Diagnosis and Treatment Planning Flashcards

A 70-year-old complete denture wearer presents with an erythematous, velvety red lesion under the maxillary denture that has been present for several months. She denies pain. What is the most appropriate first step?

Answer: Perform biopsy to rule out erythroplakia

Persistent red lesions (erythroplakia) carry a high risk of malignant transformation and must be biopsied regardless of apparent denture-related cause.

A patient requires extraction of maxillary third molars. Preoperative CBCT shows the roots closely approximating the maxillary sinus. What complication must be specifically discussed during informed consent?

Answer: Oroantral communication with risk of oroantral fistula

Proximity of maxillary molar roots to the sinus floor creates risk of oroantral communication during extraction, which may lead to a persistent oroantral fistula if not managed.

In developing a treatment plan for a patient with generalized aggressive periodontitis, which adjunct to mechanical therapy has the strongest evidence for improving outcomes?

Answer: Systemic amoxicillin and metronidazole combined with scaling and root planing

Systemic amoxicillin plus metronidazole as an adjunct to scaling and root planing has the strongest evidence base for treating generalized aggressive periodontitis.

A 35-year-old patient presents with sudden onset facial swelling, limited mouth opening, and difficulty swallowing. Intraoral exam shows an infected lower third molar. Which space infection is most life-threatening?

Answer: Ludwig's angina (bilateral submandibular/sublingual space)

Ludwig's angina involves bilateral submandibular and sublingual spaces and can rapidly progress to airway obstruction, making it a true dental emergency requiring hospitalization.

When planning crown lengthening surgery to expose adequate tooth structure, what minimum biological width must be re-established between the restorative margin and the alveolar crest?

Answer: 2.0–3.0 mm

The biologic width (junctional epithelium + connective tissue attachment) averages approximately 2 mm; a restorative margin must maintain at least 2–3 mm from the bone crest to avoid violation.

A patient presents with asymptomatic white patches on the buccal mucosa that cannot be rubbed off with a gauze pad. Biopsy reveals epithelial dysplasia. What does dysplasia indicate in the treatment plan?

Answer: Immediate surgical excision and close surveillance

Epithelial dysplasia in an oral white lesion indicates pre-malignant change requiring surgical removal and regular surveillance for recurrence or malignant transformation.

A patient declines the recommended treatment and opts for a less invasive alternative. The dentist disagrees with this choice but the patient is competent and informed. What is the ethical obligation?

Answer: Respect patient autonomy and document informed refusal

Respect for patient autonomy requires that informed, competent patients have the right to refuse recommended treatment; the dentist must document the discussion and refusal.