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BDS3 Exam Questions > 2020 paper > Flashcards

2020 paper Flashcards

1
Q

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?

A
  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
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2
Q
  1. 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

A
  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
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3
Q
  1. 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

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

A
  1. Periapical periodontitis
  2. Sensibility testing
    PA or sectional panoramic radiograph
  3. Pulpectomy then RCT
    XLA of 46
    `
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5
Q

Number of canals found in upper first premolar

A

2

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6
Q

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

A

The apical constriction, cemento-dentinal junction

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7
Q

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

A

Patency

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8
Q

What is working length in endo

A

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

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9
Q

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

A

Corrected working length

Master cone radiograph

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10
Q

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

A

Ledges
Transporation
Zipping
Perforation

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11
Q

Which systemic antibiotic is most apporpriate for ANUG

A

Metronidazole

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12
Q

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

A

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

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13
Q

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

A

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

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14
Q

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

A

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

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15
Q

Give a definition of dependence

A

A compulsive physiological and psychological need for habit forming substance

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16
Q

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

A

Nictonine patches, gum, onhalers
E cigs
Champix

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17
Q

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

A

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

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18
Q

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
A
  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
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19
Q

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

A

Frankfort plane

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20
Q

Postioning error for the incisor teeth being horizontally magnified?

A

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

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21
Q

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

A

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

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22
Q

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

A

Right half panoramic radiograph

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23
Q

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

A

Orthogonal projection

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24
Q

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
A
  1. Inferior or floor

2. Posterior or distal

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25
Q

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?
A
  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
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26
Q

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?
A
  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
27
Q

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

A

Anticougulant

Vit K anatagonist

28
Q

Which test must be carried out prior to XLA

A

INR

29
Q

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

A

SDCEP and ideally within 24hrs

30
Q

Below what level would it be safe to continue with XLA

A

<4

31
Q

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?

A

Prolonged pressure with damp gauze, Suture, LA with adrenaline, Haemostatic agent (surgicel), Tranxamic acid

Urgently refer to local Oral surgery

32
Q

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

A

Lift

Ramp

33
Q

2 revelant acts of law for impairment and disability

A

The disability discrimination act

The equality Act 2010

34
Q

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

A

Eye tracking technology
Communication boards
Physical cues

35
Q

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

A

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

36
Q

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

A

Uncontrollable muscle spasm

37
Q

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

A

Bedi mouth
Toothbrush
Rubber spatual or bite stick

38
Q

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

A

Demtentia

Learning disability

39
Q

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

A 
Ability to self care - Oh and calc
Impaired oral function
Altered tooth morophology
Systemic immundeficiency
Impaired migration of gingival fibroblasts
40
Q

Antibiotic prophylaxis - What antibiotic and dose

A

Amoxicillin 3g dose

41
Q

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

A

A single dose 30-60mins before procedure

42
Q

4 risk factors of mouth cancer

A 
Smoking tobacco
Chewing tobacco
Alcohol
Immunosuppression
Diet low in fruit and veg
43
Q

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

A

Dose

Field

44
Q

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

A
45
Q

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

A

50-60 gray

46
Q

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

A

Cervical margins

47
Q

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

A
48
Q

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

A 
Trismus
Dry mouth
Increased risk of oral infections
Skin burns 
Radiation muscositis
49
Q

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

A

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

50
Q

One mangement strategy for established osteoradionecorsis of head and neck

A

Surgical debridment

Hyperbaric oxygen therapy

51
Q

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

A

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

52
Q

What 2 methods are used for manual cleaning of instruments.

Give an example of an instrument cleaned in this way

A

Immersion - any solid instrument

Non immersion - hanpieces or insturment with lumen

53
Q

How often should a Ultrasonic cleaner be degassed

A

Everytime it is filled from empty

54
Q

What is remvoed by degassing an ultrasonic?

A

Air/oxygen

55
Q

Why is it important to degass an ultrasonic?

A

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

56
Q

Why should dental handpieces not be placed in an ultrasonic cleaner

A

They may be damaged by the ultrasonic

57
Q

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

A

To perevent the deposit of minerals on the machine and instruments

58
Q

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

A

Microbime, biofilm (plq)

59
Q

List 4 key microbial stages of caries plq formation

A

Adhesion
Colonisation
Maturation
Acid production

60
Q

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

A

Glucans

ATPase

61
Q

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

A

Enteroccus Faecalis

Adhesins, collagenase

62
Q

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

A

Sterile sampling procedures, active bacteria

63
Q

Which antimicrobial is used to disinfect root canal?

A

Sodium hypochlorite

64
Q

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?

A

Next generation sequencing

BDS3 Exam Questions (13 decks)

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