MJDF Oral Medicine and Surgery

Question 1

A 60-year-old male smoker presents with a non-healing white patch on the ventral surface of the tongue that cannot be rubbed off.
Biopsy shows moderate epithelial dysplasia.
What is the most appropriate management?

Accepted Answer

Complete surgical excision with clear margins, smoking cessation counselling, and regular long-term follow-up with clinical and histological surveillance

Answer

Reassure and review in 12 months

Answer

Prescribe topical antifungal treatment

Answer

Apply topical corticosteroid and review in 6 weeks

Question 2

What is the difference between an odontogenic keratocyst and an orthokeratinised odontogenic cyst, and why is the distinction clinically important?

Accepted Answer

The odontogenic keratocyst (OKC) has a parakeratinised lining with a high recurrence rate (25-60%) and association with Gorlin syndrome; the orthokeratinised variant has a lower recurrence rate (<5%) and no Gorlin association, making conservative treatment more predictable

Answer

They are the same entity with different names

Answer

The orthokeratinised variant is more aggressive and requires radical surgery

Answer

Neither has any clinical significance

Question 3

A patient presents 48 hours after extraction of a lower premolar with increasing pain, swelling, trismus, and a temperature of 38.5°C. There is fluctuant swelling in the buccal sulcus. What is the diagnosis and management?

Accepted Answer

Post-extraction abscess with subperiosteal collection — incision and drainage under local anaesthesia, copious irrigation, antibiotics (amoxicillin plus metronidazole), and review within 24-48 hours

Answer

Dry socket — irrigate and place Alvogyl

Answer

Normal post-operative swelling — reassure and prescribe ibuprofen

Answer

Osteomyelitis — refer for IV antibiotics and sequestrectomy

Question 4

What are the clinical features and management of oral candidiasis in a patient using a corticosteroid inhaler for asthma?

Accepted Answer

Pseudomembranous candidiasis (white patches that can be wiped off leaving erythematous mucosa) or erythematous candidiasis on the palate/dorsal tongue; managed by advising spacer use, rinsing mouth after inhaler use, and prescribing topical miconazole oral gel or nystatin suspension

Answer

Oral candidiasis does not occur with inhaled corticosteroids

Answer

It presents as black hairy tongue and requires no treatment

Answer

It always requires systemic fluconazole and discontinuation of the inhaler

Question 5

What is the recommended protocol for managing an avulsed permanent incisor in a 10-year-old child who presents within 30 minutes of the injury with the tooth stored in milk?

Accepted Answer

Replant the tooth immediately: rinse gently with saline (do not scrub the root surface), replant into the socket, apply a flexible splint for 2 weeks, prescribe antibiotics and tetanus check, begin root canal treatment 7-10 days post-replantation

Answer

Discard the tooth and plan for future prosthetic replacement

Answer

Store the tooth indefinitely and replant when the child is older

Answer

Place the tooth in the socket but do not splint it

Question 6

A patient with Sjögren's syndrome presents with xerostomia and multiple cervical caries. What is the underlying pathology and how should the dental management be tailored?

Accepted Answer

Sjögren's syndrome involves autoimmune destruction of salivary (and lacrimal) glands, reducing salivary flow; dental management includes frequent fluoride application (5000 ppm toothpaste, fluoride varnish), saliva substitutes/stimulants, sugar-free diet counselling, and regular short-interval recall appointments

Answer

The condition only affects the eyes and has no oral implications

Answer

Treatment is limited to prescribing pilocarpine only

Answer

No dental modifications are needed — treat caries as normal