Case based questions

Case analysis-1

A 25 year old patient presents with severe pain in the front tooth which broke after a hit from cricket
ball during the game. The injury was alleged to have happened an hour ago. The upper lip was seen
to have been swollen along with a hematoma formation. On Clinical examination 11 seems to have a
fracture with pulp exposure, 21 has fractured at the middle third of the crown with no pulpal
exposure. No other teeth are carious and other oral findings are normal. Patient is not affordable
and is daily wage worker and a sole breadwinner.

92. What is the diagnosis for the 11 and 21

A. Dental trauma and Dental alveolar injury
B. Ellis class 3 fracture in 11 and Ellis class 2 fracture in 21
C. Ellis class 4 fracture and dentinal fracture in 11 and 21
D. Ellis class 5 in 11 and Ellis class 2 fracture in 21.

Ans:B

93. What is the best treatment option for the 11

A. RCT followed by a crown
B. Direct pulp capping with MTA.
C. Saline irrigation and restoration with Bio ceramic cement
D. Dycal base and Composite

Ans:A

94. What would be the best aesthetic correction modality for this patient
A. Composite build up in 11 21 after RCT in 11
B. Full ceramic crown in 11 and 21
C. Zirconium Crown in 11 with RCT and LCR in 21
D. Post and core in 11 with ceramic crown and Crown in 21

Ans:A

Case Scenario-2

A 30-year-old female patient presented with chief complaint of pain and swelling over the right-side
angle of the mandible since one day. Patient earlier had similar episode of pain and swelling
associated with dental pain over the right-side lower back tooth region. These symptoms however
had subsided with oral medications in the past. Patient had now presented with a decreased mouth
opening of 10 mm.

95. Based on the above scenario the best radiographic imaging for this patient is
A. CT with 3D reconstruction of face
B. CT axial and coronal with contrast imaging
C. CT axial and coronal without contrast
D. Orthopantomogram
Ans. D
 96. All the below mentioned options match the differential diagnosis for the above patient
EXCEPT
A. Acute pericoronal abscess
B. Secondary space infection involving the masticatory spaces
C. Infected odontogenic cyst involving the right lower back tooth
D. Malignant tumor of the infratemporal fossa
Ans. D

97. Which of the following statement is false regarding the management of this patient
A. Extraction of the impacted third molar is often challenging due to restricted mouth opening
in theses patients
B. Emperical antibiotic must be started after culture sensitivity in case of odontogenic
infections
C. Abscess of submandibular space requires early incision and drainage
D. complete blood work up including blood glucose parameters (Fasting)/HBA1c is essential
even if the patient is not a known diabetic
Ans. B

Case scenario - 3
Following road traffic accident, a 20-year-old male patient reported to the emergency department
with a history of loss of consciousness for 10 minutes. No history of any vomiting was given. Patient
however had nasal bleed following the trauma. Patient complaints of improper occlusal bite and
restricted mouth opening.

98. Based on the above scenario the best radiographic imaging for this patient is
A. CT with 3D reconstruction of face
B. Skull view AP and Lateral
C. CT axial and coronal without contrast
D. Orthopantomogram
Ans. A

99. Which of the following fractures will not associated with nasal bleed OR change in occlusal
bite
A. Le fort -1
B. Le fort -2
C. Le fort -3
D. Lateral orbital wall fracture
Ans. D

100. Which of the following statement is false regarding the management of this patient
A. All maxillofacial trauma patient must be considered to have C spine injury until and unless
cleared by radiograph
B. Tracheostomy must be considered in patient with huge orofacial oedema, following the
trauma
C. Most common cause of death in patient with maxillofacial trauma is due to acute blood loss
D. Open reduction and internal fixation can be postponed till oedema subsides if airway is not
compromised and patient vitals are stable
Ans. C

Case Scenario-4
 A 50 year old male with a high density profession presents to the dental office with
complaints of Multiple loose teeth in all the quadrants. He is not a diabetic and does not
have any known medical illness requiring Medication. Oral examination reveals that
16,17,18,26,27,28 and 46,47, 48 have a mobility ranging from grade 2 to grade 3 and there is
a generalized mobility, gingival recession, moderate calculus, debris and pockets and pus
discharge from sulcus and sinuses. OPG reveals generalized bone loss ranging from
moderate to severe. Based on this presentation answer the following.
101. The diagnosis for the presenting condition may be
a. Chronic periodontitis
b. Chronic gingivitis
c. Chronic gingivitis progressing to generalized periodontitis
d. Acute periodontitist of idiopathic origin
Ans: c
102. Based on the case presentation, the initial treatment plan would be as follows
a. Scaling, Curretage, extraction of mobile teeth, observation
b. Curretage, Scaling, observation, extraction of mobile teeth
c. extraction of mobile teeth,Scaling, Curretage, observation
d. Observation, Curretage, Scaling, , extraction of mobile teeth,
Ans: a
103. The following treatment plan will be the most appropriate
a. Conventional complete denture
b. Immediate transitional partial denture
c. Implant retained denture for maxilla and mandible
d. Fixed implant supported restoration
Ans: b

Case Scenario-5

A 28-year-old male presented with difficulty in mouth opening, burning sensation in right
lower cheek region. He also complaints of pain in his 38 region and discomfort in left TMJ
region. He gave the history of chewing Ghutka and smoking for ten years. On examination,
trismus with 20 mm mouth opening and fibrotic bands in right and left buccal mucosa were
palpable. A white verrucous lesion is seen in the Right retromolar reegion. The tooth 38 was
impacted. Clicking sound in relation to right and left TMJ was identified

104. What is the primary diagnosis?

a. Pericoronitis- 38
b. Oral submucous fibrosis
c. Internal Disc derangement Left TMJ
d. Left submandibular space infection
Ans: b

105. What could be the cause for trismus?

a. Impacted 38
b. Discomfort in Left TMJ
c. Tobacco chewing
d. White verrucous lesion in the Right retromolar region
Ans: C
106. What is the first line of management?
a. Extraction of Impacted tooth 38
b. Fibrotomy followed by Nasolabial flap reconstruction
c. Wide local excision of white verrucous lesion
d. Habits cessation
Ans: d

Case Scenario-6

A 40-year-old male presented with the complaint of growth in the tongue for 4 months. He
has habit of bruxism. On examination soft tissue growth of size 1 cm is seen in relation to the
root stump of 46, 47 in the right lateral border of the tongue. Also, there were multiple
carious teeth and oral hygiene was poor

107. What is the provisional diagnosis?

e. Oral carcinoma
f. Pyogenic granuloma
g. Traumatic Fibroma
h. Hemangioma
Ans: c

108. What could be the aetiology of the soft tissue growth?

a. Periodontitis
b. Bruxism
c. Unknown
d. Root stumps- 46, 47
Ans: d

109. What is the treatment plan?

a. Scaling and follow up
b. Extraction of 46, 47 and follow up
c. Excision and biopsy of the swelling
d. Extraction of 46, 47 and excision of the growth
Ans: d