ORE Part 2 Paediatric Dentistry 2 — Questions and Answers
Question 1: What is the aetiology of molar incisor hypomineralisation (MIH)?
- Multifactorial: systemic insult during enamel mineralisation in early childhood (0–4 years) (Correct answer)
- Fluorosis only
- Trauma to primary predecessors
- Genetic inheritance exclusively
Correct answer: Multifactorial: systemic insult during enamel mineralisation in early childhood (0–4 years)
MIH results from a systemic disruption to ameloblast function during the maturation phase of enamel mineralisation (approximately 0–4 years), with many possible precipitating factors.
Question 2: What is the first-line management for hypersensitive first permanent molars affected by MIH?
- Desensitising agents, fissure sealants, and remineralisation paste (Correct answer)
- Extraction immediately
- Full coverage crown immediately
- Bleaching
Correct answer: Desensitising agents, fissure sealants, and remineralisation paste
MIH-affected molars with sensitivity and early breakdown are initially managed conservatively with desensitising toothpaste, casein phosphopeptide remineralisation, and resin-based fissure sealants.
Question 3: At what age should a child first attend a dental appointment according to current UK guidelines?
- As soon as the first tooth erupts or by age 1 (Correct answer)
- At age 3
- Before starting school (age 4–5)
- Only when symptoms arise
Correct answer: As soon as the first tooth erupts or by age 1
UK guidance recommends the first dental visit as soon as the first primary tooth erupts or by age 1, establishing dental home, providing preventive advice, and detecting early caries or anomalies.
Question 4: What is the recommended technique to minimise dental anxiety in a child undergoing their first restoration?
- Tell-Show-Do technique with positive reinforcement (Correct answer)
- Restraint without explanation
- Immediate treatment without acclimatisation
- Sedation as first choice
Correct answer: Tell-Show-Do technique with positive reinforcement
Tell-Show-Do (explain, demonstrate, perform) combined with positive reinforcement (praise) is the gold standard for behaviour management in paediatric dentistry to build trust and reduce anxiety.
Question 5: What is the significance of an infra-occluded primary molar?
- Potential space loss and tipping of adjacent teeth; may require extraction if severe (Correct answer)
- Always self-corrects
- No clinical significance
- Indicates fluorosis
Correct answer: Potential space loss and tipping of adjacent teeth; may require extraction if severe
Infra-occlusion (submerged primary molar/ankylosis) can lead to space loss as adjacent teeth tip into the space and the opposing tooth over-erupts; severe cases require extraction with space maintainer.
Question 6: What is the role of pit and fissure sealants in preventing caries in first permanent molars?
- Seal the occlusal fissures to prevent biofilm accumulation in susceptible areas (Correct answer)
- Replace fluoride application
- Act as a restorative material for existing caries
- Only indicated in low-risk patients
Correct answer: Seal the occlusal fissures to prevent biofilm accumulation in susceptible areas
Pit and fissure sealants physically block the pits and fissures of newly erupted molars, preventing bacterial colonisation in these caries-susceptible areas; most effective when placed promptly after eruption.
ORE Part 2 Paediatric Dentistry 2
What is the aetiology of molar incisor hypomineralisation (MIH)?