Periodontology past papers Flashcards
Q1 (see picture on word) Describe two patterns of bone loss evident in this radiograph
- horizontal bone loss
- vertical (angular) bone loss
Q1 what explains the development of the bone loss on the mesial aspect of the lower right second molar (47)
infrabony defects exist when the bottom of the pocket is apical to the level of the adjacent alveolar bone. Vertical bony defects are primarily a feature of the width of the initial bone prior to the onset of periodontal inflammation due to plaque induced periodontitis. The adjacent teeth in the above picture are further apart with a wider interdental bony septum and so inflammation has not destroyed the entire interdental septum , giving the vertical bone loss appearance. Interproximal vertical defects appear in spaces wider than 2.5mm
Q1 how can inter-proximal bone defects be classified in general?
they are classified according to the number of walls involved. Goldman and cohen classification
- one wall defect
- two wall defect
- three wall defect
Q1 following hygiene phase therapy, this patient’s oral hygiene was excellent but pockets of >6mm persisted in the lower right quadrant. Open flap debridement was performed:
- what feature of this patient’s disease, observable on the radiograph, is most likely to limit the success of treatment and why
Furcation involvement of 47 -
Q1 following hygiene phase therapy, this patient’s oral hygiene was excellent but pockets of >6mm persisted in the lower right quadrant. Open flap debridement was performed:
- list the best possible clinical and radiographic outcomes for this type of treatment in terms of the healed situation (3 marks)
- bleeding on probing
Q1 following hygiene phase therapy, this patient’s oral hygiene was excellent but pockets of >6mm persisted in the lower right quadrant. Open flap debridement was performed:
Give two alternative options for the management of the lower right second molar (47) (2 marks)
- guided tissue regeneration
- resective treatment - a tunnel preparation to recontour bone and tooth allowing insertion of an interdental brush
- palliative care
Q2 (pocket chart on word) A 25 year old patient presents with pocketing and attachment loss in the upper arch as illustrated in picture. The patient is fit and well. She smokes 10 cigarettes per day. She describes her diet as healthy. Radiographs were taken by the previous dentist 8 weeks ago but you do not have access to them today.
- From the above information, what would be your diagnostic statement for this patient (3 marks)
Generalised periodontitis Stage 4 grade C periodontitis which is unstable and has risk factors of smoking (10 cigarettes per day)
Q2 (pocket chart on word) A 25 year old patient presents with pocketing and attachment loss in the upper arch as illustrated in picture. The patient is fit and well. She smokes 10 cigarettes per day. She describes her diet as healthy. Radiographs were taken by the previous dentist 8 weeks ago but you do not have access to them today.
From the information given, what tooth do you consider carries the poorest prognosis (1 mark) and state your reasons (3 marks)
Tooth 16
- loss of attachment of 12mm at worst site (mid palatal)
- grade 3 mobility
- grade 3 furcation involvement
Q2 (pocket chart on word) A 25 year old patient presents with pocketing and attachment loss in the upper arch as illustrated in picture. The patient is fit and well. She smokes 10 cigarettes per day. She describes her diet as healthy. Radiographs were taken by the previous dentist 8 weeks ago but you do not have access to them today.
- with regard to prognosis, why is the green line drawing section of the chart potentially misleading (1 mark)
- Teeth on this chart are standardised and therefore not patient specific. It shows 12mm loss of attachment to be in the apical 1/3rd of the tooth however the patients root morphology may be different/longer and therefore may not actually be in the apical 1/3rd of their tooth
Q2 (pocket chart on word) A 25 year old patient presents with pocketing and attachment loss in the upper arch as illustrated in picture. The patient is fit and well. She smokes 10 cigarettes per day. She describes her diet as healthy. Radiographs were taken by the previous dentist 8 weeks ago but you do not have access to them today.
- Name two further investigations you would wish to perform for this patient (1 mark)
-
Q2 (pocket chart on word) A 25 year old patient presents with pocketing and attachment loss in the upper arch as illustrated in picture. The patient is fit and well. She smokes 10 cigarettes per day. She describes her diet as healthy. Radiographs were taken by the previous dentist 8 weeks ago but you do not have access to them today.
- Give two further pieces of information about this patient that would help you to offer an opinion on the prognosis for the teeth (1 mark)
- ## family history of periodontal disease
Q3 give four reasons why non-surgical therapy may fail to eliminate bacteria from periodontal pockets (2 marks)
- inadequate patient plaque control either due to a lack of compliance or a lack of dexterity
- residual subgingival deposits due to inexperienced operator or not enough time spent performing RSD
- residual subgingival desposits due to deep pockets or furcation lesions making it difficult for the operator to reach with instrumentation
- systemic risk factors such as smoking or uncontrolled diabetes not being addressed
Q3
2. list three potential problems that limit the usefulness of oral antibiotics in the treatment of periodontitis (3 marks)
- targeting a biofilm and
- ## antibiotic resistance
Q3
3. You are seeing a patient with a lateral periodontal abscess in tooth 22, they have accompanying systemic symptoms. The patient is keen to keep the tooth, describe how you should manage it (5 marks)
Q4 (picture on word) Susan is a 29 year old patient who is a regular attender at your practice, she has previously undergone periodontal treatment. She attends your practice as an emergency pain appointment, complaining of pain in her upper front tooth. On examination you notice a swelling pertaining to the 11 as above, the tooth is TTP and there is associated lymphadenopathy
- Give two differential diagnoses for what this condition could be (2 marks)
- periapical abscess
- periodontal abscess
Q4 (picture on word) Susan is a 29 year old patient who is a regular attender at your practice, she has previously undergone periodontal treatment. She attends your practice as an emergency pain appointment, complaining of pain in her upper front tooth. On examination you notice a swelling pertaining to the 11 as above, the tooth is TTP and there is associated lymphadenopathy
- give two special investigations you would undertake to confirm your diagnosis (2 marks)
- periapical radiograph of 11
- sensibility testing of 11 (ethly chloride and/or electric pulp test)
Q4 (picture on word) Susan is a 29 year old patient who is a regular attender at your practice, she has previously undergone periodontal treatment. She attends your practice as an emergency pain appointment, complaining of pain in her upper front tooth. On examination you notice a swelling pertaining to the 11 as above, the tooth is TTP and there is associated lymphadenopathy
- state two ways that you could drain this swelling (1 mark)
- incision
- through the periodontal pocket
Q4 (picture on word) Susan is a 29 year old patient who is a regular attender at your practice, she has previously undergone periodontal treatment. She attends your practice as an emergency pain appointment, complaining of pain in her upper front tooth. On examination you notice a swelling pertaining to the 11 as above, the tooth is TTP and there is associated lymphadenopathy
- Give your initial management of this patients swelling if not endodontically involved (5 marks)
- drain abscess by either incision or through the periodontal pocket
- carry out PMPR subgingival instrumentation short of the base of the periodontal pocket using local anesthetic
- recommend optimal analgesia and use of 0.2% chlorhexidine mouthwash until acute symptoms subside
- review within ten days and carry out definitive PMPR also arranging an appropriate recall appointment
- Associated systemic involvement so prescribe phenoxymethylpenicillin tablets, 250mg send 40 tablets and take 2 tablets four times a day for 5 days
OR
metronidazole 200mg, send 15 tablets and take 1 tablet three times a day for 5 days
Q5 ANUG a 22 year old patient presents at your surgery complaining of pain. You can smell his halitosis from the waiting room.
- on examination it is clear that he has ANUG. Describe 4 intra-oral signs of ANUG (2 marks)
- necrosis of interdental papilla and gingival margin giving characteristic punched out appearance
- ulcerated areas covered by a yellow/greyish slime (slime made from fibrin, necrotic tissue, leukocytes, erythrocytes and bacteria mass)
- strong foetor ex ore
- bleeding readily provoked
- first lesions appearing interproximally in the mandibular anterior region
Q5 ANUG a 22 year old patient presents at your surgery complaining of pain. You can smell his halitosis from the waiting room.
- What 4 risk factors pre-dispose someone to ANUG (2 marks)
young adults with predisposing factors of
- stress
- sleep deprivation
- poor oral hygiene
- smoking
- immunosuppression
Q5 ANUG a 22 year old patient presents at your surgery complaining of pain. You can smell his halitosis from the waiting room.
- Outline your treatment for this patient (6 marks)
- ultrasonic debridement with local anaesthetic
- pain may prevent patient from brushing effectively - prescribe 0.2% chlorhexidine mouthwash to use twice a day
- patients with systemic involvement/impaired immunity/lack of response to mechanical therapy prescribe antibiotics:
- 200mg metronidazole send 9 tablets (1 tablet 3 times per day for three days) - Smoking cessation if patient smokes, vitamin supplementation if required and dietary advice
- After treatment of acute symptoms carry out HPT if required
- Suggest pain relief with paracetamol
Q5 What bacteria are involved in ANUG
bacteria in ANUP is also the bacteria which is constant within the oral cavity but in conditions of ANUP the bacteria can thrive and is present in greater numbers. Spirochetas and fusobacterias are isolated in ANUP. Constant flora - fusobacterium, prevotella intermedia
Q6 Mr Fothergill is a 65 year old obese reformed smoker with a history of ischemic heart disease who has successfully completed a course of cause related therapy. However, despite excellent oral hygiene, he still has some teeth with pockets of 6 and 7mm which bleed on probing. He is keen to pursue further treatment. You elect to undertake open flap curettage.
what information would you give to the patient so he can give informed consent? (5 marks)
Q6 Mr Fothergill is a 65 year old obese reformed smoker with a history of ischemic heart disease who has successfully completed a course of cause related therapy. However, despite excellent oral hygiene, he still has some teeth with pockets of 6 and 7mm which bleed on probing. He is keen to pursue further treatment. You elect to undertake open flap curettage.
Mr Fothergill consents to treatment and you give 2ml of 2% lidocaine hydrochloride with 1:80,000 epinephrine as buccal and palatal infiltrations. As you are placing the final sutures, Mr Fothergill complains of a central crushing pain across his chest and down his left arm
What is the most likely diagnosis (1) and what would your immediate management of this patient be (4 marks)
Myocardial infarction
Immediate management
- Assess patient (ABCDE)
- administer 100% oxygen at a flow rate of 15 litres/minute through a non re-breathing oxygen mask
- give 300mg aspirin orally, tablet should be chewed
- if patient becomes unresponsive, re-assess and perform basic life support if necessary
- call for ambulance)
Q6 Mr Fothergill is a 65 year old obese reformed smoker with a history of ischemic heart disease who has successfully completed a course of cause related therapy. However, despite excellent oral hygiene, he still has some teeth with pockets of 6 and 7mm which bleed on probing. He is keen to pursue further treatment. You elect to undertake open flap curettage.
You successfully manage Mr Fothergills medical emergency. In what forms would you deliver the post-surgical advice (1 mark) and what do you want the patient to know to minimise the incidence of any post-operative complications (5 marks)
- deliver post op advice both verbally and written
- reinforce importance of mechanical plaque control (OHI)
- use a soft toothbrush around the operated area
- use chlorhexidine 0.2% mouthwash twice per day for 1-2 weeks
- ## use analgesics for pain relief
Q6 Mr Fothergill is a 65 year old obese reformed smoker with a history of ischemic heart disease who has successfully completed a course of cause related therapy. However, despite excellent oral hygiene, he still has some teeth with pockets of 6 and 7mm which bleed on probing. He is keen to pursue further treatment. You elect to undertake open flap curettage.
Mr Fothergill returns to your surgery after 1 week for suture removal and all is well. When should you next review this patient and what is the rationale behind this time interval (2 marks)
