Perio disease
know the relationship b/w VDO, VDR, etc..
if VDO decreases what do you have to do
If remember VDO is alway 2-4 mm less than VDR
VDR = Vdo - 2-4 mm



Complete Denture
Partial Denture
Perio classification
angle's classification
Major connectors
Kennedy classification
Sequeces of TX, in perio
Sequesces of deliv. Partial denture
problems with framework
what do you do if a partial denture tooth is broken
know that cement don't adhere to tooth, crown retention is mostly mechanical
if a denture pt. counts untill 60 and the upper falls
Means there is no retention
can cause by too thick posterior border
Overextended
and many more
remember never ever use,Porcelaine teeth with natural tooth

sequece of partial denture adjustment in day day of deliv.
I will write one example of attachment loss calculation:
Make sure you know how to Calculate Attachment loss:
Know the difference b/w Pocket Depth, CEJ, Gingival Margin
Know the abbreviation first:
CEJ : cemantoenamel junction
GM: gingival margin
PD: pocket depth

Negative Number, means Gingival Margin is Coronal to CEJ ( no Recession)
Positive Number means Gingiva is Apical to CEJ.

Example of Attachment loss of GM when Negative:
GM - 1 = means gingiva is 1 mm above CEJ. No attachment loss normal
So Pocket depth = attachment loss

Example of Attachment loss with GM when Positive:
GM + 1
Pocket depth 3
So total attachment loss is 4, because gingival margine is already 1 mm below CEJ.

Another example:
if the distance from Gingival margine to Mucogingvial junction is 10 mm and the pocket depth is 5 how much of attached gingive you would have?
10 mm - 5mm...= 5 mm is your attached gingiva
they can change this question adn ask different question however, underestand this will help you alot
Remember the numbers are in chart, make sure don't mix up Lingual, facial ...just look for what a question is asking.( common mistake)



For prostho: in terms of biomaterial, do we need to know composition of gold, porcelain, firing temperature......?
No, just know the thickness of materials
Alginate the thicker is better
PVS thin ( 1-3 mm)
don't need to know any dental materials at all
( don't worrary about it)
For perio: do we need to know what bacteria cause what periodontal disease?
no, however, you have to be able to calulate attachment loss and stuff,
remember, this is done in part II board, now you taking a clinical exam.
No names of bacterial, just know and read my previous post for clinical attachment loss. Make sure you know it inside and out ( please read my posts) in this forum
How instruments are designed in terms of angulations, etc? Histology? Anatomy? Different types of surgeries? Brushing techniques?
No histology
know nicotinic stomatitis for smookers ( from the slide)
know smooking is a risk factor
overall I saw one simple path question ( nicotinic stomatitis)




1- What is the axis of rotation in RPD that only has teeth #21, 22 and 27?
1.a Plan a partial for this same case.
2-In a crown prep, what is the bur used to make bevel in the chanfer margins?
3- What is the biggest problem when you try to replace teeth 9 and 10 in a RPD?

1- The axis of rotation is the fulcrum line, which is the line that passes through the most distal rests. In this case it should be the rests on the mesial of #20 and #28.

2 - I think diamond bur is the better answer choice.

3- What choices were given? It probably has something to do with esthetics, either of the actual crowns themselves or of the clasps for retention.
 
Hi everyone,

I wanted to give a few tips and advice on WREBs - I know it is a really stressful exam so just make sure you have calm nerves when you take it. They really do want you to pass so just believe that!

Prosth/perio, I used the board busters book but also looked at their candidate manual and checked out several of these books to review because I didn't feel like the board busters book was enough for prosth. It was more than fine for perio however I still went back and read chapters of Carranza where I felt uncomfortable! Also for perio, try as hard as you can to get an ideal patient - i know it's tough but just keep looking even if you already have a patient. My patient had tons of calculus but only pocket depths of 5 at the most - that was soo helpful!

For operative, practice on as many typodont teeth as you possibly can. This section just tested nerves and how you react. Don't panic if you get a pink slip - I got one and I still passed. Pink slips mean NOTHING unless you leave caries. That is the only pink slip you do not want to get. Several of my friends passed with pink slips as well. I got one for affected dentin and my heart SANK - but the floor examiner told me to do an amazing restoration so that's exactly what I did!

Endo - TOOTH SELECTION, TOOTH SELECTION, TOOTH SELECTION!!!! I cannot stress this enough. People fail this because they pick really crappy teeth with small pulp chambers and calcified teeth!! Use a maxillary central or canine and you will do FINE! For posteriors, I did a maxillary premolar and it was fine however just do what you are comfortable with. Lots of faculty don't want you to use a max premolar because they are afraid you will perforate it. However, if you stay nice and centered and point your bur in the correct orientation, you will be okay. Make sure you remove the pulp horns in all access preps!!!

PATP - this section is very straightforward. There were some other posts on this that took all my stress away and it really is not too bad. keep it nice and simple!

You will all do wonderful! Good luck!
 
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