MSA 2020 - part B

Question 1

What are the three different courses of action which can be taken in a case of child abuse?

Answer 1

Preventative Dental team management
Preventative multi-agency management
Child protection referral

Question 2

Explain what would happen with a preventative multi-agency approach in relation to child abuse?

Answer 2

If preventative dental management fails, then proceed to contact other professionals and liaise with the child’s, teacher or GMP for example.
Come up with a plan to help, set goals and arrange to follow up.

Question 3

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

Answer 3

The space will be closed by the 7’s moving into the 6’s place.
The child will have a caries free dentition.

Question 4

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

Answer 4

Can increase dental anxiety due to the traumatic experience of having an Ex at such a young age
Might require GA which has its own risks.
Space may remain and lose a permanent tooth.

Question 5

Which guidance document would you refer to for advice on dealing with patients on Warfarin AND within what timeframe should this test be carried out prior to the extractions?

Answer 5

SDCEP

72-24hrs depending if stable or not

Question 6

Below what level would it be safe to continue with extractions?

Answer 6

below INR 4

Question 7

A fit and healthy patient presents to the surgery to have the surgical removal of a carious 48.

Anatomically, which nerves must be anaesthetised to remove this tooth safely?

Answer 7

IAN
Lingual
Long buccal

Question 8

Name for a painful, unpleasant or neuralgic sensation that lasts for a fraction of a second?

Answer 8

Dysaethesia

Question 9

Give THREE clinical reasons that could account for this neuro-sensory deficit.

Answer 9

A needle may have hit the nerve during LA administration crushing the nerve or cutting it.
The nerve may have been lacerated during incisions.
Direct Trauma to the nerve from the use of extraction instruments.

Question 10

What two pieces of 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.

Answer 10

2010 Equality Act

2004 Disability Act

Question 11

This gentleman could be described as being a person with a disability.

The definition of disability varies between the medical model and the social model. Briefly describe the difference between the two models in their definition of disability.

Answer 11

The Medical model would describe it as a restriction or lack of ability to conduct activities in a range that is normal for people.
The social model would include people with impairments or that are handicapped but are still able to perform a task that is considered within the normal range.

Question 12

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 a safe dental examination.

Answer 12

Use a hoist to get the patient into the dental chair

Use a wheelchair recliner if you have one

Question 13

Which particular aspect related to his cerebral palsy may affect the dentist’s access to the mouth?
What non-pharmacological adjuncts are available to overcome this and aid the dentist’s access to the mouth?

Answer 13

Patients have limited mouth opening due to muscle tone being affected. This can make the mouth more rigid.
Massage the muscle to relax it.
Use a mouth opening prop to hold the mouth open.

Question 14

List FOUR physical characteristics which are associated with Down’s Syndrome

Answer 14

Wide spaced eyes 
Flat face esp, nasal cavity
Large tongue 
small maxilla and larger mandible meaning class 3 relationship 
small ears 
Short neck

Question 15

To confirm a diagnosis of Down’s Syndrome a genetic test is undertaken. What genetic change is responsible for Down’s Syndrome?

Answer 15

Trisomy 21

Meaning the person has three copies of chromosome 21

Question 16

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

Answer 16

Increased risk of dementia Alzheimer’s

Due to their IQ and mental capacity, don’t properly understand so therefore cannot consent.

Question 17

What are the 5 things a patient must demonstrate to show they have capacity?

Answer 17

Acting
making decisions
Communicating decisions 
Understanding decisions 
Retaining the information long enough, Having memory of the decision.

Question 18

What are the 5 key principles of the adults with incapacity Act 2000.
Code of practice.

Answer 18

Must be of benefit to the patient
Minimum necessary intervention
Take into account the wishes of the adult
Consult with relevant others such as friends and family
Excercise residual capacity.

Question 19

Who appoints a welfare guardian?

Answer 19

The court if an adult doesn’t possess the capacity.

Question 20

Who appoints a welfare power of attorney?

Answer 20

The patient while they still have capacity

Question 21

Who can consent to dental Tx?

Answer 21

• Patients with capacity
• Welfare Powers of Attorney
• Welfare Guardians
• Medical & Dental* practitioners under Section 47 of AWI Act (General Authority to Treat)
Dentists need to have had specific training
MP can from the day they qualify

Question 22

What are the 3 elements of valid consent?

Answer 22

For consent to be valid, it must be voluntary
informed,
and the person consenting must have the capacity to make the decision

Question 23

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

Answer 23

Increased risk of diabetes

Poorer manual dexterity so therefore lower levels of OH

Question 24

Mark has previously experienced Infective Endocarditis. In line with SDCEP guidance, he will require antibiotic prophylaxis for the removal of his 6 remaining teeth. He has no known allergies.

What antibiotic, when should you give it to him and what dose of antibiotic should be prescribed for Mark?

Answer 24

Amoxicillin
2g orally
Given 60mins before Tx

Question 25

List FOUR risk factors for mouth cancer

Answer 25

Smoking 
Drinking 
Genetic 
UV light 
Diet 
Age
HPV

Question 26

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 26

What was the dose

And what was the field of radiotherapy

Question 27

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

Answer 27

more than or equal to 50 gray

Question 28

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

Answer 28

A cervical margin and incisal edge

Question 29

How would you manage these teeth given that Mr Clarke is at an increased risk of osteoradionecrosis?

Answer 29

Ex teeth and suture the socket to encourage healing
pentoxifylline/Vit E
liaise with oncologist

Question 30

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

Answer 30

Oral mucositis

Xerostomia

Question 31

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.

Answer 31

Prescribe high Fluoride toothpaste, duraphat
Give good OHI
Prescribe medications to help with xerostomia like Xeratin

Question 32

List ONE management strategy for established osteoradionecrosis of the jaw?

Answer 32

Bone graft

Question 33

What TWO methods are used for manual cleaning of instruments. For each of these give an example of an instrument cleaned in this way

Answer 33

immersion - hand instruments

Non-immersion - electrical

Question 34

How often should an ultrasonic cleaner be de-gassed?

Answer 34

After each time the water is changed

Question 35

What is removed by de-gassing

Answer 35

removes oxygen and other gases from the tubes of the instruments

Question 36

Why is de-gassing important?

Answer 36

As the gases left within the water absorb some of the cavitation energy and therefore reduce the level of cleanliness.

Question 37

Why is it important to use demineralised water in the sterilizer?

Answer 37

Because suspended particles can impede operational values

Question 38

What term can be used to describe the collective group of microorganisms within the oral cavity AND what are they referred to when attached to a surface?

Answer 38

Oral microbiome

Biofilm

Question 39

List the FOUR key microbial stages of caries plaque formation.

Answer 39

Adhesion
Survival and growth
Biofilm formation
Plaque complex formation

Question 40

Name TWO key virulence factors used by Streptococcus mutans to influence enamel dissolution.

Answer 40

Adhesion

and high tolerance of acidic environments

Question 41

Name the bacterium associated with secondary endodontic infections

Answer 41

E.faecalis

Question 42

Name ONE of its key virulence factors

Answer 42

Adhesion 
other factors 
spreading
compete for nutrients 
invade host

Question 43

What culture-independent technique could be used to assess changes in the oral microbial populations following antibiotic exposure?

What is the limitation of this approach?

Answer 43

PCR of oral microbiological DNA and blast searching

Will also take into account dead Microbes DNA(