Other

Question 1

“Briefly outline the treatment plan for this patient.”

Answer 1

(note that this comes up in every exam – you may go to the past paper by year to test your tx planning skills)

Question 2

“What is the differential diagnosis? (pulpal or periapical)”-

Answer 2

see appendix

Question 3

Name the authority in Hong Kong that give the title ‘Specialist to orthodontics’ to dentist

Answer 3

The Dental Council of Hong Kong

Question 4

Name 2 centers of endochondral ossification (2)

Answer 4

Long bone of limbs; Bones of cranial base

Question 5

What are the common causes of xerostomia? [5]

Answer 5

Medications (depression, hypertension), diabetes, aging, smoking, cancer therapy, recreational drug use

Question 6

What oral diseases are associated with xerostomia? [5]

Answer 6

Fissuring and inflammation of the lips(cheilitis); Oral candidiasis; Caries; Oral ulcers; Sialadenitis (FOCOS)

Question 7

Signs of bruxism (2.5marks)

Answer 7

• Tooth wear – flattened appearance of teeth
• Masticatory muscle hypertrophy
• Increased tooth pain and sensitivity in the morning
• Headaches
• Facial pain

Question 8

Name 4 materials for cold test. (4)

Answer 8

EPT, ethyl chloride, ice, tetrafluoroethane, propane/butane/isobutane gas mixture

Question 9

Give 2 reasons for false positive value in pulp test. (2)

Answer 9

False-positive (a nonvital tooth appears to respond positively to testing)

1. Multi-rooted teeth (partially necrotic pulp)
2. Moist gangrenous(decaying) pulp in root canal
3. Proximal metallic restoration
4. Anxious patient
5. Improper isolation of tooth

Question 10

Give 2 reasons for false negative value in pulp test. (2)

Not a question on document but answers are included on the doc

Answer 10

False-negative (a vital tooth has NOT responded positively to testing)

1. Recently erupted tooth with immature root
2. Presence of pulp stone
3. Extensive caries
4. Patients heavily medicated with analgesics
5. Recently traumatized tooth (nerve rupture, but still vascular)
6. Large insulating restoration
7. Nerve supply damaged, blood supply intact
8. Secondary dentine

Question 11

2 biopsy techniques for soft tissue lesion (2)

Answer 11

Incisional biopsy; excisional biopsy

Question 12

The scope of work that can be done by a dental hygienist according to regulations of HKDC (5)

Answer 12

• Cleaning and polishing of teeth
• Scaling of teeth (i.e. the removal of tartar deposits, accretions and stains from those parts of the surface of the teeth which are exposed or which are directly beneath the free margins of the gums, including the application of medicaments thereto);
• The application to the teeth of solutions of sodium or stannous fluoride or such other similar prophylactic solutions as the [Dental] Council may from time to time determine;
• the exposure of x-ray films inter-orally or extra-orally for the investigation of lesions or suspected lesions of the mouth, jaws, teeth and associated structures; and
• the giving of advice on matters relating to dental hygiene.

Question 13

Conditions under which a hygienist can work (5)

Answer 13

(a) he is enrolled in accordance with regulation 4 of the Regulations;
(b) he is employed by a registered dentist or by any organization or establishment that has employed at least one registered dentist;
(c) any patient upon whom he undertakes dental work has first been examined by a registered dentist who has then prescribed the treatment to be carried out by the dental hygienist;
(d) such dental work is carried out –
(i) in accordance with the directions of a registered dentist who is available in the premises at all times when such dental work is being carried out; and
(ii) in such premises and under such conditions as are suitable for such work.

Question 14

Which dental prescribed drug has contraindication with oral contraceptive pills and anti-coagulate (2marks)

Answer 14

Ibuprofen (NSAIDs)

Question 15

Name the test(s) for identify the vitality and the status of a pulp. What other test can be used for diagnostic of assessing teeth (5m)

Answer 15

EPT, cold test with ethyl chloride, cold test with ice, heat test with hot water, heat test with gutta percha point

Question 16

What is the DMFT of this patient?

Anson: not sure what this means. as no case is given (page 124)

Answer 16

• DMFT 2011

2. 5 (age 5), 0.4 (age 12), 6.9 (age 35 -44), 16.2 (NOP), 25.9 (IOP)

Question 17

State the equation for Glycolysis

Answer 17

Glucose + 2 ADP + 2Pi + 2NAD+ –>
2 pyruvate + 2 ATP + 2NADH + 2H+ +2H2O
pg123

Question 18

16 over-erupted –why?

Answer 18

• Absence of opposing tooth / force

- Natural eruptive potential of tooth allow continuous eruption out of occlusion

Question 19

What topical fluoride regime for this patient?

Anson: not sure what this means. as no case is given (page 124)

Answer 19

-Fluoride varnish (22600 ppm 5% NaF) ?

Question 20

What is SDCS? What scope of service does It provide? (3)

Answer 20

School Dental Care Service
Scope of service:
• Oral health education
• Oral examination
• Preventive dental treatment
• Basic restorative dental treatment (maybe dentist, if complicated)
• Mergency surface during designated office hours

Question 21

Would SDCS offer treatment for this patient? Where can she get information about orthodontists in HK?

Answer 21

• No. Lists of registered dentists and specialists can be obtained from website of The Dental Council of Hong Kong

Question 22

What is alcohol? List three health problems associated with heavy alcohol consumptions. (5)

Answer 22

• Any of a class of organic compound containing the hydroxyl (-OH) functional group except those in which the OH group is attached to an aromatic ring
• Ethanol is primary alcohol formed by microbial fermentation of carbohydrates
• Liver cirrhosis / cancer of mouth, throat, liver / alcoholic cardiomyopathy / gastritis / brain damage (impaired memory, ataxia, irritability, depression, psychological problems)

Question 23

Where could the patient go in case of dental emergency?

Answer 23

• Dental Clinics with General Public Sessions (under Department of Health)
• Hospital Dental Service
• Or 24-hour opening private clinics

Question 24

Why lymph node would swell?

Answer 24

• Lymph nodes drain for a specified area
• When infection, microorganism is drained to the corresponding lymph node through tissue fluid
• Fluid containing foreign bodies pass through lymph node will stimulate the initiation of immune response including proliferation of defense cells (WBC, marcophages)
• May swell because of the presence of mast cells

Question 25

What is the function and pharmacological action of aspirin? (1m)

Answer 25

Inactivates COX-1 by irreversibly acetylating serine 530 on the COX-1 enzyme and a comparable serine on COX-2 → inhibits PG production during inflammation (Note on PGs: PGs are not stored, but are synthesized immediately before release) → Treat pain, fever or inflammation
COX inhibitor → inhibits TXA2 → reduce platelet aggregation → prevent thrombus formation (good to reduce risk of death after heart attack)

Question 26

What the use of bisphosphonate? Negative effects?

Answer 26

Treat osteoporosis. May cause gastroesophageal irritation. Rare: Osteonecrosis of the jaw

Question 27

A young female patient arrives at your clinic complaining of tooth sensitivity when eating cold food and drinks.
a. Suggest 3 common causes that may cause the patient’s condition. (3)

Answer 27

Bruxism, drinking soda, vomiting

Question 28

A young female patient arrives at your clinic complaining of tooth sensitivity when eating cold food and drinks.
b. What 3 other common complaint are often made by patients with the same condition? (3)

Answer 28

Pain on biting, pain when there’s wind blowing, poor aesthetics (??)

Question 29

A young female patient arrives at your clinic complaining of tooth sensitivity when eating cold food and drinks.
c. Give 4 reasons for tooth surface loss aside from caries and trauma. Explain the mechanisms behind each reason. (8)

Answer 29

• Drinking soda/sour liquids – acid erodes away enamel, leading to tooth surface loss.
• Chemotherapy drugs – can cause vomiting, which erodes away enamel
• Morning sickness – vomiting
• Abrasion – brushing teeth
• Swimmer’s erosion – pool has low pH
• Bulimia – vomiting
• GERD – gastric juice
• Lack of posterior contact, so bite with anterior teeth

Question 30

A young female patient arrives at your clinic complaining of tooth sensitivity when eating cold food and drinks.
d. What 4 factors are important when considering the need for treatment for this condition? (4)

Answer 30

Space in intercuspal position – if a lot of space, then might consider crowns
Extent of the pain
Aesthetics
Diet of patient

Question 31

A young female patient arrives at your clinic complaining of tooth sensitivity when eating cold food and drinks.
e. Write down your management strategies for this patient (7)

Answer 31

1. Inform the patient of the problem and its causes, and provide appropriate literature
2. Ascertain underlying diseases or medications associated with the presence of intrinsic acids. It may be necessary to consult with the patient’s doctor
3. Monitor progression with tooth wear indices, photos, study models, silicone impressions and splints4
4. Provide personalised dietary counselling, or refer patient to a dietitian where applicable. After completing a diet diary and personalised consultation, you may recommend:a
   o Reducing the frequency and consumption of acidic foods and drinks where appropriate
   o Sugar-free alternatives where applicable
   o Avoid frothing and swishing especially with carbonated beverages
   o Chew sugar-free gum for 20 minutes after the consumption of acidic foods, explaining the benefits outlined above
   o Do not brush for at least an hour after the consumption of acidic foods
   o Avoid occupational exposure with mouth guards, splints or neutralising agents
   o Use a high fluoride, low abrasive toothpaste, and a soft-medium bristled brush
5. Apply fluoride varnish to susceptible surfaces to provide a protective film and reduce direct contact between tooth surfaces and acid.
6. After erosion progression has halted, examine intercuspal space to see if any invasive treatment is needed:
   o A dahl appliance may be required if there is palatal erosion of the upper anterior teeth with no inter-occlusal space, as it will create an open bite and allow relative extrusion of the posterior teeth to later provide composite resin restorations
   o In generalised erosion evaluation of the freeway space may lead to restoration by way of conventional crown work.