Experience with ADC Final Examination Brisbane Venue - February 2009

What I am about to write here is my whole experience with the ADC Final Examination. My view might no be shared by many of you, but it is my point of view of things. I prepared to 95% of the exam by myself, reading books from cover to cover, relying on my experience with patients and reading past exam questions. The 5% remaining was practicing with a friend (Thank you, Carla!!!) for the Vivas, which helped me a lot for sure and visiting two friends that passed the exams some time ago weeks before my exam. I did not take any expensive courses and I am POSITIVE they are not needed and they are just trying to rip you off. In my opinion, the biggest contributing factor for the exams is clinical experience. So, instead of wasting 20 thousand dollars on a 20 week course, earn a lot of money seeing patients and increasing your expertise at the same time. I stopped working and came to Australia 2 months before the examination and I think this was a wise move. Of course, I was studying long before that, at least from June of the last year. I!ve seen a list of books here that people suggest you read. I am writing my list as well, but I think you should try to create your own. Those are the books I read cover to cover, but in addition to those I have at least 50 more books from which I had consulted the odd chapter here and then: - Sturdevant 4th ed (the 5th is already available) - Therapeutic Guidelines - Cameron for pediatric dentistry - Odell - Cawson for Oral Medicine - Shillinburg for Fixed Prosthodontics - Davenport for RPD - White/Pharaoh for Radio - Langlais Exercises of Oral Radiology and Interpretation (highly recommended) - Fragiskos for Surgery - Picture tests in Pediatric Dentistry As you can see, there are no books for endo, anesthesia, perio or pharmacology. I relied on my knowledge for this subjects. Of course, this list of books cover 50% of what you should know to the exam, at least for my exam. All your past training accounts for the other 50% in my opinion. As you will see in my Oral Surgery viva below, a lot of answers there are not anywhere on these books. For all of you out there who have been doing just one part of dentistry, don!t worry! I was freaked out by having to prepare amalgam cavities, xed bridges and design a RPD. I haven!t done any of these things in my life as a dentist. However, I practiced a lot on manikins before the exams. I won!t write every single question of the examination as a lot of previous papers cover a lot and the questions follow the same line. As you already know, the Vivas are based on what you answer. For instance, a answer to one of the questions I had in operative dentistry that was about subgingival restorations was electrosurgery or retraction cord. The professor started asking me about electrosurgery after I answered that. I told him that I have no experience with electrosurgery, but I do know a lot about retraction cords. That was it, instantly the stream owed in that direction, forgetting electrosurgery. A lot of this happened throughout the exam, so of course you don!t need to know everything. In fact, as was previously written here, the exam is pretty much basic dental knowledge, but put together in a VERY STRESSFUL situation. You are of course allowed to make small mistakes and to not know some stuff, but major aws will likely fail you. I!m writing this because of some reported mistakes of the other candidates in Brisbane that came to fail the exam.

That is it. Thanks for the support of everyone in this discussion group, especially to Martha, who helped me a lot from the beginning. Don!t listen to people trying to freak you out. It is completely possible to pass the examinations with hard work.

CD1 - procedure 1 was prepare 23 and 25 for PFM bridge. The pictures are not clear, sorry.

pedo and endo were the same as previous exams, nothing different. The rubber dam exercise in endo was to isolate a 16 with cuff technique (he specically asked for that, it was not an option). VERY IMPORTANT for those taking the exam in Brisbane (I don!t know about other places): bring your own material for CD1, because they really have a poor selection of burs and other instruments, at least for my taste. Even the basic 245 was not available for amalgam, only on slow speed. No perio probe was supplied for CD1, few carving instruments. So, there is no reason for not bringing whatever you are used to work with. In Endo is the same, bring whatever you feel you would be happy with.

CD3

Oral Radio
I had to take a PA of 12 and a right BW. This is simple, every dentist should be comfortable with it. The only thing I!m not comfortable with is the BW thing, because for some odd reason they never let us use holders for BW, in spite of what is written in every book and guideline that BW holders are indicated. So, if you!ve never taken one without a holder, practice it. Not a good idea to have your rst time in the exam. I!ll just write down the topics I got here so that will work as a study guide. From my point of view, this is a worthless viva to describe, as you guys will not be able to see anything that I saw. Here we go: - tube shift, of course, although not everybody was asked about this - OPG errors - know how to describe PA and BWs very well - know how to describe the bone lesions very well and know different differential diagnosis, preferably by specic age groups

Oral Medicine
Same thing as radiology, so I!ll just write down the topics I got: - cervical invasive resorption - external inammatory resorption - squamous cell carcinoma (study well the microscopic features of it, I was asked for these in more than one viva during the exam) - mucositis

Oral Surgery
Nobody got a patient here in Brisbane, so only viva and demonstration on a manikin. I!ll write through the whole viva exactly as it was, so enjoy. The questions are rst written without answers, so you can practice with someone exactly how it went. Further below, the questions are written with answers. One of the DA!s was there role-playing as a patient and I was asked to take the full medical history and chief complaint. She had pain in the upper left jaw, was asthmatic and was taking ventolin, was also on a course of prednisone, rst starting at 14mg/day and now she is at 10 mg/day. She took 6 Panadeine Forte in the last 24 hours to relieve the pain. After my history taking, the viva started: - The tooth she is complaining of is 26 and you are going to pull it out. What are the implications of asthma for our procedure? - Why is she taking ventolin? - Why is she taking prednisone? Why does asthmatic patients take corticosteroids? - Do you need to do anything different because of this? - What is Panedeine Forte?

- Is this dose of Panadeine Forte too much for a small-sized lady like her? - What are the side effects of opioids? - Now you are going to demonstrate the extraction on the manikin. What is the rst step, before LA? - Assemble the syringe. - What is inside the LA? - Demonstrate the LA technique on the manikim. Where exactly are you injecting for 26? - Before you actually inject, what do you do? - What type of syringe is this? - How does self-aspirating syringes aspirate? - What part of the cartridge it is responsible for that? - How much do you inject on the buccal? - Where do you inject in the palatal? - Why? - How much do you inject on the palatal? - How long does the injection takes to be effective? - How to test numbness? - On the OPG, showed me some landmarks: glenoyd fossa, articular eminence, zygomatic arch, zygomatic process, posterior wall of the sinus, inferior border of the orbit, nasal septum, shadow of the spine in the lower jaw. - Pick the other instruments you want, names of them. - Demonstrate the exo on the manikin. - Why are your ngers there? - You are extracting 26, what if 27 and 28 start to move together? What happened? - What do you do? - Which kind of splint? - For how long? - How to do the exo then? - What to do now to relieve the patients pain? Done with that part, now to case scenarios: 1 -Patient comes for extraction of lower molar, the crown is fractured, how to remove the tooth? - Would you section it? - What is the direction of sectioning? - How many roots does it have? - Then how will you extract? 2 - A patient comes with infection on the upper jaw, what are the problems for us immediately doing exo? - So is lack of profound anesthesia a problem for extraction? 3 - What are the indications of antibiotics in oral surgery? - Why joint prosthesis? - What if I come to you with a 12-year-old hip replacement, would you give me antibiotics? - What if the patients comes with a paper from the orthopedic surgeon saying he needs to take them? - On the phone, he told you he wants you to give antibiotics anyway, what do you do? - What are the other indications for antibiotics? - Why the endocarditis guidelines had changed? - When? - What are the conditions that you need to give antibiotics now? - Why indigenous australians? - If you patient had an exo with you and is swollen in the next day, then goes to the GP and the GP tells him he needs antibiotics. What do you tell the GP on the phone?

4 - 60 year old guy comes to your clinic with ulcer on lower alveolar ridge, underneath his full denture. What do you ask? - It!s there for a month, what do you do? - You can!t make sure that this is not from the denture, what do you do? - He comes back and it is still the same, what do you do then? - What are the types of biopsy? - What is the biopsy you would do in this case if you were a surgery resident in the hospital? - What to do with the specimen after you remove it? - Is there any other liquids where you can put it? Water, milk, whisky, alcohol? - How to deliver to the lab? - Can you put it in the post? - When they get the specimen in the lab, what they!ll do before they stain? - With what will they stain it? - What is the overall management of oral cancer? - What are the problems with radiotherapy? - What if you need to do an extraction after radio, how to minimize risk? - How does that work? 5 - Showed me some instruments. - rongeur. What is that for? - If you are removing 28, 27, 26, 25, 24 and 23 in the same day, would you remove all interdental septa with it? - Why not, that was used to be taught. - coupland chisel. What is that for? - Would you use it as a chisel? - Lower hawk!s bill. What is that for?

ANSWERS
The answers here are exactly what I said in the exams, no textbook answers. If you are searching for more complete answers, go to books, but rest assured that this here is enough and that you won!t have time to formulate a textbook answer. Oral Surgery Nobody got a patient here in Brisbane, so only viva and demonstration on a manikin. I!ll write through the whole viva exactly as it was, so enjoy. One of the DA!s was there role-playing as a patient and I was asked to take the full medical history and chief complaint. She had pain in the upper left jaw, was asthmatic and was taking ventolin, was also on a course of prednisone, rst starting at 14mg/day and now she is at 10 mg/day. She took 6 Panadeine Forte in the last 24 hours to relieve the pain. After my history taking, the viva started: - The tooth she is complaining of is 26 and you are going to pull it out. What are the implications of asthma for our procedure? " May have attack during procedure, I would have her puff near us.

- Why is she taking ventolin? " It!s a bronchodilator and it!s used during attacks. - Why is she taking prednisone? Why does asthmatic patients take corticosteroids? " For prevention of further attacks. - Do you need to do anything different because of this? " She can be immunosuppressed, so antibiotics might be considered. She might have an Addisonian crisis, so it would be good to double her dose on the day of surgery. (To this, he told me that he would not blame me for being overcautious, but probably in this case it would not be needed. Then I told him that different values are stated in the literature and that some say that as little as 5 days are needed to suppress adrenal function. He agreed and told me that!s why I can!t blame you.) - What is Panedeine Forte? " Analgesic, composed of 500mg of paracetamol and 30mg of codeine. - Is this dose of Panadeine Forte too much for a small-sized lady like her? " The limiting dose is of the paracetamol, which is 4g per day. She took 3g, so not a problem. - What are the side effects of opioids? " Constipation, drowsiness, respiratory depression, dizziness, tolerance - Now you are going to demonstrate the extraction on the manikin. What is the rst step, before LA? " Topical anesthetic. - Assemble the syringe. - What is inside the LA? " anesthetic and vasoconstrictor - Demonstrate the LA technique on the manikim. Where exactly are you injecting for 26? " in the mucobuccal fold - Before you actually inject, what do you do? " aspiration - What type of syringe is this? " self-aspirating - How does self-aspirating syringes aspirate? " A negative pressure is created inside the cartridge, allowing blood to ow inside. - What part of the cartridge it is responsible for that? " The plunger (I didn!t know that, but then he showed me one and it makes complete sense). - How much do you inject on the buccal? " about 3/4 of cartridge - Where do you inject in the palatal? " near the tooth, inltration - Why? " it is the place with more submucosa, so more comfort to the patient during injection - How much do you inject on the palatal? " less than the rest of the cartridge - How long does the injection takes to be effective? " less than 5 minutes usually - How to test numbness? " with any small instrument, inside the gums (that!s the way I do it, there might be a thousand different answers for that) - On the OPG, showed me some landmarks: glenoyd fossa, articular eminence, zygomatic arch, zygomatic process, posterior wall of the sinus, inferior border of the orbit, nasal septum, shadow of the spine in the lower jaw. - Pick the other instruments you want, names of them. " upper left hawk!s bill - Demonstrate the exo on the manikin. - Why are your ngers there? " give support, control my force, control the expansion

- You are extracting 26, what if 27 and 28 start to move together? What happened? " fracture of the tuberosity - What do you do? " put the tooth in the alveolus and splint from 28 to 24 or 23 - Which kind of splint? " rigid - For how long? " at least 4 weeks - How to do the exo then? " surgically - What to do now to relieve the patients pain? " get access to the pulp chamber and extirpate pulp Done with that part, now to case scenarios: 1 -Patient comes for extraction of lower molar, the crown is fractured, how to remove the tooth? " try cowhorn, if not done with it, section the roots - Would you section it? " yes - What is the direction of sectioning? " buccolingual - How many roots does it have? " 2 - Then how will you extract? " with root forceps or elevators 2 - A patient comes with infection on the upper jaw, what are the problems for us immediately doing exo? " it is a problem to give anesthesia, as blocks in the upper jaw are not usual, antibiotic cover should be considered - So is lack of profound anesthesia a problem for extraction? " yes, it is 3 - What are the indications of antibiotics in oral surgery? " joint prosthesis (he stopped me) - Why joint prosthesis? " in few, limited cases, to prevent infection - What if I come to you with a 12-year-old hip replacement, would you give me antibiotics? " no - What if the patients comes with a paper from the orthopedic surgeon saying he needs to take them? " I would call the surgeon and explain that there is no indication - On the phone, he told you he wants you to give antibiotics anyway, what do you do? " If the orthopedic surgeon held full responsibility for it, I would give them. - What are the other indications for antibiotics? " endocarditis prophylaxis - Why the endocarditis guidelines had changed? " it is not proven that the antibiotics would change anything - When have it changed? " in 2007 in America and 2008 in Australia - What are the conditions that you need to give antibiotics now? " Heart transplants with following valvulopathy, congenital heart defects in the rst 6 months after correction or forever if the defect is not completely repaired, in patients with previous endocarditis, in indigenous australians with rheumatic fever - Why indigenous australians?

" because they are immunosuppressed, they have malnutrition and are always more prone to infection (I didn!t know that, he told be all those things) - If your patient had an exo with you and is swollen in the next day, then goes to the GP and the GP tells him he needs antibiotics. What do you tell the GP on the phone? " that there is no indication of antibiotics in most oral procedures and that the swollen is due to trauma and will subside 4 - 60 year old guy comes to your clinic with ulcer on lower alveolar ridge, underneath his full denture. He is a smoker and drinker. What do you ask? " for how long it!s there? - It!s there for a month, what do you do? " check the denture - You can!t make sure that this is not from the denture, what do you do? " adjust the denture and wait at most a week to see if there is any difference - He comes back and it is still the same, what do you do then? " refer for biopsy because it is probably a squamous cell carcinoma - What are the types of biopsy? " incisional, excisional, aspiration, ne needle, smear and autopsy - What is the biopsy you would do in this case if you were a surgery resident in the hospital? " incisional - What to do with the specimen after you remove it? " put in formalin and send to the lab - Is there any other liquids where you can put it? Water, milk, whisky, alcohol? " no (he insisted in this question because he received specimens in all these weird things the last year) - How to deliver to the lab? " by courrier or in person - Can you put it in the post? " used to be legal, but not anymore - When they get the specimen in the lab, what they!ll do before they stain? " dehydration with alcohol, than include in parafn, cut thinly, stain - With what will they stain it? " hematoxylin and eosin - What is the overall management of oral cancer? " surgical resection, radiotherapy and sometimes chemotherapy - What are the problems with radiotherapy? " lack of saliva, hypovascularization of bone causing osteoradionecrosis if extractions are done after that - What if you need to do an extraction after radio, how to minimize risk? " hyperbaric oxygen therapy - How does that work? " inducing the formation of more vessels in the bone - What is the name of this process? " neoangiogenesisq 5 - Showed me some instruments. - rongeur. What is that for? " cutting bone after extraction - If you are removing 28, 27, 26, 25, 24 and 23 in the same day, would you remove all interdental septa with it? " no, don!t want to lose that much bone - Why not, that was used to be taught.

" we don!t want the patient to have a very thin alveolar ridge for any reason. (he then added exactly, we don!t want to age the patient 30 years in 5 minutes) . - coupland chisel. What is that for? " luxation, probably in a surgical extraction - Would you use it as a chisel? " no, despite of the name - Lower hawk!s bill. What is that for? " extraction of lower molars