Question 1:

The patient is an 8 year-old girl. What advice would you give the patient and parents on the future
closure of the upper diastema? What are the indications for a frenectomy

Question 1: Answer
A differential diagnosis should be made to ascertain the factors responsible for the diastema, such as
unerupted supernumerary teeth (mesiodens), small size of teeth or deep insertion of a fibrous labial
fraenum. Diastema usually reduce as the permanent canines erupt.
Complete closure often requires orthodontic intervention. A frenectomy is then indicated after
orthodontic closure to reduce the excess soft tissues. Surgical scarring assists in retention of the
space closure as the tissues contract.

Question 2:

This male patient in his mid-twenties presented with an asymptomatic area on the lateral surface of
tongue. This did not rub off and did not respond to antifungal therapy.

What is your differential diagnosis?

Differential diagnosis

Hairy leukoplakia, indicative of mid-to-late stage human immunodeficiency virus infection

(HIV).

Frictional keratosis.

Idiopathic keratosis.

Question 3:

Both of these lesions occurred on the lips of men who had spent much of their time out of doors.
From the appearance of each lesion and from its position, decide which of the following statements is
most likely to be true.
a.

Both lesions are squamous cell carcinomas.

b.

The lesion on the upper lip is a squamous cell carcinomathat on the lower lip is a basal cell
carcinoma.

c.

Both lesions are basal cell carcinomas.

d.

The lesion on the upper lip is a basal cell carcinoma, that on the lower a squamous cell
carcinoma.

(d) It is most likely that : The lesion on the upper lip is a basal cell carcinoma; that on the
lower lip, a squamous cell carcinoma. However, BCC on the vermillion border cannot be
excluded.

Question 4:

This upper right central incisor and lateral incisor were traumatised by a blow three days ago.
Patient's age is twelve years. There is no response to pulp testing, yet neighbouring teeth test
normally.
Would you proceed with pulp extirpation?

Question 4: Answer
No. Traumatised teeth will frequently yield a negative pulp test for some time after trauma, then later
test vital.

Question 5:

Slide shows the anterior teeth of a 10 year old boy. One of the upper central incisors is in torsiversion.
What are the common causes of this problem?

Question 5: Answer
Causes of displacement

Presence of an unerupted supernumerary tooth

Tooth sizebasal bone discrepancy

Tooth developed in ectopic position

Previous trauma.

Question 6:

This slide shows fracture of both maxillary central incisors in a 25 year old patient. One tooth exhibits

an Ellis Class III fracture and associated pulp exposure. The teeth are vital and the dentition is
otherwise excellent.
What are the options for treatment?

Question 6: Answer
Treatment Options :
a.

A periapical X-ray to verify that there is no root fracture.

b.

Pulp extirpation and root canal treatment.

c.

Aesthetic restoration of the lost tooth structure depending on patient's requirement and
circumstances.

d.

A partial (Cvek) pulpotomy in a previously minimally restored and symptomless tooth may
provide success in a high percentage of cases. Long term success is difficult to predict, but
decreases with increasing age.

Question 7:

This female aged 22 presented with gross loss of attached gingiva in all quadrants.
What are the likely causes, and how would you manage this condition?

Question 8: Answer

Acid erosion in combination with toothbrush abrasion.

Management

Erosion

Determine aetiology if possible

Acids come from three main sources:

o

Dietary

Regurgitated hydrochloric acid (as in anorexia, bulimia nervosa, hiatus hernia,

peptic and duodenal ulcers, mild chronic indigestion etc)

Industrial or occupational (less common today).

Removal of cause or treatment of underlying medical condition may be sufficient to halt or

slow progress.

Long term review and management is essential.

Toothbrush abrasion:
Advice on toothbrushing technique and abrasive nature of some dentifrices.

Question 8:

This patient has undergone radiotherapy for a salivary gland tumour.

What supportive measures can be offered?

Question 8: Answer
Topical fluoride therapy (rinse or gel in a custom-made stent), artificial saliva, dilute chlorhexidine
rinses, instruction in meticulous oral hygiene measures, dietary advice to minimise root surface
caries.

Question 9:

This bitewing radiograph of a fifteen year old patient reveals interproximal carious lesions confined to
enamel. Visually there is no cavitation present.
What treatment do you propose?

Question 9: Answer
Detailed diet history; assessment of patient motivation to follow a rigorous preventive regimen
involving dietary change, meticulous plaque control and home fluoride application until stability
achieved. Regular review required.
Operative intervention is necessary only in the presence of enamel cavitation.

Question 10:

This female in her mid-twenties presented with an acutely painful gingival condition, fever,
lymphadenopathy, malaise and headache.

What is the clinical diagnosis?

How would you treat the condition?

Question 10: Answer

Primary herpetic gingivo-stomatitis superimposed upon a chronic periodontitis. The

condition is distinguished clinically from acute necrotising ulcerative gingivitis by the
presence of ulcerative lesions visible on the mucosa and lips.

Treatment of the acute stage is palliative, directed towards relief of acute symptoms, e.g.,
analgesics, fluids, soft diet, rest and Tetracycline mouthwash (250 mg capsule dissolved in 5
ml water, 4-6 hourly, 3 days) or dissolve contents of 25 x 250 mg capsules in 200 ml
chloroform water; 5 ml as mouthwash every 4-6 hours.

Question 11:

This upper right central incisor was subjected to trauma one week previously. It tests vital and is
not mobile.
What immediate treatment would you suggest to help retain this tooth?

Question 11: Answer

None, apart from periodic supervision. If the pulp remains vital and the tooth is not mobile, a repair
of the fracture can be anticipated.

Question 12:

These slides are of a middle-aged female patient. The lesions on the cheeks and tongue are
bilateral.

What is your provisional diagnosis?

How would you obtain a definitive diagnosis?

Question 12: Answer

Minor erosive lichen planus. Diagnosis is based on history and clinical and histological findings
(immunofluorescence). Close monitoring is required as there is a low ,but definite risk of malignant
transformation.

Question 13:

This slide shows a missing incisor in an otherwise complete dentition.

What factors would you consider in assessing this case for a single tooth implant?

Question 13: Answer

Factors in assessment for implants

Bony morphology. (length, width and density of bone)

Soft tissue profile. (need for augmentation; relation to lipline)

Angulation of maxilla in relation to chosen implant system.

Implant system. (type of fixture and superstructure)

Restorative materials to be utilised.

Opposing occlusion.

Question 14:

Slide shows an upper right central incisor which tests non-vital and was traumatised eighteen
months previously. The patient is eight years old.
What treatment do you propose?

Question 14: Answer

Exposed dentine should be covered or restored, then the tooth treated by a calcium hydroxide
apexification procedure. Surgery is not indicated at this stage

Question 15:

A 45 year old male presented with a history of recurrent attacks of orofacial pain and concern for

his appearance due to tooth wear.

What factors may contribute to the aetiology of the orofacial pain?
Briefly how might this problem be managed?

Question 15: Answer

Factors contributing to orofacial pain

Parafunctional clenching evoking pain in jaw muscles and T.M. joints

Inadequate posterior support contributing to excessive loading of both T.M. joints

Excessive wear on anterior teeth.

Management options

Occlusal splint therapy to resolve symptoms

Restoration of edentulous space and mandibular occlusal plane.

Anterior restorations to restore tooth loss.

This female in her early thirties has had full mouth periodontal surgery, followed by full arch
metal-ceramic crowns, which have been splinted together.
What factors have contributed towards the deterioration in her periodontal condition?

Question 16: Answer

Sub-gingival margins accompanied by crowns overcontoured both mesio-distally and buccolingually, and inadequate embrasures have all contributed towards inadequate plaque control.

Question 17:

This first permanent molar tooth exhibits a combination of hypoplasia and hypocalcification of
unknown aetiology.
What are the options for treatment currently available for such a condition?

Question 17: Answer

Options for treatment

Glass-ionomer cement.

Smooth rough enamel and apply topical fluoride.

Preventive Resin Restoration. (PRR)

Amalgam restoration, if margins can be placed in areas where subsequent breakdown is

unlikely.

If tooth is fully erupted, and severely affected, a stainless steel crown can be placed.

Question 18:

The slide shows a periapical radiograph of an unerupted third molar.

What precautions would you take in assessing this tooth for removal?

Question 18: Answer

Precautions in tooth removal

Additional radiograph to display entire tooth

Surgical assessment, including possible need to section tooth

Informed consent, noting possibility of transient or permanent parasthesia following

surgery.

Question 19:

The slide shows a bitewing radiograph of posterior teeth restored with composite resin.
What deficiencies of this form of restorative material are revealed in this radiograph?

Question 19: Answer

Marginal gaps caused by contraction shrinkage of the composite, towards the curing light source.

Question 20:

This patient requests treatment to improve the colour and shape of the upper front teeth.
What are the problems associated with porcelain veneers as an option in this case?

Question 20: Answer

Problems with porcelain veneers

Past or present parafunctional habit.

Thin enamel

Absent enamel at gingival margins.