Msa

Question 1

Two pathogens that cause catheter associated infections

Answer 1

E. coli
Staphylococcus aureus

Question 2

What drug counteracts benzodiazepine sedation

Answer 2

Flumazenil

Question 3

List THREE ways to reduce infection risk when undertaking aseptic surgery

Answer 3

Hand hygiene
PPE
Sterilized instruments

Question 4

What are THREE short term effects of child neglect

Answer 4

Mental/emotional health

Social development

Cognitive development

Question 5

What are THREE long term effects of child neglect

Answer 5

Suicide

Depression

Arrest

Diabetes/heart disease

Question 6

What is competent and incompetent lips? (2 marks)

Answer 6

Competent lips: upper and lower lips meet at rest and maintain anterior oral seal, relaxed mentalis muscle

Incompetent lips: lips don’t meet at rest and cant maintain oral seal, relaxed mentalis muscle

Question 7

What circumoral musculature is involved with lip competence

Answer 7

Mentalis muscle
Patients with incompetent lips can’t keep lips together without lots of strain on mentalis muscle

Question 8

How does incompetent lips effect the upper and lower incisors

Answer 8

Proclined upper incisors

Retroclined lower incisors

Increased OJ

Can lead to AOB

Question 9

What is a strap lower lip?

Answer 9

Hyperactive lower lip

Question 10

How does a strap lower lip effect upper and lower incisors

Answer 10

Strap lower lip with competent lips: retrocline upper teeth
Strap lower lip with incompetent lips: retrocline lower teeth

Question 11

A fit and healthy patient presents to the surgery to have the surgical removal of the lower right third permeant molar (48).

1. Anatomically, which nerves must be anaesthetised to remove this tooth safely? (3 marks)

Answer 11

1) Right inferior alveolar nerve

2) Right lingual nerve

3) Right long buccal nerve

Question 12

A fit and healthy patient presents to the surgery to have the surgical removal of the lower right third permeant molar (48).

List TWO different ways you could assess that anaesthesia has been achieved? (1 mark)

Answer 12

ASK the patient if the right half of their tongue/lip/chin is numb

CHECK by probing adjacent to the 48 buccal/lingual

Question 13

After a 48 extraction 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

Answer 13

i) Paresthesia

ii) Dysesthesia

iii) Anesthesia

Question 14

Give THREE clinical reasons that could account for neuro-sensory deficit during a 48 extraction (3 marks)

Answer 14

Crushing (1 mark)

Cutting (1 mark)

Damage to the nerve from the local anesthetic (1 mark)

Question 15

A patient returns to the clinic with symptoms and signs of a dry socket.

What is the correct terminology for this? (1 mark)

Answer 15

Alveolar osteitis

Question 16

List THREE predisposing factors that could contribute to dry socket? (3 marks)

Answer 16

Smoking (1 mark)

Sex: Female (1 mark)

More common to occur in molar extractions and more likely to occur in the mandible (1 mark)

Question 17

List THREE symptoms or signs that a patient with dry socket may present with (3 marks)

Answer 17

Moderate to severe dull aching pain (1 mark)

Can radiate to patients ear and keeps them awake at night (1 mark)

Bad smell and taste (1 mark)

Question 18

How would you manage dry socket (3 marks)

Answer 18

Supportive: reassurance and analgesics (1 mark)

LA, irrigate socket with warm saline, curettage and debridement (1 mark)

Antiseptic pack with Alvogyl (1 mark)

Question 19

List FIVE risk factors for mouth cancer (2 marks)

Answer 19

Immunosuppression (0.5 marks)

Socioeconomic status (0.5 marks)

Age (0.5 marks)??

Tobacco use (0.5 marks)

Alcohol consumption (0.5 marks)

Diet low in fruits and vegetables (0.5 marks)

Question 20

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?

Answer 20

Radiation dosage and duration (1 mark)

Radiation field (1 mark)

Question 21

What dose of radiotherapy delivered to the primary tumour increases the risk of osteoradionecrosis (1 mark)

Answer 21

50-60 Gy (Gray)

Question 22

Describe the pattern of decay evidenced, which is unique to radiation caries. (1 mark)

Answer 22

Occur at cervical margins and may affect incisal edges (1 mark)

Question 23

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)

Answer 23

Provide primary orthograde endodontics and decoronate (1 mark)

Question 24

List TWO oral complications associated with radiation therapy, other than osteoradionecrosis and radiation caries, to the head and neck. (1 mark)

Answer 24

Dry mouth (0.5 mark)

Radiation mucositis (0.5 mark)

Question 25

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)

Answer 25

Increased fluoride toothpaste: 2800ppm or 5000ppm (0.5 mark)

Tooth mousse (0.5 mark)

Question 26

List ONE management strategy for established osteoradionecrosis of the jaw? (1 mark)

Answer 26

HBOT: hyperbaric oxygen therapy

Question 27

Other than alcohol, list TWO causes of liver cirrhosis (1 mark)

Answer 27

Hepatitis B and C (0.5 mark)

Nonalcoholic fatty liver disease (NAFLD) (0.5 mark)

Question 28

Patients undergoing Liver Transplantation are required to achieve a status known as “being dentally fit” prior to being listed for surgery.

List TWO priorities for such a patient in order to render them dentally fit (2 marks)

Answer 28

Treatment of active dental infections such as apical infections and gross caries (0.5 marks)

Extraction of hopeless and diseased teeth that cannot be restored (0.5 marks)

Question 29

Why is it important to establish oral health prior to receiving a transplant? (1 mark)

Answer 29

Reduced risk of infection and faster recovery

Question 30

Thrombocytopenia is a common finding in people with advanced alcoholic liver disease. List TWO reasons why thrombocytopenia may occur. (2 marks)

Answer 30

Decreased thrombopoietin production by the liver (1 mark)

Enlarged spleen (splenomegaly) causing increased removal of platelets by the spleen (1 mark)

Question 31

If thrombocytopenia occurs in isolation, above what level is it safe to undertake a dental extraction in the general dental practice setting without consulting an appropriate medical or specialist dental professional? (1 mark)

Answer 31

Dental hospital: above 50,000/microlitre

General dental practice: above 100,000/microlitre (1 mark)

Question 32

Above what number does neutrophils count have to be to undertake a dental extraction in the general dental practice setting without consulting an appropriate medical or specialist dental professional? (1 mark)

Answer 32

Above 1 (1,000 microlitre)

Question 33

Other than thrombocytopenia, explain why a patient with advanced alcoholic liver disease may have an increased risk of bleeding (1 mark)

Answer 33

Decreased synthesis of clotting factors by the liver (1 mark)

Question 34

Name THREE types of Dementia (3 marks)

Answer 34

Alzheimer’s disease (1 mark)

Vascular dementia (1 mark)

Lewy body dementia (1 mark)

Question 35

List FOUR signs or symptoms present in someone with EARLY STAGE dementia (2 marks)

Answer 35

Loss of short-term memory

Confusion

Anxiety

Inability to manage everyday tasks.

Question 36

List FOUR signs or symptoms present in someone with MIDDLE STAGE dementia (2 marks)

Answer 36

Anger, aggression and mood changes

Risk of wandering

May behave inappropriately

May experience hallucinations

Question 37

List FOUR signs or symptoms present in someone with LATE STAGE dementia (2 marks)

Answer 37

Inability to recognize familiar objects or people (0.5 mark)

Difficulty eating and swallowing (0.5 mark)

Increasing physical frailty (0.5 mark)

Incontinence and speech loss (0.5 mark)

Question 38

Following your assessment, you determine that the best course of action is for removal of her 6 remaining teeth due to grade 3 mobility.

As a general dental practitioner, you do not have the ability to assess the capacity of an individual.

List TWO people who can provide a capacity assessment for dental treatment in accordance with the Adult’s with Incapacity Act 2000. (2 marks)

Answer 38

Mental health officer (MHO) (1 mark)

A registered medical practitioner such as a doctor or psychiatrist (1 mark)

Question 39

As Mrs Anderson has had a heart valve replaced, you speak to her consultant cardiologist who requests that she is provided with oral antibiotic prophylaxis for the removal of her 6 remaining teeth. She has no known allergies.

Name the ANTIBIOTIC and the DOSE which should be prescribed? (2 marks)

Answer 39

Amoxicillin 3g orally (2 marks)

Question 40

As Mrs Anderson has had a heart valve replaced, you speak to her consultant cardiologist who requests that she is provided with oral antibiotic prophylaxis for the removal of her 6 remaining teeth. She has no known allergies

How long before the procedure should you administer antibiotics AND which guidance does this come from? (1 mark)

Answer 40

Taken one hour before the dental procedure and this is according to the SDCEP guidelines (1 mark)

Question 41

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

What might you be concerned about as a result of seeing this child? (1 mark)

Answer 41

Child abuse or neglect (1 mark)

Question 42

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

Which TWO parts of this presentation led you to have concerns of child abuse or neglect (2 marks

Answer 42

Later presentation of severe pain/sleep loss for 6 weeks (1 mark)

Multiple injuries on different parts of the face (1 mark)

Question 43

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

Suggest TWO questions which you would ask next to further investigate your concerns? (2 marks)

Answer 43

How did child sustain injuries (1 mark)

Why was the child not brought to the surgery earlier (1 mark)

Question 43

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

You decide that some aspect of the responses to your questions warrants further action.

i) Who should you discuss this with? (1 mark)

i) As a result of this onward discussion what THREE different courses of action may take place? (3 marks)

Answer 43

i) Child protection advisor (1 mark)

ii) Further investigations are undertaken, and the child protection advisor gets back to you (1 mark)

The child is referred directly to the lead pediatrician (1 mark)

The child protection advisor asks you to refer directly to social services (1 mark)

Question 44

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 44

Preventative multi agency management: inform the family health visitor (1 mark)

Question 45

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 (stage 1 preventive management of dental neglect). The parent fails to bring the child back for either of these appointments. What are the next two stages in the management of dental neglect?

Answer 45

Preventative multi agency management: inform the family health visitor (1 mark)

Child protection referral: call social services and then follow up by writing them (1 mark)

Question 46

In the last stage of the management of dental neglect how do you share your concerns initially and then what do you follow this up with? (2 marks)

Answer 46

You would initially call social services then follow this up with writing to them for a child protection referral (2 marks)

Question 47

Describe your emergency treatment of dentine/enamel fracture. (1 mark)

Answer 47

Cover all exposed dentine with glass ionomer/ composite (1 mark)

Question 48

An 8-year-old boy presents to you with a dentine/enamel fracture of tooth 11 sustained during a school rugby match. List FOUR signs and/or symptoms (excluding radiographic) which you would look for in longitudinal monitoring of this patient. (4 marks)

Answer 48

Color change of tooth (1 mark)

Presence of a sinus or abscess (1 mark)

Surrounding soft tissue swelling (1 mark)

Increased mobility (1 mark)

Question 49

The patient has another rugby match in 2 weeks time. How might you help prevent injury to anterior teeth? (1 mark)

Answer 49

Suggest he wears a gumshield/mouth guard (1 mark)

Question 50

A 2-year-old attends your surgery with his mother. She is concerned by the appearance of his upper teeth.

There is caries in the following teeth: 54 52 51 61 62 64 84 74

What diagnostic name would you give to this caries distribution? (1 mark)

Answer 50

Early childhood caries (ECC) or nursing bottle caries (same thing different name 1 mark)

Question 51

A 2-year-old attends your surgery with his mother. She is concerned by the appearance of his upper teeth.

There is caries in the following teeth: 54 52 51 61 62 64 84 74

Why are the specified teeth affected in this distribution, and not others? (3 marks)

Answer 51

Reduced salivary flow on upper teeth (1 mark)

Upper anterior are more susceptible to frequent sugar exposure from nursing bottles (1 mark)

Lower anterior teeth have greater salivary flow due to major salivary glands and pooling of saliva (1 mark)

Question 52

List FOUR causes of nursing bottle caries (2 marks)

Answer 52

Putting juice or milk in feeding bottle (0.5 mark)

Falling asleep with the feeding bottle (0.5 mark)

Poor oral hygiene (0.5 mark)

The use of feeding bottles beyond infancy/6months (0.5 mark)

Question 53

What fluoride regime could you follow in the dental surgery setting for a child with nursing bottle caries? (2 marks)

Answer 53

Fluoride varnish Duraphat 22,600ppmF fluoride 4 times a year (1 mark)

Silver diamine fluoride 44,800ppmF or APF (acidulated phosphate fluoride) (1 mark)

Question 54

List FOUR of the recommendations you would make regarding tooth brushing for this patient.
“2 year old paeds question.”

Answer 54

Smear of toothpaste (0.5 mark)

1000ppmF fluoride toothpaste (0.5 mark)

Spit do not rinse (0.5 mark)

Brush twice daily (0.5 mark)

Question 55

Give a definition of local causes of malocclusion? (2 marks)

Answer 55

A localized abnormality within either arch, usually caused by one, two or several teeth producing a malocclusion (2 marks)

Question 56

Local causes of malocclusion may be due to variation in tooth number. Please give FOUR examples of these conditions: (4 marks)

Answer 56

1) Supernumerary teeth (1 mark)

2) Hypodontia (1 mark)

3) Retained primary teeth (1 mark)

4) Early loss of primary teeth (1 mark)

Question 57

List FOUR types of supernumerary? (4 marks)

Answer 57

1) Conical (1 mark)

2) Tuberculate (1 mark)

3) Supplemental (1 mark)

4) Odontome (1 mark)

Question 58

Describe TWO methods you could use to clinically assess a patient’s antero-posterior skeletal pattern. (2 marks)

Answer 58

Visual assessment (1 mark)

Palpate skeletal bases (1 mark)

Question 59

Give TWO possible non-skeletal aetiological factors that can contribute to a class II division 1 incisor relationship malocclusion? (2 marks)

Answer 59

Digit sucking habit (1 mark)

Lower lip trap can procline upper incisors (1 mark)

Question 60

What type of orthodontic appliance might be used to harness growth potential for the patient with a class II division 1 incisor relationship malocclusion (1 mark)

Answer 60

Functional appliance (1 mark)

Question 61

Give a very brief account of how it is thought that mandibular growth occurs (3 marks)

Answer 61

The mandible develops through intramembranous ossification but is preceded by Meckel’s cartilage. (1 mark)

The mandible develops as several units including a condylar, coronoid, angular and alveolar unit all responding to different growth stimuli (1 mark)

The coronoid cartilage disappears long before birth and the symphyseal just after birth. Growth continues at the condylar cartilage until about 20 years of age. (1 mark)

Question 62

If a patient subsequently has forward growth rotation, describe a skeletal feature that you could expect to observe? (1 mark)

Answer 62

More acute gonial angle, deep bite and short face (1 mark)

Question 63

What faults in the placement of a restoration are likely to have led to a marginal overhang in amalgam (2 marks)

Answer 63

Incorrect placement of the matrix band and wedges (1 mark)

Inadequate adaptation/condensing of the material (1 mark)

Question 64

What problems could a marginal overhang give rise to, in the short and long term (4 marks)

Answer 64

Plaque retentive factor (short term) (1 mark)

Difficulty in cleaning (short term) (1 mark)

Secondary caries (long term) (1 mark)

Gingivitis, periodontitis, tooth fracture (long term) (1 mark)

Question 65

List TWO ways to correct a marginal overhang and which is the preferred/best method (3 marks)

Answer 65

Remove the restoration completely or partially and restore it again (1 mark)

Use a high speed handpiece with a yellow band finishing bur to remove the overhang (1 mark)

Removing and replacing the restoration is the best method (1 mark)

Question 66

List 3 predisposing factors for necrotizing periodontal disease (3 marks)

Answer 66

Smoking

Stress

Poor oral hygiene

Question 67

The patient is anxious and reluctant to have any dental treatment. What risks of no treatment do you explain to the patient for necrotizing periodontal disease? (1 mark)

Answer 67

Necrosis of the interdental papilla resulting in gingival craters and systemic risks including fever and malaise (1 mark)

Question 68

The patient agrees to treatment for necrotizing periodontal disease. What treatment do you provide today? (3 marks)

Answer 68

Careful superficial debridement with an ultrasonic to remove mineralized deposits. (1 mark)

Advise the patient not to brush the area aggressively and use chlorhexidine mouthwash 0.12% (1 mark)

Provide dietary advice, stress relief and vitamin supplementation (1 mark)

Question 69

Ms. White returns for another emergency appointment 2 days later after treatment of her necrotizing periodontal disease. She feels the gums are still very painful and is now complaining of fever and feeling generally tired and unwell. What treatment would you provide? (2 marks)

Answer 69

Metronidazole: 400mg TID 3 days (1 mark)

Arrange a review appointment in 1-2 weeks (1 mark)

Question 70

What is the average value of the sagittal condylar guidance angle which may be used on an articulator? (1 mark)

Answer 70

30 degrees (1 mark)

Question 71

Why is the retruded axis important in clinical dentistry?

Answer 71

Because it is a reproducible jaw position (1 mark)

Question 72

The retruded axis is said to be a border position of the mandible. What is a border position? (1 mark)

Answer 72

One determined by the anatomy of the TMJ and associated musculature (1 mark)

Question 73

What TWO records are required for mounting casts on a semi adjustable or average value articulator? (2 marks)

Answer 73

Facebow (1 mark)

Interocclusal record (bite registration) (1 mark)

Question 74

What is the average distance in millimeters between resting vertical dimension and occlusal vertical dimension and what is this clinical distance referred to as? (2 marks)

Answer 74

2-4mm (1 mark)

Freeway Space (1 mark)

Question 75

Herbert Schilder described in 1974 the concept of chemomechanical disinfection. In his paper he outlines design principles that should be applied during root canal shaping.

Name the design principles outlined by Herbert Schilder. (3 marks)

Answer 75

Create a continuously tapering funnel shape (1 mark)

Maintain apical foramen in original position (1 mark)

Keep apical opening as small as possible (1 mark)

Question 76

Besides disinfection of the root canal space name TWO other objectives of irrigant use in root canal treatment? (2 marks)

Answer 76

Removal of smear layer (1 mark)

Lubrication (1 mark)

Question 77

What is the ideal primary endodontic irrigant AND at what concentration range is it most effective? (2 marks)

Answer 77

Sodium hypochlorite (1 mark)

3-6% (1 mark)

Question 78

Name THREE factors important for the function of primary endodontic irrigant? (3 marks)

Answer 78

1) Concentration (1 mark)

2) Volume (1 mark)

3) Contact time (time in canal) (1 mark)

Question 79

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

Answer 79

Decorative ceramics has a much higher composition of koalin 50+% with no glass (1 mark)

Dental ceramics has a much higher composition of feldspar: 70-80% with 15% glass (1 mark)

Question 80

Explain what the following terms mean with regard to optical properties of the materials.

i) Translucency (2 marks)

ii) Opalescence (2 marks)

Answer 80

i) Translucency: The ability of a material to allow light to pass through but be scattered at one of the surfaces (1 mark) or leading to a blurring of the transmitted light (1 mark)

The ability of a translucent material to appear blue in reflected light (1 mark) and orange/yellow in transmitted light (1 mark)

Question 81

How can you modify the ceramic surface to make it more retentive prior to using silane? (1 mark)

Answer 81

Etch with Hydrofluoric acid (1 mark)

Question 82

Chemically how does a silane coupling agent work when bonding composite to ceramic? (2 marks)

Answer 82

The hydroxyl group on one end if the silane molecule reacts with oxide groups on the ceramic surface (1 mark)

The C=C bond on the other end reacts with similar groups in the composite material (1 mark).

Question 83

Silane coupling agents are a component part of composite resin materials

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

Answer 83

It chemically bonds the filler particles to the resin matrix (1 mark)

Question 84

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)

Answer 84

When did he start smoking and the number of years smoked?

What type of cigarettes did you smoke? e.g rollups

Have you ever tried to quit and how many attempts?

Are you interested in quitting now?

Question 85

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.

He admits that he feels that he is very dependent on tobacco. Give a definition of dependence.

Answer 85

Compulsive phycological and physiological need for a habit forming substance

Question 86

Name one model/approach that could be used to help a smoker quit?

Answer 86

Ask

Advise

Act

Question 87

Microbial biofilms are an important lifestyle within the oral cavity, and are associated with caries and periodontal disease.

Name TWO characteristics of biofilm extracellular matrix (ECM) that confers resistance from antimicrobial agents. (2 marks)

Answer 87

Contain polysaccharides that form a protective barrier and storage (glycogen) (1 mark)??

Binding proteins: like glucan binding proteins (1 mark)??

Glycocalyx for protection (1 mark)

Glucans: facilitates biofilm formation (1 mark)

Question 87

Name TWO important bacteria clearly implicated in periodontal disease, based on Socransky’s red ‘disease’ complex. (2 marks)

Answer 87

Porphyromonas gingivalis

Tannerella forsythia

Question 88

Name TWO bacteria associated with caries development (2 marks)

Answer 88

Streptococcus mutans

Viellonella spp.

Question 89

What TWO key features that enable cariogenic organisms to stick to enamel surfaces and autoaggregate, and to survive within an acidic environment? (2 marks)

Answer 89

Form adhesins which help them adhere to enamel (1 mark)

Acid tolerance due to ATPase membrane pumps that help pump out H+ ions (1 mark)

Question 90

Name TWO systemic diseases that have been shown to be associated with periodontal biofilms? (2 marks)

Answer 90

Diabetes mellitus (1 mark)

Cardiovascular disease (1 mark)

Question 91

In the correct order, what are the 5 core stages of the washer-disinfector cycle (5 marks)

Answer 91

Flush/Prewash (1 mark)

Main wash (1 mark)

Rinse (1 mark)

Thermal Disinfection (1 mark)

Drying (1 mark)

Question 92

For each of the named stages below, describe the function/purpose of the stage (5 marks)

Flush/Prewash

Main wash

Rinse

Thermal Disinfection

Drying

Answer 92

Flush/Prewash: removes gross contamination

Main wash: remove biological matter

Rinse: removes any remaining residue; biological or chemical

Thermal Disinfection: actively kills microorganisms with the use of heated water

Drying: removes any remaining moisture from instruments

Question 93

What is the most common cause of facial trauma in a female patient? (1 mark)

Answer 93

Physical abuse (1 mark)

Question 94

Aside from physical violence list FOUR other forms of abuse that might be involved in domestic abuse (2 marks)

Answer 94

Sexual (0.5 mark)

Emotional (0.5 mark)

Verbal (0.5 mark)

Financial (0.5 mark)

Question 95

What process should you follow to ask about the possibility of domestic abuse and briefly describe? (4 marks)

Answer 95

AVDR

Ask: ask about the abuse ‘Is everything okay?’ (1 mark)

Validate: showing someone that you are concerned about them ‘I am concerned about your safety’ (1 mark)

Document: be specific and detailed when recording what the patient tells you. Consider photos

Refer: signpost patient to appropriate services

Question 96

List FOUR physical signs you might see in domestic abuse? (2 marks)

Answer 96

Bruises at different stages of healing (0.5 mark)

Facial bruising (0.5 mark)

Strangle marks around neck (0.5 mark)

Fingertip bruises around the arms (0.5 mark)

Question 97

List TWO categories of patient who may be considered to be more at risk in terms of domestic abuse than others (1 mark)

Answer 97

Women (0.5 mark)

Long term illness or disability (0.5 mark)

Question 98

List FOUR benefits that digital radiography has over film radiography (4 marks)

Answer 98

No need for chemical processing (1 mark)

Easy storage & archiving of images (1 mark)

Easy transfer/sharing of images (1 mark)

Images can be manipulated (1 mark)

Question 99

When taking periapical or bitewing radiographs, rectangular collimation is used to shape the X-ray beam so that it matches the shape of the radiographic receptor in the mouth. Explain what the benefit of this is. (2 marks)

Answer 99

Dose optimization: to reduce the dose to patient by 50% (1 mark)

Reduces the amount of scattered radiation to operator (1 mark)

Question 100

Rectangular collimators contain the metal lead.

What chemical property of lead makes it particularly effective at absorbing X-ray photons? (1 mark)

Answer 100

High atomic number meaning a large number of protons in it nucleus

Question 101

During a radiographic exposure the dentist must not stand too close to the patient or X-ray source. What is the minimum distance recommended by UK guidance? (1 mark)

Answer 101

1.5 meters in a controlled area

Question 102

All medical radiation exposures must be justified. What does the term “justification” mean in the context of deciding whether or not to take a dental radiograph? (1 mark)

Answer 102

Clinical consideration of whether the benefits of the radiograph must outweigh the risks of exposure

Question 103

ALARP is an important phrase in radiation protection. What does this abbreviation stand for? (1 mark)

Answer 103

As Low As Reasonably Practicable (1 mark)

Question 104

List TWO ways in which the researchers might minimise bias in a randomized control trial?

Explain in what ways they reduce bias (4 marks)

Answer 104

Randomization: randomly assign participants so that the outcome is not based on factors like age or gender or socioeconomic factors (2 marks)

Blinding: blind the participants and assessors to which group they have been assigned so that the results do not influence either of them (2 marks)

Question 105

ARD is 9% and the CI is -0.8% to 18.9%

What does this tell you about the data

Answer 105

Cl overlaps 0 value of no difference - therefore insufficient evidence

Question 106

Aims: to compare the effectiveness of a novel sonic power toothbrush compared to a manual toothbrush in the reduction of plaque.

Methods: 130 adults attending general dental practice were allocated to one of the two types of toothbrush for twice-daily tooth brushing over 4 weeks. Plaque scores were measured at baseline and at 4 weeks follow-up.

Results: The sonic toothbrush was more effective at reducing plaque than the manual toothbrush.

Produce a P-I-C-O for this study (2 marks)

Answer 106

Population: Adults attending general dental practice

Intervention: Using a sonic power toothbrush for twice-daily tooth brushing

Comparison: Using a manual toothbrush for twice-daily tooth brushing

Outcome: Reduction in plaque scores with the use of sonic toothbrush over manual toothbrushing

Question 107

What type of handpiece is used for bone removal? (1 mark)

Answer 107

Electrical straight handpiece with saline cooled bur (1 mark)

Question 108

What are TWO aims for raising a flap in oral surgery? (2 marks)

Answer 108

To gain maximal access to underlying structures and tissues (1 mark)

To protect the surrounding soft tissues by reducing trauma to them (1 mark)

Question 109

What are 4 factors that influence flap design in oral surgery?

Answer 109

Aim of the surgical procedure (1 mark)

Condition of the surrounding tissues (1 mark)

Location of the surgical site (1 mark)

Wound healing (1 mark)

Question 110

What is the drug family of apixaban (1 mark)

Answer 110

Direct oral anticoagulants (DOAC) (1 mark)

Question 111

What does apixaban inhibit (1 mark)

Answer 111

Free and clot bound Factor Xa and prothrombinase (1 mark)

Question 112

Besides being an anticoagulant what is apixaban used for (2 marks)

Answer 112

Prevent blood clots and stroke in patients with atrial fibrillation, deep vein thrombosis, or pulmonary embolism (2 marks)

Question 113

What blood test would you do before treatment of a patient on apixaban? (1 mark)

Answer 113

Chromogenic anti-Xa assays

Question 114

What do you ask the patient to do with dosage for simple treatment vs complex extraction (2 marks)
“apixiban question”

Answer 114

Simple treatment: treat without interrupting medication (1 mark)

Complex extraction: miss morning dose before treatment and take usual evening time dose (1 mark)

Question 115

What are 3 methods of achieving hemostatic control (3 marks)

Answer 115

Even and firm pressure (1 mark)

Suturing (1 mark)

LA with adrenaline (1 mark)

Question 116

What are FOUR physical features of down syndrome (2 marks)

Answer 116

Short neck (0.5 mark)

Flattened facial profile and nose (0.5 mark)

Low muscle tone (0.5 mark)

Small head, ears and mouth (0.5 mark)

Question 117

What is the result of a genetic test of a patient with down syndrome (1 mark)

Answer 117

Trisomy of chromosome 21 (1 mark)

Question 118

List TWO reasons why patients with down syndrome have an increased risk of periodontal disease (2 marks)

Answer 118

Immune system dysfunction

Difficulties with OH

Question 118

State TWO reasons why patients with down syndrome have no capacity (1 mark)

Answer 118

AMCUR

Incapable of understanding decisions

Incapable of making decisions

Question 119

List TWO features associated with Down’s Syndrome that are likely to have contributed to his periodontal disease? (2 marks)

Answer 119

Inability to self-care: poor oral hygiene

Systemic immunodeficiency

Question 120

What is the difference between welfare guardian and welfare power of attorney (2 marks)

Answer 120

A guardianship is applied for through the courts (and can take up to 6 months to be granted) whereas a power of attorney is drawn up by a solicitor (1 mark)

A guardianship is for a fixed period of time whereas a power of attorney stays in force unless revoked by the person granting the power of attorney or death (1 mark)

Question 121

What is the antibiotic commonly used for antibiotic prophylaxis and what dose? (1 mark)

Answer 121

Amoxicillin 3g orally (1 mark)

Question 122

What is the antibiotic commonly used for antibiotic prophylaxis if the patient is allergic to Amoxicillin and what dose? (1 mark)

Answer 122

Clindamycin 600mg

Question 123

When do you prescribe antibiotic prophylaxis and when should the patient take it (1 mark)

Answer 123

For high risk patient. 1 hour before dental procedure (1 mark)

Question 124

What are 3 features of Parkinson’s disease (3 marks)

Answer 124

Resting tremors (1 mark)

Bradykinesia: difficulty initiating movement (1 mark)

Rigidity (poor posture): stiffness of muscles (1 mark)

Question 125

How does Parkinson’s differ from other cerebellar diseases (2 marks)

Answer 125

Disease of the basal ganglia caused by loss of dopamine producing cells in the substantia nigra

Other cerebellar diseases primarily affect the cerebellum (1 mark)

Other cerebellar diseases usually have an intension tremor while Parkinson’s has a resting tremor (1 mark)

Question 126

What is the reason for dry mouth in patients with Parkinson’s disease (1 mark)

Answer 126

They are usually taking anticholinergics and dopaminergic which cause xerostomia

Parkinson’s also affects the ANS (1 mark)

Question 127

How do you prevent dentures being lost in care homes? (2 marks)

Answer 127

Ensure correct labelling and storage of residents dentures (1 mark)

Mark initials on the denture using sandpaper or a sealant (1 mark)

Question 128

What are TWO most important things to consider in the provision of the future treatment of patients with Parkinson’s disease

Answer 128

Their tremor will get worse so plan treatment early on (1 mark)

Prevention: modified oral hygiene instruction (1 mark)

Question 129

What is ONE reason you should not extract teeth for dentures in a patient with Parkinson’s disease

Answer 129

Poor candidates for dentures due to poor neuromuscular control and dry mouth from anticholinergics

Question 130

Describe TWO clinical ways to assess the vertical skeletal relationship? (2 marks)

Answer 130

Cephalometric analysis of LAFH/TAFH ratio (1 mark)

Assess FMPA: Frankfort mandibular planes angle (1 mark)

Question 131

What position should the patients head be in when performing skeletal assessment in orthodontics (1 mark)

Answer 131

Frankfort horizontal plane should be parallel to the floor

Question 132

Which external reference plane of the patient should you position horizontally when setting up for a panoramic radiograph? (1 mark)

Answer 132

Frankfort plane (1 mark)

Question 133

What is used to bond porcelain to composite luting resin (1 mark)

Answer 133

Silane coupling agent (1 mark)

Question 134

How is porcelain surface prepped in the lab for bonding (1 mark)

Answer 134

Etched with hydrofluoric acid

Question 135

Why would you still light cure a dual cured composite luting resin? (1 mark)

Answer 135

In dual cured materials the physical properties are reduced by 25% if they are not light cured. (1 mark)

Question 136

When would you use a dual cured composite luting resin (1 mark)

Answer 136

If the restoration is thick use a dual cured (1 mark)

Question 137

What would you do to metal in a lab to prepare it (1 mark)

Answer 137

Sandblasting or etching (cannot etch precious metals)

Question 138

What chemical agent is used to bond metal (1 mark)

Answer 138

MDP and 4 META (1 mark)

Question 139

What are FOUR things you should ask patients about smoking (4 marks)

Answer 139

How long have you been smoking for?

How many cigarettes a day do you smoke?

What products do you use/smoke?

What age did you start smoking?

Question 139

What metal can be used for an acid-etch retained bridge (1 mark)

Answer 139

cobalt chromium (1 mark)

Question 140

What are THREE things to tell them about e-cigs (3 marks)

Answer 140

Safety in the long term is not known (1 mark)

Aid to quitting (1 mark)

Less toxic alternative to cigarette smoking but still have side effects (1 mark)

Question 141

What are 2 advice services you should refer patients to for smoking cessation help (2 marks)

Answer 141

Quit Your Way Scotland (NHS smoking cessation) (1 mark)

Smokeline Scotland (1 mark)

Community pharmacy too

Question 142

What is the methodology for smoking cessation (1 mark)

Answer 142

Ask, Advise, Act (1 mark)

Question 143

What is an impression material that would require a 3mm spacer when constructing a special tray and why do we use the spacer? (2 marks)

Answer 143

Alginate material (1 mark)

Accommodates the flow of the alginate and to properly adapt to the contours of the teeth and soft tissues (1 mark)

Question 144

Why would you prefer to use alginate over a silicone impression material? (2 marks)

Answer 144

Alginate is cheaper (1 mark)

Alginate is easier to use and tolerate due to quick set (1 mark)

Alginate is mucostatic and will take an accurate record of the tissues without displacement
Silicone is mucocompressive and is likely to tear not effective if undercuts are present

Question 145

Give TWO examples of support areas for a complete upper denture (2 marks)

Answer 145

Primary support: hard palate

Secondary support: ridge crest

Question 146

What is the primary support area for a complete lower denture (1 mark)

Answer 146

Buccal shelf (1 mark)

Question 147

What is the anatomical landmark for the extension of the buccal shelf for a complete lower denture. What muscle lies adjacent to this landmark (2 marks)

Answer 147

External oblique ridge (1 mark)

Buccinator (1 mark)

Question 148

What part of the mandible can interfere during a maxillary working impression (1 mark)

Answer 148

Retromolar pads (1 mark)

Question 149

What is the most important factor for preventing healthcare associated infections (1 mark)

Answer 149

Hand hygiene (1 mark)

Question 150

What are the 10 Standard Infection Control Precautions SCIP’s (5 marks)

Answer 150

1) Assessment of infection risk

2) Hand hygiene

3) Respiratory and cough hygiene

4) PPE

5) Safe management of the care environment

6) Safe management of care equipment

7) Safe management of healthcare linen

8) Safe management of blood and body fluids

9) Safe disposal of waste

10) Occupational safety

Question 151

What AGENT is used for blood spillages and what STRENGTH (concentration) is used and for how LONG (3 marks)

Answer 151

Sodium hypochlorite (1 mark)

10,000 ppm chlorine (1 mark)

At least 3 minutes for follow manufacturers instructions (1 mark)

Question 152

How would you break the chain of infection for the transmission of dirty forceps (1 mark)

Answer 152

Mode of transmission is the link that needs to be interrupted. Wear PPE to handle the forceps then disinfect and sterilize the forceps

Question 153

How long should you leave an irrigant in a root canal for endodontic treatment (1 mark)

Answer 153

10 minutes (follow manufacturers instructions)

Question 154

What are 4 indications that a trauma incident was not accidental? (4 marks)
“child”

Answer 154

1) Delay in seeking help (1 mark)

2) History of the trauma is vague or contradictory to child (1 mark)

3) Explanation does not fit the clinical findings (1 mark)

4) Parents behavior raises concerns (1 mark)

Question 155

What are TWO effects of trauma on primary teeth (2 marks)

Answer 155

Discoloration and infection (1 mark)

Delayed exfoliation (1 mark)

Question 156

What are FOUR long term effects that trauma can have on permanent teeth (4 marks)

Answer 156

Pulp Necrosis & Infection (1 mark)

Discoloration (1 mark)

Root Resorption (1 mark)

Dilaceration (1 mark)

Question 157

When is the ideal time to remove 6s (2 marks)

Answer 157

7’s bifurcation calcifying

8’s present

Class 1 occlusion with an average or reduced overbite

Moderate lower crowding

Moderate upper crowding

Question 158

Why is there an ideal time to remove 6s with poor prognosis? (2 marks)

Answer 158

Allows the development of a caries/infection free dentition into adolescence (1 mark)

To achieve an optimal occlusal result (1 mark)

Question 159

What are the disadvantages of removing 6s (2 mark)

Answer 159

May require compensating extraction to achieve optimal occlusion (1 mark)

The risk of extraction including bone loss, infection, shifting of adjacent teeth, changes to bite (1 mark)

Question 160

If you remove a lower with poor prognosis what would you do with the upper 6 that is non carious (1 mark)

Answer 160

Compensating extraction of upper 6 required (1 mark)

Question 161

What are FOUR reasons for a child to be anxious (4 marks)

Answer 161

Parental anxiety (1 mark)

Negative experiences (PDH) (1 mark)

Child suffers from anxiety (PMH) (1 mark)

Behavior of the dental staff (1 mark)

New environment (1 mark)

Question 162

What are TWO ways to treat anxious child (2 marks)

Answer 162

Through the use of sedation (1 mark)

Using behavioral management techniques and acclimating the child to the procedure (1 mark)

Question 163

What are FOUR behavior management methods (4 marks)

Answer 163

Positive reinforcement (1 mark)

Distraction techniques (1 mark)

Tell-show-do (1 mark)

Stop, go and rest signals (1 mark)

Question 164

What FOUR borders of the maxillary sinus are seen in an OPT (2 marks)

Answer 164

Roof (0.5 mark)

Floor (0.5 mark)

Medial wall (0.5 mark)

Posterior wall (0.5 mark)

Question 165

What is the reason for anterior teeth to be horizontally magnified in an OPT (1 mark)

Answer 165

Patient is too far back in the machine or too close to x-ray source (1 mark)

Question 166

What horizontal reference line is used when taking an OPT and the patient is viewed from the lateral aspect

Answer 166

Frankfort plane

Question 167

What is the reason posterior teeth is magnified on one side of the OPT (1 mark)

Answer 167

Patient is rotated in the machine or patient not biting symmetrical between incisors on bite peg (1 mark)

DO NOT accept tilting

Question 168

What are TWO treatment options for a perio-endo lesion (2 marks)

Answer 168

RCT, observe, RSD for residual pockets if required following 3 months after RCT

Question 169

What would you ask about the social history of a perio-endo patient (1 mark)

Answer 169

Do you smoke or use tobacco products (1 mark)

Question 170

What THREE investigations would you perform for a patient with a perio-endo lesion (1 mark)

Answer 170

1) Radiographic assessment: periapical

2) Sensibility testing: ethyl chloride or EPT

3) 6PPC to check for furcation and probing depth

Question 171

What are FOUR factors that cause oral candidiasis (2 marks)

Answer 171

Medications like prolonged antibiotic use

Immunocompromised

Poor oral hygiene

Denture wearers

Question 172

Name the organism and virulence factor which causes candidiasis (2 marks)

Answer 172

Candida albicans: hyphae for penetration

Question 173

What are the FOUR key stages to plaque formation (2 marks)

Answer 173

1) Adhesion

2) Colonization

3) Maturation

4) Acid production

Question 174

How would you test for Candida albicans and suggest lab identification method (2 marks)

Answer 174

Germ tube formation test

Chromogenic agar identification method. Candida will be blue-green

Question 174

Give TWO antifungal examples (azole and polyene) and the mechanism for both (2 marks)

Answer 174

Fluconazole (azole): inhibits the synthesis of ergosterol

Nystatin (polyene): bind to ergosterol and disrupt membrane

Question 175

Besides a randomized control trial, give THREE other study designs and explain them (6 marks)

Answer 175

Cohort - follow group over time, identify those that get disease. Used for incidence (2 marks)

Case control study- the study of people with a disease and a suitable control group of people without the disease. Retrospective study (2 marks)

Cross sectional study- observational study that analyses data collected from a population, used to estimate prevalence (2 marks)

Question 176

List FOUR patient related factors which should be considered when interpreting the results of a RCT of ultrasonic vs manual tooth brushing

Answer 176

Age

Medical history

Tooth condition

Tooth type

Question 177

How could an amalgam container be kept safe (2 marks)

Answer 177

Spill and leak proof (1 mark)

Mercury vapor suppressant (1 mark)

Question 178

What are THREE aims of an audit (3 marks)

Answer 178

Quality assurance (1 mark)

Performance evaluation (1 mark)

Continuous improvement (1 mark)

Question 179

You are a vocational trainee at a new dental practice. Principal dentist notices there is something lacking in the waste disposal procedures and asks you to look into it and present your findings.

Draw a flowchart: (5 marks)

Answer 179

Set guidelines - Observe practice - Compare with guidelines - Implement change

Question 180

What are the FOUR principles of waste management (4 marks)

Answer 180

Segregation (1 mark)

Storage (1 mark)

Disposal (1 mark)

Documentation (1 mark)

Question 181

Name THREE regulations for waste disposal (3 marks)

Answer 181

Environmental Protection Act (EPA)

Controlled Waste Regulations (CWR)

Waste (Scotland) Regulations (WR)

COSHH Act

Question 182

A patient comes in with an enamel dentine pulp fracture with an exposed root canal treatment. List FIVE functions of a provisional crown in this scenario (5 marks)

Answer 182

Improve aesthetics

Restore function

Protects the remaining structure

Prevents sensitivity and provides comfort

Guidance for the permanent restoration

Question 183

List THREE types of prefabricated crowns (3 marks)

Answer 183

Metal crowns: stainless steel, aluminum (1 mark)

Polycarbonate crowns (1 mark)

Clear plastic crowns (1 mark)

Question 184

List TWO disadvantages of a prefabricated crown (2 marks)

Answer 184

Requires a large bank of crowns (1 mark)

Inaccurate and less customizable (1 mark)

Question 185

Name the constituents of stainless steal and their percent composition (4 marks)

Answer 185

Iron: 72%

Chromium: 18%

Nickel: 8%

Titanium: 1.7%

Carbon: 0.3%

Question 186

What is work hardening? (3 marks)

Answer 186

Work hardening is the strengthening of a metal by plastic deformation. (1 mark)

The wire is made by drawing the metal in a cold state through a series of dies of successively smaller diameter. (1 mark)

Each time the material is deformed, its structure becomes more complex and more resistant to further deformation (1 mark)

Question 187

What is meant by springiness? (1 mark)

Answer 187

Rate at which a material returns to it’s original shape after being subjected to large deflections

Question 188

Name TWO disadvantages of self cure PMMA (2 marks)

Answer 188

Residual monomer - irritant (1 mark)

Poor mechanical properties since chemical activation is less efficient (1 mark)

Question 189

What are FOUR factors that can result in tooth mobility (4 marks)

Answer 189

Periodontal inflammation
Attachment loss
Widening of the periodontal ligament (occlusal trauma)
The morphology and length of the roots
Periapical bone loss
Pathology affecting the roots – resorption, trauma, etc.

Question 190

In which TWO circumstances would you intervene if a patient presented with tooth mobility (2 marks)

Answer 190

Progressively increasing mobility (1 mark)

Tooth mobility gives rise to symptoms such as difficulty chewing or discomfort (1 mark)

Question 191

Would you expect tooth mobility to increase or decrease in a patient with moderate/advanced periodontal disease following hygiene phase therapy? Explain why (2 marks)

Answer 191

It would be more likely to decrease (1 mark) due to increased tone in the supra-alveolar soft tissues leading to resistance to movement (1 mark).

Question 192

A patient has mobile lower incisors and refuses extraction as a treatment option. Horizontal bone loss is seen on radiograph. What would you advise him and what are the disadvantages of this? (2 marks)

Answer 192

Splinting may be appropriate however, splinting does not influence the rate of periodontal destruction and it may create hygiene difficulties. It is a treatment of last resort (2 marks)

Question 193

List FOUR peri-operative complications (4 marks)

Answer 193

Fracture of tooth/root

Dislocation of TMJ

Damage to soft tissues

Damage to adjacent teeth

Question 194

The patient’s root fractures during a standard extraction procedure. What radiograph would you take? (1 mark)

Answer 194

Periapical (1 mark)

Question 195

Where is the position of the mental foramen (1 mark)

Answer 195

Between the apices of the lower 4 and 5 (1 mark)

Question 196

Draw the flap design for a surgical extraction of a 44 (2 marks)

Answer 196

Learn this

Question 197

What TWO structures does the mental nerve innervate (2 marks)

Answer 197

Lower lip and chin up to midline (1 mark)

Buccal gingiva of lower anterior teeth including premolars up to midline (1 mark)

Question 198

What TWO information do you need before an extraction of a patient on Warfarin (2 marks)

Answer 198

INR (1 mark)

Date of INR (1 mark)

Question 199

What INR would you carry out an extraction if the patient is taking Warfarin and when should this be done (2 marks)

Answer 199

If INR below 4 (1 mark)

Ideally no more than 24 hours before procedure (1 mark)

Question 200

What is the most appropriate analgesic for a patient taking Warfarin (1 mark)

Answer 200

Paracetamol

Question 201

If a patients INR is unstable. How would a GP assess this?

Answer 201

Review the patients medical history and medications (1 mark)

Monitor the patients INR closely and adjust medication dosages (1 mark)

Question 202

Would you make any alterations regarding a patient on apixaban for an extraction of tooth 16? (1 mark)

Answer 202

Miss the morning dose and take usual evening dose (1 mark)

(According to SDCEP extraction of upper molar is moderate risk)

Question 203

Would you make any alterations regarding a patient on apixaban for an extraction of tooth 31? (1 mark)

Answer 203

No (1 mark)

According to SDCEP extraction of lower central is low risk

Question 204

A dentist causes a facial palsy as a result of a right inferior alveolar nerve block. The patient has a sore right temporomandibular joint

How is facial palsy caused (2 marks)

Answer 204

If the LA is deposited too far posteriorly and into the parotid gland where the facial nerve runs through (1 mark)

LA will cause paralysis of the facial nerve which innervates the facial muscles (1 mark)

Question 205

Describe THREE differences between a stroke and a facial palsy (3 marks)

Answer 205

A stroke is caused by a disruption of blood to the brain, while facial palsy is caused by damage to the facial nerve (1 mark)

A stroke affects the contralateral muscles while facial palsy affects ipsilateral muscles (1 mark)

In a stroke the patient can still wrinkle their forehead while facial palsy the patient cannot on the affected side (1 mark)

Question 206

Explain the neural anatomy which accounts for the difference in facial palsy and a stroke (3 marks)

Answer 206

In facial palsy it is a LMN lesion which affects all the muscles on the ipsilateral side (1 mark)

The facial nerve innervates the facial muscles therefore damage or dysfunction leads to complete loss of motor control to the muscles on the affected side (1 mark)

A stroke is an UMN lesion which provides motor innervation to the contralateral side. The upper motor nucleus however has bilateral innervation therefore the upper muscles of the contralateral side are unaffected hence why patient can wrinkle forehead

(1 mark)

Question 207

Name FOUR ways you can initially manage a patient with facial palsy (2 marks)

Answer 207

Reassurance

Cover eye with pad until blink reflex returns

Let someone else drive them home

Consider ibuprofen for pain or discomfort

Question 208

You take an impression of an MOD for a ceromeric inlay. How would you determine if this impression is usable (3 marks)

Answer 208

Make sure the impression captures the full extent of the preparation

Make sure there are no tears or air blows in the impression

Make sure all intended teeth and soft tissues are captured accurately

Question 209

List FOUR potential faults with an impression (4 marks)

Answer 209

Air bubbles

Tear in the material

Voids: incomplete capture of anatomy

Distortion of the material

Question 210

How would you decontaminate the impression immediately after taking it (3 marks)

Answer 210

Rinse under cold water

Place in perform for 10 minutes

Remove from perform and rinse under cold water

Cover material in damp paper towel and place into sealable bag with a label

Question 211

Give FOUR reasons why non setting calcium hydroxide an ideal inter-appointment medicament (2 marks)

Answer 211

Prolonged effectiveness: can remain active between appointments

Antibacterial properties

Biocompatible

Easy to use

Question 212

What are THREE reasons for obturating a root canal? (3 marks)

Answer 212

Seal the root canal system and prevent ingress of bacteria from coronal leak (1 mark)

To support and strengthen the remaining tooth structure (1 mark)

Prevents root infection from periradicular exudate via apical foramen (1 mark)

Question 213

Other than rubber what are the components of Gutta percha (2 marks)

Answer 213

Zinc oxide: 65%

Gutta percha: 20%

Radiopacifiers: 10%

Plasticizers: 5%

Question 214

What are THREE reasons for a sealer when using cold lateral compaction (3 marks)

Answer 214

Create fluid tight seal and acts as adhesive (1 mark)

Fills voids and irregularities in canal thus preventing ingress of bacteria (1 mark)

Lubricates the canal during obturation (1 mark)

Question 215

What are the TWO most important muscle of mastication for elevating the mandible (2 marks)

Answer 215

Masseter (1 mark)

Temporalis (1 mark)

Question 216

What is the PRIMARY muscle of mastication for protruding the mandible (1 mark)

Answer 216

Lateral pterygoid muscle (1 mark)

Question 217

What is the anterior convex part of the temporomandibular joint (1 mark)

Answer 217

Articular eminence/tubercle (1 mark)

Question 218

What is the posterior concave part of the temporomandibular joint (1 mark)

Answer 218

Glenoid/mandibular fossa (1 mark)

Question 219

What is ONE species other than Candida albicans that causes candidiasis and how can you differentiate (2 marks)

Answer 219

Candida glabrata: culture and sensitivity test to differentiate (2 marks)

Question 220

What are THREE forms of candidiasis? (3 marks)

Answer 220

Oral candidiasis (1 mark)

Genital candidiasis (1 mark)

Cutaneous candidiasis (1 mark)

Question 221

What are THREE forms of oral candidiasis (3 marks)

Answer 221

Pseudomembranous candidiasis: thrush (1 mark)

Erythematous candidiasis: denture induced stomatitis (1 mark)

Hyperplastic candidiasis: candidal leukoplakia (1 mark)

Question 222

Order the following list of treatments

Upper restoration with LA

Upper restoration with no LA

Fluoride varnish

Lower restoration with LA

Fissure sealants

Pulpotomy

OHI

Extraction

(8 marks)

Answer 222

OHI

Fluoride varnish

Fissure sealants

Upper restoration with no LA

Upper restoration with LA

Lower restoration with LA

Pulpotomy

Extraction

Question 223

What are FOUR signs that a child is anxious at the dentist (2 marks)

Answer 223

Crying or expressing fear

Difficulty communicating

Clinging on to parent or caregiver

Physical signs: sweating and trembling

Question 224

What is SIMD (1 mark)

Answer 224

The Scottish Index of Multiple Deprivation (SIMD) is a tool used to measure the level of deprivation experienced by different areas of Scotland. (1 mark)

Question 225

What are the SEVEN factors of deprivation (7 marks)

Answer 225

income

Employment

Education

Health

Crime

Skills and training

Geographic access to services

Question 226

What is another name for master impressions (1 mark)

Answer 226

Definitive impressions (1 mark)

Question 227

What are TWO factors that affect physical retention of a denture (2 mark)

Answer 227

Accurate fit (1 mark) ??

Cohesion and adhesion: salivary quality of patient (1 mark)

Border seal: by incorporating post dam (1 mark)

Question 228

What are TWO anatomical features for the positioning of the posterior border of the upper denture (2 marks)

Answer 228

Vibrating line (1 mark)

Hamular notch (1 mark)

Question 229

Name 3 anatomical features to include on a mandibular impression (3 marks)

Answer 229

Retromolar pads (1 mark)

Lingual pouch (1 mark)

Buccal shelf (1 mark)

Question 230

Name TWO materials you can use for master impressions of the lower arch (2 marks)

Answer 230

Alginate (1 mark)

Silicone elastomers: polyvinyl siloxane (1 mark)

Question 231

A nurse does not wash her hands before a patient. What should you do (2 marks)

Answer 231

Politely remind the nurse to wash her hands (1 mark)

Remind the nurse the importance of hand hygiene

If the nurse does not comply report the incident to appropriate authority (1 mark)

Question 232

You decide to give a presentation about hand hygiene. What are FOUR things to include (4 marks)

Answer 232

When to wash your hands

How to wash your hands

What to wash with

Why to wash hands

Question 233

You see a dentist wear double gloves and book a blood disease patient at the end of the day. What would you tell the dentist? (2 marks)

Answer 233

There is no added benefit to double gloving in standard dental procedures and it can be wasteful (1 mark)

The dentist should follow SICPs for ALL patients and not discriminate by booking blood diseased patients at the end of the day in case there is an emergency and the patient needs to go to hospital. (1 mark)

Question 234

After informing the dentist of the standard operating procedure what are TWO things you should do? (2 marks)
“double gloved blood disease question”

Answer 234

Implement model for improvement (1 mark)

Document (1 mark)

Question 235

What is FOUR PPE you need for carrying out manual cleaning and why would you need each one (4 marks)

Answer 235

Gown: splashing onto clothes (1 mark)

Face shield: aerosols (1 mark)

Heavy duty rubber gloves (marigold): sharps (1 mark)

Face mask: protects mouth and nose from aerosols (1 mark)

Question 236

When should you degas the ultrasonic bath (1 mark)

Answer 236

Every time it is filled from empty (1 mark)

Question 237

Why should you degas the ultrasonic bath (1 mark)

Answer 237

To remove air/oxygen (1 mark)

Question 238

How does degassing the ultrasonic bath affect it (1 mark)

Answer 238

Air/oxygen will prevent ultrasonic bubbles from reaching all surfaces of instrument (1 mark)

Question 239

Provide one good reason why dental handpieces should not be placed in the ultrasonic cleaner (1 mark)

Answer 239

May be damaged by ultrasonic activity (1 mark)

Question 240

What are TWO types of manual cleaning and name an example for each (2 marks)

Answer 240

Immersion: dental mirror

Non immersion: handpieces

Question 241

Why do you use deionized water in the sterilizer (1 mark)

Answer 241

To prevent the deposit of minerals on the instruments (1 mark)

Question 242

What percentage of patients are affected by sensitivity caused by tooth whitening (1 mark)

Answer 242

60%+ (1 mark)

Question 243

What are THREE predisposing factors likely to cause sensitivity after tooth whitening (3 marks)

Answer 243

Pre-existing sensitivity (1 mark)

Gingival recession (1 mark)

High concentration of bleaching agent (1 mark)

Question 244

One of the risks of internal non vital bleaching is external cervical resorption. What is the method of action for this? (2 marks)

Answer 244

Due to diffusion of H2O2 through dentine into periodontal tissues (2 marks)

Question 245

One of the risks of internal non vital bleaching is external cervical resorption. What are TWO causes for this?

Answer 245

High concentration of H2O2 (1 mark)

Heat (1 mark)

Question 246

How do you prevent root resorption from internal non vital bleaching (2 marks)

Answer 246

Remove GP from pulp chamber and 1mm below ACJ. Place 1mm RMGIC over GP to seal canal. This seals dentine and prevents root resorption (1 mark)

Use appropriate concentration of H2O2 and heat (1 mark)

Question 247

What are TWO indications for surgical consideration at the reevaluation stage of a patient with periodontal disease (2 marks)

Answer 247

Good OH (1 mark)

Persistent deep pockets ≥ 6mm (1 mark)

Question 248

When should you continue non surgical intervention at the reevaluation stage for a patient with periodontal disease (1 mark)

Answer 248

Poor OH, persistent inflammation with Pocket probing depth PPD 4-5mm

or

Good OH, inflammation resolved with PPD 4-5mm

Question 249

What is the aim of surgical treatment of a patient with periodontal disease (1 mark)

Answer 249

To prevent the progression of disease and restore a functional and comfortable dentition (1 mark)

Question 250

What are THREE reasons for non surgical periodontal disease treatment before surgical treatment (3 marks)

Answer 250

Improve soft tissue consistency for easier surgical management (1 mark)

Deep pockets may heal following non surgical therapy (1 mark)

Allow evaluation of patients motivation and plaque control (1 mark)

Question 251

What are THREE supportive roles of the GDP after surgical intervention of a periodontal patient has been carried out by a specialist (3 marks)

Answer 251

Maintain periodontal health (1 mark)

Monitor and treat recurrence (1 mark)

Reinforce prevention (1 mark)

Question 252

A patient has had radiotherapy to the parotid gland. What is the link of radiotherapy in that region to the formation of ulcers (2 marks)

Answer 252

Reduced salivary flow (1 mark)

Compromised immune system and damage to oral mucosa (1 mark)

Question 253

A patient has had radiotherapy to the parotid gland. Why is enhanced prevention needed for this patient (2 marks)

Answer 253

Patient is at an increased risk for caries (1 mark)

Increased risk for oral infections (1 mark)

Question 254

A patient has had radiotherapy to the parotid gland. What are complications of extractions for this patient and why? (2 marks)

Answer 254

Increased risk of infection due to compromised immune system (1 mark)

Risk of osteoradionecrosis due to weakened bone tissue and delayed healing (1 mark)

Question 255

What are FOUR effects of chemotherapy on blood count (4 marks)

Answer 255

Decreased white cell count (leukopenia) (1 mark)

Decreased red cell count (anaemia) (1 mark)

Decreased platelet count (thrombocytopenia) (1 mark)

Decreased neutrophils (neutropenia) (1 mark)

Question 256

What are FOUR diagnostic criteria for Alzheimer’s (4 marks)

Answer 256

Amnesia: short term memory loss (1 mark) ???

Aphasia (1 mark)???

Communication difficulties (1 mark) ???

Disorientation (1 mark)????

Supportive biomarkers: abnormal levels tau protein and beta amyloid (1 mark)

Memory impairment: memory loss (1 mark)

Cognitive impairment: difficulty communicating (1 mark)

Functional impairment: difficulty performing everyday activities (1 mark)

Question 257

Can the care home manager consent to dental treatment of a patient with Alzheimer’s disease (1 mark)

Answer 257

No unless they have been appointed by the court or by the patient (1 mark)

Question 258

Who can consent for a patient with Alzheimer’s disease prior to treatment (2 marks)

Answer 258

Power of attorney (1 mark)

Welfare guardian (1 mark)

Question 259

Which act is relevant in Scotland regarding a patient with Alzheimer’s not being able to consent

Answer 259

Adults with Incapacity act 2000 (Scotland)

Question 260

Which act is relevant in England regarding a patient with Alzheimer’s not being able to consent

Answer 260

Mental Capacity Act 2003 (England)

Question 261

What are TWO types of e-cigs (2 marks)

Answer 261

Cigalike e-cigs (1 mark)

Vape mods e-cigs (1 mark)

Question 262

What are THREE questions to ask a patient who wants to quit smoking (3 marks)

Answer 262

How much and how long have you been smoking for? (1 mark)

Have you tried quitting before and how many attempts? (1 mark)

What’s motivating you to quit smoking now? (1 mark)

Question 263

Upper permanent central incisor fails to erupt. The deciduous central incisor has exfoliated already and the patient mentions that there has been previous trauma to that tooth. What are 4 initial management options for this patient (4 marks)

Answer 263

Take anterior oblique maxillary radiograph to determine if permanent successor present and location (1 mark)

Wait and monitor for 12 months (1 mark)

Create/maintain space (1 mark)

Expose and apply orthodontic traction (1 mark)

Question 264

What are TWO causes of failed eruption of a permanent tooth (2 marks)

Answer 264

Obstruction e.g. overcrowding (1 mark)

Genetic and developmental factors e.g. absent successor (1 mark)

Question 265

Upper permanent central incisor fails to erupt. The deciduous central incisor has exfoliated already and the patient mentions that there has been previous trauma to that tooth. What are FOUR principles of aim of orthodontic treatment for this tooth (4 marks)

Answer 265

Maintain alignment (1 mark)

Space creation (1 mark)

Root development (1 mark)

Restore aesthetics and function (1 mark)

Question 266

A patient comes in for a surgical extraction of roots 45. What nerves are needed to be anesthetized (2 marks)

Answer 266

Right inferior alveolar nerve (1 mark)

Right lingual nerve (1 mark)

Question 267

What are THREE possible nerve deficits (3 marks)

Answer 267

Anaesthesia (numbness) (1 mark)

Paraesthesia (tingling) (1 mark)

Dysaesthesia (unpleasant sensation/pain) (1 mark)

Question 268

What are THREE ways the pulp communicates with the periodontal ligament (3 marks)

Answer 268

Apical foramen (1 mark)

Lateral and accessory canals (1 mark)

Furcal canals (1 mark)

Question 269

If a patient comes in with a non vital pulp, what is the diagnosis and treatment (2 marks)

Answer 269

Pulp necrosis (1 mark)

Endodontic treatment of affected tooth (1 mark)

Question 270

A patient comes in with a vital pulp but generalized pocketing. What is the diagnosis and treatment (2 marks)

Answer 270

Generalized periodontitis (1 mark)

OHI, PMPR and control of risk factors (1 mark)

Question 271

A patient comes in with a non-vital pulp and periodontal problem. What is the diagnosis and treatment (3 marks)

Answer 271

Endo-periodontal lesion (1 mark)

Pulpectomy followed by RCT (1 mark)

observe and could provide optimal analgesics and chlorhexidine 0.2% (1 mark)

If there is a residual pocket at 3 month review perform root surface debridement (1 mark)

Question 272

How do you check that new guidelines have been followed (1 mark)

Answer 272

Audit (1 mark)

Question 273

Briefly explain each waste stream and give ONE example

Black

Yellow

Orange

Blue

Red (5 marks)

Answer 273

Black: domestic waste e.g. food wrappers

Yellow: high risk clinical waste e.g. needles

Orange: clinical waste e.g. gloves

Blue: medicinal waste e.g. cartridges with LA

Red: special waste e.g. amalgam

Question 274

What is a multidisciplinary team? (2marks)

Answer 274

Group of healthcare professionals from different specialties who share their expertise and work together to provide the best care possible for the patient (2 marks)

Question 275

Name FOUR members of the multidisciplinary team for the management of a patient who has undergone radiotherapy

Answer 275

Dentist (1 mark)

Physio (1 mark)

Oncologist (1 mark)

Radiologist (1 mark)

Question 276

Name THREE steps to debride a wound prior to suturing and briefly describe how each is done (3 marks)

Answer 276

Physical

-Bone file or handpiece to remove sharp bony edges

-Trimmer or curette to remove soft tissue debris (1 mark)

Irrigation: Sterile saline into socket and under flap (1 mark)

Suction: Aspirate under flap to remove debris (1 mark)

Question 277

A patient is suspected of having a bleeding disorder. What THREE blood tests can you use to investigate this? (3 marks)

Answer 277

FBC (1 mark)

Prothrombin time (PT) (1 mark)

aPTT (1 mark)

Question 278

What is ONE inherited coagulation disorder (1 mark)

Answer 278

Hemophilia A (1 mark)

Question 279

What is ONE disorder of platelet numbers (1 mark)

Answer 279

Thrombocytopenia (1 mark)

Question 280

What LA technique would you use for blood disorder patient for extraction of a 47 (1 mark)

Answer 280

Follow SDCEP guidelines Liase with patients hematologist if patient is not stable

Inferior alveolar nerve block with long buccal infiltration (1 mark)

Question 281

What FOUR clotting factors are affected by Warfarin (2 marks)

Answer 281

Factor 2, 7, 9, 10, Protein C and S

Factor II: prothrombin (1 mark)

Factor VII: vitamin K dependent factors (1 mark)

Question 282

What is the max INR you should tolerate for an extraction (1 mark)

Answer 282

3.9 is the max INR you should treat (1 mark)

Question 283

What LA technique would you use for a 47 extraction on a patient who is on warfarin

Answer 283

Ideally INR within 24 hours and make sure it is below 4

Inferior alveolar nerve block with long buccal infiltration (1 mark)

Question 284

What are TWO ways clinical waste is made safe before landfill (2 marks)

Answer 284

3/4 full no more than 4kg, tied using a swan neck and taped/tagged (1 mark) ???

Stored in a designated safe and lockable area (1 mark)???

Heat disinfection (1 mark)

Incineration (1 mark)

Question 285

What are TWO sources of amalgam waste (2 marks)

Answer 285

Extracted teeth with amalgam (1 mark)

Chairside amalgam residue/waste (1 mark)

Question 286

What are TWO safety features of an amalgam container (2 marks)

Answer 286

Spill/leak proof lid (1 mark)

Mercury suppressant (1 mark)

Question 287

What license regarding disposal of amalgam and how long should it be kept for? (2 marks)

Answer 287

Consignment note (1 mark)

Kept for a minimum of 3 years (1 mark)

Question 288

What is the main antifungal to get rid of Candida albicans (1 mark)

Answer 288

Fluconazole (1 mark)

Question 289

List TWO resistance mechanisms of Candida albicans (2 marks)

Answer 289

Efflux pumps to pump out the antifungal (1 mark)

Alterations to the drug target: fungi can develop mutations or changes in the genes that encode the drug target proteins (mutations of ergosterol) (1 mark)

Question 290

Before prescribing fluoride mouth rinse to a child what should you check (3 marks)

Answer 290

Age of the child: ideally 6 and over

Fluoride intake: to prevent fluorosis

Medical history: to check for contraindications such as thyroid disorder or kidney disease

Question 291

What is the daily strength of fluoride mouth rinse (1 mark)

Answer 291

225ppm

Question 292

How do you decide between a conventional crown and a post and crown (4 marks)

Answer 292

Amount of tooth structure: more conventional, less post and crown (1 mark)

Root canal status: if tooth undergone RCT a post and crown may be needed (1 mark)

Clinical judgement: does tooth need a post? (1 mark)

Tooth type: avoid in mandibular incisors or canines. Teeth with curves canals risk perforation (1 mark)

Question 293

What is the function of a post in a post and crown (1 mark)

Answer 293

Post retains the core. Posts DO NOT strengthen or reinforce teeth (1 mark)

Question 294

What are THREE materials used for a post (3 mark)

Answer 294

Metal: cast metal or steel (1 mark)

Fiber: Carbon or glass (1 mark)

Ceramic: zirconia (1 mark)

Question 295

What are THREE types of posts which can be used

Answer 295

Prefabricated post

Tapered posts

Parallel posts

Question 296

What are THREE materials used for a core (2 mark)

Answer 296

Composite (1 mark)

Amalgam (1 mark)

Glass ionomer (1 mark)

Question 297

What are THREE ways to determine the length of a post (3 marks)

Answer 297

Radiograph to determine the length (1 mark) ???

Electronic apex locator (1 mark)???

Instrument/files to explore the canal clinically (1 mark)???

Gates Glidden with stopper radiograph (1 mark)

Measure the length of the crown and canal and have a 1:1 ratio with crown and 2/3rd length of canal (1 mark)

Custom post: take impression of the preparation (1 mark

Question 298

What are TWO problems that arise from having a post that is too wide (2 marks)

Answer 298

Tooth fracture: weakens the tooth structure (1 mark)

Root perforation (1 mark)

Question 299

What are TWO problems that arise from having a post that is too narrow (2 marks)

Answer 299

Inadequate retention of crown or core (1 mark)

Fracture: cannot withstand forces of mastication (1 mark)

Question 300

What are THREE general health effects of smoking (3 marks)

Answer 300

Increased risk of cancer: lung cancer (1 mark)

Increased risk of cardiovascular disease (1 mark)

Increased risk of respiratory problems such as COPD, emphysema, chronic bronchitis (1 mark)

Question 301

What are THREE oral health effects of smoking (3 marks)

Answer 301

Increased risk of oral cancer (1 mark)

Increased risk of gingivitis and periodontitis (1 mark)

Xerostomia (1 mark)

Question 302

What are TWO recent health promotion approaches in Scotland to reduce smoking (2 marks)

Answer 302

Tobacco display ban (1 mark)

Smoking cessation services: Quit Your Way and Smokeline (1 mark)

Question 303

What is an example of an approach to smoking cessation in a dental practice (1 mark)

Answer 303

Brief intervention through the use of Ask, Advise and Act. This can lead to signposting patients to appropriate services (1 mark)

Question 304

When performing an incisal crown prep

List the following

Incisal reduction (1 mark)

Labial:

i. Margin design & reduction? (2 marks)

ii. Benefits of that margin design (2 marks)

Palatal:

i. Margin design & reduction? (2 marks)

ii. Benefits of that margin design (2 marks)

Answer 304

Incisal reduction: 2-2.5mm (1 mark)

Labial:

i. Margin design & reduction: Shoulder margin with 1.0-1.5mm reduction (2 marks)

ii. Benefits of that margin design: Provides better aesthetics and reduces risk of over-contouring (2 marks)

Palatal:

i. Margin design & reduction: Chamfer margin with 1.0-1.5mm reduction (2 marks)

ii. Benefits of that margin design: Allows for better adaptation of the crown margin and improves retention (2 marks)

Question 305

List FOUR properties of impression material suitable for crown prep. And give an TWO examples of a material (2 marks)

Answer 305

Good accuracy: able to capture surface details

Good dimensional stability

Good tear strength and resistance

Easy to use: appropriate setting time and handling

Example: polyvinyl siloxane (PVS) or polyether (impregum). Both of these are elastomers

Question 306

What is xerostomia? (2 marks)

Answer 306

Also known as dry mouth caused by salivary glands in the mouth not producing enough saliva to keep the mouth moist (2 marks)
- when mouth creates less than half the salivary rate that is considered normal (0.3l/min). so if it produces 0.15ml/min that is considered dry mouth

Question 307

What are THREE oral health problems that xerostomia exacerbate (3 marks)

Answer 307

Dental caries

Periodontitis

Oral Candidiasis

Question 308

What FOUR drugs cause xerostomia

Answer 308

Beta blockers

Diuretics

Tricyclic antidepressants

Anticholinergic

Question 309

What are TWO non drugs related causes of xerostomia

Answer 309

Sjogren’s syndrome

Radiotherapy/chemotherapy

Question 310

What does ARAB stand for and briefly define each?

Answer 310

Active components: component responsible for moving teeth through the application of force

Retention: resistance to displacement

Anchorage: resistance to unwanted tooth movements

Baseplate: connects all the components, helps with retention and provides anchorage

Question 311

What active component and baseplate modification corrects a posterior crossbite?

Answer 311

Active component: Hyrax screw or Coffin Spring

Baseplate modification: posterior bite plane

Question 312

What is the method of retention for a URA with primary and permanent teeth and what is the gauge of wire

Answer 312

Adam’s clasp (0.7mm HSSW) for permanent

Adam’s clasp (0.6mm HSSW) for primary

Question 313

What could you add to a URA to prevent a digit sucking habit

Answer 313

Deterrents like a single palatal goal post or a double palatal goal post

Question 314

Explain what happens to posterior dentition during digit sucking (2 mark)

Answer 314

The thumb or fingers are held in the mouth causing the mandible to drop open and the tongue to be held in a lower position than normal. This means that the sucking action caused by the cheeks narrows the maxillary dentition and causes a posterior crossbite.

Question 315

What is the length of the submandibular duct

Answer 315

5-6cm

Question 316

Where does the submandibular duct arise?

Answer 316

From the submandibular gland

Question 317

Where does the submandibular duct open

Answer 317

Sublingual caruncle

Question 318

Where does the sublingual duct open?

Answer 318

Sublingual fold

Question 319

What runs inferior to the submandibular duct

Answer 319

Lingual nerve which is a branch of the mandibular division of the trigeminal nerve (CN V3)

Question 320

What group does chlorhexidine belong to?

Answer 320

Bisguanide Antiseptic

Question 321

What is chlorhexidine and what is the mode of action of it (2 marks)

Answer 321

It is a dicationic compound.

Cation adheres to cell membrane

Increases permeability of cell membrane

Precipitation of cytoplasm; Cell death

Question 322

What is the substantivity of chlorhexidine

Answer 322

Active in the oral cavity for up to 12 hours after use

Question 323

What are TWO factors affecting the substantivity of chlorhexidine

Answer 323

Improper use from patient: dilution with water

Oral hygiene practices: brushing and flossing can mechanically remove chlorhexidine

Question 324

What is the recommended concentration, volume amount and frequency of chlorhexidine
“mouthwash”

Answer 324

0.2% 10ml = 20mg twice/day

0.12% 15ml = 18mg twice/day

Question 325

What are SIX indications for chlorhexidine

Answer 325

Oral candidosis

Immunocompromised patients

Treat gingivitis/periodontitis

Maintenance of OH

Mucositis

Oral ulcerations

Question 326

What is the relationship of oral cancer to being poor other than smoking. List TWO factors.

Answer 326

Limited access to healthcare

Poor nutrition

Question 327

A nursing home has been infected with food poisoning. What are THREE factors increasing this risk

Answer 327

Inadequate hand hygiene

Poor food handling and storing

Poor washing of cutlery

Question 328

What are the 6 key links in the chain of infection

Answer 328

1) Infectious agent

2) Reservoirs

3) Portal of exit

4) Mode of transmission

5) Portal of entry

6) Susceptible host

Question 329

A nursing home has been infected with food poisoning. What are TWO ways you could break the chain of infection in this scenario

Answer 329

Eliminate the infectious agent by performing hand hygiene

Implement infection control measures such as the use of PPE in the kitchen or disposable cutlery

Question 330

What are THREE examples of advice to give to carers when performing oral hygiene on elderly to stop cross infection

Answer 330

Perform hand hygiene before and after for at least 20 seconds

Use disposable gloves and change them frequently

Ensure adequate storage of each person toothbrush and change them frequently

Question 331

What are FOUR radiographic signs that a tooth is non vital

Answer 331

Widening of PDL

Changes to the lamina dura

Loss of definition of the root canal space

Radiolucency at the apex

Internal/external inflammatory root resorption

Question 332

What are FOUR checks prior to inserting a new orthodontic appliance

Answer 332

Correct patient and appliance

Check design specifications

Check the acrylic

Check the integrity of the wire

Question 333

What are THREE checks when the appliance is inserted in the patients mouth

Answer 333

Check for blanching or soft tissue trauma

Posterior retention: flyovers first, then arrowheads

Anterior retention

Question 334

What advice and instructions would you give a patient after fitting an orthodontic upper removable appliance

Answer 334

1) Feel big and bulky

2) Excess salivation

3) Impinge on speech

4) Initial discomfort or ache

5) Wear 24/7

6) Remove after meals to clean

7) Remove when doing contact sports

8) Avoid hard, sticky and hot foods/drinks

9) Non compliance will lengthen treatment time

10) Provide emergency contact details

Question 335

A bariatric patient presents to the practice with hypertension and complains of frequent urination. What is the suspected diagnosis?

Answer 335

Type 2 Diabetes Mellitus

Question 336

A bariatric patient presents to the practice with hypertension and complains of frequent urination. What tests can be used to confirm your diagnosis and what are the values for these tests?

Answer 336

HbA1c test: 48mmol/mol (6.5%) or higher

Fasting plasma glucose test: 7mmol/L or higher

Oral glucose tolerance test: 11.1mmol/L or higher

Blood pressure monitoring: 140/90mmHg or higher

Question 337

What should a patient with type 2 diabetes do before a dental appointment

Answer 337

Check blood sugar levels

Eat and hydrate

Bring necessary supplies: glucose tablets or insulin

Question 338

What is the normal values for blood pressure and hypertension

Answer 338

Normal blood pressure: 120/80mmHg

Hypertension: 140/90mmHg or higher

Question 339

What lifestyle changes would you give for a patient who has hypertension and type 2 diabetes

Answer 339

Exercise

Weight loss

Healthy diet (limit sodium intake)

Stress management

Quit smoking and drinking

Question 340

What THREE drugs can result in gingival hyperplasia

Answer 340

Calcium channel blockers

Phenytoin

Cyclosporine

Question 341

Give the oral side effects of the following drugs

Benazepril

Atenolol

Nifedipine

Bendrofluazide

Answer 341

Benazepril: dry mouth, altered taste, mouth sores, toothache

Atenolol: dry mouth, altered taste, mouth sores, toothache

Nifedipine: dry mouth, altered taste, gingival hyperplasia, mouth sores, toothache

Bendrofluazide: dry mouth, altered taste, mouth sores, toothache

If in doubt: dry mouth and altered taste

Question 342

What are THREE virulence factors involved in dental caries by Streptococcus mutans

Answer 342

ATPase (control pH)

Glucans (attach)

Adhesins (attach)

Question 343

What are TWO virulence factors involved in periodontal disease by P. gingivalis and T. forsythia

Answer 343

P. gingivalis: Gingipains

Tanerella Forsythia: Karilysin

Question 344

Briefly outline the process which leads to inflammation in the innate immune response (6 marks)

Answer 344

1) Tissue damage or infection

2) Release of inflammatory mediators: cytokines, prostaglandins, histamines

3) Vasodilation and increased vascular permeability

4) Migration of immune cells: neutrophils, macrophages

5) Activation of immune cells: which release more cytokines and chemokines

6) Resolution of inflammation: immune cells undergo apoptosis

Question 345

List FOUR different types of T cells and briefly describe how they work

Answer 345

Helper T cells (CD4+): Release cytokines and other immune cells

Cytotoxic T cells (CD8+): directly kill infected cells by binding to antigen presenting cells (APCs)

Memory T cells: remain after infection is cleared to provide long term immunity

Natural killer T (NKT) cells: express both T cell and NK cell receptors. Same as cytotoxic

Question 346

Hanau’s Quint is a set of five variables that are used to determine occlusal contacts and their effects on dentition. What are the FIVE determinants

Answer 346

1) Condylar Inclination

2) Condylar Guidance

3) Compensating curve

4) Incisor Guidance

5) Occlusal Plane

Question 347

Which variables of Hanau’s Quint can be altered or changed

Answer 347

Condylar inclination

Compensating curve

Question 348

Why is the Retruded axis used when fabricating complete dentures (3 marks)

Answer 348

Its reproducible

Its recordable

Its learnable for the patient

Question 349

What are FIVE occlusal table considerations when setting teeth for occlusal rims

Answer 349

Anterior guidance

Occlusal plane

Curve of Spee

Curve of Wilson

Cuspal inclination

Question 350

Why don’t oral biofilms allow antibiotics to penetrate them?

Answer 350

ECM of biofilms consist of polysaccharides and proteins which create a network that restrict the diffusion of antibiotics???

Penetration barrier of LPS???

Extracellular DNA persisters???

Contain glycocalyx (protection) and glucans (facilitate biofilm formation) in their ECM

Extracellular ploymetric substance(EPS) forming penetration barrie

Question 351

Name THREE characteristics of a ghost image on a radiograph

Answer 351

Ghost images are horizontally magnified

Ghost images are on the opposite side to the original

Ghost images are radiopaque

Question 352

Give THREE ways the dose to the patient is reduced by normal radiographical techniques

Answer 352

Rectangular collimation

High speed films: F speed film

Focus to skin distance >200mm

Question 353

Describe the Compton effect and how it differs from the Photoelectric effect

Answer 353

Compton effect

-Photon in X-ray beam interacts with outer shell electron in subject

-Resulting in partial absorption & scattering of the photon

-Increases patient dose but scattered photons do not contribute usefully to image

Photoelectric effect

-Photon in X-ray beam interacts with inner shell electron in subject

Resulting in complete absorption of the photon & creation of a photoelectron

-Increases patient dose but is necessary for image formation

Question 354

What metal is used to absorb the heat generated during X-ray production?

Answer 354

Copper

Question 355

Name a metal besides tungsten used in X ray production

Answer 355

Tungsten

Question 356

Name THREE materials used for crowns

Answer 356

Metal ceramic crown

All ceramic crown: zirconia, lithium disilicate

Gold alloy crown

Question 357

How much gutta percha should be left in the canal space when placing a post?

Answer 357

3-5mm

Question 358

What name is given to the residual collar of dentine required before placing a post?

Answer 358

Ferrule

Question 359

Describe the width of taper required for the type of crown given in the above clinical photograph (Image of metal ceramic crown)

Answer 359

6 degree taper

Question 360

What is EADT and EAT and briefly explain what they mean (2 marks)

Answer 360

Extra-alveolar dry time (EADT): time that the avulsed tooth has been out of the mouth without any form of moistening

Extra-alveolar time (EAT): time that a tooth has been out of its socket after avulsion

Question 361

Name THREE potential storage mediums for an avulsed tooth

Answer 361

Milk

Saliva

Water

Question 362

Give another TWO points of information other than storage you would give to someone phoning up about an avulsion

Answer 362

Handle the tooth by the crown

Ensure its a permanent tooth then replant into socket, bite on gauze and seek dental assistance immediately

Question 363

What form of splint is used for a subluxation? What is the minimum time the splint should be in place for?

Answer 363

Flexible composite and wire (0.4mm) splint: 2 weeks minimum

Question 364

What is the fluoride regime for a high risk 4 year old

Answer 364

1500ppmF toothpaste

Fluoride varnish 22,600ppmF: 4 times a year

Question 365

At what age is it suitable to deliver mouthwash to a paediatric patient?

Answer 365

Age 6 and older

Question 366

What is the toxic ingested fluoride dose to patients

Answer 366

5mg/kg

Question 367

How do you treat the following doses of fluoride ingested

<5mg/kg

5-15mg/kg

> 15mg/kg

Answer 367

<5mg/kg Give calcium orally (milk) and observe

5-15mg/kg Give calcium orally (milk, calcium gluconate) and admit to hospital.

> 15mg/kg Admit to hospital immediately, cardiac monitoring and life support, intravenous calcium gluconate.

Question 368

What is the thickness of Shimstock articulating paper

Answer 368

8-40 microns depending on manufacturer (lecture says 8)

Question 369

This patient with periodontitis shows radiographic evidence of vertical interproximal bone loss. Briefly outline TWO theories that have been advanced to explain the development of this type of bone defect?

Answer 369

Bacterial invasion theory: Bacteria found in dental plaque produce toxins that directly damage the periodontal tissues and bone, leading to bone loss

Host immune response theory: individuals immune response may be exaggerated, leading to an excessive inflammatory response and destruction of the bone

Question 370

Besides vertical bone loss, what other type of bone loss is there and why is this significant?

Answer 370

Horizontal bone loss: characterized by even bone loss around the teeth roots. This is significant because it can lead to mobility and tooth loss if left untreated

Question 371

Following hygiene phase therapy this patient’s oral hygiene was excellent but pockets of >5 mm persisted in the lower left quadrant. Suggest FOUR appropriate treatment options for this quadrant now?

Answer 371

1) PMPR of lower left quadrant

2) Local antimicrobials (chlorhexidine)

3) Antibiotic regiment (amoxicillin 3TID 7 days)

4) Host modulation therapy: corticosteroids, bisphosphonates

Question 372

You explain the importance of good oral hygiene in the prevention of further disease and suggest a tooth-brushing regime as per the recommendations in the SIGN 83 guideline. Describe this regime

Answer 372

1) Brush 2x a day for 2 mins

2) Fluoride toothpaste and toothbrush with soft bristles and replace every 3-4 months

3) Hold toothbrush at 45 degree angle to the teeth and brush with a back and forth motion

4) Clean the tongue

5) Spit out excess toothpaste, DON’T rinse

6) Use ID aids

Question 373

You also explain the importance of dietary control for the prevention of further disease and ask the parent to fill out a diet diary. Over how many days should this diary be kept?

Answer 373

3-5 days with 1 day being a weekend (SDCEP)

Question 374

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, so you are now concerned about child neglect. What should you do next?

Answer 374

Preventative multi agency management: liase with other professionals to see if concern is shared

Question 375

List TWO pieces of current disability legislation in the UK, which, as a practicing dental surgeon, you must comply with.

Answer 375

The Equality Act 2010

Adults with Incapacity Act 2000

Question 376

Disability is often discussed with reference to ‘models’, which are described as frameworks upon which legislation and health services are based and planned.

a) What are the TWO most common models of disability? (2 marks)

b) Outline what you understand as the basis for both of the above models and describe what the main difference is between them (6 marks)

Answer 376

a) Medical model

Social model

b) Medical model:

-views disability as an individual problem caused by an impairment or differences

-emphasizes the need for medical intervention to “fix” the individual’s disability

-places the responsibility for dealing with disability on the individual and medical treatment

Social model:

-views disability as a social construct

-caused by the way society is organized

-places the responsibility on society to remove barriers and create a more inclusive environment

Question 377

What is the name for the shape of the mandibular jaws movement

Answer 377

Posselt’s envelope

Question 378

What is the biological width (in mm)

Answer 378

2-3mm: distance between the base of the gingival sulcus and the crest of the alveolar bone

Question 379

Label all the points of Posselt’s envelope (6 marks)

Answer 379

ICP, RCP, rotational movement, translational movement, maximum protrusion, edge to edge

Question 380

Talk about the feeding cycle when food bolus enters our mouth to when it leaves (10 marks)

Answer 380

1) Incise food

2) Mastication

3) Salivary glands secrete saliva containing enzymes

4) Deglutition: Solids are swallowed from the oro-pharynx; no oral seal

5) 3 Stages of swallowing:

-Buccal phase (voluntary)

-pharyngeal phase (involuntary)

-esophageal phase (involuntary)

6) Food moving from esophagus to stomach through peristalsis

7) Food enters the stomach where it is mixed with stomach acid and enzymes and eventually becomes chyme

8) Chyme passes through the small intestine where nutrients are absorbed into the bloodstream

9) The remaining waste passes through the large intestines where water is absorbed

10) The waste product is excreted through feces

Question 381

How often should fissure sealants placed in a child of high caries risk be radiographically reviewed?

Answer 381

Every 6 months

Question 382

Chlorhexidine is a common medicament used to treat periodontal disease, name THREE other instances where it can be applicable

Answer 382

Treat oral candidiasis

Irrigant

Maintain oral hygiene

Question 383

Name the process by which chlorhexidine acts upon cells and explain

Answer 383

Dicationic. One cation adheres to pellicle coated teeth; one cation adheres to cell membrane

Increases permeability of cell membrane

Precipitation of cytoplasm; Cell death

Question 384

Give ONE way in which chlorhexidine is diminished in efficacy by the patient

Answer 384

Incorrect use such as dilution with water

Question 385

What is meant by substantivity of a drug

Answer 385

Persistence of action of the drug

Question 386

What does TID mean on a prescription

Answer 386

Ter in die (latin) three times a day

Question 387

Name TWO ways in which gingival hyperplasia can be treated

Answer 387

If induced by medication: use alternative medications or alter dose

If caused by poor OH: OHI

Question 388

Give FOUR clinical signs and symptoms of necrotizing gingivitis

Answer 388

Necrosis and ulcer of interdental papilla

Pain

Gingival bleeding

Halitosis

Question 389

What antibiotic regime would you give to a patient with necrotizing gingivitis

Answer 389

400 mg Metronidazole TID for 3 days

Question 390

When are THREE instances you would give antibiotics to a patient with necrotizing gingivitis?

Answer 390

Patients with systemic involvement

Lack of response to mechanical therapy

Patients with impaired immunity

Question 391

What is the periodontal phenomenon experienced by smokers when trying to quit and briefly explain it?

Answer 391

Smoker’s paradox: refers to the temporary worsening of periodontal health when trying to quit smoking

Question 392

Name FOUR indication to extract a tooth

Answer 392

Unrestorable teeth

Orthodontic indications

Traumatic position

Symptomatic partially erupted teeth

Question 393

Name TWO drugs in which care must be taken when carrying out an extraction and explain why?

Answer 393

Antiangiogenic and antiresorptive drugs: patients who are taking these drugs are at an increased risk of developing MRONJ

Antiplatelet e.g. Clopidegrel: irreversibly inhibits the binding of ADP to its platelet receptor therefore preventing platelet aggregation and a fibrin clot production is reduced.

Anticoagulant e.g. Warfarin: prevents vitamin K dependent clotting factors 2, 7, 9, 10 which can prevent a clot from forming. Needs INR checked before extraction

Liase with GP before completing extraction on dual therapy patients due to bleeding risk

Question 394

A patient attends your surgery complaining of persistent bleeding after an extraction that was completed one day ago. Give FOUR treatments

Answer 394

Even and firm pressure with damp gauze

Sutures

LA with vasoconstrictor

Diathermy

Question 395

Name the FOUR types of porosity which can be generated in the production of the URA or a full denture.

Answer 395

Gaseous porosity

Contraction porosity

Casting porosity

Granular porosity

Question 396

What are TWO thermal properties of denture bases

Answer 396

High softening temperature

Low thermal conductivity

Thermal expansion of base = artificial tooth

Question 397

What is the optimal dose of fluoride in drinking water?

Answer 397

1ppmF

Question 398

Name TWO foods and/or drinks, other than fluoridated water, which are good sources of fluoride and which have not had fluoride added to them by the manufacturers

Answer 398

Spinach

Grapes

Grapejuice

Black Tea

Question 399

List FOUR methods of topical fluoride application for an 8 year old child

Answer 399

Fluoride varnish

Acidulated phosphate fluoride (APF) gels

Fluoride toothpaste

Fluoride mouthwash

Question 400

What is the mechanism by which fluoride helps prevents cavities? (3 marks)

Answer 400

Promotes remineralization.

Forms fluorapatite which is more resistant to demineralization

Inhibits bacterial growth

Question 401

What daily dose of fluoride tablet would you give to a 4 year old child at high risk for caries, who lives in an area with <0.3ppm fluoride in the water supply?

Answer 401

0.5mg

Question 402

What is the rationale for the use of antibiotics in periodontology? (3 marks)

Answer 402

Antibiotics helps control the growth of bacteria that cause PD

Antibiotics helps control the host immune response which slows down the progression of the disease and promotes healing

Often used to treat or prevent systemic involvement or when patient is not responding to other treatments

Question 403

What problems limit the usefulness of antibiotics in the treatment of periodontitis (3 marks)

Answer 403

Antibiotic resistance

Limited effectiveness: do not work effectively against biofilms

Allergic reactions

Question 404

In what situations would it be appropriate to prescribe a systemic antibiotic in periodontitis patients (4 marks)

Answer 404

Young people with grade B/C

Patient has systemic involvement of infection

Patient is immunocompromised

After initial hygiene phase therapy and patient has excellent oral hygiene and no contraindications

Question 405

What is the minimum data set that should be recorded onto the record block? (2 marks)

Answer 405

Midline

Canine line

Question 406

Which part of a root canal filling is the most important for ensuring long term success

Answer 406

Coronal seal

Question 407

What is the name of the technique used in obturating a canal

Answer 407

Cold lateral compaction technique

Question 408

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 from the list

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

Answer 408

Lesion of endodontic origin with periodontal involvement

Question 409

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.

Give TWO anatomical factors that may be responsible for the location of the discharging pocket

Answer 409

Furcal canal

Accessory canal

Question 410

What treatment would you perform on a lesion of endodontic origin with periodontal involvement (3 marks)

Answer 410

Pulpectomy and RCT (1 mark)

Observe and monitor (1 mark)

If there is a residual pocket at 3 month follow up then initiate root surface debridement (1 mark)

Question 411

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

What is the diagnosis from the list

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

Answer 411

Occlusal trauma

Question 412

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

Describe how you would manage this patient (3 marks)

Question 413

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

Describe how you would manage this patient (3 marks)

Answer 413

Occlusal analysis with use of miller’s forceps and thin articulating paper (1 mark)

Occlusal adjustment to remove any interference on 34 (1 mark)

Preventative management of parafunction/tooth wear - using a bite guard (1 mark)

Question 414

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.

Which Stage AND Grade would you attribute to this case?

Answer 414

Stage 3 Grade B

Question 415

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.

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

Answer 415

Smoking history (current or past)

Question 416

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.

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

Answer 416

Plaque scores

Full mouth pocket chart

Question 417

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. What is the diagnosis

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

Answer 417

8. Periapical periodontitis

Question 418

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.

What further investigations might you perform (2 marks)

Answer 418

Sensibility testing

Periapical radiograph

Question 419

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.

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

Answer 419

Extraction of 46 (1 mark)

Pulpectomy and further RCT (1 mark)

NOT analgesia

Question 420

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 she has necrosis of the interdental papilla

What is your diagnosis?

Answer 420

Acute necrotizing ulcerative gingivitis

Question 421

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

Which systemic antimicrobial is most appropriate for the condition and what dose, daily frequency, and total duration would you administer?

Answer 421

400mg Metronidazole 3 times a day for 3 days

Question 422

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

What follow up care would you arrange for a patient

Answer 422

Hygiene phase therapy

Smoking cessation advice

Question 423

List FIVE investigations included in a trauma stamp?

Answer 423

Sinus

Colour

Mobility

TTP: tender to percussion

Ethyl Chloride

EPT

Radiograph

Question 424

What are FOUR special investigations for extracting multiple teeth

Answer 424

Radiographs

Sensibility testing: ethyl chloride, EPT, GP

Percussion note

TTP

Question 425

What is the purpose of compensating extractions?

Answer 425

Designed to maintain occlusal relationship

Question 426

Define child dental neglect

Answer 426

Persistent failure to meet a child’s basic oral health needs, likely to result in the serious impairment of a child’s oral or general health or development

Question 427

What are nursing bottle caries?

Answer 427

A type of dental decay that occurs in infants/young children due to prolonged exposure to sugary liquids from a bottle or sippy cup

Question 428

What is the caries pattern in nursing bottle caries?

Answer 428

Maxillary incisors

First molars

Mandibular canines

Lower incisors protected by the tongue

Question 429

What are FOUR occlusal presentations of a digit sucking habit

Answer 429

1) Proclined upper incisors

2) Retroclined lower incisors

3) Anterior open bite

4) narrower upper arch +/- Unilateral posterior crossbite

Question 430

What are FOUR ways to manage a digit sucking habit

Answer 430

1) Positive reinforcement

2) Bitter-tasting nail varnish

3) Glove on hand, elastoplast

4) Habit breaker appliance (habit deterrent)

Question 431

What TWO appliances can be used to stop a digit sucking habit?

Answer 431

URA: Palatal goal post(s)

Fixed: Tongue rake

Question 432

What are THREE special investigations for generalised chronic periodontitis

Answer 432

Periapical X rays to stage and grade

6PPC (furcation and mobility)

Modified bleeding and plaque scores

Question 433

What are FIVE examples of local causes of malocclusion

Answer 433

Variation in tooth number

Variation in tooth size or form

Abnormalities of tooth position

Local abnormalities of soft tissues

Local pathology

Question 434

What are FOUR ideal properties of denture bases

Answer 434

Dimensionally accurate and stable

Unaffected by Oral Fluids

Non toxic/irritant

Good mechanical properties

Question 435

What are THREE examples of a denture base

Answer 435

Stainless steel

Cobalt chromium

Acrylic (PMMA)

Question 436

Acrylic is a denture base that is known to have gaseous porosity

Explain gaseous porosity (2 marks)

Answer 436

Voids in the material when PMMA is cured fast; monomer boils at 100C

Usually occurs in thicker section of the acrylic

Seriously compromises the denture’s strength

Question 437

List TWO uses of a mould liner

Answer 437

Reduces porosity

Easier for deflasking to be carried out

Question 438

Why should dentures be kept moist

Answer 438

To avoid distortion

To improve comfortability

To maintain good fit

To prevent ulcers and sores

Question 439

What are THREE properties of acrylic dentures and explain the importance of these properties

Answer 439

Biocompatible: to not harm or impact the tissues of the mouth

Good mechanical properties to withstand masticatory forces

Good color and translucency: for aesthetic purposes

Question 440

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

Answer 440

Patency

Question 441

Define the following in terms of endodontics and how are they obtained

Estimated working length

Corrected working length

Answer 441

EWL: Estimated length at which instrumentation should be limited. Radiographic assessment of WL minus 1mm.

CWL: Length at which instrumentation and subsequent obturation should be limited. Determined using radiograph or apex locator minus 0.5-1mm

Question 442

What is a working length in endodontics (2 marks)

Answer 442

The extent from apical terminus of preparation and a predefined coronal reference point

Question 443

State TWO potential causes of a corrected working length changing during the course of endodontic shaping?

Answer 443

Ledges

Perforation

Question 444

What are THREE precautions when using an irrigating a root canal

Answer 444

Inject slowly: do not use thumb can causing hypochlorite extrusion

Tissue irritation: can burn the soft tissues

Allergic reactions

Question 445

What testing can you do to distinguish between reversible and irreversible pulpitis

Answer 445

Ethyl chloride: if pain lingers it is irreversible

EPT: mild tingling is reversible, sharp or intense pain is irreversible

Question 446

What TWO radiographic views would be best to view a maxillary central incisor that has failed to erupt

Answer 446

Anterior oblique maxillary

Periapical

Question 447

What X ray should be used for a patient who cannot tolerate bitewings

Answer 447

OPT

Question 448

When are THREE instances you should not extract teeth for dentures in a patient with Parkinson’s

Answer 448

There is a contraindication for an extraction and denture in the medical history

Patient preference

The severity of the disease does not allow for extraction or denture use

Question 449

When should you extract teeth for denture use in a patient with Parkinson’s

Answer 449

Presence of infection that can impact the patients general health

Severe periodontal disease

Grossly carious teeth

Question 450

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.

Answer 450

Wheelchair recliner

Hoist to transfer to dental chair

Patient has a reclining wheelchair

Question 451

How do you communicate with a patient who cannot speak or write

Answer 451

Use visual aids

Voice generating device

Communication apps

Sign language

Question 452

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.

Answer 452

Ramp

Lift

Question 453

What are THREE cognitive tests for a person with dementia

Answer 453

MMSE: mini mental state examination

MoCA: Montreal cognitive assessment

Delayed word recall

Question 454

How do you make the dental practice a dementia friendly healthcare environment (4 marks)

Answer 454

Reception visible from entrance

Color of walls different from floor

Avoid non essential signs

Ensure good natural lighting

Question 455

What are THREE symptoms of congestive heart disease

Answer 455

Shortness of breathe

Fatigue and weakness

Swelling in the legs and ankles

Question 456

What are THREE causes of congestive heart disease

Answer 456

Hypertension

Obesity

Alcohol and drug abuse

Question 457

What are FOUR diseases which can result in congestive heart failure

Answer 457

Coronary artery disease

Cardiomyopathy

Diabetes

Valvular heart disease

Question 458

What FOUR medications treat congestive heart failure

Answer 458

ACE inhibitors: Ramipril

Diuretics: furosemide

Nitrates

Digoxin

Question 459

What antibiotic prophylaxis should be used for dental treatment to reduce heart infection risk and what dose and when should it be taken

Answer 459

Amoxicillin 3g orally 1 hour before procedure

Question 460

What microorganism causes infective endocarditis?

Answer 460

Streptococcus viridians

Question 461

What are THREE modifiable factors for aetiology of head and neck cancer (memorize)

Answer 461

Smoking/tobacco use

Alcohol consumption

HPV infection

Question 462

The liver is responsible for the production of which clotting factors involved in the coagulation cascade?

Answer 462

1, 2, 7, 9, 10, 11

Question 463

1The 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.

Answer 463

Eye tracking technology

Communication boards

Question 464

Term used to describe collective group of microorganisms in oral cavity and what are they referred to when attached to a surface

Answer 464

Microbiome

Biofilm

Question 465

Name the bacterium associated with secondary endodontic infections

Answer 465

Enterococcus faecalis

Question 466

Name ONE of the key virulence factors for the bacterium that is associated with secondary endodontic infections

Answer 466

Adhesins

Question 467

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

Answer 467

Sterile sampling procedures, active/functional bacteria

Question 468

What antimicrobial is used to disinfect root canal

Answer 468

Sodium hypochlorite 3-6%

Question 469

Culture independent technique used to assess changes in oral microbial populations following antibiotic exposure and what are limitations of that approach

Answer 469

Next generation sequencing

Limited to describing what is present rather than what communities doing (phenotypic rather than functional)

Question 470

Define the following terms below

Incidence

Prevalence

Answer 470

Incidence: number of new cases of a disease in a population over a period of time (rate)

Prevalence: proportion of the population with a disease at any point

Question 471

What are THREE warnings you should give to a patient taking metronidazole

Answer 471

Avoid consuming alcohol

Do not take if pregnant

Stop taking if any adverse reactions and seek medical advice

Question 472

What are the primary and secondary support structures for a complete lower denture

Answer 472

Primary: buccal shelf and retromolar pads

Secondary: ridge crest and genial tubercles

Question 473

What are FOUR contraindications of metronidazole

Answer 473

Alcohol

Warfarin

Pregnancy

Allergy

Question 474

What number of canals are found, most often, in an upper first premolar?

Answer 474

2

Question 475

During instrumentation of the canal where is considered the ideal end point of shaping/obturation? (2 marks)

Answer 475

Apical constriction, the junction between dentine and cementum or wet/dry interface

Question 476

What TWO common intra-operative radiographs can be utilized during endodontic treatment to aid working length determination?

Answer 476

Master cone radiograph

Correct working length radiograph

Question 477

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

Answer 477

Nicotine patches

E cigs

Question 478

After you gathered your information on a patients 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 478

Outline the advice you have given the patient in the patient’s record, so it’s clear that you addressed the topic (1 mark)

Make a note to bring it up at some time in the future, to see if he has changed his mind (1 mark)

Question 479

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.

What feature of the patient’s dental history is it important to determine? (1 mark)

Answer 479

Whether the child has suffered any trauma to that tooth

Question 480

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.

What part of the physical examination is important? (1 mark)

Answer 480

Palpate the labial sulcus

Question 481

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.

What radiographic view would be most suitable for this child?

Answer 481

Maxillary anterior occlusal or periapical

Question 482

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.

Given the history, give an account of the sequence of events that have most likely caused non-eruption of upper central incisor? (2 marks)

Answer 482

Trauma to the deciduous incisor (1 mark)

Leading to dilaceration of permanent successor (1 mark)

Question 483

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.

Give ONE other possible cause of non-eruption of the upper central incisor in this case?

Answer 483

Congenital absence

Question 484

The relative risk is 2.2 and the CI is 0.1 - 1.2

Is the evidence sufficient

Answer 484

No, because the confidence interval overlaps/contains the value of no difference which is 1 for relative risk therefore there is insufficient evidence

Question 485

The Absolute risk difference is 5.2 and the CI is 0.7 - 1.1

Is the evidence sufficient

Answer 485

Yes, because the confidence interval does NOT overlap/contain the value of no difference which is 0 for the absolute risk difference therefore there is sufficient evidence

Question 486

The odds ratio is 1.2 and the CI is 0.9 - 2.3

Is the evidence sufficient

Answer 486

No, because the confidence interval overlaps/contains the value of no difference which is 1 for odds ratio therefore there is insufficient evidence

Question 487

List the FOUR main features of a randomized control trial study design

Answer 487

Randomization

Blinding

Comparison groups

Inclusion/exclusion criteria

Question 488

Name the standards developed to improve the reporting of randomized controlled trials?

Answer 488

CONSORT guidelines

Question 489

What radiograph would you request for the management of the non eruption of the upper central incisor?

Answer 489

Periapical

Question 490

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

Answer 490

1) Removal of obstruction (if present)

2) Create space/maintain space

3) Monitor for 12 months

4) If non eruption expose and bond gold chain and apply orthodontic traction

Question 491

What is the British Standard Institute’s definition of a class III relationship?

Answer 491

The lower incisor edges lie anterior to the cingulum plateau of the upper incisors. The overjet is reduced or reversed.

Question 492

A patient has a class III. How would you describe the patient’s skeletal relationship in terms of growth or development? (2 marks)

Answer 492

Maxillary hypoplasia (1 mark)

Mandibular prognathism (1 mark)

Question 493

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

ii) Vertically above the third molar region

Answer 493

i) Floor of the maxillary sinus

ii) Posterior wall of the maxillary sinus

Question 494

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

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

Answer 494

i) Right half

ii) Orthogonal projection

Question 495

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.

What special investigation would be appropriate for this patient?

Answer 495

OPT

Question 496

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.

What information are you ideally looking for to establish the suitability of the timing of these extractions? (2 marks)

Answer 496

Bifurcation of the lower 7s

Question 497

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.

Detail your management of tooth 26 (1 mark)

Answer 497

Extract

Question 498

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.

List TWO advantages of extraction of first permanent molars of poor prognosis at this stage of development?

Answer 498

Spontaneous space closure

Render child caries free

Question 499

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. List TWO disadvantages of extraction of first permanent molars of poor prognosis at this stage of development?

Answer 499

No molars for eating/spacing

Risk of GA

Question 500

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.

What TWO things might this child require to enable these extractions (2 marks)

Answer 500

Inhalation sedation

GA

Question 501

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.

What type of drug is Warfarin AND what is its mechanism of action? (2 marks)

Answer 501

Anticoagulant

Vitamin K antagonist

Prevents clotting factors 2, 7, 9 10 and protein C and S

Question 502

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.

Which test must be carried out prior to the extractions (1 mark)

Answer 502

INR

Question 503

Which guidance document would you refer to for advice on dealing with patients on Warfarin AND within what timeframe should an INR be carried out prior to the extractions (2 marks)

Below what INR would it be safe to continue with extractions (1 mark)

Answer 503

SDCEP - ideally within 24 hours (1 mark)

NICE - within 72 hours if INR is stable (1 mark)

SDCEP: Below 4 (1 mark)

Question 504

You arrange an appointment for treatment and this is carried out uneventfully. They return the next day complaining they have been bleeding all night. Outline options that you could carry out clinically to deal with this post-operative bleeding. (4 marks)

Answer 504

Prolonged pressure with damp gauze

Sutures

LA with adrenaline

Haemostatic agent e.g surgical, equitamp

Question 505

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

If following your interventions, you still could not stop the bleeding - what would you do?

Answer 505

Urgently refer to local OS/OMFS unit or A&E

Question 506

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.

Answer 506

The Equality Act

The Disability Discrimination Act

Question 507

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. (2 marks)

Answer 507

i) Uncontrolled muscle spasm

ii) Bite stick

Mouth prop device

Question 508

List TWO medical aspects of Down’s Syndrome which may have resulted in his lack of capacity

Answer 508

Intellectual or learning disability

Dementia

Question 509

If a patient has a forward growth rotation, describe a skeletal feature that you could expect to observe

Answer 509

Deep overbite and short face
Decreased FMPA and LAFH/TAFH.

Question 510

If a patient has a backward growth rotation, describe a skeletal feature that you could expect to observe

Answer 510

Anterior open bite and long face
Increased FMPA and LAFH/TAFH

Question 511

Localised acute exacerbation of a pre-existing pocket. Usually vital, pain on lateral movements, usually mobile, loss of alveolar crest, more likely to have generalised horizontal bone loss. What is the diagnosis

Answer 511

Periodontal abscess

Question 512

Localised collection of pus around apex of a non-vital tooth as a result of pulp necrosis, non vital, TTP vertically, may be mobile, loss of lamina dura, radiolucency

What is the diagnosis?

Answer 512

Periapical abscess

Question 513

Tooth mobility which is progressively increasing and or tooth mobility with symptoms AND radiographic evidence of increased PDL width. What is the diagnosis

Answer 513

Occlusal trauma

Question 514

Periodontal disease which has reach the apex of a tooth, resorption of alveolar bone, loss of attachment, plaque, age, smoking, stress, diabetes, apical migration of junctional epithelium. What is the diagnosis?

Answer 514

Localised periodontitis

Question 515

Bleeding on Probing, inflammation of gingival tissues, false pockets due to oedema. No bone loss. Pregnancy related, puberty associated, leukaemia. What is the diagnosis

Answer 515

Acute/Chronic gingivitis

Question 516

Answer the following questions about the maxillary nerve

i) Where in the skull does it pass through?

ii) Which parasympathetic ganglion does it pass through?

iii) Name THREE branches that the maxillary nerve gives off

Answer 516

i) Foramen rotundum

ii) Pterygopalatine ganglion

iii) Nasopalatine branch

Zygomatic branch

Pharyngeal branch

Question 517

What are the alcohol limits for male and female

Answer 517

14 units of alcohol limit

Male: 3-4 units/day 2 alcohol free days

Women: 2-3 units/day 2 alcohol free days

Question 518

How would you provide health promotion for alcohol to a patient in your dental practice (3 marks)

Answer 518

Advertising regarding safe limits

Educate the patient on the risks of consuming excess alcohol

Provide resources such as leaflets and specialist services and follow them up at a later appointment

Question 519

Give an example of TWO policies associated with alcohol consumption in Scotland

Answer 519

Alcohol minimum pricing Scotland act: minimum price per unit of alcohol

Licensing Scotland act: increasing price per unit of alcohol

Question 520

What is ONE example of a chairside interventions you can provide for a patient who consumes excess alcohol and briefly describe it

Answer 520

5As: Ask, Assess, Advise, Assist, Arrange

Question 521

Name FOUR screening tools you can use to assess a patients alcohol consumption (4 marks)

Answer 521

AUDIT: alcohol use disorders identification

test (good to determine if hazardous, harmful

or dependent drinker)

FAST: fast alcohol

screening test (concise version of AUDIT)

CAGE: 4 questions

ABI’s: Alcohol Brief Interventions; opportunistic and effective

PAT: used in A&E

Question 522

Name THREE microorganisms responsible for oral candidiasis

Answer 522

Candida albicans

Candida glabrata

Candida tropicalis

Question 523

What TWO microorganisms are resistant to fluconazole

Answer 523

Candida krusei

Candida glabrata

Question 524

What THREE maxillary features should be covered in an upper impression (3 marks)

Answer 524

Maxillary tuberosity

Hamular notch

Vibrating line

Question 525

What are TWO examples of primary impression materials for an edentulous patient

Answer 525

Impression compound

Alginate

Question 526

List FOUR maxillary features that should be covered in a complete upper impression

Answer 526

Maxillary tuberosity

Hamular notches

Vibrating line

Functional width and depth of the sulcus

Question 527

List FOUR mandibular features that should be covered in a complete lower impression

Answer 527

Retromolar pads

Buccal shelf

Lingual pouch

Functional width and depth of the sulcus

Question 528

What are THREE features that indicate that a Parkinson’s patient is in pain

Answer 528

Holding face or mouth

Changes in diet/behavior

Changes to sleep

Question 529

What are FOUR dental implications of a patient with Parkinson’s

Answer 529

Difficulty tooth brushing

Swallowing may be difficult

Abnormal posture makes examination hard

Anticholinergic drugs may cause dry mouth

Question 530

What are FOUR types of cerebral palsy

Answer 530

Spastic

Dyskinetic

Ataxic

Mixed

Question 531

What are FOUR side effects of chlorhexidine

Answer 531

Staining

Decreased GI absorption

Taste disturbances

Anaphylaxis

Question 532

A patient presents to your practice with an anterior crossbite

Using ARAB how would you correct this?

How often would you activate this appliance?

Answer 532

A: Z spring 0.5mm HSSW

R: Adams clasp 4s, 6s 0.7mm HSSW

A: Only moving 1 tooth

B: Self cure PMMA

Posterior bite plane

Activate once a month

Question 533

A patient presents to your practice with a posterior crossbite

Using ARAB how would you correct this?

How often would you activate this appliance?

Answer 533

A: Hyrax screw or Coffin Spring

R: Adams clasp 4s and 6s 0.7mm HSSW (note no retentive component across midline)

A: Not required

B: Posterior Bite plane

Activate once a week

Question 534

What is the treatment for an enamel dentine pulp fracture

i) <24 hours

ii) >24 hours

Answer 534

i) Direct pulp cap of setting CaOH and seal with GI. Radiographic and clinical review at 6-8 weeks and 1 year.

ii) Pulpotomy, pulp cap with CaOH, GIC body and composite. Radiographic and clinical review at 6-8 weeks and 1 year.

Question 535

What are FOUR symptoms of trauma

Answer 535

Pain

Swelling

Bruising

Bleeding

Question 536

What are FOUR key peices of information that should be recorded in a waste transfer note and how long should it be kept for

Answer 536

Quantity

Date of closure

Destination

Origin of waste

Kept for 2 years

Question 537

What regulation is there for the management of special waste

Answer 537

Special waste regulations 2004

Question 538

What are FOUR examples of inherited bleeding disorders and what is there deficiency

Answer 538

Haemophilia A: 8

Haemophilia B: 9

Haemophilia C: 11

Von Willebrand’s disease: Von Willebrand’s factor

Question 539

What is the normal bleeding time for a healthy individual?

Answer 539

3-4 minutes

Question 540

Define niche

Answer 540

Role of an organism in ecological environment

Question 541

Name TWO key factors in the biofilms ability to adhere

Answer 541

Adhesins

Fimbrae

Question 542

What are FOUR types of sutures and provibe an example of each

Answer 542

Non resorbable monofilament: prolene

Non resorbable multifilament: mersilk

Resorbable monofilament: monocryl

Resorbable multifilament: vicryl

Question 543

What are THREE types of flap designs

Answer 543

2 (envelope) sided flap

3 sided flap

semilunar flap

Question 544

Why do you not use an air driven handpiece for surgical bone removal?

Answer 544

Surgical emphysema risk

Question 545

List THREE differences between parallel and tapered posts

Answer 545

Parallel has greater retention

Parallel less likely to cause root facture

Parallel is less conservative

Question 546

What should the length and width of a post be

Answer 546

Length: minimum 1:1 post length/crown length ratio, leaving 4-5mm of GP

Width: no more than 1/3rd of root width and 1mm of circumferential dentine

Question 547

What are the FIVE forces which can displace an upper removable appliance

Answer 547

Gravity

Mastication

Tongue

Speaking

Active components

Question 548

What is the formula for force in wire of an ortho appliance?

Answer 548

F = (k * ΔL * r^4) / L^3

where: F = force in the wire

k = spring constant or stiffness coefficient of the wire

ΔL = deflection or change in length of the wire

r = radius of the wire

L = length of the wire

Question 549

What would you check during the adjustment visits of a patient wearing an URA (3 marks)

Answer 549

Check wear

Reactivate appliance

Monitor OJ and OB

Question 550

How long will orthodontic treatment take if patients compliance is excellent

Answer 550

6-9months

Question 551

What are FOUR indications for taking an OPT (4 marks)

Answer 551

Mandibular fractures

Assessment before surgery e.g third molar extraction

Assessing generalized disease e.g. staging and grading periodontitis

Inability to tolerate intraoral films

Question 552

What are FOUR risk factors for a stroke

Answer 552

Hypertension

Smoking

Alcohol

Age

Question 553

List THREE ways to prevent a stroke

Answer 553

Reduce risk factors

Antiplatelets: aspirin

Anticoagulant if embolic risk

Question 554

What are FOUR dental implication for a stroke patient

Answer 554

Impaired mobility and dexterity

Bleeding risk

Xerostomia

Facial nerve issues

Question 555

Name FOUR psychiatric disorders

Answer 555

Schizophrenia

Bipolar

OCD

Eating disorder (bulimia or anorexia)

Question 556

List FOUR medications a patient with a psychiatric disorder can be on

Answer 556

SSRI

Tricyclic antidepressants

Benzodiazepines

Anti psychotics

Question 557

List FOUR difficulties of treating a patient with a psychiatric disorder

Answer 557

Irregular attender

Anxious

Capacity and consent issues

Lack of perception to oral problem

Side effects of medications such as tricylic anti depressants can cause dry mouth

Question 558

What are FIVE legislations in the UK for disabled people

Answer 558

MHA: Mental health act

MCA: Mental capacity act

DDA: Disability discrimination act

EA: Equality act

AWI: Adults with incapacity act

Question 559

Define the null hypothesis

Answer 559

No relationship between two measured phenomena

Question 560

Define odds ratio

Answer 560

(Number of times x event occurred / number of times x event did not occur) / (Number of times y event occurred / number of times y event did not occur)

Question 561

Define a P value

Answer 561

The probability of attaining a test statistic as extreme as the one actually observe.

If its less than <0.05 data is significant

Question 562

Define confidence interval

Answer 562

How confident/precise you can be with your estimate. The larger the sample the narrower the CI (narrower CI is better)

Question 563

What are THREE symptoms of fluoride toxicity

Answer 563

Nausea

Vomiting

Diarrheoa

Question 564

What are THREE physical signs of cystic fibrosis

Answer 564

Barrel chested

Smaller than average

Finger clubbing

Question 565

What are THREE symptoms of cystic fibrosis

Answer 565

Coughing

SOB

Wheeze

Question 566

List THREE medications often used by patients with cystic fibrosis

Answer 566

Beta 2 agonist (salbutamol)

Anticholinergics

Pancreatic enzymes

Question 567

What are THREE dental implications of a patient with cystic fibrosis

Answer 567

Delayed dental development

Increased calculus and staining

No GA

Increased bleeding

Question 568

List the nerve supplies of the following muscles

i) Masseter

ii) Temporalis

iii) Lateral pterygoid

iv) Medial pterygoid

Answer 568

All part of the mandibular division of the trigeminal nerve

i) Masseteric nerve

ii) Deep temporal nerves

iii) Nerve to lateral pterygoid

iv) Nerve to medial pterygoid

Question 569

List the functions of the following muscles

i) Masseter

ii) Temporalis

iii) Lateral pterygoid

iv) Medial pterygoid

Answer 569

i) Elevates

ii) Elevates and retracts

iii) Protrusion and lateral movement

iv) Elevates and assists with lateral movement

Question 570

You suspect a necrotizing periodontal disease on a patient. What further investigations would you carry out?

Answer 570

Blood test: check for HIV and nutritional deficiencies

Question 571

What is the origin and insertion of the temporalis muscle

Answer 571

Origin: Temporal fossa and temporal fascia

Insertion: coronoid process of the mandible

Question 572

What is the origin and insertion of the masseter muscle

Answer 572

Origin: maxillary process of zygomatic bone and zygomatic arch

Insertion: ramus and angle of mandible

Question 573

What is the origin and insertion of the medial pterygoid muscle

Answer 573

Origin: medial surface of lateral pterygoid plate (deep part), maxillary tuberosity (superficial head)

Insertion: medial aspect of the ramus and angle of the mandible

Question 574

What is the origin and insertion of the lateral pterygoid muscle

Answer 574

Origin: Greater wing of sphenoid bone (upper head). Lateral surface of lateral pterygoid plate (lower head)

Insertion: Pterygoid fovea

Question 575

What foramen does the mandibular nerve pass through

Answer 575

Foramen ovale

Question 576

What are TWO examples of local antimicrobials used to treat periodontitis

Answer 576

Chlorhexidine

Antibiotics

Question 577

What are THREE examples of host modulation therapies used to treat periodontitis

Answer 577

Corticosteroids

NSAIDs

Bisphosphonates

Question 578

What are TWO examples of alternative therapies used to treat periodontitis

Answer 578

Periostat: doxycycline

Periowave: photodisinfection

Question 579

For chairside intervention of an alcoholic patient what are the 5 A’s

Answer 579

Ask

Advise

Assess

Assist

Arrange

Question 580

What are THREE advantages of composite over amalgam

Answer 580

Aesthetics

Chemically bonded to tooth structure

Conservative (doesn’t require excess removal)

Question 581

What are TWO disadvantages of composite over amalgam

Answer 581

Technique sensitive: requires excellent moisture control

More expensive with inferior mechanical properties

Question 582

A 52-year-old male attends your clinic complaining of bleeding gums. On clinical examination you observe that the patient has localised gingivitis, characterised by inflammation. You are interested to understand the microbial basis of why this patient may have gingivitis.

What specimens could you investigate? (1 mark)

Where would you take these from? (1 mark)

Answer 582

Subgingival plaque biofilm

Paper point from gingival crevice on site of inflammation

Question 583

A 52-year-old male attends your clinic complaining of bleeding gums. On clinical examination you observe that the patient has localised gingivitis, characterised by inflammation. You are interested to understand the microbial basis of why this patient may have gingivitis.

What organism(s) do you consider important? (2 marks)

What methods could be used to identify the culprit organism? (2 marks)

How do you determine cause and effect? (1 mark)

Answer 583

P. gingivalis, T. forsythia

Selective agars, PCR, NGS. Ideally grown on plates and undertake sensitivity testing

Removal of culprit organism leads to resolution of disease

Question 584

You attend a care home and are asked to examine an elderly denture-wearing patient who is complaining of pain and is feeling unwell. To undertake the oral exam you remove the dentures and notice severe inflammation of the upper palate (denture stomatitis). You suspect that there is a microbial origin to these clinical symptoms.

What is the cause of the inflammation?

What types of specimens could be taken to isolate these microorganisms?

Answer 584

Denture associated biofilm

Oral rinse or swab from localised area, foam pad for imprint

Question 585

3. You attend a care home and are asked to examine an elderly denture-wearing patient who is complaining of pain and is feeling unwell. To undertake the oral exam you remove the dentures and notice severe inflammation of the upper palate (denture stomatitis). You suspect that there is a microbial origin to these clinical symptoms.

i) What microorganisms are associated with denture stomatitis?

ii) Why is it important to identify these; are there clinical implications?

iii) Are there systemic implications of an indwelling prosthesis for the patient?

Answer 585

i) C. albicans, C. glabrata

ii) Differentiating is important as C. glabrata is resistant to azoles

iii) Aspiration pneumonia

Possible links to cardiovascular disease

Question 586

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.

What is the most likely diagnosis

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

Answer 586

3. Generalised Periodontitis

Question 587

What is a biofilm?

Answer 587

Matrix enclosed bacterial or fungal populations adherent to each other and surfaces

Question 588

What are THREE modes of transmission of an infection

Answer 588

Ingestion (waterborne)
Inhalation (airborne)
Inoculation (bloodborne)

Question 589

How long should patient notes be kept for

Answer 589

11 years

Question 590

What is the temperature, pressure and time required for a steriliser

Answer 590

134-137C
2.1bar
3 minutes minimum

Question 591

What types of hand hygiene are used in dental practice

Answer 591

Routine hand hygiene: use of water and soap
Antiseptic hand hygiene: use of ABHR

Question 592

What are Koch’s postulates?

Answer 592

1) The microbe must be present in every case of the disease
2) The microbe must be isolated from the diseased host and grown in pure culture
3) The disease must be reproduced when a pure culture is introduced into a susceptible host
4) The microbe must be recovered from an experimentally infected host

Question 593

What is a disability?

Answer 593

A restriction of ability resulting from an impairment to perform an activity that is considered normal for a human being

Question 594

What is an impairment?

Answer 594

Any loss or abnormality of psychological, physiological or anatomical structure or function

Question 595

What is a handicap?

Answer 595

A disadvantage resulting from an impairment or disability, that prevents the fulfilment of a role that is normal for that individual

Question 596

What are the 7 elements of caries risk

Answer 596

1. Clinic
2. F- use
3. MH
4. SH
5. Plaque control
6. Dietary habits
7. Saliva

Question 597

What is the difference between IRR17 and IR(ME)R17

Answer 597

IRR17: designed to protect staff and general public
IR(ME)R17: designed to protect patients

Question 598

Explain the effect that a prolonged digit sucking habit can have on the posterior dentition (2 marks)

Answer 598

The thumb or fingers are held in the mouth causing the mandible to drop open and the tongue to be held in a lower position than normal. This means that the sucking action caused by the cheeks narrows the maxillary dentition and causes a posterior crossbite.

Question 599

Give FOUR potential barriers to receiving adequate, ongoing dental care that exist for a patient who has schizophrenia. (4 marks)

Answer 599

Difficulty obtaining consent
Irregular attendance due to lack of awareness
Difficulty with communication
Behavior issues: aggressive and agitated

Question 600

You are treating a visually impaired patient. Give THREE examples of modifications within your dental practice which will be of assistance to them.

Answer 600

Large font or braille signs
Ensure adequate lighting
Use verbal cues and audio instructions

Question 601

Give THREE examples of modifications within your practice environment which may be made to accommodate a patient in a wheelchair.

Answer 601

Ramps and lifts
Wide doorways and corridors
Disabled bathrooms

Question 602

You are treating a hearing-impaired patient. Give THREE examples of modifications within your dental practice which will be of assistance to them.

Answer 602

Use visual cues and large/clear signs
Avoid unnecessary noise e.g. music, radio
Use communication boards and eye tracking technology

Question 603

Name TWO different acquired causes of visual impairment

Answer 603

Glaucoma
Cataracts

Question 604

Mrs Anderson requires support with her daily oral care. Name ONE additional technique which you can use to support the tooth brushing of an older person. Explain how the technique is used

Answer 604

Hand over hand technique
Place your hand over the patients hand and gently brush their teeth and gums together.

Question 605

List TWO priorities for oral health management when undertaking treatment planning for a person in the early stages of dementia?

Answer 605

Treatment of any pain and infection before middle/late stage dementia
Enhanced prevention

Question 606

List TWO risks associated with older people and a general anaesthetic

Answer 606

Death
Increased risk of cardiovascular complication

Question 607

What processes would you wish to implement in the practice after you had agreed the SOP and provided training on hand hygiene (2 marks)

Answer 607

Audits to ensure SOP are being followed
Regular refresher training on hand hygiene

Question 608

What is the mode of action of azoles (2 marks)

Answer 608

Inhibits the synthesis of ergosterol by inhibiting the cytochrome P450 dependent enzyme lanosterol 14-alpha-demethylase

Question 609

What are TWO roles of epidemiology

Answer 609

Study of the causes and determinants of disease
Development of preventive programs

Question 610

Define dentally fit

Answer 610

Being free from active dental disease and oral infections

Question 611

What are TWO advantages for prefabricated crowns

Answer 611

Cheaper
No need for lab involvement: can construct in one visit

Question 612

How would you differentiate between Candida glabrata and candida albicans

Answer 612

Chromogenic agar indentification method:
Glabrata: pink
Albicans: blue/green

Question 613

What are FOUR principles of aim of orthodontic treatment

Answer 613

Restore stability
Restore function
Improve aesthetics
Facilitate other forms of dentistry

Question 614

What type of study would provide the highest level of evidence for the effectiveness of treatment?

Answer 614

Meta analysis and systematic review of randomised controlled trials

Question 615

How will the actual extent of caries present clinically in comparison to radiograph

Answer 615

Radiograph is 2D representation of a 3D therefore can be misleading.
Clinically the caries will present as larger and deeper lesions with tactile sensation. Location of the caries clinically will also be more reliable

Question 616

Describe in FOUR stages the sequence of operative procedures you would need to undertake in order to render the teeth caries free subsequent to administration of LA and dental dam placement

Answer 616

1) Identify and remove carious enamel
2) Identify the maximal extent of the lesion at the ADJ
3) Progressively remove peripheral caries from the ADJ first, then circumferentially deeper.
4) Only then remove deep caries over pulp

Question 617

What are FOUR tooth factors that can cause tooth mobility

Answer 617

1) Height of PDL
2) Width of PDL
3) Inflammation
4) Number, size and shape of roots

Question 618

What is the antibiotic regimen for periodontal abscess and periapical abscess

Answer 618

Amoxicillin 500mg 3x a day for 5 days

Question 619

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.
List 3 causes that may be contributing to this post-operative complication (3 marks)

Answer 619

Any 3 of:
Damage to periostium / alveolus / vessel during extraction or other local factor
Medication (must state example of antiplatelet, anticoagulant)
Alcoholism
Liver Disease
Systemic Disease such as Haemophilia

Question 620

State one pre-extraction blood test that would allow you to test their bleeding/clotting status.

Answer 620

Any of the following:
FBC
Platelet count
INR
APPT
PT

Question 621

On examination, tooth 11 has lost a sufficient portion of its coronal tissue, exposing a previous root canal treatment.
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.
1. List FIVE functions of a provisional restoration in relation to this case

Answer 621

ANY FIVE ANSWERS FROM:
▪ Establish and/or maintain dental aesthetics
▪ Prevent microleakage/bacterial leakage
▪ Confirm that tooth preparation is adequate
▪ Provide occlusal stability
▪ Preserve or improve mastication
▪ Preserve or improve speech
▪ Assess aesethics and function prior to definitive restoration

Question 622

2. What variations of preformed provisional crowns could be available to you for this case? “provisional crown”

Answer 622

Polycarbonate (Directa)
Clear-plastic crown forms filled with composite
Preformed malleable composite crowns

Question 623

3. What are the disadvantages of preformed provisional crowns in comparison to custom provisional crowns?

Answer 623

ANY TWO ANSWERS FROM:
▪ Unlikely to fit accurately
o Cervically
o Occlusally
o Interdentally
▪ Time consuming to prepare
▪ Large bank of crowns needed to accommodate variation between patients
▪ Costly

Question 624

1. Which type of study would provide the highest level of evidence for the effectiveness of this treatment?

Answer 624

Systematic Review (and meta-analysis) of RCTs (2 marks)

Question 625

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.
4. Choosing one of these features, describe how you would implement it in the above study

Answer 625

a. Blinding: make treatment and comparison drugs look identical to blind patients (1 mark); ensure clinician measuring outcome in patients is masked to what patient is on (1 mark); data analyst can be masked to group also (1 mark)