OSCE 2002 II

T H E N A T I O N A L D E N T A L E X A M I N I N G B O A R D O F C A N A D A

OBJECTIVE STRUCTURED CLINICAL EXAMINATION – 2002 RELEASED VERSION

STATION A

Questions 1 - 4 A 35 year old female is complaining of generalized "bleeding gums". Using the print of the radiographs (not available for display) and casts (not available for display), answer the following questions on the answer score sheet.

Question: 1 Periodontal examination reveals adequate attached gingiva between teeth 1.5 and 1.6 with probing depths of 4mm. In addition to scaling and root planing, what is the most appropriate treatment for this area? A. Observation. B. Perform a gingivectomy. C. Place a free gingival graft. D. Perform full thickness flap procedure with ostectomy. E. Replace the defective restorations. Question: 2 Resolution of the edematous suprabony pockets in the mandibular anterior will A. result in a potential cosmetic problem. B. result in teeth with an increased mobility. C. result in increased bony support for the teeth. D. require apicoectomy procedures. E. require orthodontic procedures. Question: 3 Tooth 4.6 has 4mm probing depths on the mesio-buccal and mesio-lingual, but no other probing depths over 3mm and no symptoms. Treatment of choice for this tooth is to replace the defective restoration and A. prescribe a systemic antibiotic. B. improve oral hygiene. C. place a crown on the tooth to close the diastema. D. upright the tooth orthodontically and place a 3 unit fixed partial denture. E. extract the tooth. Question: 4 Select the correct statement concerning teeth 1.5 and 1.6. A. There is caries on the mesial and distal of both teeth. B. These teeth require endodontic treatment. C. These teeth should be extracted. D. The pulp chambers of these teeth are calcified. E. There is calculus present on the roots of these teeth.

T H E N A T I O N A L D E N T A L E X A M I N I N G B O A R D O F C A N A D A OBJECTIVE STRUCTURED CLINICAL EXAMINATION – 2002 RELEASED VERSION

STATION B Questions 5 - 8

Using the cast (not available for display), answer the following questions on the answer score sheet. Question: 5 The major connector on the removable partial denture framework is A. positioned in an excessive undercut area. B. too close to the gingival margin. C. too narrow as it is designed. D. too far from the gingival margin. Question: 6 The component of the removable partial denture framework on tooth 4.6 A. is unnecessary. B. requires modification of the tooth prior to making a final impression. C. directs functional occlusal forces along the long axis of the tooth. D. should only be used if the tooth is periodontally compromised. Question: 7 The gridwork (meshwork) over the edentulous area in the fourth quadrant of the denture framework A. will interfere with the mylohyoid muscle. B. has adequate relief for acceptable retention of an acrylic denture base. C. is placed too far to the buccal. D. has too small a surface area to provide for acceptable retention of an acrylic denture base. Question: 8 Assuming that tooth 3.4 has no periodontal problems, the tip of the clasp on tooth 3.4 should be placed A. occlusal to the survey line. B. at the survey line. C. in a .005 inch (.125mm) undercut gingival to the survey line. D. in a .01 to .02 inch (.25 to .50mm) undercut gingival to the survey line. E. in a .04 inch (1.0mm) undercut gingival to the survey line.


STATION C

Questions 9 - 12 Using the information in the case history and the clinical photographs (not available for display), answer the following questions on the answer score sheet. CASE HISTORY A 28 year old pregnant female presents with multiple ulcers on the free gingiva, edematous interdental papillae, shallow ulcers on the attached gingiva and gingival bleeding. Some intact vesicles and ulcers are present on the hard palate and tongue. The patient has a temperature of 39oC (102.2oF) and has multiple, palpable, painful mandibular and cervical lymph nodes. These symptoms have been present for 2 days. Question: 9 The most likely diagnosis is A. recurrent aphthous stomatitis. B. pregnancy gingivostomatitis. C. acute streptococcal gingivostomatitis. D. acute herpetic gingivostomatitis. E. erythema multiforme. Question: 10 Treatment for this patient should include 1. topical steroids. 2. topical anaesthetic as required. 3. systemic acyclovir. 4. regular intake of fluids. A. (1) (2) (3) B. (1) and (3) C. (2) and (4) D. (4) only E. All of the above. Question: 11 Which of the following medications is contraindicated for the management of this patient’s condition? A. Acetaminophen. B. Ibuprofen. C. Acetylsalicylic acid. D. Betamethasone.


STATION C

Questions 9 - 12 Question: 12 The patient should be informed that these symptoms will resolve A. in the next two days. B. in 5 - 12 days. C. in 3 - 4 weeks. D. at the end of her pregnancy.


STATION D Questions 13 - 16

Using the information in the case history and the print of the radiographs (not available for display), answer the following questions on the answer score sheet. CASE HISTORY The patient is a healthy 9 year old girl with no contraindications to routine dental treatment. Question: 13 The most appropriate treatment for tooth 7.5 is to A. disc the mesial surface and place a fluoride varnish. B. place a MO restoration. C. place a MOD restoration. D. do a pulpotomy and stainless steel crown. E. extract tooth 7.5 and place a fixed space maintainer. Question: 14 Tooth 5.4 is causing pain when the patient chews. The most appropriate treatment of tooth 5.4 is to A. relieve the occlusion. B. place a DO zinc-oxide eugenol restoration. C. place a DO amalgam restoration. D. perform a pulpotomy and restore with a stainless steel crown. E. extract tooth 5.4. Question: 15 During the removal of the caries in tooth 6.5 the pulp is exposed and a pulpotomy is initiated. After removal of the pulp tissue from the pulp chamber with a round bur, profuse bleeding occurs from the floor of the pulp chamber. This bleeding is most likely caused by A. multiple pulp polyps. B. accessory pulp canals. C. perforation of the floor of the pulp chamber. D. vascular anomaly of pulp tissue. E. an undiagnosed bleeding disorder.


STATION D Questions 13 - 16

Question: 16 Tooth 8.4 is asymptomatic. The appropriate treatment is A. no treatment and allow to exfoliate. B. placement of a stainless steel crown restoration. C. direct pulp capping and restoration. D. pulpotomy and restoration. E. extraction.


STATION E Questions 17 - 17

NOTE: This type of station was not used in 2002 but may be used on future examinations.

(4 marks) Using the following information, write a prescription for an analgesic for the patient, Norman Brown, who lives at 100 Plain Street, Anywhere City. Patient Information: Age: 28 years Blood Pressure: 120/80mmHg Gender: male Pulse Rate: 72/minute Height: 178 cm (5’10”) Respiration Rate: 15/minute Weight: 75kg (159 lbs) Temperature: 37°C (98.6°F) Chief Complaint: Pain in right jaw History of Chief Complaint: Tooth 4.6 had non restorable caries. It has just been extracted,

requiring a flap and bone removal. Dental History: Medical History:

Significant Findings: None

Current Medication: None

Allergies: None Social/Family History: Significant Findings: No significant findings.

Clinical Examination: Significant Findings:

Extraoral findings: No significant findings.

Intraoral findings: Surgical site with flap sutured in place.


STATION E Questions 17 - 17

QUESTION: 17

Doctor XXXXXXX, D.D.S. 333 Maple Street

Anywhere City, Canada Telephone: 345-6789

Date: ____________________

Name: Address:

Rx

NO REPEAT

REPEAT TIMES

SIGNATURE: XXXXXXXXXXXXXXXXX (do not sign prescription)


STATION F Questions 18 - 21

Using the information in the case history, answer the following questions on the answer score sheet. CASE HISTORY The prescription shown was given to a 35 year old, 55kg (121 lb.) patient following periodontal surgery. His medical history is non contributory. He has no known drug allergy and take no other medication. Question: 18 The prescription 1. indicates that the patient should take the medication when needed. 2. indicates the patient should take the medication every three hours. 3. would lead to an excessive daily dosage of codeine. 4. lists 2 medications that can be combined into a single pill.

A. (1) (2) (3) B. (1) and (3) C. (2) and (4) D. (4) only E. All of the above. Question: 19 The prescription is unacceptable because 1. too many tablets are prescribed. 2. a repeat has been indicated. 3. the interval between doses is too long. 4. the dentist’s signature is missing.

A. (1) (2) (3) B. (1) and (3) C. (2) and (4) D. (4) only E. All of the above.


STATION F Questions 18 - 21

Question: 20 The medications prescribed would be acceptable if the patient A. had a gastric ulcer. B. had a confirmed allergy to acetaminophen. C. had a confirmed allergy to ibuprofen. D. were 7 years old.

Question: 21 After taking the prescribed medication, this patient may experience 1. drowsiness due to the codeine. 2. bleeding due to acetylsalicylic acid. 3. constipation due to the codeine. 4. nausea due to acetylsalicylic acid.

A. (1) (2) (3) B. (1) and (3) C. (2) and (4) D. (4) only E. All of the above.


STATION G Questions 22 - 25

Using the prints of the radiographs (not available for display), answer the following questions on the answer score sheet. Question: 22 There is radiographic evidence of 1. severe generalized bone loss. 2. an apical radiolucency on tooth 3.5. 3. recurrent caries on tooth 3.5. 4. an open interproximal contact between 3.5 and 3.6. A. (1) (2) (3) B. (1) and (3) C. (2) and (4) D. (4) only E. All of the above. Question: 23 There is radiographic evidence of A. an apical radiolucency on tooth 1.2. B. recurrent caries on tooth 1.2. C. generalized calculus. D. an apical radiolucency on tooth 1.3. Question: 24 The appearance of tooth 4.7 is most likely due to A. macrodontia. B. gemination. C. hemifacial hypertrophy. D. bending of the film. E. fusion. Question: 25 The patient in this radiograph is a 24 year old male. Tooth 4.8 is asymptomatic. The most appropriate management procedure for tooth 4.8 at this time is A. surgical removal. B. surgical exposure of the crown. C. to take another radiograph. D. extraction of tooth 4.7. E. vitality testing of tooth 4.7.


STATION H Questions 26 - 33

Examine the cavity preparations on the cast (not available for display) and answer the following questions on the answer score sheet. Question: 26 The cavity preparation for an amalgam restoration on tooth 3.6 was performed to treat a carious lesion on the mesial surface that extended just past the dentino-enamel junction. There was no caries in any occlusal fissures. The occlusal outline form is A. acceptable. B. too narrow bucco-lingually. C. too wide at the isthmus. D. overextended mesio-distally. E. underextended mesio-distally. Question: 27 The cavity preparation for an amalgam restoration on tooth 4.6 was performed to treat a carious lesion on the distal and occlusal surfaces that extended just past the dentino-enamel junction. Assuming that all the caries has been removed, the distal proximal box is A. acceptable. B. too flared lingually. C. underextended buccally with undermined enamel. D. underextended gingivally. E. too deep pulpally.


STATION H Questions 26 - 33

Question: 28 The cavity preparation for an amalgam restoration on tooth 1.4 was performed to treat a carious lesion on the distal surface that extended just past the dentinoenamel junction. The preparation is A. acceptable. B. too flared lingually. C. underextended buccally with undermined enamel. D. underextended gingivally. E. too deep pulpally. Question: 29 Assuming that all the caries has been removed, the cavity preparation for amalgam on tooth 2.7 is A. acceptable. B. too narrow buccolingually. C. too shallow pulpally. D. underextended gingivally. E. overextended buccally.


STATION I Questions 26 - 33

Using the information provided in the case history, answer the following questions on the answer score sheet. CASE HISTORY A 22 year old man presents with a chief complaint of increasingly severe pain of two days duration and decreasing ability to open his mouth as widely as usual. The patient is otherwise healthy except for an allergy to penicillin. The left submandibular lymph nodes are enlarged and tender to palpation. A radiograph reveals that there is a disto-angular impaction of tooth 3.8. Removal of bone and sectioning of the tooth would be necessary in order to remove it. Vital signs are: Temperature: 38oC (100.4oF), orally Pulse: 92/minute, regular Respiration: 16/minute Blood Pressure: 120/80mm Hg Question: 30 The most likely diagnosis is a/an A. acute pulpitis. B. acute pericoronitis. C. chronic pericoronitis. D. acute dento-alveolar abscess. E. submandibular space infection.


STATION I Questions 26 - 33

Question: 31 The patient will be referred for the removal of tooth 3.8. At this initial appointment, the most appropriate treatment is to prescribe an antibiotic and to 1. perform a gingivectomy around tooth 3.8 and place a periodontal dressing. 2. advise the patient to place a topical antibiotic in the 3.8 area. 3. establish drainage through the buccal mucosa. 4. rinse the 3.8 area with saline or peroxide in a syringe. A. (1) (2) (3) B. (1) and (3) C. (2) and (4) D. (4) only E. All of the above. Question: 32 Which of the following patient instructions should be provided when prescribing the antibiotic? 1. Use all medication provided. 2. Advise if signs and symptoms persist after 48 hours. 3. Discontinue use of drug if a rash occurs. 4. Follow instructions precisely.

A. (1) (2) (3) B. (1) and (3) C. (2) and (4) D. (4) only E. All of the above. Question: 33 Which of the following antimicrobials would be the most appropriate for this patient? A. Clindamycin. B. Cephalexin. C. Fluconazole. D. Tetracycline. E. Amoxicillin.


STATION J Questions 34 - 37

Using the information contained in Diagram 8, answer the following questions on the answer score sheet.

Diagram 8 is a cross section through the mandible that includes glands, muscles, tissue spaces, ligaments, bone, blood vessels and nerves. The syringe is positioned to begin an injection for an inferior alveolar nerve block.

Diagram 8


STATION J Questions 34 - 37

Question: 34 The sphenomandibular ligament is labelled A. 1 B. 2 C. 3 D. 4 E. 5 Question: 35 The structure labelled 6 is the A. inferior alveolar nerve. B. medial pterygoid muscle. C. long buccal nerve. D. pterygomandibular raphe. E. sphenomandibular ligament. Question: 36 Which of the following is/are the most likely consequence(s) of an injection into structure 1? 1. Trismus 2. Resistance to injection. 3. Pain. 4. Lack of anesthesia. A. (1) (2) (3) B. (1) and (3) C. (2) and (4) D. (4) only E. All of the above. Question: 37 Which of the following is the most likely consequence of an injection into the structure labelled 7? A. Trismus. B. Resistance to injection. C. Transient facial paralysis. D. Permanent facial paralysis. E. Dysphagia.


STATION K Questions 38 - 41

Using the prints of the radiographs labelled A, B and C (not available for display), answer the following questions on the answer score sheet. Question: 38 On radiograph A, there is radiographic evidence that tooth 1.5 has 1. calculus on the mesial. 2. caries on the distal. 3. an overhanging restoration on the mesial. 4. bone loss on the distal. A. (1) (2) (3) B. (1) and (3) C. (2) and (4) D. (4) only E. All of the above. Question: 39 On radiograph A, there is radiographic evidence that tooth 4.7 has 1. bone loss on the mesial. 2. caries on the mesial. 3. bone loss on the distal. 4. caries on the distal. A. (1) (2) (3) B. (1) and (3) C. (2) and (4) D. (4) only E. All of the above.


STATION K Questions 38 - 41

Question: 40 On radiograph B, the most likely diagnosis of the radiopacity distal to the malformed tooth is A. tooth 2.7. B. salivary calculus. C. a dystrophic calcification. D. the coronoid process. E. a phlebolith. Question: 41 On radiograph C, the most likely diagnosis of the radiopacity noticed at the apex of tooth 1.7 is a/an A. antrolith. B. mucous retention cyst. C. periapical cyst. D. osteoma. E. zygoma.


STATION L Questions 42 - 45

Using the information in the case history, the diagnostic casts (not available for display) and the photographs (not available for display), answer the following questions on the answer score sheet. CASE HISTORY An 11 year old male patient presents with a thumb sucking habit. He has a history of behavioural problems, fair oral hygiene and appears to breathe only through his mouth. The mixed dentition analysis shows a discrepancy of +2.5mm in the mandible and +1.8mm in the maxilla. The cephalometric analysis findings are as follows:

SNA: 79 degrees SNB: 80 degrees ANB: 6 degrees 1.1 to NA: 23 degrees 4.1 to NB: 2.8mm Pg to NB: 7.8mm Interincisal: 108 degrees Lower Face Height: 66mm FMA: 23 degrees



Question: 42 The dentoalveolar classification of this malocclusion is A. Class II Division 0. B. Class II Division 1. C. Class II Division 2. D. Class I. E. Class III. Question: 43 The profile type for this patient is A. orthognathic. B. prognathic. C. straight. D. convex. E. concave. Question: 44 The malocclusion in this patient is of A. neuromuscular origin. B. neuromuscular and skeletal origin. C. skeletal origin. D. dentoalveolar origin.



Using the information in the case history and the clinical photograph (not available for display), answer the following question on the answer score sheet. Question: 45 The patient states that she is “bad a lot”, but refuses to give details about the cause of the swelling. Her mother says that she falls into things frequently. The most appropriate management of this patient is to 1. counsel the mother about looking after her child better. 2. report the finding to the child welfare agency (Children’s Aid Society) in your jurisdiction. 3. observe and recall the patient in one week. 4. call and refer the patient to her physician for further examination and testing. A. (1) (2) (3) B. (1) and (3) C. (2) and (4) D. (4) only E. All of the above.


STATION M Questions 46 - 49

Using the case history and the print of the radiograph (not available for display), answer the following questions on the answer score sheet. CASE HISTORY Patient: 17 year old female Chief complaint: Sensitive teeth Bleeding gums Medical history: Confirmed history of rheumatic fever with residual heart murmur Dental history: Brushes once a week Last dental visit 3 years ago Clinical findings: Localized bleeding on probing, with plaque accumulation No pocketing greater than 3mm Caries that extends subgingivally on several teeth

Question: 46 On examination, you diagnose caries is on the following surfaces: A. M2.4, MD2.5, MD2.6, M2.7, MD3.6, M3.7 B. MD2.5, MD2.6, M2.7, D3.4, MD3.5, MD3.6, M3.7 C. MD2.5, MD2.6, MD3.6, M3.7 D. MD2.5, MD2.6, M2.7, MD3.6, M3.7 Question: 47 What is the most probable cause for the gingival bleeding in this patient? A. Calculus and presence of plaque. B. Leukemia. C. Cyclic neutropenia. D. Presence of plaque only.


STATION M Questions 46 - 49

Question: 48 The most appropriate management for this patient is oral hygiene followed by A. a medical consultation including a complete blood count prior to initiating any treatment. B. prophylactic antibiotic coverage for scaling and root planing followed by restorative

procedures. C. prophylactic antibiotic coverage for restorative procedures only. D. scaling and root planing and restorative procedures with no prophylactic antibiotic coverage. Question: 49 Which of the following is the most appropriate treatment for tooth 3.7? A. No treatment. B. Endodontic treatment. C. Cervical restoration. D. MOD restoration. E. Full crown restoration.


STATION N Questions 50 - 53

Using the case history, the casts (not available for display) and the print of the radiographs (not available for display), answer the following questions on the answer score sheet. CASE HISTORY Twelve years ago, the patient had a crown placed on tooth 1.1. The tooth had been fractured by a hockey stick. Tooth 1.1 is now “loose” and has a 12mm narrow pocket on the mesio-vestibular (mesio-labial) aspect, bleeds on probing and has a mobility of M2. The vestibular margin of the ceramo-metal crown on tooth 1.1 is open 1mm. Question: 50 The radiopacity in the mesial cervical region of tooth 1.6 is most likely A. vertical (angular) bone loss. B. an enamel pearl. C. calculus. D. a cementicle. E. a radiographic artifact. Question: 51 The correct radiographic interpretation for the radiopacity mid-root on tooth 4.5 is A. sclerosing osteitis. B. a mandibular torus. C. an odontoma. D. a deciduous root tip. E. a cementoma. Question: 52 In the mandibular anterior region there is radiographic evidence of A. hypercementosis. B. attrition. C. caries. D. severe bone loss. E. loss of lamina dura.


STATION N Questions 50 - 53

Question: 53 The most likely cause of the condition on the mesio-vestibular (mesio-labial) area of tooth 1.1 is A. calculus. B. a foreign body. C. a vertical root fracture. D. an overcontoured restoration. E. an open crown margin.


STATION O Questions 54 - 57

Using the information provided and the prints of the radiographs labelled A and B (not available for display), answer the following questions on the answer score sheet. Question: 54 The most likely diagnosis of the pulpal condition of the mandibular right central incisor shown in radiograph A is A. irreversible pulpitis. B. reversible pulpitis. C. pulpal necrosis. D. hemorrhagic pulpitis. Question: 55 Assuming that the patient (see the print of Radiograph A) presents with an acute periapical (alveolar) abscess with facial swelling and an elevated temperature, which of the following emergency treatments would you undertake to gain control of the clinical situation? A. Establish drainage through the crown. B. Establish extraoral drainage. C. Prescribe an analgesic and schedule an appointment in 1 week. D. Perform nonsurgical endodontic therapy and apicoectomy. E. Perform an excisional biopsy. Question: 56 Radiograph B was taken 24 months after the treatment. The tooth is asymptomatic. Your evaluation of the outcome of the treatment is that A. residual infection remains. B. an apical cyst is present. C. healing is progressing normally. D. treatment has failed.


STATION O Questions 54 - 57

Using the print of the radiograph (not available for display) and the case history below, answer the following question on the answer score sheet. CASE HISTORY Chief complaint: Sensitivity to pressure and biting in upper left region. Dental history: Endodontics on tooth 2.4 eight months ago. Clinical examination: Tooth 2.4 is sensitive to percussion. Tooth 2.5 is not sensitive to percussion. Question: 57 You should inform the patient that A. tooth 2.4 needs another 2 months to “settle down”. B. an adjacent tooth with a periapical lesion is causing the sensitivity. C. there is a carious lesion on tooth 2.4 that is causing the sensitivity. D. the endodontic therapy is not successful and needs to be redone. E. the data from the history, radiograph and diagnostic tests are insufficient to determine the

cause of the sensitivity.


STATION P Questions 58 - 61

Using the information in the case history and photograph 138, answer the following questions on the answer score sheet. CASE HISTORY A 60kg (132 lbs.), 34 year old female patient presents with no specific medical problems except multiple food allergies. Two minutes following the administration of 1.8ml, 2% lidocaine with 1:100,000 epinephrine, the patient appears flushed. There is a progressively increasing amount of swelling and urticaria in her face and neck, and she begins to wheeze. She has a weak pulse of 112 beats/minute, and blood pressure of 80/40. The emergency kit contains an EpiPen as shown in photograph 138.

Photograph 138



Question: 58 Which of the following management strategies is/are correct for this patient? 1. The drug should be administered intramuscularly. 2. Oxygen should also be administered to this patient. 3. If the symptoms continue to worsen within 5 minutes, a second dose should be administered. 4. The patient’s pulse and blood pressure should be monitored. A. (1) (2) (3) B. (1) and (3) C. (2) and (4) D. (4) only E. All of the above. Question: 59 What is/are the effect(s) of using the drug shown in this picture? 1. It has a rapid onset of action 2. It raises systolic blood pressure. 3. It dilates bronchioles. 4. It has a long duration of action. A. (1) (2) (3) B. (1) and (3) C. (2) and (4) D. (4) only E. All of the above.



Question: 60 Which of the following is/are correct? 1. The drug shown is indicated for the management of pain from angina pectoris. 2. Following the administration of the drug shown, administration of an injectable

antihistamine should be considered for this patient. 3. The dose of the drug is appropriate for administration to a 15kg (34 lbs.), 4 year old child. 4. The dose of the drug is appropriate for administration to a 75kg (165 lbs.), 44 year old with

epilepsy and a gastric ulcer. A. (1) (2) (3) B. (1) and (3) C. (2) and (4) D. (4) only E. All of the above. Question: 61 Which of the following statements is correct? A. The drug shown should be administered to this patient. B. The concentration of the drug in the EpiPen is the same as that found in the local anaesthetic

cartridge just administered. C. The dose contained within the EpiPen is the maximum daily dose this patient should receive. D. This device should not be used as the drug must be given intravenously to this patient.


STATION Q Questions 62 - 65

Using the information in the case history and the diagrams, answer the following questions on the answer score sheet. CASE HISTORY A 47 year old male presents for the extraction of a carious tooth 2.6. He is a one package per day smoker and has a history of peptic ulcer disease. Question: 62 Removal of the carious tooth 2.6 may require sectioning. Which is the most appropriate pattern for sectioning this tooth?

Diagram 21



Question: 63 Following the extraction of tooth 2.6, a 6mm communication between the tooth socket and the maxillary sinus is noted. Which of the following is the most appropriate incision design for a buccal advancement flap for the closure of this communication?

Diagram 22 Question: 64 Six hours post surgery, the patient returns with bleeding from the surgical site. Which of the following steps is CONTRAINDICATED in the management of bleeding from this site? A. Place a resorbable dressing in the socket. B. Electrocautery of the base of the socket. C. Placement of non-resorbable sutures. D. Placement of topical thrombin in the socket.



Using the information in the case history and the print of the radiograph (not available for display), answer the following question on the answer score sheet. CASE HISTORY This 54 year old male has experienced progressively increasing pain and swelling of the left posterior mandible, as well as trismus, for the past 2 months. Question: 65 The most likely diagnosis for this patient is (a) A. periodontitis. B. traumatic occlusion. C. radicular cyst. D. traumatic bone cyst. E. malignancy of the mandible.


STATION R Questions 66 - 69

Using the print of the radiographs (not available for display), answer the following questions on the answer score sheet. Question: 66 Which of the following is/are evident in the radiographs? 1. A dentigerous cyst. 2. Ectopic eruption. 3. A supernumerary tooth. 4. Periapical radiolucencies. A. (1) (2) (3) B. (1) and (3) C. (2) and (4) D. (4) only E. All of the above. Question: 67 This patient is likely to have a lack of arch space for the eruption of the permanent teeth due to 1. a Bolton discrepancy. 2. interproximal caries. 3. ectopic eruption of maxillary cuspids. 4. non-spaced primary dentition. A. (1) (2) (3) B. (1) and (3) C. (2) and (4) D. (4) only E. All of the above.


STATION R Questions 66 - 69

Using the clinical photograph (not available for display), answer the following questions on the answer score sheet.

Question: 68 The infant is approximately A. 6 months old. B. 12 months old. C. 18 months old. D. 24 months old. Question: 69 The infant had normal appearing teeth at the time of eruption, but soon after eruption, the parent noticed brown soft areas appearing. The most likely diagnosis of this condition is A. amelogenesis imperfecta. B. dentinogenesis imperfecta. C. tetracycline staining. D. severe fluorosis. E. nursing bottle caries.


STATION S Questions 70 - 73

Using the photographs (not available for display), answer the following questions on the answer score sheet. CASE HISTORY Upon removal of a 3-unit provisional fixed partial denture the composite resin core (build-up) on tooth 3.7 was dislodged and remained in the provisional restoration. The tooth has a normal response to vitality testing. Question: 70 The most likely cause of dislodgement is A. forceful removal of the temporary. B. inadequate retention for the core (build-up). C. the presence of an occlusal prematurity on tooth 3.7. D. the presence of undercuts in the preparation of tooth 3.7. Question: 71 Which of the following is the most appropriate treatment for tooth 3.7? A. Place a new bonded amalgam core (build-up). B. Place a new glass ionomer core (build-up). C. Increase the parallelism of the buccal and lingual walls. D. Perform endodontic treatment and place a post and core restoration. E. Prepare tooth 3.4 for a third abutment tooth.


STATION S Questions 70 - 73

Using the model (not available for display), answer the following questions on the answer score sheet. Question: 72 Which of the following modifications is required to make the resistance form of the MOD preparation acceptable for an amalgam restoration? A. Deepen the pulpal floor. B. Sharpen the internal line angles. C. Enlarge the proximal boxes buccolingually. D. Bevel the gingival seats. Question: 73 The finish line (margin) of the metal crown preparation on tooth 4.5 is A. acceptable but could be smoothed. B. acceptable but could be widened. C. unacceptable because it is in an undercut area. D. unacceptable because it is rough and discontinuous.


STATION T Questions 74 - 77

Using the information in the photograph (not available for display), answer the following questions on the answer score sheet. Question: 74 A 65 year old female presents with a chief complaint of a slowly enlarging, painless mass in the cheek that does not blanch on pressure. The most likely diagnosis is a/an A. hamartoma. B. adenoma. C. hemangioma. D. fibroma. E. retention cyst (ranula). Question: 75 Select the most appropriate option that you would consider for the management of this same patient. A. Marsupialization. B. Cauterization. C. Injection of sclerosing agents. D. Incisional biopsy. E. Excisional biopsy.


STATION T Questions 74 - 77

Using the information in the case history and in the photograph (not available for display), answer the following questions on the answer score sheet. CASE HISTORY A 45 year old, otherwise healthy, female presents with a chief complaint of oral pain over the previous two weeks. She is unable to eat comfortably and recalls experiencing this twice before. She has lesions on her buccal mucosa. Question: 76 The most likely diagnosis is A. aphthous stomatitis. B. erythema multiforme. C. herpetic gingivostomatitis. D. recurrent herpes. E. erosive lichen planus.

Question: 77 Which of the following management options is most appropriate? A. Salt/bicarbonate mouth rinse. B. Topical steroid. C. Tetracycline mouth rinse. D. Acyclovir. E. Nystatin.


STATION U Questions 78 - 81

Using the case history and the photograph (not available for display), answer the following questions on the answer score sheet. CASE HISTORY Two months ago this patient had two implants placed. One was placed in the 1.3 region and one in the 2.3 region. The patient is asymptomatic and in good health. Question: 78 The implants are located A. too far to the palatal. B. too far to the buccal. C. too far to the distal. D. ideally. Question: 79 Considering the location of the implants, the best prosthodontic option would be to A. fabricate a conventional denture without using the implants. B. fabricate a fixed bridge. C. fabricate a ball retained overdenture. D. add one more implant in the midline and fabricate a fixed bridge.



Using the information in photographs 32 and 33 and the prints of radiographs 48 and 49 and the case history, answer the following question on the answer score sheet. CASE HISTORY A 34 year old female patient complains about the gingival reaction around teeth 1.2 and 1.3. The porcelain fused to metal splint on teeth 1.2, 1.3 and 1.4 was cemented less than 1 month ago.

Photograph 32 Radiograph 48

Photograph 33 Radiograph 49



Question: 80 The most likely cause of this reaction is A. the placement of margins within 1mm of crestal bone. B. a deficient marginal adaptation. C. an allergic reaction to the porcelain. D. an allergic reaction to metal. E. excessive occlusal forces.



Using the information in photographs 21 and 22, answer the following question on the answer score sheet.

Photograph 21 Photograph 22 Question: 81 The crown shown in photographs 21 and 22 should not be cemented because the A. buccal surface is over contoured. B. occlusal table is too wide and may lead to cheek biting. C. occlusal anatomy is undefined. D. gingival adaptation on the die is inadequate. E. contour of the interproximal surfaces is unacceptable.


STATION V Questions 82 - 88

Using model A (not available for display), answer the following questions on the answer score sheet. Question: 82 The occlusal rest seat preparation on the tooth labelled “X” on model A is A. acceptable. B. too deep. C. too shallow. D. too wide buccolingually. E. undercut. Question: 83 The occlusal rest seat preparation on the tooth labelled “Y”on model A is A. acceptable. B. too deep. C. too shallow. D. too wide buccolingually. E. undercut.


STATION V Questions 82 - 88

Using the cast (not available for display), answer the following questions on the answer score sheet. Question: 84 The occlusal rest seat preparation on tooth 4.6 is A. acceptable. B. undercut. C. too wide buccolingually. D. too deep. Question: 85 The occlusal rest seat preparation on tooth 4.4 is A. acceptable. B. undercut. C. too wide buccolingually. D. too deep.


STATION W Questions 86 - 89

Using the diagnostic casts labelled 51A and 51B (not available for display), answer the following questions on the answer score sheet. Question: 86 This patient has a A. Class II Division 1 malocclusion. B. Class II Division 2 malocclusion. C. Class I malocclusion. D. Class III malocclusion.

Question: 87 Correction of the excessive horizontal overlap (overjet) requires A. retraction (lingual tipping) of teeth 1.2, 1.1, 2.1 and 2.2. B. retraction (lingual tipping) of teeth 1.1 and 2.1. C. protraction (labial tipping) of teeth 4.2, 4.1, 3.1 and 3.2. D. retraction of teeth 1.2, 1.1, 2.1 and 2.2 with no inclination change.


STATION W Questions 86 - 89

Using the information in the case history and the print of the radiographs labelled 50 (not available for display), answer the following questions on the answer score sheet. CASE HISTORY The patient is a healthy 8 year old boy with no contraindications to routine dental treatment. He resides in a non-fluoridated community. Question: 88 Tooth 7.5 has received the following dental treatment. A. Direct pulp cap and amalgam restoration. B. Indirect pulp cap and amalgam restoration. C. Pulpotomy and amalgam restoration. D. Apexification and amalgam restoration. E. Pulpotomy and stainless steel crown restoration. Question: 89 The amalgam restoration that was previously placed on tooth 6.4 has an overhang on the distal. This overhang was most likely a result of A. excessive gingival bleeding during amalgam placement. B. the contour of the adjacent restoration. C. patient movement during placement of the amalgam. D. incorrect placement of the wedge.


STATION X Questions 90 - 93

Using the prints of the radiographs (not available for display), the case history and the clinical examination data, answer the following questions on the answer score sheet. CASE HISTORY A 58 year old male presented for the removal of teeth 3.7 and 4.5. His medical history was non-contributory. Question: 90 Four days following the extraction of tooth 3.7, the patient presents with pain of 24 hours duration. The pain kept him up all night, was not relieved by his prescribed analgesics and radiated to the left ear. There is minimal swelling associated with the surgical site. The treatment of choice for this patient is A. a 10 day course of penicillin. B. incision and drainage. C. curettage of the socket. D. analgesics and observation. E. irrigation and packing with sedative dressing.



Question: 91 During the removal of the mandibular right second premolar, the crown fractured and a flap was raised in order to allow for bone removal. Post-operatively, the patient experienced numbness of the lower right lip and chin. Which of the following designs of surgical incision would most likely result in this complication?

Using the information in the case history and the print of the radiographs (not available for display), answer the following questions on the answer score sheet. CASE HISTORY This patient had a fixed partial denture cemented one year ago. The patient is presently asymptomatic but reports that she had severe sensitivity to cold for about 2 weeks following the cementation of the fixed partial denture.



Question: 92 The root resorption at the apex of tooth 3.7 is most likely a result of A. inflammation. B. healing. C. idiopathic causes. D. pressure. Question: 93 The most appropriate management of tooth 3.7 is A. antibiotic therapy and observation. B. apical curettage and retrofilling. C. non-surgical root canal treatment. D. non-surgical root canal treatment, apical curettage and retro filling.


STATION Y Questions 94 - 97

Using the information in photographs 17, 18 and 19 and the case history, answer the following questions on the answer score sheet. CASE HISTORY Six months ago, a 28 year old patient received an implant supported porcelain fused to metal crown to replace tooth 1.3 (photograph 17 shows the restoration initially after placement).

Photograph 17



She now presents with a fracture of the cusp tip and ridges of the crown (photographs 18 and 19).

Photograph 18 Photograph 19

Question: 94 The most likely cause of the fracture is A. contamination of porcelain during fabrication. B. contamination of metal during fabrication. C. incompatible occlusion with the design of the metal framework. D. incompatible co-efficient of thermal expansion between the metal and porcelain. E. an inadequate condensation of the porcelain. Question: 95 The best way to repair this fracture would be to A. remake the crown. B. remove the crown and have the porcelain refired. C. prepare the crown for a porcelain veneer. D. replace the missing porcelain with composite. E. polish the fractured area of porcelain.



Using the clinical photograph (not available for display), answer the following question on the answer score sheet. Question: 96 Tooth 3.7 has no visible decalcification or caries activity. The patient is 28 years old. The appropriate management for this tooth is A. an occlusal amalgam. B. a pit and fissure sealant. C. a preventive resin restoration. D. observation only.



After examining photograph 137, answer the following question on the answer score sheet.

Photograph 137 Question: 97 Which pre-existing soft tissue problem on the facial aspect of tooth 4.3 should have been taken into consideration before initial preparation? A. Pyogenic granuloma. B. Gingival abscess. C. Lack of attached gingiva. D. Rolled marginal tissue.

OSCE 2002 II

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acrylic denture

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