ORE Part 1 Pharmacology in Dentistry 2

Question 1

What is the mechanism of action of non-steroidal anti-inflammatory drugs (NSAIDs) in dentistry?

Accepted Answer

Inhibit cyclo-oxygenase (COX) enzymes, reducing prostaglandin synthesis, decreasing pain, inflammation, and fever

Answer

NSAIDs (ibuprofen, diclofenac) inhibit COX-1 and COX-2, reducing prostaglandin synthesis at sites of inflammation. This reduces sensitisation of peripheral nociceptors, providing analgesic and anti-inflammatory effects.

Question 2

According to the BNF, what is the first-line analgesic for post-extraction dental pain?

Accepted Answer

Ibuprofen 400 mg three times daily (if not contraindicated) or paracetamol 1g four times daily

Answer

For post-extraction pain, ibuprofen 400 mg TDS is first-line if no contraindications. Paracetamol 1g QDS is used if NSAIDs are contraindicated. Combination (ibuprofen + paracetamol) provides superior analgesia to either alone.

Question 3

What antibiotic is recommended by SDCEP guidelines for dentoalveolar infections with systemic features?

Accepted Answer

Amoxicillin 500 mg three times daily for 5 days (or metronidazole 400 mg TDS if penicillin allergic)

Answer

Scottish Dental Clinical Effectiveness Programme (SDCEP) and NICE guidelines recommend amoxicillin as first-line antibiotic for acute dentoalveolar infection with systemic spread. Metronidazole or phenoxymethylpenicillin are alternatives.

Question 4

What is the recommended management of a patient on warfarin requiring a simple dental extraction?

Accepted Answer

Do NOT stop warfarin; check INR within 24–72 hours of procedure; if INR ≤4.0 proceed with local haemostatic measures (packing, sutures, haemostatic dressings)

Answer

SDCEP/NICE guidance: patients on warfarin should NOT routinely stop their anticoagulation for simple extractions. Check INR within 72 hours. If ≤4.0, proceed with local haemostatic measures. Stopping warfarin risks systemic thromboembolism.

Question 5

What is the clinical significance of prescribing metronidazole to a patient drinking alcohol?

Accepted Answer

Metronidazole inhibits acetaldehyde dehydrogenase causing a disulfiram-like reaction: flushing, nausea, headache, and cardiovascular effects with even small amounts of alcohol

Answer

Metronidazole blocks acetaldehyde dehydrogenase, causing acetaldehyde accumulation when alcohol is consumed. This disulfiram-like reaction causes severe flushing, nausea, vomiting, headache, and palpitations.

ORE Part 1 Practice Test

ORE Part 1 Practice Test

ORE Part 1 Pharmacology in Dentistry 2