2020 paper

Question 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.

What is the diagnosis
Give TWO anatomical factors that may be responsible for the location of the
discharging pocket?
What treatment would you perform?

Answer 1

1. Lesion of endodontic origin with perio involvement
2. Furcation, accessory canals
3. Root canal treatment, observe, RSD for residual pocket if required following 3months after RCT

Question 2

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

Diagnosis
How you would manage this patient

Answer 2

1. Occlusal trauma
2. Occulsal analysis with the use of Millers forceps and thin articulating paper
   Occulsal adjustment to remove any interference on 34
   Preventitive management of parafunction/tooth wear

Question 3

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.

Diagnosis
Stage and Grade
What is the single most important factor to determine from the social history
What further investigations would you carry out

Answer 3

1. Generalised perio
2. Stage 3, Grade B
3. Smoking
4. Plq index, full mouth pocket chart

Question 4

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.

Diagnosis
Further investigations
Best treatment options for relief of patients pain

Answer 4

1. Periapical periodontitis
2. Sensibility testing
   PA or sectional panoramic radiograph
3. Pulpectomy then RCT
   XLA of 46
   `

Question 5

Number of canals found in upper first premolar

Answer 5

2

Question 6

Where is considered the ideal end point of shaping/obturation in endo?

Answer 6

The apical constriction, cemento-dentinal junction

Question 7

What is the term for mainintiang communication between the pulpal space and peri-radicular tissues

Answer 7

Patency

Question 8

What is working length in endo

Answer 8

The extent from the apical terminus of the preparation and a predifined cornoal reference point

Question 9

What 2 common intra-operative radiographs can be utilised during endo to aid working length determination

Answer 9

Corrected working length

Master cone radiograph

Question 10

State 2 potential causes of a corrected working length chaning during the course of endo shaping?

Answer 10

Ledges
Transporation
Zipping
Perforation

Question 11

Which systemic antibiotic is most apporpriate for ANUG

Answer 11

Metronidazole

Question 12

What is the dose, frequency and total duration of adminstration for ANUG

Answer 12

Metronidazole - 400mg, 3 day for 3-5days

Question 13

What 3 specific warnings should be given for the antibiotic for ANUG

Answer 13

Avoid alcohol
Do not take if pregnant
Stop taking antibiotic if any adverse reactions and seek medical advice
Increased risk of oral candidosis

Question 14

What follow up care would you give for a patient with ANUG

Answer 14

Review in 1/2 weeks, HPT, Smoking cessation advice

Question 15

Give a definition of dependence

Answer 15

A compulsive physiological and psychological need for habit forming substance

Question 16

There are various evidence based treatments that can be used to help support patients who want to quit smoking.
give 2 examples

Answer 16

Nictonine patches, gum, onhalers
E cigs
Champix

Question 17

Patient decides he does not want to quit just now, what should you do?

Answer 17

Outline the adivce you gave the patient in the patient’s records so its clear you addressed the topic
Make a note to bring it up at some point in the future to see if he has changed his mind

Question 18

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 patients dental history is it important to determine
2. What part of the physical examination is important
3. What radiographic view would be most suitable for this child
4. Given the history, give an account of thr sequence of events that have most likely caused non eruption of upper central incisor
5. Give 1 other possible cause of non-eruption of the upper central incisor in this case
6. What are the principles of ortho management of non eruption of upper central incisors

Answer 18

1. a history of trauma
2. palptation of the labial sulcus
3. PA
4. Trauma to decidous incisor, leading to dilaceration of permanent successor
5. Unerupted supernumrary tooth preventing eruption, cogential absence
6. Removal of obstruction, create space and observe, if non eruption, expose and place gold chain, ortho traction

Question 19

Which external refernece plane of the patient should you position horizontal when setting up for a panoramic radiograph?

Answer 19

Frankfort plane

Question 20

Postioning error for the incisor teeth being horizontally magnified?

Answer 20

Patient toot far back in the machine or too far away from cassette

Question 21

Positioning error for the posterior teeth on one side being wider than on the other?

Answer 21

Patient is rotated in the machine
or
Patient not being symmetrically between incisors on bite peg

Question 22

Panoramic for a pre extraction radiograph for PE 48 when there is no evidence of 38 in the mouth

Answer 22

Right half panoramic radiograph

Question 23

Panoramic for a child patient with caries who cannto tolerate BW’s?

Answer 23

Orthogonal projection

Question 24

Maxiallary sinus is found on a panoramic. Which margin walls are seens in:

1. Horizontally above the roots of the premoalrs and molars
2. Vertically above the 3rd molar region

Answer 24

1. Inferior or floor

2. Posterior or distal

Question 25

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?

Answer 25

1. The child may be a victim of abuse or neglect 2. Late presentation of severe pain/ sleep loss for 6 weeks Multiple injuries on different parts of the face 3. how did the child sustain the injuries? Has the child had previous injuries seen by someone else? Why was the child not brought along to the surgery earlier? 4. Child protection advisor 5. Further inestigations undertaken and the child portection advisor gets back to you The child is referred directly to the lead paeds The child protection advisor asks you to refer directly to social services 6. Multiagency response - inform health visitor

Question 26

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

Answer 26

1. OPT 2. Bifurcation of thr lower 7's just formed 3. XLA 4. Sponatnuous space closure Render child caries free Reduction of future ortho needs 5. No molars for eating/spacing Risk of GA Bad experience Removal of a carious free tooth 6. Sedation - inhalation sedation GA

Question 27

What types of drug is warfarin and what is its mechanism of action?

Answer 27

Anticougulant | Vit K anatagonist

Question 28

Which test must be carried out prior to XLA

Answer 28

INR

Question 29

Which guidance doc would you refer to for advice on dealing with patients on Warfarin and within what timeframe should this test be carried out prior to XLA

Answer 29

SDCEP and ideally within 24hrs

Question 30

Below what level would it be safe to continue with XLA

Answer 30

<4

Question 31

Outline options that you would carry out clincially to deal with post op bleeding If following clinical interventions to stop post op bleeding does not work what would you do?

Answer 31

Prolonged pressure with damp gauze, Suture, LA with adrenaline, Haemostatic agent (surgicel), Tranxamic acid Urgently refer to local Oral surgery

Question 32

Name 2 adjustments that will allow a person in a wheelchair access to a above ground level dental practice

Answer 32

Lift | Ramp

Question 33

2 revelant acts of law for impairment and disability

Answer 33

The disability discrimination act | The equality Act 2010

Question 34

Give 2 augementative and alternative communication methods which could be used for someone with cerbral palsy

Answer 34

Eye tracking technology Communication boards Physical cues

Question 35

2 options to allow for the improved positioning of someone who is unable to weight bear for a dental exam

Answer 35

Transfer to dental chair by hoist Wheelchair tipper Patient has reclining wheelchair

Question 36

What particular aspect related to cerebral palsy may affect the dentist's access to the mouth

Answer 36

Uncontrollable muscle spasm

Question 37

What non- pharmacological adjuncts are available to ovecome and aid dentist's access to mouth?

Answer 37

Bedi mouth Toothbrush Rubber spatual or bite stick

Question 38

Give 2 medical aspects of Down syndrome which may have resulted in his lack of capactiy

Answer 38

Demtentia | Learning disability

Question 39

Give 2 features associated with down syndrome that are likley to contribute to his perio disease

Answer 39

``` Ability to self care - Oh and calc Impaired oral function Altered tooth morophology Systemic immundeficiency Impaired migration of gingival fibroblasts ```

Question 40

Antibiotic prophylaxis - What antibiotic and dose

Answer 40

Amoxicillin 3g dose

Question 41

When should you provide antibiotic prophylaxis and obersve the person taking them?

Answer 41

A single dose 30-60mins before procedure

Question 42

4 risk factors of mouth cancer

Answer 42

``` Smoking tobacco Chewing tobacco Alcohol Immunosuppression Diet low in fruit and veg ```

Question 43

2 additional pieces of info do you require to know about radiotherapy treatment the person recieved?

Answer 43

Dose | Field

Question 44

2 additional pieces of info do you require to know about radiotherapy treatment the person recieved?

Question 45

What does of radiotherapy delivered to the primary tumour increases the risk of osteoradionecrosis

Answer 45

50-60 gray

Question 46

Describe the pattern of decay evidenced which is unique to radiation caries

Answer 46

Cervical margins

Question 47

Describe the pattern of decay evidenced which is unique to radiation caries

Question 48

List 2 oral complications associted with radiation therapy other than osteoradionecrosis and radiation caries

Answer 48

``` Trismus Dry mouth Increased risk of oral infections Skin burns Radiation muscositis ```

Question 49

List 2 preventitive measures thart should be implented to reduce risk of futre dental disease for patients who have recieved radiotherapy

Answer 49

Increased fluoride toothpaste - 2800ppm - 5000ppm Tooth mousse Fluoride trays Prescribe oral saliva substitues

Question 50

One mangement strategy for established osteoradionecorsis of head and neck

Answer 50

Surgical debridment | Hyperbaric oxygen therapy

Question 51

3 examples of PPE and what each item is protecting you from

Answer 51

Gown - splashing Marigold gloves - sharps Full face visor - aerosols

Question 52

What 2 methods are used for manual cleaning of instruments. | Give an example of an instrument cleaned in this way

Answer 52

Immersion - any solid instrument | Non immersion - hanpieces or insturment with lumen

Question 53

How often should a Ultrasonic cleaner be degassed

Answer 53

Everytime it is filled from empty

Question 54

What is remvoed by degassing an ultrasonic?

Answer 54

Air/oxygen

Question 55

Why is it important to degass an ultrasonic?

Answer 55

Air/oxygen will prevent ultraosonic bubbles from reaching all the surface of the instruments

Question 56

Why should dental handpieces not be placed in an ultrasonic cleaner

Answer 56

They may be damaged by the ultrasonic

Question 57

Why is it important to use de-mineralised water in the steriliser?

Answer 57

To perevent the deposit of minerals on the machine and instruments

Question 58

What term is used to describe the collective group of microgranisms within the oral cavity and what are they referrred to when attached to a surface

Answer 58

Microbime, biofilm (plq)

Question 59

List 4 key microbial stages of caries plq formation

Answer 59

Adhesion Colonisation Maturation Acid production

Question 60

2 key virulence factors caused by strep. mutans that influecne enamel dissolution

Answer 60

Glucans | ATPase

Question 61

Name the bacterium associated with secondary endo infection and name one of its key virulence factors

Answer 61

Enteroccus Faecalis | Adhesins, collagenase

Question 62

Why is it difficult to determine causality from a specific bacteria in endo infection

Answer 62

Sterile sampling procedures, active bacteria

Question 63

Which antimicrobial is used to disinfect root canal?

Answer 63

Sodium hypochlorite

Question 64

What culture independent technique could be used to assess changes in the oral microbial populations following antibiotic exposure What is the limitation of this approach?

Answer 64

Next generation sequencing