MJDF Part 1 - Membership of Joint Dental Faculties Pharmacology and Therapeutics Questions and Answers

Question 1

A 28-year-old patient presents with a painful, localised dentoalveolar abscess associated with the lower left first molar. There are no signs of systemic involvement or spreading infection. After establishing drainage, you consider prescribing an analgesic. According to the dental pain ladder in the UK, which of the following is the most appropriate first-line oral analgesic for this patient, assuming no contraindications?

Accepted Answer

Ibuprofen 400mg alone

Answer

According to UK prescribing guidelines, such as those referenced in the British National Formulary (BNF), a non-steroidal anti-inflammatory drug (NSAID) like ibuprofen is the first-line choice for dental pain due to its anti-inflammatory properties, provided there are no contraindications (e.g., asthma, gastric issues). Paracetamol is an effective alternative if NSAIDs are contraindicated. Combining paracetamol and ibuprofen is reserved for more severe pain that is not managed by a single agent. Co-codamol is higher up the pain ladder and should be reserved for when NSAIDs and/or paracetamol are ineffective or contraindicated.

Question 2

A 45-year-old patient requires a routine dental extraction and reports taking alendronic acid 70mg once weekly for the past six years for osteoporosis. According to the Scottish Dental Clinical Effectiveness Programme (SDCEP) guidance, what is the primary pharmacological risk that must be considered and managed for this patient?

Accepted Answer

Medication-Related Osteonecrosis of the Jaw (MRONJ)

Answer

Alendronic acid is an oral bisphosphonate. Patients taking anti-resorptive drugs, such as bisphosphonates, are at an increased risk of developing Medication-Related Osteonecrosis of the Jaw (MRONJ) following invasive dental procedures like extractions. The SDCEP provides specific guidance for risk assessing and managing these patients to minimise the chance of MRONJ developing.

Question 3

A 35-year-old adult patient suddenly develops signs of a severe anaphylactic reaction in the dental chair after the administration of a local anaesthetic. According to the Resuscitation Council UK guidelines, what is the correct first-line drug, dose, and route of administration?

Accepted Answer

Adrenaline 1:1000, 500 micrograms, Intramuscular (IM)

Answer

The Resuscitation Council UK guidelines clearly state that the first-line treatment for anaphylaxis in an adult is an intramuscular injection of 500 micrograms of adrenaline (0.5ml of 1:1000 solution) into the anterolateral aspect of the thigh. Other drugs like hydrocortisone and salbutamol are second-line treatments and should not delay the administration of adrenaline. Intravenous adrenaline is reserved for specialist use in refractory cases.

Question 4

A dentist prescribes a course of metronidazole 400mg three times daily for a patient with acute necrotising ulcerative gingivitis (ANUG). Which of the following pieces of advice is critical to give the patient to avoid a significant adverse reaction?

Accepted Answer

Avoid consuming alcohol during treatment and for 48-72 hours after

Answer

Metronidazole can cause a disulfiram-like reaction when taken with alcohol. This reaction can include severe nausea, vomiting, flushing, tachycardia, and headache. The British National Formulary (BNF) and other UK guidelines strongly advise patients to avoid all alcohol during the course of metronidazole and for at least 48-72 hours after finishing the course.

Question 5

A patient with a known, documented allergy to procaine (an ester-type local anaesthetic) requires restorative treatment. Which of the following local anaesthetic agents would be considered safe to use for this patient?

Accepted Answer

Articaine

Answer

Local anaesthetics are broadly classified into amides and esters. True allergic reactions are much more common with esters, as their metabolism produces para-aminobenzoic acid (PABA), a known allergen. A true allergy to one ester contraindicates the use of all esters (like procaine, benzocaine, amethocaine). Amide local anaesthetics (like lidocaine, prilocaine, and articaine) are structurally different and do not produce PABA. Therefore, an amide agent is the safe choice. Articaine, while having an ester group, is classified as an amide and is metabolised differently, making it safe in cases of ester allergy.

MJDF Part 1 Practice Test

MJDF Part 1 Practice Test

MJDF Part 1 - Membership of Joint Dental Faculties Pharmacology and Therapeutics Questions and Answers