Grand Final Mock Exam 10

Isabella Rossi, a 28-year-old graphic designer, presents with a one-week history of intensely painful and bleeding gums, accompanied by a foul taste and odour.

She reports feeling unusually fatigued for the past few months, with aching joints, particularly in her hands. She also notes a red rash that appears across her cheeks and nose after sun exposure and mentions that she has been bruising more easily recently. She is not taking any regular medications and has no known allergies. She does not smoke and consumes alcohol occasionally.

Extraoral examination reveals a faint, reddish discolouration across the bridge of her nose and cheeks. There is no palpable cervical lymphadenopathy. Intraoral examination shows severe, generalised gingival inflammation. The interdental papillae in the mandibular and maxillary anterior regions are blunted and have a ‘punched-out’ appearance, covered by a greyish, sloughing film. Gentle wiping of this film reveals a raw, spontaneously bleeding surface. A distinct, fetid odour is noticeable. Scattered, pinpoint red spots are visible on the soft palate. Assessment of her oral hygiene reveals minimal plaque and calculus deposits.

1. Based on the intraoral findings for Isabella Rossi, what is the most likely provisional diagnosis for her acute gingival condition-

A. Chronic periodontitis with severe gingival inflammation

Correct Incorrect Correct answer

B. Desquamative gingivitis with epithelial sloughing

Correct Incorrect Correct answer

C. Necrotising gingivitis affecting the gingival tissues

Correct Incorrect Correct answer

D. Acute herpetic gingivostomatitis with oral ulceration

Correct Incorrect Correct answer

E. Severe plaque-induced gingivitis with heavy bleeding

Correct Incorrect Correct answer

Isabella Rossi, a 28-year-old graphic designer, presents with a one-week history of intensely painful and bleeding gums, accompanied by a foul taste and odour.

She reports feeling unusually fatigued for the past few months, with aching joints, particularly in her hands. She also notes a red rash that appears across her cheeks and nose after sun exposure and mentions that she has been bruising more easily recently. She is not taking any regular medications and has no known allergies. She does not smoke and consumes alcohol occasionally.

Extraoral examination reveals a faint, reddish discolouration across the bridge of her nose and cheeks. There is no palpable cervical lymphadenopathy. Intraoral examination shows severe, generalised gingival inflammation. The interdental papillae in the mandibular and maxillary anterior regions are blunted and have a ‘punched-out’ appearance, covered by a greyish, sloughing film. Gentle wiping of this film reveals a raw, spontaneously bleeding surface. A distinct, fetid odour is noticeable. Scattered, pinpoint red spots are visible on the soft palate. Assessment of her oral hygiene reveals minimal plaque and calculus deposits.

2. Given Isabella Rossi’s systemic symptoms and signs, including fatigue, rash, and palatal petechiae, what is the most critical initial investigation-

A. Full blood count

Correct Incorrect Correct answer

B. Periapical radiographs of the anterior teeth

Correct Incorrect Correct answer

C. Microbiological swab of the gingival lesions

Correct Incorrect Correct answer

D. A viral culture from the oral ulcers

Correct Incorrect Correct answer

E. An incisional gingival biopsy for histopathology

Correct Incorrect Correct answer

Isabella Rossi, a 28-year-old graphic designer, presents with a one-week history of intensely painful and bleeding gums, accompanied by a foul taste and odour.

She reports feeling unusually fatigued for the past few months, with aching joints, particularly in her hands. She also notes a red rash that appears across her cheeks and nose after sun exposure and mentions that she has been bruising more easily recently. She is not taking any regular medications and has no known allergies. She does not smoke and consumes alcohol occasionally.

Extraoral examination reveals a faint, reddish discolouration across the bridge of her nose and cheeks. There is no palpable cervical lymphadenopathy. Intraoral examination shows severe, generalised gingival inflammation. The interdental papillae in the mandibular and maxillary anterior regions are blunted and have a ‘punched-out’ appearance, covered by a greyish, sloughing film. Gentle wiping of this film reveals a raw, spontaneously bleeding surface. A distinct, fetid odour is noticeable. Scattered, pinpoint red spots are visible on the soft palate. Assessment of her oral hygiene reveals minimal plaque and calculus deposits.

3. Considering all of Isabella Rossi’s clinical findings, what is the most likely primary aetiological factor for her acute oral condition-

A. A primary viral infection with oral manifestations

Correct Incorrect Correct answer

B. High levels of emotional stress compromising immunity

Correct Incorrect Correct answer

C. Heavy smoking causing vasoconstriction and tissue necrosis

Correct Incorrect Correct answer

D. Poor oral hygiene leading to bacterial overgrowth

Correct Incorrect Correct answer

E. An underlying systemic disease affecting immune function

Correct Incorrect Correct answer

Isabella Rossi, a 28-year-old graphic designer, presents with a one-week history of intensely painful and bleeding gums, accompanied by a foul taste and odour.

She reports feeling unusually fatigued for the past few months, with aching joints, particularly in her hands. She also notes a red rash that appears across her cheeks and nose after sun exposure and mentions that she has been bruising more easily recently. She is not taking any regular medications and has no known allergies. She does not smoke and consumes alcohol occasionally.

Extraoral examination reveals a faint, reddish discolouration across the bridge of her nose and cheeks. There is no palpable cervical lymphadenopathy. Intraoral examination shows severe, generalised gingival inflammation. The interdental papillae in the mandibular and maxillary anterior regions are blunted and have a ‘punched-out’ appearance, covered by a greyish, sloughing film. Gentle wiping of this film reveals a raw, spontaneously bleeding surface. A distinct, fetid odour is noticeable. Scattered, pinpoint red spots are visible on the soft palate. Assessment of her oral hygiene reveals minimal plaque and calculus deposits.

4. What is the most appropriate immediate management plan for Isabella Rossi at this appointment-

A. Refer to a periodontist for specialist periodontal management

Correct Incorrect Correct answer

B. Prescribe a chlorhexidine mouthwash only and review her progress

Correct Incorrect Correct answer

C. Perform extensive subgingival scaling and root planing immediately

Correct Incorrect Correct answer

D. Gentle debridement, oral hygiene instruction, and urgent medical referral

Correct Incorrect Correct answer

E. Prescribe systemic antibiotics and schedule a review in one week

Correct Incorrect Correct answer

Isabella Rossi, a 28-year-old graphic designer, presents with a one-week history of intensely painful and bleeding gums, accompanied by a foul taste and odour.

She reports feeling unusually fatigued for the past few months, with aching joints, particularly in her hands. She also notes a red rash that appears across her cheeks and nose after sun exposure and mentions that she has been bruising more easily recently. She is not taking any regular medications and has no known allergies. She does not smoke and consumes alcohol occasionally.

Extraoral examination reveals a faint, reddish discolouration across the bridge of her nose and cheeks. There is no palpable cervical lymphadenopathy. Intraoral examination shows severe, generalised gingival inflammation. The interdental papillae in the mandibular and maxillary anterior regions are blunted and have a ‘punched-out’ appearance, covered by a greyish, sloughing film. Gentle wiping of this film reveals a raw, spontaneously bleeding surface. A distinct, fetid odour is noticeable. Scattered, pinpoint red spots are visible on the soft palate. Assessment of her oral hygiene reveals minimal plaque and calculus deposits.

5. What is the most appropriate advice for Isabella Rossi regarding her home care to manage the acute oral symptoms-

A. Cease all oral brushing until the acute pain subsides

Correct Incorrect Correct answer

B. Rinse frequently with warm salt water every single hour

Correct Incorrect Correct answer

C. Use an interdental brush vigorously to clean between teeth

Correct Incorrect Correct answer

D. Apply a topical corticosteroid cream to the inflamed gums

Correct Incorrect Correct answer

E. Use a soft toothbrush and chlorhexidine mouthwash

Correct Incorrect Correct answer

An 8-year-old Anglo-Australian female, Sarah Pearson, is brought to the clinic by her mother for an emergency appointment. Her mother reports that Sarah fell off her scooter approximately one hour ago and ‘knocked her front tooth right out’.

Sarah is visibly distressed and complains of a sore mouth. The mother has brought the missing tooth with her, wrapped in a tissue. Sarah’s medical history is significant for a repaired unilateral cleft lip and palate, for which she underwent several surgeries as an infant. She has no known drug allergies and is not taking any medications. A well-healed surgical scar is visible on her upper lip.

Examination reveals soft tissue swelling around her mouth and a small abrasion on her chin. Intraoral examination shows that tooth 11 is absent from the socket. The socket is filled with a blood clot, and there is a minor laceration of the buccal gingiva. The adjacent teeth, 12 and 21, are present and do not exhibit any mobility or visible fractures. The avulsed tooth 11 appears intact with an incompletely formed root apex, and there is some debris on the root surface. A targeted radiographic imaging of the area confirms an empty socket with intact lamina.

6. Based on the clinical findings for Sarah Pearson, what is the most accurate diagnosis for the injury to tooth 11-

A. Intrusive luxation of tooth 11

Correct Incorrect Correct answer

B. Uncomplicated crown fracture of tooth 11

Correct Incorrect Correct answer

C. Subluxation injury of tooth 11

Correct Incorrect Correct answer

D. Avulsion of tooth 11

Correct Incorrect Correct answer

E. Alveolar fracture involving tooth 11

Correct Incorrect Correct answer

An 8-year-old Anglo-Australian female, Sarah Pearson, is brought to the clinic by her mother for an emergency appointment. Her mother reports that Sarah fell off her scooter approximately one hour ago and ‘knocked her front tooth right out’.

Sarah is visibly distressed and complains of a sore mouth. The mother has brought the missing tooth with her, wrapped in a tissue. Sarah’s medical history is significant for a repaired unilateral cleft lip and palate, for which she underwent several surgeries as an infant. She has no known drug allergies and is not taking any medications. A well-healed surgical scar is visible on her upper lip.

Examination reveals soft tissue swelling around her mouth and a small abrasion on her chin. Intraoral examination shows that tooth 11 is absent from the socket. The socket is filled with a blood clot, and there is a minor laceration of the buccal gingiva. The adjacent teeth, 12 and 21, are present and do not exhibit any mobility or visible fractures. The avulsed tooth 11 appears intact with an incompletely formed root apex, and there is some debris on the root surface. A targeted radiographic imaging of the area confirms an empty socket with intact lamina.

7. To assess the socket and adjacent teeth for Sarah Pearson, which radiographic imaging modality is most appropriate as the initial investigation-

A. Cone-beam computed tomography (CBCT) for 3D detail

Correct Incorrect Correct answer

B. Orthopantomogram (OPG) for a broad overview

Correct Incorrect Correct answer

C. Bitewing radiograph for interproximal assessment

Correct Incorrect Correct answer

D. Upper standard occlusal radiograph for displacement

Correct Incorrect Correct answer

E. Periapical radiograph of the 11 region

Correct Incorrect Correct answer

An 8-year-old Anglo-Australian female, Sarah Pearson, is brought to the clinic by her mother for an emergency appointment. Her mother reports that Sarah fell off her scooter approximately one hour ago and ‘knocked her front tooth right out’.

Sarah is visibly distressed and complains of a sore mouth. The mother has brought the missing tooth with her, wrapped in a tissue. Sarah’s medical history is significant for a repaired unilateral cleft lip and palate, for which she underwent several surgeries as an infant. She has no known drug allergies and is not taking any medications. A well-healed surgical scar is visible on her upper lip.

Examination reveals soft tissue swelling around her mouth and a small abrasion on her chin. Intraoral examination shows that tooth 11 is absent from the socket. The socket is filled with a blood clot, and there is a minor laceration of the buccal gingiva. The adjacent teeth, 12 and 21, are present and do not exhibit any mobility or visible fractures. The avulsed tooth 11 appears intact with an incompletely formed root apex, and there is some debris on the root surface. A targeted radiographic imaging of the area confirms an empty socket with intact lamina.

8. Considering the circumstances of Sarah Pearson’s injury, which factor most significantly compromises the long-term prognosis of the avulsed tooth 11-

A. History of a repaired cleft palate

Correct Incorrect Correct answer

B. Extended extra-oral dry time

Correct Incorrect Correct answer

C. Debris present on the root surface

Correct Incorrect Correct answer

D. Presence of a minor gingival laceration

Correct Incorrect Correct answer

E. Open apex of the tooth

Correct Incorrect Correct answer

An 8-year-old Anglo-Australian female, Sarah Pearson, is brought to the clinic by her mother for an emergency appointment. Her mother reports that Sarah fell off her scooter approximately one hour ago and ‘knocked her front tooth right out’.

Sarah is visibly distressed and complains of a sore mouth. The mother has brought the missing tooth with her, wrapped in a tissue. Sarah’s medical history is significant for a repaired unilateral cleft lip and palate, for which she underwent several surgeries as an infant. She has no known drug allergies and is not taking any medications. A well-healed surgical scar is visible on her upper lip.

Examination reveals soft tissue swelling around her mouth and a small abrasion on her chin. Intraoral examination shows that tooth 11 is absent from the socket. The socket is filled with a blood clot, and there is a minor laceration of the buccal gingiva. The adjacent teeth, 12 and 21, are present and do not exhibit any mobility or visible fractures. The avulsed tooth 11 appears intact with an incompletely formed root apex, and there is some debris on the root surface. A targeted radiographic imaging of the area confirms an empty socket with intact lamina.

9. What is the most appropriate immediate management for Sarah Pearson’s avulsed tooth 11, considering its condition and history-

A. Replant the tooth and apply a rigid splint for 4 weeks

Correct Incorrect Correct answer

B. Replant the tooth and apply a flexible splint for 2 weeks

Correct Incorrect Correct answer

C. Do not replant the tooth and consider a space maintainer

Correct Incorrect Correct answer

D. Clean the root surface with a curette before replantation

Correct Incorrect Correct answer

E. Soak the tooth in water and replant tomorrow

Correct Incorrect Correct answer

An 8-year-old Anglo-Australian female, Sarah Pearson, is brought to the clinic by her mother for an emergency appointment. Her mother reports that Sarah fell off her scooter approximately one hour ago and ‘knocked her front tooth right out’.

Sarah is visibly distressed and complains of a sore mouth. The mother has brought the missing tooth with her, wrapped in a tissue. Sarah’s medical history is significant for a repaired unilateral cleft lip and palate, for which she underwent several surgeries as an infant. She has no known drug allergies and is not taking any medications. A well-healed surgical scar is visible on her upper lip.

Examination reveals soft tissue swelling around her mouth and a small abrasion on her chin. Intraoral examination shows that tooth 11 is absent from the socket. The socket is filled with a blood clot, and there is a minor laceration of the buccal gingiva. The adjacent teeth, 12 and 21, are present and do not exhibit any mobility or visible fractures. The avulsed tooth 11 appears intact with an incompletely formed root apex, and there is some debris on the root surface. A targeted radiographic imaging of the area confirms an empty socket with intact lamina.

10. Following the immediate management of Sarah Pearson’s avulsed tooth, which adjunctive therapy is most appropriate to consider-

A. Steroid cream

Correct Incorrect Correct answer

B. Tetanus booster

Correct Incorrect Correct answer

C. Systemic antibiotics

Correct Incorrect Correct answer

D. Fluoride mouthwash

Correct Incorrect Correct answer

E. Opioid analgesics

Correct Incorrect Correct answer

James Murray, a 24-year-old university student, presents to your clinic with a chief complaint of intensely painful and bleeding gums, which started about a week ago. He reports a ‘horrible taste’ in his mouth and significant discomfort when eating or brushing. The pain is constant and severe. He attributes the recent onset to stress from
his final university exams.

James’s medical history is unremarkable, and he reports no known drug allergies. He is a smoker, consuming 10-15 cigarettes per day, a habit that has increased with recent academic pressure. His diet primarily consists of convenience foods and energy drinks, and he admits to brushing his teeth only once daily. He is afebrile.

Clinical examination reveals pronounced halitosis. The gingiva are generally erythematous and oedematous. In the mandibular anterior region (teeth 32 to 42), the interdental papillae appear blunted and ‘punched-out’, covered by a greyish, sloughing pseudomembrane.

These areas exhibit spontaneous bleeding and are exquisitely tender to touch. Mild submandibular lymphadenopathy is palpable. A partial periodontal charting reveals no probing depths greater than 4 mm. On tooth 31, the probing depth is 3 mm, and there is 2 mm of gingival recession where the cemento-enamel junction is visible.

11. Which combination of clinical findings is most pathognomonic for James Murray’s condition-

A. Generalised inflammation with punched-out interdental papillae and deep pockets

Correct Incorrect Correct answer

B. Diffuse inflammation with punched-out interdental papillae and greyish pseudomembrane

Correct Incorrect Correct answer

C. Localised fluctuant swelling associated with a single tooth

Correct Incorrect Correct answer

D. Erythematous and oedematous gingivae with spontaneous bleeding

Correct Incorrect Correct answer

E. Necrotic, 'punched-out' interdental papillae with a greyish pseudomembrane

Correct Incorrect Correct answer

James Murray, a 24-year-old university student, presents to your clinic with a chief complaint of intensely painful and bleeding gums, which started about a week ago. He reports a ‘horrible taste’ in his mouth and significant discomfort when eating or brushing. The pain is constant and severe. He attributes the recent onset to stress from
his final university exams.

James’s medical history is unremarkable, and he reports no known drug allergies. He is a smoker, consuming 10-15 cigarettes per day, a habit that has increased with recent academic pressure. His diet primarily consists of convenience foods and energy drinks, and he admits to brushing his teeth only once daily. He is afebrile.

Clinical examination reveals pronounced halitosis. The gingiva are generally erythematous and oedematous. In the mandibular anterior region (teeth 32 to 42), the interdental papillae appear blunted and ‘punched-out’, covered by a greyish, sloughing pseudomembrane.

These areas exhibit spontaneous bleeding and are exquisitely tender to touch. Mild submandibular lymphadenopathy is palpable. A partial periodontal charting reveals no probing depths greater than 4 mm. On tooth 31, the probing depth is 3 mm, and there is 2 mm of gingival recession where the cemento-enamel junction is visible.

12. What is the primary clinical justification for the panoramic radiograph to be taken for James Murray-

A. To determine the extent of the palpable submandibular lymphadenopathy

Correct Incorrect Correct answer

B. To confirm the clinical diagnosis of necrotising gingivitis on the radiograph

Correct Incorrect Correct answer

C. To assess for interproximal caries resulting from his poor oral hygiene

Correct Incorrect Correct answer

D. To identify periapical pathology as the primary source of his pain

Correct Incorrect Correct answer

E. To exclude alveolar bone loss and differentiate from necrotising periodontitis

Correct Incorrect Correct answer

James Murray, a 24-year-old university student, presents to your clinic with a chief complaint of intensely painful and bleeding gums, which started about a week ago. He reports a ‘horrible taste’ in his mouth and significant discomfort when eating or brushing. The pain is constant and severe. He attributes the recent onset to stress from
his final university exams.

James’s medical history is unremarkable, and he reports no known drug allergies. He is a smoker, consuming 10-15 cigarettes per day, a habit that has increased with recent academic pressure. His diet primarily consists of convenience foods and energy drinks, and he admits to brushing his teeth only once daily. He is afebrile.

Clinical examination reveals pronounced halitosis. The gingiva are generally erythematous and oedematous. In the mandibular anterior region (teeth 32 to 42), the interdental papillae appear blunted and ‘punched-out’, covered by a greyish, sloughing pseudomembrane.

These areas exhibit spontaneous bleeding and are exquisitely tender to touch. Mild submandibular lymphadenopathy is palpable. A partial periodontal charting reveals no probing depths greater than 4 mm. On tooth 31, the probing depth is 3 mm, and there is 2 mm of gingival recession where the cemento-enamel junction is visible.

13. Based on the clinical findings, what is the most likely diagnosis for James Murray-

A. A diagnosis of primary herpetic gingivostomatitis

Correct Incorrect Correct answer

B. Necrotising gingivitis

Correct Incorrect Correct answer

C. A diagnosis of an acute periodontal abscess

Correct Incorrect Correct answer

D. A diagnosis of severe plaque-induced gingivitis

Correct Incorrect Correct answer

E. A diagnosis of necrotising periodontitis

Correct Incorrect Correct answer

James Murray, a 24-year-old university student, presents to your clinic with a chief complaint of intensely painful and bleeding gums, which started about a week ago. He reports a ‘horrible taste’ in his mouth and significant discomfort when eating or brushing. The pain is constant and severe. He attributes the recent onset to stress from
his final university exams.

James’s medical history is unremarkable, and he reports no known drug allergies. He is a smoker, consuming 10-15 cigarettes per day, a habit that has increased with recent academic pressure. His diet primarily consists of convenience foods and energy drinks, and he admits to brushing his teeth only once daily. He is afebrile.

Clinical examination reveals pronounced halitosis. The gingiva are generally erythematous and oedematous. In the mandibular anterior region (teeth 32 to 42), the interdental papillae appear blunted and ‘punched-out’, covered by a greyish, sloughing pseudomembrane.

These areas exhibit spontaneous bleeding and are exquisitely tender to touch. Mild submandibular lymphadenopathy is palpable. A partial periodontal charting reveals no probing depths greater than 4 mm. On tooth 31, the probing depth is 3 mm, and there is 2 mm of gingival recession where the cemento-enamel junction is visible.

14. Given the diagnosis, what is the most appropriate first step in the clinical management for James Murray-

A. Prescribe systemic antibiotics only and schedule a review in one week

Correct Incorrect Correct answer

B. Provide oral hygiene instruction and smoking cessation advice only

Correct Incorrect Correct answer

C. Gentle debridement of necrotic tissue and plaque under local anaesthesia

Correct Incorrect Correct answer

D. Perform full mouth aggressive scaling and root planing immediately

Correct Incorrect Correct answer

E. Advise chlorhexidine mouthwash only until his acute symptoms subside

Correct Incorrect Correct answer

James Murray, a 24-year-old university student, presents to your clinic with a chief complaint of intensely painful and bleeding gums, which started about a week ago. He reports a ‘horrible taste’ in his mouth and significant discomfort when eating or brushing. The pain is constant and severe. He attributes the recent onset to stress from
his final university exams.

James’s medical history is unremarkable, and he reports no known drug allergies. He is a smoker, consuming 10-15 cigarettes per day, a habit that has increased with recent academic pressure. His diet primarily consists of convenience foods and energy drinks, and he admits to brushing his teeth only once daily. He is afebrile.

Clinical examination reveals pronounced halitosis. The gingiva are generally erythematous and oedematous. In the mandibular anterior region (teeth 32 to 42), the interdental papillae appear blunted and ‘punched-out’, covered by a greyish, sloughing pseudomembrane.

These areas exhibit spontaneous bleeding and are exquisitely tender to touch. Mild submandibular lymphadenopathy is palpable. A partial periodontal charting reveals no probing depths greater than 4 mm. On tooth 31, the probing depth is 3 mm, and there is 2 mm of gingival recession where the cemento-enamel junction is visible.

15. In addition to mechanical debridement, which pharmacological agent is most appropriate to prescribe for James Murray to treat the underlying infection-

A. Metronidazole

Correct Incorrect Correct answer

B. A course of oral amoxicillin

Correct Incorrect Correct answer

C. Regular doses of paracetamol

Correct Incorrect Correct answer

D. Application of a topical corticosteroid

Correct Incorrect Correct answer

E. A course of oral doxycycline

Correct Incorrect Correct answer

James Edwards, a 7-year-old boy, is brought to your dental practice by his mother for an emergency appointment. About 30 minutes ago, he fell off his scooter and knocked out an upper front tooth. His mother presents the tooth wrapped in a dry tissue. She explains that she picked it up from the pavement by the ‘pointy end’ and wiped the
dirt off with the tissue before wrapping it up.

James’s medical history is significant for well-controlled asthma, for which he uses a salbutamol inhaler as needed, and a documented allergy to penicillin that causes a non-anaphylactic rash. His tetanus immunisations are up-to-date. He is an active child who enjoys outdoor activities.

Extra-oral examination reveals a small, bleeding laceration on his upper lip but no other facial injuries. He is alert and shows no signs of a head injury.

Intra-orally, the socket of tooth 11 is empty and oozing blood. There is tenderness on palpation of the alveolar bone, but no segmental mobility is detected.

Tooth 21 is tender to percussion, exhibits Grade 1 mobility, and has visible bleeding from the gingival crevice. Tooth 12 is also tender to percussion but is not mobile, and there is no bleeding from its gingival crevice.

While you are examining James, his mother mentions that he had a similar, less severe fall about 3 months ago where the tooth 63 was damaged and got discoloured.

16. Based on the history provided by James Edwards’ mother, what is the most critical assessment of the first aid for the avulsed tooth 11-

A. The tooth root was cleaned appropriately by the mother and is ready for replantation

Correct Incorrect Correct answer

B. The extra-oral time of 30 minutes is the only factor affecting the tooth's prognosis

Correct Incorrect Correct answer

C. The tooth was handled by the root and stored dry, compromising periodontal ligament viability

Correct Incorrect Correct answer

D. The patient's up-to-date tetanus immunisation is the most positive prognostic factor

Correct Incorrect Correct answer

E. The primary clinical concern is the management of the soft tissue laceration on the lip

Correct Incorrect Correct answer

James Edwards, a 7-year-old boy, is brought to your dental practice by his mother for an emergency appointment. About 30 minutes ago, he fell off his scooter and knocked out an upper front tooth. His mother presents the tooth wrapped in a dry tissue. She explains that she picked it up from the pavement by the ‘pointy end’ and wiped the
dirt off with the tissue before wrapping it up.

James’s medical history is significant for well-controlled asthma, for which he uses a salbutamol inhaler as needed, and a documented allergy to penicillin that causes a non-anaphylactic rash. His tetanus immunisations are up-to-date. He is an active child who enjoys outdoor activities.

Extra-oral examination reveals a small, bleeding laceration on his upper lip but no other facial injuries. He is alert and shows no signs of a head injury.

Intra-orally, the socket of tooth 11 is empty and oozing blood. There is tenderness on palpation of the alveolar bone, but no segmental mobility is detected.

Tooth 21 is tender to percussion, exhibits Grade 1 mobility, and has visible bleeding from the gingival crevice. Tooth 12 is also tender to percussion but is not mobile, and there is no bleeding from its gingival crevice.

While you are examining James, his mother mentions that he had a similar, less severe fall about 3 months ago where the tooth 63 was damaged and got discoloured.

17. What is the most accurate diagnosis for the injuries sustained by teeth 21 and 12 in James Edwards’ case-

A. The injuries to teeth 21 and 12 are indicative of an alveolar fracture

Correct Incorrect Correct answer

B. Tooth 21 has an extrusive luxation and tooth 12 has a subluxation injury

Correct Incorrect Correct answer

C. Teeth 21 and 12 both have subluxation injuries due to the trauma

Correct Incorrect Correct answer

D. Teeth 21 and 12 both have concussion injuries from the initial impact

Correct Incorrect Correct answer

E. Tooth 21 has a subluxation injury and tooth 12 has a concussion injury

Correct Incorrect Correct answer

James Edwards, a 7-year-old boy, is brought to your dental practice by his mother for an emergency appointment. About 30 minutes ago, he fell off his scooter and knocked out an upper front tooth. His mother presents the tooth wrapped in a dry tissue. She explains that she picked it up from the pavement by the ‘pointy end’ and wiped the
dirt off with the tissue before wrapping it up.

James’s medical history is significant for well-controlled asthma, for which he uses a salbutamol inhaler as needed, and a documented allergy to penicillin that causes a non-anaphylactic rash. His tetanus immunisations are up-to-date. He is an active child who enjoys outdoor activities.

Extra-oral examination reveals a small, bleeding laceration on his upper lip but no other facial injuries. He is alert and shows no signs of a head injury.

Intra-orally, the socket of tooth 11 is empty and oozing blood. There is tenderness on palpation of the alveolar bone, but no segmental mobility is detected.

Tooth 21 is tender to percussion, exhibits Grade 1 mobility, and has visible bleeding from the gingival crevice. Tooth 12 is also tender to percussion but is not mobile, and there is no bleeding from its gingival crevice.

While you are examining James, his mother mentions that he had a similar, less severe fall about 3 months ago where the tooth 63 was damaged and got discoloured.

18. After replantation of tooth 11, what is the most appropriate systemic antibiotic management for James Edwards

A. Prescribe metronidazole to cover potential anaerobic contamination

Correct Incorrect Correct answer

B. Prescribe amoxicillin as the standard first-line treatment

Correct Incorrect Correct answer

C. Prescribe doxycycline due to the penicillin allergy

Correct Incorrect Correct answer

D. Prescribe cefalexin as a suitable alternative to penicillin

Correct Incorrect Correct answer

E. Withhold any antibiotic as its use is not strongly supported

Correct Incorrect Correct answer

James Edwards, a 7-year-old boy, is brought to your dental practice by his mother for an emergency appointment. About 30 minutes ago, he fell off his scooter and knocked out an upper front tooth. His mother presents the tooth wrapped in a dry tissue. She explains that she picked it up from the pavement by the ‘pointy end’ and wiped the
dirt off with the tissue before wrapping it up.

James’s medical history is significant for well-controlled asthma, for which he uses a salbutamol inhaler as needed, and a documented allergy to penicillin that causes a non-anaphylactic rash. His tetanus immunisations are up-to-date. He is an active child who enjoys outdoor activities.

Extra-oral examination reveals a small, bleeding laceration on his upper lip but no other facial injuries. He is alert and shows no signs of a head injury.

Intra-orally, the socket of tooth 11 is empty and oozing blood. There is tenderness on palpation of the alveolar bone, but no segmental mobility is detected.

Tooth 21 is tender to percussion, exhibits Grade 1 mobility, and has visible bleeding from the gingival crevice. Tooth 12 is also tender to percussion but is not mobile, and there is no bleeding from its gingival crevice.

While you are examining James, his mother mentions that he had a similar, less severe fall about 3 months ago where the tooth 63 was damaged and got discoloured.

19. How should you best explain the long-term prognosis for the avulsed tooth 11 to James Edwards’ mother-

A. Explain – Reassure the mother that the tooth will likely be fine once it has been replanted and splinted, as the extra-oral time was short

Correct Incorrect Correct answer

B. Advise the mother that the tooth cannot be saved and should not be replanted due to the significant damage that has already occurred

Correct Incorrect Correct answer

C. Explain that the prognosis for tooth 11 is guarded due to the dry storage and handling of the root, which likely damaged the periodontal ligament cells

Correct Incorrect Correct answer

D. Criticise the mother for her incorrect first aid, explaining that this has ruined the tooth's chances of long-term survival and success

Correct Incorrect Correct answer

E. State that the 30-minute extra-oral time means the prognosis is excellent, and that the initial handling method is not a major concern

Correct Incorrect Correct answer

James Edwards, a 7-year-old boy, is brought to your dental practice by his mother for an emergency appointment. About 30 minutes ago, he fell off his scooter and knocked out an upper front tooth. His mother presents the tooth wrapped in a dry tissue. She explains that she picked it up from the pavement by the ‘pointy end’ and wiped the
dirt off with the tissue before wrapping it up.

James’s medical history is significant for well-controlled asthma, for which he uses a salbutamol inhaler as needed, and a documented allergy to penicillin that causes a non-anaphylactic rash. His tetanus immunisations are up-to-date. He is an active child who enjoys outdoor activities.

Extra-oral examination reveals a small, bleeding laceration on his upper lip but no other facial injuries. He is alert and shows no signs of a head injury.

Intra-orally, the socket of tooth 11 is empty and oozing blood. There is tenderness on palpation of the alveolar bone, but no segmental mobility is detected.

Tooth 21 is tender to percussion, exhibits Grade 1 mobility, and has visible bleeding from the gingival crevice. Tooth 12 is also tender to percussion but is not mobile, and there is no bleeding from its gingival crevice.

While you are examining James, his mother mentions that he had a similar, less severe fall about 3 months ago where the tooth 63 was damaged and got discoloured.

20. Regarding the previously traumatised primary tooth that is now grey, what is the most appropriate advice for James Edwards’ mother-

A. Advise that the grey discolouration likely indicates pulp necrosis and requires clinical and radiographic monitoring for infection

Correct Incorrect Correct answer

B. Advise that the primary tooth must be extracted immediately to prevent any damage to the underlying permanent tooth

Correct Incorrect Correct answer

C. Recommend initiating root canal therapy on the primary tooth to treat the pulp and resolve the discolouration

Correct Incorrect Correct answer

D. Advise that the grey colour is simply bruising within the tooth and will likely resolve on its own without treatment

Correct Incorrect Correct answer

E. Advise that the discolouration is of no consequence and can be ignored as it is only a primary tooth

Correct Incorrect Correct answer

Sarah King, a 5-year-old girl, is brought to your dental practice by her mother. Her mother is concerned about a “sore tooth and a bit of a fever”. She adds, “I’m worried it might be that hand, foot, and mouth thing that’s been going around her daycare. She had some spots on her hands a few days ago, but they’ve faded now.” Sarah points to her lower left jaw when asked where it hurts. The pain started two days ago and kept her awake last night. Sarah’s mother reports that her daughter had a mild fever and was reluctant to eat for several days last week. During this time, she was given a sugar-containing liquid paracetamol formulation. Her mother admits that toothbrushing has been difficult over the past week due to Sarah’s oral discomfort. Sarah’s diet typically includes fruit juice with her lunch and crackers for snacks between meals. They live in a suburb with fluoridated community water.

Sarah has no known medical conditions or allergies. On examination, Sarah’s temperature is 37.8°C. There is a firm, localised swelling in the left submandibular area, which is tender to gentle palpation.

Intraorally, there is a generalised accumulation of plaque. Tooth 74 presents with a large, open cavity on the occlusal surface with early caries on other teeth as well.

21. Based on the history provided for Sarah King, what is the most significant contributing risk factor for her current dental condition-

A. Inherently weak primary tooth enamel

Correct Incorrect Correct answer

B. Frequent dietary sugar intake

Correct Incorrect Correct answer

C. Lack of adequate fluoride exposure

Correct Incorrect Correct answer

D. The recent, debilitating viral illness

Correct Incorrect Correct answer

E. Consistently poor oral hygiene

Correct Incorrect Correct answer

Sarah King, a 5-year-old girl, is brought to your dental practice by her mother. Her mother is concerned about a “sore tooth and a bit of a fever”. She adds, “I’m worried it might be that hand, foot, and mouth thing that’s been going around her daycare. She had some spots on her hands a few days ago, but they’ve faded now.” Sarah points to her lower left jaw when asked where it hurts. The pain started two days ago and kept her awake last night. Sarah’s mother reports that her daughter had a mild fever and was reluctant to eat for several days last week. During this time, she was given a sugar-containing liquid paracetamol formulation. Her mother admits that toothbrushing has been difficult over the past week due to Sarah’s oral discomfort. Sarah’s diet typically includes fruit juice with her lunch and crackers for snacks between meals. They live in a suburb with fluoridated community water.

Sarah has no known medical conditions or allergies. On examination, Sarah’s temperature is 37.8°C. There is a firm, localised swelling in the left submandibular area, which is tender to gentle palpation.

Intraorally, there is a generalised accumulation of plaque. Tooth 74 presents with a large, open cavity on the occlusal surface with early caries on other teeth as well.

22. To address the underlying cause of Sarah King’s caries, what is the most effective behavioural advice to give her mother-

A. Start using a high-fluoride (5000 ppm) toothpaste

Correct Incorrect Correct answer

B. Ensure the child rinses with water after every meal

Correct Incorrect Correct answer

C. Replace her daily fruit juice with sugar-free cordial

Correct Incorrect Correct answer

D. Reduce the frequency of sugar consumption between meals

Correct Incorrect Correct answer

E. Improve toothbrushing technique and overall frequency

Correct Incorrect Correct answer

Sarah King, a 5-year-old girl, is brought to your dental practice by her mother. Her mother is concerned about a “sore tooth and a bit of a fever”. She adds, “I’m worried it might be that hand, foot, and mouth thing that’s been going around her daycare. She had some spots on her hands a few days ago, but they’ve faded now.” Sarah points to her lower left jaw when asked where it hurts. The pain started two days ago and kept her awake last night. Sarah’s mother reports that her daughter had a mild fever and was reluctant to eat for several days last week. During this time, she was given a sugar-containing liquid paracetamol formulation. Her mother admits that toothbrushing has been difficult over the past week due to Sarah’s oral discomfort. Sarah’s diet typically includes fruit juice with her lunch and crackers for snacks between meals. They live in a suburb with fluoridated community water.

Sarah has no known medical conditions or allergies. On examination, Sarah’s temperature is 37.8°C. There is a firm, localised swelling in the left submandibular area, which is tender to gentle palpation.

Intraorally, there is a generalised accumulation of plaque. Tooth 74 presents with a large, open cavity on the occlusal surface with early caries on other teeth as well.

23. Considering all the clinical findings for Sarah King, what is the most likely diagnosis-

A. Acute dentoalveolar abscess originating from tooth 74

Correct Incorrect Correct answer

B. Primary herpetic gingivostomatitis with oral discomfort

Correct Incorrect Correct answer

C. Acute bacterial infection of the submandibular gland

Correct Incorrect Correct answer

D. Symptomatic irreversible pulpitis affecting tooth 74

Correct Incorrect Correct answer

E. A secondary infection from Hand, Foot, and Mouth Disease

Correct Incorrect Correct answer

Sarah King, a 5-year-old girl, is brought to your dental practice by her mother. Her mother is concerned about a “sore tooth and a bit of a fever”. She adds, “I’m worried it might be that hand, foot, and mouth thing that’s been going around her daycare. She had some spots on her hands a few days ago, but they’ve faded now.” Sarah points to her lower left jaw when asked where it hurts. The pain started two days ago and kept her awake last night. Sarah’s mother reports that her daughter had a mild fever and was reluctant to eat for several days last week. During this time, she was given a sugar-containing liquid paracetamol formulation. Her mother admits that toothbrushing has been difficult over the past week due to Sarah’s oral discomfort. Sarah’s diet typically includes fruit juice with her lunch and crackers for snacks between meals. They live in a suburb with fluoridated community water.

Sarah has no known medical conditions or allergies. On examination, Sarah’s temperature is 37.8°C. There is a firm, localised swelling in the left submandibular area, which is tender to gentle palpation.

Intraorally, there is a generalised accumulation of plaque. Tooth 74 presents with a large, open cavity on the occlusal surface with early caries on other teeth as well.

24. After addressing the acute issue with tooth 74 for Sarah King, what is the most appropriate preventive measure for her remaining dentition-

A. Place fissure sealants on all other primary molars

Correct Incorrect Correct answer

B. Application of fluoride varnish to all remaining teeth

Correct Incorrect Correct answer

C. Prescribe daily systemic fluoride supplements to take

Correct Incorrect Correct answer

D. Recommend a daily non-fluoride remineralising agent

Correct Incorrect Correct answer

E. Prophylactic restoration of any incipient lesions found

Correct Incorrect Correct answer

Sarah King, a 5-year-old girl, is brought to your dental practice by her mother. Her mother is concerned about a “sore tooth and a bit of a fever”. She adds, “I’m worried it might be that hand, foot, and mouth thing that’s been going around her daycare. She had some spots on her hands a few days ago, but they’ve faded now.” Sarah points to her lower left jaw when asked where it hurts. The pain started two days ago and kept her awake last night. Sarah’s mother reports that her daughter had a mild fever and was reluctant to eat for several days last week. During this time, she was given a sugar-containing liquid paracetamol formulation. Her mother admits that toothbrushing has been difficult over the past week due to Sarah’s oral discomfort. Sarah’s diet typically includes fruit juice with her lunch and crackers for snacks between meals. They live in a suburb with fluoridated community water.

Sarah has no known medical conditions or allergies. On examination, Sarah’s temperature is 37.8°C. There is a firm, localised swelling in the left submandibular area, which is tender to gentle palpation.

Intraorally, there is a generalised accumulation of plaque. Tooth 74 presents with a large, open cavity on the occlusal surface with early caries on other teeth as well.

25. Which piece of health education advice is most relevant and impactful for Sarah King’s mother-

A. Reassure her that primary teeth are not critically important

Correct Incorrect Correct answer

B. Advise on choosing sugar-free formulations of liquid medications

Correct Incorrect Correct answer

C. Instruct her to stop all juice and crackers from the diet

Correct Incorrect Correct answer

D. Explain the viral illness directly caused the dental infection

Correct Incorrect Correct answer

E. Advise boiling fluoridated tap water before the child drinks it

Correct Incorrect Correct answer

A 34-year-old Filipino-Australian woman, Maria Reyes, presents for an emergency appointment complaining of pain and swelling around her lower left wisdom tooth, which started two days ago. She also reports feeling generally unwell with body aches, a persistent dry cough, and a low-grade fever since yesterday.

Her medical history is non-contributory, and she takes no regular medications. She has no known drug allergies. Maria works as a primary school teacher and mentions she has not had her annual influenza vaccination this year. She is a non-smoker and consumes alcohol socially.

On examination, her temperature is 38.1°C. Extra-orally, there is mild, tender swelling in the left submandibular region and palpable, tender left submandibular lymph nodes. She has a limited mouth opening of 25mm interincisally.

Intra-orally, the operculum overlying the partially erupted tooth 38 is erythematous, oedematous, and acutely tender to palpation. A small amount of purulent exudate is expressed from beneath the operculum on gentle pressure. The adjacent tooth 37 is asymptomatic, responds normally to sensibility testing, and is not tender to percussion. Her overall oral hygiene is fair.

26. Based on the clinical examination of Maria Reyes, which combination of findings most accurately represents the key local signs of her acute dental infection-

A. Acute pericoronitis tooth 38

Correct Incorrect Correct answer

B. Irreversible pulpitis with respect to tooth 38

Correct Incorrect Correct answer

C. Irreversible pulpitis with respect to tooth 37

Correct Incorrect Correct answer

D. Viral Influenza infection

Correct Incorrect Correct answer

E. Acute apical abscess with respect to tooth 38

Correct Incorrect Correct answer

A 34-year-old Filipino-Australian woman, Maria Reyes, presents for an emergency appointment complaining of pain and swelling around her lower left wisdom tooth, which started two days ago. She also reports feeling generally unwell with body aches, a persistent dry cough, and a low-grade fever since yesterday.

Her medical history is non-contributory, and she takes no regular medications. She has no known drug allergies. Maria works as a primary school teacher and mentions she has not had her annual influenza vaccination this year. She is a non-smoker and consumes alcohol socially.

On examination, her temperature is 38.1°C. Extra-orally, there is mild, tender swelling in the left submandibular region and palpable, tender left submandibular lymph nodes. She has a limited mouth opening of 25mm interincisally.

Intra-orally, the operculum overlying the partially erupted tooth 38 is erythematous, oedematous, and acutely tender to palpation. A small amount of purulent exudate is expressed from beneath the operculum on gentle pressure. The adjacent tooth 37 is asymptomatic, responds normally to sensibility testing, and is not tender to percussion. Her overall oral hygiene is fair.

27. Considering all of Maria Reyes’s local and systemic symptoms, what is the most comprehensive diagnosis-

A. A spreading odontogenic infection from tooth 38 into the adjacent buccal space

Correct Incorrect Correct answer

B. An acute influenza infection causing referred pain to the left mandibular region

Correct Incorrect Correct answer

C. Acute pericoronitis of tooth 38 only, with fever due to the dental infection

Correct Incorrect Correct answer

D. Acute pericoronitis of tooth 38 with a concurrent suspected viral respiratory illness

Correct Incorrect Correct answer

E. Systemic sepsis originating from a localised odontogenic infection around tooth 38

Correct Incorrect Correct answer

A 34-year-old Filipino-Australian woman, Maria Reyes, presents for an emergency appointment complaining of pain and swelling around her lower left wisdom tooth, which started two days ago. She also reports feeling generally unwell with body aches, a persistent dry cough, and a low-grade fever since yesterday.

Her medical history is non-contributory, and she takes no regular medications. She has no known drug allergies. Maria works as a primary school teacher and mentions she has not had her annual influenza vaccination this year. She is a non-smoker and consumes alcohol socially.

On examination, her temperature is 38.1°C. Extra-orally, there is mild, tender swelling in the left submandibular region and palpable, tender left submandibular lymph nodes. She has a limited mouth opening of 25mm interincisally.

Intra-orally, the operculum overlying the partially erupted tooth 38 is erythematous, oedematous, and acutely tender to palpation. A small amount of purulent exudate is expressed from beneath the operculum on gentle pressure. The adjacent tooth 37 is asymptomatic, responds normally to sensibility testing, and is not tender to percussion. Her overall oral hygiene is fair.

28. What is the most appropriate immediate management plan for Maria Reyes’s acute presentation-

A. Prescribe a course of amoxicillin and schedule a review appointment for one week later

Correct Incorrect Correct answer

B. Implement transmission-based precautions, debride and irrigate the operculum, and provide oral hygiene instructions

Correct Incorrect Correct answer

C. Refer to her GP for the respiratory illness before commencing any definitive dental treatment

Correct Incorrect Correct answer

D. Advise only warm saline rinses and prescribe paracetamol for symptomatic pain relief

Correct Incorrect Correct answer

E. Proceed immediately with the surgical extraction of tooth 38 under local anaesthetic cover

Correct Incorrect Correct answer

A 34-year-old Filipino-Australian woman, Maria Reyes, presents for an emergency appointment complaining of pain and swelling around her lower left wisdom tooth, which started two days ago. She also reports feeling generally unwell with body aches, a persistent dry cough, and a low-grade fever since yesterday.

Her medical history is non-contributory, and she takes no regular medications. She has no known drug allergies. Maria works as a primary school teacher and mentions she has not had her annual influenza vaccination this year. She is a non-smoker and consumes alcohol socially.

On examination, her temperature is 38.1°C. Extra-orally, there is mild, tender swelling in the left submandibular region and palpable, tender left submandibular lymph nodes. She has a limited mouth opening of 25mm interincisally.

Intra-orally, the operculum overlying the partially erupted tooth 38 is erythematous, oedematous, and acutely tender to palpation. A small amount of purulent exudate is expressed from beneath the operculum on gentle pressure. The adjacent tooth 37 is asymptomatic, responds normally to sensibility testing, and is not tender to percussion. Her overall oral hygiene is fair.

29. Once her acute symptoms have subsided, what is the most appropriate definitive treatment plan for Maria Reyes-

A. Perform an operculectomy to surgically expose the crown of the impacted tooth 38

Correct Incorrect Correct answer

B. Schedule for extraction of tooth 38 once the acute local and systemic symptoms have resolved

Correct Incorrect Correct answer

C. Advise that no further treatment is required after the acute phase has been managed

Correct Incorrect Correct answer

D. Prescribe long-term prophylactic antibiotics to manage any future recurrent pericoronitis infections

Correct Incorrect Correct answer

E. Place a preventative restoration on tooth 37 to prevent future food trapping

Correct Incorrect Correct answer

A 34-year-old Filipino-Australian woman, Maria Reyes, presents for an emergency appointment complaining of pain and swelling around her lower left wisdom tooth, which started two days ago. She also reports feeling generally unwell with body aches, a persistent dry cough, and a low-grade fever since yesterday.

Her medical history is non-contributory, and she takes no regular medications. She has no known drug allergies. Maria works as a primary school teacher and mentions she has not had her annual influenza vaccination this year. She is a non-smoker and consumes alcohol socially.

On examination, her temperature is 38.1°C. Extra-orally, there is mild, tender swelling in the left submandibular region and palpable, tender left submandibular lymph nodes. She has a limited mouth opening of 25mm interincisally.

Intra-orally, the operculum overlying the partially erupted tooth 38 is erythematous, oedematous, and acutely tender to palpation. A small amount of purulent exudate is expressed from beneath the operculum on gentle pressure. The adjacent tooth 37 is asymptomatic, responds normally to sensibility testing, and is not tender to percussion. Her overall oral hygiene is fair.

30. Which impacted lower 3rd molar tooth is the hardest to remove-

A- Mesioangular

Correct Incorrect Correct answer

B- Distoangular

Correct Incorrect Correct answer

C- Horizontal

Correct Incorrect Correct answer

D- Vertical

Correct Incorrect Correct answer

E- All

Correct Incorrect Correct answer

Eddie Thaiday, a 24-year-old Torres Strait Islander male, presents for a check-up, stating he hasn’t seen a dentist in several years. His main concern is “food getting stuck in a hole in a lower right back tooth.” He reports occasional, mild and brief sensitivity to cold drinks in that area, which resolves immediately after the stimulus is removed. He denies any spontaneous,throbbing, or lingering pain.

His medical history is unremarkable. He takes no regular medications and has no known drug allergies. He is a non-smoker and consumes alcohol occasionally. He works as a tradesperson and finds it difficult to schedule regular dental appointments.

Clinical examination reveals a large, open carious lesion on the tooth 45 with soft, discoloured dentine. The surrounding gingiva appears healthy. Pulp sensibility testing on tooth 45 elicits a sharp response to a cold stimulus that subsides immediately upon removal. The tooth responds to electric pulp testing at a level comparable to the adjacent teeth. It is not tender to percussion or palpation.

A targeted radiographic imaging radiograph of tooth 45 shows a deep radiolucency extending into the pulpal third of the dentine. The periodontal ligament appears normal without widening.

31. Based on the history and clinical examination findings for tooth 45, what is the most likely pulpal diagnosis for Eddie Thaiday-

A. The clinical findings are most consistent with irreversible pulpitis

Correct Incorrect Correct answer

B. The clinical findings are most consistent with pulp necrosis

Correct Incorrect Correct answer

C. The clinical findings are most consistent with symptomatic apical periodontitis

Correct Incorrect Correct answer

D. The clinical findings are most consistent with reversible pulpitis

Correct Incorrect Correct answer

E. The clinical findings are most consistent with a cracked tooth

Correct Incorrect Correct answer

Eddie Thaiday, a 24-year-old Torres Strait Islander male, presents for a check-up, stating he hasn’t seen a dentist in several years. His main concern is “food getting stuck in a hole in a lower right back tooth.” He reports occasional, mild and brief sensitivity to cold drinks in that area, which resolves immediately after the stimulus is removed. He denies any spontaneous,throbbing, or lingering pain.

His medical history is unremarkable. He takes no regular medications and has no known drug allergies. He is a non-smoker and consumes alcohol occasionally. He works as a tradesperson and finds it difficult to schedule regular dental appointments.

Clinical examination reveals a large, open carious lesion on the tooth 45 with soft, discoloured dentine. The surrounding gingiva appears healthy. Pulp sensibility testing on tooth 45 elicits a sharp response to a cold stimulus that subsides immediately upon removal. The tooth responds to electric pulp testing at a level comparable to the adjacent teeth. It is not tender to percussion or palpation.

A targeted radiographic imaging radiograph of tooth 45 shows a deep radiolucency extending into the pulpal third of the dentine. The periodontal ligament appears normal without widening.

32. What is the most accurate interpretation of the periapical radiograph for Eddie Thaiday’s tooth 45-

A. The radiograph is inconclusive and a CBCT is required for a more definitive diagnosis

Correct Incorrect Correct answer

B. The radiograph shows a distinct periapical radiolucency indicating early signs of chronic infection

Correct Incorrect Correct answer

C. The radiograph indicates deep caries approaching the pulp with no signs of periapical pathology

Correct Incorrect Correct answer

D. The radiograph suggests internal resorption is occurring within the tooth's main pulp chamber

Correct Incorrect Correct answer

E. The radiograph indicates moderate caries that is confined only to the outer dentine layer

Correct Incorrect Correct answer

Eddie Thaiday, a 24-year-old Torres Strait Islander male, presents for a check-up, stating he hasn’t seen a dentist in several years. His main concern is “food getting stuck in a hole in a lower right back tooth.” He reports occasional, mild and brief sensitivity to cold drinks in that area, which resolves immediately after the stimulus is removed. He denies any spontaneous,throbbing, or lingering pain.

His medical history is unremarkable. He takes no regular medications and has no known drug allergies. He is a non-smoker and consumes alcohol occasionally. He works as a tradesperson and finds it difficult to schedule regular dental appointments.

Clinical examination reveals a large, open carious lesion on the tooth 45 with soft, discoloured dentine. The surrounding gingiva appears healthy. Pulp sensibility testing on tooth 45 elicits a sharp response to a cold stimulus that subsides immediately upon removal. The tooth responds to electric pulp testing at a level comparable to the adjacent teeth. It is not tender to percussion or palpation.

A targeted radiographic imaging radiograph of tooth 45 shows a deep radiolucency extending into the pulpal third of the dentine. The periodontal ligament appears normal without widening.

33. During caries excavation on tooth 45 for Eddie Thaiday, a pinpoint carious exposure occurs.The exposed pulp bleeds bright red, and haemostasis is achieved within three minutes. What is the most accurate definitive diagnosis-

A. Mechanical pulp exposure in a healthy pulp

Correct Incorrect Correct answer

B. Asymptomatic apical periodontitis with pulp necrosis

Correct Incorrect Correct answer

C. Pulp necrosis with chronic apical periodontitis

Correct Incorrect Correct answer

D. Irreversible pulpitis with carious pulp exposure

Correct Incorrect Correct answer

E. Reversible pulpitis with carious pulp exposure

Correct Incorrect Correct answer

Eddie Thaiday, a 24-year-old Torres Strait Islander male, presents for a check-up, stating he hasn’t seen a dentist in several years. His main concern is “food getting stuck in a hole in a lower right back tooth.” He reports occasional, mild and brief sensitivity to cold drinks in that area, which resolves immediately after the stimulus is removed. He denies any spontaneous,throbbing, or lingering pain.

His medical history is unremarkable. He takes no regular medications and has no known drug allergies. He is a non-smoker and consumes alcohol occasionally. He works as a tradesperson and finds it difficult to schedule regular dental appointments.

Clinical examination reveals a large, open carious lesion on the tooth 45 with soft, discoloured dentine. The surrounding gingiva appears healthy. Pulp sensibility testing on tooth 45 elicits a sharp response to a cold stimulus that subsides immediately upon removal. The tooth responds to electric pulp testing at a level comparable to the adjacent teeth. It is not tender to percussion or palpation.

A targeted radiographic imaging radiograph of tooth 45 shows a deep radiolucency extending into the pulpal third of the dentine. The periodontal ligament appears normal without widening.

34. Given the diagnosis for Eddie Thaiday’s tooth 45, what is the most appropriate immediate treatment to preserve pulp vitality-

A. Extract the tooth and plan for a future replacement

Correct Incorrect Correct answer

B. Perform direct pulp capping with a bioceramic material

Correct Incorrect Correct answer

C. Initiate complete root canal therapy to remove the pulp

Correct Incorrect Correct answer

D. Place a sedative dressing and restore the tooth temporarily

Correct Incorrect Correct answer

E. Perform a partial pulpotomy and place a bioceramic material

Correct Incorrect Correct answer

Eddie Thaiday, a 24-year-old Torres Strait Islander male, presents for a check-up, stating he hasn’t seen a dentist in several years. His main concern is “food getting stuck in a hole in a lower right back tooth.” He reports occasional, mild and brief sensitivity to cold drinks in that area, which resolves immediately after the stimulus is removed. He denies any spontaneous,throbbing, or lingering pain.

His medical history is unremarkable. He takes no regular medications and has no known drug allergies. He is a non-smoker and consumes alcohol occasionally. He works as a tradesperson and finds it difficult to schedule regular dental appointments.

Clinical examination reveals a large, open carious lesion on the tooth 45 with soft, discoloured dentine. The surrounding gingiva appears healthy. Pulp sensibility testing on tooth 45 elicits a sharp response to a cold stimulus that subsides immediately upon removal. The tooth responds to electric pulp testing at a level comparable to the adjacent teeth. It is not tender to percussion or palpation.

A targeted radiographic imaging radiograph of tooth 45 shows a deep radiolucency extending into the pulpal third of the dentine. The periodontal ligament appears normal without widening.

35. When performing vital pulp therapy on Eddie Thaiday’s tooth 45, which material is considered the standard of care for direct contact with the exposed pulp tissue-

A. A reinforced zinc oxide eugenol

Correct Incorrect Correct answer

B. A conventional glass ionomer cement

Correct Incorrect Correct answer

C. A traditional calcium hydroxide liner

Correct Incorrect Correct answer

D. Hydraulic calcium silicate cement (bioceramic)

Correct Incorrect Correct answer

E. A resin-modified glass ionomer cement

Correct Incorrect Correct answer

Zahra Al-Jubouri, a 48-year-old Iraqi-Australian woman, presents for a routine dental examination. When asked about any concerns, she mentions a ‘rough feeling’ inside her cheeks that has been present for about six months. She also reports a mild, intermittent burning sensation in the same areas, which is more noticeable when she eats spicy or acidic foods like tomatoes.

Her medical history is significant for type 2 diabetes, which is well-controlled with metformin. She reports no known drug allergies. She is a non-smoker and consumes alcohol occasionally, having one or two standard drinks per week. She maintains good oral hygiene. Extraoral examination reveals no palpable cervical lymph nodes. Intraorally, there are symmetrical, bilateral, fine, white, lace-like striations on the buccal mucosa. The lesions cannot be wiped off with gauze. The surrounding mucosa appears mildly erythematous.

Palpation confirms the lesions are soft, with no areas of induration or ulceration. A review of her dental chart notes that tooth 18 is absent and tooth 34 has a large multi-surface amalgam restoration that appears clinically sound. The rest of the oral examination is unremarkable.

36. Based on the clinical findings for Zahra Al-Jubouri, what is the most likely provisional diagnosis for the white lesions on her buccal mucosa-

A. Lichenoid mucositis, a reaction to a known agent

Correct Incorrect Correct answer

B. Oral lichen planus

Correct Incorrect Correct answer

C. Traumatic keratosis from chronic irritation

Correct Incorrect Correct answer

D. Pseudomembranous candidiasis, a removable fungal infection

Correct Incorrect Correct answer

E. Oral leukoplakia, a uniform white patch

Correct Incorrect Correct answer

Zahra Al-Jubouri, a 48-year-old Iraqi-Australian woman, presents for a routine dental examination. When asked about any concerns, she mentions a ‘rough feeling’ inside her cheeks that has been present for about six months. She also reports a mild, intermittent burning sensation in the same areas, which is more noticeable when she eats spicy or acidic foods like tomatoes.

Her medical history is significant for type 2 diabetes, which is well-controlled with metformin. She reports no known drug allergies. She is a non-smoker and consumes alcohol occasionally, having one or two standard drinks per week. She maintains good oral hygiene. Extraoral examination reveals no palpable cervical lymph nodes. Intraorally, there are symmetrical, bilateral, fine, white, lace-like striations on the buccal mucosa. The lesions cannot be wiped off with gauze. The surrounding mucosa appears mildly erythematous.

Palpation confirms the lesions are soft, with no areas of induration or ulceration. A review of her dental chart notes that tooth 18 is absent and tooth 34 has a large multi-surface amalgam restoration that appears clinically sound. The rest of the oral examination is unremarkable.

37. Given the provisional diagnosis for Zahra Al-Jubouri, what is the most appropriate next step to establish a definitive diagnosis for her condition-

A. Incisional biopsy of a representative lesion

Correct Incorrect Correct answer

B. Prescribe a topical corticosteroid and review in one month

Correct Incorrect Correct answer

C. Complete an excisional biopsy of the entire affected area

Correct Incorrect Correct answer

D. Refer for allergy testing for dental materials

Correct Incorrect Correct answer

E. Take a cytological smear from the mucosal surface

Correct Incorrect Correct answer

Zahra Al-Jubouri, a 48-year-old Iraqi-Australian woman, presents for a routine dental examination. When asked about any concerns, she mentions a ‘rough feeling’ inside her cheeks that has been present for about six months. She also reports a mild, intermittent burning sensation in the same areas, which is more noticeable when she eats spicy or acidic foods like tomatoes.

Her medical history is significant for type 2 diabetes, which is well-controlled with metformin. She reports no known drug allergies. She is a non-smoker and consumes alcohol occasionally, having one or two standard drinks per week. She maintains good oral hygiene. Extraoral examination reveals no palpable cervical lymph nodes. Intraorally, there are symmetrical, bilateral, fine, white, lace-like striations on the buccal mucosa. The lesions cannot be wiped off with gauze. The surrounding mucosa appears mildly erythematous.

Palpation confirms the lesions are soft, with no areas of induration or ulceration. A review of her dental chart notes that tooth 18 is absent and tooth 34 has a large multi-surface amalgam restoration that appears clinically sound. The rest of the oral examination is unremarkable.

38. An incisional biopsy is performed on Zahra Al-Jubouri. Histopathology reveals a band-like lymphocytic infiltrate at the epithelial-connective tissue interface and liquefaction degeneration of the basal cell layer. What is the definitive diagnosis-

A. Epithelial dysplasia

Correct Incorrect Correct answer

B. Oral lichen planus

Correct Incorrect Correct answer

C. Pemphigus vulgaris

Correct Incorrect Correct answer

D. Discoid lupus erythematosus

Correct Incorrect Correct answer

E. Mucous membrane pemphigoid

Correct Incorrect Correct answer

Zahra Al-Jubouri, a 48-year-old Iraqi-Australian woman, presents for a routine dental examination. When asked about any concerns, she mentions a ‘rough feeling’ inside her cheeks that has been present for about six months. She also reports a mild, intermittent burning sensation in the same areas, which is more noticeable when she eats spicy or acidic foods like tomatoes.

Her medical history is significant for type 2 diabetes, which is well-controlled with metformin. She reports no known drug allergies. She is a non-smoker and consumes alcohol occasionally, having one or two standard drinks per week. She maintains good oral hygiene. Extraoral examination reveals no palpable cervical lymph nodes. Intraorally, there are symmetrical, bilateral, fine, white, lace-like striations on the buccal mucosa. The lesions cannot be wiped off with gauze. The surrounding mucosa appears mildly erythematous.

Palpation confirms the lesions are soft, with no areas of induration or ulceration. A review of her dental chart notes that tooth 18 is absent and tooth 34 has a large multi-surface amalgam restoration that appears clinically sound. The rest of the oral examination is unremarkable.

39. Following the definitive diagnosis for Zahra Al-Jubouri, what is the primary long-term management goal for her condition-

A. Long-term – Achieve a complete cure of the lesions using topical agents

Correct Incorrect Correct answer

B. Administer systemic antibiotics to eliminate the causative agent

Correct Incorrect Correct answer

C. Cease the patient's metformin medication to resolve the lesions

Correct Incorrect Correct answer

D. Manage symptoms and conduct long-term monitoring for malignant transformation

Correct Incorrect Correct answer

E. Surgically excise all affected mucosal areas to prevent spread

Correct Incorrect Correct answer

Zahra Al-Jubouri, a 48-year-old Iraqi-Australian woman, presents for a routine dental examination. When asked about any concerns, she mentions a ‘rough feeling’ inside her cheeks that has been present for about six months. She also reports a mild, intermittent burning sensation in the same areas, which is more noticeable when she eats spicy or acidic foods like tomatoes.

Her medical history is significant for type 2 diabetes, which is well-controlled with metformin. She reports no known drug allergies. She is a non-smoker and consumes alcohol occasionally, having one or two standard drinks per week. She maintains good oral hygiene. Extraoral examination reveals no palpable cervical lymph nodes. Intraorally, there are symmetrical, bilateral, fine, white, lace-like striations on the buccal mucosa. The lesions cannot be wiped off with gauze. The surrounding mucosa appears mildly erythematous.

Palpation confirms the lesions are soft, with no areas of induration or ulceration. A review of her dental chart notes that tooth 18 is absent and tooth 34 has a large multi-surface amalgam restoration that appears clinically sound. The rest of the oral examination is unremarkable.

40. To address Zahra Al-Jubouri’s symptomatic burning sensation, what is the most appropriate initial pharmacological management-

A. Prescribe a course of systemic corticosteroids

Correct Incorrect Correct answer

B. Recommend no active treatment, only observation

Correct Incorrect Correct answer

C. Prescribe a topical corticosteroid

Correct Incorrect Correct answer

D. Prescribe a course of a topical antifungal agent

Correct Incorrect Correct answer

E. Advise daily use of a chlorhexidine mouthwash

Correct Incorrect Correct answer

Daniel Cruz, a 26-year-old Filipino-Australian university student, presents with a dull, persistent ache in his lower right jaw that has been present for the past week. The pain intensifies when chewing and has started to disrupt his study for final exams. He reports no fever or general feeling of being unwell.

His medical history is significant for Type 1 diabetes mellitus, which is managed with an insulin pump, and self-reported significant dental anxiety. He has no known drug allergies. He mentions feeling stressed due to his upcoming examinations.

Extra-oral examination reveals no facial swelling, tenderness, or lymphadenopathy. Intra-orally, tooth 48 is partially erupted with a mesially angulated crown visible. The overlying operculum appears red and swollen.
Tooth 48 is tender to percussion, and there is also tenderness on the distal aspect of tooth 47. No obvious carious lesions are visible on either tooth. His mouth opening is restricted to 30mm interincisally due to discomfort.

An OPG reveals tooth 48 is mesioangularly impacted with its crown impinging on the distal aspect of tooth 47. The roots of 48 appear fully formed and are superimposed over the inferior alveolar nerve (IAN) canal. A distinct darkening of the apical third of the distal root of 48 is visible where it crosses the canal.

41. When considering the surgical plan for Daniel Cruz, which radiographic finding presents the most significant risk-

A. The mesioangular impaction of tooth 48, with its roots positioned near the inferior alveolar nerve

Correct Incorrect Correct answer

B. Proximity of the roots of tooth 48 to the inferior alveolar nerve canal

Correct Incorrect Correct answer

C. The impingement of tooth 48 on the distal root of tooth 47

Correct Incorrect Correct answer

D. Soft tissue inflammation of the operculum overlying the impacted tooth

Correct Incorrect Correct answer

E. Fully formed apical roots of the impacted tooth, near the inferior alveolar nerve

Correct Incorrect Correct answer

Daniel Cruz, a 26-year-old Filipino-Australian university student, presents with a dull, persistent ache in his lower right jaw that has been present for the past week. The pain intensifies when chewing and has started to disrupt his study for final exams. He reports no fever or general feeling of being unwell.

His medical history is significant for Type 1 diabetes mellitus, which is managed with an insulin pump, and self-reported significant dental anxiety. He has no known drug allergies. He mentions feeling stressed due to his upcoming examinations.

Extra-oral examination reveals no facial swelling, tenderness, or lymphadenopathy. Intra-orally, tooth 48 is partially erupted with a mesially angulated crown visible. The overlying operculum appears red and swollen.
Tooth 48 is tender to percussion, and there is also tenderness on the distal aspect of tooth 47. No obvious carious lesions are visible on either tooth. His mouth opening is restricted to 30mm interincisally due to discomfort.

An OPG reveals tooth 48 is mesioangularly impacted with its crown impinging on the distal aspect of tooth 47. The roots of 48 appear fully formed and are superimposed over the inferior alveolar nerve (IAN) canal. A distinct darkening of the apical third of the distal root of 48 is visible where it crosses the canal.

42. What is the most accurate and comprehensive diagnosis for Daniel Cruz’s condition-

A. Symptomatic impacted tooth 48 that is indicated for a routine surgical extraction

Correct Incorrect Correct answer

B. Myofascial pain with referral from masticatory muscles due to examination stress

Correct Incorrect Correct answer

C. Acute pericoronitis of tooth 48, which presents a low surgical extraction risk

Correct Incorrect Correct answer

D. Irreversible pulpitis of tooth 47 caused by pressure from the impacted tooth 48

Correct Incorrect Correct answer

E. Symptomatic impacted tooth 48 with a high risk of inferior alveolar nerve injury

Correct Incorrect Correct answer

Daniel Cruz, a 26-year-old Filipino-Australian university student, presents with a dull, persistent ache in his lower right jaw that has been present for the past week. The pain intensifies when chewing and has started to disrupt his study for final exams. He reports no fever or general feeling of being unwell.

His medical history is significant for Type 1 diabetes mellitus, which is managed with an insulin pump, and self-reported significant dental anxiety. He has no known drug allergies. He mentions feeling stressed due to his upcoming examinations.

Extra-oral examination reveals no facial swelling, tenderness, or lymphadenopathy. Intra-orally, tooth 48 is partially erupted with a mesially angulated crown visible. The overlying operculum appears red and swollen.
Tooth 48 is tender to percussion, and there is also tenderness on the distal aspect of tooth 47. No obvious carious lesions are visible on either tooth. His mouth opening is restricted to 30mm interincisally due to discomfort.

An OPG reveals tooth 48 is mesioangularly impacted with its crown impinging on the distal aspect of tooth 47. The roots of 48 appear fully formed and are superimposed over the inferior alveolar nerve (IAN) canal. A distinct darkening of the apical third of the distal root of 48 is visible where it crosses the canal.

43. Given the clinical and radiographic findings for Daniel Cruz, what is the most appropriate next step in his management-

A. Perform an immediate operculectomy under local anaesthesia to relieve symptoms

Correct Incorrect Correct answer

B. Prescribe a course of analgesics and review in one week to proceed to extract the tooth in general practice setting

Correct Incorrect Correct answer

C. Proceed with surgical extraction of tooth 48 in the general practice setting

Correct Incorrect Correct answer

D. Referral to an oral and maxillofacial surgeon for assessment and management

Correct Incorrect Correct answer

E. Arrange for conscious sedation prior to any planned surgical intervention

Correct Incorrect Correct answer

Daniel Cruz, a 26-year-old Filipino-Australian university student, presents with a dull, persistent ache in his lower right jaw that has been present for the past week. The pain intensifies when chewing and has started to disrupt his study for final exams. He reports no fever or general feeling of being unwell.

His medical history is significant for Type 1 diabetes mellitus, which is managed with an insulin pump, and self-reported significant dental anxiety. He has no known drug allergies. He mentions feeling stressed due to his upcoming examinations.

Extra-oral examination reveals no facial swelling, tenderness, or lymphadenopathy. Intra-orally, tooth 48 is partially erupted with a mesially angulated crown visible. The overlying operculum appears red and swollen.
Tooth 48 is tender to percussion, and there is also tenderness on the distal aspect of tooth 47. No obvious carious lesions are visible on either tooth. His mouth opening is restricted to 30mm interincisally due to discomfort.

An OPG reveals tooth 48 is mesioangularly impacted with its crown impinging on the distal aspect of tooth 47. The roots of 48 appear fully formed and are superimposed over the inferior alveolar nerve (IAN) canal. A distinct darkening of the apical third of the distal root of 48 is visible where it crosses the canal.

44. When discussing the proposed surgical removal of tooth 48 with Daniel Cruz, which potential complication is most critical to explain-

A. Temporary or permanent altered sensation (paraesthesia) of the lower lip and chin

Correct Incorrect Correct answer

B. A significant fracture of the mandible during the surgical extraction procedure

Correct Incorrect Correct answer

C. Significant post-operative infection and swelling requiring prolonged antibiotic therapy

Correct Incorrect Correct answer

D. Formation of an oroantral communication with the adjacent maxillary sinus

Correct Incorrect Correct answer

E. Iatrogenic damage to the adjacent second molar, requiring future restorative work

Correct Incorrect Correct answer

Daniel Cruz, a 26-year-old Filipino-Australian university student, presents with a dull, persistent ache in his lower right jaw that has been present for the past week. The pain intensifies when chewing and has started to disrupt his study for final exams. He reports no fever or general feeling of being unwell.

His medical history is significant for Type 1 diabetes mellitus, which is managed with an insulin pump, and self-reported significant dental anxiety. He has no known drug allergies. He mentions feeling stressed due to his upcoming examinations.

Extra-oral examination reveals no facial swelling, tenderness, or lymphadenopathy. Intra-orally, tooth 48 is partially erupted with a mesially angulated crown visible. The overlying operculum appears red and swollen.
Tooth 48 is tender to percussion, and there is also tenderness on the distal aspect of tooth 47. No obvious carious lesions are visible on either tooth. His mouth opening is restricted to 30mm interincisally due to discomfort.

An OPG reveals tooth 48 is mesioangularly impacted with its crown impinging on the distal aspect of tooth 47. The roots of 48 appear fully formed and are superimposed over the inferior alveolar nerve (IAN) canal. A distinct darkening of the apical third of the distal root of 48 is visible where it crosses the canal.

45. To promote optimal healing after the eventual surgery for Daniel Cruz, what is the most important patient-specific advice to provide-

A. Maintaining stable blood glucose levels to support optimal post-operative healing

Correct Incorrect Correct answer

B. Avoiding all strenuous physical activity for the first 48 hours

Correct Incorrect Correct answer

C. Adhering to a soft diet for several days to protect the surgical site

Correct Incorrect Correct answer

D. Using a chlorhexidine mouthwash for at least seven days post-operatively

Correct Incorrect Correct answer

E. Taking all prescribed analgesics regularly to effectively manage post-operative pain

Correct Incorrect Correct answer

Linh Le, a 45-year-old office manager, presents for an appointment. Her chief complaint is-
“I broke a piece off my upper left back tooth a few days ago while eating nuts. It feels sharp to my tongue, but there’s no pain.” Ms. Le’s medical history is significant for hypertension, which is well-controlled with ramipril 5 mg daily. She reports no known drug allergies. She is a non-smoker and consumes one glass of wine on weekends. She mentions her job is often stressful and that she sometimes wakes with a tight or tired jaw.

Extraoral examination is unremarkable.
Intraorally, the palatal cusp of tooth 25 is missing, exposing a section of dentine. A large, mesio-occluso-distal amalgam restoration occupies the majority of the remaining crown.

Tooth 25 is not tender to percussion or palpation and exhibits no mobility. Periodontal probing depths are 2-3 mm circumferentially with no bleeding on probing. Pulp vitality testing with a cold stimulus elicits a response that ceases immediately upon removal. The oral mucosa appears generally dry, with little saliva pooling in the floor of the mouth. Generalised mild attrition is noted on posterior.

46. Based on the clinical findings for Ms. Le’s tooth 25, what is the most accurate initial assessment of the tooth’s condition-

A. Dentine hypersensitivity from the exposed tooth structure

Correct Incorrect Correct answer

B. Simple fracture of the existing amalgam restoration

Correct Incorrect Correct answer

C. Structurally compromised tooth due to cusp fracture adjacent to a large restoration

Correct Incorrect Correct answer

D. An acute periodontal abscess localised to tooth 25

Correct Incorrect Correct answer

E. Cracked tooth syndrome causing the cusp fracture

Correct Incorrect Correct answer

Linh Le, a 45-year-old office manager, presents for an appointment. Her chief complaint is-
“I broke a piece off my upper left back tooth a few days ago while eating nuts. It feels sharp to my tongue, but there’s no pain.” Ms. Le’s medical history is significant for hypertension, which is well-controlled with ramipril 5 mg daily. She reports no known drug allergies. She is a non-smoker and consumes one glass of wine on weekends. She mentions her job is often stressful and that she sometimes wakes with a tight or tired jaw.

Extraoral examination is unremarkable.
Intraorally, the palatal cusp of tooth 25 is missing, exposing a section of dentine. A large, mesio-occluso-distal amalgam restoration occupies the majority of the remaining crown.

Tooth 25 is not tender to percussion or palpation and exhibits no mobility. Periodontal probing depths are 2-3 mm circumferentially with no bleeding on probing. Pulp vitality testing with a cold stimulus elicits a response that ceases immediately upon removal. The oral mucosa appears generally dry, with little saliva pooling in the floor of the mouth. Generalised mild attrition is noted on posterior.

47. To fully assess the condition of tooth 25 and the surrounding structures, which initial radiographic investigation is most appropriate-

A. A single maxillary occlusal radiograph of the area

Correct Incorrect Correct answer

B. Cone-beam computed tomography (CBCT) of the quadrant

Correct Incorrect Correct answer

C. Periapical and bitewing radiographs of tooth 25

Correct Incorrect Correct answer

D. No radiographs required as the fracture is clearly visible

Correct Incorrect Correct answer

E. A panoramic radiograph (OPG) for a general overview

Correct Incorrect Correct answer

Linh Le, a 45-year-old office manager, presents for an appointment. Her chief complaint is-
“I broke a piece off my upper left back tooth a few days ago while eating nuts. It feels sharp to my tongue, but there’s no pain.” Ms. Le’s medical history is significant for hypertension, which is well-controlled with ramipril 5 mg daily. She reports no known drug allergies. She is a non-smoker and consumes one glass of wine on weekends. She mentions her job is often stressful and that she sometimes wakes with a tight or tired jaw.

Extraoral examination is unremarkable.
Intraorally, the palatal cusp of tooth 25 is missing, exposing a section of dentine. A large, mesio-occluso-distal amalgam restoration occupies the majority of the remaining crown.

Tooth 25 is not tender to percussion or palpation and exhibits no mobility. Periodontal probing depths are 2-3 mm circumferentially with no bleeding on probing. Pulp vitality testing with a cold stimulus elicits a response that ceases immediately upon removal. The oral mucosa appears generally dry, with little saliva pooling in the floor of the mouth. Generalised mild attrition is noted on posterior.

48. After clinical and radiographic examination of tooth 25, which revealed no periapical pathology, what is the most likely definitive diagnosis for Ms. Le’s tooth-

A. Cracked tooth syndrome with associated reversible pulpitis

Correct Incorrect Correct answer

B. A vertical root fracture extending from the amalgam restoration

Correct Incorrect Correct answer

C. Irreversible pulpitis requiring endodontic treatment

Correct Incorrect Correct answer

D. Uncomplicated crown fracture with normal pulp and apical tissues

Correct Incorrect Correct answer

E. Reversible pulpitis secondary to the recent tooth fracture

Correct Incorrect Correct answer

Linh Le, a 45-year-old office manager, presents for an appointment. Her chief complaint is-
“I broke a piece off my upper left back tooth a few days ago while eating nuts. It feels sharp to my tongue, but there’s no pain.” Ms. Le’s medical history is significant for hypertension, which is well-controlled with ramipril 5 mg daily. She reports no known drug allergies. She is a non-smoker and consumes one glass of wine on weekends. She mentions her job is often stressful and that she sometimes wakes with a tight or tired jaw.

Extraoral examination is unremarkable.
Intraorally, the palatal cusp of tooth 25 is missing, exposing a section of dentine. A large, mesio-occluso-distal amalgam restoration occupies the majority of the remaining crown.

Tooth 25 is not tender to percussion or palpation and exhibits no mobility. Periodontal probing depths are 2-3 mm circumferentially with no bleeding on probing. Pulp vitality testing with a cold stimulus elicits a response that ceases immediately upon removal. The oral mucosa appears generally dry, with little saliva pooling in the floor of the mouth. Generalised mild attrition is noted on posterior.

49. Given the diagnosis for tooth 25, what is the most appropriate definitive treatment plan for Ms. Le to ensure long-term structural integrity-

A. A protective amalgam onlay to cover the cusps.

Correct Incorrect Correct answer

B. Full coverage indirect restoration (all-ceramic crown)

Correct Incorrect Correct answer

C. Monitor the tooth as it is currently asymptomatic

Correct Incorrect Correct answer

D. Extraction and replacement with a dental implant

Correct Incorrect Correct answer

E. A direct multi-surface composite resin restoration

Correct Incorrect Correct answer

Linh Le, a 45-year-old office manager, presents for an appointment. Her chief complaint is-
“I broke a piece off my upper left back tooth a few days ago while eating nuts. It feels sharp to my tongue, but there’s no pain.” Ms. Le’s medical history is significant for hypertension, which is well-controlled with ramipril 5 mg daily. She reports no known drug allergies. She is a non-smoker and consumes one glass of wine on weekends. She mentions her job is often stressful and that she sometimes wakes with a tight or tired jaw.

Extraoral examination is unremarkable.
Intraorally, the palatal cusp of tooth 25 is missing, exposing a section of dentine. A large, mesio-occluso-distal amalgam restoration occupies the majority of the remaining crown.

Tooth 25 is not tender to percussion or palpation and exhibits no mobility. Periodontal probing depths are 2-3 mm circumferentially with no bleeding on probing. Pulp vitality testing with a cold stimulus elicits a response that ceases immediately upon removal. The oral mucosa appears generally dry, with little saliva pooling in the floor of the mouth. Generalised mild attrition is noted on posterior.

50. When preparing tooth 25 for the planned all-ceramic (lithium disilicate) crown for Ms. Le, which design feature is most critical for the material’s success-

A. A circumferential shoulder or heavy chamfer finish line with 1.0-1.5 mm axial reduction

Correct Incorrect Correct answer

B. A total occlusal convergence or taper of approximately 20-25 degrees for easy seating

Correct Incorrect Correct answer

C. A knife-edge finish line with minimal axial reduction to preserve tooth structure

Correct Incorrect Correct answer

D. An occlusal reduction of only 0.5 mm to be as conservative as possible

Correct Incorrect Correct answer

E. Retention grooves and boxes similar to a traditional gold crown preparation for retention

Correct Incorrect Correct answer

Takeshi Yamamoto, a 42-year-old Japanese-Australian project manager, presents for an emergency appointment complaining of severe pain from his upper left jaw. Four days ago, he had his upper left molar (tooth 17) extracted at a different clinic due to extensive coronal decay.

He reports that the pain was manageable for the first two days but began to intensify significantly on the third day. He now describes the pain as a constant, severe, throbbing ache that radiates towards his ear. Over-the-counter paracetamol and ibuprofen provide minimal relief. He also reports a foul taste in his mouth and is concerned about bad breath.

Mr. Yamamoto’s medical history is significant for hypertension, for which he takes metoprolol 50 mg daily. He has no known drug allergies. He is a smoker and reports smoking approximately 10 cigarettes per day. He mentions he was given verbal and written post-operative instructions but admits he returned to work immediately and may not have followed them closely.

Clinical examination reveals no extraoral swelling or lymphadenopathy. Intraorally, the extraction socket for tooth 17 appears empty, with exposed, dull, greyish-looking bone visible at the base. The blood clot appears to be lost.

51. Based on the history and clinical examination, what is the most accurate interpretation of Mr. Yamamoto’s post-operative condition-

A. The patient's symptoms are consistent with the expected course of normal post-operative healing after an extraction

Correct Incorrect Correct answer

B. The clinical signs strongly indicate a spreading suppurative infection originating from the extraction socket

Correct Incorrect Correct answer

C. The severe pain is most likely caused by a retained root fragment remaining after the tooth extraction

Correct Incorrect Correct answer

D. The patient's smoking habit is the direct cause of the delayed healing and severepost-operative symptoms

Correct Incorrect Correct answer

E. The clinical presentation is highly suggestive of a localised inflammatory complication involving loss of the blood clot

Correct Incorrect Correct answer

Takeshi Yamamoto, a 42-year-old Japanese-Australian project manager, presents for an emergency appointment complaining of severe pain from his upper left jaw. Four days ago, he had his upper left molar (tooth 17) extracted at a different clinic due to extensive coronal decay.

He reports that the pain was manageable for the first two days but began to intensify significantly on the third day. He now describes the pain as a constant, severe, throbbing ache that radiates towards his ear. Over-the-counter paracetamol and ibuprofen provide minimal relief. He also reports a foul taste in his mouth and is concerned about bad breath.

Mr. Yamamoto’s medical history is significant for hypertension, for which he takes metoprolol 50 mg daily. He has no known drug allergies. He is a smoker and reports smoking approximately 10 cigarettes per day. He mentions he was given verbal and written post-operative instructions but admits he returned to work immediately and may not have followed them closely.

Clinical examination reveals no extraoral swelling or lymphadenopathy. Intraorally, the extraction socket for tooth 17 appears empty, with exposed, dull, greyish-looking bone visible at the base. The blood clot appears to be lost.

52. To investigate the cause of Mr. Yamamoto’s severe pain and rule out other pathologies, what is the most appropriate initial investigation-

A. A periapical radiograph of the extraction site

Correct Incorrect Correct answer

B. A cone-beam computed tomography scan of the area

Correct Incorrect Correct answer

C. An orthopantomogram to assess the entire jaw

Correct Incorrect Correct answer

D. A bacterial swab for culture and sensitivity testing

Correct Incorrect Correct answer

E. No imaging is ever required, as the clinical signs are pathognomonic

Correct Incorrect Correct answer

Takeshi Yamamoto, a 42-year-old Japanese-Australian project manager, presents for an emergency appointment complaining of severe pain from his upper left jaw. Four days ago, he had his upper left molar (tooth 17) extracted at a different clinic due to extensive coronal decay.

He reports that the pain was manageable for the first two days but began to intensify significantly on the third day. He now describes the pain as a constant, severe, throbbing ache that radiates towards his ear. Over-the-counter paracetamol and ibuprofen provide minimal relief. He also reports a foul taste in his mouth and is concerned about bad breath.

Mr. Yamamoto’s medical history is significant for hypertension, for which he takes metoprolol 50 mg daily. He has no known drug allergies. He is a smoker and reports smoking approximately 10 cigarettes per day. He mentions he was given verbal and written post-operative instructions but admits he returned to work immediately and may not have followed them closely.

Clinical examination reveals no extraoral swelling or lymphadenopathy. Intraorally, the extraction socket for tooth 17 appears empty, with exposed, dull, greyish-looking bone visible at the base. The blood clot appears to be lost.

53. An investigation of the extraction site for Mr. Yamamoto reveals no retained root fragments or other bony pathology. What is the most likely diagnosis-

A. Acute osteomyelitis of the maxilla

Correct Incorrect Correct answer

B. Alveolar osteitis (dry socket)

Correct Incorrect Correct answer

C. A post-operative soft tissue infection

Correct Incorrect Correct answer

D. A form of atypical facial pain

Correct Incorrect Correct answer

E. Acute maxillary sinusitis post-extraction

Correct Incorrect Correct answer

Takeshi Yamamoto, a 42-year-old Japanese-Australian project manager, presents for an emergency appointment complaining of severe pain from his upper left jaw. Four days ago, he had his upper left molar (tooth 17) extracted at a different clinic due to extensive coronal decay.

He reports that the pain was manageable for the first two days but began to intensify significantly on the third day. He now describes the pain as a constant, severe, throbbing ache that radiates towards his ear. Over-the-counter paracetamol and ibuprofen provide minimal relief. He also reports a foul taste in his mouth and is concerned about bad breath.

Mr. Yamamoto’s medical history is significant for hypertension, for which he takes metoprolol 50 mg daily. He has no known drug allergies. He is a smoker and reports smoking approximately 10 cigarettes per day. He mentions he was given verbal and written post-operative instructions but admits he returned to work immediately and may not have followed them closely.

Clinical examination reveals no extraoral swelling or lymphadenopathy. Intraorally, the extraction socket for tooth 17 appears empty, with exposed, dull, greyish-looking bone visible at the base. The blood clot appears to be lost.

54. Having diagnosed the problem, what is the most appropriate immediate management for Mr. Yamamoto’s condition-

A. Aggressively curette the socket walls to induce fresh bleeding and clot formation

Correct Incorrect Correct answer

B. Prescribe a seven-day course of broad-spectrum systemic antibiotics for the infection

Correct Incorrect Correct answer

C. Gently irrigate the socket with sterile saline and place an obtundent dressing

Correct Incorrect Correct answer

D. Advise the patient to continue with frequent warm salt water rinses at home

Correct Incorrect Correct answer

E. Suture the socket closed under local anaesthesia to protect the exposed bone

Correct Incorrect Correct answer

Takeshi Yamamoto, a 42-year-old Japanese-Australian project manager, presents for an emergency appointment complaining of severe pain from his upper left jaw. Four days ago, he had his upper left molar (tooth 17) extracted at a different clinic due to extensive coronal decay.

He reports that the pain was manageable for the first two days but began to intensify significantly on the third day. He now describes the pain as a constant, severe, throbbing ache that radiates towards his ear. Over-the-counter paracetamol and ibuprofen provide minimal relief. He also reports a foul taste in his mouth and is concerned about bad breath.

Mr. Yamamoto’s medical history is significant for hypertension, for which he takes metoprolol 50 mg daily. He has no known drug allergies. He is a smoker and reports smoking approximately 10 cigarettes per day. He mentions he was given verbal and written post-operative instructions but admits he returned to work immediately and may not have followed them closely.

Clinical examination reveals no extraoral swelling or lymphadenopathy. Intraorally, the extraction socket for tooth 17 appears empty, with exposed, dull, greyish-looking bone visible at the base. The blood clot appears to be lost.

55. In addition to local measures, which systemic analgesic is most appropriate to manage Mr.Yamamoto’s pain-

A. A prescription for paracetamol only, at a higher dosage

Correct Incorrect Correct answer

B. No systemic analgesics, as the local dressing is sufficient

Correct Incorrect Correct answer

C. An immediate-release opioid analgesic, such as oxycodone

Correct Incorrect Correct answer

D. NSAIDs with paracetamol taken regularly initially

Correct Incorrect Correct answer

E. A combination analgesic of paracetamol with codeine for severe pain

Correct Incorrect Correct answer

Minh Bui, a 55-year-old Vietnamese-Australian chef, presents with a chief complaint of a “loose feeling and bad taste” from his upper left back tooth, which he identifies as an implant. The discomfort is mild and more noticeable when chewing.

He received the implant at tooth 26 eight years ago after the tooth was extracted due to a fracture. His medical history is significant for hypertension, managed with ramipril 5mg daily, and a history of generalised periodontitis, which has been stable for the last five years following treatment and regular maintenance. He has no known drug allergies. He reports drinking alcohol socially and does not smoke.

Intraoral examination reveals a screw-retained PFM crown on an implant at site 26. The crown exhibits slight buccolingual mobility upon manual palpation, though the implant fixture itself feels stable within the bone. The surrounding peri-implant mucosa is erythematous and oedematous. Periodontal probing reveals depths of 7mm on the buccal and 6mm on the mesial aspect, with bleeding on probing. Gentle pressure on the buccal gingiva results in the expression of a small amount of purulent exudate from the peri-implant sulcus. His oral hygiene is generally fair, with moderate plaque accumulation on posterior teeth.

56. Based on the clinical examination of the implant at site 26, what is the most accurate interpretation of Minh Bui’s presenting signs-

A. Clinical findings consistent with peri-implant mucositis only, without deeper tissue involvement

Correct Incorrect Correct answer

B. Signs of severe localised inflammation and infection around an implant with a prosthetic complication

Correct Incorrect Correct answer

C. A mechanical failure of the implant crown with no associated biological complications

Correct Incorrect Correct answer

D. A periodontal abscess originating from an adjacent natural tooth, not the implant

Correct Incorrect Correct answer

E. A localised recurrence of generalised periodontitis affecting the implant site directly

Correct Incorrect Correct answer

Minh Bui, a 55-year-old Vietnamese-Australian chef, presents with a chief complaint of a “loose feeling and bad taste” from his upper left back tooth, which he identifies as an implant. The discomfort is mild and more noticeable when chewing.

He received the implant at tooth 26 eight years ago after the tooth was extracted due to a fracture. His medical history is significant for hypertension, managed with ramipril 5mg daily, and a history of generalised periodontitis, which has been stable for the last five years following treatment and regular maintenance. He has no known drug allergies. He reports drinking alcohol socially and does not smoke.

Intraoral examination reveals a screw-retained PFM crown on an implant at site 26. The crown exhibits slight buccolingual mobility upon manual palpation, though the implant fixture itself feels stable within the bone. The surrounding peri-implant mucosa is erythematous and oedematous. Periodontal probing reveals depths of 7mm on the buccal and 6mm on the mesial aspect, with bleeding on probing. Gentle pressure on the buccal gingiva results in the expression of a small amount of purulent exudate from the peri-implant sulcus. His oral hygiene is generally fair, with moderate plaque accumulation on posterior teeth.

57. To further assess the condition of the implant at site 26, what is the most appropriate initial investigation for Minh Bui-

A. Bitewing radiograph of the upper left quadrant

Correct Incorrect Correct answer

B. Cone Beam Computed Tomography (CBCT) of the maxilla

Correct Incorrect Correct answer

C. Periapical radiograph of the implant at site 26

Correct Incorrect Correct answer

D. Microbiological sampling of the peri-implant sulcus

Correct Incorrect Correct answer

E. Pulp sensibility testing of adjacent teeth 25 and 27

Correct Incorrect Correct answer

Minh Bui, a 55-year-old Vietnamese-Australian chef, presents with a chief complaint of a “loose feeling and bad taste” from his upper left back tooth, which he identifies as an implant. The discomfort is mild and more noticeable when chewing.

He received the implant at tooth 26 eight years ago after the tooth was extracted due to a fracture. His medical history is significant for hypertension, managed with ramipril 5mg daily, and a history of generalised periodontitis, which has been stable for the last five years following treatment and regular maintenance. He has no known drug allergies. He reports drinking alcohol socially and does not smoke.

Intraoral examination reveals a screw-retained PFM crown on an implant at site 26. The crown exhibits slight buccolingual mobility upon manual palpation, though the implant fixture itself feels stable within the bone. The surrounding peri-implant mucosa is erythematous and oedematous. Periodontal probing reveals depths of 7mm on the buccal and 6mm on the mesial aspect, with bleeding on probing. Gentle pressure on the buccal gingiva results in the expression of a small amount of purulent exudate from the peri-implant sulcus. His oral hygiene is generally fair, with moderate plaque accumulation on posterior teeth.

58. Radiograph of tooth 26 reveals vertical bone loss extending 4mm from the implant platform, with exposed coronal threads. Given this and the clinical findings, what is the most likely diagnosis for Minh Bui-

A. Fractured implant fixture below the bone crest

Correct Incorrect Correct answer

B. Peri-implant mucositis without bone loss

Correct Incorrect Correct answer

C. Loose abutment screw as a mechanical issue

Correct Incorrect Correct answer

D. Peri-implantitis with associated bone loss

Correct Incorrect Correct answer

E. Periodontal abscess on an adjacent vital tooth

Correct Incorrect Correct answer

Minh Bui, a 55-year-old Vietnamese-Australian chef, presents with a chief complaint of a “loose feeling and bad taste” from his upper left back tooth, which he identifies as an implant. The discomfort is mild and more noticeable when chewing.

He received the implant at tooth 26 eight years ago after the tooth was extracted due to a fracture. His medical history is significant for hypertension, managed with ramipril 5mg daily, and a history of generalised periodontitis, which has been stable for the last five years following treatment and regular maintenance. He has no known drug allergies. He reports drinking alcohol socially and does not smoke.

Intraoral examination reveals a screw-retained PFM crown on an implant at site 26. The crown exhibits slight buccolingual mobility upon manual palpation, though the implant fixture itself feels stable within the bone. The surrounding peri-implant mucosa is erythematous and oedematous. Periodontal probing reveals depths of 7mm on the buccal and 6mm on the mesial aspect, with bleeding on probing. Gentle pressure on the buccal gingiva results in the expression of a small amount of purulent exudate from the peri-implant sulcus. His oral hygiene is generally fair, with moderate plaque accumulation on posterior teeth.

59. Following the diagnosis for Minh Bui, what is the most appropriate initial management step to address the condition-

A. Attempt to tighten the loose abutment screw and place the patient on a soft diet

Correct Incorrect Correct answer

B. Prescribe a course of systemic antibiotics and schedule a review appointment for one week

Correct Incorrect Correct answer

C. Immediately extract the implant and plan for a future prosthetic replacement option

Correct Incorrect Correct answer

D. Provide oral hygiene instruction and schedule a three-month review to monitor progress

Correct Incorrect Correct answer

E. Remove the implant-supported crown, debride the implant surface, and irrigate the peri-implant pocket

Correct Incorrect Correct answer

Minh Bui, a 55-year-old Vietnamese-Australian chef, presents with a chief complaint of a “loose feeling and bad taste” from his upper left back tooth, which he identifies as an implant. The discomfort is mild and more noticeable when chewing.

He received the implant at tooth 26 eight years ago after the tooth was extracted due to a fracture. His medical history is significant for hypertension, managed with ramipril 5mg daily, and a history of generalised periodontitis, which has been stable for the last five years following treatment and regular maintenance. He has no known drug allergies. He reports drinking alcohol socially and does not smoke.

Intraoral examination reveals a screw-retained PFM crown on an implant at site 26. The crown exhibits slight buccolingual mobility upon manual palpation, though the implant fixture itself feels stable within the bone. The surrounding peri-implant mucosa is erythematous and oedematous. Periodontal probing reveals depths of 7mm on the buccal and 6mm on the mesial aspect, with bleeding on probing. Gentle pressure on the buccal gingiva results in the expression of a small amount of purulent exudate from the peri-implant sulcus. His oral hygiene is generally fair, with moderate plaque accumulation on posterior teeth.

60. Initial non-surgical therapy for Minh Bui has failed to resolve the deep pockets around implant 26. What is the most appropriate next surgical step in his management-

A. Surgical flap access for debridement of the implant surface

Correct Incorrect Correct answer

B. Implant removal and replacement with a three-unit fixed partial denture

Correct Incorrect Correct answer

C. Guided bone regeneration around the implant without raising a surgical flap

Correct Incorrect Correct answer

D. A simple gingivectomy procedure to reduce the overall pocket depth

Correct Incorrect Correct answer

E. Implantoplasty to smooth exposed threads without raising a surgical flap

Correct Incorrect Correct answer

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