Sample Questions MJDF Part 2
(Source 1: MJDF Website- Questions & Model Answers)
Case Topic: Discussion of possible treatment options
Relevant social history
Non-smoker/never smoked Drinks 1 to 2 glasses of wine several evenings a week
Relevant medical history
Fit and well
Information about scenario
- Tooth 21 traumatised at the age of 7 years; restored with a series of composite restorations, then a post crown at age 16 years.
- 21 root fractured approximately 1 year ago and root extracted 9 months ago.
- Currently wearing a tissue borne acrylic P/- to replace this tooth.
- Otherwise intact dentition, minimally restored.
- Excellent oral hygiene.
At this station
The patient wants to discuss with you the available options to replace the missing incisor with something more permanent.
additional ‘specialist’ input.
Case topic: History taking
Mr Joe Bloggs
Relevant social history
Non-smoker, social drinker
Relevant medical history
Fit and well with no relevant medical history
Relevant dental history
Information about scenario
Patient has booked an appointment, informing your receptionist that he has a painful mouth.
At this station
Take a full history from the patient concentrating on his complaints. Then discuss his concerns and any further tests you may prescribe.
Case Topic: Planning treatment
Relevant Medical History
Fit and well, Tetanus immunisation up-to-date
Relevant Dental History
Regular attender – no restorations
Information about scenario
Imagine you are a dentist in general dental practice.
David had trauma to his upper anterior teeth while playing football yesterday.
The upper right central incisor was avulsed (knocked out).
The coach found the tooth on the ground, rinsed it with water and pushed it back into the socket.
On examination the tooth appears well positioned. The adjacent and opposing teeth appear intact.
Both the upper right and left central incisors exhibit Grade I mobility.
Radiographs of the upper and lower anterior teeth show no root fracture or other pathology.
At this station
The patient wishes to know if he requires any further treatment. He is concerned about the prognosis for his front teeth.
EXAMPLE 5 (OSCE)
A patient of yours Mr Smith, has attended the practice today, with a carious lower third molar tooth. It is asymptomatic at present but needs to be surgically removed. Mr Smith is fit and well, and not taking any medication from his doctor.
A radiograph of the area is provided. You do not have to examine the patient. You are required to obtain valid informed consent from Mr Smith so the procedure can be carried out later.
An examiner will observe you and award marks on your competency. The examiner will not interact with you while you are undertaking your task.
EXAMPLE 6 (OSCE)
You have been provided with photographs and mounted study models of your patient, Mrs Jones, aged 67.
She has agreed to have a new chrome-cobalt partial denture to replace her existing one, which she has had for over 15 years. It is comfortable but as one of the clasps broke recently she has decided to have a new one, similar to her existing one.
You are required to write a prescription to your laboratory for the new partial denture.
EXAMPLE 7 (SCR)
Mr D is a 40-year-old building contractor. He presents at your practice complaining of pain from his “upper front teeth”. He smokes and has an annoying cough. He tells you that he “hates the dentist”.
Kinds of questions you could be asked in an SCR exercise:
- Is the history given here adequate?
- What further information would you require about the history of the presenting complaint?
- Could the patient’s history of “an annoying cough” be important? How could persistent coughs be relevant to the dental team?
- You know that this patient smokes; what questions would you ask to fully assess this risk factor?
- What do you think this patient’s attitude is to his oral health from the information given?
- How would you determine the cause of this patient’s pain?
- Radiographic examination showed an area of radiolucency over the UR1. What treatment would you carry out to relieve the patient’s pain?
EXAMPLE 8 (SCR)
At a local meeting many colleagues reported changing local anaesthetic agent to articaine.
Your practice is presently using lidocaine.
Their decision was based on data presented by the manufacturer suggesting that articaine is more effective.
You have decided your practice decision will be evidence-based, and you have downloaded the first article in a search on the world wide web.
Please critically appraise the abstract and materials and methods given below.
At the next station you will discuss the paper and how you arrive at a decision to purchase the new local anaesthetic.
International Journal of Paediatric Dentistry
Volume 16 Page 252 - July 2006 doi:10.1111/j.1365-263X.2006.00745.x
Volume 16 Issue 4
Comparison of articaine 4% and lidocaine 2% in paediatric dental patients
D. RAM1 & E. AMIR2 Objective. To evaluate and compare the reaction of children who
received local anaesthesia with lidocaine 2% with 1 : 100 000 epinephrine and articaine 4% with 1 : 200 000 epinephrine and to assess the time of the onset, efficacy, duration of numbness of the soft tissues, children's sensation after treatment to both anaesthetic solutions, as well as the occurrence of adverse events.
Samples and methods. Sixty-two children (34 girls and 28 boys) aged 5–13 years (mean age 8·4 ± 2·3) from two established paediatric dental clinics who needed similar operative procedures preceded by local anaesthesia were randomly assigned to receive either lidocaine or articaine at their first or second visit. Modified Taddio's behavioural pain scale was used to evaluate pain reaction during injection and treatment. The sensation after injection and treatment was evaluated using the Wong–Baker FACES pain rating scale. Parents recorded the time when the feeling of local anaesthesia in soft tissues disappeared.
Results. Duration of numbness of soft tissues was significantly longer for articaine (3·43 ± 0·7 h) than for lidocaine (3·0 ± 0·8 h) (P = 0·003). No difference regarding the efficacy of the anaesthesia was observed.
Reaction to pain was similar for both local anaesthetic solutions and no significant difference was found between genders. The efficacy of the anaesthesia was similar for both solutions. The feeling after treatment was similar for both solutions. The rate of adverse effects was similar for the two solutions.
Conclusions. Articaine 4% with 1 : 200 000 epinephrine is as effective as lidocaine 2% with 1 : 100 000 epinephrine. The effect of numbness of soft tissues was longer lasting with articaine than with lidocaine.
Participants in the study included 62 children (34 girls and 28 boys) aged 5– 13 years (mean age 8·4 ± 2·3, median 8), mean weight 30·44 ± 8·80 kg, median 29, from two established paediatric dental clinics in Jerusalem and Tel Aviv. Inclusion criteria were the need for at least two clinical sessions for similar operative procedures with local anaesthesia in the same arch, not as emergency procedures. An experienced paediatric dentist carried out the treatment for each child in each centre (one dentist per centre).
A random cross-over design was used and each child served as his or her own control. The average duration of simple and complex procedures was comparable in each child between articaine and lidocaine. All children were healthy, and none needed a sedative or other pharmacological support to receive dental treatment. Informed consent was obtained from the accompanying parent after explaining and describing the procedure. The child's age and weight, type and amount of local anaesthesia, the need for additional local anaesthesia, and the time of onset were recorded. Each patient was randomly assigned to receive either lidocaine HCl 2% with
1 : 100 000 epinephrine (OctocaineR, Novocol Pharmaceutical of Canada Inc. Cambridge, Ontario, Canada N1R) or articaine HCl 4% with 1 : 200 000 epinephrine (Ubistesin, ESPE Dental AG, D-82229 Seefeld, Germany) for the first visit, with the other solution administered during the second visit.
Up to one cartridge of lidocaine (maximum dose: 4 mg/kg body weight) and articaine (maximum dose: 5 mg/kg body weight) was administered . Before the injection, topical anaesthetic gel on a cotton roll was applied for 1 min to the injection site. The injection of the local anaesthetic solution was slow with an average duration of nearly 2 min (approximately 1 mL/min) .
The modified behavioural pain scale, suggested by Taddio et al. , was used for objective evaluation of the children's reaction during injection. The scale comprised the following parameters: (i) facial display, (ii) arm/leg movements, (iii) torso movements, and (iv) crying. The facial display followed Craig's behavioural description of facial actions, which describes pain . Only two of the four of most descriptive facial actions were evident (eye brow bulge or eye squeeze), as the mouth was open and the nose was partly covered by the operator's hand during injection. All behaviour parameters were evaluated during injection and subsequent treatment.
A trained dental assistant, who did not participate in the treatment and was blinded to the agent being used, recorded the behavioural parameters in each centre. To check on recording, 15 patients who were not included in this study were evaluated as a pilot study.
The time of onset was evaluated by asking the child when the sensation of numbness started. The Wong–Baker FACES pain rating scale (FPS) was used for subjective evaluation of feeling after the injection . This scale shows good construct validity as a self-report pain measure. The FPS measures the unpleasantness or affective dimension of a child's pain experience after injection and is used in children aged 3–17 years. The child is shown a set of six cartoon faces with varying facial expressions ranging from a smile/laughter to tears. Each face has a numerical value. After verbal instructions were given on how to use the FPS, the children were asked to select the face 'which looks like how you feel deep down inside, not the face you show to the world'. The children were asked to rank their sensation immediately after the injection, and by phone 1 and 2 h after.
The efficacy of the anaesthesia was evaluated during treatment. Additional local anaesthetic solution was added when children showed or reported signs of pain. Parents were instructed to ask the child and to record the time when the feeling of numbness disappeared (offset time). They were asked by phone after 1, 2 or more hours to report it and were also asked about the occurrence of adverse effects. Differences in parameters were evaluated by McNemar test and paired t-test. Significance was set at P < 0·05.
Questions Examiner 1
- How was this study designed? Follow up question: Is this a reasonable design?
- Was adequate randomisation achieved?
- How did the authors arrive at the sample size?
- Was anyone blind to the agent being given?
- Are the methods of assessment satisfactory?
- What were main outcomes?
- Would this report make you change your practice?
Introduce further information: Lidocaine is £0.12 /cartridge
Articaine presently on offer £0.13 for 6 months but normally £0.21
- Is a change cost-effective?
- Could you apply the report outcome to adults?
- What would you do to continue to pursue the question if this would be a good alternative anaesthetic?
(Source 2: Questions experienced by candidates in the past are below)
November 2011 MJDF Part 2
1. Generalized aggressive periodontitis
1.Patient takes phenytoin – photo shows gingival overgrowth
2.Any further information you would want from history?
3.Family history of periodontitis/early tooth loss
6.Treatment options to replace tooth 7.RecessionTreatment options8.Local antimicrobial – patient has allergic reactionManagement of anaphylaxis
2. Critical appraisal on neurotoxicity/ADR (adverse drug reaction) of different LA’s (trial in Denmark)
- Articaine showed highest incidence
- Comment on methodology
- Was is the trend in the second graph
- What does the first graph show
- Is measuring sale volumes of LA a good way of measuring amount used.
- If you were to design a LA, what would be the ideal properties
- Nurse has needlestick – manage
3. Trauma to 14 year old - central incisor – lateral luxation + extrusion
1.Patent had fallen off sofa and injured incisor, also bruised eye + frenum tear. Patient had emergency treatment hospital (Sunday night) and comes to see you on Monday morning. – no splint placed
2.Patient not happy with position - options
3.Manage, splint time?
5.NAI?How would you proceed if suspected Do the signs and history add up?6.Asks what is arrow on ant occlusal radiograph showinganterior nasal spine/nasal floor/root # name radiograph taken: ant occlusal + PA
1.Classification Detection/measure? Screening in dentistry –Cancer (toluidine blue) Caries (BWs), Periodontitis (BPE)2.Patient gets angry that you and your nurse cant smell halitosis – management 3.Complaints procedure in secondary care
5. Denture stomatitis – wants new denture and is a clarinet player
1.Treatment on denture stomatitis
2.What extra would you want from history
Reason he wants new?
What is he happy with in current
3.They then say he is on warfarin
What precautions if he needs XLA
Cannot prescribe miconazole
Say he also needs tooth extracted, how do you manage XLA?
Comes back in pain (dry socket) – management (do not give NSAIDs!)
What time of day/week do you see him
4.What is important in design on new denture
Retention as he plays clarinet?
1.Rubber dam isolate lr5 for mod
what if no retention for clamp? – drill retention groove into filling/ add composite/ choose clamp with better retention
3.Patient comes in with tooth ache after having filling done by another dentist last week, you take BWs and see multiple caries including under new filling and another on same tooth which was missed.
Explain to very angry patient and calm her down.
4.Incisional biopsy + suture
Where would you take biopsy from (photos)
What pot? Formal saline
5.Partial denture design for lower: free end saddle on one side and missing 6 on other side. Only 4mm space from gingival margin to FOM.
What Kennedy class ?– 2 mod 1,
What major connector?
Place waste/instruments etc into correct bins/disinfection process
Difference between consignment note and waste disposal note
Who disposes of the waste
Where is waste stored in practice
What waste is yellow bag with black stripe for, examples of what would go in there.
8.MI – manage
9.Asthma attack – manage
10.IV bisphosphonates – explain to her consequences of having tooth out. She is in pain and wants treatment.
11.Give OHI, 25 year old patient has gingivitis and worried as mum lost her teeth.
12.Your VT has called you to help explain to a patient that end of gates glidden broken and gone down throat. No rubber dam used! Patient very angry, calm her and explain procedure and next steps.
13.URA to correct x-bite and arch expansion – give instructions (written)
Full time wear?
Patient swims, and plays hockey, and plays wind instrument
14.You are an experienced associate, new associate not happy to take part in medical history audit. Principal wants you to talk to him.
Explain importance of audit
Importance of MH
Explain it is not to check on him, and that everyone should do it.
1.Casts and iotn sheet given – no ruler
2.Name 4 anomalies
Overjet > 9mm
Displacement of CPs
3.What is DHC grade – 5a
4.AC: how do you use it in practice – 3 stages
NEW! November 2012 MJDF Part 2
1. Prescription for ANUG – Metronidazole tds 3/7
2. Actor – take pain history, patient has trigeminal neuralgia, discuss how you would mange it and treatment options
3. Medical emergencies: asthma - salbutamol and oxygen (asked flow rate)
4. Medical emergencies: MI, patient does not get better after GTN, give aspirin does not get better, actor asks what is going on, what will happen when I get to hospital and will I need to stay at the hospital. Examiner asks anything else that can be given? Nitrous oxide
5. Setting up X-ray holder
6. Rubber dam. What would you do if the tooth you wanted to clamp was at an unfavorable angle.
7. Hand washing and putting on surgical gloves
8. Give OHI for someone who has gingivitis.
9. Radiographs: grading and faults
10. Patient has TMJ dysfunction. Explain what it is, you have already given jaw exercises and advised to not chew hard things, what else would you do?
11. Take a working length radiograph of a tooth. What would you right on the records concerning working length?
12. Patient has chronic perio and is a smoker, explain teeth requiring XLA and why.
13. Patient has red patch requires urgent referral to hospital explain why.
14. Biopsy and suture.
1. Critical appraisal, of cox 2 inhibitor. Randomized clinical control trial comparing with codeine/paracetamol and placebo
- discuss the study
- what were the exclusion criteria?
- were the intervals at which results were taken ideal?
- what does intention to treat mean?
- describe the graph and table they give you, do you feel good spread
- how does a cox 2 inhibitor differ from ibuprofen?
- how are drugs stored in practice?
- how do u make sure prescriptions not misused?
- what would you check before prescribing ibuprofen?
2. Decay in deciduous dentition of patient with fallots tetralogy 6 yrs old with learning difficulties
- what clinical signs would tell you which tooth causing problem (buccal sinus present in pic)?
- what would you ask for in relation to pain?
- what special tests would you do?
- shown radiographs what can you see?
- what treatment would you do to get patient out of pain and definitive diagnosis?
- patient has high fever what would you do?
- Cardiologist has advised antibiotic cover what discussion would you have with dad?
- patient returns after treatment and gets infective endocarditis because you didn’t give abs what would you say?
- how would you treat patient with learning difficulties?
- Patients who have fallots tetralogy get atrial fibrillation later in life how would you manage these pts?
- Ortho? If teeth taken out early
3. Lady has read about herbal remedies and is getting pain from anterior teeth wants antibiotics with no treatment
- pain history
- discuss finding on PA radiographs
- which teeth would you vitality test?
- how would you convince patient to have treatment?
- bleaching guidelines and if can you do if under 18?
- patient refuses to have rubber dam how do you convince?
- how would you isolate single tooth with rubber dam?
4. Patient has XLA gets dry socket
- what is dry socket?
- predisposing factors
- patient requires another tooth XLA’d what can be done to prevent
- how would u treat?
- what are the side effects of chlorhexidine?
- patient has anaphylaxis from chlorhexidine, how would you treat?
- patient returns complains of altered taste sensation, how would you treat?
5. Patient wants fillings replaced with a composite advertised as a bulk fill comp with no in vivo studies and no clinical studies
- would you use it and why?
- after doing large filling, patient gets sensitivity to cold/sweet. What would you say to patient?
- you replace filling and it gets better. Patient then gets dentine sensitivity from area of root debridement, what would you say to patient and how could you treat it?
- Pregnancy epuli
- Oroantral communication
- Aggressive periodontal disease
- Avulsed tooth and management
- Tooth whitening article (critically appraise)
- Caries article (critically appraise)
- Osteogenesis imperfecta- Picture
- Management of dentinogenesis imperfect in children
- Bad referral letter- Comment
- Child abuse- Management
- Treatment of fractured central incisors
- 3 different dentists do poor quality treatment- discuss if they have breached professionalism/ NHS contract/ GDC registration.
-Discuss complaint procedure- is this different in hospital/ general practice
11. Oral submucous fibrosis
- Differential diagnosis of red/ white patch
- Definition of dysplasia
12. LR6 PA periodontitis/ Acute pseudomembranous candidiasis/ HIV?- Drug abuser.
- Nurse has needlestick- management
- Risk of transmissionM
- Post-exposure prophylaxis (side effects of drugs)
13. Failing anterior resin bonded bridge on a 30year old female. Her wedding is next week. BPE 1/2 and she wants treatment options.
What would you ask in the history?
Why do you think the bridge failed?
What would you explain to the patient?
How would you treat this case?
How might you cement a RBB?
What materials might you use?
- Discuss panavia
- Bridge design
14. Dry mouth- root caries/ Class 5 cavities (how to restore/ material to use- composite/GIC- advantages/ disadvantages)
- Composition of GIC
- Curing process of composites
- Sjogrens- write to doctor to carry out relevant blood tests
-Methotrexate/ Fluoxetine/ Prednisolone
15. Socket will not stop bleeding- what are causes/ treatment options
16. Hall technique crowns article (critically appraise)- Study design/ Articles credibility/ Validity/ P-Values? ‘The Hall Technique; a randomized controlled clinical trial of a novel method of managing carious primary molars in general dental practice: acceptability of the technique and outcomes at 23 months (http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=2265270)’
- Name 3 solutions you can use
- Lip laceration during restorative work- communication
- Medical emergencies
- Broken instrument during RCT- communication
- Periodontal disease- communication and explanation
- Nurses 360 degree appraisal
-What is a 360 appraisal (everyone in practice appraising person)
-Good aspects 1st (be encouraging)- communication skills good
- Areas to improve (turns up late/ clinical skills poor)
- How to improve (CPD/ Courses)
- Prescription writing – amoxicillin (patient alcoholic)
- Referral letter
- Medical record keeping
- Post XLA pain after 4 days- diagnose and communication
- Dry socket
- Obtain consent for wisdom tooth extraction
- Placement of rubber dam
- MOD cavity LL4 (make sure you place clamp on correct tooth)
- Recurrent apthous ulceration- history taking
- Incisional biopsy and suturing (choose correct instruments and dispose of needle after)
- horizontal mattress
- single interrupted
- HIV confidentiality breached- gets angry and you need to calm him down and manage the situation
- Give patient OHI/ TBI
- Name instruments on MOS tray
- Infective endocarditis guidelines- patient wants to know why its no longer needed and is scared of getting IE
- Fluoride prescribing for a child
- Picture of a dental surgery- zoning
- Arrange PA in order (15 radiographs)
- Burnt a patients lip with a hot instrument- communication
- Management of a diabetic patient
- Interpret BPE score
- Needlestick management
- Treatment planning- diastema/ missing tooth
- Patient has pain and swelling- take a history
- Radiographs with caries/ periodontal disease- explain findings and treatment options to patient
- Mild dysplasia- explain to patient
- explain role of alcohol/ smoking
- need for regular review
- Failed RCT- explain
- Balancing extractions- explain
- Impacted canine- discuss options and referral to orthodontics
- Advantages/ disadvantages of XLA/ leave/ move/ cysts
- Patient has spacing- treatment options
- PA radiolucency on radiograph (post crown)- discuss findings and options
- Assess patients risk after hygienist has had needlestick
- Discuss with father about extractions under GA
- Risks including death (1/100000 risk)
- Days off school
-Which teeth (primary/ secondary)
- Smoking cessation
- Blood tests show anaemia- discuss
- Missing LL5 but LLE present- tx options
- Explain to parent that an adult tooth was accidently extracted instead of a primary tooth under GA and treatment options now available
- Caries- motivate a patient to lower risk
- Lichen planus- discuss and tx options
- Rampant caries- motivate mum/ give HI/ diet
- Warfarin patient needs XLA- discuss
- Missing lateral and peg lateral- explain and discuss tx options
- Chest pain history
- Give an IM injection (choose needle and medicine)
- Denture design
-CO/CR and acrylic
- Kennedy classification
- History of assault and trauma- convert medical notes into a police report
- MOS consent
- Your associate is on holiday and you see his patients. You notice is work is dodgy- next steps?
- write a letter to your local dental committee
- UL6 cusp fracture- tx options
- Audit on radiographs
- Explain audit cycle and standards
- Numerous white patches- differential diagnosis
- Fill in lab docket for MCR on LR6
- Referral letter for patient with pericoronitis
- IOTN – dental health and aesthetic component
- Casts given
- Learn IOTN sheet
-NHS- who qualifies?
- Waste disposal – different types of waste
- Write letter to GDC about colleague who is not taking adequate MH
- Different stages in washer disinfector cycle
- Different aspects of HTM0105