ORE Part 1 Clinical Dentistry 2 — Questions and Answers
Question 1: A patient presents with multiple oral ulcers, genital ulcers and ocular inflammation. Which condition should be suspected?
- Pemphigus vulgaris
- Behçet's disease (Correct answer)
- Systemic lupus erythematosus
- Crohn's disease
Correct answer: Behçet's disease
The triad of recurrent oral ulcers, genital ulcers and uveitis (ocular inflammation) is the classic presentation of Behçet's disease. It is a systemic vasculitis more common in populations along the ancient Silk Road and requires multidisciplinary management.
Question 2: What is the most common cause of bilateral parotid gland enlargement?
- Pleomorphic adenoma
- Mumps
- Sjögren's syndrome (Correct answer)
- Warthin's tumour
Correct answer: Sjögren's syndrome
Sjögren's syndrome is the most common cause of chronic bilateral parotid enlargement. It is an autoimmune condition affecting exocrine glands, causing dry eyes (keratoconjunctivitis sicca) and dry mouth (xerostomia). Mumps causes bilateral enlargement but is acute and self-limiting.
Question 3: Which investigation is most appropriate for assessing the relationship between an impacted lower third molar and the inferior alveolar canal?
- Periapical radiograph
- Cone beam computed tomography (CBCT) (Correct answer)
- Lateral cephalogram
- Upper standard occlusal radiograph
Correct answer: Cone beam computed tomography (CBCT)
CBCT provides three-dimensional imaging that accurately demonstrates the spatial relationship between the impacted tooth roots and the inferior alveolar canal. NICE guidelines recommend CBCT when conventional radiographs show signs of a close relationship, such as darkening of roots or interruption of the canal outline.
Question 4: A 55-year-old patient on long-term bisphosphonate therapy for osteoporosis requires a dental extraction. What is the primary concern?
- Excessive bleeding
- Drug interaction with local anaesthetic
- Medication-related osteonecrosis of the jaw (MRONJ) (Correct answer)
- Increased risk of dry socket only
Correct answer: Medication-related osteonecrosis of the jaw (MRONJ)
MRONJ is a serious complication in patients taking bisphosphonates, particularly after invasive dental procedures. The SDCEP guidance recommends a thorough risk assessment, and extraction should only proceed when necessary, with appropriate consent regarding the risk of exposed necrotic bone that fails to heal.
Question 5: Which of the following is the most appropriate initial management for a patient presenting with acute necrotising ulcerative gingivitis (ANUG)?
- Scaling and root planing under local anaesthetic
- Metronidazole 400mg three times daily for 3 days and gentle debridement (Correct answer)
- Referral for biopsy
- Chlorhexidine mouthwash alone
Correct answer: Metronidazole 400mg three times daily for 3 days and gentle debridement
ANUG is managed initially with metronidazole (the antimicrobial of choice targeting the anaerobic fusiform and spirochaete bacteria), gentle superficial debridement, and oral hygiene instruction. Aggressive scaling should be avoided in the acute phase due to pain and risk of bacteraemia.
Question 6: In the UK, for how long must dental records be retained for adult patients according to current GDC and NHS guidance?
- 5 years after last treatment
- 10 years after last treatment
- 11 years after last treatment (Correct answer)
- Indefinitely
Correct answer: 11 years after last treatment
Current UK guidance requires dental records to be retained for a minimum of 11 years after the last entry for adult patients. For children, records should be kept until the patient reaches age 25, or for 11 years after the last treatment, whichever is longer.
ORE Part 1 Clinical Dentistry 2
A patient presents with multiple oral ulcers, genital ulcers and ocular inflammation.
Which condition should be suspected?