Best of Fives for Dentistry

Douglas Hammond
BDS (Wales) MFGDP (UK)

iv Best oF Fives For Dentistry

© 2006 PASTEST LTD Egerton Court Parkgate Estate Knutsford Cheshire WA16 8DX Telephone: 01565 752000 All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording or otherwise without the prior permission of the copyright owner. First Published 2006 ISBN: 1905635 19 2 ISBN 13: 978 1905635 19 1 A catalogue record for this book is available from the British Library. The information contained within this book was obtained by the author from reliable sources. However, while every effort has been made to ensure its accuracy, no responsibility for loss, damage or injury occasioned to any person acting or refraining from action as a result of information contained herein can be accepted by the publishers or author. PasTest Revision Books and Intensive Courses PasTest has been established in the field of postgraduate medical education since 1972, providing revision books and intensive study courses for doctors preparing for their professional examinations. Books and courses are available for the following specialties: MRCGP MRCP Parts 1 and 2, MRCPCH Parts 1 and 2, MRCPsych, MRCS, MRCOG , Parts 1 and 2, DRCOG, DCH, FRCA, PLAB Parts 1 and 2. For further details contact: PasTest, Freepost, Knutsford, Cheshire WA16‑7BR Tel: 01565 752000 Fax: 01565 650264 www.pastest.co.uk enquiries@pastest.co.uk Text prepared by Carnegie Book Production, Lancaster Printed and bound in the UK by MPG Books Ltd, Bodmin, Cornwall

Contents

v

Contents
About the Author Introduction 1 2 3 4 5 6 7 8 9 10 Index Oral Medicine Oral Surgery Dental Materials Child Dental Health and Orthodontics Oral Pathology Periodontics Pharmacology Radiology Restorative Dentistry Human Disease vii ix 1 23 45 67 95 117 145 167 189 213 235

ABout the Author

vii

About the Author
Douglas Hammond BDS (Wales) MFGDP (UK) Clinical Lecturer in Oral and Maxillofacial surgery, Royal London Hospital. Douglas graduated from Cardiff Dental Hospital and completed various hospital and practice jobs. He then began working as a part‑time lecturer in Oral and Maxillofacial Surgery at the Royal London Hospital in 2002, whilst embarking on a medicine degree at University College London. He should graduate in June 2007. From there he hopes to continue into specialist training in Oral and Maxillofacial Surgery.

introDuCtion

ix

introduction
This book aims to cover most of the aspects required in finals for dentistry. It tries to cover a broad section of subjects, most of which are the “examiner’s favourites”. There is a mixture of questions with some requiring straightforward recognition and others requiring the application of knowledge. All of the most basic subjects are covered and some of the more complex subjects. Hopefully this will be a good revision aid to those revising for finals.

Periodontics

6

PerioDontiCs

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6.1

Which one of the following bacterial species is not associated with adult periodontitis?
A B C D E Fusobacterium nucleatum Bacteroides forsythus Porphyromonas gingivalis Shigella sonnei Prevotella intermedia

1 1 1 1 1
6.2

When looking at the notes of a patient, you see annotation for a Basic Periodontal Examination (BPE). What does a score of 3 mean on this particular index?
A B C D E Gingival bleeding, no overhangs or calculus, pockets > 3.5 mm Pockets within colour‑coded area, 4.5–6.5 mm Colour‑coded area disappears, pockets > 5.5 mm Pockets within colour‑coded area, 3.5–5.5 mm Colour‑coded area disappears, pockets > 5.5 mm

1 1 1 1 1
6.3

Which one of the following statements regarding acute necrotising ulcerative gingivitis (ANUG) is true?
A B C D E It is caused by Gram‑positive anaerobic bacteria It is characterised by chronic onset It affects non‑smokers more than smokers It is caused by acid fast bacilli It is characterised by interproximal necrosis

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120 Best oF Fives For Dentistry

6.1

D

All of the bacteria in the list are responsible for adult periodontitis except S. sonnei, which is responsible for acute diarrhoea.

6.2

D

The WHO probe is used for carrying out BPE. The index is shown below.
Score 0 1 2 3 4 Disease No disease Gingival bleeding, no overhangs or calculus, pockets < 3.5 mm No pockets > 3.5 mm, no supragingival calculus or subgingival overhangs present Pockets within the colour‑coded area, 3.5–5.5 mm Colour‑coded area disappears, pockets > 5.5 mm

6.3

E

ANUG is caused by Gram‑negative aerobic bacteria, usually in the mandible, has a very distinctive smell (fetor oris) and is more common in smokers and those with poor oral hygiene.

PerioDontiCs

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6.4

Correct treatment of a patient with ANUG is:
A B C D E 20% chlorhexidine mouthwashes twice daily Amoxicillin 500 mg three times daily for 5 days and 20% chlorhexidine mouth washes twice daily Erythromycin 250 mg four times daily for 5 days and 20% chlorhexidine mouthwashes twice daily Scaling and oral hygiene instruction Metronidazole 400 mg three times daily for 5 days and hydrogen peroxide mouthwash twice daily

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6.5

Which one of the following statements about tooth mobility is incorrect?
A B C D E Movement of a crown of the tooth in the horizontal plane of less than 0.2 mm is considered normal Grade 1 means movement of the crown of a tooth in the horizontal plane is 0.2–1 mm Grade 2 means movement of the crown of a tooth in the horizontal plane is greater than 1 mm Grade 3 means movement of the crown of a tooth in the horizontal plane is greater than 3 mm Grade 3 means movement of the crown of a tooth in the vertical plane

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6.6

Which one of the following clinical conditions predispose patients with impaired/defective neutrophil function to severe periodontitis?
A B C D E Patterson–Brown–Kelly syndrome Chediak–Higashi disease Hypothyroidism Hyperthyroidism Gardner’s syndrome

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122 Best oF Fives For Dentistry

6.4

E

ANUG is a very painful condition. The most efficacious mouthwash is hydrogen peroxide, and the bacterial component is treated with metronidazole. Amoxicillin and erythromycin would be ineffective in treatment of this condition.

6.5

D

Tooth mobility is graded as shown in the table below.
Grade 1 2 Description Movement of the crown of a tooth in the horizontal plane is 0.2–1 mm Movement of the crown of a tooth in the horizontal plane is greater than 1 mm Movement of the crown of a tooth in the vertical plane

3

6.6

B

None of the others are relevant to periodontal disease.

PerioDontiCs

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6.7

Which one of the following is associated with abnormal collagen formation leading to periodontal disease?
A B C D E Type 1 diabetes mellitus Papillon–Lefèvre syndrome Hypophosphatasia Type 2 diabetes mellitus Hyperphosphatasia

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6.8

What is the name of the probe shown in the figure?

1 1 1 1 1

A B C D E

Briault’s Community Periodontal Index of Treatment Needs (CPITN) World Health Organization (WHO) Williams’ Florida

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6.7

C

Hypophosphatasia, as well as Ehlers–Danlos syndrome are associated with abnormal collagen formation and periodontal disease. Papillon–Lefèvre syndrome is associated with abnormal neutrophil function, which leads to periodontal disease.

6.8

D

The probe shown is the Williams’ probe, which has 1 mm increments for accurate measurement of the pocket depth.

PerioDontiCs

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6.9

In juvenile periodontitis, which bacterium is the recognised aetiological agent?
A B C D E Porphyromonas gingivalis Prevotella intermedia Actinobacillus actinomycetemcomitans Borrelia burgdorferi Fusobacterium intermedium

1 1 1 1 1
6.10

Which teeth are most commonly affected in juvenile periodontitis?
A B C D E Incisors and first permanent molars Incisors and canines Canines and premolars Premolars and first permanent molars Canines and first permanent molars

1 1 1 1 1
6.11

For which teeth/surfaces would you use a Gracey no 1 or no 2 curette when scaling?
A B C D E All teeth All surfaces of anterior teeth Mesial surfaces of anterior teeth All surfaces of posterior teeth Mesial surfaces of posterior teeth

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126 Best oF Fives For Dentistry

6.9

C

A. actinomycetemcomitans is a capnophilic, non‑motile rod that possesses a potent leucotoxin, which causes lysis of polymorphonuclear leucocytes.

6.10

A

As these are the first teeth to erupt, they seem to be the teeth which are affected most by juvenile periodontitis.

6.11

B

A Gracey no 1 or no 2 is ideally shaped to facilitate scaling of all surfaces of anterior teeth.