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BDS III CPA PAST PAPERS SORTED BY TOPIC (2005 – 2019) > PERIODONTOLOGY ODTP > Flashcards

PERIODONTOLOGY ODTP Flashcards

1
Q

Patient has throbbing pain. PA of Q3 given.

a. 4 Pathological findings from the x-ray

A

Don’t even understand this drawing

 External Root Resorption

 Horizontal bone loss
 Vertical bone loss

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2
Q

Patient has throbbing pain. PA of Q3 given.

b. Diagnosis of 36

A
  • Irreversible Pulpitis with furcation involvement
    • Why?
      • Seems like patient is having throbbing pain so irreversible pulpitis.
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3
Q

Patient has throbbing pain. PA of Q3 given.

c. Factors to consider when determining the prognosis of 36

A

 Anatomical anomalies that may prove different for periodontal treatment to treat

 Furcational involvement of the tooth
 Any presence of calculus
 Bone loss level

 Any systemic diseases like diabetes and osteoporosis

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4
Q

Patient has throbbing pain. PA of Q3 given.

d. Two Tx options for Quadrant 3 i. Tx1:
ii. Tx2:
e. Risk of Tx

A

No answers given

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5
Q

a. What is your most likely periodontal diagnosis? (1)

A

 Aggressive periodontitis

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6
Q

b. From the radiograph, what problem is affecting tooth 35?

How would this problem affect the treatment of periodontal disease using scaling and root surface debridement? (4)

A
  • Problem of tooth 35
    • Bone level loss till apex of the tooth and grade 4 furcation
    • Presence of enamel pearls or cervical enamel projections
  • How does this affect treatment outcome?
    • This is a periodontal risk which may affect the prognosis of the tooth
    • The enamel pearls or cervical enamel projections may affect the treatment outcome because it may proof difficult to remove plaque from there.
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7
Q

a. List 4 periodontal findings (4)

A

 Gingival Swelling and Redness
 Generalized Horizontal Bone Loss
 Deep periodontal pockets in sextant 6 and 8

 Mobility
 Generalized Recession
 Furcation Involvement

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8
Q

b. What is your diagnosis (1)

A

 Generalized Aggressive Periodontitis Stage 3 or 4 Grade C

 Stage 3 or 4 because of the bone level
 Grade C because familial aspects and bone level to age ratio.

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9
Q

c. Suggest the plan of management/therapy (3)

A
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10
Q

d. What are the possible positive treatment outcome in response to your therapy plan (3)

A
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11
Q

a. List out the local modifiable risk factors based on the information given

A
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12
Q

b. Base on the x-ray explain why the prognosis of 17 is poor

A

 Vertical bone loss, severe horizontal bone loss, incomplete separation of root difficult for RSD, convergent root less retention -> higher mobility

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13
Q

c. You have performed scaling and root debridement for the px and he came back one month later as shown in the lower photograph. You would like the dental hygienist to perform some tasks. Write a prescription for the hygienist (7)

A

Dear (Name of Dental Hygienist),

The patient, (Name), MH: smoker, alcoholic, DM, hypertension, down syndrome, cancer, low IQ syndrome
Would perform OHI: ID brush, tooth brush, dietary analysis
Supragingival scaling on xxx

Discharge the patient after finish perio treatment, thank you

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14
Q

a. List four abnormality found in OPG
b. A nonvital upper incisor with an isolated 10 mm pocket on the palatal side, no caries and no recent trauma, 3 possible causes

A

 Palato-Radicular Groove

 Perio-Endo Lesion

 Vertical Root Fracture

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15
Q

a. 4 modifiable risk factors for periodontitis (4m)

A

Modifiable risk factors
 Smoking, DM, oral hygiene, plaque retentive factors

Non-modifiable risk factors
 Genetic risk, immune compromised, tooth anatomy

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16
Q

b. Describe Xray findings

A

NA

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17
Q

a. Describe the clinical photo (4)

A

 Swollen and red gingiva
 Generalized gingival reccession

 Increased ID space
 Poor OH with plaque and calculus

 Anterior crossbite

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18
Q

b. Describe the periodontal condition from the radiographs. (6)

A

 Generalized horizontal bone loss up to one-third of teeth

 Localized angular bone loss

 Multiple teeth with vertical bone loss up to apex

 Furcation involvement for most of the molars

 PA: bone loss up to apex of buccal roots → Severe generalized periodontitis (not the real dx? because it’s aggressive) (this q is just asking to describe the condition, no need the dx xd)

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19
Q

c. What is the general approach for non-surgical periodontal therapy? (4)

A

 OHI

 Supragingival scaling → review gingival response for 2weeks → RSD → evaluate periodontal conditions after 6-8 weeks with OHI reinforcement and evaluation in between → if satisfactory, continue review regularly; if unsatisfactory, re-do RSD or reinforce OHI or consider surgical therapy

 for gingivitis, it is to remove the causative agent → OHI + supragingival scaling

 for periodontitis, it is to arrest progression of disease and regenerate damaged structure → systemic phase, preventive phase - OHI + RSD

20
Q

d. What is the likely diagnosis? And would you modify the treatment plan and how?(4)

A

 Aggressive Periodontitis
 Do Scaling and RSD asap within 2 days (Dr Lai’s ppt - within 7 to 14 days)
 Adjunctive antibiotic therapy: amoxicillin 500mg + metronidazole 200mg, TID, 3/7

21
Q

e. You have to let your patient sign some consent form related to the risks/sequelae/consequences of non-surgical periodontal therapy. What are the 3 main points to be highlighted? (3)

A

 Increased recession (esthetics problems)
 Dentinal hypersensitivity
 Transient increased mobility of teeth
 Tenderness of soft tissue due to trauma from instrumentation

22
Q

f. What are the diagnosis and prognosis of 16 and 17? What would you do to relieve the acute symptoms of the teeth? (2)

A

 Severe periodontitis, perio endo lesion (should be primary periodontal, secondary endodontic lesion causing pulpitis)

 Prognosis is poor. Bone is unlikely to regenerate. (prognosis is poor because of severe bone loss to apex of buccal roots, patient’s family history, and mobility of the teeth)

 Xn/emergency RCT or extirpate pulp/analgesics

23
Q

g. What is the mechanism of tooth drifting for this px?(2)

A

 Reduced periodontal support due to reduced height of alveolar bone, weakened transseptal fibers and swollen ginigva.

 Bone remodelling

24
Q

a. Describe the clinical photo(3 marks)

A

 Recession?
 Dark triangles?
 Gingival condition: Swollen? Inflamed? Redness?  Presence of Plaque and Calculus?
 Bite?

25
Q

b. What is the likely diagnosis and prognosis of 47? Please give your justification and what treatment will you suggest?(5 marks)

A
  • Poor prognosis because bone level till apex and furcation involvement
  • Treatment
    • Periodontal surgery
    • Bone grafting
    • Or Root resection
26
Q

c. What is the likely diagnosis and prognosis of 17? Please give your justification and what treatment will you suggest? (5 marks)

A

Can’t answer

27
Q

d. What is the V-shaped radiolucency shown in the panoramic radiograph?

A

 Furcation?

28
Q

e. What is the structure marked in the periapical radiograph of 17?

A

Can’t answer

29
Q

f. State the initial periodontal treatment (3 marks)

A

 OHI

 Supragingival scaling → review gingival response for 2weeks → RSD → evaluate periodontal

conditions after 6-8 weeks with OHI reinforcement and evaluation in between → if satisfactory,

continue review regularly; if unsatisfactory, re-do RSD or reinforce OHI or consider surgical therapy

 for gingivitis, it is to remove the causative agent → OHI + supragingival scaling

 for periodontitis, it is to arrest progression of disease and regenerate damaged structure → systemic phase, preventive phase - OHI + RSD

30
Q

g. From the photos and radiographs, what is the condition of the periodontal health

A

 Poor?

31
Q
  1. C/O: Spontaneous intense pain on upper left back teeth; gum swelling and bleeding on

brushing for years. Given: PAN. (Summative, 2005)

a. Write down five clinical findings.
b. What is the likely diagnosis for the patient’s complaint?

A

 Generalized chronic periodontitis / gingivitis
 Irreversible pulpitis (assume not apical periodontitis due to insufficient info)

32
Q
  1. C/O: Spontaneous intense pain on upper left back teeth; gum swelling and bleeding on

brushing for years. Given: PAN. (Summative, 2005)

c. What is the mechanism of development of the above problem?

A
  • Dull pain in irreversible pulpitis
    • Untreated caries / recurrent caries in 46 invade into pulp through dentinal tubules
    • Bacterial toxin stimulate pulpal inflammation
    • Presence of inflammatory mediators lower pain threshold, allowing endotoxin stimulate the C fiber (located more center in pulp) to initiate dull pain sensation
  • Acute apical periodontitis
    • Continuous bacterial irritants together with inflammatory mediators cause the pulp severely inflamed and fail to heal and eventually become non vital
    • Inflammation cease and infection no longer be confined and spread apically eventually
    • Toxin and irritants from necrotic pulp cause periradicular tissue inflammation
    • Bone destruction occur due to osteoclastic activity initiated by bacterial toxin and host mediators
  • Bleeding in chronic periodontitis / gingivitis
    • Bacterial lipopolysaccharide from dental plaque activate a series of pro inflammatory cytokines and inflammatory mediators from macrophag e , PMN and fibroblasts that mediate periodontal inflammation and subsequent tissue destruction
    • Migration and infiltration of PMNs and macrophages to the sulcus
    • Cytokines induce vasodilation and increase permeability of vessel to allow further migration of inflammatory cells→swelling
    • Enzymes like MMP, collagenase secreted by both host and bacteria cause epithelial and connective tissue breakdown
    • Highly inflamed status easily cause bleeding by external stimulation like brushing
33
Q
  1. C/O: Spontaneous intense pain on upper left back teeth; gum swelling and bleeding on

brushing for years. Given: PAN.

d. What disease could have caused the gum swelling and bleeding? What are three risk factors for the disease?

A

 Gingivitis and periodontitis
 Systemic: DM / medication causing gingival enlargement / immunocompromised / hormonal change

 Behavioral: smoking / poor OH habit / stress
 Genetic: IL 1 polymorphism
 Local: iatrogenic treatment, overhang restoration, denture, furcation

34
Q
  1. C/O: Spontaneous intense pain on upper left back teeth; gum swelling and bleeding on

brushing for years. Given: PAN.

e. Briefly outline the treatment plan for this patient.

A

 Emergency: RCT of 27

 Hygienic: OHI

 Scaling

 Review

 Crown 27

35
Q

a. What are the findings in the information provided that you need to take into account for making your diagnosis?
b. What is the prognosis of 36? What treatment options may you provide? (5)

A
  • Clinical factors
    • Deepest probing depth / extent and distribution of attachment loss / furcation involvement / mobility
  • Radiographic factors
    • Root length / shape / furcation morphology / remaining bone support
  • Other factors
    • Restorative & endodontic status / functional value (as abutment) / position in the arch
  • OHI, scaling, root debridement
  • Odontoplasty, open debridement, surface demineralization, root resection (amputation, hemisection), GTR, bone graft, tunnel preparation
  • Extraction with or without prosthetic replacement
36
Q

Information Given:

72 year-old female
C/O: Pain of upper left molar region. Pain on biting.
HPC: Swollen gum 2 months ago. Spontaneous pain. Visited dentist and subsized 1 month after. DH: The dentist she visited performed “a cut” to relieve her symptoms.
MH: unremakable
I/O: Pain of percussion //Peri showing 25 – 28

a. You are going to perform periodontal therapy for the patient. Before that, you would like to send her to the auxillary staff to prepare the patient for your treatment. What will you write on the prescription? (5)

A
  • Would dental hygienist please kindly provide following preventive treatment to this patient:
    • OHI for brushing and interdental cleaning
    • Diet analysis
    • Fluoride varnish
    • Supragingival gross scaling
37
Q
  1. Periodontology (Formative, 2014)
    a. Describe what you can see in the photo provided. (5)
A

 Multiple missing teeth / Calculus in lower anterior region / Plaque accumulation / Tooth drifting / Abrasion

38
Q
  1. Periodontology (Formative, 2014)
    b. Treatment plan for this patient and justifications
A

 Systemic phase > emergency phase > preventive phase > corrective phase > re-evaluation phase > maintenance phase

39
Q

a. What is BPE? (1)

A

 BPE is a simple and rapid screening tool that is used to indicate the level of examination needed and to provide basic guidance on treatment needed

 Neither monitoring periodontal process nor linking to diagnosis

40
Q

b. What does the code “4*” mean? (2)

A

4 = Color band of WHO probe completely inserted into the pocket, i.e. pocket > 5.5 mm

* = Furcation involvement, (or pocket plus recession greater than 7 mm)

41
Q

c. What is your diagnosis? What is the diagnostic criteria for the condition? (5)

A
42
Q

d. What further information do you need to assess the condition of the teeth? (2)

A

 Mobility, vitality, alveolar bone loss

43
Q

e. What is informed consent? What should be included in the informed consent in this case? (5)

A
44
Q

f. How to conduct the debridement in order to maximize the adjunctive effect of anti- microbial medicament? (1)

A

 Finish root debridement as fast as possible (e.g. within 2 weeks) and immediately prescribe antibiotics just after the last debridement

45
Q

g. Write the prescription for analgesic and antimicrobial medication for this case (6)

A

 Antimicrobial: amoxicillin 500 mg and metronidazole 200 mg, both TID and 7 days

 Analgesic: ibuprofen 200 - 400 mg TID 7 days ?, paracetamol 500 - 1000 mg QID prn

BDS III CPA PAST PAPERS SORTED BY TOPIC (2005 – 2019) (62 decks)

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