FOH Scenarios

Question 1

A patient presents with V-shaped lesions near the gum line but denies aggressive brushing. What is the likely cause, and how would you manage it?

Answer 1

Likely abfraction caused by biomechanical forces. Recommend a night guard and monitor occlusion.

Question 2

A patient with a history of HIV presents for a routine check-up. What precautions should you take during treatment?

Answer 2

Follow universal precautions, monitor for oral lesions, and confirm stable CD4 count with medical clearance if needed.

Question 3

A Hepatitis C-positive patient needs dental treatment. What considerations should you make for their care?

Answer 3

Ensure liver function tests are stable, avoid medications metabolized in the liver, and use infection control protocol

Question 4

A needle-stick injury occurs during treatment. What steps should you take immediately?

Answer 4

Wash the area thoroughly, report the incident, and initiate PeP within 72 hours if HIV exposure is suspected.

Question 5

What signs would indicate a restoration has violated the biologic width?

Answer 5

Gingival recession, chronic inflammation, and** bone loss o**n radiographs.

Question 6

How should you design interproximal embrasures in restorations to optimize periodontal health?

Answer 6

Ensure the** gingival papilla **can fill the space without being impinged, and allow for easy cleaning.

Question 7

What is the impact of losing posterior occlusal support on the anterior teeth?

Answer 7

It can lead to increased stress and wear on anterior teeth, causing attrition or mobility.

Question 8

A patient complains of sore gums after receiving a new crown. What occlusal factors would you check?

Answer 8

Verify if the crown is in hyperocclusion or causing excessive forces on the supporting structures.

Question 9

During an extraction, an adjacent tooth is luxated. What is your immediate action?

Answer 9

Inform the patient, reposition the luxated tooth, and document the incident.

Question 10

Post-extraction, the patient reports severe pain and a foul taste. What complication do you suspect, and how do you manage it?

Answer 10

Suspect a dry socket. Irrigate the socket, place a medicated dressing, and provide pain relief.

Question 11

A patient with a history of bleeding disorders requires an extraction. How would you prepare for the procedure?

Answer 11

Consult with their physician, ensure clotting factors are stable, and have hemostatic agents ready.
For normal patients who are not on anticoagulation, the INR is usually 1.0 regardless of the ISI or the particular performing laboratory. [8]For patients who are on anticoagulant therapy, the therapeutic INR ranges between 2.0 to 3.0.

Question 12

: A patient reports difficulty maintaining an open mouth during dental procedures. Which muscle fatigue could explain this?

Answer 12

The temporalis muscle due to its role in jaw stabilization.

remember, temp is up top so it pulls up.

Question 13

You diagnose an active root carious lesion on the buccal surface of a maxillary premolar. The patient is unable to tolerate fluoride varnish. What alternative preventive measure can you recommend?

Answer 13

High-fluoride toothpaste (e.g., Neutrafluor 5000) and improved oral hygiene practices.

Question 14

During the extraction of a primary molar, the child becomes anxious and begins crying. How would you manage this situation to ensure patient safety and cooperation?

Answer 14

Pause the procedure, provide reassurance, use distraction techniques, and consider nitrous oxide sedation if appropriate.

Question 15

A parent requests extraction of a mobile primary tooth that is close to exfoliation. What advice would you provide?

Answer 15

Recommend monitoring for natural exfoliation unless the tooth causes pain or discomfort.

Question 16

A patient presents with chronic inflammation around an equigingival restoration. How would you assess and address this issue?

Answer 16

Assess for plaque accumulation and margin integrity. Recommend re-contouring or replacing the restoration if necessary.

Question 17

After placing a crown, the patient reports gingival bleeding and tenderness. What steps would you take to resolve the issue?

Answer 17

: Evaluate the crown margin placement, adjust if it violates the biologic width, and ensure proper oral hygiene instructions are given.

Question 18

During a post-operative review, the patient shows signs of bone loss near a recent restoration. What might have gone wrong, and how would you manage it?

Answer 18

The restoration may have violated the biologic width. Refer to a periodontist for possible surgical crown lengthening.

Question 19

During an exam, you observe both attrition and abfraction lesions in a bruxism patient. What comprehensive management would you propose?

Answer 19

Provide a night guard, monitor occlusion, and recommend restorative treatment for affected areas.

Question 20

A patient with HIV presents with oral candidiasis. How would you manage this condition?

Answer 20

Prescribe antifungal medication (e.g., nystatin) and ensure the patient is compliant with their antiretroviral therapy.

Question 21

After performing a procedure on a patient with HIV, you accidentally sustain a needle-stick injury. What is your immediate course of action?

Answer 21

Wash the wound, report the incident, and begin PeP within 72 hours if indicated.

Question 22

: A patient has persistent gingival inflammation despite good oral hygiene. How would you evaluate the restoration margins?

Answer 22

Use a periodontal probe to check margin placement and assess radiographs for biologic width violations.

Question 23

During extraction, the patient’s mouth fills with blood, and you suspect arterial damage. How would you respond?

Answer 23

Apply firm pressure with gauze, use hemostatic agents, and refer urgently if bleeding persists.

Question 24

Clinical Findings:

53 years old
Interdental CAL ≥5 mm
More than 5 teeth lost due to periodontitis
Probing depths ≥6 mm
Bone loss extends to apical third
Vertical bone loss
Evidence of <2 mm additional attachment loss over 5 years
Non-diabetic
Smokes half a pack of cigarettes per day
Question:

Determine the stage of periodontitis.
Determine the grade of periodontitis.

Answer 24

Answer:

Stage IV: Severe periodontitis with potential for loss of dentition

Based on extensive CAL, vertical bone loss, and history of tooth loss affecting more than 5 teeth.
Grade B: Moderate progression

Evidence of <2 mm attachment loss over 5 years, but grade modifiers include smoking.

Question 25

Clinical Findings:

20 years old
Interdental CAL of 3-4 mm
No tooth loss due to periodontitis
Bone loss extends to the mid-third of the root on the first molar
Evidence of >2 mm attachment loss over 5 years
Oral hygiene excellent, very minimal plaque or calculus
Question:

Determine the stage of periodontitis.
Determine the grade of periodontitis.

Answer 25

Answer:

Stage III: Severe periodontitis with potential for tooth loss

Bone loss extends to the mid-third, CAL is 3-4 mm, and complexity factors are moderate (age and extent of bone loss).
Grade C: Rapid progression

Evidence of >2 mm attachment loss over 5 years, with destruction exceeding biofilm deposits.

Answer 26

Grading Criteria Recap
Grade A (Slow Progression):

No CAL or RBL over 5 years.
Bone loss/age ratio <0.25.
Heavy biofilm with low levels of destruction.
Grade B (Moderate Progression):

<2 mm CAL or RBL over 5 years.
Bone loss/age ratio 0.25–1.0.
Destruction matches biofilm levels.
Grade C (Rapid Progression):

≥2 mm CAL or RBL over 5 years.
Bone loss/age ratio >1.0.
Destruction exceeds expectations for biofilm levels.
Grade modifiers: smoking, uncontrolled diabetes, or other systemic conditions.

Question 27

the grading criteria for periodontitis progression:

Answer 27

Mnemonic: “Slow Bears Race Moderately, Cheetahs Chase Rapidly”
Slow (Grade A - Slow Progression):
S: Stable (No CAL or RBL over 5 years)
L: Low bone loss/age ratio (<0.25)
O: Overwhelming biofilm, but low destruction.
Bears (Grade B - Moderate Progression):
B: Biofilm destruction matches disease.
E: Evidence of <2 mm CAL or RBL over 5 years.
A: Age ratio moderate (0.25–1.0).
R: Rate of disease progression moderate.
Cheetahs (Grade C - Rapid Progression):
C: Complex destruction (≥2 mm CAL or RBL over 5 years).
H: High bone loss/age ratio (>1.0).
A: Aggressive destruction exceeds biofilm levels.

Question 28

Question 1:
A 50-year-old patient presents with a history of controlled hypertension, a missing tooth in the lower right quadrant (36), and sensitivity in the upper left molar region. The patient is a smoker (10 cigarettes/day) and has a family history of periodontal disease. The patient reports mild discomfort when chewing on the upper left molars and wants to replace the missing tooth. Develop a treatment plan based on the phases of care framework within your scope.

Answer 28

Here’s the adjusted version of the clinical scenario-based OSCE questions tailored for an Oral Health Therapist (OHT), emphasizing referrals for procedures outside your scope:

Question 1:
A 50-year-old patient presents with a history of controlled hypertension, a missing tooth in the lower right quadrant (36), and sensitivity in the upper left molar region. The patient is a smoker (10 cigarettes/day) and has a family history of periodontal disease. The patient reports mild discomfort when chewing on the upper left molars and wants to replace the missing tooth. Develop a treatment plan based on the phases of care framework within your scope.

Answer 1:
Systemic Phase:

Confirm hypertension management and medications with the patient.
Evaluate the impact of smoking on oral health and provide cessation advice.
Discuss the importance of medical clearance if required due to hypertension.
Acute Phase:

Address the sensitivity in the upper left molars (likely 26 or 27) by performing a clinical and radiographic examination.
Stabilize with temporary restoration if there is visible enamel or dentine loss.
Refer to a dentist for definitive diagnosis and restoration of 26/27 if the tooth requires more complex care.
Control Phase:

Provide tailored oral hygiene instructions with a focus on smoking cessation and plaque control.
Perform a full-mouth periodontal debridement and reinforce home care instructions.
Apply desensitizing agents to manage sensitivity in exposed root areas, if present.
Definitive Phase:

Refer to a dentist or prosthodontist for replacement of missing tooth 36 (e.g., implant or bridge options).
If significant periodontal issues are present, refer to a periodontist for further evaluation and advanced care.
Maintenance Phase:

Recall every 3 months for periodontal maintenance and smoking cessation reinforcement.
Apply fluoride varnish every 3 months to address caries risk due to smoking.

Question 29

A 65-year-old patient presents with a fractured amalgam restoration on tooth 16 and generalized gingival recession with 2-3 mm pockets. The patient takes blood thinners for atrial fibrillation and reports dry mouth due to medications. They are concerned about aesthetics and function.

Answer 29

Systemic Phase:

Confirm the use of blood thinners and consult the patient’s physician to assess bleeding risk during dental treatment.
Address dry mouth management with recommendations for salivary substitutes, hydration, and high-fluoride toothpaste.
Acute Phase:

Stabilize the fractured amalgam restoration on 16 with a temporary material.
Refer to a dentist for the definitive restoration (e.g., ceramic onlay or crown).
Control Phase:

Perform non-surgical periodontal therapy for generalized gingival recession and pockets.
Educate the patient on proper brushing techniques and use of desensitizing toothpaste for recession-related sensitivity.
Definitive Phase:

Refer to a dentist for definitive restorative treatment of tooth 16.
If severe gingival recession is present, refer to a periodontist for possible grafting or advanced periodontal care.
Maintenance Phase:

Recall every 3 months for periodontal maintenance.
Fluoride varnish applications every 3 months to manage caries risk due to dry mouth.

Question 30

A 40-year-old patient complains of a sharp pain in tooth 11 when consuming cold beverages. Clinical examination reveals a deep incisal edge crack. The patient has a history of bruxism and wears a nightguard irregularly.

Answer 30

Answer 3:
Systemic Phase:

Rule out any systemic factors exacerbating bruxism and encourage consistent nightguard use.
Educate the patient about the long-term consequences of untreated bruxism.
Acute Phase:

Provide immediate relief by sealing the crack with a temporary composite material.
Refer to a dentist for definitive treatment, such as a veneer or crown.
Control Phase:

Recommend a new or adjusted nightguard for bruxism management and discuss strategies for stress reduction.
Provide education on avoiding hard foods that can exacerbate the crack or lead to further damage.
Definitive Phase:

Refer to a dentist for definitive restoration of tooth 11 (e.g., veneer or crown).
Refer to an orthodontist or restorative dentist if occlusal adjustments are needed to balance the bite.
Maintenance Phase:

Monitor the restored tooth and bruxism management at 6-month recall appointments.
Reinforce the use of the nightguard and regular occlusal checks.