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2 Hours

The University of Manchester

Degree of BDS, Final Examination

Clinical Dentistry II

Tuesday 30th May 2006

9.45 11.45

All questions should be answered.

All questions are of equal value. Please write your answers in the spaces

provided. Answers written outside the provided spaces will not be marked.

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The use of electronic calculators is not permitted. ________________________________________________________________

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1. A three year old involved in an accident in a playground intrudes the two upper primary incisors so that only a third of the crown is visible.

a) What would be your immediate care? (5 marks)

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b) What are the potential consequences to the developing permanent incisor

teeth? (5 marks)

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2. An 8 year old child attends your practice for the first time. You consider providing fissure sealants.

What are your indications for offering fissure sealants? (10 marks)

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3. You examine a fifteen year old patient for the first time and notice that she has has a number of missing permanent teeth. The parent asks you to give the

possible reasons for the teeth not being present.

Give five possible reasons for the missing permanent teeth. (10 marks) ________________________________________________________________

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4. Radiographs are essential in endodontic treatment.

a) When would you take periapical radiographs during normal endodontic

procedures? (3 marks)

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b) What features of significance can be determined from these periapical

radiographs? (7 marks)

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5. A 19 year old female presents with a left sided facial swelling related to pericoronitis around her lower third molar.

a) Give three other clinical features of pericoronitis that may be present? (3 marks)

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b) Describe your immediate management (3 marks)

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c) Give four reasons for the removal of third molar teeth (4 marks)

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6. A 34 year old female presents with intense pain following the extraction of her lower first permanent molar.

a) What is the most likely cause of her pain? (2 marks)

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b) Give four factors that may have predisposed to this patient's condition (4 marks)

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c) Outline your management of this patient. (4 marks)

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7. A patient complains that his teeth are wearing down.

a) What are the three main causes of tooth surface loss? (3 marks)

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b) Describe the typical appearance of the teeth associated with an excessive

consumption of carbonated soft drinks. (5 marks)

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c) How would you distinguish the wear described in b) from other causes? (2

marks)

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8. You are fitting a full coverage gold crown to a lower first molar tooth and the crown will not seat fully.

Give five possible reasons why the crown will not seat fully and in each case explain your subsequent management. (10 marks)

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9. A 12 year old patient attends with a missing upper left canine which you suspect may be displaced palatally.

a) How do you confirm your diagnosis? (6 marks)

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b) It is confirmed that the tooth is palatally displaced. Give four possible treatment options for the management of this tooth. (4 marks)

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10. A patient has an upper central incisor inside the bite. You decide to construct an upper removable appliance to procline the incisor over the bite. The

appliance has been constructed and the patient is now attending for you to fit this

appliance.

What are the stages you would go through at this visit? (10 marks)

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11. IOTN is being used increasingly in the NHS, and all dentists need to be familiar with it.

a) What does IOTN stand for? (1 mark)

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b) What are its constituent parts? (1 mark)

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c) Give four uses of IOTN? (4 marks)

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d) Give four limitations of IOTN? (4 marks)

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12. A forty-five year old man presents with white striated lesions on the buccal mucosa

a) Give the characteristic histological features of oral lichenoid mucositis (3

marks).

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b) Describe the typical clinical features of cutaneous lichen planus including

sites (3 marks).

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c) Give two general and two local causes of lichenoid reaction (4 marks).

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13. A seventy year old woman presents with dry mouth and you suspect that she has Sjogrens syndrome.

a) Give four autoimmune (connective tissue) diseases that may be part of secondary Sjogrens syndrome (4 marks).

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b) Give three potential complications of xerostomia (3 marks).

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c) Describe three histological changes seen in salivary glands in Sjogrens syndrome (3 marks).

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14. In the examination of patients with periodontal disease it is necessary to differentiate between chronic gingivitis and chronic periodontitis.

a) What is the main clinical finding that differentiates between these two

conditions. (3 marks)

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b) Give the three histological features that are diagnostic for chronic periodontitis. (3 marks)

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c) Give two examples of periodontal pathogens found in the red complex described by Socransky and Hafferjee. (4 marks)

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15. Adjunctive antimicrobial therapy is an established treatment modality in periodontal therapy. The antimicrobials may be delivered systemically or locally.

a) Give four disadvantages of the systemic antimicrobial therapy. (4 marks)

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b) Give four advantages of local delivery antimicrobial agents. (4 marks) ________________________________________________________________

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c) Give a prescription for a suitable systemic adjunctive antimicrobial

regimen for a patient with generalised aggressive periodontitis (2 marks)

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16. Type 1 and 2 Diabetes are well established risk factors for chronic inflammatory periodontitis.

a) Give four ways in which Type 1 and 2 Diabetes modifies the host response. (8 marks)

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b) How does the subgingival flora differ between a diabetic patient and a non

diabetic patient? (1 mark)

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c) What factor other than plaque control will influence the outcome of

periodontal therapy in a Diabetic patient? (1mark)

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17. A 50- year old man has denture stomatitis

a) What clinical features are usually observed in the affected mouth? (4

marks)

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b) How might you treat this condition? (5marks)

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c) What is the organism most commonly isolated from denture plaque in

patients with denture stomatitis? (1 mark)

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18. A 65 year old patient has been successfully wearing full dentures for a number of years. You decide to provide him with replica dentures,

a) Give two indications for the prescription of replica dentures (2 marks) ________________________________________________________________

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b) Describe the clinical stages in the construction of replica dentures. (8

marks)

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19. A 48 year old patient is diagnosed with chronic osteomyelitis following the extraction of a lower left first molar tooth many weeks ago.

a) Describe the clinical features of the condition. (4marks)

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b) Describe the radiological features of the condition. (4marks)

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c. Outline the management of this patient. (3 marks)

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20. Within general practice practitioners have to comply with two sets of radiation protection legislation.

a) Name the two sets of radiation protection legislation (4 Marks).

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b) Which of these two regulations relates principally to the protection of

workers and the public, but also addresses the equipment aspects of patient

protection? (2 Marks)

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c) State which governmental body oversees these regulations: (1 Mark)

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d) Which of these two regulations relates to patient protection? (2 Marks)

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e) State which governmental body oversees these regulations: (1 mark)

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