Question 1:

This X-ray is of the upper right quadrant of a 50 year old woman. The upper right first premolar
displays Class II mobility, and the depth of the gingival sulcus is no more than 3 mm. The tooth is
vital.

(i) What treatment would you recommend?

(ii) If the dentition revealed generalised 4-5 mm gingival crevice depths, how would your treatment
differ?

Question 1: Answer
The tooth shows radiographic evidence of traumatic occlusion. Perform occlusal analysis and treat
occlusal discrepancies.

Basic prophylaxis and preventive care, followed by (i). above. Review in 4-6 weeks.

Question 2:

This condition is primarily seen in young adults and may be limited to the mouth, or produce systemic
manifestations. The crusting of the lips is characteristic of the oral condition.
 What is the name of the oral condition?
What is the aetiology of the condition?
What treatment can be recommended?

Question 2: Answer
Erythema Multiforme.

A hypersensitivity vasculitis with several possible precipitating factors. Variable clinical signs with
acute onset and fever. Usually preceded by upper respiratory tract infection and vesiculobullous
lesions on hands, feet and orolabial region. Oral lesions progress from papules to vesicles which
coalesce and ulcerate.

Supportive therapy: hydration (possibly IV), Chlorhexidine and anaesthetic mouthrinses; tetracycline
mouthrinse; Severe cases may warrant oral or systemic steroid therapy

Question 3:

The pulp canal space of the upper left central (centre of film) of an 11 year old patient, who had
fallen and traumatized that tooth one year earlier, shows significant reduction in size; the tooth also
exhibits a slight yellow discoloration relative to the neighbouring central. At six months post trauma,
both teeth reacted vitally and equally to thermal and electric pulp testing, but now the left central
fails to react to thermal testing, although electric stimulus still evokes a response. The right central
remains unchanged to both tests and in colour, and neither tooth shows periapical change.

Should root canal therapy be now carried out on the upper left central?
 Question 3: Answer
No. With calcific obliteration of the pulp obviously in progress, lack of response to thermal testing
is no longer significant. Positive results with electric testing indicates that the pulp is still viable,
and further obliterative calcification of this canal can be expected. Except where dowel space for
post crowning is clearly required, this process should be allowed to continue, as further colour
deterioration and future periapical breakdown of such teeth have been shown to be most unlikely.

Question 4:

This patient is receiving orthodontic treatment and has returned to you for a routine examination.

How would you manage the patient's periodontal problem?

Question 4: Answer
Detailed oral hygiene instruction, including use of interdental cleaning aids and possible use of
electric/battery operated toothbrush

Chlorhexidine and/or fluoride mouthrinses, possible use of high-strength fluoride toothpaste

Question 5:
This patient is experiencing palatal discomfort, and has been wearing the same full maxillary denture
the past 20 years.

What is the condition present on the palate, and how can it be managed?

Question 5: Answer
Denture Stomatitis (also known as chronic atrophic candidosis and erythematous candidosis).
Meticulous denture cleanliness

Dentures soaked 10-30 mins in sodium hypochlorite solution (Milton's) twice weekly. If
dentures contain metal parts, 0.2% chlorhexidene solution should be used, although staining
may be a problem.
Antifungal therapy; Nystatin (100 000 units/m/L) or Amphotericin (i) Ointment applied to
tissue fitting surface and inserted, qid, 2-4 weeks. (ii) Lozenges 10mg, dissolved in mouth,
without dentures in place, qid, 2-4 weeks. Theres also miconazole 2% gel apply 4Xday
contraindicated w Warfarin etc.
Rebase or remake denture
Assessment of diet, with a view to reduction of high carbohydrate intake, if appropriate.

Question 6:
The teeth on this slide have hypoplastic rings visible on the crowns.

At approximately what age would this defect have occurred?

What is the most likely cause?

Question 6: Answer
3 years, plus or minus 6 months
This is an example of mild chronological hypomineralisation. Multiple possible causative
factors - refer to patient history.

Question 7:

In restoration of endodontically treated anterior teeth, is it advisable to place some form of

endodontic post?

uestion 7: Answer
Depends on amount of missing tooth structure. Teeth with small to moderate Class III restorations
have higher resistance to fracture with conservative restoration of access cavity only. Principal
concern is removal of additional tooth structure during post placement. Parallel-sided posts tend to
produce stress concentration at apical end of post; tapering posts have a detrimental wedging
effect.

Question 8:
Glass ionomer cement is a useful material for restoring cervical abrasion cavities.

What is the mechanism of adhesion of glass ionomer cement to calcified tissue?

Notwithstanding this material's shortcomings regarding its physical properties and critical
handling procedures, what are some other applications of glass ionomer cement?

Question 8: Answer
Ionic attraction between polyacrylic acid and calcium.

Applications for glass ionomer cement:

Cementation of cast restorations

Pit and fissure sealants
Class III & V carious lesions
As a base in the "sandwich technique" for composite restorations
Small Class II cavities in primary teeth
Repair of crown margin
Temporary dressing

Question 9:
The lower left central incisor has been replaced by a fixed bridge.

What is the correct name-for the bridge shown?

What is the essential feature of the abutment preparation?
How is the bridge secured to the abutment teeth?

Question 9: Answer
An Enamel Bonded or Maryland bridge
Minimal preparation, essentially limited to enamel; good geometric form; adequate
coverage of enamel.
The tooth-fitting surfaces are electrolytically etched. The bridge is bonded with composite
resin cement to the acid-etched abutment teeth.

Question 10:

This slide shows a 21 year old male with no missing teeth and a caries-free dentition. Patient has
hypertrophied masseter muscles, and has heavily worn enamel on all teeth, together with large
areas of exposed dentine on anterior and premolar teeth. Patient has presented to have his front
teeth 'capped'.

What is this patient's overriding problem, and how would you treat this case?

Question 10: Answer

Parafunctional bruxing habit.
Treatment involves splint therapy while an attempt is made to isolate and address the
aetiology of the bruxing habit - probably stress. Relaxation therapy / behaviour
modification may assist. Complex restorative procedures should be delayed until some
control is achieved.

Question 11:

This lower right first molar had been restored with amalgam for 15 years. The patient began to
experience pain to both warm and cold, which lingered for some time after the stimulus was
removed. The tooth was occasionally sensitive on mastication, but was not tender to percussion.

What is your diagnosis, and how would you treat the problem?

Question 11: Answer

Cracked tooth syndrome (disto lingual cusp).
Determine extent and direction of split if possible; transillumination is often useful.
Many splits terminate supragingivally and may be restored simply by removing the
fractured tooth structure and restoring. When doubt exists about the extent of the split, or
pulpal involvement, a copper or stainless steel band should be cemented, retaining a
sedative dressing, and pulp sensibility assessed after 6-8 weeks.
Teeth with extensive cracks should be ultimately restored by a cast restoration (onlay or
full crown).
Question 12:

This X-ray was taken for a 55 year old female who presented complaining of slight tenderness of
labial tissue in the lower right canine-premolar area, with some tooth mobility for about four
weeks. Clinical examination revealed moderate mobility in the premolar and slight in the canine.
The soft tissues exhibited a bluish discoloration and slight tenderness to palpation in this area.
Electric pulp tests were faintly positive but inconclusive.

What is your provisional diagnosis and how would you treat the case?

Question 12: Answer

Provisional diagnosis is tumour rather than periapical cyst. Histopathology for final diagnosis,
following surgical removal of the tumour and the involved teeth, with regular postoperative follow-
up. The lesion proved to be a giant cell tumour.

uestion 13:
Is six-monthly, professional topical fluoride application of clinical benefit in an optimal fluoride area?

Question 13: Answer

Topical fluoride application should be reserved for patients at risk of developing dental caries,
eg high sugar consumption, xerostomia, poor oral hygiene, fixed appliance orthodontics.

Question 14:

This slide depicts phenytoin hypertrophy in a male aged 27 years.

In this case of phenytoin gingival enlargement, what therapeutic measures can be taken?
What are some other conditions that may give rise to gingival enlargement, greater than the
usual inflammatory response?
Therapeutic measures for phenytoin (Dilantin) hypertrophy are

meticulous plaque removal (possibly including chlorhexidine mouthwashes)

Surgical reshaping of the gingiva and excellent plaque control

Contact should be made with patient's physician regarding possible alternative medication, e.g.,
carbamazepine (Tegretol).

Other conditions include:

Cyclosporin A therapy (immunosupressive)

Nifedipine (antihypertensive)
Hereditary gingival fibromatosis.
Leukaemic gingivitis.
Pregnancy gingivitis.
Mouth breather's gingivitis.

Question 15:

This slide reveals a number of all-ceramic restorations in place.

What is the most significant contraindication for this type of restoration?

List five (or more) preferred features of cavity design and treatment planning.

Contraindications: Bruxing, clenching or other destructive chewing habits.

Preferred Features:

margins in enamel
1.5 mm of occlusal reduction
even thickness of porcelain
adequate coronal tooth structure to provide resistance and retention with divergent walls and
rounded internal and external line angles
occlusal scheme with minimal contact in lateral excursions
care with occlusal adjustment, which may disrupt surface and trigger crack propagation.

Question 16:
A 36 year old patient had endodontic treatment performed on the first molar shown 2 years
previously. A narrow 9 mm pocket has developed adjacent to the mesio-buccal root. The adjacent
tissues have become swollen and painful on three occasions and the tooth has become mobile.

What is the most likely cause of the problem, and how can it be treated?

Question 16: Answer

Vertical fracture involving the mesio-buccal root. This may be able to treated by root resection.

Question 17:

A 28 year old female presented with a midline anterior palatal swelling which had recurred on several
occasions, and was fluctuant to palpation. The associated incisor teeth had been adequately root
filled previously.

What is the likely diagnosis?

What tests could be employed to reach a diagnosis?
What treatment can be provided?
Question 17: Answer
Nasopalatine duct cyst (incisive canal cyst).
Radiographs; aspiration of cyst contents. Histological examination is important.
Treatment is by enucleation; recurrence is uncommon.

Question 18:

This slide reveals significant tooth loss involving the lower incisor teeth. The upper incisors also
displayed loss of structure on labial and palatal surfaces. The patient complained of sensitivity of the
affected teeth.

What may have been responsible for this loss of tooth structure?

Question 18: Answer

The lesions are typical of exposure to dietary acid. A keen athlete, the patient regularly sipped acidic
"sports drinks" on a daily basis. Similar destruction can occur with citrus fruits, carbonated soft drinks
and chewing of vitamin C (ascorbic acid) tablets.

Question 19:
This 33 year old male patient presented with ulceration and fenestration of the lingual tissues behind
the lower anterior teeth. The patient had fractured his cast metal denture and, since its repair, the
lingual bar had caused pressure in these areas.

How would you manage this problem?

Question 19: Answer

The soft tissues may respond with meticulous oral hygiene. Otherwise, a connective tissue graft may
be required. In any event, the denture should be remade.

Question 20:

What measures can be taken to improve the seating of full coverage cast restorations?

Question 20: Answer

Die relief to one millimetre of the margin, during fabrication.
Conservative application of luting agent at cementation.
Vibration of the crown during initial seating at cementation.
Venting the crown.