Prometric Exam Questions for Paediatric Dentistry Specialists 2026: 20 MCQs with Answers on Behaviour Management, Caries Risk and Fluoride, Pulp Therapy, Dental Trauma, Space Maintenance, Local Anaesthesia Doses, Sedation, Molar Incisor Hypomineralisation and Special Care

The specialist paediatric dentistry paper (PED5911 at DHA, with CPE5912 for consultants, and the equivalent SCFHS, QCHP and NHRA papers) is 100 to 150 single-best-answer questions in up to three hours with a pass mark of about 60%. Early childhood caries rates in the Gulf are among the highest in the world and children's dental services are a government priority, so demand for licensed paediatric dentists is strong. The paper tests behaviour management, prevention, pulp therapy, trauma and the safety calculations that a specialist is expected to get right every time.

Behaviour management and communication

Question 1

Before examining a 4-year-old at a first visit, the dentist shows the mirror, lets the child touch it, explains what it does in simple words and then uses it. This technique is:

1. Voice control
2. Tell-show-do, the foundation of non-pharmacological behaviour guidance, usually combined with positive reinforcement, distraction and modelling
3. Protective stabilisation
4. Hand-over-mouth, which is no longer accepted

Answer: B. Hand-over-mouth is not endorsed by current AAPD guidance; protective stabilisation requires informed consent, a specific indication and documentation.

Question 2

According to the Frankl scale, a child who is reluctant, accepts treatment with some evidence of negative attitude but is cooperative when asked is rated:

1. Frankl 1, definitely negative
2. Frankl 2, negative
3. Frankl 3, positive
4. Frankl 4, definitely positive

Answer: C. Frankl 3 ("positive") describes acceptance with reservation; Frankl 2 is reluctance with uncooperative behaviour; the scale is documented at each visit.

Question 3

Which child is the most appropriate candidate for comprehensive dental treatment under general anaesthesia?

1. A cooperative 8-year-old with one small occlusal cavity
2. A 3-year-old with extensive early childhood caries in multiple quadrants, dental pain, failed attempts with behaviour management and nitrous oxide, whose parents give informed consent after a medical assessment
3. A 12-year-old who is slightly anxious
4. A child whose parent prefers it for convenience

Answer: B. GA is justified by treatment need and inability to cooperate (very young age, extensive treatment, special needs), with all treatment completed in one session and a preventive plan to avoid repeat GA.

Prevention and caries management

Question 4

A 2-year-old is brought in with chalky white lesions on the maxillary incisors near the gingival margin, a history of a night-time bottle with milk and juice, and no previous dental visit. The management includes:

1. Reassure and review at age 6
2. Diagnose early childhood caries, counsel to stop the night-time bottle and limit sugar frequency, start twice-daily brushing with a smear of 1,000 ppm fluoride toothpaste, apply fluoride varnish (22,600 ppm) at least twice a year, and arrest the lesions with silver diamine fluoride or treat as indicated, with three-monthly recall
3. Extract the incisors
4. Prescribe a fluoride tablet daily and nothing else

Answer: B. The first dental visit is recommended by the first birthday; maternal transmission of cariogenic bacteria and bottle habits are the counselling points.

Question 5

Which statement about silver diamine fluoride (38%) is correct?

1. It restores the tooth to its original shape
2. It arrests active caries lesions in about 70 to 90% of cases when applied every six to twelve months, stains the carious dentine black permanently, is useful in young, anxious or medically complex children and for buying time before definitive treatment, and requires informed consent about the staining
3. It is contraindicated in all children under 6
4. It eliminates the need for fluoride toothpaste

Answer: B. It is contraindicated in silver allergy and in teeth with pulpal involvement or ulceration of soft tissue; potassium iodide may reduce staining.

Question 6

A 6-year-old has a large asymptomatic occlusal-proximal carious lesion in a lower second primary molar with no radiographic evidence of pulpal involvement and a cooperative but anxious temperament. A conservative option with strong evidence is:

1. Extraction
2. The Hall technique: a preformed stainless steel crown cemented over the tooth with glass ionomer without caries removal, local anaesthetic or tooth preparation, sealing the lesion from the biofilm, with separators placed a few days earlier if contacts are tight
3. Amalgam restoration
4. Composite with total caries removal under rubber dam only

Answer: B. Trials show the Hall technique outperforms conventional restorations for survival in primary molars; it requires no clinical or radiographic signs of pulpal pathology.

Question 7

A 9-year-old has first permanent molars with yellow-brown opacities and post-eruptive breakdown of enamel, extreme sensitivity to brushing and cold, and demarcated opacities on the permanent incisors. The diagnosis and management principles are:

1. Fluorosis; bleaching
2. Molar incisor hypomineralisation (MIH); desensitisation and fluoride, early sealing or glass ionomer coverage, preformed crowns for severely affected molars, and planned extraction of hopeless first permanent molars at about 8 to 10 years (when the second molar bifurcation is forming) so the second molars drift into place, with orthodontic input
3. Amelogenesis imperfecta; full-mouth crowns
4. Dentinogenesis imperfecta

Answer: B. MIH affects first permanent molars and incisors specifically; fluorosis is symmetrical and diffuse; amelogenesis imperfecta affects all teeth in both dentitions.

Pulp therapy

Question 8

A 5-year-old has a carious exposure of a vital lower first primary molar with no history of spontaneous pain, no swelling or sinus, and normal radiographic appearance. The indicated treatment and preferred medicament are:

1. Pulpectomy with gutta-percha
2. Pulpotomy, removing the coronal pulp and placing mineral trioxide aggregate (MTA) or ferric sulfate over the radicular pulp (formocresol is used less now), followed by a stainless steel crown
3. Extraction and space maintainer
4. Direct pulp cap with calcium hydroxide, which has high success in primary teeth

Answer: B. Direct pulp capping has poor success in primary teeth; MTA pulpotomy has the best long-term outcomes. Spontaneous pain, swelling, a sinus, pathological mobility or furcal radiolucency indicate irreversible pulpitis or necrosis.

Question 9

A primary molar has a necrotic pulp with a furcal radiolucency, but the tooth is restorable and more than two thirds of the root remains. The treatment and the filling material are:

1. Pulpotomy with MTA
2. Pulpectomy with a resorbable filling material such as zinc oxide eugenol or an iodoform-calcium hydroxide paste, so that the material resorbs with the root as the permanent successor erupts; gutta-percha is never used in primary teeth
3. Extraction regardless of restorability
4. Antibiotics alone

Answer: B. Extraction is indicated for non-restorable teeth, internal resorption perforating the root, extensive root resorption, or in children with cardiac conditions at risk of endocarditis.

Question 10

A 9-year-old has a non-vital, immature upper central incisor with an open apex after trauma a year ago. The options for creating an apical barrier or encouraging root maturation are:

1. Conventional root filling with gutta-percha immediately
2. An MTA apical plug (single-visit apexification) or regenerative endodontic procedures (revascularisation) with disinfection and a blood clot scaffold, which can allow continued root development; long-term calcium hydroxide apexification is used less because it weakens dentine
3. Extraction and implant
4. Pulpotomy

Answer: B. Implants are contraindicated until growth is complete; a decoronated root or a resin-bonded bridge preserves bone and space meanwhile.

Dental trauma

Question 11

A parent telephones: a 10-year-old's upper central incisor has been knocked out completely at school 10 minutes ago. The advice is:

1. Put the tooth in a tissue and come tomorrow
2. Find the tooth, hold it by the crown, rinse briefly in milk or saline if dirty, reimplant it immediately into the socket and have the child bite on a handkerchief, or if that is not possible store it in milk, saline or saliva (never water) and attend immediately; permanent teeth are replanted, primary teeth are not
3. Scrub the root with a brush
4. Store it in water

Answer: B. Extra-alveolar dry time over 60 minutes means non-viable periodontal ligament cells and a poor prognosis; replanted teeth are splinted flexibly for two weeks, and pulp treatment is started within two weeks in closed-apex teeth.

Question 12

A 7-year-old's permanent central incisor is displaced palatally and locked in bone (lateral luxation) with an open apex. Management is:

1. Extraction
2. Reposition under local anaesthesia, flexible splint for about four weeks, soft diet and chlorhexidine, with clinical and radiographic follow-up for pulp survival, because immature teeth frequently revascularise; root canal treatment is started only if necrosis is confirmed
3. Immediate root canal treatment
4. Rigid splint for three months

Answer: B. Intrusion of an immature tooth may be allowed to re-erupt spontaneously; rigid or prolonged splinting increases ankylosis. The IADT guidelines are the reference.

Question 13

A 3-year-old falls and intrudes an upper primary incisor almost completely. Radiograph shows the apex displaced towards the permanent tooth germ. Management is:

1. Reposition and splint
2. Extract the primary incisor to protect the developing permanent successor, with follow-up for developmental defects of the permanent tooth; if the apex were displaced away from the germ, spontaneous re-eruption could be awaited
3. Leave it and review in a year
4. Root canal treatment

Answer: B. Primary tooth trauma is managed to protect the permanent successor; enamel hypoplasia or dilaceration of the successor are the sequelae warned about.

Space management and development

Question 14

A 6-year-old loses a lower second primary molar to caries; the first permanent molar has erupted and the second premolar is not near eruption. The appropriate space maintainer is:

1. No space maintainer is ever needed in the lower arch
2. A band and loop (or crown and loop) from the first permanent molar, or a lower lingual holding arch if bilateral and the permanent incisors have erupted, because loss of a second primary molar leads to rapid mesial drift of the first permanent molar
3. A removable partial denture
4. A distal shoe, which is used when the permanent molar has not yet erupted

Answer: B. The distal shoe guides an unerupted first permanent molar and is contraindicated in children at risk of endocarditis; space maintainers are reviewed for the successor's eruption and for caries around bands.

Question 15

A 10-year-old has a retained upper primary central incisor with the permanent incisor erupting palatally. Radiograph shows the primary root largely intact. Management is:

1. Wait for natural exfoliation
2. Extract the retained primary incisor to allow the permanent tooth to improve its position, with assessment for crossbite correction (an upper removable appliance with a Z-spring) if the permanent incisor erupts in crossbite
3. Extract the permanent incisor
4. Bond a bracket to the primary tooth

Answer: B. Over-retained primary teeth, supernumeraries (mesiodens) and odontomes are causes of delayed or ectopic eruption and are checked radiographically when eruption is asymmetric by more than six months.

Pharmacology and safety

Question 16

A 20 kg child needs local anaesthesia for treatment in two quadrants using 2% lidocaine with 1:100,000 adrenaline (1.8 mL cartridges). The maximum dose and number of cartridges are:

1. 7 mg/kg; 8 cartridges
2. About 4.4 mg/kg (maximum 7 mg/kg in some references; the conservative 4.4 mg/kg is used in children), that is about 88 mg, which is 4.4 mL or roughly 2.4 cartridges, so no more than two full cartridges in this child
3. No maximum applies in children
4. 10 cartridges

Answer: B. Each 1.8 mL cartridge of 2% lidocaine contains 36 mg. Articaine 4% is dosed at about 7 mg/kg (72 mg per cartridge) and is not recommended under 4 years. Overdose causes CNS excitation then depression, and self-inflicted lip biting after mandibular blocks is a common complication.

Question 17

Which statement about nitrous oxide-oxygen inhalation sedation in children is correct?

1. It is a form of general anaesthesia
2. It provides minimal sedation with the child conscious and responsive, titrated usually to 30 to 50% nitrous oxide with a minimum of 30% oxygen, requires nasal breathing and cooperation, is contraindicated with blocked nasal airway, severe COPD, recent middle ear or eye surgery, first-trimester pregnancy and some psychiatric conditions, and needs 100% oxygen for 3 to 5 minutes at the end to prevent diffusion hypoxia
3. It requires fasting for eight hours
4. It is contraindicated in all asthmatic children

Answer: B. Fasting is not required for nitrous oxide alone (a light meal is advised); scavenging protects staff.

Question 18

Which child requires antibiotic prophylaxis before an extraction according to current cardiac guidance?

1. A child with a repaired atrial septal defect six years ago with no residual defect
2. A child with a prosthetic valve, a previous episode of infective endocarditis, unrepaired cyanotic congenital heart disease, or a repaired defect with residual shunt or prosthetic material within six months, for whom amoxicillin 50 mg/kg (maximum 2 g) is given 30 to 60 minutes before the procedure
3. A child with a heart murmur of any kind
4. Every child having an extraction

Answer: B. Prophylaxis is targeted at the highest-risk cardiac conditions; meticulous oral health is the main protective factor and the cardiologist confirms the category.

Safeguarding and special care

Question 19

A 5-year-old presents with a torn labial frenum, bruising to both cheeks and a fractured incisor; the explanation is a fall from a chair two days ago, but the parent delayed attendance and the history changes during the visit. The dentist should:

1. Treat the tooth and discharge
2. Recognise indicators of possible physical abuse (injuries inconsistent with the history, delayed presentation, bilateral injuries, changing account), provide treatment, document and photograph with consent, and report through the hospital's child protection pathway as the law requires
3. Confront the parent with accusations
4. Refer only if it happens again

Answer: B. Over half of physical abuse injuries involve the head and neck; dental neglect (untreated rampant caries despite advice) is also a safeguarding concern.

Question 20

A 7-year-old with autism spectrum disorder needs a dental examination and fissure sealants. The most appropriate approach is:

1. Immediate general anaesthesia for any treatment
2. Pre-visit preparation with a social story or photographs, a consistent routine and clinician, a quiet low-stimulation environment, short appointments at a predictable time, gradual desensitisation visits, visual supports, and involving the parent's knowledge of the child's triggers and communication, escalating to sedation or GA only when needed
3. Restraint by staff
4. Refusing treatment

Answer: B. Children with special healthcare needs have higher caries rates and more barriers to care; Gulf authorities expect paediatric dentists to manage them within structured special care pathways.

How to practise

• Memorise the safety numbers: local anaesthetic maximum doses per kilogram and cartridge contents, fluoride toothpaste concentrations by age, antibiotic prophylaxis doses, nitrous oxide ranges.
• Learn the trauma guidelines by tooth type: primary versus permanent, open versus closed apex, splinting times.
• Know the indications: pulpotomy versus pulpectomy versus extraction, Hall technique, SDF, GA criteria, space maintainers.
• Practise under time in the Paediatric Dentistry bank or the Consultant Paediatric Dentistry bank, using the error-log method.

Related sets: general dentistry questions, orthodontics questions and dental assistant and hygienist questions. Specialist recognition is in the specialist dentist guide.

Frequently asked questions

How many questions are in the Prometric paediatric dentistry specialist exam?

Typically 100 to 150 single-best-answer MCQs in up to three hours, with a pass mark of about 60%, varying by authority.

Which paediatric dentistry topics come up most?

Behaviour management, caries prevention and SDF, pulp therapy in primary teeth, dental trauma, space maintenance, local anaesthetic doses and sedation criteria.

Does the exam include dose calculations?

Yes. Expect local anaesthetic, fluoride and antibiotic prophylaxis calculations by weight.

Which guidelines does the exam follow?

Current AAPD guidelines, IADT trauma guidelines and standard paediatric dentistry texts; shared principles are tested.

Are these real exam questions?

No. They are original practice questions written to the published blueprint. Real exam content is confidential.