Diagnosis and Treatment Planning Flashcards

A 45-year-old patient presents with a painless, slow-growing swelling on the posterior mandible. Radiograph shows a well-defined unilocular radiolucency with scalloped borders around the crowns of impacted third molars. What is the most likely diagnosis?

Answer: Odontogenic keratocyst

Odontogenic keratocysts (OKC) characteristically show scalloped borders and a tendency to grow along the medullary space with minimal cortical expansion.

A patient's periodontal chart shows generalized probing depths of 5-7 mm with bleeding on probing, bone loss on radiographs, and Class II furcation involvement on maxillary molars. How should this periodontitis be classified?

Answer: Stage III, Grade B

Stage III periodontitis is characterized by tooth loss potential due to severe bone loss and furcation involvement (Class II or III), without masticatory dysfunction.

Which finding on a panoramic radiograph would most indicate the need for immediate referral to an oral surgeon before initiating orthodontic treatment?

Answer: Multilocular radiolucency in the posterior mandible

A multilocular radiolucency in the posterior mandible raises concern for ameloblastoma or other aggressive jaw lesions requiring biopsy before any elective dental treatment.

A 60-year-old patient taking bisphosphonates for osteoporosis requires extraction of a non-restorable mandibular molar. Which is the most critical consideration in the treatment plan?

Answer: Consult with the prescribing physician regarding risk of MRONJ

Medication-related osteonecrosis of the jaw (MRONJ) risk must be assessed by consulting the prescribing physician before any dentoalveolar surgery in bisphosphonate patients.

A 7-year-old child presents with a maxillary central incisor that was avulsed 2 hours ago and stored dry. What is the most appropriate management?

Answer: Do not reimplant; space maintenance and prosthetic replacement

Dry storage for more than 60 minutes results in non-vital periodontal ligament cells, making reimplantation of primary teeth contraindicated; in permanent teeth, reimplantation is still considered but with poor prognosis.

When evaluating occlusion as part of treatment planning, which finding most strongly indicates the need for an occlusal splint before restorative work?

Answer: Signs and symptoms of bruxism with wear facets

Active bruxism with wear facets indicates parafunctional forces that can destroy restorations; stabilization with an occlusal splint is indicated before placing definitive restorations.

A 55-year-old smoker presents with a 3-week-old non-healing ulcer on the lateral border of the tongue. What is the most appropriate next step?

Answer: Perform incisional biopsy or immediate referral for biopsy

Any oral ulcer persisting more than 2 weeks in a tobacco user must be considered potentially malignant until proven otherwise, requiring urgent biopsy.