2020

Question 1

List four problems that can occur when instrumenting a tooth with curved roots using only stainless steel ISO handfiles? and give reasons for each of the problems?

Answer 1

• Ledges - internal transportation of the canal due to working short of the working length and due to less flexibility of file
• Perforation - excessive force is applied when using the instrument
• Apical Zipping - due to the tendency of the instrument to straighten in a curved canal
• Blockage of the canal - dentine debris getting packed in the apical portion of the root

Question 2

Describe the process of canal shaping and cleansing (not obturation) using ProTaper Universal instrumentation of root canals. Assume that straight line access has been achieved and working length has been determined with a size 10 stainless steel hand file. Your apical finishing size should be 0.25mm

Answer 2

• Assuming that dental dam has been placed and EWL determined and straight line access is achieved
• Size 15-K file to enlarge the glide path to facilitate instrumentation
• Use S1 to 2/3 of working length
• Coronal flaring using Sx file to prepare the coronal third to 2/3 of EWL
• Take radiograph to determine CWL
• Use size 10 and 15 K-files for patency to CWL
• Use S1 , S2 , F1 , F2 in order to correct working length to prepare the apical third of the canal using balanced force
• Irrigate with sodium hypochlorite between each file to flush out debris
• After preparation the irrigation potocol is 17% EDTA for 1 minute then 3% of NaOCl for 10 minutes injecting slowly using thumb

Question 3

With regards to “non-Y2 amalgam”

Give 2 advantages in terms of performance of a non Y2 amalgam?

Answer 3

• less creep
• Higher mechanical strength
• More corrosion resistant

Question 4

How does the manufacturer reduce Y2 from the structure of amalgam?

Answer 4

Addition of Silver copper particles which reacts with silver tin particles , making tin less available for the y2 production

Question 5

With regard to zinc free amalgam , why was it necessary for manufacturers to add zinc to amalgam?

Answer 5

Acts as a scavenger molecule which oxidises rather than the other consistuents

Question 6

What effect could occur in a freshly placed amalgam restoration as a result of the presence of zinc in the amalgam alloy?

Answer 6

• Delayed expansion as a result of contamination with moisture

Question 7

Explain the mechanism of this effect ( slag formation)

Answer 7

Zinc can react with saliva or blood to form ZnO and produce hydrogen gas
* hydrogen increases pressure which may cause the restoration to rise leading to a higher chance of deformation under occlusal load and cause trauma to pulp

Question 8

What is the main symptoms that the patient feels when slag forms from zinc in amalgam?

Answer 8

• Pain

Question 9

A 33-year-old patient presents with a discoloured upper left central incisor tooth. The patient has no caries or restorations of any kind in any teeth and is fit and healthy. The discolouration, first noticed two years ago, has been getting steadily worse. There are no symptoms, and the patient is concerned with the appearance. He recalls a blow to the tooth when playing sport a few years previously.

Determine how you would determine the aetiology of the discolouration?

Answer 9

• Full history of trauma
• TTP
• Radiographs ( Periapical of 22)
• Sensibility testing of 22 and 21

Question 10

A 33-year-old patient presents with a discoloured upper left central incisor tooth. The patient has no caries or restorations of any kind in any teeth and is fit and healthy. The discolouration, first noticed two years ago, has been getting steadily worse. There are no symptoms, and the patient is concerned with the appearance. He recalls a blow to the tooth when playing sport a few years previously.

State 3 sequale of dental trauma that may influence your treatment planning for this tooth ?

Answer 10

• Pulp health
• Mobility - excessive, ankylosis
• Root resorption

Question 11

A 33-year-old patient presents with a discoloured upper left central incisor tooth. The patient has no caries or restorations of any kind in any teeth and is fit and healthy. The discolouration, first noticed two years ago, has been getting steadily worse. There are no symptoms, and the patient is concerned with the appearance. He recalls a blow to the tooth when playing sport a few years previously.

List and describe two restorative procedures you may carry out to improve the aesthetics of this tooth?

Answer 11

• External vital bleaching using hydrogen peroxide which is applied to the tooth after placing dental dam and petroleum jelly on the gingivae to protect it , which can be applied for up to 5 times until desired colour is achieved
• Porcelain veneer - by taking impressions of the tooth with or without preparing it depending on the operator judgement and sending it to the lab for the fabrication of a veneer which is then bonded to the tooth using a composite resin luting cement with silane coupling agent

Question 12

Describe 2 patterns of bone loss evident in this radiograph?

Answer 12

• Horizontal and vertical

Question 13

What explains the development of bone loss on the mesial aspect of the lower right second premolar?

Answer 13

• Presence of plaque accumulation (scalloping) in the distal aspect of the tooth , the canal curvature may have acted as a plaque trap

Question 14

How can interproximal bone defects be classified in general

Answer 14

According the walls involved - 1,2,3 wall defects

Question 15

Following hygiene phase therapy this patient’s oral hygiene was excellent but pockets of >6mm persisted in the lower right quadrant. Open flap debridement was performed

What feature of this patient’s disease which is on the radiograph is most likely to limit the success of this treatment and why?

Answer 15

Fucration involvement due to bone loss making access for cleaning difficult leading to poor prognosis of tooth

Question 16

List the best possible outcome clinical and radiographic outcomes for this type of treatment in terms of the healed situation?

Answer 16

• Pocket depths less than 4mm
• Bleeding on probing less than 10%
• Plaque scores less than 15%

Question 17

Give two other treatment options for managing the lower right second molar ?

Answer 17

• Guided tissue regeneration
• Tunneling - Furcation

Question 18

A patient comes in with a fractured MCC crown with core fractured inside the crown, patient has no pain and the tooth is not root treated

What 4 features of the remaining tooth tissue of the central incisor might indicate wither it can be successfuly restored or not?

Answer 18

• Quality of tooth tissue remaining
• Amount of tooth tissue remaining (ferrule should be 1.5 in height and width)
• Type of fracture (if the pulp is involved)
• Mobility and health of periodontal tissue

Question 19

A middle-aged gentleman attended your surgery with the metal ceramic crown from his upper right central incisor in his hand. He has no pain. You notice that the dentine core has fractured off inside the crown. There is no history of previous root canal therapy.

The tooth is restorable , list and describe 3 ways in which the space can be restored in the short term ?

Answer 19

• Rebond Fractured MCC crown using a temporary cement
• Overdenture with a single acrylic tooth- on the remaining tooth structure
• Vacuum formed splint with the fractured MCC crown or with an acrylic tooth crown
• A temporary crown using a prefabricated tooth matrix done chair-side using temporary resin material

Question 20

A patient has the following missing teeth: 38, 37, 36, 35, 45 and 46. You decide to provide a definitive removable partial denture. The patient has a well maintained mouth with no active disease and you can assume has suitable survey lines.

What supporting components would you use? list the type and surface?

Answer 20

• 34 mesial rest - part of RPI system
• 44 distal rest
• 47 mesial rest

Question 21

A patient has the following missing teeth: 38, 37, 36, 35, 45 and 46. You decide to provide a definitive removable partial denture. The patient has a well maintained mouth with no active disease and you can assume has suitable survey lines.

List the retentive components that you would use, indicate component name , FDI and position

Answer 21

• 34 - gingivally approaching I-bar clasp with guide plate ( Part of RPI system)
• 44 - Gingivally approaching I-bar clasp
• 47 - Circumferential ring clasp
• 43 - mesial rest for indirect retention

Question 22

A patient has the following missing teeth: 38, 37, 36, 35, 45 and 46. You decide to provide a definitive removable partial denture. The patient has a well maintained mouth with no active disease and you can assume has suitable survey lines.

Name the major connectors and state the reasons for your choice including the choice of material

Answer 22

• Lingual bar - CoCr - as it can provide good clearance for the patient to clean and is more comfortable in the mouth ( it need 8mm clearance on the lingual aspect)

Question 23

A patient has the following missing teeth: 38, 37, 36, 35, 45 and 46. You decide to provide a definitive removable partial denture. The patient has a well maintained mouth with no active disease and you can assume has suitable survey lines.

Which feature of your design would provide indirect retention?

Answer 23

cingulum rest on 43
Major connector

Question 24

The illustration is of an upper edentulous ridge , please identify the anatomical landmarks indicated ?

Answer 24

A - incisive papilla
B - Maxillary tuberosity
C - Palatine fovea

Question 25

In terms of complete dentures what is meant by stability?

Answer 25

Resistance of the denture to lateral movement

Question 26

In terms of complete dentures what is meant by retention?

Answer 26

Resistance of the denture to vertical displacement ( away from the gingivae)

Question 27

How do you achieve adequate retention in a conventional complete upper denture?

Answer 27

* Ensure denture have a good peripheral seal insuring good extensions * Accurate post dam placement * Maximise palatal coverage of the denture base * Ensure to have a balanced occlusion with opposing arch

Question 28

In terms of biometric principles where are denture teeth located on ?

Answer 28

* Upper - buccal to the alveolar ridge * Lower - on the alveolar ridge

Question 29

A fit and healthy 32 year-old patient requires surgical removal of his lower left wisdom tooth. He is very anxious about the surgery and has opted to have the treatment carried out under intravenous sedation. Why is written consent required in advance of the treatment day in sedation?

Answer 29

* So the patient can take their time to consider the information provided and allow a timeframe for the patient to decide thoroughly

Question 30

A fit and healthy 32 year-old patient requires surgical removal of his lower left wisdom tooth. He is very anxious about the surgery and has opted to have the treatment carried out under intravenous sedation. What drug would a UK trained dentist select to sedate the patient intravenously? What preparation should be used?

Answer 30

* Midazolam 5mg/5ml - 2mg bolus titrated in 1mg increments every minute

Question 31

A fit and healthy 32 year-old patient requires surgical removal of his lower left wisdom tooth. He is very anxious about the surgery and has opted to have the treatment carried out under intravenous sedation. What vital signs would you monitor and record before, during and after procedure?

Answer 31

* Heart rate * Blood pressure * Oxygen saturation * BMI (height and weight)

Question 32

What is the antidote for midazolam?

Answer 32

Flumazenil 500mcg in 5 ml

Question 33

A fit and healthy 32 year-old patient requires surgical removal of his lower left wisdom tooth. He is very anxious about the surgery and has opted to have the treatment carried out under intravenous sedation. List 3 instructions that the patient should follow post sedation for a minimum of 12 hours after he is discharged from your care ?

Answer 33

* Do not make important decision * Do not drive or operate heavy machinery * Rest

Question 34

Your patient has sustained a displaced fracture of the right body of the mandible. Other than pain, bruising and swelling , name 6 clinical signs or symptoms commonly described in such injury?

Answer 34

* Bleeding * Facial asymmetry * Occlusal derangement * Trismus * Mobile teeth * Numbness in the chin and lower lips on the side of injury

Question 35

Your patient has sustained a displaced fracture of the right body of the mandible. * What are two radiographic views appropriate to help in establishing the diagnosis of a mandibular fracture?

Answer 35

* OPT * PA mandible

Question 36

Your patient has sustained a displaced fracture of the right body of the mandible. List three factors that may cause displacement of the fracture?

Answer 36

* Direction of fracture line * Magnitude of force applied * Attachment of muscles in the fracture site

Question 37

List 3 treatment options for a fractured mandible?

Answer 37

* Leave and monitor * Open reduction with internal fixation * Intermaxillary fixation (IMF)

Question 38

A 35-year-old male presents with pain, swelling and pus discharge around a partially erupted lower right wisdom tooth. He feels slightly unwell and has some mild facial swelling. Describe 6 features you would specifically consider, relating to the patient's history, extraoral examination or investigations?

Answer 38

* Is the airway compromised * Palpate swelling for tenderness, temprature * Ask patient of when did the swelling start and has it changes in size * Ask the patient if this pain happened before and frequency * Check mouth opening - note if limited * When did he start feeling unwell * Pain history * Take OPT * Source of infection and check opposing tooth * If the patient is allergic to antibiotics

Question 39

A 35-year-old male presents with pain, swelling and pus discharge around a partially erupted lower right wisdom tooth. He feels slightly unwell and has some mild facial swelling. What is the appropriate immediate management of this patient?

Answer 39

* Check if airway is compromised - if compromised refer for emergency management * Reassure patient and gain consent * Incise and drain abscess under LA * Prescribe analgesia * Prescribe antibiotics as patient with systemic symptoms * Advise patient on CHX mouthwash * Consider extraction of wisdom tooth if recurrent pericoronitis * Adjust opposing occlusion to relieve area if trauma is from opposing tooth

Question 40

What are the two main branches at risk of damage during removal lower wisdom teeth and which structures would be affected in the event of such damage?

Answer 40

* Lingual nerve - sensation of the anterior 2/3 of tongue * Inferior alveolar nerve - lower lips and chin

Question 41

Give a differential diagnosis of this lesion?

Answer 41

* Condyloma acuminata * Squamous cell carcinoma * Squamous cell papilloma

Question 42

If you suspected that the lesion is malignant , name three histological features that need to be identified in the biopsy?

Answer 42

* Mitotic activity * Cellular and Neuclear atypia * Architectural changes in the epithelium such as dysplasia

Question 43

List 3 different clinical presentation of oral squamous cell carcinoma?

Answer 43

* Exophytic lesion * Ulceration * Leukoplakia or Erythroplakia

Question 44

The pathology report comes back stating that the lesion is benign , what do you think have cause this growth to appear? and how you would confirm this ? how would you confirm this?

Answer 44

HPV - by detecting the HPV DNA through a PCR test

Question 45

A patient present with evidence of bony expansion of their maxilla The patient is elderly and has a high alkaline phosphate level What condition might have caused this?

Answer 45

Paget's disease

Question 46

A patient present with evidence of bony expansion of their maxilla The patient has a raised serum calcium level What condition might have caused this?

Answer 46

Hyperparathyroidism

Question 47

A patient present with evidence of bony expansion of their maxilla The patient is 15 years old and has bilateral maxillary expansion What condition might have caused this?

Answer 47

Cherubism

Question 48

A patient present with evidence of bony expansion of their maxilla Radiography shows a radiolucency with generalised loss of lamina dura What condition might have caused this?

Answer 48

Paget's disease

Question 49

A patient present with evidence of bony expansion of their maxilla The patient has pigmented spots on their skin and has precocious puberty What condition might have caused this?

Answer 49

Albright's syndrome

Question 50

A patient presents with pain in their face. Which condition would be the most likely diagnosis in the following scenarios 1. middle-ages female patient with constant burning sensation affecting the palate and tongue, with erythema of the mucosa 2. male patient with a recent onset dull throbbing pain over the maxilla worsened by bending over to tie his shoes 3. Young, adult female patient with episodic unilateral peri-orbital pain lasting 20 minutes with nasal congestion , the pain being brought on by shaking of the head 4. Elderly female patient with sharp, shooting pain over the right cheek brought on by eating and associated with lacrimation 5. Elderly female patient with unilateral , throbbing temporal pain and loss of muscular power around the shoulders

Answer 50

1. burning mouth syndrome 2. maxillary sinusitis 3. chronic paroxysmal hemicranias 4. trigeminal neuralgia 5. temporal arteritis

Question 51

A patient is referred to the Oral Medicine clinic for evaluation of her dry mouth Sjogren's syndrome can be part of the spectrum of autoimmune characteristic features are often seen in salivary gland biopsies in this condition, from which part of the orofacial structures is it the most common to take a salivary gland biopsy as part of the investigation of suspected Sjogren's?

Answer 51

Labial gland

Question 52

List two features on the histological examination of a labial gland biopsy that would be compatible with Sjogren's syndrome?

Answer 52

* Collection of more than 50 lymphocytes around a duct - lymphocytic foci * Acinar atrophy

Question 53

Focal swelling in the major salivary glands is usually associated with salivary malignancy. What feature in relation to a parotid gland lump may suggest a malignant rather than a benign tumour?

Answer 53

* Asymmetrical * Causes obstruction * Causes pain and facial palsey

Question 54

What is the most common salivary gland tumour in the parotid gland?

Answer 54

Pleomorphic adenoma

Question 55

What is the most common salivary gland tumour in the salivary glands of the upper lip?

Answer 55

Adenoid cystic carcinoma

Question 56

What is the most common salivary gland tumour of the salivary glands in the soft palate?

Answer 56

Mucoepidermoid carcinoma

Question 57

List two ways that the skeletal base relationship may be assessed clinically in the anteroposterior plane.

Answer 57

* Visually with the patient Frankfort plane parallel to the floor * Palpate skeletal bases using Kettles method

Question 58

Cephalometric analysis reveals that a patient has an ANB angle of 8 degrees. What does this suggest about their skeletal pattern?

Answer 58

The maxilla is more than 3mm anterior to the mandible meaning they have moderate skeletal class 2

Question 59

List two ways that the skeletal pattern can be assessed clinically in the vertical plane?

Answer 59

* FMPA angle * Upper anterior face height to lower anterior face height

Question 60

What is meant by a class III incisor relationship?

Answer 60

* The mandibular incisors lie anterior to the cingulum plateau of the maxillary incisors * with reduced or reversed overjet

Question 61

What is a balancing extraction and why might you consider a balancing extraction?

Answer 61

* When the same tooth on the opposite side of the same arch is also extracted , used to prevent midline shift

Question 62

A child presents with the upper left permanent central incisor in crossbite , when is the ideal time to treat this type of malocclusion?

Answer 62

As soon as the problem has been detected

Question 63

List 3 features of an anterior crossbite that would make it favourable for treatment with a removable appliance?

Answer 63

* Palatally tipped tooth in crossbite * Space is present * Good overbite to aid retention

Question 64

What active component can be used for correcting an anterior crossbite?

Answer 64

Z- spring 0.5mm HSSW on palatal aspect of tooth

Question 65

What retentive components to use to correct an anterior crossbite in a child?

Answer 65

* Adams crib on the 6s - 0.7mm HSSW * Adams crib on the primary 4s - 0.6mm HSSW

Question 66

What anchorage considerations to correct an anterior crossbite in a child in one tooth?

Answer 66

Present as only moving on tooth

Question 67

What baseplate modifications to correct an anterior crossbite in a child in one tooth?

Answer 67

Self-cure PMMA with flat posterior bite plane

Question 68

What other than z-spring can be used to correct an anterior crossbite?

Answer 68

* Palatal finger spring 0.5mm HSSW on the tooth

Question 69

A 13-year-old female patient with discoloured upper incisors is very upset by the appearance of these teeth. It is affecting her at school and she won’t smile. Apart from the discolouration she is clinically symptom free and the teeth are vital. What baseline information or special tests would you undertake pre-treatment?

Answer 69

* Shade * Clinical photographs * Informed consent which is written and signed * Sensibility testing * Full history * Radiographs if indicated * Diagram of defect

Question 70

You decide to provide a course of microabrasion using 18% hydrochloric acid with pumice , outline the eight stages in the treatment?

Answer 70

* PPE for the dental team and patient * Clean all teeth affected with pumice and water * Apply petrolium jelly to protect the gingivae * Place dry dam and wedjets + sodium bicarbonate gaurd behind the teeth * Apply HCL pumice slurry to teeth using a slow rotating rubber cup for 5 seconds for a maximum of 10 applications * Wash teeth with aspiration after every 5 second application and review color and shape and reapply sodium bicarbonate * Once to desired result , apply Fluoride Varnish (Profluorid) * polish with finest sand disc paper and toothpaste

Question 71

What information would you give a patient that has just finished microabrasion treatment?

Answer 71

Warn patient to avoid eating or drinking high coloured foor for the next 24h to avoid staining , review in 4-6 weeks

Question 72

You decide to provide a course of vital bleaching following microabrasion , what bleaching agent will you use and at what strength?

Answer 72

* Carbamide peroxide 10%

Question 73

A 12-year-old girl presents to you with developmentally absent upper lateral incisors, second premolars and third molars. What clinical term describes this condition?

Answer 73

Hypodontia

Question 74

A 12-year-old girl presents to you with developmentally absent upper lateral incisors, second premolars and third molars. The girl is very concerned about the aesthetics of her upper anterior teeth. Outline two potential treatment options.

Answer 74

* Restorative options - bridges or RPD * Orthodontic treatment - space closure (simple or space closure plus)

Question 75

List 2 syndromes associated with missing teeth?

Answer 75

* Cleft lip and palate * Down's syndrome

Question 76

A 12-year-old girl presents to you with developmentally absent upper lateral incisors, second premolars and third molars. You decide to refer the girl to a multidisciplinary team. List 3 of the specialities that should Ideally be represented on the team?

Answer 76

* Restorative dentistry * Paediatric dentist * Orthodontist

Question 77

Percentage of people having a missing primary teeth? and percentage having a missing permanent teeth?

Answer 77

Primary - less than 1% Permanent - less than 6%

Question 78

A 3-year-old child is brought to your surgery following trauma to his upper left central incisor. Suggest four aspects of the presentation and history which should make you suspect non-accidental injury?

Answer 78

* Injury in the triangle of safety * Injury do not match explanation given * Delay in seeking help * Multiple injuries with different healing rates

Question 79

List two possible sequelae to the primary dentition following the trauma?

Answer 79

* Discolouration of tooth * Delayed exfoliation

Question 80

A 3-year-old child is brought to your surgery following trauma to his upper left central incisor. List 4 possible sequale to the permanent dentition following the trauma?

Answer 80

* Delayed eruption * Resorption of the tooth * Ectopic position of the tooth * Change in crown/root morphology

Question 81

This is an extract from an advertisement in a dental magazine State the research question using the PICO framework?

Answer 81

Population - smokers Intervention - shiny sheen Comparison - brand market leader Outcomes - preventing tooth staining

Question 82

What kind of study is this?

Answer 82

Randomised control trial

Question 83

What two steps have been taken to minimise bias in this study?

Answer 83

* Blinding * Random allocation

Question 84

Explain why random allocation and inclusion and exclusion criteria minimise bias?

Answer 84

* Both groups are randomly allocated reducing the selection bias * Blinding ensures that the assessor does not influence the outcome of the treatment

Question 85

How would you communicate the risk ratio (RR) to a colleague

Answer 85

The results of this study suggests that there is 9% reduction in the risk of Shiny Sheen causing tooth staining, than the brand market leader

Question 86

Is there sufficient evidence that Shiny Sheen is effective at preventing tooth staining in the population of smokers? and why?

Answer 86

NO , the confidence interval overlaps 1 which means that the results are statistically insignificant

Question 87

List four additional pieces of information you would wish to know before drawing firm conclusions on whether or not you would consider recommending Shiny Sheen as a smokers’ toothpaste.

Answer 87

* Information about smoking habit frequency and duration * Oral health of participants at baseline * Information of compliance of participants with using the intervention * Information on any side effects the participants experienced due to the intervention * Any follow up input from participants after the 1 month period and participant satisfaction

Question 88

A 27-year-old male with congenitally absent maxillary lateral incisors attends your practice. He has been wearing an upper acrylic denture to replace his missing teeth for the past 10-years and now wishes to discuss alternative treatment options. After discussion with the patient, you decide to restore the spaces with bridgework. Which type of bridgework design would be most suitable for this case? and which teeth would you choose as an abutement?

Answer 88

Cantilever resin retained bridge , tooth 11 and 21

Question 89

What clinical records would you obtain from the patient to allow dental technician to manufacture a resin retained bridge?

Answer 89

* Master Impression of the patient mouth after preparation of abutements * Tooth shade * Bite registration * Occlusal records - OVD , RFH , FWS

Question 90

Other than bridgework, what alternatives are there to replace missing space?

Answer 90

* Implants * RPD

Question 91

What are the advantages of resin modified glass ionomer cement ?

Answer 91

Has resin particles * Higher mechanical strength * Lower solubility than GIC * Sets on command with light * Chemically bonds to tooth * Has fluoride release

Question 92

Why is using conventional glass ionomer cement as a luting cement is wrong?

Answer 92

* May absorb moisture * Weak mechanically - prone to caries ingression

Question 93

What luting cement would you to cement a metal post and core?

Answer 93

GIC

Question 94

which luting cement would you use to cement a porcelain veneer?

Answer 94

light cure composite resin luting cement with silane coupling agent

Question 95

What would you use to cement a fibre post?

Answer 95

Dual cure composite luting cement

Question 96

Patient attends with severe toothache associated with tooth 37 which is tender to percussion What 3 questions would you ask this patient that may lead you to a diagnosis of the cause?

Answer 96

* When did the pain start? and decribe the character of it? * Is there any factors that helped relieve the pain or make it worse? and how? Did analgesics work? * Are you stressed?

Question 97

From the photograph and radiograph, list 3 findings that are relevant to the patient symptoms of pain from 37?

Answer 97

* Secondary caries under amalgam restoration on 37 (distal) * Fractured distobuccal cusp on 37 * Defective restoration margins on MOD amalgam on the 37 with discolouration

Question 98

What is the apical diagnosis of tooth 37 ? TTP positive and pain

Answer 98

Symptomatic Apical periodontitis

Question 99

Which immediate pain relief treatment options will you offer your patient on completion of your assessment of tooth 37?

Answer 99

* LA * Remove restoration and caries , pulp extirpation and temporary restoration or XLA

Question 100

Give four reasons why non-surgical therapy may fail to eliminate bacteria from periodontal pockets?

Answer 100

* Pockets may be blocked (healed over calculus) * Pockets may be too deep that instruments cannot reach the bacteria * Patient poor compliance with OHI leads to persistent bacteria * Clinician may lack instrumentation skills

Question 101

List three potential problems that limit the usefulness of oral antibiotics in the treatment of periodontitis.

Answer 101

* Antibiotics may not be able to penetrate the biofilm * Antibiotics may not reach sites of periodontal bacteria * Due to antibiotic resistance

Question 102

You are seeing a patient with a lateral periodontal abscess in tooth 22, they have accompanying systemic symptoms. The patient is keen to keep the tooth, describe how you should manage this as a dentist?

Answer 102

* Incise and drain abscess or drain through pocket ( LA if needed) * Supra and sub-gingival PMPR short of the base of the pocket to avoid spread of infection or traumatising the pocket * Prescribe antibiotics to the patient due to systemic symptoms ( check allergies) *Prescribe CHX mouthwash * Advise patient on analgesia and OHI

Question 103

A 53 year old female patient requests new complete dentures. She has worn the present set for 15 years and they are now becoming loose. Her medical history is clear. The photograph shows her upper arch with the dentures removed. The palatal denture-bearing mucosa is red. Which organism is most likely to have proliferated in the denture bearing area?

Answer 103

Candida albicans

Question 104

A 53 year old female patient requests new complete dentures. She has worn the present set for 15 years and they are now becoming loose. Her medical history is clear. The photograph shows her upper arch with the dentures removed. The palatal denture-bearing mucosa is red. Give 3 most likely contributing factors to this infection?

Answer 104

* Poor denture hygiene * ill fitting denture * Wearing the denture all the time and not taking them off at night

Question 105

List 4 interventions which would form a good treatment plan for a patient presenting with denture induced stomatitis?

Answer 105

* Denture hygiene instructions * Denture wearing instructions * Oral hygiene instructions * Antifungal medication/ CHX mouthwash * Denture adjustment if ill fitting

Question 106

What might have happened to the occluding surfaces of the denture teeth after 15 years (1 mark) and can anything be done to the existing dentures to rectify this in the short term (1 mark)?

Answer 106

Wear , autopolymerising resin added to build the teeth back

Question 107

You have just completed surgical removal of tooth 37 which fractured during an attempted forceps extraction. Your patient is a 21-year-old male with poorly controlled asthma. You intend to prescribe analgesia for the patient. Name a suitable analgesic for this patient that you are allowed to prescribe on an NHS prescription?

Answer 107

* Paracetamol

Question 108

You have just completed surgical removal of tooth 37 which fractured during an attempted forceps extraction. Your patient is a 21-year-old male with poorly controlled asthma. You intend to prescribe analgesia for the patient. Which group of analgesics would you avoid in this patient?

Answer 108

NSAIDS

Question 109

List all the essential information that you should include when you are writing an NHS prescription.

Answer 109

* Patient details - name, address , age , date of birth and CHI * Prescriber details : name, address and contact number of practice * Drug name * Drug preparation and dose * Duration of treatment * Frequency of drug * Instructions on how to take the drug * Prescriber signature * Date of prescription and cross out any free space

Question 110

Where would you refer to for the dose and possible complications if a drug you are prescribing?

Answer 110

BNF

Question 111

How long is an NHS prescription for a non controlled drug valid

Answer 111

6 months from the date of prescription

Question 112

A 48-year-old female presents complaining of fluid escape from her nose when she drinks. She had tooth 27 extracted 6 months ago. This was a difficult extraction and she says she has been aware of a ‘hole in her gum’ ever since. You examine her and find a communication between the oral cavity and maxillary sinus. What is the correct clinical term for this problem?

Answer 112

* Oro-antral fistula

Question 113

A 48-year-old female presents complaining of fluid escape from her nose when she drinks. She had tooth 27 extracted 6 months ago. This was a difficult extraction and she says she has been aware of a ‘hole in her gum’ ever since. You examine her and find a communication between the oral cavity and maxillary sinus. Other than fluid escape from the nose when drinking, list 5 patient symptoms that may be elicited on taking the history?

Answer 113

* Xerostomia * Difficulty eating and speaking * Whistle sound when breathing * Halitosis and bad smell * Unable play sound instruments or smoke * Change in taste

Question 114

Briefly describe the operative procedure to treat OAF, assuming appropriate anaesthesia has been achieved

Answer 114

* Remove any necrotic tissue and irrigate * If less than 2mm , encourage bleeding and suture margin to achieve haemostasis * If more than 2mm - carry out a buccal advancement flap and suture

Question 115

On examination there were creamy-white plaques on the oral mucosa, which could be easily removed to leave an erythematous base. What is the most likely clinical diagnosis?

Answer 115

Oral pseudomembranous candidosis

Question 116

two conditions which might be associated with development of pseudomembranous candidosis

Answer 116

* Diabetes (poorly controlled) * HIV (immunocompromised)

Question 117

What is one advantage and disadvantage of mouth swab?

Answer 117

* Site specific * Can be painful

Question 118

What is one advantage and disadvantage of oral rinse?

Answer 118

* More comfortable to the patient * Not site specific so includes microbes which may not be relevant to the diagnosis

Question 119

What should the clinician request the laboratory to do with the microbiology sample?

Answer 119

To identify the microbiological culture and microscopic examination and susceptibility to antifungals.

Question 120

The patient’s condition is sensitive to Fluconazole. Drug interactions may be important with this medication. Name two medicines with which fluconazole may interact and the consequence of the drug interaction

Answer 120

* Warfarin - increase warfarin concentration in the blood therefore increase the risk of bleeding * Statins (simvastatin) - increase the risk of statin side effects such as myopathy and hepatoxicity

Question 121

Why does herpes simplex becomes recurrent?

Answer 121

* Due to its ability to establish latency in the host after initial infection at young age , where it stays dormant in the trigeminal ganglion , reactivation to the virus happens due to triggers such as stress and immune suppression causing the virus to replicate and lead the clinical presentation

Question 122

Give a topical preparation suitable for treating Herpes labialis, including drug name, preparation strength and instructions to be given to the patient

Answer 122

Aciclovir cream 5% Send = 2g Label = Apply to lesion every 4 hours (5 times daily) for 5 days

Question 123

If a patient with herpes labialis , with persistent lesions that do not respond to aciclovir cream , what other preparation would you give to the patient?

Answer 123

Aciclovir tablets 200mg 25 tablets, 5 tablets daily for 5 days

Question 124

Name 3 known triggers for recurrent herpes simplex?

Answer 124

* Illness or fever (weakened immune system) * Stress * UV light exposure (sun exposure)

Question 125

A fit, healthy 24-year-old female presents with recurrent oral ulceration affecting the buccal mucosa which arise in crops of 2 - 10 and last for 10 days before healing without scarring. She has always had the occasional mouth ulcer but for the past three months she is getting several ulcers at a time with only a short break between one episode and the next. What is the clinical diagnosis?

Answer 125

Recurrent apthous stomatitis

Question 126

A fit, healthy 24-year-old female presents with recurrent oral ulceration affecting the buccal mucosa which arise in crops of 2 - 10 and last for 10 days before healing without scarring. She has always had the occasional mouth ulcer but for the past three months she is getting several ulcers at a time with only a short break between one episode and the next. What blood investigations appropriate for this patient?

Answer 126

* Coeliac disease screening test * Haematinics (iron, folate and vitamin b12) * FCB

Question 127

What is the likely diagnosis based on these blood tests?

Answer 127

* Microcytic anaemia

Question 128

Give 2 possible causes for microcytic anaemia?

Answer 128

* Iron deficiency * Thalassemia

Question 129

give three topical therapies which could be offered for control of the symptoms of oral ulceration?

Answer 129

* Chlorhexidine mouthwash * Benzydamine mouthwash * Betamethasone mouthwash

Question 130

What is a supernumerary tooth?

Answer 130

* An additional tooth or toothlike entity to the normal number in the dentition

Question 131

In which part of the mouth do most supernumerary teeth occur?

Answer 131

Upper anterior ( between 11 and 12)

Question 132

Supernumerary teeth can be classified according to their position or shape. List and describe four different morphological types of supernumerary teeth you know?

Answer 132

* Conical - peg shaped * Tuberculate - barrel shape and usually in a pair * Supplemental - same morphology as original tooth * Odontome - can be complex of compound made out of dentine, pulp and enamel tissue

Question 133

What 4 effects can supernumerary teeth have upon the permanent dentition?

Answer 133

* Delayed or failed eruption * Crowding * Diastemas * Ectopic path of eruption * Impaction

Question 134

A 9-year-old presents and you discover that they have a persistent thumb sucking habit. What occlusal changes might you see?

Answer 134

* Proclined uppers incisors * Retroclines lower incisors * Anterior open bite * Unilateral posterior crossbite * Narrow upper arch

Question 135

What is the BSI definition of class 2 division 1?

Answer 135

Lower incisors edge occludes posterior to the cingulum plateau of the upper incisors with the upper incisors proclined of average inclincation * overjet is increased

Question 136

A patient wears a Twin-block appliance for 9 months and their overjet is reduced from 10mm to 2mm. List six possible changes that functional appliances can produce to allow this.

Answer 136

* Tipping of teeth - retroclined upper incisors proclined lower incisors * Dentoalveolar compensation Maxillary incisors move towards palate (posteriorly) Mandibular incisors move anteriorly towards lips * Restrict maxillary growth * Promotes mandibular growth

Question 137

You have conducted a clinical and radiographic examination of a 6 year old child. You have decided to provide a primary molar pulpotomy on tooth 55. 4 indications for a pulpotomy on a primary molar?

Answer 137

* Medical history precludes extraction * Pulpal exposure more than 1mm * The primary tooth should be maintained as successor is absent * Good patient co-operation * Caries into 2/3rds of dentine

Question 138

Describe the stages involved in the primary molar pulpotomy?

Answer 138

* LA + dam + caries removal if present and remove pulp chamber and access the pulp * Remove coronal necrotic pulp tissue 2-3mm using high speed and irrigate until healthy pulp is achieved * Achieve haemostasis by CW soaked in saline in the pulp chamber for 2 minutes , once achieved * Then restore tooth by placing CoOH and GI then SCC * Give post operative instructions

Question 139

When factors during a pulpotomy influence the decision of proceeding to pulpectomy?

Answer 139

* Hyperaemic pulp or no bleeding (haemostasis is not achieved) * Extent of infection is beyond coronal pulp

Question 140

A 9-year-old child with Down Syndrome attends your clinic for the first time for routine care. Name 4 associated medical conditions that down syndrome children have an increased chance of presenting with during their childhood?

Answer 140

* Congenital heart defects * Hearing loss (deafness) * Leukaemia * Epilepsy

Question 141

What are four classical presenting extra oral features involving the head and neck of a child with down syndrome?

Answer 141

* Flat nasal bridge * Widely spaced almond shaped eyes * Small low-setting ears * Class 3 skeletal base profile * Brush-field spots on iris

Question 142

Name 6 possible intra-oral manifestations of down's syndrome?

Answer 142

* Microdontia * Hypodontia * Macroglossia * Fissured tongue * Anterior open bite * Increased risk of caries and periodontal disease * Malocclusion

Question 143

Discuss the impact of the patient’s condition of down's syndrome on the preventive care and treatment that will be provided? Give six examples.

Answer 143

The patient is at high caries risk so enhanced prevention is necessary due to the higher risk of developing caries and periodontal disease , the patient may require the following in their prevention: * High fluoride toothpaste 1500ppm as the child is 10 years old * Brushing and oral hygiene instruction with demonstration , chairside at every dental visit * Education about their high risk of caries and making sure they understand the impact of the condition on their dentition * Fluoride varnish 4 times a year * Fissure seal all pits and fissures using GIC due to poor moisture control * Diet diary and diet advice to avoid sugary drinks and snacks and replace them with healthy options * Take radiographs (bitewings) every 6 months to detect any early lesions * Increase number of recall appointments * Consent capability and if they investigate who is the legal guardian * Advice on the use of CHX mouthwash

Question 144

You have started work in a new practice and an 11 year old patient attends for a check-up. In her notes you see that she sustained a lateral luxation injury to tooth 11 around 18 months ago. Suggest six clinical assessments or investigations you would carry out as part of the patient’s trauma review. (3 marks)

Answer 144

* Colour * Mobility * TTP * Sinus - tenderness in sulcus * Sensibility testing - EPT and ECT * Radiographs of the tooth (Periapicals)

Question 145

What type of resorption is affecting tooth 11? What makes it progress and what is the treatment plan?

Answer 145

* External inflammatory root resorption * Infection of bacteria due to pulp necrosis following trauma makes it progress * Remove cause , root canal treatment

Question 146

You warn the patient and parent that the long term prognosis for the tooth is poor if the resorption fails to stop. What would you tell them about immediate, intermediate and long-term treatment options should the resorption continue?

Answer 146

* Immediate - manage pain with analgesia * Intermediate - monitor the tooth clinically and radiographically to detect ant changes * Long term - extract the tooth and maintain space for definitive restoration such as implant, resin retained bridge or removable partial denture

Question 147

List three side effects directly associated with the chronic use of the drug Cocaine on the structures of the head and neck and oral tissues

Answer 147

* Oral ulceration * Wear due to bruxism * Perforation of the nasal septum

Question 148

List two complications that may arise in the dental surgery if local anaesthetic with adrenaline is administered to a patient who has recently abused cocaine?

Answer 148

* Hypertensive crisis * Cardiac arryhthmia * Severe mood swings

Question 149

List 4 negative side effects of opiate abuse?

Answer 149

* Addiction * Vomiting and nausea * Drowsiness * Headaches * Respiratory depression * Death

Question 150

What chemical class of drugs does methadone belong to ?

Answer 150

* Synthetic Opioids

Question 151

Methadone can be taken orally. Two formulas exist, one which contains sugar and an alternative formula which is sugar-free. List two environmental or lifestyle factors which increase the risk of dental caries for an individual who is prescribed methadone ?

Answer 151

* Poor oral hygiene * Low socioeconomic status * High sugar diet

Question 152

Methadone can be taken orally. Two formulas exist, one which contains sugar and an alternative formula which is sugar-free. Name one negative aspect associated with the prescribing of sugar free methadone which may lead to harm ?

Answer 152

Sugar free methadone lacks chloroform therefore the patient can inject this increasing the risk of adverse effects such as HIV transmission of disease through needle use

Question 153

Give 4 reasons for cleaning surgical instruments?

Answer 153

* Remove gross contamination * Remove any restorative material from the instrument * Aid disinfection process of instrument * Ensures that equipment is functioning optimally

Question 154

Why is testing of washer disinfector and sterilisers so important?

Answer 154

* It is a medical legal requirement and ensure it is working optimally , effectively and efficiently

Question 155

What are the five stages of the washer disinfector and explain why each stage is important ?

Answer 155

* Flush - remove gross debris * Wash - mechanical (water) and chemical (detergent) and heat removes any debris to aid disinfection and prevent debris from sticking to instrument during disinfection * Rinse - to remove any residue of detergent by rinsing the instruments by water * Disinfection - steam helps kills microorganisms * Dry - removes moisture the instruments are dry after the process