2020 june

Question 1

Question 1: Restorative Diagnosis

Possible diagnoses

1. Gingivitis
2. Localised Periodontitis
3. Generalised Periodontitis
4. Dentine Hypersensitivity
5. Lesion of endodontic origin with periodontal involvement
6. Lesion of periodontal origin with endodontic involvement
7. Occlusal trauma
8. Periapical periodontitis
9. Periodontal abscess
10. Reversible pulpitis
11. True combined periodontal-endodontic lesion

For each of the following scenarios select the MOST LIKELY diagnosis from the terms in the table above and answer the supplementary questions.
Each answer may be used once, more than once, or not at all.

1. A patient presents with a 7 mm pocket that is discharging pus, on the mid-buccal aspect of tooth 26. The tooth is non-vital and there is very little pathological periodontal pocketing elsewhere in the patient’s mouth.
   i) What is the most likely diagnosis from the above list?
   (1 mark)

ii) Give TWO anatomical factors that may be responsible for the location of the discharging pocket?
(2 marks)

iii)	What treatment would you perform? 
(3 marks)
 
Possible diagnoses
1.	Gingivitis
2.	Localised Periodontitis
3.	Generalised Periodontitis
4.	Dentine Hypersensitivity
5.	Lesion of endodontic origin with periodontal involvement
6.	Lesion of periodontal origin with endodontic involvement
7.	Occlusal trauma
8.	Periapical periodontitis
9.	Periodontal abscess
10.	Reversible pulpitis
11.	True combined periodontal-endodontic lesion

2. A 35-year-old patient presents complaining of mobility of tooth 34, which he feels is becoming worse. On examination, tooth 34 demonstrates Grade II mobility. There is no attachment loss but there is evidence of moderate toothwear affecting a number of teeth, likely attributable to attrition. Radiographic examination reveals generalised widening of the periodontal ligament space of tooth 34 and the tooth responds positively to sensibility testing

i) What is the most likely diagnosis from the above list?
(1 mark)

ii) Describe how would you manage this patient?
(3 marks)

3. A 60-year-old patient presents complaining of generalised bleeding gums. There are CPITN scores of 4 in each sextant, with 78% sites showing bleeding on probing. A panoramic radiograph shows generalised horizontal bone loss, with 50% alveolar bone loss at the worst sites. The medical history is clear and the dentition is only lightly restored.

i) What is the most likely diagnosis from the above list?
(1 mark)

ii) Which Stage AND Grade would you attribute to this case?
(1 mark)

iii) What is the single most important factor to determine from the social history?

										(1 mark)             

 
Possible diagnoses
1.	Gingivitis
2.	Localised Periodontitis
3.	Generalised Periodontitis
4.	Dentine Hypersensitivity
5.	Lesion of endodontic origin with periodontal involvement
6.	Lesion of periodontal origin with endodontic involvement
7.	Occlusal trauma
8.	Periapical periodontitis
9.	Periodontal abscess
10.	Reversible pulpitis
11.	True combined periodontal-endodontic lesion

iv) What further investigations would you carry out?
(2 marks)

4. A patient presents complaining of a constant throbbing pain from the right side of her mandible. This has kept her awake at night. On examination, you establish that tooth 46 is grossly carious and is tender to percussion.

i) What is the most likely diagnosis from the above list?
(1 mark)

ii) What further investigations might you perform?
(2 marks)

iii) What are the best treatment options for relief of the patient’s pain?
(2 marks)

Answer 1

1. (i) Lesion of endodontic origin with periodontal involvement
   (ii) Furcal Canal – pathology breaking through into the furcation explaining the mid-buccal aspect. Palatal root stopping pathology from expanding up palatal side, therefore periodontal involvement expresses buccally where it is less inhibited.

(iii) *primary Endodontic Therapy – Root canal and coronal restoration
* Periodontal Therapy within 10 days – supra and sub gingival scaling
* Surgical investigation and treatment – open flap debridement? Emdogain – promotes periodontal fibre regeneration.

2. (i) Occlusion trauma

(ii) *Control plaque induced inflammation – OHI, scale & polish etc
* Correction of occlusal relations
* Splinting

3. (i) Generalised periodontitis.
   (ii) Grade B Stage 3 (severe), unstable
   (iii) Whether or not they are a smoker and if they have just quit.
   (iv) 6Point pocket chart on whole mouth, plaque and gingivitis index
4. (I) Periapical periodontitis
   (ii) Periapical radiograph of tooth, sensibility tests with ethyl chloride and electric pulp test
   (iii) Root canal treatment, extraction

Question 2

Question 2: Endodontics

A patient has attended complaining of pain related to tooth 14. Following a complete history and clinical examination you have made a diagnosis of irreversible pulpitis. Having explained the diagnosis to the patient you have obtained consent to perform root canal treatment.

1. What number of canals are found, most often, in an upper first premolar? (1mark)
2. During instrumentation of the canal where is considered the ideal end point of shaping/obturation?
   (2 marks)
3. What is the term for maintaining communication between the pulpal space and peri-radicular tissues?
   (1 mark)

You have satisfactorily anaesthetised and isolated the tooth. After accessing the pulp chamber of tooth 14, you aim to identify the working length of the canals identified.

4. What is a working length in endodontics?
   (2 marks)
5. What TWO common intra-operative radiographs can be utilized during endodontic treatment to aid working length determination?
   (2 marks)
6. Please state 2 potential causes of a corrected working length changing during the course of endodontic shaping?
   (2 marks)

Answer 2

1. 2 most often (1-3)
2. 1 mm away from the apical foramen and up to the beginning of the pulp chamber
3. Lateral canals that can communicate with the periodontal tissues, that have been left unobturated.
4. Working length (determined by a radiograph or an apex locator) is the ideal length to which the canal should be shaped and obturated and falls 1mm short of the apical constriction, it is within the green area of the apex locator, found by reaching red reading and retracting by 1mm.
5. Working length periapical radiograph with a 10-15 file in the canal, a periapical with the master cone inserted (should be at corrected working length)
6. Blockage of the canal or apical transportation

Question 3

Question 3: Periodontology

A 27-year-old female patient presents at your practice, complaining of sore gums and bad breath. She is a smoker and is in the middle of university exams. Her medical history is unremarkable. The symptoms have been present for 3 days. She has felt feverish for 24 hours. On examination, extra-orally, there is presence of lymphadenopathy and the clinical appearance, intra-orally, is as shown in the photograph. A panoramic radiograph shows no abnormalities.

1. What is your diagnosis?
   (1 mark)

You provide oral hygiene instruction, and gentle debridement with an ultrasonic scaler. You also decide to prescribe a systemic antimicrobial.

2. Which systemic antimicrobial is most appropriate for the condition illustrated in the picture?
   (1 mark)
3. For the antibiotic you have suggested in the above answer what is the dose, daily frequency and total duration of administration
   (3 marks)
4. Write down THREE specific warnings you would give the patient about the antibiotic you have selected?
   (3 marks)
5. What follow up care would you arrange for the patient?
   (2 marks)

Answer 3

1. Acute Necrotising ulcerative gingivitis
2. Metronidazole
3. 400mg and she should take it 3 times a day for 7 days
4. Chlorhexidine can cause reversible tooth coloring if used for prolonged period of time , it can cause loss of taste and tingling of the tongue and also can cause pain to the inflamed gingival. Make sure to use half an hour after brushing otherwise the active ingredient of chlorhexidine will be deactivated by the toothpaste.
   (3 marks)
5. That they might feel sick.
   They might get a metallic taste in their mouth, this is called drug mouth and will go away when you stop taking the antibiotic.
   Do not drink alcohol while taking the antibiotics.
   *watch alcohol intake
   *It increases the anti-coagulant effect of warfarin
   *Do not take if you are pregnant
6. HPT- OHI, sub and supragingival scaling
   Periodontal surgery if required
   Smoking cessation advice and if interested refer on

Question 4

Question 5: Ceramics

All porcelain is ceramic but not all ceramic is porcelain.

1. What are the two main differences in composition between decorative and dental ceramic.
   (2 marks)

Ceramics are the most aesthetic materials used in dentistry.

2. Explain what the following terms mean with regard to optical properties of the materials.
   i) Translucency: (2 marks)
   ii) Opalescence : (2 marks)

Silane coupling agents are used when bonding composite to most ceramic surfaces.

3. How can you modify the ceramic surface to make it more retentive prior to using silane?
   (1 mark)
4. Chemically how does a silane coupling agent work when bonding composite to ceramic?
   (2 marks)

Silane coupling agents are a component part of composite resin materials

5. What is the function of silane in a composite restorative material?
   (1 mark)

Answer 4

1. (Decorative has a much higher percentage of Kaolin, Dental has a much higher amount of feldspar)+(dental ceramics contain glass whilst decorative don’t.)
2. (i) how much light is allowed through the material
   (ii) helps scatter light, gives the tooth more of an orangey colour making it look a lot more natural.
3. Etch the surface with acid
4. It forms c=c bonds with the etched porcelain and bonds to the composite resin
5. It works as a wetting agent

Question 5

Question 6: Study Evaluation

Please read the following reference material, adapted from a research paper

Objective
The purpose of this study was to evaluate the potential benefit of an ultrasonic device in apical surgery on the outcome of treatment.

Study design
Patients were referred for apical surgery on one of their previously endodontically treated teeth. The patients were randomised into two groups. One group was allocated to treatment with an ultrasonic device and the second group allocated to treatment with a bur in an otherwise similar protocol. One year after treatment the results were evaluated using both radiological and clinical criteria by two oral surgeons who were blinded for the therapy.

Results
A total of 399 patients were recruited to the study. One-year follow-up data were obtained from 290 patients (141 bur and 149 ultrasonic). The table presents the overall results

1. What is the most appropriate primary study design to “to evaluate the potential benefit of an ultrasonic device in apical surgery on the outcome of treatment”?
   (1 mark)
2. List the FOUR main features of this study design:
   (2 marks)
3. Choosing ONE of these features, describe how you would implement it in the above study:
   (2 marks)
4. In relation to the Absolute risk difference and the 95% Confidence Interval, what conclusion would you draw from the table? Explain your answer.
   (2 marks)
5. List FOUR patient-related factors which should be considered when interpreting the results:
   (2 marks)
6. Name the standards developed to improve the reporting of randomized controlled trials?
   (1 mark)

End of Question

Answer 5

1. Randomised control trial
2. Blinding or masking of the participants to minimse bias, characteristic inclusion and exclusion criteria, specification of participants and control comparison groups
3. Blinding the participants: the dentists evaluating the end results would not know what technique was used.
4. The evidence is insufficient because the confidence interval overlaps zero
5. When was the tooth treated, medical history of the patients should be matched, the tooth should be the same if possible, the initial reason for root treatment should be matched.
6. CONSORT

Question 6

Question 7: Smoking Cessation

1. A 56 year old male patient comes to the dental practice for a routine dental examination.You can see from the notes that he smokes 20 cigarettes per day. What other questions would you ask him around his tobacco use and to ascertain whether he would be interested in quitting?
   (4 marks)
2. He admits that he feels that he is very dependent on tobacco. Give a definition of dependence.
   (1 mark)
3. Name one model/approach that could be used to help him quit?
   (1 mark)
4. There are various evidence- based treatments that can be used to help support patients who want to quit smoking. Give TWO examples
   (2 marks)
5. After you gathered your information on his smoking and quitting habits, your patient tells you that now is not the right time for him to quit due to personal circumstances. What should you do now?
   (2 marks)

Answer 6

1. What kind of cigarettes does he smoke, has he tried quitting in the past, how long has he been smoking for, would he like any support in quitting. (Age started smoking/ cigarettes or roll ups/ number of years a smoker/how many attempts to quit smoking)
2. (A compulsive craving to use a drug despite its harmful consequences)
3. The A approach of smoking cessation: Ask, Advise, Act, Assist, Assess, and arrange followup
4. Cognitive behavioural therapy and Smoking cessation.
5. You should ask the patient if there is something he would like to discuss with you, and you reassure that you understand it may be a difficult time, you don’t pressure the patient and you let them know that you are there for them if they would be interested in being referred in the future.

Question 7

Question 8: Late Erupting
An 8-year-old boy in the mixed dentition attends your surgery complaining that he does not like the look of his front teeth (see photograph above). The deciduous tooth upper incisor became black and firm 3 years ago and fell out recently. He has no relevant medical history.

1. What feature of the patient’s dental history is it important to determine?
   (1 mark)
2. What part of the physical examination is important?
   (1 mark)
3. What radiographic view would be most suitable for this child?
   (1 mark)
4. Given the history, give an account of the sequence of events that have most likely caused non-eruption of upper central incisor?
   (2 marks)
5. Give ONE other possible cause of non-eruption of the upper central incisor in this case?
   (1 mark)

 
6. What are the principles of the orthodontic management of non-eruption of upper central incisors?
(4 marks)

End of Question

Answer 7

1. What caused the deciduous to fall out? Trauma or caries?
   Brushing habits and any other caries present and caries risk.
2. Check for presence of canines, count the teeth and assess if they are in chronological accordance to the age of patient and their timing. check caries.
3. OPT
   4.Patient potentially fell and hit the tooth which became non vital and fell out. During the trauma the permanent successor germ was traumatised and either fell out together with the deciduous or has been pushed and become ectopic and has yet not come through.
4. (adjacent teeth encroaching on eruption space?)
5. Xray to see if the tooth is present and palpate, if it is expose the tooth and bond it, create space to pull down and align and monitor for 1.5 year. If the tooth is not present then consider balancing extraction.

Question 8

A 17-year-old boy attends your surgery complaining that he does not like the look of his front teeth. He requests advice about orthodontic treatment (see photographs above). He has no relevant medical or dental history.

1. Describe TWO clinical ways to assess the antero-posterior skeletal relationship
   (2 marks)
2. Describe TWO clinical ways to assess the vertical skeletal relationship
   (2 marks)
3. How should the patient’s head be positioned during these clinical assessments?
   (1 mark)
4. Looking at the intra-oral photograph, what is the patient’s incisor relationship?
   (1 mark)
5. What is the British Standard Institute’s definition of this relationship?
   (2 marks)
6. How would you describe the patient’s skeletal relationship in terms of growth or development?
   (2 marks)

End of Question

Answer 8

1. Skeletal assessment visually and direct palpation of skeletal position by measuring the difference between innermost curvatures of upper and lower lip with fingers.or lateral cephalometry and Eastman analysis.
2. FMPA (Frankfort mandibular plane angle) or using cephalometric values to measure the face types with percentages using lateral cephalometry
3. Straight by looking at their own eyes in the mirror. With the Frankfort plane being parallel to the floor.
4. Class III
5. Lower incisor edges occlude with or fall anterior to the cingulum plateau of the upper incisors. There is also a reduced overjet or reversed overjet.
6. There is a mandibular hyperplasia and prognathism or maxillary hypoplasia, potentially parents are similar.

Question 9

Question 10: Panaromic Radiology

1. Which external reference plane of the patient should you position horizontally when setting up for a panoramic radiograph?
   (1 mark)
2. When you look at the radiograph you have taken, some of the teeth are horizontally distorted. Which positioning error results in the following:

i) The incisor teeth being horizontally magnified
(1 mark)

ii) The posterior teeth on one side being wider than on the other
(1 mark)

3. The patient is unable to remove their earrings with the result that there are ghost images of the earrings. Give THREE important features that apply to all ghost images.
   (3 marks)
4. What panoramic radiograph would you ask to be taken in the following clinical situations:

i) A pre-extraction radiograph for partially erupted 48, when there is no evidence of 38 in the mouth; 48 is to be extracted under local analgesia
(1 mark)

ii) For a child patient with caries, who cannot tolerate bitewings
(1 mark)

5. The maxillary sinus is depicted in a panoramic radiograph. Which margins or walls are seen in the following locations:

i) Horizontally above the roots of the premolars and molars.
(1 mark)

ii) Vertically above the third molar region.
(1 mark)

End of Question

Answer 9

1. Frankfort plane
2. (i) Patient too far back in the machine
   (ii) The patient moved while the radiograph was taken
3. They are on the contralateral side to their real position, they are higher up than what they are in reality and they are horizontally magnified
4. (i) OPT
   (ii) OPT
5. (i) inferior border
   (ii) Posterior border

Question 10

Question 11: Paeds

A 4-year-old child is brought to your surgery complaining of severe pain and sleep loss for the last six weeks. The child is a new patient to your practice. On extraoral examination you notice that the child has bruising on their right cheek and a small abrasion on their right temple (see photograph above).

1. What might you be concerned about as a result of seeing this child?
   (1 mark)
2. Which TWO parts of this presentation led you to have concerns regarding this?
   (2 marks)
3. Suggest TWO questions which you would ask next to further investigate your concerns? (2 marks)
4. You decide that some aspect of the response to these questions warrants further action. Who should you discuss this with?
   (1 mark)
5. As a result of this onward discussion what THREE different courses of action may take place?
   (3 marks)
6. You establish the only concern is regarding dental caries. After ensuring the painful tooth is treated you tell the parent that the child has a number of other carious teeth requiring attention and make two appointments for them to come back. The parent fails to bring the child back for either of these appointments. What should you do next?
   (1 mark)

Answer 10

1. Child abuse and negligence
2. The fact that the bruise is in an area that couldn’t be easily caused by an accidental injury , and that they have been in pain for so much as six weeks with sleep loss and haven’t been brought in earlier.
3. Ask the child how did they get the bruise and ask parents how and when did it happen?
   Have the parents seeked medical attention for the pain or the bruising?
4. (social services or health visitor?)
5. Talk to the parent and record in the notes, liase with other professionals such as the gp, Refer to Child protection or social services
6. (Write to a health visitor and ask them to visit)

Question 11

Question 12: Paeds/Ortho

A 9-year-old poorly co-operative child attends your surgery with gross caries evident clinically in teeth 16, 36 and 46. The prognosis of these teeth is poor and they require extraction. All other teeth are caries free.

1. What special investigation would be appropriate for this patient?
   (1 mark)
2. What information are you ideally looking for to establish the suitability of the timing of these extractions?
   (2 marks)
3. Detail your management of tooth 26.
   (1 mark)
4. List TWO advantages of extraction of first permanent molars of poor prognosis at this stage of development?
   (2 marks)
5. List TWO disadvantages of extraction of first permanent molars of poor prognosis at this stage of development?
   (2 marks)
6. What might this child require to enable these extractions?
   (2 marks)

End of Question

Answer 11

1. (OPT)
2. Check if the 7 is developed, ideally at formation of the bifurcation and if the 8s are present, check for crowding
3. Since the 36 is extracted then the 26 must be extracted for compensation
4. The 7s that will erupt will mesially close the space and also there will be a caries free dentition with no spaces.
5. Will need to extract the 26 which is caries free only to compensate and it is can be difficult and quite scary for the child .
6. GA or conscious sedation.

Question 12

Question 13: Oral Surgery

You assess that your patient requires removal of teeth 25 and 26 due to caries. The patient has never had teeth taken out before. When discussing their medical history, you elicit they take Warfarin for Atrial Fibrillation.

1. What type of drug is Warfarin AND what is its mechanism of action?
   (2 marks)
2. Which test must be carried out prior to the extractions
   (1 mark)
3. Which guidance document would you refer to for advice on dealing with patients on Warfarin AND within what timeframe should this test be carried out prior to the extractions
   (2 marks)
4. Below what level would it be safe to continue with extractions?
   (1 mark)

You arrange an appointment for treatment and this is carried out uneventfully.
They return the next day complaining they have been bleeding all night.

5. Outline options that you could carry out clinically to deal with this post-operative bleeding.
   (3 marks)
6. If following your interventions, you still could not stop the bleeding – what would you do?
   (1 mark)

End of Question

Answer 12

1. Warfarin is an anticoagulant (coumarin) acting on inhibiting vit K dependent reactions of coagulation cascade and factors S,C and Z causing the clotting factors 2,7,9,10 to be inhibited.
2. INR test
3. Management of Dental Patients Taking Anticoagulants or Antiplatelet Drugs SDCEP/ 24 hours
4. The INR should be below 4
5. Use a oxidized cellulose collagen or gelatine sponge in the socket (caltostat or surgical, use LA with adrenaline as a vasoconstrictor or suture the socket.
6. Refer the patient to A&E

Question 13

Question 14: Oral Surgery

A fit and healthy patient presents to the surgery to have the surgical removal of a carious 48.

1. Anatomically, which nerves must be anaesthetised to remove this tooth safely?
   (3 marks)
2. List TWO different ways you could assess that anaesthesia has been achieved?
   (1 mark)
3. The patient presents one week later with neuro-sensory deficit affecting the right chin and lip region. Using the descriptions below provide the dental terminology.
   (3 marks)
   i) pins and needles feeling, or partial loss of sensation:

ii) painful, unpleasant or neuralgic sensation that lasts for a fraction of a second:
iii) total loss of sensation

4. Give THREE clinical reasons that could account for this neuro-sensory deficit.
   (3 marks)

End of Question

Answer 13

1. Inferior alveolar nerve and ligual nerve on the right side, part of the right mental nerve should feel numb.
2. Poke around the soft tissues of the tooth with a sharp probe, check if the lip on the right side is anaesthetised.
3. (i) paraestesia (pins and needles) or hypoaesthesia (partial loss)
   (ii) dysaesthesia or trigeminal neuralgia
   (iii) Anaesthesia
4. (Root of tooth was too close to the nerve causing trauma upon extraction/LA needle pierced the nerve upon injection/pressure pushed on to the nerve during the procedure has led to damage/bruising)

Question 14

Question 15: Cerebral Palsy

You are working as a General Dental Practitioner. The dental practice in which you work cannot be accessed from street level as it is situated in a building one level above ground.

A 24-year-old male with cerebral palsy, who uses a wheelchair, arrives with his carer and wishes to gain access to your dental surgery premises.

1. Adjustments can be made to a building to improve access for someone using a wheelchair.

Name TWO adjustments that will allow a person in a wheelchair access to your above ground level dental practice.
(1 mark)

2. Legislation in the U.K. has sought to ensure that all new dental practice premises are built to allow people with an impairment or disability equal access.

Name TWO relevant Acts of Law.
(2 marks)

3. This gentleman could be described as being a person with a disability.

The definition of disability varies between the medical model and the social model. Briefly describe the difference between the two models in their definition of disability.
(2 marks)

4. The patient is unable to communicate with you verbally. Due to his cerebral palsy he is unable to communicate using sign language or pen and paper.

List TWO other augmentative and alternative communication methods which could be utilised for this gentleman.
(2 marks)

 
5. Having gained consent from this patient, you are now required to examine him. You are unable to do this safely with him in his current position in his wheelchair. He is unable to weight bear.

Name TWO options that are available to allow for the improved positioning of this gentleman to allow for safe dental examination.
(1 mark)

6. Having positioned the patient correctly, you are now required to access the patient’s mouth.

i) Which particular aspect related to his cerebral palsy may affect the dentist’s access to the mouth?
(1 mark)

ii) What non-pharmacological adjuncts are available to overcome this and aid the dentist’s access to the mouth?

       Name TWO aids.
								(1 mark)

End of Question

Answer 14

1. Ramps with handles,big enough doors to allow passageway of a wheelchair with a turning point.
2. (Disability Discrimination Act 2004)
   (The Equality Act 2010)
3. (Medical says people are disabled because of their impairments and should look to be fixed by treatment
   Social disability – refers to societal problems and the way that society is organised and not down to the persons impairment)
4. (computers that track eye movement to help form sentences/agree to a gesture that means yes or no and use yes or no questions.)
5. Hoist or a wheelchair recleiner
6. (i) It may be difficult for him to turn to face straight or difficult to open mouth fully with muscles being stiff or uncontrolled movements.
   (ii) (plastic mouth openers/tongue depressors)

Question 15

Question 16: Learning Disability

Mark, a 50 year old male, attends your general dental practice. He has a diagnosis of Down’s Syndrome and was born with a congenital heart defect.

1. List FOUR physical characteristics which are associated with Down’s Syndrome
   (2 marks)
2. To confirm a diagnosis of Down’s Syndrome a genetic test is undertaken. What genetic change is responsible for Down’s Syndrome?
   (1 mark)
3. Mark requires the extraction of his remaining six teeth. Following assessment you decide he lacks the capacity to consent to this treatment.

List TWO medical aspects of Down’s Syndrome which may have resulted in his lack of capacity.
(1 mark)

4. Mark’s mother is legally registered as his Welfare Guardian.
   Considering the Adults with Incapacity (Scotland) Act 2000, List TWO differences between a Welfare Guardian and a Welfare Power of Attorney?
   (2 marks)
5. Mark requires the removal of his remaining six teeth as a result of periodontal disease.List TWO features associated with Down’s Syndrome that are likely to have contributed to his periodontal disease?
   (2 marks)

 
6. Mark has previously experienced Infective Endocarditis. In line with SDCEP guidance he will require antibiotic prophylaxis for the removal of his 6 remaining teeth. He has no known allergies.

i) What antibiotic and what dose of antibiotic should be prescribed for Mark?
(1 mark)

ii) When should you provide and observe Mark taking the antibiotics prescribed?
(1 mark)

End of Question

Answer 15

1. (slanting eyes/short and broad hands/class 3 skeletal relationship/shorter in stature)
2. Trisomy to chromosome 21 or partial extra copy of chromosome 21
3. (intellectual impairment/Alzheimer’s dementia)
4. (guardian is court appointed – POA appointed by individual) (POA is in force until individuals death – guardian has to be reviewed and can expire)
5. Patient may be immunocompromised with gingival fibroblasts being unable to migrate to regenerate the periodontal tissue and poor positioning of teeth can lead to plaque traps and they patient may be unable to clean due to learning disability.
6. (i) (3g amoxicillin sachet)
   (ii) (3g amoxicillin sachet 60 mins before procedure???)

Question 16

Question 17: Cancer

Mr Clarke is a 67-year-old who presents to your general dental practice complaining of black staining on his teeth. He is otherwise asymptomatic.
Mr Clarke received treatment for mouth cancer 15 years ago. This included surgery with adjuvant radiotherapy. He is currently disease free.
He is prescribed no medications.
1. List FOUR risk factors for mouth cancer
(2 marks)

2. Mr Clarke received adjuvant radiotherapy to treat his mouth cancer. What TWO additional pieces of information do you require to know about the radiotherapy treatment he received?
   (2 Marks)
3. What dose of radiotherapy delivered to the primary tumour increases the risk of osteoradionecrosis
   (1 Mark)
4. Describe the pattern of decay evidenced, which is unique to radiation caries.
   (1 Mark)

 

5. Following clinical investigation, the coronal tooth structure of all the remaining teeth is found to be extensively decayed and therefore deemed unrestorable.

How would you manage these teeth given that that Mr Clarke is at an increased risk of osteoradionecrosis?
(1 mark)

6. List TWO oral complications associated with radiation therapy, other than osteoradionecrosis and radiation caries, to the head and neck.
   (1 mark)
7. List TWO preventative measures that should be implemented to reduce the risk of future dental disease for patients who have received radiotherapy to the head and neck.
   (1 mark)
8. List ONE management strategy for established osteoradionecrosis of the jaw?
   (1 mark)

End of Question

Answer 16

1. Smoking, drinking, age, genetics and family history(UV light exprosure/leukoplakia)
2. Which area was treated by radiation and what dose.
3. 50 grey and above
4. (rampant caries on incisal edges and cervical margins)
5. Cannot extract the teeth so root treat the teeth and maybe restora some with GI or keep roots but root fill them and remove crowns to make a denture but keep the roots to avoid resorbtion.
6. Xerostomia and ulcerations mucositis.
7. Make sure that the patient is dentally fit and manage patient with a treatment plan before they have their radiotherapy, ensure correct ohi is maintained before and after the treatment as well as use duraphat. (Pentoxyfylline/Vitamin E)
8. (saline irrigations and antibiotics during infectious periods)

Question 17

Question 18: Decontamination

The following questions relate to a Local Decontamination Unit.

1. Personal Protective Equipment (PPE) must be worn when carrying out manual washing of used instruments. Provide THREE examples of PPE and describe what EACH ITEM is protecting you from.
   (3 marks)
2. What TWO methods are used for manual cleaning of instruments. For each of these give an example of an instrument cleaned in this way
   (2 marks)
3. i. How often should an ultrasonic cleaner be de-gassed.
   (1 mark)ii. What is removed by de-gassing
   (1 mark)iii. Why is it important to do this?
   (1 mark)iv. Provide one good reason why dental handpieces should not be placed in the ultrasonic cleaner.
   (1 mark)
4. Why is it important to use de-mineralised water in the sterilizer?
   (1 mark)

End of Question

Answer 17

1. Marigold gloves to protect hands from the detergents, full facemask to protect any debri or detergents getting in the eyes and mouth, apron to ensure no transmission of infection
2. Under water brushing immersion, for instruments that cannot be destroyed by abrasion of scrubbing - extraction forceps
   Or wiping with non linting cloth and detergent for items that get compromised if soaked – highspeed
3. (i) Once a day
   (ii) The oxygen in the water
   (iii) The oxygen in the air will not allow bubbles to form in the ultrasonic cleaner with intensity needed to clean the instruments.
   (IV) Because the inside turbine may be compromised.
4. Because minerals can cause salts to block parts of the sterilizer and create areas for bugs to grow on.

Question 18

Question 19: Microbiology

The oral environment is commonly associated with a selection of different microorganisms that may or may not be surface attached.

1. What term can be used to describe the collective group of microorganisms within the oral cavity AND what are they referred to when attached to a surface?
   (1 mark)
2. i) List the FOUR key microbial stages of caries plaque formation.
   (2 marks)

ii) Name TWO key virulence factors used by Streptococcus mutans to influence enamel dissolution.
(1 mark)

3. i) Name the bacterium associated with secondary endodontic infections
   (1 mark)ii) Name ONE of its key virulence factors?
   (1 mark)
4. i) Why is it difficult to determine causality from a specific bacteria in endodontic infection?
   (1 mark)

(ii) Which antimicrobial is primarily used to disinfect the root canal?
(1 mark)

5) i) What culture independent technique could be used to assess changes in the oral microbial populations following antibiotic exposure?
(1 mark)

ii) What is the limitation of this approach?
(1 mark)

Answer 18

1. Biofilm and attached to a tooth surface they are called plaque
2. (i) (adhesion, survival and growth, biofilm formation, complex plaque)
   (ii) (Adhesive and high tolerance to acidic environments)
3. (i) e. faecalis
   (ii) (adhesive & forms biofilms, produces superoxides to protect itself)
4. (i) Usually more than one type of bacteria in the canal due caries and potential periodontal disease that have migrated into the canal
   (ii) Sodium hypochlorite

5(i) (PCR DNA testing)

(ii) (will take into account microbes that haven’t adapted and died)