2020 Mo

Question 1

A patient has returned to the surgery following an extraction carried out by a colleague earlier in the day complaining of continual bleeding from the socket.

1. List 3 causes that may be contributing to this post-operative complication.
   (3 marks)
2. Outline options for your initial management of this.
   (5 marks)
3. State one pre-extraction blood test that would allow you to test their bleeding/clotting status.
   (1 mark)
4. If you could not stop the bleeding – what would you do?
   (1 mark)

Answer 1

1. Coagulation problems and blood clot formation problem, fragment of bone being sharp inside the socket, patient has been interfering with the clot formation .
2. Reassure patient, make sure they have no blood disorder or on warfarin or other anticoagulant.
   Apply pressure.
   Open and clean the socket with blunt instrument to examine if there are any fragments of broken bone.
   Use caldostat in the socket.
   inject local anaesthetic with adrenaline topically to cause vasoconstriction
   suture socket to promote healing.
3. INR: prothromin to thrombin time
4. Send patient to A&E with a referral

Question 2

Question 2: Orthodontics

1. A 13-year-old girl presents as a new patient for a routine examination. She gives a history of digit sucking. List FOUR occlusal features that can present due to a prolonged digit sucking habit:
   (4 marks)
2. Describe FOUR methods that could be used to dissuade a digit sucking habit?
   (4 marks)
3. Explain the effect that a prolonged digit sucking habit can have on the posterior dentition:
   (2 marks)

Answer 2

1. Anterior open bite, unilateral open bite, narrowing of upper arch and posterior chrossbite, lower incisor retroclined and upper incisors proclined.
2. Fixed Upper appliance, wear gloves, use cremes that taste bad, paint the nails.
3. Due to sucking of the digit the cheeks which are sucked inwards increase pressure on the posteriors, causing narrowing of the upper arch, that way the teeth are not in correct ICP and are forced to shift to a more comfortable position causing an posterior crossbite

Question 3

Question 3: Restorative

A 23-year old female presents to your practice having suffered trauma from a fall on a night out over the weekend. On examination, tooth 11 has lost a sufficient portion of its coronal tissue, exposing a previous root canal treatment.

You take a periapical radiograph which reveals there is no evidence of root fracture and the root canal treatment is adequate within the canal.

The tooth will require a post crown as its definitive restoration. However, the dental laboratory will not be able to construct the restoration for at least two weeks and the patient has a series of important work meetings throughout her upcoming week.

You decide to provisionally restore the fractured 11 chairside with a temporary post crown.

1. List FIVE functions of a provisional restoration in relation to this case.
   (5 marks)
2. What variations of preformed provisional crowns could be available to you for this case?
   (3 marks)
3. What are the disadvantages of preformed provisional crowns in comparison to custom provisional crowns?
   (2 marks)

Answer 3

1. Restore occlusion for speech and eating, Aesthetic, prevent ingress of bacteria inside the root canal, allow gingival healing, allow for planning of the definitive restoration
2. Clear plastic crown, preformed metal crown, fabricated crown made of Protemp.
3. It may be inaccurate as there are limited sizes and shapes, may not be aesthetically pleasing

Question 4

Question 4: Perio

This question concerns tooth mobility.

1. Give FOUR factors that may contribute to increased tooth mobility?
   (4 marks)
2. Give TWO circumstances in which you would decide to intervene in order to try to reduce the mobility of a tooth or teeth?
   (2 marks)
3. In a patient with periodontal disease, following successful hygiene phase therapy would tooth mobility be more likely to increase or decrease? Give reasons for your answer.
   (2 marks)
4. A patient has very mobile lower incisors, which are giving rise to discomfort, but refuses extractions. Radiographic examination demonstrates advanced horizontal bone loss. What would you advise AND what are the disadvantages of this form of treatment?
   (2 marks)

Answer 4

1. Increased pocketing around tooth, pdl damage, root resorbtion or bone loss(osteonecrosis), infection/abscess. (shedding primary teeth)
2. If the teeth have a chance to be saved, and they are causing problems with occlusion or other restorative treatment.
3. Its more likely that mobility will decrease as the periodontal ligament will heal and pockets will become smaller since biofilm has been removed stopping inflammation
4. Splint the teeth to adjacent teeth: this could cause extra periodontal damage and increase in local plaque retention factors as it will be difficult to clean between the fixed splint, you can also offer a removable clear plastic splint, but that could also be difficult to clean.

Question 5

Question 5: PMHP RCT

Researchers at Glasgow Dental School are investigating whether nystatin prevents oral candidosis in patients receiving treatment for head and neck cancer. Before embarking on a research study, the investigators search the literature to establish the current evidence base for this particular question.

1. Which type of study would provide the highest level of evidence for the effectiveness of this treatment?
   (2 marks)
2. The researchers find that there are no good quality, low bias studies published in the literature to answer this question, and decide to design and conduct their own study. What is the most appropriate study design to answer the research question?
   (1 mark)
3. List the FOUR main features of this study design:
4. Choosing one of these features, describe how you would implement it in the above study:
   (2 marks)
5. Name the standards developed to improve the reporting of randomized controlled trials?
   (1 mark)

Answer 5

1. Randomised control trial(systematic review of similar RCT’s)
2. Randomised control trial
3. Have a placebo and comparison group, blind or mask the participants,
   Specify participants, have correct inclusion and exclusion criteria
   Randomised allocation of participants into each group
4. Group the participants by grading and staging cancer of specific types, age and gender, and give one patient nystatin and the other give a placebo drug that is known to have no effect on oral candidosis.
5. CONSORT