September 2014

SBQ

1 Lost amalgam filling (upper 6 Photo)

SBQ: Patient (Woman 40 y.o.) presented because 16 amalgam restoration pop off while
having breakfast (filling present for 5 years). Tooth is sensitive to cold, pain lasting for a few
seconds. Patient has several amalgam restorations.

Photo - Upper Right side teeth

16- 2 cusps missing, dark area of dentin on mesial-occlusal-facial- palatal surfaces
14 -MOD , 15 - MOD, 17 - MO: amalgam fillings. Margins of fillings on premolars looked
ditched, and fillings have overextended the margins.

(MARCH/SEP 2014) Q1 Why the pt was sensitive to cold

A Dentine exposure
B Reversible Pulpitis
C Irreversible Pulpitis
D Pulpal necrosis

(Mar 2014) Q2 Which restorative procedure would be the MOST RETENTIVE to replace the
fracture amalgam:
A post + core + crown
B core GIC + crown
C amalgam with 3 pins
D Composite

SIMILAR(SEP 2014) Q3 In a posterior vital molar with a core the BEST MATERIAL to
restore is:
A Amalgam with minimum of 3 pins
B Composite resin
C GIC + crown

Q4 The other teeth right next to the 16 also had amalgam restorations , whats wrong with the
restoration on the 14 & 15 (20 years old fillings)
A Creep
B Corrosion
C Marginal breakdown/ leakage
D Enamel wear off
E Thermal expansion of the amalgam

Q5 The cause of the filling on 16 to be lost:

A Secondary caries
B Non-retentive cavity/ improper cavity design
C Occlusal forces
D Vertical fracture of the crown
E Corrosion

Q6 What is the major challenge in treatment if the tooth needs RCT?

A Rubber dam placement
B Root curvature
C Periapical infection

A. what is the cause ?

Retention
Caries
Occlusal forces

B. How would you restore ?

Amalgam 3 pins
Composite
GIC
Crown
Onlay

2. Shallow amalgam restoration with no lining. Information given: tenderness next day, Cold
sensitivity one week after restored.

A what would the probable cause ?

Bite
Pulp injury
No Lining

3. 11, 21 margins failure (photo given)

poor quality endodontic treatment.

Postcore- retraction cord- gingival health- financial issues- aesthetics- consider restorability-
extraction .

4. information given (photo): high caries developed in less than three years.

one lady came to clinic,45 years of age,recently moved to a new suburb.previously her oral
hygiene was good ,but now its very poor.One proximal caries on11, large caries on
23(Almost half of the tooth are gone). She wants to her smile to be perfect(3 pic given)
information given (photo): high caries developed in less than three years.

1. what is the cause of her degraded oral hygiene status?

A,.Move to new area B Recent changes in saliva C Stress.

2. canine restoration (photo), what would be the difficulties?

Canine guidance
Marginal seal between teeth13 and 12.
Recreate contact point

3. implant premolar area.

Not enough DVO

Poorer bone quality
Space to place two implants

. when to do teeth whitening ?

After caries control
After finishing restorations
At anytime
Before aesthetic restorations.

5. incisive fracture ( young patient, photo included) came into the practice three days after
fracture.

A. Treatment of choice?
Pulpectomy
Pulp cap (hydroxyl calcium or corticosteroid)
Pulpotomy+ MTA

6. premolar amalgam margins failure (photo given)

micro leakage
corrosion
Creep.

7. Post core inserted not long ago, it presents mobility, what to check ?

A.Occlusion

B. What situation presents poor prognosis.

VRF, vertical root fracture.

C. what treatment is recommended.

Perio surgery to lengthen the tooth
Ortho extrusion+gum surgery
Subgingival extension/preparation
D. patient elected extraction, what would best replacement option
Implant/crown.

8. Bridge (chipped porcelain/ photo given )

A. probable cause ?
Hyper occlusion
Wrong framework

B. what is the most common cause of failure for PFM crowns/bridges ? and also resin
bridge ?

9. very worn anterior teeth, however posterior teeth are looking ok ( photo given )

. causes ?
attrition
erosion
abrasion

How to establish that the disease is active?

Smooth and shine surfaces.

. What would be the first management?

Cover dentine to avoid pulp injury
Nightguard

10. gingivitis, 33/44 heavily filled no lower posterior support.

. First treatment ?
Scale and clean
Crown preps
Extraction

Patient decides to go with crowns.

11. full upper and lower denture ( information given) GP reported that it is pressing mental
nerve.

. what are the symptoms?

Numbness lower lip and chin
Numbness of floor of the mouth but it doesnt go across medial line

12. old patient whom wear a full upper denture/ no lower denture, wear the denture 24 hours
was referred by a GP.

a.Patient presents with angular cheilits and mucosa stomatitis

. acute hypertrophic
chronic hypertrophic
acute hypotrophy
chronic hypotrophy

Chronic atrophy

b. first management
oral and denture hygiene

c. above procedure has not improved the scenario?

Antifungal treatment
New denture
Antifungal 10mg lozenge

d. Important points about stomatitis.

It can affect the tissue to the stage that denture will not fit anymore.
Potential to Malignancy
Recontamination

13. year old upper denture/ only inferior anterior teeth/ ( photo given).

a. red lump looking on upper anterior region, what would it be ?

incisive papilla
labial frenum
root stump

b. if a lower denture would be fabricated, what are the visible difficulties?

A large tongue

14. He drank last night and can't remember the details, but suffered a blow or trauma(?).

1) According to some Australian Medical Guidelines how many drinks per day is the
maximum recommended dose for a male?
a. 1
b. 2
c. 4
d. 8

2) How many milliliters of alcohol are in 1 standard drink?

a. 10mg/12.5ml
b. 20ml
c. 25ml
d. 50ml

* Posteroanterior view of left half of the skull

( could see the fracture line in the left condylar neck and displacement of fragments???)

Q3There was a xray of the same person which shows left condyle and the options were to
identify the abnormality?
a) displaced left condylar fracture
b) sub condylar fracture
c) body fracture
d) ramus fracture
e) left condylar fracture

Q4what is the treatment ?

a) soft diet
b) closed reduction
c) open reduction
d) inter maxillary fixation
e) elastic intermaxillary fixation

Q5what is the most common long term complication?

a) malocclusion
b) loss of balance
c) right tmj dysfunction
d) left tmj dysfunction

15. A 60 year male has had 16 extracted. He comes after 10weeks that his socket has still not
healed. He is on alendronate for the last 6 years.

1.What is alendronate is prescribed for ?

A. osteoporosis
B. osteoarthritis
C. multiple myleoma

2.Diagnosis?
A.OAC/fistula
B. Dry socket
C. Osteoradionecrosis
D. Bisphosphonate (osteonecrosis of the jaw)

3.Treatment ?
A. Leave it alone
B. Primary closure of the socket
C. Bone graft
D. Curette the socket

4. What to discuss with pt GP ?

A. stop treatment (alendronate )
B. Give antibiotic
C. Change to another medication to non nitrogen
D. Nothing

5. How long it is going to take to heal?

A. 3 months
B. 6 months
C. one year
D. never

16. patient presents with numbness on lower lip, had a block injection one week previously
(4% articaine ) patient takes Lithium

A.What is the risk level of using articaine in comparison to lidocaine when applying a block
injection???

A) 25%
B) 50%
C) 100%
D) 200%

B.What is the lithium prescription ?

Minor depression
Lack of lithium
Minor anxiety

C.How to proceed ?
Do a sensation test and come back in one month
Do a sensation test and come back in three months
Do nothing/ wait

D.Which is not commonly used to check the sensation

2 points
blunt
sharp
thermal

Pressure

E. Review

after a week
After 1 month
After 3 months
After 6 months

17. patient with atrial fibrillation takes warfarin.

1)What is the therapeutic range of INR?

a. 2-3
b.2-4
2) What is the aim INR for patient with atrial fibrillation?
a. 1
b. 2
c. 3
d. 4

3) If you cease warfarin, what is the major risk?

a. cerebro-vascular stroke
b. MI
c. deep vein thrombosis

4) This pt had joint replacement before and you are going to extract her tooth, which
antibiotic prophylaxis will you prescribe:
a. amoxicillin 2g 1hour before procedure
b. no need for antibiotic prophylaxis

18. A patient has type I diabetes. Multilocular radiolucency in the angle of the mandible
(multilocular was given in the text of the question).
*OPG -- Large radiolucent lesion in the right mandibular angle.
47(or 48 can't remember) is positioned in close proximity to the lesion. Only crown can be
seen (horizontally impacted). Well beyond the occlusal plain, near the roots of 46(47?).

1) What is the diagnosis?

a. dentigorous cyst
b. ameloblastoma
c. odontogenic keratocyst

2) Best radiograph for it?

a. lateral oblique
b. CT
c. MRI

3) What is the treatment?

a. enaculation + extraction + Carnoy's solution
b. resection
c. excision
d. marsupilization
e. curettage

4) Which of the following is best to assess glycemic control of patient?

a. Random blood sugar
b. Glycoselated haemoglobin
c. Glucose tolerance test
d. Blood hemoglobin

5) What is the major risk in this patient?

a. poor healing
b. infection
c. control of glucose before operation
d. control of glucose after operation
e. fracture of mandible

18. 9 y.o. boy has pain, swelling in infraorbital region, fever 39,8'C. Tooth 12 is extremely
painful to percussion, no caries detected.
*PA of 13,12,11 it shows extremely immature root of tooth #12 with dens invaginatus,
retained #53 and unerupted #13

1) Diagnosis by PA
a. dens in dente
b. supernumerary tooth
c. vertical fracture

2) Treatment
A. LA and start Rct
B. Give antibiotic and send home & further treatment after swelling subside
C. LA and extraction
C. LA, extraction and drainage
D. Hospitalization and IV antibiotics and extraction

3) His mother concerned about if ext will be done what will replace the tooth.
(Q about if ext what will u do next)
A. Replace with removable partial denture
B. Resin boned bride on the central
C. Do nothing and tell mother that canine will erupt in place of lateral
D. Referral to orthodontist for consultation
E. Immediate implant

4) His mother would like to save the tooth and doesn't prefer the ext. option. What will u tell
her:
A. Tell her that saving the tooth will take much time and repeated visits to put Ca(oh) until
apex closure
B. Rct has very poor prognosis and ext will be better option
C. Refer to endondontist
D. Rct is impossible

5) The other lateral incisor 22 has the same clinical and Radiographic appearance but no
symptoms with normal response to vitality and no tenderness to percussion .
What will u do:
A. To come again for follow-up
B. Prophylactic pulpotomy
C. Pulpectomy and initiate root closure
D. Sealing of any deep fissure and regular follow up
19. 11 y.o.
* Picture
Photo from the front in occlusion. Deep bite.
*Dental charting was given -- erupted 22&23 unerupted 12

1) Q-n about the main concern according to the chart:

a. 23 erupted before 12
b. 22 erupted before 12
c. nothing is abnormal
d. missing 12
e. Presence of all second primary molars ( 75,85,55,45) at the age of 10.

2) Away from the charting, Whats obvious finding from pt picture:

a. Deep bite
b. gingivitis
c. dental caries

3) Treatment of patient condition:

a. bite plane to allow eruption of molars and intrusion of incisors
b. removable appliance to arrange teeth and it can allow other correction

The Patient came with her mother after 3 or 5 days (cant remember exactly) and her mother
stated that she developed urticaria after last visit.

4) What you will do or tell the mother:

a. explain that it's not possible to get allergy after 5 days and use latexgloves
b. use latex free gloves and refer to medical practitioner for evaluation
c. abandon any treatment and refer to allergist as repeated exposure may result in
anaphylaxis.
d.

5) For Urticaria, you will give:

a. oral antihistaminics
b. adrenaline
c. steroids

20. Patient who is a factory worker , in regular exposure to chemical acidic fumes comes with
generalized gingival soreness. Chronic smoker and drinker. The picture shows severe red
swollen debrided gingiva with ulcerations

1. What is your provisional diagnosis after taking the history

a. ANUG
b. Primary herpetic gingivostomatitis
c. Chronic periodontitis
d. Periodontal abscess
2. What is the immediate treatment
a. Incision drainage
b. Gentle debridement followed with 0.12% chlorhexidine
c. Gentle debridement followed with 20% hydrogen peroxide

3. How would you manage systemically

a. Amoxicillin
b. Acyclovir
c. Metronidazole 200 mg but should be 400mg for 3 days

4.Which is the hight risk for future ocurrence of this condition

a. Smoking
b. Acidic fumes

5. Why will primary herpetic gingivostomatitis not be a common occurrence in this patient
a. Because it occurs commonly in female adolescents
b. Because early exposre in childhood would have lead to formation of antibodies against it
c. Because he is a smoker

21. A medical practitioner Mr Smith who visits dentist only when he has dental complain,
comes after 5 years. His 37 is sensitive to hot & cold plus bad smell comes. He wants it
extracted and says if u don't do it then he shall himself do it since he learnt it during his
medical training. He has had 2 courses of amoxicillin which did not help. He says that 46 also
went this way. U take his BW from 5 years ago and compare with BW taken now. *BW's

1. According to u what is the reason of his complaint

a) poor oral hygiene, open contact and food impaction
b) 35 sec caries
c) 26 distal amalgam bulge
d) 37 mesial periodontal defect
e) resistant bacteria because of antibiotic

2. What do u say to Mr Smith

a) take OPG & convince him. Explain , maybe change his mind
b) refer to oral surgeon for 2nd opinion and to explain pt
c) extract 37 as he insists, and he will do it anyway, make him sign a consent form
d) give him instruments to do extraction

3) Periodontal state prognosis is based on assessment of

a. periodontal pockets
b. attachment loss
4) what is the most significant difference between two BWs:
a. carious 15
b.

5) How would you treat this pt:

a. scaling and root planning
b. raise a flap to scale and root planning
c. extraction 37

23. 10 y.o. boy has no symptoms. Mother brings him in for a dental check. They are going to
move to USA in 6 month.
*OPG
75, 84 large fillings, radiolucency in furcation and apical area (???)
35 horizontally impacted
44 vertically impacted

Q1) What is the diagnosis?

a. dental abscess
b. periapical granuloma / chronic abscess
(there was no option of periodontitis)

Q2) When the boy was 7y.o he experienced pain and attended another dentist. Those fillings
on 75, 84 were made at that time. There were given 2 BWs taken before treatment 3 years
ago. BW 75, what treatment could be done when she was 7yrs ?
BW 84 what treatment could be done when she was 7yrs, pain on biting and eating?
*BWs
75, 84 grossly carious (cant remember clearly, but I think almost to the pulp)

Pulpotomy +ssc

Q3) Treatment
a. extraction of 75, 84, no space maintenance
b. no treatment, another check-up in USA
c. referral for consultation to orthodontist, surgeon, than extraction and ortho traction of
35,44, continued in USA

d.Extract plus space maintainer

e. Refer to oral surgeon
f. Ortho+exo+ bond

4.OPG s a better radiograph, why ?

Less radiation than 2 btw and 1 pa xray
5.Diagnostic of teeth 75/84 ?
Periapical abcess
Dentigerous cyst
Periapical granuloma

24. 35 y.o. man came because of sensitivity with cold in tooth #16
* Picture showing the pt closing in his comfortable postion
Photo of teeth in occlusion from the side. Mandibular proghnathism.

1) Ortho diagnosis
a. Class I
b. Class II div 1
c. Class II div 2
d. Class III

2) What is the most appropriate initial diagnostic test to do:

A. Lateral cephalometric
B. Correlation between centric occlusion and retruded contact position
C. Study models
D ...

3) Question about what to tell the patient

A. Avoid asking the pt if he didn't has problem
B. Ask him and if he is not concerned about his malocclusion, don't tell him anything further
C. Ask him and if he is not concerned about his malocclusion, discuss with him briefly the
advantage/disadvantage of correcting the bite briefly.
D. Ask him and if he is not concerned about his malocclusion, discuss in details the treatment
plan and all up to date data of the treatment

4) When is the best time to treat this malocclusion:

A. Before 8 yrs for maxillary expansion
B. Before growth spurt to get maximum benefit of growth.
C. After 18-24years to get benefit of surgery

5) If you are going to commence ortho ttt for this pt, how will u restore tooth #16:
A. Resin modified GI
B. Elective RCT and crown
C. Crown for better prognosis with ortho ttt
D. Extract

E. composite

25. A 60 yrs old lady with HbA1c level 12% on aledronate for ttt of osteoporosis reports to
you as she is unhappy with her current ttt.
She has generalized attachment loss of 6mm.
OPG provided (recently splinted lower anterior segment) floating 41, diffuse apical RL
present for 34 to 36 region. She feels at her age she should remove all her teeth..
Smoked previously but quit

1) Diagnosis of her condition:*****

a. chronic periodontitis
b. acute periodontitis
c. plaque induced gingivitis
d. non-plaque induced gingivitis
e. aggressive periodontitis

Q2. What will be the most significant sign in determining prognosis of 36

A. Angular bone loss distal to 36
B. Silver amalgam in 36
C. Furcation involvement in 36
D. Radiolucency involving periapical region of 36
E.
Q3. HB1AC signifies
A. Sugar level for past 2-3 months
B.
C.
D.
4) Q asking about what is the most imp risk factor in treating this pt:
a. Smoking
b. Bisphosphonates
c. Diabetes
d.

5) What is the most significant problem in giving RPD to this pt?

a. Forces other than axial will contribute to rapid bone loss in abutment teeth
b. Higher survey line on canine resulting in clasps that r visible in oral cavity..
c. Insertion of RPD will increase plaque accumulation in this pt