ORE Part 1 Clinical Dentistry — Questions and Answers
Question 1: A 45-year-old patient presents with a deep carious lesion on the mandibular first molar approaching the pulp. The tooth is vital with no spontaneous pain. What is the most appropriate treatment?
- Extraction and implant placement
- Indirect pulp capping with calcium hydroxide and restoration (Correct answer)
- Direct composite restoration without pulp protection
- Immediate root canal treatment
Correct answer: Indirect pulp capping with calcium hydroxide and restoration
Indirect pulp capping with calcium hydroxide is the treatment of choice for deep carious lesions in vital teeth without signs of irreversible pulpitis. This preserves pulp vitality by placing a biocompatible liner over the remaining thin dentine layer, promoting reparative dentine formation.
Question 2: Which clinical sign best differentiates irreversible pulpitis from reversible pulpitis?
- Pain on cold stimulus that resolves within seconds
- Spontaneous pain that lingers after stimulus removal (Correct answer)
- Sensitivity to sweet foods only
- Pain exclusively on biting pressure
Correct answer: Spontaneous pain that lingers after stimulus removal
Irreversible pulpitis is characterised by spontaneous pain that persists or lingers after the stimulus is removed, often waking the patient at night. Reversible pulpitis produces a sharp but brief response that ceases when the stimulus is removed.
Question 3: A patient presents with a painless, fluctuant swelling on the buccal mucosa adjacent to a non-vital upper premolar. What is the most likely diagnosis?
- Periapical abscess with sinus tract (Correct answer)
- Periodontal abscess
- Mucocele
- Salivary gland tumour
Correct answer: Periapical abscess with sinus tract
A painless fluctuant swelling adjacent to a non-vital tooth is characteristic of a chronic periapical abscess that has established a sinus tract for drainage. The absence of pain is due to the pressure being relieved through the sinus.
Question 4: What is the recommended fluoride concentration in toothpaste for a 4-year-old child in the UK according to current guidelines?
- 500 ppm
- 1000 ppm
- 1350–1500 ppm (Correct answer)
- No fluoride toothpaste recommended
Correct answer: 1350–1500 ppm
Current UK guidelines (Delivering Better Oral Health) recommend toothpaste containing at least 1350 ppm fluoride for children aged 3 years and over. A smear of paste is used for children under 3, and a pea-sized amount from age 3–6.
Question 5: Which type of hypersensitivity reaction is most commonly associated with local anaesthetic allergy in dentistry?
- Type I (immediate/anaphylaxis)
- Type II (cytotoxic)
- Type III (immune complex)
- Type IV (delayed/contact) (Correct answer)
Correct answer: Type IV (delayed/contact)
True allergy to local anaesthetics is extremely rare, but when it occurs with amide-type agents, it is most commonly a Type IV delayed hypersensitivity reaction (contact dermatitis). Type I anaphylactic reactions are more associated with ester-type local anaesthetics and preservatives.
Question 6: A 30-year-old patient requires extraction of a lower wisdom tooth. The inferior alveolar nerve block fails to achieve adequate anaesthesia. What is the most likely reason?
- The patient has a high pain threshold
- Accessory innervation from the mylohyoid nerve (Correct answer)
- The anaesthetic solution has expired
- The patient consumed caffeine before the appointment
Correct answer: Accessory innervation from the mylohyoid nerve
The mylohyoid nerve commonly provides accessory sensory innervation to the mandibular molars in a significant proportion of patients. When an inferior alveolar nerve block fails, supplemental infiltration targeting the mylohyoid nerve or long buccal nerve often achieves anaesthesia.
ORE Part 1 Clinical Dentistry
A 45-year-old patient presents with a deep carious lesion on the mandibular first molar approaching the pulp.
The tooth is vital with no spontaneous pain.
What is the most appropriate treatment?