Msa COPY Flashcards
Two pathogens that cause catheter associated infections
E. coli
Staphylococcus aureus
What drug counteracts benzodiazepine sedation
Flumazenil
List THREE ways to reduce infection risk when undertaking aseptic surgery
Hand hygiene
PPE
Sterilized instruments
What are THREE short term effects of child neglect
Mental/emotional health
Social development
Cognitive development
What are THREE long term effects of child neglect
Suicide
Depression
Arrest
Diabetes/heart disease
What is competent and incompetent lips? (2 marks)
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
What circumoral musculature is involved with lip competence
Mentalis muscle
Patients with incompetent lips can’t keep lips together without lots of strain on mentalis muscle
How does incompetent lips effect the upper and lower incisors
Proclined upper incisors
Retroclined lower incisors
Increased OJ
Can lead to AOB
What is a strap lower lip?
Hyperactive lower lip
How does a strap lower lip effect upper and lower incisors
Strap lower lip with competent lips: retrocline upper teeth
Strap lower lip with incompetent lips: retrocline lower teeth
A fit and healthy patient presents to the surgery to have the surgical removal of the lower right third permeant molar (48).
- Anatomically, which nerves must be anaesthetised to remove this tooth safely? (3 marks)
1) Right inferior alveolar nerve
2) Right lingual nerve
3) Right long buccal nerve
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)
ASK the patient if the right half of their tongue/lip/chin is numb
CHECK by probing adjacent to the 48 buccal/lingual
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
i) Paresthesia
ii) Dysesthesia
iii) Anesthesia
Give THREE clinical reasons that could account for neuro-sensory deficit during a 48 extraction (3 marks)
Crushing (1 mark)
Cutting (1 mark)
Damage to the nerve from the local anesthetic (1 mark)
A patient returns to the clinic with symptoms and signs of a dry socket.
What is the correct terminology for this? (1 mark)
Alveolar osteitis
List THREE predisposing factors that could contribute to dry socket? (3 marks)
Smoking (1 mark)
Sex: Female (1 mark)
More common to occur in molar extractions and more likely to occur in the mandible (1 mark)
List THREE symptoms or signs that a patient with dry socket may present with (3 marks)
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)
How would you manage dry socket (3 marks)
Supportive: reassurance and analgesics (1 mark)
LA, irrigate socket with warm saline, curettage and debridement (1 mark)
Antiseptic pack with Alvogyl (1 mark)
List FIVE risk factors for mouth cancer (2 marks)
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)
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?
Radiation dosage and duration (1 mark)
Radiation field (1 mark)
What dose of radiotherapy delivered to the primary tumour increases the risk of osteoradionecrosis (1 mark)
50-60 Gy (Gray)
Describe the pattern of decay evidenced, which is unique to radiation caries. (1 mark)
Occur at cervical margins and may affect incisal edges (1 mark)
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)
Provide primary orthograde endodontics and decoronate (1 mark)
List TWO oral complications associated with radiation therapy, other than osteoradionecrosis and radiation caries, to the head and neck. (1 mark)
Dry mouth (0.5 mark)
Radiation mucositis (0.5 mark)
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)
Increased fluoride toothpaste: 2800ppm or 5000ppm (0.5 mark)
Tooth mousse (0.5 mark)
List ONE management strategy for established osteoradionecrosis of the jaw? (1 mark)
HBOT: hyperbaric oxygen therapy
Other than alcohol, list TWO causes of liver cirrhosis (1 mark)
Hepatitis B and C (0.5 mark)
Nonalcoholic fatty liver disease (NAFLD) (0.5 mark)
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)
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)
Why is it important to establish oral health prior to receiving a transplant? (1 mark)
Reduced risk of infection and faster recovery
Thrombocytopenia is a common finding in people with advanced alcoholic liver disease. List TWO reasons why thrombocytopenia may occur. (2 marks)
Decreased thrombopoietin production by the liver (1 mark)
Enlarged spleen (splenomegaly) causing increased removal of platelets by the spleen (1 mark)
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)
Dental hospital: above 50,000/microlitre
General dental practice: above 100,000/microlitre (1 mark)
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)
Above 1 (1,000 microlitre)
Other than thrombocytopenia, explain why a patient with advanced alcoholic liver disease may have an increased risk of bleeding (1 mark)
Decreased synthesis of clotting factors by the liver (1 mark)
Name THREE types of Dementia (3 marks)
Alzheimer’s disease (1 mark)
Vascular dementia (1 mark)
Lewy body dementia (1 mark)
List FOUR signs or symptoms present in someone with EARLY STAGE dementia (2 marks)
Loss of short-term memory
Confusion
Anxiety
Inability to manage everyday tasks.
List FOUR signs or symptoms present in someone with MIDDLE STAGE dementia (2 marks)
Anger, aggression and mood changes
Risk of wandering
May behave inappropriately
May experience hallucinations
List FOUR signs or symptoms present in someone with LATE STAGE dementia (2 marks)
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)
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)
Mental health officer (MHO) (1 mark)
A registered medical practitioner such as a doctor or psychiatrist (1 mark)
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)
Amoxicillin 3g orally (2 marks)
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)
Taken one hour before the dental procedure and this is according to the SDCEP guidelines (1 mark)
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)
Child abuse or neglect (1 mark)
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
Later presentation of severe pain/sleep loss for 6 weeks (1 mark)
Multiple injuries on different parts of the face (1 mark)
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)
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)
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)
Preventative multi agency management: inform the family health visitor (1 mark)
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?
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)
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)
You would initially call social services then follow this up with writing to them for a child protection referral (2 marks)
Describe your emergency treatment of dentine/enamel fracture. (1 mark)
Cover all exposed dentine with glass ionomer/ composite (1 mark)
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)
Color change of tooth (1 mark)
Presence of a sinus or abscess (1 mark)
Surrounding soft tissue swelling (1 mark)
Increased mobility (1 mark)
The patient has another rugby match in 2 weeks time. How might you help prevent injury to anterior teeth? (1 mark)
Suggest he wears a gumshield/mouth guard (1 mark)
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)
Early childhood caries (ECC) or nursing bottle caries (same thing different name 1 mark)
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)
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)
List FOUR causes of nursing bottle caries (2 marks)
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)
What fluoride regime could you follow in the dental surgery setting for a child with nursing bottle caries? (2 marks)
Fluoride varnish Duraphat 22,600ppmF fluoride 4 times a year (1 mark)
Silver diamine fluoride 44,800ppmF or APF (acidulated phosphate fluoride) (1 mark)
List FOUR of the recommendations you would make regarding tooth brushing for this patient.
“2 year old paeds question.”
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)
Give a definition of local causes of malocclusion? (2 marks)
A localized abnormality within either arch, usually caused by one, two or several teeth producing a malocclusion (2 marks)
Local causes of malocclusion may be due to variation in tooth number. Please give FOUR examples of these conditions: (4 marks)
1) Supernumerary teeth (1 mark)
2) Hypodontia (1 mark)
3) Retained primary teeth (1 mark)
4) Early loss of primary teeth (1 mark)
List FOUR types of supernumerary? (4 marks)
1) Conical (1 mark)
2) Tuberculate (1 mark)
3) Supplemental (1 mark)
4) Odontome (1 mark)
Describe TWO methods you could use to clinically assess a patient’s antero-posterior skeletal pattern. (2 marks)
Visual assessment (1 mark)
Palpate skeletal bases (1 mark)
Give TWO possible non-skeletal aetiological factors that can contribute to a class II division 1 incisor relationship malocclusion? (2 marks)
Digit sucking habit (1 mark)
Lower lip trap can procline upper incisors (1 mark)
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)
Functional appliance (1 mark)
Give a very brief account of how it is thought that mandibular growth occurs (3 marks)
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)
If a patient subsequently has forward growth rotation, describe a skeletal feature that you could expect to observe? (1 mark)
More acute gonial angle, deep bite and short face (1 mark)
What faults in the placement of a restoration are likely to have led to a marginal overhang in amalgam (2 marks)
Incorrect placement of the matrix band and wedges (1 mark)
Inadequate adaptation/condensing of the material (1 mark)
What problems could a marginal overhang give rise to, in the short and long term (4 marks)
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)
List TWO ways to correct a marginal overhang and which is the preferred/best method (3 marks)
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)
List 3 predisposing factors for necrotizing periodontal disease (3 marks)
Smoking
Stress
Poor oral hygiene
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)
Necrosis of the interdental papilla resulting in gingival craters and systemic risks including fever and malaise (1 mark)
The patient agrees to treatment for necrotizing periodontal disease. What treatment do you provide today? (3 marks)
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)
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)
Metronidazole: 400mg TID 3 days (1 mark)
Arrange a review appointment in 1-2 weeks (1 mark)
What is the average value of the sagittal condylar guidance angle which may be used on an articulator? (1 mark)
30 degrees (1 mark)
Why is the retruded axis important in clinical dentistry?
Because it is a reproducible jaw position (1 mark)
The retruded axis is said to be a border position of the mandible. What is a border position? (1 mark)
One determined by the anatomy of the TMJ and associated musculature (1 mark)
What TWO records are required for mounting casts on a semi adjustable or average value articulator? (2 marks)
Facebow (1 mark)
Interocclusal record (bite registration) (1 mark)
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)
2-4mm (1 mark)
Freeway Space (1 mark)
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)
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)
Besides disinfection of the root canal space name TWO other objectives of irrigant use in root canal treatment? (2 marks)
Removal of smear layer (1 mark)
Lubrication (1 mark)
What is the ideal primary endodontic irrigant AND at what concentration range is it most effective? (2 marks)
Sodium hypochlorite (1 mark)
3-6% (1 mark)
Name THREE factors important for the function of primary endodontic irrigant? (3 marks)
1) Concentration (1 mark)
2) Volume (1 mark)
3) Contact time (time in canal) (1 mark)
What are the two main differences in composition between decorative and dental ceramic (2 marks)
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)
Explain what the following terms mean with regard to optical properties of the materials.
i) Translucency (2 marks)
ii) Opalescence (2 marks)
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)
How can you modify the ceramic surface to make it more retentive prior to using silane? (1 mark)
Etch with Hydrofluoric acid (1 mark)
Chemically how does a silane coupling agent work when bonding composite to ceramic? (2 marks)
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).
Silane coupling agents are a component part of composite resin materials
What is the function of silane in a composite restorative material? (1 mark)
It chemically bonds the filler particles to the resin matrix (1 mark)
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)
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?
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.
Compulsive phycological and physiological need for a habit forming substance
Name one model/approach that could be used to help a smoker quit?
Ask
Advise
Act
Name TWO important bacteria clearly implicated in periodontal disease, based on Socransky’s red ‘disease’ complex. (2 marks)
Porphyromonas gingivalis
Tannerella forsythia
Name TWO bacteria associated with caries development (2 marks)
Streptococcus mutans
Viellonella spp.
What TWO key features that enable cariogenic organisms to stick to enamel surfaces and autoaggregate, and to survive within an acidic environment? (2 marks)
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)
Name TWO systemic diseases that have been shown to be associated with periodontal biofilms? (2 marks)
Diabetes mellitus (1 mark)
Cardiovascular disease (1 mark)
In the correct order, what are the 5 core stages of the washer-disinfector cycle (5 marks)
Flush/Prewash (1 mark)
Main wash (1 mark)
Rinse (1 mark)
Thermal Disinfection (1 mark)
Drying (1 mark)
For each of the named stages below, describe the function/purpose of the stage (5 marks)
Flush/Prewash
Main wash
Rinse
Thermal Disinfection
Drying
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
What is the most common cause of facial trauma in a female patient? (1 mark)
Physical abuse (1 mark)
Aside from physical violence list FOUR other forms of abuse that might be involved in domestic abuse (2 marks)
Sexual (0.5 mark)
Emotional (0.5 mark)
Verbal (0.5 mark)
Financial (0.5 mark)
What process should you follow to ask about the possibility of domestic abuse and briefly describe? (4 marks)
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
List FOUR physical signs you might see in domestic abuse? (2 marks)
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)
List TWO categories of patient who may be considered to be more at risk in terms of domestic abuse than others (1 mark)
Women (0.5 mark)
Long term illness or disability (0.5 mark)
List FOUR benefits that digital radiography has over film radiography (4 marks)
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)
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)
Dose optimization: to reduce the dose to patient by 50% (1 mark)
Reduces the amount of scattered radiation to operator (1 mark)
Rectangular collimators contain the metal lead.
What chemical property of lead makes it particularly effective at absorbing X-ray photons? (1 mark)
High atomic number meaning a large number of protons in it nucleus
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)
1.5 meters in a controlled area
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)
Clinical consideration of whether the benefits of the radiograph must outweigh the risks of exposure
ALARP is an important phrase in radiation protection. What does this abbreviation stand for? (1 mark)
As Low As Reasonably Practicable (1 mark)
List TWO ways in which the researchers might minimise bias in a randomized control trial?
Explain in what ways they reduce bias (4 marks)
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)
ARD is 9% and the CI is -0.8% to 18.9%
What does this tell you about the data
Cl overlaps 0 value of no difference - therefore insufficient evidence
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)
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
What type of handpiece is used for bone removal? (1 mark)
Electrical straight handpiece with saline cooled bur (1 mark)
What are TWO aims for raising a flap in oral surgery? (2 marks)
To gain maximal access to underlying structures and tissues (1 mark)
To protect the surrounding soft tissues by reducing trauma to them (1 mark)
What are 4 factors that influence flap design in oral surgery?
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)
What is the drug family of apixaban (1 mark)
Direct oral anticoagulants (DOAC) (1 mark)
What does apixaban inhibit (1 mark)
Free and clot bound Factor Xa and prothrombinase (1 mark)
Besides being an anticoagulant what is apixaban used for (2 marks)
Prevent blood clots and stroke in patients with atrial fibrillation, deep vein thrombosis, or pulmonary embolism (2 marks)
What blood test would you do before treatment of a patient on apixaban? (1 mark)
Chromogenic anti-Xa assays
What do you ask the patient to do with dosage for simple treatment vs complex extraction (2 marks)
“apixiban question”
Simple treatment: treat without interrupting medication (1 mark)
Complex extraction: miss morning dose before treatment and take usual evening time dose (1 mark)
What are 3 methods of achieving hemostatic control (3 marks)
Even and firm pressure (1 mark)
Suturing (1 mark)
LA with adrenaline (1 mark)
What are FOUR physical features of down syndrome (2 marks)
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)
What is the result of a genetic test of a patient with down syndrome (1 mark)
Trisomy of chromosome 21 (1 mark)
State TWO reasons why patients with down syndrome have no capacity (1 mark)
AMCUR
Incapable of understanding decisions
Incapable of making decisions
List TWO features associated with Down’s Syndrome that are likely to have contributed to his periodontal disease? (2 marks)
Inability to self-care: poor oral hygiene
Systemic immunodeficiency
What is the difference between welfare guardian and welfare power of attorney (2 marks)
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)
What is the antibiotic commonly used for antibiotic prophylaxis and what dose? (1 mark)
Amoxicillin 3g orally (1 mark)
What is the antibiotic commonly used for antibiotic prophylaxis if the patient is allergic to Amoxicillin and what dose? (1 mark)
Clindamycin 600mg
When do you prescribe antibiotic prophylaxis and when should the patient take it (1 mark)
For high risk patient. 1 hour before dental procedure (1 mark)
What are 3 features of Parkinson’s disease (3 marks)
Resting tremors (1 mark)
Bradykinesia: difficulty initiating movement (1 mark)
Rigidity (poor posture): stiffness of muscles (1 mark)
How does Parkinson’s differ from other cerebellar diseases (2 marks)
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)
What is the reason for dry mouth in patients with Parkinson’s disease (1 mark)
They are usually taking anticholinergics and dopaminergic which cause xerostomia
Parkinson’s also affects the ANS (1 mark)
How do you prevent dentures being lost in care homes? (2 marks)
Ensure correct labelling and storage of residents dentures (1 mark)
Mark initials on the denture using sandpaper or a sealant (1 mark)
What are TWO most important things to consider in the provision of the future treatment of patients with Parkinson’s disease
Their tremor will get worse so plan treatment early on (1 mark)
Prevention: modified oral hygiene instruction (1 mark)
What is ONE reason you should not extract teeth for dentures in a patient with Parkinson’s disease
Poor candidates for dentures due to poor neuromuscular control and dry mouth from anticholinergics
Describe TWO clinical ways to assess the vertical skeletal relationship? (2 marks)
Cephalometric analysis of LAFH/TAFH ratio (1 mark)
Assess FMPA: Frankfort mandibular planes angle (1 mark)
What position should the patients head be in when performing skeletal assessment in orthodontics (1 mark)
Frankfort horizontal plane should be parallel to the floor
Which external reference plane of the patient should you position horizontally when setting up for a panoramic radiograph? (1 mark)
Frankfort plane (1 mark)
What is used to bond porcelain to composite luting resin (1 mark)
Silane coupling agent (1 mark)
How is porcelain surface prepped in the lab for bonding (1 mark)
Etched with hydrofluoric acid
Why would you still light cure a dual cured composite luting resin? (1 mark)
In dual cured materials the physical properties are reduced by 25% if they are not light cured. (1 mark)
When would you use a dual cured composite luting resin (1 mark)
If the restoration is thick use a dual cured (1 mark)
What would you do to metal in a lab to prepare it (1 mark)
Sandblasting or etching (cannot etch precious metals)
What chemical agent is used to bond metal (1 mark)
MDP and 4 META (1 mark)
What metal can be used for an acid-etch retained bridge (1 mark)
cobalt chromium (1 mark)
What are THREE things to tell them about e-cigs (3 marks)
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)
What are 2 advice services you should refer patients to for smoking cessation help (2 marks)
Quit Your Way Scotland (NHS smoking cessation) (1 mark)
Smokeline Scotland (1 mark)
Community pharmacy too
What is the methodology for smoking cessation (1 mark)
Ask, Advise, Act (1 mark)
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)
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)
Why would you prefer to use alginate over a silicone impression material? (2 marks)
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
Give TWO examples of support areas for a complete upper denture (2 marks)
Primary support: hard palate
Secondary support: ridge crest
What is the primary support area for a complete lower denture (1 mark)
Buccal shelf (1 mark)
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)
External oblique ridge (1 mark)
Buccinator (1 mark)
What part of the mandible can interfere during a maxillary working impression (1 mark)
Retromolar pads (1 mark)
What is the most important factor for preventing healthcare associated infections (1 mark)
Hand hygiene (1 mark)
What are the 10 Standard Infection Control Precautions SCIP’s (5 marks)
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
What AGENT is used for blood spillages and what STRENGTH (concentration) is used and for how LONG (3 marks)
Sodium hypochlorite (1 mark)
10,000 ppm chlorine (1 mark)
At least 3 minutes for follow manufacturers instructions (1 mark)
How would you break the chain of infection for the transmission of dirty forceps (1 mark)
Mode of transmission is the link that needs to be interrupted. Wear PPE to handle the forceps then disinfect and sterilize the forceps
How long should you leave an irrigant in a root canal for endodontic treatment (1 mark)
10 minutes (follow manufacturers instructions)
What are 4 indications that a trauma incident was not accidental? (4 marks)
“child”
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)
What are TWO effects of trauma on primary teeth (2 marks)
Discoloration and infection (1 mark)
Delayed exfoliation (1 mark)
What are FOUR long term effects that trauma can have on permanent teeth (4 marks)
Pulp Necrosis & Infection (1 mark)
Discoloration (1 mark)
Root Resorption (1 mark)
Dilaceration (1 mark)
When is the ideal time to remove 6s (2 marks)
7’s bifurcation calcifying
8’s present
Class 1 occlusion with an average or reduced overbite
Moderate lower crowding
Moderate upper crowding
Why is there an ideal time to remove 6s with poor prognosis? (2 marks)
Allows the development of a caries/infection free dentition into adolescence (1 mark)
To achieve an optimal occlusal result (1 mark)
What are the disadvantages of removing 6s (2 mark)
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)
If you remove a lower with poor prognosis what would you do with the upper 6 that is non carious (1 mark)
Compensating extraction of upper 6 required (1 mark)
What are FOUR reasons for a child to be anxious (4 marks)
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)
What are TWO ways to treat anxious child (2 marks)
Through the use of sedation (1 mark)
Using behavioral management techniques and acclimating the child to the procedure (1 mark)
What are FOUR behavior management methods (4 marks)
Positive reinforcement (1 mark)
Distraction techniques (1 mark)
Tell-show-do (1 mark)
Stop, go and rest signals (1 mark)
What FOUR borders of the maxillary sinus are seen in an OPT (2 marks)
Roof (0.5 mark)
Floor (0.5 mark)
Medial wall (0.5 mark)
Posterior wall (0.5 mark)
What is the reason for anterior teeth to be horizontally magnified in an OPT (1 mark)
Patient is too far back in the machine or too close to x-ray source (1 mark)
What horizontal reference line is used when taking an OPT and the patient is viewed from the lateral aspect
Frankfort plane
What is the reason posterior teeth is magnified on one side of the OPT (1 mark)
Patient is rotated in the machine or patient not biting symmetrical between incisors on bite peg (1 mark)
DO NOT accept tilting
What are TWO treatment options for a perio-endo lesion (2 marks)
RCT, observe, RSD for residual pockets if required following 3 months after RCT
What would you ask about the social history of a perio-endo patient (1 mark)
Do you smoke or use tobacco products (1 mark)
What THREE investigations would you perform for a patient with a perio-endo lesion (1 mark)
1) Radiographic assessment: periapical
2) Sensibility testing: ethyl chloride or EPT
3) 6PPC to check for furcation and probing depth
What are FOUR factors that cause oral candidiasis (2 marks)
Medications like prolonged antibiotic use
Immunocompromised
Poor oral hygiene
Denture wearers
Name the organism and virulence factor which causes candidiasis (2 marks)
Candida albicans: hyphae for penetration
What are the FOUR key stages to plaque formation (2 marks)
1) Adhesion
2) Colonization
3) Maturation
4) Acid production
Give TWO antifungal examples (azole and polyene) and the mechanism for both (2 marks)
Fluconazole (azole): inhibits the synthesis of ergosterol
Nystatin (polyene): bind to ergosterol and disrupt membrane
Besides a randomized control trial, give THREE other study designs and explain them (6 marks)
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)
List FOUR patient related factors which should be considered when interpreting the results of a RCT of ultrasonic vs manual tooth brushing
Age
Medical history
Tooth condition
Tooth type
How could an amalgam container be kept safe (2 marks)
Spill and leak proof (1 mark)
Mercury vapor suppressant (1 mark)
What are THREE aims of an audit (3 marks)
Quality assurance (1 mark)
Performance evaluation (1 mark)
Continuous improvement (1 mark)
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)
Set guidelines - Observe practice - Compare with guidelines - Implement change
What are the FOUR principles of waste management (4 marks)
Segregation (1 mark)
Storage (1 mark)
Disposal (1 mark)
Documentation (1 mark)
Name THREE regulations for waste disposal (3 marks)
Environmental Protection Act (EPA)
Controlled Waste Regulations (CWR)
Waste (Scotland) Regulations (WR)
COSHH Act
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)
Improve aesthetics
Restore function
Protects the remaining structure
Prevents sensitivity and provides comfort
Guidance for the permanent restoration
List THREE types of prefabricated crowns (3 marks)
Metal crowns: stainless steel, aluminum (1 mark)
Polycarbonate crowns (1 mark)
Clear plastic crowns (1 mark)
List TWO disadvantages of a prefabricated crown (2 marks)
Requires a large bank of crowns (1 mark)
Inaccurate and less customizable (1 mark)
Name the constituents of stainless steal and their percent composition (4 marks)
Iron: 72%
Chromium: 18%
Nickel: 8%
Titanium: 1.7%
Carbon: 0.3%
What is work hardening? (3 marks)
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)
What is meant by springiness? (1 mark)
Rate at which a material returns to it’s original shape after being subjected to large deflections
Name TWO disadvantages of self cure PMMA (2 marks)
Residual monomer - irritant (1 mark)
Poor mechanical properties since chemical activation is less efficient (1 mark)
What are FOUR factors that can result in tooth mobility (4 marks)
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.
In which TWO circumstances would you intervene if a patient presented with tooth mobility (2 marks)
Progressively increasing mobility (1 mark)
Tooth mobility gives rise to symptoms such as difficulty chewing or discomfort (1 mark)
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)
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).
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)
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)
List FOUR peri-operative complications (4 marks)
Fracture of tooth/root
Dislocation of TMJ
Damage to soft tissues
Damage to adjacent teeth
The patient’s root fractures during a standard extraction procedure. What radiograph would you take? (1 mark)
Periapical (1 mark)
Where is the position of the mental foramen (1 mark)
Between the apices of the lower 4 and 5 (1 mark)
Draw the flap design for a surgical extraction of a 44 (2 marks)
Learn this
What TWO structures does the mental nerve innervate (2 marks)
Lower lip and chin up to midline (1 mark)
Buccal gingiva of lower anterior teeth including premolars up to midline (1 mark)
What TWO information do you need before an extraction of a patient on Warfarin (2 marks)
INR (1 mark)
Date of INR (1 mark)
What INR would you carry out an extraction if the patient is taking Warfarin and when should this be done (2 marks)
If INR below 4 (1 mark)
Ideally no more than 24 hours before procedure (1 mark)
What is the most appropriate analgesic for a patient taking Warfarin (1 mark)
Paracetamol
If a patients INR is unstable. How would a GP assess this?
Review the patients medical history and medications (1 mark)
Monitor the patients INR closely and adjust medication dosages (1 mark)
Would you make any alterations regarding a patient on apixaban for an extraction of tooth 16? (1 mark)
Miss the morning dose and take usual evening dose (1 mark)
(According to SDCEP extraction of upper molar is moderate risk)
Would you make any alterations regarding a patient on apixaban for an extraction of tooth 31? (1 mark)
No (1 mark)
According to SDCEP extraction of lower central is low risk
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)
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)
Describe THREE differences between a stroke and a facial palsy (3 marks)
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)
Explain the neural anatomy which accounts for the difference in facial palsy and a stroke (3 marks)
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)
Name FOUR ways you can initially manage a patient with facial palsy (2 marks)
Reassurance
Cover eye with pad until blink reflex returns
Let someone else drive them home
Consider ibuprofen for pain or discomfort
You take an impression of an MOD for a ceromeric inlay. How would you determine if this impression is usable (3 marks)
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
List FOUR potential faults with an impression (4 marks)
Air bubbles
Tear in the material
Voids: incomplete capture of anatomy
Distortion of the material
How would you decontaminate the impression immediately after taking it (3 marks)
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
Give FOUR reasons why non setting calcium hydroxide an ideal inter-appointment medicament (2 marks)
Prolonged effectiveness: can remain active between appointments
Antibacterial properties
Biocompatible
Easy to use
What are THREE reasons for obturating a root canal? (3 marks)
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)
Other than rubber what are the components of Gutta percha (2 marks)
Zinc oxide: 65%
Gutta percha: 20%
Radiopacifiers: 10%
Plasticizers: 5%
What are THREE reasons for a sealer when using cold lateral compaction (3 marks)
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)
What are the TWO most important muscle of mastication for elevating the mandible (2 marks)
Masseter (1 mark)
Temporalis (1 mark)
What is the PRIMARY muscle of mastication for protruding the mandible (1 mark)
Lateral pterygoid muscle (1 mark)
What is the anterior convex part of the temporomandibular joint (1 mark)
Articular eminence/tubercle (1 mark)
What is the posterior concave part of the temporomandibular joint (1 mark)
Glenoid/mandibular fossa (1 mark)
What is ONE species other than Candida albicans that causes candidiasis and how can you differentiate (2 marks)
Candida glabrata: culture and sensitivity test to differentiate (2 marks)
What are THREE forms of candidiasis? (3 marks)
Oral candidiasis (1 mark)
Genital candidiasis (1 mark)
Cutaneous candidiasis (1 mark)
What are THREE forms of oral candidiasis (3 marks)
Pseudomembranous candidiasis: thrush (1 mark)
Erythematous candidiasis: denture induced stomatitis (1 mark)
Hyperplastic candidiasis: candidal leukoplakia (1 mark)
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)
OHI
Fluoride varnish
Fissure sealants
Upper restoration with no LA
Upper restoration with LA
Lower restoration with LA
Pulpotomy
Extraction
What are FOUR signs that a child is anxious at the dentist (2 marks)
Crying or expressing fear
Difficulty communicating
Clinging on to parent or caregiver
Physical signs: sweating and trembling
What is SIMD (1 mark)
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)
What are the SEVEN factors of deprivation (7 marks)
income
Employment
Education
Health
Crime
Skills and training
Geographic access to services
What is another name for master impressions (1 mark)
Definitive impressions (1 mark)
What are TWO factors that affect physical retention of a denture (2 mark)
Accurate fit (1 mark) ??
Cohesion and adhesion: salivary quality of patient (1 mark)
Border seal: by incorporating post dam (1 mark)
What are TWO anatomical features for the positioning of the posterior border of the upper denture (2 marks)
Vibrating line (1 mark)
Hamular notch (1 mark)
Name 3 anatomical features to include on a mandibular impression (3 marks)
Retromolar pads (1 mark)
Lingual pouch (1 mark)
Buccal shelf (1 mark)
Name TWO materials you can use for master impressions of the lower arch (2 marks)
Alginate (1 mark)
Silicone elastomers: polyvinyl siloxane (1 mark)
A nurse does not wash her hands before a patient. What should you do (2 marks)
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)
You decide to give a presentation about hand hygiene. What are FOUR things to include (4 marks)
When to wash your hands
How to wash your hands
What to wash with
Why to wash hands
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)
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)
After informing the dentist of the standard operating procedure what are TWO things you should do? (2 marks)
“double gloved blood disease question”
Implement model for improvement (1 mark)
Document (1 mark)
What is FOUR PPE you need for carrying out manual cleaning and why would you need each one (4 marks)
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)
When should you degas the ultrasonic bath (1 mark)
Every time it is filled from empty (1 mark)
Why should you degas the ultrasonic bath (1 mark)
To remove air/oxygen (1 mark)
How does degassing the ultrasonic bath affect it (1 mark)
Air/oxygen will prevent ultrasonic bubbles from reaching all surfaces of instrument (1 mark)
Provide one good reason why dental handpieces should not be placed in the ultrasonic cleaner (1 mark)
May be damaged by ultrasonic activity (1 mark)
What are TWO types of manual cleaning and name an example for each (2 marks)
Immersion: dental mirror
Non immersion: handpieces
Why do you use deionized water in the sterilizer (1 mark)
To prevent the deposit of minerals on the instruments (1 mark)
What percentage of patients are affected by sensitivity caused by tooth whitening (1 mark)
60%+ (1 mark)
What are THREE predisposing factors likely to cause sensitivity after tooth whitening (3 marks)
Pre-existing sensitivity (1 mark)
Gingival recession (1 mark)
High concentration of bleaching agent (1 mark)
One of the risks of internal non vital bleaching is external cervical resorption. What is the method of action for this? (2 marks)
Due to diffusion of H2O2 through dentine into periodontal tissues (2 marks)
One of the risks of internal non vital bleaching is external cervical resorption. What are TWO causes for this?
High concentration of H2O2 (1 mark)
Heat (1 mark)
How do you prevent root resorption from internal non vital bleaching (2 marks)
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)
What are TWO indications for surgical consideration at the reevaluation stage of a patient with periodontal disease (2 marks)
Good OH (1 mark)
Persistent deep pockets ≥ 6mm (1 mark)
When should you continue non surgical intervention at the reevaluation stage for a patient with periodontal disease (1 mark)
Poor OH, persistent inflammation with Pocket probing depth PPD 4-5mm
or
Good OH, inflammation resolved with PPD 4-5mm
What is the aim of surgical treatment of a patient with periodontal disease (1 mark)
To prevent the progression of disease and restore a functional and comfortable dentition (1 mark)
What are THREE reasons for non surgical periodontal disease treatment before surgical treatment (3 marks)
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)
What are THREE supportive roles of the GDP after surgical intervention of a periodontal patient has been carried out by a specialist (3 marks)
Maintain periodontal health (1 mark)
Monitor and treat recurrence (1 mark)
Reinforce prevention (1 mark)
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)
Reduced salivary flow (1 mark)
Compromised immune system and damage to oral mucosa (1 mark)
A patient has had radiotherapy to the parotid gland. Why is enhanced prevention needed for this patient (2 marks)
Patient is at an increased risk for caries (1 mark)
Increased risk for oral infections (1 mark)
A patient has had radiotherapy to the parotid gland. What are complications of extractions for this patient and why? (2 marks)
Increased risk of infection due to compromised immune system (1 mark)
Risk of osteoradionecrosis due to weakened bone tissue and delayed healing (1 mark)
What are FOUR effects of chemotherapy on blood count (4 marks)
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)
What are FOUR diagnostic criteria for Alzheimer’s (4 marks)
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)
Can the care home manager consent to dental treatment of a patient with Alzheimer’s disease (1 mark)
No unless they have been appointed by the court or by the patient (1 mark)
Who can consent for a patient with Alzheimer’s disease prior to treatment (2 marks)
Power of attorney (1 mark)
Welfare guardian (1 mark)
Which act is relevant in Scotland regarding a patient with Alzheimer’s not being able to consent
Adults with Incapacity act 2000 (Scotland)
Which act is relevant in England regarding a patient with Alzheimer’s not being able to consent
Mental Capacity Act 2003 (England)
What are TWO types of e-cigs (2 marks)
Cigalike e-cigs (1 mark)
Vape mods e-cigs (1 mark)
What are THREE questions to ask a patient who wants to quit smoking (3 marks)
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)
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)
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)
What are TWO causes of failed eruption of a permanent tooth (2 marks)
Obstruction e.g. overcrowding (1 mark)
Genetic and developmental factors e.g. absent successor (1 mark)
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)
Maintain alignment (1 mark)
Space creation (1 mark)
Root development (1 mark)
Restore aesthetics and function (1 mark)
A patient comes in for a surgical extraction of roots 45. What nerves are needed to be anesthetized (2 marks)
Right inferior alveolar nerve (1 mark)
Right lingual nerve (1 mark)
What are THREE possible nerve deficits (3 marks)
Anaesthesia (numbness) (1 mark)
Paraesthesia (tingling) (1 mark)
Dysaesthesia (unpleasant sensation/pain) (1 mark)
What are THREE ways the pulp communicates with the periodontal ligament (3 marks)
Apical foramen (1 mark)
Lateral and accessory canals (1 mark)
Furcal canals (1 mark)
If a patient comes in with a non vital pulp, what is the diagnosis and treatment (2 marks)
Pulp necrosis (1 mark)
Endodontic treatment of affected tooth (1 mark)
A patient comes in with a vital pulp but generalized pocketing. What is the diagnosis and treatment (2 marks)
Generalized periodontitis (1 mark)
OHI, PMPR and control of risk factors (1 mark)
A patient comes in with a non-vital pulp and periodontal problem. What is the diagnosis and treatment (3 marks)
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)
How do you check that new guidelines have been followed (1 mark)
Audit (1 mark)
Briefly explain each waste stream and give ONE example
Black
Yellow
Orange
Blue
Red (5 marks)
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
What is a multidisciplinary team? (2marks)
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)
Name FOUR members of the multidisciplinary team for the management of a patient who has undergone radiotherapy
Dentist (1 mark)
Physio (1 mark)
Oncologist (1 mark)
Radiologist (1 mark)
Name THREE steps to debride a wound prior to suturing and briefly describe how each is done (3 marks)
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)
A patient is suspected of having a bleeding disorder. What THREE blood tests can you use to investigate this? (3 marks)
FBC (1 mark)
Prothrombin time (PT) (1 mark)
aPTT (1 mark)
What is ONE inherited coagulation disorder (1 mark)
Hemophilia A (1 mark)
What is ONE disorder of platelet numbers (1 mark)
Thrombocytopenia (1 mark)
What LA technique would you use for blood disorder patient for extraction of a 47 (1 mark)
Follow SDCEP guidelines Liase with patients hematologist if patient is not stable
Inferior alveolar nerve block with long buccal infiltration (1 mark)
What FOUR clotting factors are affected by Warfarin (2 marks)
Factor 2, 7, 9, 10, Protein C and S
Factor II: prothrombin (1 mark)
Factor VII: vitamin K dependent factors (1 mark)
What is the max INR you should tolerate for an extraction (1 mark)
3.9 is the max INR you should treat (1 mark)
What LA technique would you use for a 47 extraction on a patient who is on warfarin
Ideally INR within 24 hours and make sure it is below 4
Inferior alveolar nerve block with long buccal infiltration (1 mark)
What are TWO ways clinical waste is made safe before landfill (2 marks)
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)
What are TWO sources of amalgam waste (2 marks)
Extracted teeth with amalgam (1 mark)
Chairside amalgam residue/waste (1 mark)
What are TWO safety features of an amalgam container (2 marks)
Spill/leak proof lid (1 mark)
Mercury suppressant (1 mark)
What license regarding disposal of amalgam and how long should it be kept for? (2 marks)
Consignment note (1 mark)
Kept for a minimum of 3 years (1 mark)
What is the main antifungal to get rid of Candida albicans (1 mark)
Fluconazole (1 mark)
List TWO resistance mechanisms of Candida albicans (2 marks)
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)
Before prescribing fluoride mouth rinse to a child what should you check (3 marks)
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
What is the daily strength of fluoride mouth rinse (1 mark)
225ppm
How do you decide between a conventional crown and a post and crown (4 marks)
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)
What is the function of a post in a post and crown (1 mark)
Post retains the core. Posts DO NOT strengthen or reinforce teeth (1 mark)
What are THREE materials used for a post (3 mark)
Metal: cast metal or steel (1 mark)
Fiber: Carbon or glass (1 mark)
Ceramic: zirconia (1 mark)
What are THREE types of posts which can be used
Prefabricated post
Tapered posts
Parallel posts
What are THREE materials used for a core (2 mark)
Composite (1 mark)
Amalgam (1 mark)
Glass ionomer (1 mark)
What are THREE ways to determine the length of a post (3 marks)
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
What are TWO problems that arise from having a post that is too wide (2 marks)
Tooth fracture: weakens the tooth structure (1 mark)
Root perforation (1 mark)
What are TWO problems that arise from having a post that is too narrow (2 marks)
Inadequate retention of crown or core (1 mark)
Fracture: cannot withstand forces of mastication (1 mark)
What are THREE general health effects of smoking (3 marks)
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)
What are THREE oral health effects of smoking (3 marks)
Increased risk of oral cancer (1 mark)
Increased risk of gingivitis and periodontitis (1 mark)
Xerostomia (1 mark)
What are TWO recent health promotion approaches in Scotland to reduce smoking (2 marks)
Tobacco display ban (1 mark)
Smoking cessation services: Quit Your Way and Smokeline (1 mark)
What is an example of an approach to smoking cessation in a dental practice (1 mark)
Brief intervention through the use of Ask, Advise and Act. This can lead to signposting patients to appropriate services (1 mark)
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)
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)
List FOUR properties of impression material suitable for crown prep. And give an TWO examples of a material (2 marks)
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
What is xerostomia? (2 marks)
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
What are THREE oral health problems that xerostomia exacerbate (3 marks)
Dental caries
Periodontitis
Oral Candidiasis
What FOUR drugs cause xerostomia
Beta blockers
Diuretics
Tricyclic antidepressants
Anticholinergic
What are TWO non drugs related causes of xerostomia
Sjogren’s syndrome
Radiotherapy/chemotherapy
What does ARAB stand for and briefly define each?
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
What active component and baseplate modification corrects a posterior crossbite?
Active component: Hyrax screw or Coffin Spring
Baseplate modification: posterior bite plane
What is the method of retention for a URA with primary and permanent teeth and what is the gauge of wire
Adam’s clasp (0.7mm HSSW) for permanent
Adam’s clasp (0.6mm HSSW) for primary
What could you add to a URA to prevent a digit sucking habit
Deterrents like a single palatal goal post or a double palatal goal post
Explain what happens to posterior dentition during digit sucking (2 mark)
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.
What is the length of the submandibular duct
5-6cm
Where does the submandibular duct arise?
From the submandibular gland
Where does the submandibular duct open
Sublingual caruncle
Where does the sublingual duct open?
Sublingual fold
What runs inferior to the submandibular duct
Lingual nerve which is a branch of the mandibular division of the trigeminal nerve (CN V3)
What group does chlorhexidine belong to?
Bisguanide Antiseptic
What is chlorhexidine and what is the mode of action of it (2 marks)
It is a dicationic compound.
Cation adheres to cell membrane
Increases permeability of cell membrane
Precipitation of cytoplasm; Cell death
What is the substantivity of chlorhexidine
Active in the oral cavity for up to 12 hours after use
What are TWO factors affecting the substantivity of chlorhexidine
Improper use from patient: dilution with water
Oral hygiene practices: brushing and flossing can mechanically remove chlorhexidine
What is the recommended concentration, volume amount and frequency of chlorhexidine
“mouthwash”
0.2% 10ml = 20mg twice/day
0.12% 15ml = 18mg twice/day
What are SIX indications for chlorhexidine
Oral candidosis
Immunocompromised patients
Treat gingivitis/periodontitis
Maintenance of OH
Mucositis
Oral ulcerations
What is the relationship of oral cancer to being poor other than smoking. List TWO factors.
Limited access to healthcare
Poor nutrition
A nursing home has been infected with food poisoning. What are THREE factors increasing this risk
Inadequate hand hygiene
Poor food handling and storing
Poor washing of cutlery
What are the 6 key links in the chain of infection
1) Infectious agent
2) Reservoirs
3) Portal of exit
4) Mode of transmission
5) Portal of entry
6) Susceptible host
A nursing home has been infected with food poisoning. What are TWO ways you could break the chain of infection in this scenario
Eliminate the infectious agent by performing hand hygiene
Implement infection control measures such as the use of PPE in the kitchen or disposable cutlery
What are THREE examples of advice to give to carers when performing oral hygiene on elderly to stop cross infection
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
What are FOUR radiographic signs that a tooth is non vital
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
What are FOUR checks prior to inserting a new orthodontic appliance
Correct patient and appliance
Check design specifications
Check the acrylic
Check the integrity of the wire
What are THREE checks when the appliance is inserted in the patients mouth
Check for blanching or soft tissue trauma
Posterior retention: flyovers first, then arrowheads
Anterior retention
What advice and instructions would you give a patient after fitting an orthodontic upper removable appliance
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
A bariatric patient presents to the practice with hypertension and complains of frequent urination. What is the suspected diagnosis?
Type 2 Diabetes Mellitus
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?
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
What should a patient with type 2 diabetes do before a dental appointment
Check blood sugar levels
Eat and hydrate
Bring necessary supplies: glucose tablets or insulin
What is the normal values for blood pressure and hypertension
Normal blood pressure: 120/80mmHg
Hypertension: 140/90mmHg or higher
What lifestyle changes would you give for a patient who has hypertension and type 2 diabetes
Exercise
Weight loss
Healthy diet (limit sodium intake)
Stress management
Quit smoking and drinking
What THREE drugs can result in gingival hyperplasia
Calcium channel blockers
Phenytoin
Cyclosporine
Give the oral side effects of the following drugs
Benazepril
Atenolol
Nifedipine
Bendrofluazide
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
What are THREE virulence factors involved in dental caries by Streptococcus mutans
ATPase (control pH)
Glucans (attach)
Adhesins (attach)
What are TWO virulence factors involved in periodontal disease by P. gingivalis and T. forsythia
P. gingivalis: Gingipains
Tanerella Forsythia: Karilysin
Briefly outline the process which leads to inflammation in the innate immune response (6 marks)
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
List FOUR different types of T cells and briefly describe how they work
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
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
1) Condylar Inclination
2) Condylar Guidance
3) Compensating curve
4) Incisor Guidance
5) Occlusal Plane
Which variables of Hanau’s Quint can be altered or changed
Condylar inclination
Compensating curve
Why is the Retruded axis used when fabricating complete dentures (3 marks)
Its reproducible
Its recordable
Its learnable for the patient
What are FIVE occlusal table considerations when setting teeth for occlusal rims
Anterior guidance
Occlusal plane
Curve of Spee
Curve of Wilson
Cuspal inclination
Why don’t oral biofilms allow antibiotics to penetrate them?
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
Name THREE characteristics of a ghost image on a radiograph
Ghost images are horizontally magnified
Ghost images are on the opposite side to the original
Ghost images are radiopaque
Give THREE ways the dose to the patient is reduced by normal radiographical techniques
Rectangular collimation
High speed films: F speed film
Focus to skin distance >200mm
Describe the Compton effect and how it differs from the Photoelectric effect
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
What metal is used to absorb the heat generated during X-ray production?
Copper
Name a metal besides tungsten used in X ray production
Tungsten
Name THREE materials used for crowns
Metal ceramic crown
All ceramic crown: zirconia, lithium disilicate
Gold alloy crown
How much gutta percha should be left in the canal space when placing a post?
3-5mm
What name is given to the residual collar of dentine required before placing a post?
Ferrule
Describe the width of taper required for the type of crown given in the above clinical photograph (Image of metal ceramic crown)
6 degree taper
What is EADT and EAT and briefly explain what they mean (2 marks)
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
Name THREE potential storage mediums for an avulsed tooth
Milk
Saliva
Water
Give another TWO points of information other than storage you would give to someone phoning up about an avulsion
Handle the tooth by the crown
Ensure its a permanent tooth then replant into socket, bite on gauze and seek dental assistance immediately
What form of splint is used for a subluxation? What is the minimum time the splint should be in place for?
Flexible composite and wire (0.4mm) splint: 2 weeks minimum
What is the fluoride regime for a high risk 4 year old
1500ppmF toothpaste
Fluoride varnish 22,600ppmF: 4 times a year
At what age is it suitable to deliver mouthwash to a paediatric patient?
Age 6 and older
What is the toxic ingested fluoride dose to patients
5mg/kg
How do you treat the following doses of fluoride ingested
<5mg/kg
5-15mg/kg
> 15mg/kg
<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.
What is the thickness of Shimstock articulating paper
8-40 microns depending on manufacturer (lecture says 8)
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?
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
Besides vertical bone loss, what other type of bone loss is there and why is this significant?
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
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?
1) PMPR of lower left quadrant
2) Local antimicrobials (chlorhexidine)
3) Antibiotic regiment (amoxicillin 3TID 7 days)
4) Host modulation therapy: corticosteroids, bisphosphonates
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
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
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?
3-5 days with 1 day being a weekend (SDCEP)
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?
Preventative multi agency management: liase with other professionals to see if concern is shared
List TWO pieces of current disability legislation in the UK, which, as a practicing dental surgeon, you must comply with.
The Equality Act 2010
Adults with Incapacity Act 2000
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)
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
What is the name for the shape of the mandibular jaws movement
Posselt’s envelope
What is the biological width (in mm)
2-3mm: distance between the base of the gingival sulcus and the crest of the alveolar bone
Label all the points of Posselt’s envelope (6 marks)
ICP, RCP, rotational movement, translational movement, maximum protrusion, edge to edge
Talk about the feeding cycle when food bolus enters our mouth to when it leaves (10 marks)
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
How often should fissure sealants placed in a child of high caries risk be radiographically reviewed?
Every 6 months
Chlorhexidine is a common medicament used to treat periodontal disease, name THREE other instances where it can be applicable
Treat oral candidiasis
Irrigant
Maintain oral hygiene
Name the process by which chlorhexidine acts upon cells and explain
Dicationic. One cation adheres to pellicle coated teeth; one cation adheres to cell membrane
Increases permeability of cell membrane
Precipitation of cytoplasm; Cell death
Give ONE way in which chlorhexidine is diminished in efficacy by the patient
Incorrect use such as dilution with water
What is meant by substantivity of a drug
Persistence of action of the drug
What does TID mean on a prescription
Ter in die (latin) three times a day
Name TWO ways in which gingival hyperplasia can be treated
If induced by medication: use alternative medications or alter dose
If caused by poor OH: OHI
Give FOUR clinical signs and symptoms of necrotizing gingivitis
Necrosis and ulcer of interdental papilla
Pain
Gingival bleeding
Halitosis
What antibiotic regime would you give to a patient with necrotizing gingivitis
400 mg Metronidazole TID for 3 days
When are THREE instances you would give antibiotics to a patient with necrotizing gingivitis?
Patients with systemic involvement
Lack of response to mechanical therapy
Patients with impaired immunity
What is the periodontal phenomenon experienced by smokers when trying to quit and briefly explain it?
Smoker’s paradox: refers to the temporary worsening of periodontal health when trying to quit smoking
Name FOUR indication to extract a tooth
Unrestorable teeth
Orthodontic indications
Traumatic position
Symptomatic partially erupted teeth
Name TWO drugs in which care must be taken when carrying out an extraction and explain why?
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
A patient attends your surgery complaining of persistent bleeding after an extraction that was completed one day ago. Give FOUR treatments
Even and firm pressure with damp gauze
Sutures
LA with vasoconstrictor
Diathermy
Name the FOUR types of porosity which can be generated in the production of the URA or a full denture.
Gaseous porosity
Contraction porosity
Casting porosity
Granular porosity
What are TWO thermal properties of denture bases
High softening temperature
Low thermal conductivity
Thermal expansion of base = artificial tooth
What is the optimal dose of fluoride in drinking water?
1ppmF
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
Spinach
Grapes
Grapejuice
Black Tea
List FOUR methods of topical fluoride application for an 8 year old child
Fluoride varnish
Acidulated phosphate fluoride (APF) gels
Fluoride toothpaste
Fluoride mouthwash
What is the mechanism by which fluoride helps prevents cavities? (3 marks)
Promotes remineralization.
Forms fluorapatite which is more resistant to demineralization
Inhibits bacterial growth
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?
0.5mg
What is the rationale for the use of antibiotics in periodontology? (3 marks)
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
What problems limit the usefulness of antibiotics in the treatment of periodontitis (3 marks)
Antibiotic resistance
Limited effectiveness: do not work effectively against biofilms
Allergic reactions
In what situations would it be appropriate to prescribe a systemic antibiotic in periodontitis patients (4 marks)
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
What is the minimum data set that should be recorded onto the record block? (2 marks)
Midline
Canine line
Which part of a root canal filling is the most important for ensuring long term success
Coronal seal
What is the name of the technique used in obturating a canal
Cold lateral compaction technique
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
- Gingivitis
- Localised Periodontitis
- Generalised Periodontitis
- Dentine Hypersensitivity
- Lesion of endodontic origin with periodontal involvement
- Lesion of periodontal origin with endodontic involvement
- Occlusal trauma
- Periapical periodontitis
- Periodontal abscess
- Reversible pulpitis
- True combined periodontal-endodontic lesion
Lesion of endodontic origin with periodontal involvement
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
Furcal canal
Accessory canal
What treatment would you perform on a lesion of endodontic origin with periodontal involvement (3 marks)
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)
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
- Gingivitis
- Localised Periodontitis
- Generalised Periodontitis
- Dentine Hypersensitivity
- Lesion of endodontic origin with periodontal involvement
- Lesion of periodontal origin with endodontic involvement
- Occlusal trauma
- Periapical periodontitis
- Periodontal abscess
- Reversible pulpitis
- True combined periodontal-endodontic lesion
Occlusal trauma
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)
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)
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)
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?
Stage 3 Grade B
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?
Smoking history (current or past)
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)
Plaque scores
Full mouth pocket chart
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
- Gingivitis
- Localised Periodontitis
- Generalised Periodontitis
- Dentine Hypersensitivity
- Lesion of endodontic origin with periodontal involvement
- Lesion of periodontal origin with endodontic involvement
- Occlusal trauma
- Periapical periodontitis
- Periodontal abscess
- Reversible pulpitis
- True combined periodontal-endodontic lesion
- Periapical periodontitis
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)
Sensibility testing
Periapical radiograph
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)
Extraction of 46 (1 mark)
Pulpectomy and further RCT (1 mark)
NOT analgesia
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?
Acute necrotizing ulcerative gingivitis
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?
400mg Metronidazole 3 times a day for 3 days
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
Hygiene phase therapy
Smoking cessation advice
List FIVE investigations included in a trauma stamp?
Sinus
Colour
Mobility
TTP: tender to percussion
Ethyl Chloride
EPT
Radiograph
What are FOUR special investigations for extracting multiple teeth
Radiographs
Sensibility testing: ethyl chloride, EPT, GP
Percussion note
TTP
What is the purpose of compensating extractions?
Designed to maintain occlusal relationship
Define child dental neglect
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
What are nursing bottle caries?
A type of dental decay that occurs in infants/young children due to prolonged exposure to sugary liquids from a bottle or sippy cup
What is the caries pattern in nursing bottle caries?
Maxillary incisors
First molars
Mandibular canines
Lower incisors protected by the tongue
What are FOUR occlusal presentations of a digit sucking habit
1) Proclined upper incisors
2) Retroclined lower incisors
3) Anterior open bite
4) narrower upper arch +/- Unilateral posterior crossbite
What are FOUR ways to manage a digit sucking habit
1) Positive reinforcement
2) Bitter-tasting nail varnish
3) Glove on hand, elastoplast
4) Habit breaker appliance (habit deterrent)
What TWO appliances can be used to stop a digit sucking habit?
URA: Palatal goal post(s)
Fixed: Tongue rake
What are THREE special investigations for generalised chronic periodontitis
Periapical X rays to stage and grade
6PPC (furcation and mobility)
Modified bleeding and plaque scores
What are FIVE examples of local causes of malocclusion
Variation in tooth number
Variation in tooth size or form
Abnormalities of tooth position
Local abnormalities of soft tissues
Local pathology
What are FOUR ideal properties of denture bases
Dimensionally accurate and stable
Unaffected by Oral Fluids
Non toxic/irritant
Good mechanical properties
What are THREE examples of a denture base
Stainless steel
Cobalt chromium
Acrylic (PMMA)
Acrylic is a denture base that is known to have gaseous porosity
Explain gaseous porosity (2 marks)
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
List TWO uses of a mould liner
Reduces porosity
Easier for deflasking to be carried out
Why should dentures be kept moist
To avoid distortion
To improve comfortability
To maintain good fit
To prevent ulcers and sores
What are THREE properties of acrylic dentures and explain the importance of these properties
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
What is the term for maintaining communication between pulpal space and peri-radicular tissues
Patency
Define the following in terms of endodontics and how are they obtained
Estimated working length
Corrected working length
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
What is a working length in endodontics (2 marks)
The extent from apical terminus of preparation and a predefined coronal reference point
State TWO potential causes of a corrected working length changing during the course of endodontic shaping?
Ledges
Perforation
What are THREE precautions when using an irrigating a root canal
Inject slowly: do not use thumb can causing hypochlorite extrusion
Tissue irritation: can burn the soft tissues
Allergic reactions
What testing can you do to distinguish between reversible and irreversible pulpitis
Ethyl chloride: if pain lingers it is irreversible
EPT: mild tingling is reversible, sharp or intense pain is irreversible
What TWO radiographic views would be best to view a maxillary central incisor that has failed to erupt
Anterior oblique maxillary
Periapical
What X ray should be used for a patient who cannot tolerate bitewings
OPT
When are THREE instances you should not extract teeth for dentures in a patient with Parkinson’s
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
When should you extract teeth for denture use in a patient with Parkinson’s
Presence of infection that can impact the patients general health
Severe periodontal disease
Grossly carious teeth
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.
Wheelchair recliner
Hoist to transfer to dental chair
Patient has a reclining wheelchair
How do you communicate with a patient who cannot speak or write
Use visual aids
Voice generating device
Communication apps
Sign language
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.
Ramp
Lift
What are THREE cognitive tests for a person with dementia
MMSE: mini mental state examination
MoCA: Montreal cognitive assessment
Delayed word recall
How do you make the dental practice a dementia friendly healthcare environment (4 marks)
Reception visible from entrance
Color of walls different from floor
Avoid non essential signs
Ensure good natural lighting
What are THREE symptoms of congestive heart disease
Shortness of breathe
Fatigue and weakness
Swelling in the legs and ankles
What are THREE causes of congestive heart disease
Hypertension
Obesity
Alcohol and drug abuse
What are FOUR diseases which can result in congestive heart failure
Coronary artery disease
Cardiomyopathy
Diabetes
Valvular heart disease
What FOUR medications treat congestive heart failure
ACE inhibitors: Ramipril
Diuretics: furosemide
Nitrates
Digoxin
What antibiotic prophylaxis should be used for dental treatment to reduce heart infection risk and what dose and when should it be taken
Amoxicillin 3g orally 1 hour before procedure
What microorganism causes infective endocarditis?
Streptococcus viridians
What are THREE modifiable factors for aetiology of head and neck cancer (memorize)
Smoking/tobacco use
Alcohol consumption
HPV infection
The liver is responsible for the production of which clotting factors involved in the coagulation cascade?
1, 2, 7, 9, 10, 11
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.
Eye tracking technology
Communication boards
Term used to describe collective group of microorganisms in oral cavity and what are they referred to when attached to a surface
Microbiome
Biofilm
Name the bacterium associated with secondary endodontic infections
Enterococcus faecalis
Name ONE of the key virulence factors for the bacterium that is associated with secondary endodontic infections
Adhesins
Why is it difficult to determine causality from a specific bacteria in endodontic infection
Sterile sampling procedures, active/functional bacteria
What antimicrobial is used to disinfect root canal
Sodium hypochlorite 3-6%
Culture independent technique used to assess changes in oral microbial populations following antibiotic exposure and what are limitations of that approach
Next generation sequencing
Limited to describing what is present rather than what communities doing (phenotypic rather than functional)
Define the following terms below
Incidence
Prevalence
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
What are THREE warnings you should give to a patient taking metronidazole
Avoid consuming alcohol
Do not take if pregnant
Stop taking if any adverse reactions and seek medical advice
What are the primary and secondary support structures for a complete lower denture
Primary: buccal shelf and retromolar pads
Secondary: ridge crest and genial tubercles
What are FOUR contraindications of metronidazole
Alcohol
Warfarin
Pregnancy
Allergy
What number of canals are found, most often, in an upper first premolar?
2
During instrumentation of the canal where is considered the ideal end point of shaping/obturation? (2 marks)
Apical constriction, the junction between dentine and cementum or wet/dry interface
What TWO common intra-operative radiographs can be utilized during endodontic treatment to aid working length determination?
Master cone radiograph
Correct working length radiograph
There are various evidence- based treatments that can be used to help support patients who want to quit smoking. Give TWO examples
Nicotine patches
E cigs
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)
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)
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)
Whether the child has suffered any trauma to that tooth
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)
Palpate the labial sulcus
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?
Maxillary anterior occlusal or periapical
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)
Trauma to the deciduous incisor (1 mark)
Leading to dilaceration of permanent successor (1 mark)
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?
Congenital absence
The relative risk is 2.2 and the CI is 0.1 - 1.2
Is the evidence sufficient
No, because the confidence interval overlaps/contains the value of no difference which is 1 for relative risk therefore there is insufficient evidence
The Absolute risk difference is 5.2 and the CI is 0.7 - 1.1
Is the evidence sufficient
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
The odds ratio is 1.2 and the CI is 0.9 - 2.3
Is the evidence sufficient
No, because the confidence interval overlaps/contains the value of no difference which is 1 for odds ratio therefore there is insufficient evidence
List the FOUR main features of a randomized control trial study design
Randomization
Blinding
Comparison groups
Inclusion/exclusion criteria
Name the standards developed to improve the reporting of randomized controlled trials?
CONSORT guidelines
What radiograph would you request for the management of the non eruption of the upper central incisor?
Periapical
What are the principles of the orthodontic management of non-eruption of upper central incisors? (4 marks)
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
What is the British Standard Institute’s definition of a class III relationship?
The lower incisor edges lie anterior to the cingulum plateau of the upper incisors. The overjet is reduced or reversed.
A patient has a class III. How would you describe the patient’s skeletal relationship in terms of growth or development? (2 marks)
Maxillary hypoplasia (1 mark)
Mandibular prognathism (1 mark)
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
i) Floor of the maxillary sinus
ii) Posterior wall of the maxillary sinus
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
i) Right half
ii) Orthogonal projection
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?
OPT
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)
Bifurcation of the lower 7s
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)
Extract
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?
Spontaneous space closure
Render child caries free
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?
No molars for eating/spacing
Risk of GA
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)
Inhalation sedation
GA
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)
Anticoagulant
Vitamin K antagonist
Prevents clotting factors 2, 7, 9 10 and protein C and S
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)
INR
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)
SDCEP - ideally within 24 hours (1 mark)
NICE - within 72 hours if INR is stable (1 mark)
SDCEP: Below 4 (1 mark)
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)
Prolonged pressure with damp gauze
Sutures
LA with adrenaline
Haemostatic agent e.g surgical, equitamp
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?
Urgently refer to local OS/OMFS unit or A&E
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.
The Equality Act
The Disability Discrimination Act
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)
i) Uncontrolled muscle spasm
ii) Bite stick
Mouth prop device
List TWO medical aspects of Down’s Syndrome which may have resulted in his lack of capacity
Intellectual or learning disability
Dementia
If a patient has a forward growth rotation, describe a skeletal feature that you could expect to observe
Deep overbite and short face
Decreased FMPA and LAFH/TAFH.
If a patient has a backward growth rotation, describe a skeletal feature that you could expect to observe
Anterior open bite and long face
Increased FMPA and LAFH/TAFH
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
Periodontal abscess
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?
Periapical abscess
Tooth mobility which is progressively increasing and or tooth mobility with symptoms AND radiographic evidence of increased PDL width. What is the diagnosis
Occlusal trauma
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?
Localised periodontitis
Bleeding on Probing, inflammation of gingival tissues, false pockets due to oedema. No bone loss. Pregnancy related, puberty associated, leukaemia. What is the diagnosis
Acute/Chronic gingivitis
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
i) Foramen rotundum
ii) Pterygopalatine ganglion
iii) Nasopalatine branch
Zygomatic branch
Pharyngeal branch
What are the alcohol limits for male and female
14 units of alcohol limit
Male: 3-4 units/day 2 alcohol free days
Women: 2-3 units/day 2 alcohol free days
How would you provide health promotion for alcohol to a patient in your dental practice (3 marks)
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
Give an example of TWO policies associated with alcohol consumption in Scotland
Alcohol minimum pricing Scotland act: minimum price per unit of alcohol
Licensing Scotland act: increasing price per unit of alcohol
What is ONE example of a chairside interventions you can provide for a patient who consumes excess alcohol and briefly describe it
5As: Ask, Assess, Advise, Assist, Arrange
Name FOUR screening tools you can use to assess a patients alcohol consumption (4 marks)
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
Name THREE microorganisms responsible for oral candidiasis
Candida albicans
Candida glabrata
Candida tropicalis
What TWO microorganisms are resistant to fluconazole
Candida krusei
Candida glabrata
What THREE maxillary features should be covered in an upper impression (3 marks)
Maxillary tuberosity
Hamular notch
Vibrating line
What are TWO examples of primary impression materials for an edentulous patient
Impression compound
Alginate
List FOUR maxillary features that should be covered in a complete upper impression
Maxillary tuberosity
Hamular notches
Vibrating line
Functional width and depth of the sulcus
List FOUR mandibular features that should be covered in a complete lower impression
Retromolar pads
Buccal shelf
Lingual pouch
Functional width and depth of the sulcus
What are THREE features that indicate that a Parkinson’s patient is in pain
Holding face or mouth
Changes in diet/behavior
Changes to sleep
What are FOUR dental implications of a patient with Parkinson’s
Difficulty tooth brushing
Swallowing may be difficult
Abnormal posture makes examination hard
Anticholinergic drugs may cause dry mouth
What are FOUR types of cerebral palsy
Spastic
Dyskinetic
Ataxic
Mixed
What are FOUR side effects of chlorhexidine
Staining
Decreased GI absorption
Taste disturbances
Anaphylaxis
A patient presents to your practice with an anterior crossbite
Using ARAB how would you correct this?
How often would you activate this appliance?
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
A patient presents to your practice with a posterior crossbite
Using ARAB how would you correct this?
How often would you activate this appliance?
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
What is the treatment for an enamel dentine pulp fracture
i) <24 hours
ii) >24 hours
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.
What are FOUR symptoms of trauma
Pain
Swelling
Bruising
Bleeding
What are FOUR key peices of information that should be recorded in a waste transfer note and how long should it be kept for
Quantity
Date of closure
Destination
Origin of waste
Kept for 2 years
What regulation is there for the management of special waste
Special waste regulations 2004
What are FOUR examples of inherited bleeding disorders and what is there deficiency
Haemophilia A: 8
Haemophilia B: 9
Haemophilia C: 11
Von Willebrand’s disease: Von Willebrand’s factor
What is the normal bleeding time for a healthy individual?
3-4 minutes
Define niche
Role of an organism in ecological environment
Name TWO key factors in the biofilms ability to adhere
Adhesins
Fimbrae
What are FOUR types of sutures and provibe an example of each
Non resorbable monofilament: prolene
Non resorbable multifilament: mersilk
Resorbable monofilament: monocryl
Resorbable multifilament: vicryl
What are THREE types of flap designs
2 (envelope) sided flap
3 sided flap
semilunar flap
Why do you not use an air driven handpiece for surgical bone removal?
Surgical emphysema risk
List THREE differences between parallel and tapered posts
Parallel has greater retention
Parallel less likely to cause root facture
Parallel is less conservative
What should the length and width of a post be
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
What are the FIVE forces which can displace an upper removable appliance
Gravity
Mastication
Tongue
Speaking
Active components
What is the formula for force in wire of an ortho appliance?
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
What would you check during the adjustment visits of a patient wearing an URA (3 marks)
Check wear
Reactivate appliance
Monitor OJ and OB
How long will orthodontic treatment take if patients compliance is excellent
6-9months
What are FOUR indications for taking an OPT (4 marks)
Mandibular fractures
Assessment before surgery e.g third molar extraction
Assessing generalized disease e.g. staging and grading periodontitis
Inability to tolerate intraoral films
What are FOUR risk factors for a stroke
Hypertension
Smoking
Alcohol
Age
List THREE ways to prevent a stroke
Reduce risk factors
Antiplatelets: aspirin
Anticoagulant if embolic risk
What are FOUR dental implication for a stroke patient
Impaired mobility and dexterity
Bleeding risk
Xerostomia
Facial nerve issues
Name FOUR psychiatric disorders
Schizophrenia
Bipolar
OCD
Eating disorder (bulimia or anorexia)
List FOUR medications a patient with a psychiatric disorder can be on
SSRI
Tricyclic antidepressants
Benzodiazepines
Anti psychotics
List FOUR difficulties of treating a patient with a psychiatric disorder
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
What are FIVE legislations in the UK for disabled people
MHA: Mental health act
MCA: Mental capacity act
DDA: Disability discrimination act
EA: Equality act
AWI: Adults with incapacity act
Define the null hypothesis
No relationship between two measured phenomena
Define odds ratio
(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)
Define a P value
The probability of attaining a test statistic as extreme as the one actually observe.
If its less than <0.05 data is significant
Define confidence interval
How confident/precise you can be with your estimate. The larger the sample the narrower the CI (narrower CI is better)
What are THREE symptoms of fluoride toxicity
Nausea
Vomiting
Diarrheoa
What are THREE physical signs of cystic fibrosis
Barrel chested
Smaller than average
Finger clubbing
What are THREE symptoms of cystic fibrosis
Coughing
SOB
Wheeze
List THREE medications often used by patients with cystic fibrosis
Beta 2 agonist (salbutamol)
Anticholinergics
Pancreatic enzymes
What are THREE dental implications of a patient with cystic fibrosis
Delayed dental development
Increased calculus and staining
No GA
Increased bleeding
List the nerve supplies of the following muscles
i) Masseter
ii) Temporalis
iii) Lateral pterygoid
iv) Medial pterygoid
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
List the functions of the following muscles
i) Masseter
ii) Temporalis
iii) Lateral pterygoid
iv) Medial pterygoid
i) Elevates
ii) Elevates and retracts
iii) Protrusion and lateral movement
iv) Elevates and assists with lateral movement
You suspect a necrotizing periodontal disease on a patient. What further investigations would you carry out?
Blood test: check for HIV and nutritional deficiencies
What is the origin and insertion of the temporalis muscle
Origin: Temporal fossa and temporal fascia
Insertion: coronoid process of the mandible
What is the origin and insertion of the masseter muscle
Origin: maxillary process of zygomatic bone and zygomatic arch
Insertion: ramus and angle of mandible
What is the origin and insertion of the medial pterygoid muscle
Origin: medial surface of lateral pterygoid plate (deep part), maxillary tuberosity (superficial head)
Insertion: medial aspect of the ramus and angle of the mandible
What is the origin and insertion of the lateral pterygoid muscle
Origin: Greater wing of sphenoid bone (upper head). Lateral surface of lateral pterygoid plate (lower head)
Insertion: Pterygoid fovea
What foramen does the mandibular nerve pass through
Foramen ovale
What are TWO examples of local antimicrobials used to treat periodontitis
Chlorhexidine
Antibiotics
What are THREE examples of host modulation therapies used to treat periodontitis
Corticosteroids
NSAIDs
Bisphosphonates
What are TWO examples of alternative therapies used to treat periodontitis
Periostat: doxycycline
Periowave: photodisinfection
For chairside intervention of an alcoholic patient what are the 5 A’s
Ask
Advise
Assess
Assist
Arrange
What are THREE advantages of composite over amalgam
Aesthetics
Chemically bonded to tooth structure
Conservative (doesn’t require excess removal)
What are TWO disadvantages of composite over amalgam
Technique sensitive: requires excellent moisture control
More expensive with inferior mechanical properties
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)
Subgingival plaque biofilm
Paper point from gingival crevice on site of inflammation
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)
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
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?
Denture associated biofilm
Oral rinse or swab from localised area, foam pad for imprint
- 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?
i) C. albicans, C. glabrata
ii) Differentiating is important as C. glabrata is resistant to azoles
iii) Aspiration pneumonia
Possible links to cardiovascular disease
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
- Gingivitis
- Localised Periodontitis
- Generalised Periodontitis
- Dentine Hypersensitivity
- Lesion of endodontic origin with periodontal involvement
- Lesion of periodontal origin with endodontic involvement
- Occlusal trauma
- Periapical periodontitis
- Periodontal abscess
- Reversible pulpitis
- True combined periodontal-endodontic lesion
- Generalised Periodontitis
What is a biofilm?
Matrix enclosed bacterial or fungal populations adherent to each other and surfaces
What are THREE modes of transmission of an infection
Ingestion (waterborne)
Inhalation (airborne)
Inoculation (bloodborne)
How long should patient notes be kept for
11 years
What is the temperature, pressure and time required for a steriliser
134-137C
2.1bar
3 minutes minimum
What types of hand hygiene are used in dental practice
Routine hand hygiene: use of water and soap
Antiseptic hand hygiene: use of ABHR
What are Koch’s postulates?
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
What is a disability?
A restriction of ability resulting from an impairment to perform an activity that is considered normal for a human being
What is an impairment?
Any loss or abnormality of psychological, physiological or anatomical structure or function
What is a handicap?
A disadvantage resulting from an impairment or disability, that prevents the fulfilment of a role that is normal for that individual
What are the 7 elements of caries risk
- Clinic
- F- use
- MH
- SH
- Plaque control
- Dietary habits
- Saliva
What is the difference between IRR17 and IR(ME)R17
IRR17: designed to protect staff and general public
IR(ME)R17: designed to protect patients
Explain the effect that a prolonged digit sucking habit can have on the posterior dentition (2 marks)
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.
Give FOUR potential barriers to receiving adequate, ongoing dental care that exist for a patient who has schizophrenia. (4 marks)
Difficulty obtaining consent
Irregular attendance due to lack of awareness
Difficulty with communication
Behavior issues: aggressive and agitated
You are treating a visually impaired patient. Give THREE examples of modifications within your dental practice which will be of assistance to them.
Large font or braille signs
Ensure adequate lighting
Use verbal cues and audio instructions
Give THREE examples of modifications within your practice environment which may be made to accommodate a patient in a wheelchair.
Ramps and lifts
Wide doorways and corridors
Disabled bathrooms
You are treating a hearing-impaired patient. Give THREE examples of modifications within your dental practice which will be of assistance to them.
Use visual cues and large/clear signs
Avoid unnecessary noise e.g. music, radio
Use communication boards and eye tracking technology
Name TWO different acquired causes of visual impairment
Glaucoma
Cataracts
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
Hand over hand technique
Place your hand over the patients hand and gently brush their teeth and gums together.
List TWO priorities for oral health management when undertaking treatment planning for a person in the early stages of dementia?
Treatment of any pain and infection before middle/late stage dementia
Enhanced prevention
List TWO risks associated with older people and a general anaesthetic
Death
Increased risk of cardiovascular complication
What processes would you wish to implement in the practice after you had agreed the SOP and provided training on hand hygiene (2 marks)
Audits to ensure SOP are being followed
Regular refresher training on hand hygiene
What is the mode of action of azoles (2 marks)
Inhibits the synthesis of ergosterol by inhibiting the cytochrome P450 dependent enzyme lanosterol 14-alpha-demethylase
What are TWO roles of epidemiology
Study of the causes and determinants of disease
Development of preventive programs
Define dentally fit
Being free from active dental disease and oral infections
What are TWO advantages for prefabricated crowns
Cheaper
No need for lab involvement: can construct in one visit
How would you differentiate between Candida glabrata and candida albicans
Chromogenic agar indentification method:
Glabrata: pink
Albicans: blue/green
What are FOUR principles of aim of orthodontic treatment
Restore stability
Restore function
Improve aesthetics
Facilitate other forms of dentistry
What type of study would provide the highest level of evidence for the effectiveness of treatment?
Meta analysis and systematic review of randomised controlled trials
How will the actual extent of caries present clinically in comparison to radiograph
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
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
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
What are FOUR tooth factors that can cause tooth mobility
1) Height of PDL
2) Width of PDL
3) Inflammation
4) Number, size and shape of roots
What is the antibiotic regimen for periodontal abscess and periapical abscess
Amoxicillin 500mg 3x a day for 5 days
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)
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
State one pre-extraction blood test that would allow you to test their bleeding/clotting status.
Any of the following:
FBC
Platelet count
INR
APPT
PT
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
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
- What variations of preformed provisional crowns could be available to you for this case? “provisional crown”
Polycarbonate (Directa)
Clear-plastic crown forms filled with composite
Preformed malleable composite crowns
- What are the disadvantages of preformed provisional crowns in comparison to custom provisional crowns?
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
- Which type of study would provide the highest level of evidence for the effectiveness of this treatment?
Systematic Review (and meta-analysis) of RCTs (2 marks)
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
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)
How would you test for Candida albicans and suggest lab identification method (2 marks)
Germ tube formation test
Chromogenic agar identification method. Candida will be blue-green
What are FOUR things you should ask patients about smoking (4 marks)
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?
List TWO reasons why patients with down syndrome have an increased risk of periodontal disease (2 marks)
Immune system dysfunction
Difficulties with OH
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)
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)
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)
How did child sustain injuries (1 mark)
Why was the child not brought to the surgery earlier (1 mark)
