Semester One Final Examinations, 2019 DENT4060 Dental Practice IVA

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School of Dentistry
EXAMINATION
Semester One Final Examinations, 2019

DENT4060 Dental Practice IVA

This paper is for Herston Campus students.

Examination Duration: 120 minutes

Reading Time: 10 minutes For Examiner Use Only

Exam Conditions: Question Mark

This is a Central Examination

This is a Closed Book Examination - no materials permitted

During reading time - write only on the rough paper provided

This examination paper will be released to the Library

Materials Permitted In The Exam Venue:

(No electronic aids are permitted e.g. laptops, phones)

None

Materials To Be Supplied To Students:

4 x 6-Page Answer Booklet

1 x Multiple Choice Answer Sheet

Instructions To Students:

Total sections: 5
Total questions: 25
Total marks: 120

Answer Section A on an MCQ answer sheet. Answer sections B,C,D and E in

SEPARATE answer booklets. LABEL all four (4) booklets and questions.

Sections and questions are not of equal weight. The number of questions in
each section and the number of marks for each question are specified on the
exam paper.
Additional exam materials (e.g. answer booklets, rough paper) will be
provided upon request.

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Semester One Final Examinations, 2019 DENT4060 Dental Practice IVA

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Semester One Final Examinations, 2019 DENT4060 Dental Practice IVA

SECTION A (Questions 1 – 14) (14 marks in total)

(DentoMaxilloFacial Radiology, Periodontology, Oral Surgery)

All MCQS must be answered on the Multiple Choice Answer Sheet provided.
(1 mark each)

Select the most appropriate answer:

1. When multiple small soft tissue opacities are noted on a panoramic radiograph
superimposed over the rami, they are most likely to represent:
a) Antroliths
b) Carotid artery calcification
c) Tonsilloliths
d) Rhinoliths
e) Susuks

2. For an object to cause the formation of a ghost image on a panoramic radiograph, the
object must:
a) Lie above the hard palate
b) Lie between the centre of rotation of the source and the detector
c) Lie between the centre of rotation of the source and the source
d) Lie below the hard palate
e) Lie outside the field of view

3. What is considered as physiological tooth mobility?

a) Tooth mobility due to endodontic origin pathology
b) Tooth mobility due to compromised healthy periodontium
c) Tooth mobility due to acute trauma
d) Tooth mobility due to ongoing periodontal disease
e) Tooth mobility due to occlusal trauma

4. Which of the following is NOT a clinical indication for mucogingival procedures?

a) Aesthetic demands from a patient
b) Dentine hypersensitivity due to progressive localised recession
c) Discomfort during chewing due to an interfering lining mucosa
d) Gingival hyperplasia, affecting OH access
e) Lack of keratinised tissue around the gingival margin

5. Which of the following is a contra-indication for free gingival graft procedure?

a) Good oral hygiene
b) High mandibular labial frenulum attachment
c) Realistic aesthetic expectation
d) Shallow vestibule depths
e) Smoking

6. Which of the following is NOT an indication for root coverage therapy?

a) Absence of keratinized mucosa/ gingiva
b) Aesthetic concerns
c) Progressive recession
d) Sensitivity
e) Oral hygiene

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Semester One Final Examinations, 2019 DENT4060 Dental Practice IVA

7. Choose the CORRECT statement regarding the definition of induration

a) Lesion that exhibits rapid growth
b) Lesion that bleeds on gentle manipulation
c) Lesion and surrounding tissue is firm to the touch
d) Lesion feels attached to adjacent structures
e) Lesion has red speckled appearance

8. Choose the CORRECT statement regarding Necrotising Sialometaplasia

a) Affects Minor salivary gland in the cheek
b) It is a true neoplasm
c) Is associated with smoking
d) Is very painful
e) Occurs in young males

9. Choose the INCORRECT statement regarding Pleomorphic adenoma

a) Does not recur after excision
b) May become malignant
c) Rapid growth
d) The palate is the most common intra-oral site
e) 75% of all parotid tumours

10. Choose the INCORRECT statement regarding Salivary gland neoplasms

a) Almost one third of submandibular gland swellings are malignant
b) The Parotid gland is most commonly affected
c) Sublingual salivary gland neoplasms are uncommon
d) 45% of Minor Salivary gland swellings are malignant
e) 10% of Sublingual gland neoplasms are malignant

11. What is the MOST common cause of a non-painful, hard swelling in the posterior
palate?
a) Adenoid cystic carcinoma
b) Infection
c) Mid-line torus
d) Mucoepidermoid carcinoma
e) Paget’s disease

12. A patient presents with an abscess associated with a carious permanent mandibular
first molar tooth. Which anatomical spaces are most likely to be involved?
a) Sublingual, buccal
b) Submandibular, buccal
c) Submandibular, mental
d) Submandibular, pterygoid
e) Submandibular, sublingual

13. Which of the following is a developmental innocuous cyst of bone origin?

a) Dermoid cyst
b) Mucous retention cyst
c) Submandibular mucous cyst
d) Stafne’s bone cyst
e) Thyroglossal duct cyst

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Semester One Final Examinations, 2019 DENT4060 Dental Practice IVA

14. Which of the following is NOT a developmental aggressive cyst?

a) Calcifying odontogenic cyst
b) Cystic ameloblastoma
c) Dental eruption cyst
d) Odontogenic keratocyst
e) a and b

Short Answer Questions

SECTION B
Oral Medicine (Questions 15 - 18) (35 marks in total)
Question 15 (7 marks in total)
A middle aged male presents with the asymptomatic lesion as shown in the photograph.
The lesion was not present at his previous dental visit one year ago.

a) Briefly describe the clinical appearance of the lesion as shown in the photograph.
(2 marks)

b) Based on your description of the lesion shown above, what is your most likely clinical
diagnosis? (1 mark)

c) An incisional biopsy was performed on the tongue lesion and the pathologist reports
that the lesion is dysplastic. List four (4) histopathologic features of epithelial
dysplasia. (4 marks)

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Question 16. (7 marks in total)

An adult male reports to you with a complaint of sore palate of a few days duration. The
lesions are shown in the photograph below. He also complains of constitutional
symptoms such as fever, headache and malaise.

a) Describe the clinical appearance as shown in the photograph. (2 marks)

b) What is your most likely clinical diagnosis? (1 mark)

c) Describe the pathogenesis of this disorder. (2 marks)

d) List two (2) complications which are known to occur in patients with this disorder?
(2 marks)
Question 17. (10 marks in total)
An adult male reports to you complaining of sore gums and oral malodour. The
photograph below shows signs of pathology confined to the gingival tissues in relation to
the left mandibular canine and premolars.

a) Provide a clinical description of the lesions seen on the gingival tissues. (2 marks)

b) What additional information on his health would you seek from this patient? (3 marks)

c) What is your most likely clinical diagnosis of the gingival condition? (1 mark)

d) How do you treat the gingival disease in this patient? (4 marks)

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Question 18. (11 marks in total)

John, a 64 year old male reports to you with a complaint of sore mouth of two weeks
duration. John’s medical history reveals that he is on medication for chronic bronchitis,
hypertension, diabetes and rheumatoid arthritis.

a) Describe the clinical appearance of John’s mouth shown in the above photograph
and provide the most likely clinical diagnosis of the oral condition. (3 marks)

b) List four (4) predisposing factors which might contribute to the

development of the oral condition as seen in the above patient. (4 marks)

c) Provide a treatment protocol for the oral condition shown above. (4 marks)

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SECTION C
Special Needs Dentistry (Question 19 – 20) (30 marks in total)

Question 19. (15 marks in total)

Mr JB is a 45-50 year old man who has presented because of severe toothache from
tooth 15, which has worsened in recent days and now is continuous, and occurs with
no stimulation. You notice that Mr JB has a high body mass index, and he seems
somewhat sleepy and lethargic, despite the time of day and his current pain.

He has been managed by a psychiatrist for mental health issues for the past 20
years. He suffers from chronic schizophrenia, which first manifested during his
university studies when he was 22. His current prescription medications include
aripiprazole (Abilify), which he has been on for 2 months, having previously taken
olanzapine (Zyprexa) for 5 years. He also has been prescribed propranolol (Inderal)
to reduce tremor, which is a side effect of his anti-psychotic medication. To aid his
sleep by quieting the “voices” that he hears, most nights he usually takes temazepam
(Restoril). He has also recently started using St John’s wort, which he purchased from
a health food store.

His bitewing radiographs are shown below.

a) Why does Mr JB have an aggressive pattern of dental caries? (4 marks)

b) After lying supine for the visit, when Mr JB gets up from the dental chair at the
end of the visit, he is unstable and likely to fall. Why is this, and how can you
stop this from happening? (3 marks)

c) Why does Mr JB hear “voices”, despite being compliant with taking his
medications? (2 marks)

d) If Mr JB needs to have tooth 15 extracted, is he at risk of increased bleeding,

and if so, why? (2 marks)

e) Why does Mr JB have a high BMI, and what is the long term significance of
this? (4 marks)

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Question 20. (15 marks in total)

John Williams is a 78 year old retired man who had a stroke (CVA) three years ago.
When taking his medical history, you note that he has been on anticoagulant therapy
since his stroke. He recently was switched by his doctor from Coumadin (warfarin) to
Pradaxa (dabigtran), as he had a lot of problems getting a stable acceptable INR
when he was on warfarin. John will need a broken down endodontically treated lower
premolar tooth with a vertical root fracture extracted in your clinic.

a) What type of medicine is Pradaxa (dabigtran) in terms of its method of action?

(2 marks)

b) List four (4) situations or medical conditions where this same anticoagulant
medicine could be used, other than following a stroke. (4 marks)

c) When planning to do the extraction, what are four key common dietary factors will
you need to ask John about when assessing the bleeding risk for that procedure?
(4 marks)

d) What two specific pieces of advice will you give John about whether he needs to
change the dose of his medicine or change his diet before the extraction? (3 marks)

e) What time of day would it be best schedule the extraction, and why? (2 marks)

SECTION D
DentoMaxilloFacial Radiology (Question 21) (8 marks in total)
Question 21.

a) What is the significance of lymph node calcifications when noted on

panoramic radiographs or cone beam data sets? (4 marks)

b) Write short notes on the radiographic features of an osteoma. (4 marks)

SECTION E
Periodontics and Care Planning (Questions 22-25) (33 marks in total)
Question 22.

What anatomical factors determine tooth mobility? (4 marks)

Question 23.

What are the clinical indications for splinting of mobile teeth to non-mobile teeth?
(5 marks)
Question 24.

Describe the healing phases following gingival augmentation procedure (e.g. Free
gingival graft) (9 marks)

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Semester One Final Examinations, 2019 DENT4060 Dental Practice IVA

Question 25. (15 marks in total)

Megan is a 28 year old women who presented to you for an emergency appointment.
She complains of pain on the lower left hand side. The pain started a week ago and she
reports pain on biting, pain to cold which lingers as well as sleep disturbance.
She smokes 6-10 cigarettes per day and brushes her teeth once day. She also drinks 2
cans of Coca-Cola per day and snacks between meals with chocolate and biscuits.
Medically, she takes Ventolin for her asthma. Otherwise, no other medications,
conditions or allergies.
Upon clinical examination and radiographically you notice the 36 has carious retained
roots and the 37 has mesial-occlusal caries which extends into the pulp. The 36 and 37
are both tender to percussion and the 37 lingers with the cold test.

a) During the systemic phase of your treatment plan, what would you ask her to
determine if she is medically fit to undergo dental treatment? (3 marks)

b) As part of the acute phase of your care planning, what are the potential treatment
options for the 36 and 37 in order to resolve any symptomatic problems?
(2 marks)

c) When providing informed consent to your patient, what would you need to inform
her prior to undertaking treatment for both the 36 and 37? (7 marks)

d) What would you implement for your patient during the disease control phase in
order to eliminate future causes and risk factors? (3 marks)

END OF EXAMINATION

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