“150”, Aptitude Test Questions and Answers for Dental Surgeon Grade II – MDA & LGA.
ABSTRACT
This preparation package contains 150 multiple-choice
questions and answers designed to help candidates preparing for the Dental
Surgeon Grade II – MDA & LGA public service online aptitude test in
Tanzania. The questions cover clinical dentistry, oral surgery, restorative
dentistry, periodontology, prosthodontics, orthodontics, paediatric dentistry,
dental trauma, infection prevention, oral-health promotion, outreach services,
research, health-data management, quality improvement, supervision, planning
and budgeting. The questions are deliberately structured to reflect the
analytical and closely related answer choices commonly encountered in
competitive aptitude examinations, emphasizing clinical judgment, professional
knowledge, problem-solving and practical application rather than simple recall.
Each question is accompanied by the correct answer and a clear rationale to
strengthen understanding and improve candidates' readiness for the actual
assessment.
Prepared by: Dental
Surgeon Grade II
Based in Dar-es-salaam.
0628729934.
Date: August 08, 2026
Dear applicants,
This collection of questions and answers
has been carefully prepared to help all of you to understand the key areas
tested during the interview. The goal is to provide a useful, and practical
study guide so you can all perform confidently and fairly in the selection
process. I wish you the best of luck, and may this resource support you in
achieving success!
Warm regards,
Dental Therapist Grade II
For Personal Use by Applicants Preparing
for MDA and LGA Dental Surgeon Grade II interview at Public Service Recruitment
Service.
ALL
QUESTIONS ARE COMPILED TOGETHER.
1. A 32-year-old patient presents with severe spontaneous pain from
a mandibular first molar. The pain is poorly localized, worsens at night, and
persists for several minutes after exposure to cold. Radiographic examination
shows no obvious periapical radiolucency. Which diagnosis is MOST consistent
with these findings?
A. Reversible pulpitis B. Symptomatic
irreversible pulpitis C. Acute apical periodontitis D. Pulpal necrosis
Answer: B. Symptomatic irreversible
pulpitis
Rationale: Spontaneous, severe, poorly localized
pain that lingers after a thermal stimulus is characteristic of symptomatic
irreversible pulpitis. At this stage, the pulp is inflamed beyond the point at
which it can predictably recover, although periapical radiographic changes may
still be absent. Reversible pulpitis generally produces short,
stimulus-dependent pain that disappears quickly after removal of the stimulus.
Acute apical periodontitis is primarily associated with pain on biting or
percussion and represents apical periodontal involvement rather than the
characteristic lingering thermal pain described here, while pulpal necrosis
usually produces little or no response to vitality testing.
2. During extraction of a maxillary first molar, the clinician
suspects that a communication has developed between the extraction socket and
the maxillary sinus. Which finding would provide the STRONGEST clinical
indication of an oroantral communication?
A. Persistent bleeding from the
extraction socket B. Tenderness of the adjacent maxillary teeth C. Passage of
air or fluid between mouth and nose D. Mild swelling around the extraction
site
Answer: C. Passage of air or fluid
between mouth and nose
Rationale: An oroantral communication creates an
abnormal connection between the oral cavity and maxillary sinus, particularly
when the roots of posterior maxillary teeth are closely related to the sinus
floor. Passage of air or fluid between the oral cavity and nasal/sinus region
is a strong clinical indication. Bleeding is common after extraction and is not
specific to sinus involvement, while tenderness of adjacent teeth and mild
postoperative swelling are also nonspecific findings. The clinician should
avoid unnecessarily probing the socket because this may enlarge the
communication or introduce contamination.
3. A patient presents with facial swelling, fever, malaise and
difficulty opening the mouth. Examination shows a spreading odontogenic
infection involving the submandibular and sublingual spaces. Which management
principle should receive the HIGHEST priority?
A. Assess and protect the airway while
arranging urgent control of the infection B. Provide routine analgesia and
delay definitive treatment C. Give oral-hygiene instructions and observe the
patient D. Wait for the swelling to disappear before treating the source
Answer: A. Assess and protect the airway
while arranging urgent control of the infection
Rationale: A spreading odontogenic infection
involving multiple fascial spaces can rapidly become life-threatening,
particularly when the airway is threatened. Airway assessment and protection
therefore take priority, followed by urgent control of the source and appropriate
drainage and antimicrobial therapy when indicated. Simply providing analgesics
or observing the patient does not address the potentially progressive
infection. Waiting for the swelling to disappear before treating the source can
allow the infection to worsen.
4. A patient undergoing a dental extraction suddenly becomes pale,
sweaty and light-headed. The patient reports feeling faint but remains
responsive. The blood pressure is low and the pulse is initially slow. Which
action is MOST appropriate as the immediate response?
A. Place the patient upright and continue
treatment B. Place the patient supine with legs elevated and assess vital
signs C. Administer additional local anaesthetic to control discomfort D. Ask
the patient to walk outside for fresh air
Answer: B. Place the patient supine with
legs elevated and assess vital signs
Rationale: The presentation is typical of a
vasovagal episode, in which transient reduction in cerebral perfusion produces
pallor, sweating, nausea and faintness. The immediate response is to stop
treatment, position the patient appropriately—generally supine with the legs
elevated where suitable—and assess airway, breathing, circulation and vital
signs. Keeping the patient upright may worsen cerebral perfusion, additional
local anaesthetic is inappropriate, and asking the patient to walk creates an
unnecessary risk of collapse or injury.
5. A 45-year-old patient presents with generalized gingival
bleeding, periodontal pocketing and progressive tooth mobility. Radiographs
demonstrate horizontal loss of alveolar bone affecting several teeth. Which
factor would be MOST important to assess when determining the patient's
periodontal prognosis?
A. The patient's preferred tooth-brushing
method B. The number of teeth currently restored C. The extent and pattern of
periodontal attachment loss D. The colour of the patient's existing dental
fillings
Answer: C. The extent and pattern of
periodontal attachment loss
Rationale: Periodontal prognosis depends heavily on
the amount and distribution of periodontal attachment and bone loss, together
with factors such as tooth mobility, furcation involvement, crown-root
considerations, plaque control, smoking and systemic conditions. Attachment
loss provides a more meaningful indication of periodontal destruction than
superficial gingival appearance alone. The number of restored teeth and colour
of restorations may have relevance to other aspects of treatment but do not
independently determine periodontal prognosis. Brushing technique is important
for disease control but does not itself establish the existing severity of
periodontal destruction.
6. A patient presents with a painless ulcer on the lateral border
of the tongue that has persisted for more than three weeks despite removal of
an apparent local irritant. What is the MOST appropriate next step?
A. Continue observation for another month B.
Prescribe antibiotics and review after symptoms disappear C. Arrange
appropriate investigation, including biopsy or specialist referral D. Treat
the lesion repeatedly with topical analgesics
Answer: C. Arrange appropriate
investigation, including biopsy or specialist referral
Rationale: A persistent oral ulcer, particularly
one lasting longer than two weeks without an obvious reversible cause, requires
investigation to exclude potentially serious pathology, including oral
malignancy. A non-healing ulcer on the lateral tongue deserves particular
attention because this is a recognized high-risk site. Continuing observation
without investigation may delay diagnosis. Antibiotics are not routinely
indicated for a persistent ulcer without evidence of bacterial infection, while
topical analgesics may relieve symptoms but do not establish the diagnosis.
7. A 9-year-old child presents with a deep carious lesion in a
permanent first molar. The tooth is vital, has no spontaneous pain and shows no
radiographic evidence of periapical disease. During excavation, a small pulp
exposure occurs. Which factor is MOST important when deciding whether
vital pulp therapy may be appropriate?
A. The child's age alone B. The ability
to achieve effective haemostasis and maintain pulp vitality C. The colour of
the carious dentine remaining D. Whether the tooth is the first permanent
molar
Answer: B. The ability to achieve
effective haemostasis and maintain pulp vitality
Rationale: In a young permanent tooth with a vital
pulp and no evidence of irreversible pulpal or periapical disease, vital pulp
therapy may be appropriate when the pulp is capable of healing and adequate
haemostasis can be achieved. Depending on the extent and nature of the
exposure, procedures such as partial pulpotomy or other appropriate vital pulp
therapy may be considered. Age and tooth type provide useful context but do not
independently determine treatment suitability. Effective control of
contamination, assessment of the pulp and a well-sealed restoration are central
to successful treatment.
8. A patient with a history of poorly controlled hypertension
presents for elective dental extraction. Before treatment, the blood pressure
is markedly elevated and the patient reports a severe headache. What is the
MOST appropriate approach?
A. Proceed with extraction using minimal
local anaesthetic B. Proceed because dental pain is more dangerous than
hypertension C. Defer elective treatment and arrange appropriate medical
assessment D. Give the patient a sedative and begin treatment immediately
Answer: C. Defer elective treatment and
arrange appropriate medical assessment
Rationale: Markedly elevated blood pressure
accompanied by symptoms such as severe headache requires careful medical
assessment rather than proceeding with an elective invasive procedure. Dental
treatment can generate additional physiological stress and may increase risk in
an unstable patient. The appropriate response is to defer elective treatment
and arrange medical evaluation, while urgent dental treatment would require an
individualized risk assessment and appropriate coordination. Simply minimizing
local anaesthetic or administering a sedative does not address the underlying
medical concern.
9. A 19-year-old patient presents with an unerupted mandibular
third molar. The tooth is partially covered by soft tissue, and the patient has
recurrent episodes of pain and swelling around the area. Which diagnosis BEST
explains the acute condition?
A. Pericoronitis B. Alveolar osteitis C.
Chronic periodontitis D. Irreversible pulpitis
Answer: A. Pericoronitis
Rationale: Pericoronitis is inflammation of the
soft tissue surrounding a partially erupted tooth, most commonly a mandibular
third molar. Food and bacterial accumulation beneath the operculum can produce
localized pain, swelling, tenderness and sometimes trismus or systemic
symptoms. Alveolar osteitis typically develops after extraction and is
characterized primarily by significant post-extraction pain. Chronic
periodontitis affects periodontal tissues more generally, while irreversible
pulpitis is a pulpal condition and would not explain inflammation of the soft
tissue overlying a partially erupted third molar.
10. A patient requires extraction of a mandibular molar. After
administration of an inferior alveolar nerve block, the patient reports
numbness of the lower lip but still experiences sharp pain when the tooth is
manipulated. Which interpretation is MOST appropriate?
A. The inferior alveolar nerve block has
definitely failed completely B. The lingual nerve must have been completely
blocked C. The tooth may have accessory innervation or persistent pulpal
inflammation D. The patient is necessarily exaggerating the level of pain
Answer: C. The tooth may have accessory
innervation or persistent pulpal inflammation
Rationale: Numbness of the lower lip indicates that
the inferior alveolar nerve has been affected, but it does not guarantee
complete pulpal anaesthesia of the tooth. Accessory innervation, anatomical
variation and particularly inflamed pulpal tissues can contribute to incomplete
anaesthesia. The appropriate clinical response is to reassess the diagnosis and
anaesthetic technique and supplement anaesthesia when indicated. The presence
of lip numbness therefore should not be interpreted as absolute proof that the
tooth itself is completely anaesthetized.
11. A dental clinic in a district hospital has recorded a steady
increase in cases of dental caries among schoolchildren over several years. The
dental surgeon is asked to design an intervention for the surrounding
community. Which approach is MOST likely to produce a sustainable
population-level reduction in dental caries?
A. Treating only children who report
toothache B. Combining preventive education, fluoride measures and accessible
dental care C. Increasing extraction services for severely decayed teeth D.
Advising families to seek private treatment when symptoms develop
Answer: B. Combining preventive
education, fluoride measures and accessible dental care
Rationale: Effective community oral-health
improvement requires prevention as well as treatment. A comprehensive strategy
can combine oral-health education, appropriate fluoride exposure, dietary
counselling, early detection, preventive services and accessible restorative
care. Treating only symptomatic children addresses existing disease without
substantially reducing future incidence. Extraction manages advanced disease
but does not prevent its development, while directing families elsewhere may
reduce access rather than improve population oral health. Sustainable
public-health programmes therefore target both individual risk and
community-level determinants.
12. During an outreach programme, a dental surgeon identifies many
children with untreated caries but has limited clinical time and equipment.
Which approach BEST reflects sound public-health prioritization?
A. Provide comprehensive treatment to the
first few children encountered B. Treat only children whose parents are
immediately available C. Extract every visibly carious tooth to maximize the
number treated D. Prioritize urgent disease, prevention and appropriate
referral according to need
Answer: D. Prioritize urgent disease,
prevention and appropriate referral according to need
Rationale: Outreach services must allocate limited
resources according to clinical urgency, disease burden, prevention needs and
the capacity of the service. Children with acute infection, pain or other
urgent conditions should receive appropriate immediate care, while preventive
education and feasible preventive interventions should be provided to the wider
group. Cases requiring treatment beyond outreach capacity should be referred
appropriately. Extracting all visibly carious teeth is neither an appropriate
substitute for comprehensive diagnosis and treatment planning nor a sound
public-health strategy.
13. A patient presents with a mandibular fracture following trauma.
The patient has difficulty breathing and there is significant intraoral
bleeding. What should receive PRIORITY before definitive fracture
management?
A. Selection of the final fixation
technique B. Taking detailed dental impressions C. Assessment and
stabilization of the airway D. Immediate definitive occlusal reconstruction
Answer: C. Assessment and stabilization
of the airway
Rationale: In a trauma patient, airway and
breathing take precedence over definitive fracture management. Mandibular
trauma accompanied by bleeding, swelling or altered anatomy can compromise the
airway, making immediate assessment and stabilization essential. Definitive
fixation, impressions and detailed occlusal reconstruction are important later
but should not delay management of an immediately life-threatening airway
problem. The clinician must therefore first establish whether the airway is
patent and protect it when necessary.
14. A patient receiving a local anaesthetic injection suddenly
develops metallic taste, ringing in the ears, circumoral numbness and
increasing agitation. Which complication should be suspected?
A. Local anaesthetic systemic toxicity B.
Vasovagal syncope C. Acute hypoglycaemia D. Postoperative infection
Answer: A. Local anaesthetic systemic
toxicity
Rationale: Metallic taste, tinnitus, circumoral
numbness and neurological symptoms developing soon after administration of
local anaesthetic are characteristic early manifestations of local anaesthetic
systemic toxicity. Recognition is important because symptoms may progress to
more severe central nervous system and cardiovascular effects. Vasovagal
episodes more commonly present with pallor, sweating, nausea and faintness.
Hypoglycaemia can cause sweating, confusion and behavioural changes but does
not characteristically begin with the specific sensory symptoms described.
Infection cannot develop immediately as a result of the injection.
15. A 14-year-old patient presents with delayed eruption of a
maxillary canine. A panoramic radiograph demonstrates that the permanent canine
is displaced and appears to be positioned palatally. What is the MOST
appropriate general management principle?
A. Extract the canine immediately
regardless of its position B. Assess the position, space and associated
structures before treatment planning C. Wait until the patient reaches
adulthood before investigating further D. Remove the adjacent central incisor
to create additional space
Answer: B. Assess the position, space and
associated structures before treatment planning
Rationale: An unerupted or ectopically positioned
maxillary canine requires comprehensive assessment of its location, available
space, root development, relationship with adjacent teeth and potential
pathology before treatment is selected. Management may involve orthodontic
space creation, surgical exposure and orthodontic traction, or extraction in
selected circumstances. Immediate extraction without assessment is
inappropriate, while delaying investigation may increase the risk of
complications such as root resorption or displacement. Removal of a healthy
adjacent incisor solely to create space is not an appropriate initial strategy.
16. A dental surgeon is reviewing infection-prevention practices in
a district dental clinic. Which action is MOST effective for preventing
transmission of microorganisms through contaminated dental instruments?
A. Wiping instruments with alcohol before
reuse B. Rinsing instruments under running water and returning them to the
tray C. Storing used instruments in closed trays until the end of the week D. Sterilizing
reusable critical instruments using an appropriate validated process
Answer: D. Sterilizing reusable critical
instruments using an appropriate validated process
Rationale: Critical dental instruments that
penetrate soft tissue or bone, or otherwise enter normally sterile tissues,
require sterilization using an appropriate validated process. Simply wiping
instruments with alcohol or rinsing them with water does not reliably eliminate
all microorganisms, including resistant forms. Used instruments should be
handled promptly and safely rather than stored for prolonged periods. Proper
cleaning before sterilization is also essential because organic material can
interfere with the effectiveness of the sterilization process.
17. A patient complains of severe pain two days after mandibular
molar extraction. Examination shows an extraction socket with loss of the
normal blood clot and no obvious purulent discharge. Which condition is MOST
likely?
A. Acute osteomyelitis B. Periapical
abscess C. Alveolar osteitis D. Recurrent pericoronitis
Answer: C. Alveolar osteitis
Rationale: Alveolar osteitis, commonly called dry
socket, typically develops a few days after extraction and is characterized by
significant localized pain associated with loss or breakdown of the
extraction-site blood clot. The socket may appear relatively empty, and the
condition does not necessarily involve purulent infection. Acute osteomyelitis
is a deeper bone infection and usually has a different clinical presentation. A
periapical abscess concerns an infected tooth or its apical tissues, while
pericoronitis occurs around a partially erupted tooth rather than an extraction
socket.
18. A dental surgeon is preparing a monthly report for oral-health
services in a public health facility. Why is accurate routine health-service
data particularly important?
A. It eliminates the need for clinical
judgment B. It provides evidence for planning, monitoring and resource
allocation C. It guarantees that every reported patient received complete
treatment D. It replaces the need for community outreach activities
Answer: B. It provides evidence for
planning, monitoring and resource allocation
Rationale: Accurate routine health-service
information supports planning, monitoring service performance, identifying
disease patterns, estimating workload and making informed resource-allocation
decisions. In the public sector, reliable data also contributes to accountability
and evaluation of health programmes. Data cannot replace clinical judgment, nor
does recording a service automatically prove that treatment was complete or
successful. Similarly, reporting systems complement rather than replace
community outreach and other service-delivery activities.
19. A patient with poorly controlled diabetes presents with a
painful periodontal abscess and generalized periodontal disease. Which
consideration is MOST important when planning management?
A. Addressing the periodontal infection
while considering the patient's glycaemic control and systemic status B.
Treating the periodontal condition without considering systemic status C.
Avoiding all periodontal treatment until diabetes is permanently cured D.
Extracting all mobile teeth before assessing the periodontal condition
Answer: A. Addressing the periodontal
infection while considering the patient's glycaemic control and systemic status
Rationale: Diabetes and periodontal disease have a
clinically important bidirectional relationship, and poor glycaemic control can
adversely affect periodontal health and healing. Management should therefore
address the local periodontal infection while considering the patient's
systemic status and coordinating medical care where appropriate. Periodontal
treatment should not simply be withheld until diabetes is cured, because
effective dental management remains important. Conversely, extraction of all
mobile teeth without comprehensive assessment would be unnecessarily
destructive and would not constitute appropriate periodontal treatment
planning.
20. A district dental surgeon notices that waiting time for patients
has increased substantially over several months. Before introducing a major
service change, the surgeon wants to determine the underlying cause and improve
performance systematically. Which approach is MOST appropriate?
A. Immediately employ additional staff
without assessing the problem B. Conduct a structured quality-improvement
assessment using service data C. Reduce the number of patients accepted
regardless of clinical need D. Stop outreach services to increase the clinic's
daily capacity
Answer: B. Conduct a structured
quality-improvement assessment using service data
Rationale: A quality-improvement approach begins by
defining the problem, collecting relevant data, identifying contributing
factors and testing appropriate interventions. Waiting time may result from
patient flow, appointment systems, staffing patterns, equipment availability,
documentation or other operational factors, so simply adding staff may not
address the actual cause. Restricting access or stopping outreach may create
additional problems rather than improve the system. Structured assessment
therefore provides a rational basis for selecting and evaluating corrective
measures.
21. A patient presents with a non-restorable mandibular molar
associated with chronic infection. The patient develops increasing pain and
facial swelling while awaiting treatment. Which factor should MOST influence
the decision to bring the extraction forward?
A. The patient's clinical deterioration
and risk of spreading infection B. The number of patients waiting in the
reception area C. The colour of the patient's adjacent teeth D. The patient's
preference for a particular dental chair
Answer: A. The patient's clinical
deterioration and risk of spreading infection
Rationale: Increasing pain and facial swelling
indicate a change in the patient's clinical condition and may suggest
progression of the odontogenic infection. This should influence the urgency and
setting of treatment because uncontrolled dental infection can spread to
surrounding tissues and, in severe cases, threaten the airway or cause systemic
illness. Administrative convenience and cosmetic considerations should not
override clinical urgency. The patient's deterioration and risk of
complications should therefore guide prioritization.
22. A dental surgeon wants to determine whether a newly introduced
school-based oral-health programme has improved students' oral-health outcomes
after one year. Which activity would BEST support this objective?
A. Recording the number of meetings held
by the programme team B. Asking only
programme staff whether they believe it succeeded C. Counting the number of
health-education posters distributed D. Comparing documented indicators
before and after implementation
Answer: D. Comparing documented
indicators before and after implementation
Rationale: Evaluation requires measurable
indicators that can demonstrate whether the intervention achieved its intended
outcomes. Comparing relevant baseline and follow-up measures can provide
evidence of changes in oral-health knowledge, behaviours, disease prevalence or
service utilization, depending on the programme objectives. Staff opinions,
numbers of posters and numbers of meetings may describe activities or processes
but do not necessarily demonstrate health outcomes. A strong evaluation
therefore links measurable indicators to the objectives established when the
programme was designed.
23. A patient requires a dental procedure but reports a previous
episode of severe allergic reaction to a medication. The patient cannot
remember the exact drug name. What is the MOST appropriate initial action?
A. Assume the reaction was mild and
proceed with treatment B. Document the history and clarify the suspected drug
and reaction before prescribing it C. Prescribe the same drug at a lower dose
to test tolerance D. Ignore the history because the reaction occurred several
years ago
Answer: B. Document the history and
clarify the suspected drug and reaction before prescribing it
Rationale: A reported history of severe drug
allergy must be taken seriously because re-exposure to the causative medication
can produce a potentially serious reaction. The clinician should document the
history and obtain as much information as possible about the drug, nature of
the reaction and circumstances before making prescribing decisions. Giving a
smaller dose as an informal test is unsafe and inappropriate. The fact that the
reaction occurred years earlier does not eliminate the need to consider it,
particularly when the reaction was described as severe.
24. A dental surgeon is planning an oral-health research project in
a district and intends to collect information from patients about their health
conditions. Which consideration is MOST important before commencing data
collection involving human participants?
A. Ensuring appropriate ethical approval
and informed participation B. Collecting as much information as
possible regardless of relevance C. Publishing preliminary findings before
completing data collection D. Allowing participants to modify the research
results after analysis
Answer: A. Ensuring appropriate ethical
approval and informed participation
Rationale: Research involving human participants
must follow appropriate ethical principles, including ethical review where
required, informed participation, confidentiality and protection of
participants' rights and welfare. Collecting excessive information without
justification can create unnecessary privacy risks. Preliminary findings should
not be presented as final results before appropriate analysis, and participants
cannot simply alter research findings after analysis because this would
compromise scientific integrity. Ethical and scientifically sound research
therefore requires appropriate approval, informed participation and responsible
data management.
25. A Dental Surgeon Grade II has been assigned responsibility for
improving the quality of oral-health services at a district hospital. The
facility has adequate staff but frequently experiences shortages of essential
dental materials. Which action is MOST appropriate as part of effective service
management?
A. Wait until materials are completely
exhausted before reporting the shortage B. Reduce documentation so available
materials can be used more quickly C. Estimate requirements using service data
and incorporate them into procurement and budgeting plans D. Purchase
materials informally whenever individual clinicians identify shortages
Answer: C. Estimate requirements using
service data and incorporate them into procurement and budgeting plans
Rationale: Effective management of dental services
requires forecasting material requirements from workload, consumption patterns,
patient volume, treatment needs and available stock, followed by appropriate
planning, budgeting and procurement through established systems. Waiting until
supplies are completely exhausted increases the risk of service interruption.
Reducing documentation undermines accountability and makes future forecasting
more difficult, while informal purchasing may bypass established procurement
and financial-control procedures. Using reliable service data to plan
requirements therefore links clinical service delivery with sound public-sector
management.
26. A 26-year-old patient presents with a mandibular first molar
that has a deep carious lesion. The tooth does not respond to cold testing, and
there is tenderness to percussion. Radiography shows a small periapical
radiolucency. Which diagnosis BEST explains the pulpal and periapical findings?
A. Reversible pulpitis with normal apical
tissues B. Symptomatic irreversible pulpitis without apical involvement C.
Pulpal necrosis with asymptomatic apical periodontitis D. Pulpal necrosis with
symptomatic apical periodontitis
Answer: D. Pulpal necrosis with
symptomatic apical periodontitis
Rationale: Failure of the tooth to respond to cold
testing in the presence of deep caries strongly suggests pulpal necrosis, while
tenderness to percussion indicates inflammation of the apical periodontal
tissues. The periapical radiolucency provides additional evidence of apical
pathology associated with the necrotic pulp. Reversible and irreversible
pulpitis are pulpal inflammation diagnoses that generally involve a responsive
pulp, whereas the combination of absent vitality response and percussion
tenderness is more consistent with necrosis accompanied by symptomatic apical
periodontitis.
27. A patient presents with a large proximal carious lesion in a
mandibular molar. The tooth is restorable, responds normally to vitality
testing and has no spontaneous pain. Which principle should MOST influence the
decision to preserve affected dentine during selective caries removal?
A. All discoloured dentine must always be
removed B. Complete excavation is necessary regardless of pulp exposure risk C.
Caries removal should balance disease control with preservation of sound tooth
structure and pulp vitality D. Soft dentine should remain permanently beneath
every restoration
Answer: C. Caries removal should balance
disease control with preservation of sound tooth structure and pulp vitality
Rationale: Modern operative dentistry emphasizes
preservation of tooth structure and avoidance of unnecessary pulp exposure
while achieving effective caries management and a durable seal. In a vital
tooth without evidence of irreversible pulpal disease, indiscriminate
excavation to hard dentine throughout a deep lesion can unnecessarily increase
the risk of pulp exposure. Conversely, leaving infected dentine without
appropriate sealing or treatment is not universally appropriate. The clinical
decision therefore depends on lesion depth, pulpal status, restorability and
the ability to establish an effective restoration.
28. A patient returns one day after extraction complaining of mild
pain and slight swelling. The socket contains a stable clot, there is no fever
and the patient is otherwise well. Which management is MOST appropriate?
A. Immediate surgical curettage of the
socket B. Routine postoperative advice and appropriate analgesia C. Immediate
systemic antibiotics for presumed infection D. Re-extraction of the tooth
socket
Answer: B. Routine postoperative advice
and appropriate analgesia
Rationale: Mild pain and limited swelling during
the first postoperative days are common following dental extraction and do not
by themselves indicate infection or another complication. When the socket
contains an intact clot and there are no systemic signs or other concerning
findings, supportive management with appropriate analgesia and postoperative
instructions is generally sufficient. Routine antibiotics are not indicated
solely because postoperative discomfort exists, and unnecessary curettage or
re-extraction can interfere with normal healing.
29. A mandibular first molar has extensive coronal destruction but
adequate periodontal support and sufficient remaining tooth structure to permit
restoration. The pulp is necrotic and there is a well-defined periapical
lesion. Which treatment approach is MOST appropriate if the tooth is considered
restorable?
A. Extraction followed by observation B.
Periodontal surgery alone C. Root canal treatment followed by appropriate
definitive restoration D. Scaling and polishing followed by review
Answer: C. Root canal treatment followed
by appropriate definitive restoration
Rationale: A restorable tooth with pulpal necrosis
and apical disease requires management of the infected root canal system and
subsequent restoration capable of protecting the remaining tooth structure.
Root canal treatment addresses the primary endodontic source, while the
definitive restoration helps restore function and prevent further structural
failure. Periodontal treatment alone cannot eliminate an infected root canal
system, and scaling does not treat pulpal necrosis. Extraction is appropriate
when a tooth is non-restorable or has an unfavorable prognosis, but the
scenario specifically establishes that the tooth is restorable.
30. A 38-year-old patient presents with a slowly enlarging, painless
swelling of the posterior mandible. Radiography reveals a well-defined
multilocular radiolucency with expansion and thinning of the cortical plates.
Which is the MOST appropriate next step?
A. Prescribe antibiotics and review after
two weeks B. Perform routine periodontal scaling and reassess the swelling C.
Extract the nearest tooth and assume the lesion is odontogenic D. Arrange
appropriate imaging and obtain a definitive diagnostic assessment
Answer: D. Arrange appropriate imaging
and obtain a definitive diagnostic assessment
Rationale: A slowly enlarging, painless mandibular
swelling with a well-defined multilocular radiolucency and cortical expansion
raises concern for a significant intraosseous lesion and cannot safely be
managed as routine dental infection without further investigation. Appropriate
imaging helps establish the extent and anatomical relationships of the lesion,
while definitive diagnosis may require specialist assessment and tissue
sampling. Empirical antibiotics, periodontal treatment or extraction of an
adjacent tooth without establishing the diagnosis could delay appropriate
management and potentially compromise subsequent treatment planning.
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