DE5050

2.5 hours

The University of Manchester

Degree of BDS, Final Examination

Clinical Dentistry I

Wednesday 31st May 2006

9.45 to 12.15.

All questions should be answered. For each question you are provided with 5 possible
answers. You should select the most appropriate answer. There will be no penalty for
wrong answers.

Dark pencils only must be used on the answer sheets. To fill in the response you
should use a solid line within the bracket. If you change your mind or make a
mistake after having filled in a box you can correct mistakes by the use of an eraser.

The question paper must not be removed from the examination room. Failure to
submit all the pages of this document with your answer sheet will result in a mark of
zero.

________________________________________________________________

The use of electronic calculators is not permitted.

________________________________________________________________

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Q1 A 65 year old female presents at your surgery complaining of an extremely sharp pain of a
few seconds duration which arises whenever she touches an area of skin above the right hand
side of her upper lip adjacent to the angle of her mouth. The patient is fit and well and is not taking
any medication. You make a diagnosis of trigeminal neuralgia.

What is the drug of choice for treating trigeminal neuralgia in such a patient?

A. Carbamazepine
B. Oxcarbamazepine
C. Gabapentin
D. Phenytoin
E. Ibuprofen

Q2 A patient on examination was found to have swollen gingiva around a crown that had been
present for several years. The papillae were particularly enlarged.

What is the most important feature of a crown that may be responsible for this?

A. Material of the Crown

B. The occlusion
C. Proximal Contour
D. Labial Contour
E. Surface finish

Q3 A 13 year old girl presents with an unerupted permanent canine and a retained primary
canine. You cannot palpate the unerupted canine in the buccal sulcus and you are uncertain as to
whether it is displaced palatally or in the line of the arch.

Which single radiographic view would be most helpful in locating the unerupted tooth?

A. Bitewing
B. DPT
C. Lateral oblique
D. Single periapical
E. Upper anterior occlusal

Q4 A 30 year old man with unknown allergy to latex goes into anaphylactic shock whilst being
treated in the dental surgery.

Which drug and route of administration is of most benefit in this situation?

A. Hydrocortisone - orally
B. Chlorphenamine – intramuscularly
C. Chlorphenamine - orally
D. Epinephrine - intravenously
E. Epinephrine – intramuscularly

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Q5 A 62 year old female presents at your surgery complaining of a persistent, dull ache
affecting her upper left 4. The pain is present all the time but varies in its severity although the
patient cannot think of any exacerbating factors. It is not relieved by analgesics. Over the past 18
months the patient has had several teeth extracted from the upper left quadrant. Each extraction
brings about temporary relief of her symptoms only for them to recur in an adjacent tooth.

What is the most likely cause of the patient’s pain?

A. Acute/reversible pulpitis
B. Dentine sensitivity
C. Chronic/irreversible pulpitis
D. Atypical odontalgia
E. Trigeminal neuralgia

Q6 A 25 year old patient attends your surgery complaining of a swelling at the angle of the
mandible. A radiograph shows a uni-locular radiolucency associated with the crown of an
unerupted wisdom tooth.

Which of the following is the most likely diagnosis?

A. Radicular cyst
B. Dentigerous cyst
C. Lateral periodontal cyst
D. Ameloblastoma
E. Odontogenic keratocyst

Q7 A 70 year old female, who suffers with persistent looseness of her lower complete denture, is
considered for implants. She will require radiological evaluation of the potential implant sites.

Which would be the most appropriate radiological investigation at this stage?

A. MRI scan of the mandible

B. CT scan of the mandible
C. Periapical radiographs of the mandibular anterior region
D. True lower anterior occlusal view
E. Panoramic radiograph

Q8 Six months ago you saw a child patient, then aged 9 years. His upper right maxillary
canine was palpable in the labial sulcus but the upper left was not. The situation is now
unchanged, so you have taken two periapicals of the non-palpable tooth. They both show that
there is some resorption of the C| root but the permanent canine appears somewhat mesially
angled and is more mesial on the more mesially positioned film.

What is your the best course of action?

A. Keep a careful watch on it and take another x-ray in 6 months.

B. Refer to an oral surgeon for early exposure of the permanent canine.
C. Refer to an oral surgeon for early removal of the permanent canine before it
damages the lateral incisor.
D. Refer to an orthodontist for a treatment plan.
E. Wait and watch’ until the child is 11.

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Q9 An apical radiolucency (2mm) is noticed as an incidental radiographic finding associated
with the apex of the mesiobuccal root of the lower right first molar. The tooth has been root filled
but is 2mm short of the radiographic apex. There are no other clinical or radiographic findings and
the patient is fit and well.

What is the most appropriate course of action?

A. Extract the tooth.

B. Redo the root filling
C. Perform periapical surgery.
D. Advise the patient of the situation and monitor clinically and radiographically
E. Prescribe antibiotics then review

Q10 A 60 year old female attends your surgery complaining of soreness affecting her gingivae.
No other area of her oral mucosa is affected, she has no skin lesions and other mucosal surfaces
do not appear to be affected. She is fit and well and is not taking any medication. On examination
intra-orally a desquamative gingivitis is present. Your differential diagnosis lies between lichen
planus and mucous membrane pemphigoid. You carry out an incision biopsy and send the fresh
tissue to the laboratory without putting it into formalin.

What procedure, performed on sections of fresh frozen tissue, do you expect the histopathology
department to perform in addition to conventional staining with haemotoxylin and eosin?

A. Indirect immunofluorescence
B. Direct immunofluorescence
C. Papanicolaou (PAP) staining
D. Periodic acid Schiff (PAS) staining
E. Immunoperoxidase staining

Q11 A 43year old patient is missing on the upper right the first premolar and molar. He has
good oral hygiene and requests a fixed replacement for these teeth. The other teeth on the same
side are all moderately restored with MOD amalgam restorations and are vital, except the canine,
which has a very large restoration and is root-filled. He has group function. Radiographs show a
large sinus cavity and no peri-apical pathology.

What would be the restoration of choice for replacement of the missing teeth?

A. Implant supported crowns

B. A conventional fixed bridge using the 7 and 5 as abutments
C. Two conventional cantilevered bridges, using the 7 and 3 as abutments
D. A resin-bonded bridge, using the 7 and 5 as abutments
E. A conventional fixed-moveable bridge using the 7 and 5 as abutments

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Q12 Epidemiological studies have shown that dental decay is normally greater
amongst northerners and those in socially deprived circumstances.

Which of the following would be most effective in reducing caries in a high risk
population?

A. Brushing with fluoride toothpaste

B. Publicity campaign
C. Fluoridation of the water supply
D. Dietary advice via schools
E. Fissure sealant provision

Q13 A 58 year old male presents at your surgery complaining of a sharp pain of no more than
30 minutes duration arising from his upper left molar region. The pain is brought on by cold
stimuli but persists after the stimulus is removed. It does not seem to occur spontaneously. He
has tried taking paracetemol and this does temporarily stop the pain from recurring. The upper
left 6 reacted to a lower current on electronic pulp testing than the upper right 6, upper left 7 or
the lower left molars.

What is the most likely cause of the patient’s pain?

A. Acute/reversible pulpitis
B. Dentine sensitivity
C. Chronic/irreversible pulpitis
D. Periapical periodontitis
E. Trigeminal neuralgia

Q14 A 60 year old patient attends your surgery complaining of a sore mouth. He has Type II
diabetes well controlled by diet and metformin. On examination white patches which cannot be
removed are present on his buccal mucosa.

What is the most likely diagnosis?

A. Frictional keratosis
B. Leukoplakia
C. Lichen Planus
D. White sponge naevus
E. Candidosis

Q15 Bruxism is a common form of parafunctional activity of which the patient may or may not
be aware. It may be important in the development of a treatment plan to determine whether the
patient is an active bruxist.

The principle clinical sign of active bruxism is:

A. Head and / or neck pain

B. Excessive tooth wear
C. Temporomandibular joint clicking
D. Sensitive teeth
E. Cheek ridging and tongue scalloping

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Q16 A 60 year old female attends your surgery complaining of soreness affecting her gingivae.
No other area of her oral mucosa is affected but she has noticed an itchy rash on the flexor
surface of her forearms. She is fit and well and is not taking any medication. Scattered
purple/red papules each about 4mm in greatest dimension are present on the flexor surface of
her forearms and on intraoral examination a desquamative gingivitis is present.

Based on the above findings what is your diagnosis?

A. Mucous membrane pemphigoid

B. Lichen planus
C. Pemphigus vulgaris
D. Erythema multiforme
E. Lichenoid drug reaction

Q17 An 80 year old patient presents with an ulcer in the floor of the mouth. This has been
present for several months and has not responded to conventional treatment. An incisional
biopsy is taken.

Which of the following histological changes in the epithelium confirm a diagnosis of squamous
cell carcinoma?

A. Hyperkeratosis
B. Acanthosis
C. Dysplasia
D. Invasion
E. Discontinuous epithelium

Q18 A 35 year old patient complains of swollen gums. This has been present for several
years.

What is the commonest cause of this complaint?

A. Cyclosporin therapy
B. Vitamin C deficiency
C. Chronic Gingivitis
D. Atenolol therapy
E. Pregnancy

Q19 A 45 year old patient attends the dental clinic complaining of a clicking jaw.
Examination reveals a reproducible click of the right TMJ when opening wide. Upon
asking the patient to open wide, close with incisors edge-to-edge and then open and
close to this position, the click is absent.

From the options below, which one is the most likely diagnosis?

A. Myofascial pain
B. Disc displacement with reduction
C. Disc displacement without reduction
D. TMJ osteoarthritis
E. Arthralgia

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Q20 Cigarette smoking is considered to be the most important factor next to microbial
plaque in periodontal disease progression.

Which of the following is the most important factor in the disease progression in smokers?

A. Smokers have drier mouths than non-smokers

B. Smokers have poorer oral hygiene than non-smokers.
C. Nicotine will impair the chemotactic and phagocytic properties of PMNs.
D. The gingival blood flow is reduced in smokers.
E. Smokers alter the oral environment encouraging the growth of anaerobic
bacteria

Q21 An adult patient attends your practice complaining of pain and swelling associated with a
previously restored upper first premolar tooth. The pain has been present for a number of days and
is no longer responding to analgesics. His dentition is otherwise well maintained and his
periodontal health is good.

What is the most appropriate approach to treatment?

A. Antibiotics and analgesics.

B. Extract the tooth
C. Carry out a pulpotomy. Temporary dressing.
D. Carry out a pulpectomy. Temporary dressing
E. Establish open drainage

Q22 A patient reports that his post crown has fallen out. This crown had been
present for many years. You note that there appears to be a hairline vertical
fracture of the root. The tooth is symptomless.

What is the most sensible approach to treatment?

A. Replace the post crown using a resin-reinforced glass ionomer material

B. Replace the post crown using a polycarboxylate cement
C. Replace the post crown using a dentine bonding agent and a resin-
reinforced glass ionomer material
D. Replace the post crown using a resin composite luting agent
E. Arrange to extract the tooth

Q23 A patient says that he does not like the appearance of his previously root filled upper central
incisor tooth. His dentition is otherwise well maintained and his periodontal health is good. The
tooth appears to be darker than the adjacent teeth.

What is the most appropriate approach to treatment?

A. Provision of a post crown

B. Provision of an all ceramic crown
C. Provision of a metal bonded to ceramic crown
D. Carry out a non vital bleaching procedure
E. Provision of a porcelain veneer

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Q24 A 20 year old patient attends your surgery for the first time. You suspect that he may have
proximal caries as he has a frequent sugar intake.

Which of the following is the most accurate method of diagnosing proximal caries in a lower molar
tooth in this young adult?

A. Clinical history
B. Periapical radiograph
C. Bitewing radiograph X
D. Digital image
E. Electronic resistance measurements

Q25 A 25 year old male attends for the first time complaining of sensitivity of a number of teeth.
On examination, the occlusal surfaces of all the teeth are worn with obvious wear facets on the
canines and premolars. Posterior amalgam restorations are proud of the surrounding tooth.

What would be the first stage management?

A. Take impressions for study models

B. Prescribe fluoride mouth rinse
C. Replace the amalgam restorations
D. Dietary analysis
E. Placement of resin sealant to sensitive teeth

Q26 A 35 year old male patient who admits to grinding his teeth at night has a number of wedge-
shaped cervical (Class V) lesions on his upper premolar teeth. These are causing some sensitivity
and are approximately 3mm deep.

What is the correct management option?

A. Provide tooth brushing instruction and fluoride

B. Restore the lesions with compomer
C. Restore the lesions with micro-filled composite
D. Restore the lesions with a hybrid composite
E. Restore the lesions with conventional glass-ionomer

Q27 A patient attends with pain of four days duration in a carious upper molar tooth.
The pain is constant and is not relieved by paracetemol. Sleep has been disturbed
by the pain. The tooth is tender to percussion and gives a positive response to Ethyl
Chloride.

What is the most likely diagnosis?

A. Pericoronitis
B. Apical periodontitis
C. Marginal periodontitis
D. Reversible pulpitis
E. Irreversible pulpitis

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Q28 You are trying in a partial chrome denture framework which fails to seat
properly. It fits the master cast.

What is the most likely cause of this problem?

A. Insufficient expansion of the investment material

B. Distortion of the impression
C. Contraction of the metal framework during casting
D. Failure to block out unwanted undercuts
E. Complex denture design

Q29 Bitewing radiography is the main special text used to help in diagnosis of
proximal caries. The performance (accuracy) of a diagnostic test like bitewing
radiography can be expressed in terms of sensitivity and specificity.

Which of the following is a reasonable summary of the diagnostic accuracy of bitewing radiography
for proximal caries diagnosis?

A. Moderate sensitivity and low specificity

B. Moderate sensitivity and moderate specificity
C. Moderate sensitivity and high specificity
D. High sensitivity and moderate specificity
E. High sensitivity and high specificity

Q30 You are interested in finding out what the risk indicators are for a rare form of oral cancer
and decide to undertake a study to examine this.

What type of study would be the most appropriate for addressing this issue?

A. Cohort
B. Prevalence study
C. Clinical trial
D. Case-control study
E. Case-series

Q31 You take a panoramic radiograph of a patient and discover a well-defined, corticated
radiolucent area below the inferior dental canal just anterior to the mandibular angle.

What is the most likely diagnosis?

A. Radicular cyst
B. Stafne bone cavity
C. Metastatic carcinoma of the breast
D. Adenomatoid odontogenic tumour
E. Complex odontome

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Q32 You take a panoramic radiograph out of a patient’s records but you find that
the film has a low density and poor contrast.

Which of the following errors could lead to low density and poor contrast?

A. Too long a development time

B. Developer temperature too high
C. Developer temperature too low
D. Inadequate fixation
E. Poor film storage after processing

Q33 You want to evaluate the effectiveness of using tetracycline as an adjunct to scaling and
root planing for the treatment of chronic periodontitis.

What type of primary study design would be most appropriate for addressing this topic?

A. Cohort study
B. Non-randomised controlled trial
C. Randomised controlled trial
D. Case-control study
E. Case-series

Q34 Radiation protection of patients is partly dependent upon equipment factors (x-
ray set and film or digital system). The different factors that can be changed vary in
financial cost to the dentist and in their effectiveness in cutting x-ray dose.

Which of the following provides the most cost-effective means of minimizing patient
radiation dose in dental intraoral radiography?

A. Constant potential (‘DC’) x-ray set

B. Rare earth filtration
C. Lead apron
D. D speed film
E. F speed film

Q35 A 42 year old man presented with a firm fixed swelling in the right preauricular region which
had been enlarging over the last month. He had also developed a right sided facial palsy.

What is the most likely diagnosis?

A. Adenoid cystic carcinoma

B. Squamous carcinoma
C. Sebaceous cyst
D. Branchial cyst
E. Pleomophic adenoma

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Q36 A 14 year old patient attends with a decayed and extensive hypoplastic LL7. He is a very
irregular attender with poor oral health habits. A radiograph shows the presence of an unerupted
LL8 and the LL6 is sound.

What would be the most appropriate long-term treatment for this tooth?

A. Amalgam restoration
B. Antibiotics
C. Extraction
D. Root canal therapy
E. Sedative dressing

Q37 A 7 year old boy has previously had all primary molars restored and a pulpotomy on upper
right E. He has an early mixed dentition with lower lateral incisors erupting. There is a midline
diastema of 2 mm. The upper right E has become symptomatic and requires extraction.

The most likely long term effect of the extraction on the occlusion is:

A. Early eruption of the second premolar.

B. Loss of upper central line.
C. No significant effect.
D. Overeruption of the lower right teeth.
E. Potential crowding in the upper right quadrant

Q38 An eight year old boy presents with an anterior crossbite involving upper right 1 and lower
right 1. There is labial attrition on the upper right 1 and a mandibular displacement of 2mm.

What component of your upper removable appliance would you use to correct the position of the
upper right 1?

A. Adam’ clasp
B. T spring
C. Palatal finger spring
D. Southend clasp
E. Labial bow

Q39 A 12 year old patient presents with bilateral crossbite and asymmetric increased overjet,
with incomplete overbite.

What is the most likely causative factor?

A. Lower lip resting between upper and lower anterior teeth.

B. Nail-biting.
C. Persistent digit-sucking habit.
D. Tongue thrust on swallowing.
E. Use of a ‘dummy’ or comforter as an infant.

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Q40 Membranes of expanded polytetrafluorethylene have been designed for periodontal
regenerative techniques.

Which of the following defects will respond most predictably to regenerative therapy?

A. Shallow, wide 1-wall defect

B. Shallow, wide 2-wall defect
C. Deep, narrow 3-wall defect
D. Deep narrow 1-wall defect
E. Shallow, narrow 2-wall defect

Q41 Hamp (1975) classified furcation defects as degree I, II or III.

Which of the following is the ideal treatment for a degree II furcation involvement of a mandibular
molar?

A. Tunnel preparation
B. Root resection
C. Furcation plasty
D. Extraction
E. Guided Tissue Regeneration

Q42 You examine a patient and find BPE code 4 in all sextants. Radiographs show generalised
horizontal bone loss with a minimum of 50% of bone support remaining on all teeth.

Which of the following is the most important factor when considering the prognosis for the teeth?

A. Age of the patient

B. The Oral Hygiene Status
C. Bleeding on Probing Score
D. Mobility
E. Gingival Recession

Q43 A 30 yr-old patient attends complaining of occasional pain from the lower left quadrant.
Clinical examination reveals an extensively restored dentition with generally good oral hygiene.
There is no significant periodontal pocketing other than an isolated defect in the region of the
furcation of lower left first molar which is non-mobile. The gingival tissue in this area appears
erythematous and slightly hyperplastic with a purulent exudate on probing.

From the list below, which is the most appropriate next step?

A. Obtain a radiograph
B. Biopsy the gingival tissue
C. Remove the restoration
D. Vitality testing
E. Prescribe antibiotics

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Q44 A 40 yr old patient had root-canal treatment to his upper first molar. This was performed 6
months ago using contemporary techniques under rubber dam and was crowned after completion
of treatment. He attends complaining of continued discomfort from this tooth. Radiographic
examination shows each of the three roots to be obturated with a well-condensed filling to the full
working length though there is no evidence of in-fill of the periapical lesion when compared to the
pre-op view. There is crestal bone loss and no furcal involvement.

What is the most likely cause of the continued problem?

A. Extra-radicular infection
B. Contamination of canal(s) with E.faecalis
C. Uninstrumented canal
D. Vertical root fracture
E. Perio-endo problem

Q45 A mother is concerned that her child’s adult upper front teeth have not erupted and asks
your advice.

What is the usual age in years for the upper permanent central incisors to erupt?

A. 5 years.
B. 6 years.
C. 7 years.
D. 8 years.
E. 9 years.

Q46 You decide to refer an eight year old child to the oral surgery department in your local
hospital for extractions under a general anaesthetic.

What key reason for asking for a general anaesthetic would you put in the referral letter?

A. Parents request GA.

B. Failed to complete treatment under inhalation sedation.
C. Child would not accept local analgesia
D. Parents think hospital more convenient.
E. Not one of my regular patients.

Q47 An eight-year-old boy presents with pain of three days duration that has kept him awake.
On examination you see a grossly carious lower left 6 and some associated buccal swelling.

Which of the following is the most appropriate to give immediate relief of his pain?

A. Extract the LL6.

B. Gently excavate the caries and obtain drainage.
C. Give antibiotics.
D. Incise any swelling
E. Refer for general anaesthetic

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Q48 A 10 year old girl tripped and knocked out her upper incisor 10 minutes ago. She is holding
it in her hand.

What is your most effective immediate treatment?

A. Accept the tooth is lost and do nothing.

B. Refer to specialist.
C. Re-plant immediately.
D. Root fill, clean and re-plant.
E. Sterilise root in alcohol and re-implant.

Q49 You are treating a patient who has a long history of recurrent episodes of oral candidosis.
His mouth has recently become sore once again and you want to prescribe some antifungals for
him. You check his medical history and find that he suffers from atrial fibrillation and is taking
warfarin.

Which of the following drugs would be most appropriate to treat this patient’s candidosis?

A. Metronidazole
B. Nystatin
C. Fluconazole
D. Miconazole
E. Amoxycillin

Q50 A dental company has claimed that ozone is better than conventional methods for treating
decay in peoples’ mouths.

Which of the following would provide the best evidence to support these claims?

A. Systematic review of Randomised Controlled Trials

B. Randomised controlled trial
C. Cohort study
D. Case/control study
E. Anecdotal evidence

Q51 Page and Schroeder (1976) in their description of the pathogenesis of periodontal disease
described four stages in the process, the initial, early, established and advanced lesion.

Which of the following is the main feature defining the early lesion?

A. Emigration of the phagocytes through the junctional epithelium.

B. Presence of lymphocytes which are mainly T cells
C. Increase in crevicular fluid.
D. Predominance of plasma cells and B lymphocytes
E. Proliferation of the junctional epithelium.

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Q52 A GDP in Manchester randomly selects 5000 patients, aged between 45 and 55 years, who
are free from periodontitis. He determines that 300 of them are smokers. He follows all 5000
patients for 10 years, by which time 150 had developed periodontitis. Of the patients with
periodontitis, 60 had previously been identified as smokers and 90 as non-smokers.

What type of study is this?

A. Case-series
B. Prevalence study
C. Clinical trial
D. Case-control study
E. Cohort

Q53 Randomised controlled trials enable us to establish cause and effect.

The main reason for using this study design is to:

A. Ensure that making a Type II error is minimised.

B. Ensure that test and control groups are similar.
C. Ensure that test and control groups are of equal size.
D. Help recruitment of patients into the trial.
E. Provide sufficient power for the study.

Q54 You identify a research paper that examines the effectiveness of a new drug (Drug A) for the
prevention of recurrent migraines. The study randomises 40 patients (20 to each group) to receive
either Drug A or the current standard treatment. Following 8 weeks of treatment the number of
patients who have had a migraine in each group is recorded. Four patients receiving Drug A have
a migraine compared to six patients receiving standard treatment.

What do the results tell you about the risk of migraine in patients receiving Drug A?

A. The risk is 0.2

B. The risk of migraine is greater for those receiving Drug A
C. The risk is 0.3
D. There is insufficient information to calculate the risk
E. The risk is 4/40

Q55 A 53 year old male patient presents with an asymptomatic white patch on the
ventral surface of his tongue. He has smoked 35 cigarettes a day since he was 17.

An incisional biopsy of the white patch is likely to show which histological feature:

A. Basal cell liquefaction

B. Hyperkeratosis
C. Saw tooth rete ridges
D. Acantholysis
E. Basal cell hypoplasia

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Q56 A 46 year old female presents with a slowly enlarging painless firm swelling in
the hard palate to the left of the midline.

The most likely diagnosis is:

A. A dental abscess
B. Torus palatinus
C. Osteoma
D. Pleomorphic adenoma
E. Canalicular adenoma

Q57 A 29 year old man has a prosthetic (mechanical) aortic valve. He had
bacterial endocarditis five years ago. He now requires removal of his upper and
lower right third molars.

Which antibiotic prophylaxis is recommended prior to the procedure?

A. Amoxicillin and clindamycin

B. Metronidazole and cephalexin
C. Amoxicillin and gentamycin
D. Amoxycillin and vancomycin
E. Erythromycin and vancomycin

Q58 A patient presents for their first appointment with you. He has complete
dentures. He has worn upper dentures for 30 years and the lower complete for just
3. Prior to this he had the lower premolar – premolar teeth and did not use the lower
denture supplied to him. Unusually the patient is happy with the lower denture but
the upper is causing considerable problems, especially with regard to retention. After
your examination you determine that the patient has a flabby anterior ridge and this
seems to be the source of many of the problems.

How will you deal with this problem?

A. Surgical excision of the flabby portion of the ridge using an atraumatic

technique
B. A selective pressure impression at the secondary impression stage
C. A highly muco-compressive impression to flatten the ridge and improve
retention
D. Cut a window in the finished denture to allow the ridge to protrude through
unhindered
E. A highly muco-static impression at the primary impression stage to allow
the ridge to be recorded at rest, followed by a normal impression at the
secondary stage

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Q59 A 24 year old man presents with a loculated cystic radiolucency in the lower
third molar area approximately 3cm in diameter. There is no tooth associated with the
cyst and there is no bucco-lingual expansion of the mandible. There is no resorption
of the roots of the overlying second molar tooth.

How would this be treated?

A. Marsupialisation
B. Enucleation and ethyl chloride
C. Block resection
D. Enucleation and Carnoy’s solution
E. Enucleation and formalin solution

Q60 A 21 year old female presents for the first time to your practice. She is very upset with the
appearance of her upper left central incisor. On examination you find healthy oral hard and soft
tissues and excellent oral hygiene. On close examination you can see that the upper left central
incisor is slightly greyer than the upper right central incisor and has a composite restoration placed
palatally.

What is the most appropriate form of treatment given the information you have?

A. Bleaching with carbamide peroxide in custom formed trays of upper and lower
arches
B. A bonded crown
C. A composite veneer
D. A porcelain veneer
E. Non-vital bleaching with carbamide peroxide

Q61 EDTA (ethylene diamine tetra-acetate) has useful roles in certain situations in clinical
dentistry.

When would you use EDTA?

A. As a root end filling material

B. As a pulp capping agent
C. As a root canal chelating agent
D. As a mouthwash
E. As a dentine bonding agent

Q62 A patient presents with a history of clicking from their temporomandibular joint. This click
occurs mid way through the opening cycle and is consistent. There is some pre-auricular pain and
the lateral pterygoid muscle on the affected side is tender to resisted movement test. There is no
trismus and the click is not present when the patient opens from an incisor edge to edge
relationship, instead of her normal Class I occlusion. The patient would like treatment.

The most appropriate occlusal splint for this patient would be:

A. Stabilisation splint
B. Localised Occlusal Interference Splint
C. Bite Raiser
D. Soft Bite Guard
E. Anterior Repositioner Splint

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Q63 Glass ionomer cements are used in restoring Class V cavities.

Which of the following constituents are most likely to be present in glass ionomer
cements?

A.. Alumino-silicate glass and phosphoric acid

B. Phosphoric acid and zinc oxide
C. Polyacrylic acid and zinc oxide
D. Aluminosilicate glass and polyacrylic acid
E. Itaconic acid and zinc oxide

Q64 A manufacturer’s representative proves to you that a device has a high sensitivity in
detecting enamel caries.

Which of the following statements best describe the device?

A. The device is good at detecting caries when it is truly present

B. The device tends to detect caries when it is not present
C. The device is good at detecting the absence of caries when there is truly no
caries present.
D. Statements about the sensitivity of the device in detecting caries are
meaningless
E. Sensitivity and specificity of the device in detecting dentinal caries will be the
same.

Q65 A patient presents with a history of a post-crown having fallen out. The post-
crown was originally placed fifteen years ago and had been successful up until four
months ago since when it has come out and been recemented four times. At
recementation there was no evidence of any caries. The patient had been a regular
attender and not needed any restorative treatment for the last eight years.

Which of the following is the most likely cause for the failure of this crown?

A. The post was to narrow

B. The post was to short.
C. The root canal treatment was failing.
D. A vertical root fracture was present.
E. There were excessive occlusal loads on the tooth.

Q66 In dental epidemiology, indices are used to measure the oral health of a
population. The DMF index is commonly used to measure the prevalence and
severity of dental caries.

What is the main limitation of this approach?

A. It does not allow statistical analysis.

B. It gives equal weight to decayed, missing and filled teeth.
C. It is difficult to calibrate examiners.
D. It is reversible.
E. There is no gold standard

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Q67 “The biological process by which the architecture and function of the lost
tissue is completely restored”.

In Periodontology this is a definition of which of the following

A. New Attachment
B. Regeneration
C. Repair
D. Primary Healing
E. Reattachment

Q68 There has been much debate regarding the effectiveness of fluoride in water
for preventing tooth decay. A systematic review of the evidence drew conclusions
as to the reductions in decay which can be expected.

Fluoridation of public water supplies:

A. Reduces tooth decay by 10%.

B. Reduces tooth decay by 20%.
C. Reduces tooth decay by 30%.
D. Reduces tooth decay by 40%.
E. Reduces tooth decay by 50%.

Q69 An obese 40 year old who takes metformin is seen at the end of a morning
clinic. After administration of local analgesia in the supine position the patient
complains of feeling unwell. She is pale and sweating and is confused. No pulse
was detectable. She was given oxygen and maintained in the supine with no
improvement in condition.

What would be the most appropriate drug to administer next?

A. Glucagon
B. Glucose
C. Adrenaline
D. Hydrocortisone
E. Chlorphenamine

Q70 A 12 year old boy is brought in by his mother who is concerned about the
appearance of his central and lateral maxillary incisors. She says they look like
they might be decayed. They are a new family to the practice having recently
moved to the area from Birmingham. On examination you notice a generalised
whitening of the incisors which seems to worse at the incisal edges. After you
have dried the teeth you notice that the whiteness appears to be linear running
from mesial to distal. There is a similar pattern on the lower incisors.

What is the most likely explanation for the presentation of the boy’s incisors?

A. Tetracycline staining
B. Early caries (white spots)
C. Fluorosis
D. Demarcated Enamel Opacities
E. Previous treatment with composites

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Q71 A 23 year old patient attends complaining of pain in an upper right molar
and is keen to keep the tooth. The pain is typically sharp in nature, is triggered by
cold and persists after removal of the cold stimulus. The tooth is not tender to
percussion; a radiograph of the upper right first molar shows a large radiolucency
extending to the pulp horn but no peri-radicular changes.

What treatment is most likely needed in this case?

A. Oral hygiene instruction and fluoride application

B. Excavation of caries and placement of a permanent restoration
C. Root-canal treatment
D. Indirect pulp cap and restoration
E. Direct pulp cap and restoration

Q72 A child of 5 years attends with pain from a grossly decayed lower right D
which has a discharging sinus. He is a hemophiliac.

Which of the following is the most appropriate treatment to relieve his pain?

A. Antibiotics
B. Extraction
C. Fluoride application
D. Non-vital pulpotomy
E. Vital pulpotomy

Q73 You are designing a partial denture for a patient with several missing teeth in
the maxilla.

The reason for surveying the model prior to designing the denture is to:

A. Measure and mark out hard and soft tissue undercuts on the casts
B. Relate the intended position of the inter-papillary plane of the patient to
the casts
C. Establish the position of the post dam
D. Relate the maxillary and mandibular casts
E. Aid setting up the prosthetic teeth prior to trial insertion

Q74 The parotid gland is one of the major salivary glands that supply the oral cavity.

Where is the orifice of the duct of the parotid gland located?

A. At the hamular notch

B. In proximity to the incisive papilla
C. On the buccal mucosa near the maxillary second molar
D. Slightly posterior to the mandibular central incisors
E. Distal to the maxillary third molars on the palatal side

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Q75 Any patient receiving treatment under IV sedation must have their blood
pressure recorded as part of their assessment.

What is the maximum blood pressure that is generally regarded as being

compatible with safe sedation in general dental practice?

A. 160/95
B. 140/95
C. 160/90
D. 170/100
E. 120/80

Q76 A 13 year old boy with Down’s syndrome attends for the first time. He is
cooperative and has no relevant medical history. He is caries free, apart from two
small occlusal cavities in his lower second primary molars. His mother requests
that these teeth are restored.

Which of the following is the most appropriate management?

A. Arranging to extract these teeth at a future visit.

B. Arranging to place two simple restorations at a future visit.
C. Reassurance that these teeth can be left until they exfoliate naturally,
with no treatment being necessary.
D. Recommending use of fluoride mouthwash.
E. Take DPT to check on unerupted teeth.

Q77 A 3 year old child attends, showing evidence of bottle caries and also decay affecting
primary molars. The child’s mother has heard that some sugars are damaging her child’s teeth.
She is not sure which foods to avoid.

From the following, which are you most likely to suggest she avoids?

A. Bread
B. Cheese
C. Ground almonds
D. Pure fruit juices
E. Whole fruits and vegetables

Q78 An adult patient complains of her prominent upper front teeth and receding chin. She says
she did not get ‘braces’ when she was younger because the family had to move area a lot. Her
oral care and health is good, and she has a 9 mm overjet.

Where is the most suitable place to refer her?

A. A GDP friend who has a special interest in orthodontics and has been trained
to use fixed appliances.
B. A specialist practitioner who uses a lot of functional appliances.
C. A private specialist practitioner, because she’s too old to get NHS treatment
now.
D. A hospital consultant, as it is likely she will need surgery now to correct her
problem.
E. The nearest dental hospital, although it is 70 miles away.

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Q79 You are meeting a three year old patient for the first time. His mother explains
that he had a unilateral cleft lip and palate that was repaired in infancy. She has
heard that orthodontics will usually be required when he is older. She asks you what
is the commonest orthodontic problem that occurs with a repaired cleft palate.

What is the most appropriate answer?

A. A contracted maxillary arch

B. An anterior open bite.
C. An elongated maxillary arch.
D. An expanded maxillary arch.
E. An increased overjet

Q80 Chronic periodontitis is a disease of the periodontium initiated and sustained by microbial
plaque.

Which of the following is the main diagnostic feature of the disease?

A. Tooth Mobility
B. Loss of attachment
C. Pain
D. Gingival recession
E. Drifting

Q81 Gingivitis and periodontitis are associated with the loss of normal tissue.

Which of the following is the principal cause of the tissue loss?

A. Bacterial enzymes such as collagenase and hyaluronidase

B. Release of lysosomal enzymes and oxygen free radicals by PMNs and
macrophages
C. Cytotoxic metabolic by products such as ammonia, hydrogen sulphide and
toxic amides
D. Complement activation
E. Release of bacterial endotoxins and exotoxins.

Q82 Localised gingival recession is recession of the gingiva confined to one surface of the tooth.

Which of the following is the most important factor leading to the development of localised gingival
recession?

A. Habit activity.
B. Class 2 division 2 malocclusion with complete overbite
C. Excessive toothbrushing
D. Bony dehiscence
E. Fenestration

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Q83 A 48 year old woman complains of a sore area on the right buccal mucosa
adjacent to a restored tooth. The lesion has a lichenoid appearance and this is
confirmed histopathologically following a biopsy.

Which of the following restorative materials is most frequently associated with

lichenoid changes.?

A. Gold
B. Amalgam
C. Porcelain
D. composite
E. Glass ionomer cement

Q84 A patient attends your surgery complaining of severe pain, swelling and mobility associated
with a lower first molar tooth in which there is a broken filling. A periapical radiograph indicates that
the tooth has not been root filled and there is loss of apical lamina dura associated with the distal
root and at the bifurcation. The periodontal bone support is good. There is no significant pocketing.

What is the likely diagnosis?

A. Chronic periapical periodontitis

B. An acute periodontal-endodontic periodontitis
C. A chronic periodontal-endodontic periodontitis
D. An acute periapical periodontitis
E. Pararadicular periodontitis

Q85 An upper incisor in a 16 year old patient has suffered trauma and the coronal tissue has
been lost. The tooth has been endodontically treated.

How is the tooth best restored?

A. With a fibre post, direct core and crown.

B. With a direct core and crown.
C. With composite
D. With an indirect post-core from a pre-fabricated pattern and a crown
E. With a custom indirect post-core and crown

Q86 A 55 year old female presents at your surgery complaining of a sharp pain of no more than
a few minutes duration arising from her lower incisors. The pain only occurs when she eats or
drinks cold or sweet foods and only lasts for as long as the stimulus is present. A previous dentist
applied a varnish to the teeth affected which seemed to help. The teeth indicated by the patient
appear healthy but when you blow air onto them the patient experiences the pain.

What is the most likely cause of the patient’s pain?

A. Acute/reversible pulpitis
B. Dentine sensitivity
C. Chronic/irreversible pulpitis
D. Atypical odontalgia
E. Trigeminal neuralgia

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Q87 As a newly qualified dentist you are offered a contract in which remuneration is on capitation
basis.

What is the most important and well-recognised feature of this method of remuneration?

A. Tends to encourage under-prescribing

B. Tends to encourage high technical quality of work
C. Tends to encourage high output of procedures
D. Tends to encourage over-prescribing
E. Tends to encourage low technical quality of work

Q88 A 50 year old male patient has a Class III jaw relationship with an anterior open bite. It is
planned to restore his lower right second molar, which has suffered tooth wear and fracture, with
an indirect restoration. This tooth has approximately 2mm of coronal height.

What would be the most suitable approach to restore this tooth?

A. Provide an adhesively retained gold onlay

B. Provide a conventional full crown
C. Increase the vertical dimension and provide a full crown
D. Surgically crown lengthen and provide a gold crown
E. Provide an adhesively retained ceramic onlay

Q89 Gracey curettes are specially designed for subgingival debridement and are site specific.

Which curette is recommended for use on the lingual surface of a lower second molar?

A. Gracey Curette number 1 and 2.

B. Gracey Currette number 3 and 4
C. Gracey Currette number 7 and 8.
D. Gracey Currette number 11 and 12.
E. Gracey Currette number 13 and 14.

Q90 Lignocaine (2%) is widely used in dental procedures. It is most often used in combination
with epinephrine (1 in 80,000).

In which one of the following patients is the use of epinephrine containing local analgesia
potentially hazardous?

A. Patient with severe hypertension

B. Patient on tricyclic antidepressants
C. Patient who is an alcoholic
D. Patient on monoamine oxidase inhibitors (MAOIs)
E. Patient with Grand Mal epilepsy

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Q91 An 80 year old male presents at your surgery complaining of a sharp stabbing pain of no
more than 2-3 minutes duration arising from his upper left pre-molar region. The pain can be
brought on by cold stimuli but also occurs spontaneously and has been sufficiently severe to wake
the patient from sleep. He has tried taking paracetemol but this has been of no benefit. On
examination the patient has a heavily restored upper left 4, which is vital to electrical pulp testing
and shows no radiographic evidence of caries. Blowing cold air onto the tooth produces the pain
but the pain also occurs spontaneously when you are examining the patient. There is no evidence
of a crack or fracture in the tooth itself.

What is the most likely cause of the patient’s pain?

A. Acute/reversible pulpitis
B. Dentine sensitivity
C. Chronic/irreversible pulpitis
D. Atypical odontalgia
E. Trigeminal neuralgia

Q92 A patient complains of a lower incisor which has been mobile for several months. The
radiograph indicates a normal level of bony support although the periodontal space has widened.
The apical bone appears normal. The tooth is tender to pressure.

Which of the following tests and or examinations would be most likely to provide a diagnosis?

A. Masticatory muscle palpation

B. Electric pulp test
C. Occlusal examination
D. Ethyl chloride test
E. Hot gutta percha application

Q93 A nine year old boy presents with a class I occlusion with no crowding or overjet with a
grossly carious upper left 6 which is not suitable for restoration. The upper left 7 is very near to
eruption. Upper right 6, lower right 6 and lower left 6 are sound and fissure sealed. The oral
hygiene is good.

What is the most appropriate extraction pattern for this patient?

A. Extract all four 1st permanent molars

B. Extract upper left 6 and lower left 6
C. Extract upper left 6 and lower right 6
D. Extract upper right 6 and upper left 6
E. Extract upper left 6 only

Q94 A new patient attends your practice. At the initial examination, you carry out a Basic
Periodontal Examination (BPE).

What does a BPE score of 1 signify?

A. Periodontal health
B. Probing depths greater than 3.5mm
C. Presence of overhanging restorations
D. Presence of supragingival calculus
E. Presence of bleeding on probing

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Q95 A patient presents with a history of pain in the right pre-auricular region. There is an
intermittent click during opening; when the click is not present the patient can open to a normal
range. On examination the masticatory muscles, including the lateral pterygoid, on the RHS side
are tender.

What is the most likely diagnosis?

A. Bruxism
B. Myofascial pain (or Pain dysfunction syndrome)
C. Disc Displacement with Reduction
D. Osteoarthrosis
E. Disc Displacement without Reduction

Q96 A 23 year old male presents to your surgery. He lost his upper lateral incisors some 10
years ago in a swimming pool accident. Since then he has been wearing a ‘spoon’ denture which
he now feels in aesthetically unacceptable. He has sought an opinion on dental implants but has
been told that he would need bone grafting for this to be successful and he is not prepared to
undergo this. His dentition is excellent with no restorations and a Class I occlusion. He wants
some advice on what the best treatment might be.

Which option would you put first on your list of possibilities?

A. Two fixed – fixed resin bonded bridges using the central and canine teeth
B. Two cantilever resin bonded bridges from the central incisors and canines.
C. Two conventional fixed – fixed bridges from the canine
D. Conventional cantilever bridges from the canines
E. Cobalt chrome partial denture

Q97 A new filling material has been developed by the Dental School. After publication of
laboratory results, the researchers conducted a randomised clinical trial in general dental practice
where patients requiring one filling were randomly allocated either to old or new filling material
group. After five year follow up, the mean survival time between two materials was compared, and
P-value of 0.125 was reported.
Which answer is correct?

A. There are no important differences in the properties of the materials

B. There is no difference in restoration mean survival time between the two
materials
C. The difference between two material is not clinically impotant
D. The difference between the materials is very small
E. The new material is useless

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Q98 All the films which have been manually processed by an unsupervised new trainee dental
nurse in your practice are extremely dark.

Which of the following errors could lead to a dark film?

A. Insufficient exposure
B. Films have been left in the developer for too long a period of time
C. Films have been in the fixer for too long a period of time
D. The concentration of the developer is too dilute
E. The concentration of the fixer is too dilute

Q99 Your colleague is having problems as every panoramic film that he produces shows
extremely wide anterior teeth which are also blurred. The film also invariably has the images of the
condyles cut off from the sides of the film.

The most likely cause of this is:

A. The patient is incorrectly positioned too far forward relative to the image layer
B. The patient is incorrectly positioned with the chin too low
C. The patient is incorrectly positioned too far back relative to the image layer
D. The patient is in a slumped position in the machine
E. The patients is incorrectly positioned with the head tilted in the machine

Q100 When an individual is exposed to radiation a certain amount of radiation is needed before
clinical signs of damage to somatic cells appear.

For these effects to occur a minimum radiation dose has to be exceeded and this is known as:

A. Background radiation dose

B. Threshold dose
C. Equivalent dose
D. Absorbed dose
E. Effective dose

Q101 A stabilisation splint [Michegan splint] is commonly indicated in patients

needing advanced restorative dentistry and patients suffering from some
Temporomandibular Disorders

Other than upper and lower impressions, which of the following records will be
needed to construct this splint?

A. Facebow and a protrusive wax record

B. Facebow and an “Oclusal Sketch”
C. Centric Relation [Retruded Contact Position] record
D. Facebow and a Centric Occlusion [Incuspation Position] record
E. Facebow and Centric Relation [Retruded Contact Position] record

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Q102 Dentists are encouraged to carry out a thorough soft tissue examination and be vigilant for
any lesions that might possibly be malignant or have malignant potential. Currently it is not
recommended that dentists use a mucosal staining method for screening the general population for
oral cancer.

What is the most likely reason for this advice?

A. Unnecessary intervention where there is a false positive test result

B. False reassurance where there is a false negative test result
C. Low uptake of screening by those with low risk
D. Low uptake of screening by those with high risk
E. Negative result reinforcing existing bad habits

Q103 You have been treating a 66 year old patient for some years but she has recently
developed several new cervical carious lesions. You think her mouth looks dry but she is not
complaining of this. You decide to measure her unstimulated salivary flow rate.

Which of the following salivary flow rates would confirm a diagnosis of dry mouth?

A. 0.07 ml/minute
B. 1 ml/minute
C. 0.3 ml/minute
D. 0.5 ml/minute
E. 1.5 ml/minute

Q104 A 23 year old male patient has been assaulted and received a blow to his lower jaw.

What are the most likely fractures he has sustained?

A. Parasymphysis and zygomatic butress

B. Angle of mandible and hyoid
C. Parasymphysis and coronoid process
D. Angle of mandible and zyomatic process
E. Parasymphysis and condylar process

Q105 A patient attends your surgery complaining of a swelling at the angle of the mandible.
There is no obvious dental cause for this swelling.

Which of the following investigations is essential in moving from provisional to definitive diagnosis?

A. Radiographs
B. CT scan
C. Aspiration
D. Biopsy
E. Full Blood Count

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Q106 A 55 year old female patient is missing her upper right second premolar and
upper right first molar and also is missing the upper left second molar. The upper
right second molar is functional and has an amalgam restoration (MOD and buccal
wall) that requires replacing. The patient has no functional or aesthetic concerns.

What would be the treatment of choice in this situation?

A. Provide an upper removable partial denture

B. Replace the amalgam in the upper right 7 only
C. Provide a full coverage crown in the upper right 7
D. Provide a fixed bridge in the upper right quadrant
E. Provide a full coverage crown in the upper right 7 with guide planes and
occlusal rests

Q107 A 19 year old patients attends your surgery complaining of a painful mouth which has been
present for about 7 days. He has a raised temperature, general malaise and a marked
lyphadenopathy.

Which one of the following is the most likely diagnosis?

A. Lateral periodontal abscess

B. Acute pulpitis
C. Acute necrotising ulcerative gingivitis
D. Desquamative gingivitis
E. Acute herpetic gingivostomatitis

Q108 Endodontic treatment has failed on an upper first molar; the patient is keen to retain the
tooth. There are persistent symptoms from the tooth. Radiographically there is evidence of
periapical radiolucency although the three canals are obturated with good length and compaction.

What is the best course of action?

A. Extract the tooth

B. Re-treatment with an iodine solution as irrigant
C. Re-treatment with hypochlorite solution as irrigant
D. Re-treat the tooth, looking particularly for additional canals
E. Surgical apicectomy

Q109 A patient is having a lower right 8 extracted under intravenous sedation with midazolam.

Which one of the following would be a sign of over-sedation?

A. Tachycardia
B. Bradycardia
C. Hyperventilation
D. Flushing of the skin
E. Sweating

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Q110 A panoramic cassette was opened in the darkroom to remove and process the exposed
film. On opening the cassette, a piece of paper was discovered on the surface of the intensifying
screen.

What kind of artefact would the presence of paper in the cassette most likely produce?

A. A black artefact
B. No artefact
C. A white artifact
D. Reticulation
E. Dichroic fog

Q111 A patient with a diagnosed heart murmur has been confirmed as requiring antibiotic
prophylaxis.

For which of the following procedures will the patient require cover?

A. Partial denture definitive impression

B. Endodontic obturation
C. Conventional porcelain laminate veneer preparation
D. Restoration of subgingival class V cervical carious lesion
E. Class I occlusal amalgam restoration requiring local anaesthetic

Q112 A 60 year old female attends your surgery complaining of soreness affecting her gingivae.
No other area of her oral mucosa is affected but she complains of occasional bleeding and crusting
inside her nose and itchiness affecting one of her eyes. She is fit and well and is not taking any
medication. On examination intra-orally a desquamative gingivitis is present. Her left eye looks
inflamed and there is some evidence of scarring giving rise to symblephron formation between the
conjunctiva lining her lower eyelid and that covering the surface of her eye itself.

Based on the above findings what is your diagnosis?

A. Mucous membrane pemphigoid

B. Lichen planus
C. Pemphigus vulgaris
D. Erythema multiforme
E. Lichenoid drug reaction

Q113 Dental amalgams contain different levels of copper (> 6 %) in the alloy.

What is the function of the copper in the amalgam?

A. To act as a scavenger
B. To reduce the setting time
C. To prevent an exothermic reaction on setting
D. To reduce/eliminate the formation of the gamma 2 phase
E. To prevent hydrolysis

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Q114 A study was conducted with the following objective: To determine the
individual and combined effects of potential risk factors in relation to the
temporomandibular disorder, Pain Dysfunction Syndrome (PDS). The first group
comprised new referrals between May 1997 and August 1999 to the
temporomandibular disorder clinic of the University Dental Hospital, diagnosed with
PDS. The second group consisted of patients without PDS randomly selected from
twenty-four dental practices. Using a postal questionnaire information was collected
on socio-demographic, local mechanical, psychological factors, co-morbidities and
illness behaviour.

What type of study is this?

A. Case series
B. Cross-sectional study
C. Case-control study
D. Case report
E. Randomised clinical trial

Q115 In a randomised double-blind single-centre clinical trial, the effect of pre-

operative administration of Ibuprofen 600mg or Diclofenac 100mg tablets was
compared for post-operative pain relief in 119 patients having day surgery under
general anaesthesia for surgical removal of impacted third molars. Pain was
assessed using visual analogue scales (VAS) pre-operatively, 15minutes, 30
minutes, 1 and 3 hours post-operatively.

Which answer is correct? The trial was double-blind because ….

A. Each patient received both treatments

B. The patients could choose the treatment
C. The patients did not know they were in a trial
D. Both patients and the nurse assessing did not know treatment allocation
E. The nurse assessing the patients knew which treatment they have received

Q116 You arrive at a new practice and notice that almost every radiograph in the patient’s notes
has turned brown. Your nurse confirms that this is a widespread problem that no-one has ever
remedied and she also remarks that the films tend to get browner with age.

What corrective action will you take to remedy the problem?

A. Develop the films for the correct period of time

B. Heat the developer to a higher temperature
C. Ensure films are fixed for the correct period of time
D. Wash the films properly after fixing
E. Change the solutions more regularly

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Q117 A 10½ year old boy with an uncrowded sound dentition attends your practice.
His permanent canines are unerupted and not palpable and primary canines are
retained. On radiographic examination, you find the canines are mesially inclined
and in the line of the arch.

What is the most appropriate management option?

A. Arrange surgical removal of permanent canines.

B. Extract primary canines.
C. Extract upper first premolars.
D. Grind primary canines.
E. Monitor occlusal development.

Q118 You suspect that there is occlusal caries in the lower right first permanent molar of a 10
year old child. You wish to confirm your suspicions.

Which diagnostic test is most commonly used in this situation?

A. Bitewing radiography
B. Electro-conductive caries monitors
C. Fibro-optic transillumination
D. Panoramic radiography
E. Visual examination of a dried tooth.

Q119 A child of 6 years requires antibiotic prophylaxis for extraction of a LRD under Local
Analgesia. There is no history of antibiotic allergies in his medical history.

Which of the following is the most appropriate regime for antibiotic prophylaxis?

A. 3g Amoxicinin 1hour pre-op

B. 1.5g Amoxicinin 1hour pre-op
C. 1.5g Penicillin 1hour pre-op
D. 250mg Amoxicinin 3 times per day for 1 week prior to extraction
E. 300mg Clindamycin 1hour pre-op

Q120 Complete denture articulation should incorporate certain features.

Which of the following is a required feature?

A. Incisal guidance
B. Canine guidance
C. Balancing side contacts
D. Unilateral contacts on excursive movements
E. Posterior disclussion (open bite) on lateral excursion

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Q121 You are working as a general practitioner and you have referred a 13 year old for an
orthodontic opinion. Your orthodontic colleague has recommended the extraction of the upper
second premolars. You undertake these under local anesthesia without incident. A week later the
child is booked in as an emergency. He has fallen off his bike and the maxillofacial SHO at the
local hospital was forced to extract the upper incisors as they so badly damaged. Orthodontic
treatment has been abandoned and you are now considering a referral to the restorative
department of the dental school for an opinion. You need to write a referral letter to the restorative
Consultant.

Other than those described, the rest of the dentition is intact. What Kennedy classification will you
use to describe the child’s tooth loss?

A. Class I mod 1
B. Class II
C. Class III mod 2
D. Class IV
E. Class III mod 1

Q122 A child of 9 with a crowded mixed dentition attends with her parent. The child reports that
the upper first permanent molars are very sensitive. On examination, they appear hypoplastic and
very broken down.

Which of the following management strategies are you most likely to recommend?

A. Early extraction of the hypoplastic upper molars with compensating extraction

of the lower first permanent molars.
B. Restore the first permanent molars.
C. Serial extractions.
D. Put on regular review.
E. Extract the first molars when she is 12.

Q123 In studying the impact of dental caries on communities the Care Index is sometimes used.
This is denoted by the formula F/DMF.

What is the most appropriate interpretation of the Care Index?

A. Shows the incidence of new decay

B. Shows the prevalence of decay in the community
C. Shows the extent to which decay is prevented
D. Shows the extent to which decay is treated restoratively
E. Shows the extent to which decay is treated by extraction

Q124 You notice that a 20 year old patient has marked tooth surface loss associated with the
labial and palatal aspects and incisal edges of the upper anterior teeth. They are sensitive to hot
and cold. The remainder of the dentition is mainly unaffected

What is the likely diagnosis?

A. Attrition
B. Active erosion
C. Passive erosion
D. Abfractions
E. Abrasion

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 DE5050
Q125 A 65 year old man presents for a denture review. He complains that his upper denture
causes him some discomfort occasionally but otherwise he has no complaints. Upon removal of
the denture you notice a thick plaque covering the palatal mucosa. When brushed with a cotton
wool roll, it can be removed, and the underlying mucosa is red and areas of it bleed. Upon
questioning the patient you find that he rarely removes his denture. The denture itself is stained
and has heavy calculus deposits on it. The patient’s medical history is clear.

How will you deal with this problem?

A. Swab the mucosa for microbiology, prescribe an anti-fungal cream and advise
on denture hygiene initially
B. Arrange for an incisional biopsy as an emergency appointment at the local
DH
C. Arrange for a denture reline to be conducted
D. Prescribe a broad spectrum antibiotic and review in 7 days with a view to
replacing the denture
E. Do a chair-side reline using a tissue conditioner and advise on denture
hygiene

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