Using the information provided for Patient Walter Smith, answer questions 1 to 10 on the answer score sheet.

 Patient Walter Smith

Patient Information:

Age: 62 Years                                     Blood Pressure:140/ 90mmHg

Gender: Male                                      Pulse Rate: 87 bpm

Height: 170 cm (ft/in)                         Respiration Rate: 19/min

Weight: 89kg (lbs)                              Temperature: 37.7°C (°F)

Chief Complaint: Patient feels difficulty in closing his lower right side of jaw. It hurts sharp when patient close his jaw.
History of Chief Complaint: Dull Pain started in lower right side of jaw last month, initially as sensitivity to cold liquids and afterwards to hot too.  Pain converted to sharp pain for a week and then changed to dull pain again. This pain goes to sharp sensation when chewing food on right side or on closing of jaws.

Dental History: Patient isn`t a regular visitor of dental clinic. Last visit was for oral prophylaxis 2 years back.

Medical History:

Significant Findings: Patient is a known Insulin dependent diabetic for 12 years and Known Hypertensive for 10 years.

Current Medication: Tylenol for control of pain SOS, Atenolol and Insulin

Allergies: None Reported

Social/Family History:

Living with family,  owns a restaurant.

Clinical Examination:

Significant Findings:

Extraoral: WNL

Intraoral:  Gums have swelling, Plaque, recession on certain teeth. Oral hygiene poor. Missing 2.6

Question: 1  (Select ONE OR MORE correct answers.)

In addition to periodontal probing and palpation, which of the following is/are indicated to establish a diagnosis for this patient?

1. Periapical radiograph(s).
2. Bitewing radiograph(s).
3. Panoramic radiograph.
4. Tooth percussion.
5. Application of pressure on individual cusps.
6. Assessment of tooth mobility.
7. Electric pulp testing.
8. Thermal test(s).
9. Evaluation of the occlusion.
10. Selective local anesthesia.
11. Blood testing.
12. Microbial testing.
13. Cytological smear.
14. Incisional biopsy.
15. Excisional biopsy.

Question: 2  (Select ONE OR MORE correct answers.)

Which of the following should be included in the treatment plan for the management of this patient?

1. No special consideration needed.
2. Prophylactic antibiotics.
3. Short appointment.
4. Anxiolytic/sedative drug administration.
5. Prophylactic nitroglycerin.
6. Avoid NSAIDs.
7. Avoid opioids.
8. Avoid epinephrine.
9. Minimize the use of epinephrine.
10. Avoid local anesthetic.
11. Adjust current medication.
12. Stop current medication prior to appointment.
13. Delay routine treatments.
14. Treat at the end of the day.
15. Must treat in a hospital facility.

Dentist performed a Periodontal Exam

The recordings for a Sextant were representative of her complete dentition

Vestibular

Lingual

Dentist noticed Pus oozing out from the swollen gingiva of 4.6

Dentist performed Pulp Vitality test all the teeth responded but 4.6 didn’t respond to Thermal and Electrical tests

Question: 3  (Select ONE OR MORE correct answers.)

Which of the following conditions is/are consistent with this patient’s periodontal

findings?

1. Healthy periodontal status.
2. Drug-influenced gingival enlargement.
3. Generalized aggressive periodontitis.
4. Generalized chronic periodontitis.
5. Localized aggressive periodontitis.
6. Localized chronic periodontitis.
7. Periodontal abscess.
8. Gingivitis modified by systemic factors.
9. Gingivitis associated with plaque only.
10. Necrotizing ulcerative gingivitis.
11. Necrotizing ulcerative periodontitis.
12. Gingival manifestations of systemic disease.
13. Endodontic – periodontic lesion.
14. Vertical root fracture.
15. Horizontal root fracture.

Question: 4  (Select ONE correct answer.)

What is the most likely diagnosis for this patient’s pain?

1. Pericoronitis.
2. Alveolar osteitis (dry socket).
3. Irreversible pulpitis.
4. Reversible pulpitis.
5. Acute periradicular periodontitis.
6. Acute periradicular abscess.
7. Periodontal abscess.
8. Tooth fracture.
9. Temporomandibular disorder.
10. Trigeminal neuralgia.
11. Atypical facial pain.
12. Maxillary sinusitis

Dentist wanted to start Endodontic treatment on tooth 3.6

Question: 5  (Select ONE OR MORE correct answers.)

Which of the following would be/would have been appropriate to achieve anesthesia for Endodontic Opening on 4.6? 

1. Supraperiosteal/Paraperiosteal/Infiltration injection.
2. Inferior alveolar nerve block.
3. Incisive nerve block.
4. Mental nerve block.
5. Gow-Gates mandibular nerve block.
6. Buccal nerve block.
7. Periodontal ligament injection (intraligamentary).
8. Intraosseous injection.
9. Intrapulpal injection.
10. Varizani/Akinosi technique.

Question: 6  (Select ONE correct answer.)

Which of the following would be the maximum number of cartridges of 2% Lidocaine with 1:100,000 Epinephrine that could safely be given to this patient at one time?

1. 0.
2. 1.
3. 2.
4. 3.
5. 4.
6. 5.
7. 6.
8. 7.
9. 8.
10. 9.
11. 10.
12. 11.
13. 12.
14. 13.
15. 14.

While examining the patient, dentist noticed this lesion on the tongue of this patient