Semester One Final Examinations, 2021 DENT4060 Dental Practice IVA

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School of Dentistry Question Mark

EXAMINATION
Semester One Final Examination, 2021

DENT4060 Dental Practice IVA

This paper is for Herston Campus students.

Examination Duration: 120 minutes

Reading Time: 10 minutes

Exam Conditions:

This is a Closed Book examination - no written materials permitted

No calculators 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: Additional exam materials (eg. answer booklets, rough

paper) will be provided upon request. Answer SAQ sections in separate answer
booklets.
Exam paper sections are composed as follows: A- OMFS (12 Questions/17 marks),
B- DMFR (2 Questions/6 Marks), C- Oral Medicine (2 Questions/44 Marks), D-
Special Needs Dentistry (2 Questions/31 Marks) and E- Periodontology (1
Questions/22 Marks).

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Semester One Final Examinations, 2021 DENT4060 Dental Practice IVA

SECTION A (Question 1 – 12) (17 marks in total)

(Oral and Maxillofacial Surgery- OMFS)
All MCQs questions must be answered on the Multiple Choice Answer
Sheet provided. (1 Mark each)

1. Which of the following is NOT a surgical treatment option for removal of a

cyst?

a. Resection
b. Enucleation
c. Radiotherapy for 6 weeks
d. Marsupialisation
e. Reconstruction

2. For a radicular cyst, what is the best treatment option to ensure its
eradication?

a. Root canal therapy and apicectomy with removal of apical cyst

b. Root canal therapy
c. Antibiotics only
d. Extraction of offending tooth and enucleation of the apical cyst
e. a and d

3. From the following options, select the best definition of the term
“Fluctuance”:

a. A restriction in movement
b. An area that is attached via a stalk
c. A consistency indicating the presence of fluid
d. A flat region that is slightly raised
e. None of the above

4. Treatment of submandibular gland calculus does NOT include:

a. Excision of the submandibular gland

b. Sialendoscopy
c. Excision of the submandibular and sublingual glands together
d. Lithotripsy
e. Conservative management

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5. Treatment of a mucous retention phenomena (eg mucocoele or ranula)

does NOT include:

a. Surgical removal
b. Marsupialisation
c. Low dose radiotherapy
d. Injection of Botulinum toxin
e. Laser therapy

6. Causes of Xerostomia does NOT include:

a. Sjogren’s Syndrome
b. Rabies
c. Cystic Fibrosis
d. Epstein-Barr Virus
e. Hypertension

7. The best method to diagnose a submandibular duct calculus is:

a. Intra-oral palpation
b. Bimanual palpation and Ultrasound
c. Orthopantomogram and Bimanual palpation
d. Magnetic Resonance Imaging
e. Lithotripsy

8. The following are related to Sjogren’s Syndrome EXCEPT:

a. Sialadenosis
b. Xerostomia
c. Xeropthalmia
d. Caries
e. Lymphoma

9. A firm symmetrical mass on the lingual aspect of the mandible is most

likely a:

a. cherubism
b. Torus
c. Exostoses
d. ameloblastoma
e. Ranula

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Semester One Final Examinations, 2021 DENT4060 Dental Practice IVA

10. Which is NOT a feature of Sialolithiasis

a. Occur in the submandibular duct 80% of the time

b. Normally bilateral
c. Pain on gustatory reflex
d. Can cause systemic symptoms
e. usually in the duct of the Less commonly the parotid gland

11. The biopsy sample has returned as an unrepresentative sample of a

suspected malignancy. The following are appropriate next steps EXCEPT:

a. Re-assure the patient that it is nothing

b. Re-biopsy the lesion
c. Referral to an oral and maxillofacial surgeon for biopsy
d. Provide a 2 week course of antifungal treatment and re-biopsy the
lesion
e. Referral to an Oral Medicine Specialist

SECTION A Short Answer Questions

All SAQs questions must be answered on the answer booklets provided.

Question 12. What are the indications to refer a patient to hospital for
assessment of their head injury? (6 marks)

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Semester One Final Examinations, 2021 DENT4060 Dental Practice IVA

SECTION B (Dento Maxillofacial Radiology -DMFR) (Question 13 – 14)

(6 marks in total)
All SAQs questions must be answered on the answer booklets provided.

Question 13. Describe at least six (6) key radiographic features of Fibrous
Dysplasia. (0.5 mark per included feature) (Total 3 marks)

Question 14. List 6 radio-opaque anatomic features that are visible on panoramic
radiographs (not including teeth). (3 marks)

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SECTION C
Oral Medicine (Question 15 – 16) (44 marks in total)
All SAQs questions must be answered on the answer booklets provided.

Question 15.
A 55-year-old male presented to your dental clinic complaining of persistent
gingival inflammation and pain. He told you that he may have burnt the site of
interest while eating hot food. His clinical presentation is shown in the photographs
below.

a) Describe the clinical presentation that is shown on the photograph. (5 marks)

b) List three (3) differential diagnoses that may present with this clinical
appearance. (3 marks)

c) List five (5) questions you would ask the patient when taking a clinical history,
AND briefly explain how these questions will assist in narrowing down the
differential diagnoses you have listed above. (5 marks)

d) In your clinical examination, list four (4) clinical features and/or investigations
you would specifically assess for (in your capacity as a general dental
practitioner), to assist with your clinical diagnosis. For each listed item, briefly
justify why you have chosen to perform this assessment/investigation. (4
marks)

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Semester One Final Examinations, 2021 DENT4060 Dental Practice IVA

e) Provide a treatment plan for this patient that demonstrates your role as a
general dental practitioner in the management of their oral mucosal condition.
(5 marks)

Question 16.
A 63-year-old lady presented to your clinic with the complaint of persistent
sensitivity on her cheek. Her medical history includes hypertension, for which she
takes Perindopril (ACE inhibitor). You noticed clinical abnormalities on her cheek,
as shown in the photograph below.

a. Describe the clinical presentation that is shown on the photograph. (5

marks)

b. List three (3) differential diagnoses that may present with this clinical
appearance. (3 marks)

c. List five (5) questions you would ask the patient when taking a clinical
history, AND briefly explain how these questions will assist in narrowing
down the differential diagnoses you have listed above. (5 marks)

d. In your clinical examination, list four (4) clinical features and/or

investigations you would specifically assess for (in your capacity as a
general dental practitioner), to assist with your clinical diagnosis. For each
listed item, briefly justify why you have chosen to perform this
assessment/investigation. (4 marks)

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e. Provide a treatment plan for this patient that demonstrates your role as a
general dental practitioner in the management of their oral mucosal
condition. (5 marks)

SECTION D
Special Needs Dentistry (Question 17 – 18) (31 marks in total)
All SAQs questions must be answered on the answer booklets provided.
Question 17
A patient has presented in your emergency dental clinic. He is a 50-55 year old
patient and you can see that he is unkempt in appearance, as he has shown up 20
minutes late to your appointment. He is visibly thin and slightly grey in colour and
is unemployed and homeless.
When you asked about his medical history, he mumbles about taking a few
medications that his doctor prescribes but has no idea why or what they are for. He
drinks 5 or more glasses of “rum and coke” a day and smokes 20 cigarettes a day,
with no intention of quitting. He denies taking any recreational drugs today.
You called his G.P. who informs you that he is on insulin and Diabex (metformin)
for his Type 2 Diabetes that is not well controlled. They also informed you that this
patient is on 75mg of Paliperidone on a monthly basis through injection for his
schizoaffective disorder. The patient vaguely explained that he is here for an
extraction but denied being in pain.

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Semester One Final Examinations, 2021 DENT4060 Dental Practice IVA

Based on the previous clinical case, please respond to the following questions
(a,b,c):

a. Please list and discuss four (4) reasons you would be hesitant to provide an
extraction for this patient at this stage? (8 marks – 4 marks for the reasons
and 4 marks for the explanation)

b. How would you modify your oral health instruction given this patient’s current
predicament? (3 marks)

c. Please explain and discuss four (4) ways that poorly-controlled Type 2
Diabetes Mellitus impacts on your dental management of this patient? (6
marks – 4 marks for explaining 4 mechanisms that may affect dental
management and 2 marks for the 4 reasons)

Question 18
You have been referred to see a 65-year-old patient who has undergone
chemoradiation therapy, due to a glottic squamous cell carcinoma that had a
pathologic staging of T3N0M0. The oncology team has also performed a total
laryngectomy. You are told that all of the cancer has been removed. This patient is
still smoking 15 cigarettes a day and takes aspirin, sertraline, pregabalin,
oxycodone and rosuvastatin. He is visibly thin and has an ill-fitting upper denture.

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Semester One Final Examinations, 2021 DENT4060 Dental Practice IVA

Base on the previous clinical case, please respond to the following questions
(a,b,c):

a. Please use a table to show the different pathologic staging (including a short
explanation) for each T, N and M stages for oropharyngeal squamous cell
carcinoma (assume Human Papilloma Virus 16 negative (-ve) (10 marks)

T (Primary tumour) N (Nodal involvement) M (Metastasis)

b. Why is there a difference between TNM staging for Human Papilloma Virus 16
negative (-ve) and Human Papilloma Virus 16 positive (+ve) oropharyngeal
squamous cell carcinoma? (2 marks)

c. Provide two (2) reasons why this patient is at high risk of root caries. (2 marks)

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Semester One Final Examinations, 2021 DENT4060 Dental Practice IVA

SECTION E
Periodontics (Question 19) (22 marks in total)
All SAQs questions must be answered on the answer booklets provided.
Question 19
A 53 year old non-smoker male patient was presented to the outpatient dental
clinic. His chief complaint is bleeding gums and loose teeth, and he cannot chew
the food properly. He is taking pain killers for back pain and otherwise healthy.
Patient is aware he has a gum disease and wants to save his teeth. He lost his 11
and 21 due to a trauma 20 years ago.
Periodontal chart reveals generalized deep pockets ranging between 5-9 mm deep
and generalized gingival recession ranging between 1-5 mm, as seen in the clinical
photos below. He has abundant supra and subgingival and calculus deposits as
seen in the clinical photos. Bleeding on probing is more than 80%.
35 is grade III mobility and patient mentioned it is causing discomfort on biting. 36,
37 and 38 are missing. 46 is grade II mobility with grade I furcation involvement.
Patient mentioned he eats mainly on the right side.
Vitality testing revealed that all teeth are vital.
Panoramic radiography is showing generalized moderate to severe bone loss.
Periapical radiographs of 46 showing vertical bone loss near the apex of the mesial
root.

Clinical photos:

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Periodontal chart:

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Panoramic radiograph:

Periapical radiograph 46:

Questions:
a. What is the most accurate diagnosis of this case based on the information
provided? (3 marks). Support your diagnosis with reasoning (2 marks).

b. Discuss the treatment phases and treatment sequence stating number of

visits and duration between visits proposed for this periodontitis case (5
marks).

c. On a reassessment visit after initial therapy, 46 still has a residual pocket

depth of 8mm in the Mesio-buccal site with evident vertical bone loss to the
apical one third of the mesial root. Note that 46 responds normal to pulp
testing.

What treatment options you would propose to treat the residual pocket? (4
marks).

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You decided to do regenerative surgical periodontal therapy in 46.

d. Discuss the rationale and principles of periodontal regeneration. (4 marks).

e. Discuss the technique you would choose to treat the mesial vertical defect
of 46 and why (4 marks).

END OF EXAMINATION

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