ORE Part 1 Oral Biology & Pathology 4

Question 1

What is the clinical significance of 'Ramsay Hunt syndrome' in dental practice?

Accepted Answer

Varicella-zoster virus reactivation in the geniculate ganglion causing unilateral facial palsy, ear pain, and vesicles in the ear canal and soft palate — requiring antiviral treatment and dental/neurological awareness

Answer

Ramsay Hunt syndrome (herpes zoster oticus) involves VZV reactivation in CN VII (geniculate ganglion), causing lower motor neuron facial palsy, severe ear pain (otalgia), and vesicles in the EAC and soft palate. Urgent antiviral therapy is needed.

Question 2

What oral manifestation is characteristic of Addison's disease?

Accepted Answer

Diffuse melanotic (brown) pigmentation of the oral mucosa, particularly the buccal mucosa

Answer

Addison's disease (primary adrenal insufficiency) causes excess ACTH secretion which stimulates melanocytes, producing diffuse mucosal hyperpigmentation, characteristically on the buccal mucosa, gingivae, and lips.

Question 3

What is 'leukoplakia' and when should it be biopsied?

Accepted Answer

A white patch on the oral mucosa that cannot be scraped off and cannot be attributed to any other disease — biopsy indicated if it does not resolve in 2 weeks, is dysplastic, or is in a high-risk site

Answer

Leukoplakia is a clinical diagnosis of exclusion. All suspicious white patches should be biopsied if not resolving in 2 weeks or after removal of any obvious cause, particularly in high-risk sites (floor of mouth, lateral tongue).

Question 4

What is the pathogenesis of periapical abscess formation?

Accepted Answer

Bacterial products from pulp necrosis spread beyond the apex, triggering acute inflammation with neutrophil accumulation and pus formation in the periapical tissues

Answer

Pulp necrosis from caries/trauma allows bacteria to colonise the root canal. Bacteria and their products exit the apex, stimulating acute inflammatory infiltrate (mainly neutrophils), resulting in pus accumulation (abscess) in periapical bone or soft tissue.

Question 5

What is the difference between a primary and secondary herpetic infection in the oral cavity?

Accepted Answer

Primary (herpetic gingivostomatitis) is a widespread severe first infection; secondary (herpes labialis, cold sores) is recurrent localised reactivation at mucocutaneous junction

Answer

Primary HSV-1 infection (gingivostomatitis) causes widespread vesicles and ulcers on gingiva and mucosa with systemic upset, typically in children. Recurrent cold sores (herpes labialis) represent localised reactivation at the lip vermilion.

ORE Part 1 Practice Test

ORE Part 1 Practice Test

ORE Part 1 Oral Biology & Pathology 4