Mock Exam

Alan Peterson, a 52-year-old male, presents with mild facial swelling extending around his upper lip and nose. He has a history of trauma (fell while fixing his house roof 8 months ago) and has multiple broken incisors. He stopped using methamphetamine 2 months ago. His last medical check-up was over a year ago, and he has diabetes with an HbA1c of 9%.
Upon examination, his temperature is 37.8°C, indicating a low-grade fever. He reports occasional pain and tenderness in the maxillary anterior region. He is seeking treatment for his dental problems. And extraction od the tooth #31.

Q1: Which tooth is the most probable cause of the swelling based on clinical radiograph?

Alan Peterson, a 52-year-old male, presents with mild facial swelling extending around his upper lip and nose. He has a history of trauma (fell while fixing his house roof 8 months ago) and has multiple broken incisors. He stopped using methamphetamine 2 months ago. His last medical check-up was over a year ago, and he has diabetes with an HbA1c of 9%.
Upon examination, his temperature is 37.8°C, indicating a low-grade fever. He reports occasional pain and tenderness in the maxillary anterior region. He is seeking treatment for his dental problems. And extraction od the tooth #31.

Q2: What is the next diagnostic test to confirm the most likely offending tooth?

Alan Peterson, a 52-year-old male, presents with mild facial swelling extending around his upper lip and nose. He has a history of trauma (fell while fixing his house roof 8 months ago) and has multiple broken incisors. He stopped using methamphetamine 2 months ago. His last medical check-up was over a year ago, and he has diabetes with an HbA1c of 9%.
Upon examination, his temperature is 37.8°C, indicating a low-grade fever. He reports occasional pain and tenderness in the maxillary anterior region. He is seeking treatment for his dental problems. And extraction od the tooth #31.

Q3: What is the most likely diagnosis?

Alan Peterson, a 52-year-old male, presents with mild facial swelling extending around his upper lip and nose. He has a history of trauma (fell while fixing his house roof 8 months ago) and has multiple broken incisors. He stopped using methamphetamine 2 months ago. His last medical check-up was over a year ago, and he has diabetes with an HbA1c of 9%.
Upon examination, his temperature is 37.8°C, indicating a low-grade fever. He reports occasional pain and tenderness in the maxillary anterior region. He is seeking treatment for his dental problems. And extraction od the tooth #31.

Q4: What is the most appropriate management of the offending tooth in a patient with diabetes (HbA1c = 9%)?

Alan Peterson, a 52-year-old male, presents with mild facial swelling extending around his upper lip and nose. He has a history of trauma (fell while fixing his house roof 8 months ago) and has multiple broken incisors. He stopped using methamphetamine 2 months ago. His last medical check-up was over a year ago, and he has diabetes with an HbA1c of 9%.
Upon examination, his temperature is 37.8°C, indicating a low-grade fever. He reports occasional pain and tenderness in the maxillary anterior region. He is seeking treatment for his dental problems. And extraction od the tooth #31.

Q5: What is the most appropriate anesthetic technique to extract tooth #31 in this patient?

A 60-year-old female presents for a routine dental visit for a scale and clean after not attending dental care for approximately seven years.
His medical history includes type 2 diabetes mellitus, recently tested and found to be uncontrolled, and hypertension.
Social history reveals cigarette smoking for the past 30 years and occasional alcohol consumption. He works in a physically demanding outdoor occupation.
On oral examination, you identify an asymptomatic, non-scrapable white lesion on the lateral border of the tongue.
The lesion appears persistent, with no obvious surface changes.
The patient believes it “might have been there for a while” but cannot be certain.

Q1. At this stage, what is the MOST appropriate immediate clinical action?

A 60-year-old female presents for a routine dental visit for a scale and clean after not attending dental care for approximately seven years.
His medical history includes type 2 diabetes mellitus, recently tested and found to be uncontrolled, and hypertension.
Social history reveals cigarette smoking for the past 30 years and occasional alcohol consumption. He works in a physically demanding outdoor occupation.
On oral examination, you identify an asymptomatic, non-scrapable white lesion on the lateral border of the tongue.
The lesion appears persistent, with no obvious surface changes.
The patient believes it “might have been there for a while” but cannot be certain.

Q2. Which of the following is LEAST likely to explain the nature of this lesion at this stage?

A 60-year-old female presents for a routine dental visit for a scale and clean after not attending dental care for approximately seven years.
His medical history includes type 2 diabetes mellitus, recently tested and found to be uncontrolled, and hypertension.
Social history reveals cigarette smoking for the past 30 years and occasional alcohol consumption. He works in a physically demanding outdoor occupation.
On oral examination, you identify an asymptomatic, non-scrapable white lesion on the lateral border of the tongue.
The lesion appears persistent, with no obvious surface changes.
The patient believes it “might have been there for a while” but cannot be certain.

Q3. While completing your clinical notes, you consider whether any action performed now would meaningfully contribute to identifying and managing the condition, without delaying definitive management. Which action is MOST appropriate?

A 60-year-old female presents for a routine dental visit for a scale and clean after not attending dental care for approximately seven years.
His medical history includes type 2 diabetes mellitus, recently tested and found to be uncontrolled, and hypertension.
Social history reveals cigarette smoking for the past 30 years and occasional alcohol consumption. He works in a physically demanding outdoor occupation.
On oral examination, you identify an asymptomatic, non-scrapable white lesion on the lateral border of the tongue.
The lesion appears persistent, with no obvious surface changes.
The patient believes it “might have been there for a while” but cannot be certain.

Q4. The patient asks why observation for a short period is not sufficient, given the absence of pain or functional limitation. Which factor MOST strongly justifies escalation rather than short-term review?

A 60-year-old female presents for a routine dental visit for a scale and clean after not attending dental care for approximately seven years.
His medical history includes type 2 diabetes mellitus, recently tested and found to be uncontrolled, and hypertension.
Social history reveals cigarette smoking for the past 30 years and occasional alcohol consumption. He works in a physically demanding outdoor occupation.
On oral examination, you identify an asymptomatic, non-scrapable white lesion on the lateral border of the tongue.
The lesion appears persistent, with no obvious surface changes.
The patient believes it “might have been there for a while” but cannot be certain.

Q5. Before the patient leaves, you consider actions that may address concurrent risk immediately, while ensuring the primary concern is not detracted from. Which action is MOST appropriate?

A 58-year-old woman from Brisbane attends with worsening pain and swelling associated with tooth 36 for 2 days. She also reports bleeding gums and requests periodontal cleaning once the pain settles.

Medical history reveals mitral valve prolapse, previous rash after penicillin, and poorly controlled type 2 diabetes mellitus. She denies swallowing difficulty or breathing difficulty.

Clinical examination shows buccal facial swelling adjacent to tooth 36, tenderness to percussion, and purulent discharge from the gingival sulcus. There is no trismus, no floor of mouth swelling, and no neck swelling. Extraction can be completed today in the clinic setting.

Question 1

Which diagnosis most appropriately accounts for the current presentation?

A 58-year-old woman from Brisbane attends with worsening pain and swelling associated with tooth 36 for 2 days. She also reports bleeding gums and requests periodontal cleaning once the pain settles.

Medical history reveals mitral valve prolapse, previous rash after penicillin, and poorly controlled type 2 diabetes mellitus. She denies swallowing difficulty or breathing difficulty.

Clinical examination shows buccal facial swelling adjacent to tooth 36, tenderness to percussion, and purulent discharge from the gingival sulcus. There is no trismus, no floor of mouth swelling, and no neck swelling. Extraction can be completed today in the clinic setting.

Question 2

Given extraction can be completed today, which antimicrobial approach is most appropriate for her condition?

A 58-year-old woman from Brisbane attends with worsening pain and swelling associated with tooth 36 for 2 days. She also reports bleeding gums and requests periodontal cleaning once the pain settles.

Medical history reveals mitral valve prolapse, previous rash after penicillin, and poorly controlled type 2 diabetes mellitus. She denies swallowing difficulty or breathing difficulty.

Clinical examination shows buccal facial swelling adjacent to tooth 36, tenderness to percussion, and purulent discharge from the gingival sulcus. There is no trismus, no floor of mouth swelling, and no neck swelling. Extraction can be completed today in the clinic setting.

Question 3

Based on her medical history, which statement regarding prophylactic antibiotics is most appropriate for future routine dental care?

A 58-year-old woman from Brisbane attends with worsening pain and swelling associated with tooth 36 for 2 days. She also reports bleeding gums and requests periodontal cleaning once the pain settles.

Medical history reveals mitral valve prolapse, previous rash after penicillin, and poorly controlled type 2 diabetes mellitus. She denies swallowing difficulty or breathing difficulty.

Clinical examination shows buccal facial swelling adjacent to tooth 36, tenderness to percussion, and purulent discharge from the gingival sulcus. There is no trismus, no floor of mouth swelling, and no neck swelling. Extraction can be completed today in the clinic setting.

Question 4

Following successful extraction and drainage today, which additional advice is most appropriate?

A 58-year-old woman from Brisbane attends with worsening pain and swelling associated with tooth 36 for 2 days. She also reports bleeding gums and requests periodontal cleaning once the pain settles.

Medical history reveals mitral valve prolapse, previous rash after penicillin, and poorly controlled type 2 diabetes mellitus. She denies swallowing difficulty or breathing difficulty.

Clinical examination shows buccal facial swelling adjacent to tooth 36, tenderness to percussion, and purulent discharge from the gingival sulcus. There is no trismus, no floor of mouth swelling, and no neck swelling. Extraction can be completed today in the clinic setting.

Question 5

Which newly developed feature would most strongly change management from community treatment to urgent hospital transfer?

A 9-year-old boy, Ethan, is brought by his father Michael to a dental clinic in Sydney with 2 days of fever (38.5°C), marked irritability, refusal to eat, and reduced fluid intake. His father reports Ethan cries when attempting to drink and has passed urine only once since morning.

Examination shows tender bilateral cervical lymphadenopathy, generalized erythematous swollen gingiva, and multiple shallow ulcers affecting the gingiva and labial mucosa. Several lesions appear to have started as vesicles. No facial swelling is present. No hand or foot rash is seen.

Question 1

Which diagnosis most appropriately accounts for the presentation?

A 9-year-old boy, Ethan, is brought by his father Michael to a dental clinic in Sydney with 2 days of fever (38.5°C), marked irritability, refusal to eat, and reduced fluid intake. His father reports Ethan cries when attempting to drink and has passed urine only once since morning.

Examination shows tender bilateral cervical lymphadenopathy, generalized erythematous swollen gingiva, and multiple shallow ulcers affecting the gingiva and labial mucosa. Several lesions appear to have started as vesicles. No facial swelling is present. No hand or foot rash is seen.

Question 2

All of the following may form part of appropriate management today except:

A 9-year-old boy, Ethan, is brought by his father Michael to a dental clinic in Sydney with 2 days of fever (38.5°C), marked irritability, refusal to eat, and reduced fluid intake. His father reports Ethan cries when attempting to drink and has passed urine only once since morning.

Examination shows tender bilateral cervical lymphadenopathy, generalized erythematous swollen gingiva, and multiple shallow ulcers affecting the gingiva and labial mucosa. Several lesions appear to have started as vesicles. No facial swelling is present. No hand or foot rash is seen.

Question 3

The father asks whether antibiotics already started elsewhere should be continued. Which response is most appropriate?

A 9-year-old boy, Ethan, is brought by his father Michael to a dental clinic in Sydney with 2 days of fever (38.5°C), marked irritability, refusal to eat, and reduced fluid intake. His father reports Ethan cries when attempting to drink and has passed urine only once since morning.

Examination shows tender bilateral cervical lymphadenopathy, generalized erythematous swollen gingiva, and multiple shallow ulcers affecting the gingiva and labial mucosa. Several lesions appear to have started as vesicles. No facial swelling is present. No hand or foot rash is seen.

Question 4

The father asks how much fluid Ethan should aim to drink over 24 hours. Which advice is most appropriate?

A 9-year-old boy, Ethan, is brought by his father Michael to a dental clinic in Sydney with 2 days of fever (38.5°C), marked irritability, refusal to eat, and reduced fluid intake. His father reports Ethan cries when attempting to drink and has passed urine only once since morning.

Examination shows tender bilateral cervical lymphadenopathy, generalized erythematous swollen gingiva, and multiple shallow ulcers affecting the gingiva and labial mucosa. Several lesions appear to have started as vesicles. No facial swelling is present. No hand or foot rash is seen.

Question 5

Which additional feature would most strongly support considering early antiviral therapy rather than supportive care alone?

Andrew is a 55-year-old presents with a completely edentulous upper jaw and a fully dentate lower jaw complaining of loose upper denture and itchy lower teeth. On clinical examination, teeth #35 and #45 exhibit Grade III mobility, 4 mm of gingival recession, and pocket depths of 5 mm. The patient has a medical history of type 2 diabetes mellitus and reports smoking half a standard pack of cigarettes per day.

Q1. According to the 2017 Classification of Periodontal and Peri-Implant Diseases and Conditions, what is the most appropriate periodontal staging and grading for this patient?

Andrew is a 55-year-old presents with a completely edentulous upper jaw and a fully dentate lower jaw complaining of loose upper denture and itchy lower teeth. On clinical examination, teeth #35 and #45 exhibit Grade III mobility, 4 mm of gingival recession, and pocket depths of 5 mm. The patient has a medical history of type 2 diabetes mellitus and reports smoking half a standard pack of cigarettes per day.

Q2. Given the attached photo, what is the most appropriate impression technique?

Andrew is a 55-year-old presents with a completely edentulous upper jaw and a fully dentate lower jaw complaining of loose upper denture and itchy lower teeth. On clinical examination, teeth #35 and #45 exhibit Grade III mobility, 4 mm of gingival recession, and pocket depths of 5 mm. The patient has a medical history of type 2 diabetes mellitus and reports smoking half a standard pack of cigarettes per day.

Q3. The mandibular arch is presented after the extraction of teeth #35 and #45, as seen in the image.

According to Kennedy’s Classification of partially edentulous arches, what is the most appropriate classification for this case?

Andrew is a 55-year-old presents with a completely edentulous upper jaw and a fully dentate lower jaw complaining of loose upper denture and itchy lower teeth. On clinical examination, teeth #35 and #45 exhibit Grade III mobility, 4 mm of gingival recession, and pocket depths of 5 mm. The patient has a medical history of type 2 diabetes mellitus and reports smoking half a standard pack of cigarettes per day.

Q4. You are performing the bridge preparation for the missing lower teeth. During

give anaesthetic and dental syringe fallen in the floor while the dental assistant handle the same needle, the needle poked one of the patient in the corridor, how is liable initially for this needle stick injury? 

Andrew is a 55-year-old presents with a completely edentulous upper jaw and a fully dentate lower jaw complaining of loose upper denture and itchy lower teeth. On clinical examination, teeth #35 and #45 exhibit Grade III mobility, 4 mm of gingival recession, and pocket depths of 5 mm. The patient has a medical history of type 2 diabetes mellitus and reports smoking half a standard pack of cigarettes per day.

Q5. You have constructed the fixed partial denture (bridge) for the patient. The bridge fits accurately on the master cast, but when you try it in the patient’s mouth, it does not seat properly. What should you suspect first?