Education is not the learning of facts , But the training of the mind to think

To Doctors who helped in this Collection Thank you a lot !

Thanks to old collections also ! they were a true guide like Garima
! Khalil!

Thanks a lot !

Contributors

Dr N | Dr H | Dr Ng| Dr AA | Dr M |

Thanks to Ayisha

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• In exam always answer on point and direct!

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 MFD PART 2 OSCES

OSCE 1:

A. What are the bones forms the zygomatic arch process

- Temporal process of the zygomatic bone
- Zygomatic process of the temporal bone

B. muscle that originates from the inf border of the arch

- Masseter muscle

C. which nerve supply this muscle?

- mandibular division from the trigeminal nerve
D. Muscles that originate from the zygomatic arch :
- Zygomaticus minor –

E. 2 X-ray views other than CT

- SMV
- Occipitomental view OM

F. 2 surgical approaches for zygomatic arch fracture

- Gilles approach (extraoral)
- Keen approach ( Transoral )

G. Signs of zygomatic arch fracture

- Subconjunctival hemorrhage
- Diplopia
- Flattening of the cheek
- Tenderness over the cheek
- Trismus
- Retrobulbar hemorrhage

[1]
 MFD PART 2 OSCES

OSCE 2

A. How does disinfectants affect viruses and bacteria.

- They kill bacteria , viruses by damaging the proteins in outer layers leaking the DNA
- Other disinfectant lead to Damage the DNA

B. something about environmental hazards using Gas anesthesia

- Nitrous oxide ‘ gas anesthesia ‘ can damage the ozone layer which human can rely on
➔ There is also a biohazard from Nitros oxide – can affect the pregnant woman

C. Mention 3 water unit guidelines ( for further info : intensive Rcsi course )
- Use Distilled water \ reverse osmosis – or bottle water
- If mains water, A air gap should used prevent backsiphonage
- Anti retraction valves
- Total viable count should be <100-200 cfu/ml
- Dry out each session
- Service and maintaince

D. Enumerate 3 things for protection from anesthesia gases ?

- Active scavenging system
- Ventilation
- Exposure limits which include workplace exposure limits ‘ WEL ‘

[2]
 MFD PART 2 OSCES

OSCE 3

A. Mention salivary glands

- Parotid gland
- submandibular glands
- sublingual glands
- minor salivary glands

B. preganglionic nerves
- Parotid gland – glossopharyngeal (CN lX)
- Submandibular- sublingual , minor salivary glands – facial
nerve (CN Vll )

C. receptors
- Muscarinic M3

D. Neurotransmitter
- Acetylcholine

E. Mention 4 parasympathetic effects on the salivary glands ?

- Acinar cells increase secretion of saliva .
- Duct cells will increase Hco3 .
- Co- transmitters lead to increase of the blood flow to the gland .
- Contraction of the myoepithelium .

F. What is the content of parotid saliva?

- Serous .

G. What is the complications after surgical parotidectomy?

- Facial nerve paralysis .
- Frey’s syndrome – in 10% of cases .
- Fistula .

H. What is the Frey’s syndrome?

- Sweating while eating ‘ gustatory sweating ‘& facial flushing occurs post parotidectomy .

[3]
 MFD PART 2 OSCES

OSCE 4

A. What do you see in the opg

- Multilocular , radiolucent lesion , well defined rounded margins , in the area from
angle of the mandible to the ramus

B. What can you see in the histology slide ? & what is your Diagnosis ?
- Sparse fibroblast lying in myxoid of ground substance- rich matrix
- Odontogenic myxoma

C. What expected signs \ symptoms ?

- Bone expansion
- Parasthesia
- Tooth mobility
- Pain
- Facial asymmetry

D. Where is the most common location ? and is it begnin or malignant ?

- In posterior of mandible
- Begnin

E. What is the treatment ?

- Surgical excision

F. Why is it highly recurrent ?

- Without capsule – difficult to remove entirely

[4]
 MFD PART 2 OSCES

OSCE 5

clinical photo upper E caries asymptomatic

A. Differential diagnosis ?

- Caries with healthy pulp

- Reversible pulpitis
- Irreversible pulpitis
- Necrosed pulp

B. Give 3 Rx options other than silver diamine fluoride

- RMGIC
- GIC
- Composite
- GIC with stainless steel crown

C. Enumerate: 3 advantages and 3 disadvantages of silver diamine fluoride

- ADV: - easy to use , quick , painless , used on non-cooperative child .
- DISADV: Discolorations, bad taste, Irritant, fluorosis, toxicity.

[5]
 MFD PART 2 OSCES

OSCE 6

extrinsic discoloration

A. causes of intrinsic and extrinsic tooth discoloration

• intrinsic causes
- incorporate pigments during tooth formation – tetracycline staining
- trauma to the tooth
- excessive fluoride intake
- localized infection of developing tooth germ
- systemic infection disease like rubella

• Extrinsic causes :
- Excessive consumption of tea , coffee , curry
- Longterm smoking
- Chromogenic bacteria
- Poor oral Hygiene
- Chlorohexidine long term usage

B. feasible treatment to the discoloration in the pic

- microabrasion
- tooth whitening
- veeners
- crown

[6]
 MFD PART 2 OSCES

OSCE 7

Clinical photo 12 y child with missing upper L 1 and there's OPG missing
upper lateral left in OPG there's like melodeons and radiopacity like odontoma

A. Give 3 features u see in OPG

- Radiopacity in the upper left incisor region

- Absence of permanent lateral incisor
- Presence of supernumery tooth ‘ mesodense ‘

B. Causes of unerupted upper 1 (8 causes)

- Presence of supernumery tooth ‘ mesodense ‘

- Abnormal position of the crypt
- Trauma -dilaceration
- Over-retained primary tooth
- Early loss of primary tooth
- Hypothyroidism
- Primary failure of eruption
- Presence of pathological lesions ‘ cysts or odontoma ‘

C. Mention 2 plain Xray to diagnose case :

- OPG
- Upper occlusal xray
- (CBCT – if for special investigation other than plain xrays )

[7]
 MFD PART 2 OSCES

OSCE 8

• BPE scores and what does it stand for and treatments to score 1 2 and 4

- BPE score 1 –bleeding on probing , no calculus or overhangs . depth is less than 3.5 mm

- BPE score 2 – supra- or sub gingival calculus or plaque retentive factors is present 3.5 mm

- BPE score 4 –probing depth is more than 5.5 mm \ entirely non visible

BPE 1 – OH instructions reestablished

BPE 2- OHI , removal of the plaque retentive factors and also sub – supra calculus
BPE 4 – OHI RSD , Assess of the need for complex treatment and refer to specialist

[8]
 MFD PART 2 OSCES

OSCE 9

ectopic canine

A. Give 4 surgical procuedures for impacted canine

- surgical exposure and orthodontic traction
- surgical exposure only
- surgical remove – “ in case of any pathology or damage for adjacent teeth ‘
- follow up and monitor

B. when not to do surgery

- in case of growing patient and there is enough space ,and the tooth angulation from xrays toward
the space .

C. surgical complications of extraction other than swelling bleeding.

- Oronasal communications
- Injury to the incisive nerve and artery
- Trauma to the lateral incisor , Central incisor -- loss of vitality or bone loss around them

D. When to remove impacted canine

- Damaging to the adjacent teeth ‘ lateral incisors and central incisors ‘
- Pathological development of cysts or tumors
- Orthodontic indications ‘ ortho analysis ‘

E. Give 3 xrays to locate the canine

- Upper occlusal xray
- Opg + preapical view
- Two preapicals – horizontal parallex technique
- CBCT

F. Complication of the no treatment ?

- root resorption
- loss of vitality
- crowding
- displacement , cyst formation

[9]
 MFD PART 2 OSCES

OSCE 10

• White lesion on the dorsum of the tongue of the patient and patient is hypertensive
using Atenolol and patient is controlled diabetic patient

A. Give 4 intraoral description of what you see ?

- alveolar mucosa glazed & thin
- tongue is smooth , fissured
- no saliva pooling in the floor of the mouth
- white lesion , cant be wiped off \ can be wiped of ? ( if it can be wiped off = candida >
answer will be xerostomia . ) ( in case it cannot be wiped off = it means it’s a lichenoid reaction )
B. Mention 4 questions you will ask the patient ?
- Do you use any drugs
- Do you have any other lesions extraorally – flexor , arms , wrest ( wickman stria “
- Any itching , discomfort ?
- Do you feel burning sensation ?
- Is it changing is size ?
C. Mention 4 differential diagnosis ?
- Geographical tongue
- Candidasis
- Dry mouth syndrome
- Lichenoid reaction
- Lichen planus / atrophic , erosive
D. Mention type of suggested biopsy ?
- Pouch biopsy
- Brush biopsy
E. Definitive diagnosis :
- Lciehnoid reaction
F. What microscopical features of it ( licheonoid reaction )
- Hyperkeratosis
- Bands of lymphocytes infiltrate , civatte bodies
- Saw tooth rete ridges
G. What extra oral features in “ Lichenoid reaction )
- Skin lesions = in flexor , arm , wrest , legs [ wickhman striae ]
- Rigid nails
- Alopecia
H. Drugs can lead to lichenoid reaction
- Beta blockers ; atenolol Oral hypoglycemia Anti-malaria Gold , carbamazepine Diuretics NSAIDS
I. what investigations you can do ?
- biopsy
- autoantibody serum
- patch allergy test
- clinical picture
-

[10]
 MFD PART 2 OSCES

-
OSCE 11
A. types of sealers

- zinc oxide eugenol based – tubliseal

- calcium hydroxide - sealapex
- resin based – AH plus – adseal
- GI based – ketac endo
- MTA based – MTA fillapex

B. Components of sealers -
- Read most important sealers components – refer to pinkbook 7th edition

C. Signs of successful endodontic

- No tenderness on percussion or palpation
- No signs of infection , normal tooth mobility
- Resolved preapical radiolucency

D. Ideal requirements for sealer

- Biocompatible
- Bacteriostatic
- Easy to mix
- Bond to walls – non shrinking
- Non staining , tacky when mixed
- Insoluble in tissue fluids
- Seal hermetically , good working time

[11]
 MFD PART 2 OSCES

OSCE 12

Theres 3 photos 1 for colored trays un perforated, other 2 photo for tray
perforated, and3 photo for impression material in sag like alginate.

A. what type of tray you will use in dentate and edentulous

• dentate → Flang tray
• edentulous → short flang Tray
B. Define Syneresis, imbibition
• Syneresis – Shrinkage of the impression after water evaporate from it
• Imbibition – swelling of the impression after absorption of water – when placed in humid
environment
C. What is the Type of impression in photo
• Alginate impression → non reversible hydrocolloid
D. Photo 3 colors of trays every color what mean?
• red –child small
• orange – medium child
• blue – large child
• green – small adult
• yellow – medium adult
• Purple – large adult

[12]
 MFD PART 2 OSCES

OSCE 13

• a pic of flabby tissue of ant maxilla

A. Name the syndrome
- Kelly syndrome \ Combination syndrome

B. Other clinical features

- Enlarged tuberosity
- Resorption of the anterior maxilla
- Prescence of flabby ridge
- Overeruption of lower anterior teeth
- Papillary hyperplasia

C. How to treat clinically :

• Either conservatively or surgically
- Remove denture and rest the tissue in case the patient is using the denture
- use open window impression to take impression for flabby ridge
- Surgical removal of flabby ridge , bone augmentation in posterior area , extraction of lower anterior +
placing implants . surgical reduction of the tuberosity in case of any severe undercuts there

[13]
 MFD PART 2 OSCES

OSCE 14

A. What is mechanism of action of Clopidogrel?

- Antiplatelet mechanism

B. Excess bleeding from the extraction site. How will you manage. What drugs will you take.
- Gauze pressure pack
- Bone- wax
- 8 figure suture
- Tranexamic acid

C. Apixaban work on which factor

- Factor in 2 + 10

D. Mention Diseases of liver can cause bleeding

- Liver cirrhosis
- Chronic hepatitis
- Liver failure

E. Acquired cause of bleeding : ans ref : oxford applied dental page 207 , Table 18.8 : Thanks Dr S
- Vit K deficiency ( including warfarin treatment )
- Heparin treatment
- Massive blood transfusion
- Streptokinase thrombolytic therapy

F. Warafarin acts on which factors ?

- 2,7,9,10

[14]
 MFD PART 2 OSCES

OSCE 15

A. Rubber dam techniques

- Clamp first
- Clamp with dam

B. Types of clamps ?
- Wingless clamp
- Winged clamp
C. 5 pieces found in the kit
- Dam sheet
- Clamps
- U-shape frame
- Clamp forceps
- Punch forceps
- Scissors

D. Rubber dam inversion /eversion ?

- after the rubber dam is in place the process is pushing Rubber
dam under the gingival margin, into the sulcus

E. what instruments used to do the inversion / eversion ?

- plastic instrument
- excavator

F. what is the adv of rubber dam

- Clean dry field of work
- Reduce the aerosol
- Reduce the chance of swallowing endodontic instruments.
- Harmful corrosive irrigants are contained
- Decrease contamination of pulp system
- Improve visibility with retraction for lips and cheeks
-
G. disadv of rubber dam
- Take time to apply
- Latex allergy
- May lead to wrong shade selection

[15]
 MFD PART 2 OSCES

- Reduced commniucation between dentist and patient

- Cost increase

OSCE 16

A. Give generic name for xa

- Apixaban – (Axapam )

B. Generic name for iia

- Dabigatran ( Pradaxa)

C. Warfarin action
- Blocking the function of Vit K

D. 2 hemostasis action of platelets

- Activation
- Aggregation
- Adhesion to injured blood vessels and forms the plug

E. From where orgins of platelets

- Megakaryocyte

F. What is life span of platelet

- 8 days

G. What is those signs ?

1- Toxic material
2- eye protection must be worn

[16]
 MFD PART 2 OSCES

OSCE 17

A. Mention two reasons for being Atypical? TMJ joint

- Congruity
- Synovial fluid , synovial membrane
- Fibrocartilaginous disc
- Hinge type joint

B. Mention 3 groups of jaw closers muscles

- Masseter
- Temporalis
- Medial pterygoid

C. Mention 2 groups of jaw openers muscles ?

- Lateral pterygoid
- Anterior belly of diagastric

D. Main innervation of tmj ?

- Auriculotemporal nerve , massetric nerve , deep temporal nerve

[17]
 MFD PART 2 OSCES

OSCE 18

• Horizontal matterss suture video

A. Name of this type of suture ?

- Horizontal mattress suture

B. Mention 3 instruments used in suturing ?

- Needle holder
- Tissue forceps
- Needle and suturing material
- Scissor

C. Mention 3 types of resorbable sutures ?

- Chromic catgut
- Vicryl
- Monocryl
- Dexon

[18]
 MFD PART 2 OSCES

OSCE 19

Picture of patient with erythema multiform and target lesions

D. Name of the oral lesion ?

- Erythema multiform

E. Name of the hand \ finger lesion ?

- Target lesion , bulls eye lesion

F. Mention two associated infections ?

- Mycoplasma pneumonia
- HSV

G. Mention three causative drugs ?

- NSAIDS , carbamazepine , penicillin , sulpha drugs

H. Mention two medication for it ?

- Hydrocortisone IV / steroids
- Immunosuppressant = Azathioprine + IV rehydration

I. What is the name of the Major form of erythema multiform ?

- Steven Johnson syndrome

[19]
 MFD PART 2 OSCES

OSCE 20

• According to the picture :

A. What is the name of this procedure ?
- Hemimaxillectomy

B. What is the name of the appliance ?

- Maxillary obturator with Removable partial denture

C. What is the advantage if the appliance 3 points ?

- Restore function ,
- Restore esthetic
- Prevent wound contamination
- Help in feeding
- Reduces psychological impact of the surgery ‘ defect ‘

D. what are the retention means of this appliance (3 points)

- remaining teeth ( intracoronal or extra coronal retention )
- remaining alveolar ridge
- Residual hard palate
- Height of the lateral wall provides indirect retention
- Undercuts from the defect it self

[20]
 MFD PART 2 OSCES

OSCE 21

• picture of the mandible with a fracture at the angle associated with 3 rd molar ( was in the line of
fracture )

A. is it favorable or not ?
- non favorable

B. mention two muscles causing displacement

- medial pterygoid muscle
- masseter muscle
- anterior digastric

C. locate the area of tension ?

- in the upper border of the mandible ‘ ramus ‘

D. locate the area of compression

- Lower border of the mandible ‘ angle ‘

E. mention 4 causes to extract the teeth in fracture line ?

- teeth that prevent reduction of the fracture
- fracture in the root
- where there is extensive periodontal damage , and alveolar wall broken
- may delay the healing ( also will have deep pockets )
- displacement of teeth from their bony sockets \
- teeth with previous preapical lesion.

[21]
 MFD PART 2 OSCES

OSCE 22

• picture of anterior open bite teeth in a patient with history of vomiting

A. mention 4 types of NCTSL ‘ non carious tooth surface loss ‘

- abrasion
- erosion
- attrition
- Abfraction

B. mention 4 complaints the patient may have ?

- Dentine hypersensitivity
- Esthetic concern
- Halitosis \ malodor
- Change taste
- Discoloration

C. mention 4 oral clinical features

- Enamel halo
- Glazed enamel
- Confined to the palatal area of the incisors
- Restorations proudly stand

D. mention medications ?
- omeprazole
- pantoprazole

E. mention investigations you need to take - >

- serial study cast
- putty index
- photographs

F. before starting treatment what should you plan before ?

- check the activity of the disease – active or non
- discover the cause
- know the type of tooth wear

[22]
 MFD PART 2 OSCES

OSCE 23

Adult patient came to you clinic complaining of his gingiva bleeding and enlargement

A. mention 4 causes of gingival enlargement

- Hormonal
- Genetic – hereditary gingival fibromatosis
- Systemic condition ‘ plasma cell gingivitis \ leukemia
- Nutritional deficiency – Vit c def

B. Mention drugs can lead to gingival enlargement

- Phenytoin
- Ciclosporin
- Nefidipine

C. Mention two treatment options ?

- Non surgical – cause finding and root planning , scaling , also with chemical plaque control –
- Surgical phase – gingivectomy , gingivoplasty then followed with maintaince phase – recall and
evaluation

[23]
 MFD PART 2 OSCES

OSCE 24

• Case with scc in the floor of the mouth

A. Mention two most common sites

- Posterior lateral surface of the tongue

- Floor of the mouth
- Soft palate, lower lip

B. 4 clinical features ?

- Minimal pain in early phase

- Can be endophytic ( invasive ,ulcerated )
- Can be exophytic ( fungating , mass forming , papillary and verruciform )
- White lesion – leukoplakia with red erythroplakia
- Indurated , non responding to treatment , in old patients – with associated risks ‘ smoking , alcohol’
- Erythroplakia – red patch

C. Mention 3 prognostic features ?

- Anatomical sites , disease staging

- Cervical lymph nodes metastasis
- Histopathological differentiation \ well diff , mod diff , poor diff \
- Perineural invasion , angiogenesis

D. Histopathological features that will be the very good prognosis?

- Well differentiated squamous cell carcinoma

[24]
 MFD PART 2 OSCES

OSCE 25

Opg showing an impacted canine

A. What is the name of this radiograph

- Orthopantogram , panorama xray

B. What can you see ?

- Impacted upper canine in the left side

C. Mention three other radiographical investigations ?

- CBCT
- Upper occlusal standard with OPG
- Horizontal \ vertical parallax technique
- Two preapical with shift SLOB

D. Mention 4 surgical treatment

- Surgical exposure with ortho traction
- Surgical exposure only
- Surgical removal → in case it led to damage to adjacent teeth or associated with pathological lesions
- Autotransimplantation
- Close monitor and follow up

E. Mention 2 complication of no treatment

- Loss of vitality for adjacent teeth

- Development of cyst \ pathological lesion
- Crowding
- Root resorption

[25]
 MFD PART 2 OSCES

OSCE 26

• Signs
A. What is this sign ?
- Single use only

B. What is the second sign ?

- Helix test

C. What are the criteria for handpiece sterilization

- Dry
- Time 3 -5 minutes
- Saturated steam
- Temperature 134 c
- Direct contact with steam
- Vaccum > 2.2 Bar

D. What are the 2 documents that will follow the instruments from the beginning till end of sterilization
process ? * please double check this question .
- Bowie Dick test
- Sticker with date ,temp , load , name of supervisor –

E. Mention 3 things that dedicate that the sink is for washing the hands
- Hand washing gel \ soap dispenser
- Disposable Towel dispenser
- Disposable bin

[26]
 MFD PART 2 OSCES

OSCE 27

A. Nerve supply to this muscle , Branch of which nerve ?

- Frontal muscle : FACIAL NERVE , TEMPORTAL BRANCH OF THE FACIAL NERVE

B. how to test this muscle

- Wrinkle the forhead , raise the eyebrow [eye brow]

C. Drainage of maxillary sinus through ?

- Middle meatus

D. Facial nerve branches ?

- Temporal
- Zygomatic
- Buccal
- Mandibular marginal
- Cervical

E. Muscles innervated by it ?and muscle action

- Temporal – frontalis [frontalis is wrinkle the forhead] – wrinkling
- Zygomatic – orbicularis oculi- close eye
- Buccal – buccinator - blowing the cheek
- Marginal mandibular -muscle of the lower lip[orbicularis oris ] – kissing muscle
- Cervical -platysma muscle – shrunk the neck [make wrinkles in the neck ]

F. name the foramen under the eye ? The nerve passing through it ? Supply to which tooth ?
- Infraorbital foramen , infraorbital nerve , supplies anterior teeth

[27]
 MFD PART 2 OSCES

OSCE 28
• Patient with extracted lateral incisor and has been Essix retainer

A. what change horizontally and vertically within 6 months in mm

will occur ?

- After six months horizontal bone \ width change3-3.5mm

- Vertical bone change 0.5 – 1 mm

B. what is more being resorbed maxilla or mandible and why

- mandible is 4X more resorbed than maxilla Essix retainers are mainly used
- maxilla is less resorbed because → * cancellous bone , Trabeculae because they offer good stability in
the surgical area and protect the
C. How to preserve it? wound during the initial healing
- Bone augmentation phase. An Essix appliance, which is
D. If patient came after two years with damaged essix, what is the an acrylic shell, similar to a
dimensions needed for screw retained abutment and narrow implant bleaching tray, that has a denture
? tooth attached to replace the missing
• Screw retained implant – tooth. This prosthesis is the easiest
- Width > 7mm for tooth replacement and
- Height > 10 mm preservation after surgical
procedures.
- Mesiodistal > 7 mm
• Narrow small diameter implant –
- Width > 5mm
- Height >10 mm
- Mesiodistal >6 mm
E. What are bone graft types , mention one name for each type?

- Autograft : extraoral: ribs, fibula, tibia, iliac crest ,Intraoral: chin, ramus,
tuberosity
- Xenograft: Tissue from another species, again treated to reduce ,any recipient
immune reaction :- bovine derived , porcine derived
- Allograft: Tissue from a human donor specially prepared to reduce abnormal
antigen , “Bone grafts , cartilage grafts :- Ref Churchill page 388
- Alloplast : hydroxyapatite, calcium phosphate cement
F. ideal properties of bone graft ?
- Osteoconductive – osteoinductive – osteogenic potential –
absorbable – mechanically stable -biocompatible
G. when not to use bone graft?
- infection in the site of graft – excessive smoking or alcohol -server
medical fragility – uncontrolled systemic disease -radiation therapy

[28]
 MFD PART 2 OSCES

OSCE 29

HIV patient – also seen in organ Transplanted patient

A. describe what you see ?

(Irregular corrugated white lesion on the lateral surface of the tongue)

B. Clinical features
- white, asymptomatic lesion
- irregular elevated plaque \ patch can not be removed
- may occur bilaterally
- Irregular corrugated white lesion on the lateral surface of the tongue
- Surface of lesion have vertical orientation
-
C. what is your differential diagnosis

- Hairy leukoplakia
- Candida leukoplakia
- Erosive Lichen planus
- Lupus erythematosus
- Chronic Frictional keratosis

D. causative organism?
- Herpes simplex 4- Epstein Bar virus (EBV)

E. What investigations required for this case ?

- Biopsy
- PCR
- Electron microscope

F. What is the treatment

- Not required – in some cases acyclovir

[29]
 MFD PART 2 OSCES

OSCE 30

A. Mention 7 covid 19 precautions by WHO?

1. MAINATAIN A SAFE DISTANCE FROM OTHER PEOPLE “ SOCIAL DISTANCING “

2. WEAR A MASK
3. CLEAN YOUR HANDS BEFORE PUTTING YOUR MASK AND AFTER
4. MAKE SURE YOUR NOSE , CHIN , MOUTH AND WELL COVERED BY MASK
5. AVOID THE 3CS : CROWDED AREA , CLOSED SPACES , CLOSE CONTACT
6. AVOID TOUCHING YOUR EYES OR NOSE
7. REGULARY RUB YOUR HANDS WITH ALCOHOL BASED HAND RUB OR WASH IT REGULARY
8. ISOLATE YOUR SELF AND STAY IN HOME IF ANY MILD SYMPTOMS APPEARS ON YOU

B. Mention In dental precautions for dental offices ?

1. triage to the patient

2. maintain safety distance 2 meter in waiting room
3. one person at time in waiting room
4. all dental chair and suface equipped by disposable film
5. disinfect the room after therapy
6. less use of aerosol produce instrument
7. transport medical waste in opposite area

[30]
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OSCE 31

A. Name the foramen colored in

green? What nerve passing
through it? What
Type of fibers that nerve carry it ?

- Mandibular foramen , inferior alveolar nerve , mixed fibers

B. Name the nerve crossing the area in red? And the name structures innervated by nerve? Which nerve
travel with this nerve?

- Lingual nerve ,sensation for anterior 2\3 or the tounge , lingual gingiva of all teeth ,floor of the
mouth , Chorda Tympani ,

C. What is Name muscle attached the area in blue? Name nerve supply? From which pharyngeal arch?
- Mylohyoid muscle ,Mylohyoid nerve from the posterior division of the mandibular nerve from the
trigeminal nerve , 1st pharyngeal arch .
D. Where the root of the nerve suppling the taste sensation of the anterior 2/3 of tongue located?

- Gengiculate gangilion lies superior salivatory nucleus and nucleus of tractus solitaries

[31]
 MFD PART 2 OSCES

OSCE 32

A. When giving IV nerve block what are the nerve that

needed to be anesthetized?
- IDV nerve
- Long buccal nerve [ it anaesthestized by go gate block or
buccal infiltration not by this type of block] –
- Lingual nerve
B. Prevalence temporary lingual nerve injury during 3rd
molar extraction?
- 2%
C. Give 6 complications after IV nerve block?
- Trismus
- Bleeding (hematoma)
- Bruising
- LA anaphylactic shock from the LA material
- Swelling
- faulty injection in the IV vessels
- Facial palsy

D. the patient come with trismus after few days from IV nerve block, give 2 causes?
- Swelling/ hematoma
- Spread of infection from the pericoronitis

E. give 2 complications of lingual nerve injury other than Paresthesia, anesthesia?

- taste loss, alteration
- Atrophy in fungiform papilla
- Affect salivation in the region NERVE DAMAGE PREVALNCE
- Numbing of the tongue, slurring speech
• Lingual
- Neuropraxia
- permanent = 0.5%
- Temporary = 2%
F. Maximum recommendation dose of 2% lidocaine 1:80000
• IAN
epinephrine in healthy patients given in mg/kg
- Temporary = 8%
- 4.4 mg/Kg - Permanent 3%
G. Max dose for prilocaine felypressin → 6.6mg\ kg
H. Max dose for articaine with epinipherine / 7mg /kg

[32]
 MFD PART 2 OSCES

OSCE 33

A. Diabetic patient with extra oral fistula, what two important question
to ask the
patient?
- What Medication you are taking \ dose also
- is he controlled \ un controlled DM – his readings
- Did patient take any meals before coming \ Breakfast
- Any past dental history ? any complications ?

B. If the patient has an extraction 8 weeks ago and the socket didn't heal, with no history of radiation,
he said he is taking specific medication for bone, what might be your diagnosis?
- MRONJ – medication related osteonecrosis of the jaw

C. What the cause of this condition?

- Inhibition in bone remodeling (osteoclast inhibited )
- Inhibition of angiogenesis
- Toxic effect of soft tisssue inflammation and infection
- Infection and repeated microtrauma
- Suppression of immunity

D. What is the appropriate therapy?-

- OHI , patient education , Antibiotic and analgesics , surgical debridement , mouthwash , follow up

E. If the patient is hypoglycemic, what will be your management?

• If conscious give glucose orally in any form.

•If unconscious place in recovery position, give 1 mg glucagon intramuscularly, or obtain
intravenous access if possible and administer 50 ml of 20—50% dextrose

[33]
 MFD PART 2 OSCES

OSCE 34

It was a clinical.pic with mild recession on lower anterior Radiograph showed periapical
radiolucency of one of incisors

A. Describe what you see

- Well defined unilocular radiolucency associated with incisor root , with mild gingival
recession

B. What other tests you need to achieve diagnosis

- Pocket depth
- Sensitivity test \ thermal – electrical
- Percussion
- Palpation
- Mobility test

C. Write about pulp vitality tests

- Thermal test ‘ GP hot , or Co2 cold ‘
- Electric pulp test
- Pulpal oximetry
- Pulpal doppler flowmetry

D. What are treatment protocol for an endo perio lesion?

- First resolved the acute infection & inflammation by Drainage.
- Then treat with orthograde RCT
- Then periodontal lesion will resolve substantially
- Combined preapical surgery & periodontal surgery is option but carries poor long-term prognosis
E. What are adv of using a rubber dam? And Disadvantages?
- Clean dry field of work
- Reduce the aerosol
- Reduce the chance of swallowing endodontic instruments.
- Harmful corrosive irrigants are contained
- Decrease contamination of pulp system
- Improve visibility with retraction for lips and cheeks
F. Disadva:
- Take time to apply
- Latex allergy
- May lead to wrong shade selection
- Reduced communication between dentist and patient
- Cost increase

[34]
 MFD PART 2 OSCES

OSCE 34

A. Describe what you see?

- Shallow ulcer in buccal mucosa and palate and irregular border with
erythema halo covered with yellowish slough

B. Differential diagnosis?
- Pemphigoid
- Pemphigus vulgaris
- Erythema multiform
- Erosive lichen planus
- Systemic lupus erythematosus

C. If there is multiple ulcer involve skin, and oral ulcer precede, with no eye involvement, what is your
diagnosis?
- Pemphigus vulgaris

D. What is the difference between pemphigus vulgaris and Mucous membrane pemphigoid

1. Pemphigus vulgaris :
• blisters are intraepithelial ( Acantholysis ) – Niklosky sign + , superficial , flaccid bullae , no scarring ,
More Fatal and dangerous , lesion on genitals , anus lyrnx phyrnx eye also

2. Mucous membrane pemphigoid (MMP)

• Blisters are subepithelial
• Niklosky sign Negative , deep , tense bullae , scaring , less dangerous

E. Investigations?
- Clinical examination → Niklosky sign
- Indirect (serum ) immunofluorescence
- Direct immunofluorescence
- Biopsy
- CBC

F. Molecular biology has a role in pathological diagnosis. Name one molecular biological technique.
- PCR
- In situ hybridization

G. Treatment?
- OH improvement
- Minimizing irritation of lesion
- Use specific therapies for underlying disease
- Local immunosuppressive treatment
- Systemic corticosteroid & topical steroids
- Supportive therapy and Rehydration

[35]
 MFD PART 2 OSCES

OSCE 35

A. Describe what you see?

- White lesion in left buccal mucosa with white stria
Next to amalgam restoration

B. Differential diagnosis?-
- Lichen planus, lichenoid reaction, leukoplakia, white
sponge nevus,
candida; frictional keratosis .systemic or discoid
lupus erythamatosis

C. Investigation?
- Clinical picture \ white striae , flexor arms etc
- Biopsy
- Autoantibody serum
- Patch allergy test

D. Definitive diagnosis? Histopathological feature?

Lichenoid reaction
1- Hyperkeratosis → white lesion biopsy
2- Atrophy → red erosive biopsy
3- Saw tooth rette ridges
4- Band like lymphocytic infiltrate
5- Liquefactive degeneration of the basal cells

E. Extra oral feature?

Skin lesion affect the flexor, arms, wrest and legs [wickham striae ] and called Kopner’s phenomina
Rigid nails, alopecia

F. Treatment?
Patient education, remove sources of irritation, oral hygiene,
symptomatic relief, topical corticosteroid, systemic immunosuppression .
G. Drugs induce lichenoid reaction.
Non steroid anti-inflammatory drugs
Beta blockers
Diuretic
Oral hypoglycemia drug metformine

Antimalaria ...thiazide diuretic ..gold ..amalgam ..carbamazepine ..methyldopa ..nifedipine ,,

anticonvulsant drug

[36]
 MFD PART 2 OSCES

OSCE 36

- OPG – panorama radiograph showing mix dentition patient with missing

lowers 5
and retained lower Ds, and lower right 7 unerupted Infraocclusion causes

A. What Causes of delayed eruption? - Mechanical

- General: hereditary gingival fibromatosis, down syndrome, - Chemical
hypothyroidism, - Idiopathic
gardener syndrome, cleidocranial dysostosis, rickets - 1\5 patient have premolar
- Local causes: congenital absence, crowding, retention of primary tooth, aplasia
supernumerary tooth, dilaceration, dentigerous cyst, trauma, abnormal - Developmental anomalies
- Impacted 3
position of crypt, primary failure of eruption
- Peg lateral shapes
- Ectopic 1st molar
B. Management for infraoccluded primary& permanent molars rather than
monitoring? Source – RCSI intensive course
With permanent successor
1. non extraction – assess in 6 months waiting for normal exfoliation
2. extraction - Followed with orthodontic treatment :
- if between 1/2 – 2/3 of permanent tooth root developed
- in case of Sever infraocclusion with risk of complete submergence

Without permanent successor

• extraction
- If sever infraocclusion and radiograph evidence of ankylosis
- Extract to prevent lateral open bite and poor bone for future implant
- Orthodontic decision to maintain or close space.

• non extraction
- Keep primary molar and restore either with composites
buildups or stainless steel crowns to prevent tipping

[37]
 MFD PART 2 OSCES

OSCE 37

A. Name of this joint? And why it’s Atypical

Atypical synovial joint (Biarthrodial hinge joint)

Paired joint congruity (bilateral)
Disc is fibrocartilaginous
Characteristic of capsule: congruity, synovial membrane and synovial
fluid

B. What is the articulating parts?

Head of condyle and glenoid fossa

C. What type of movement can perform and why?

Hinging and gliding or translation and rotation
Because disc have biconcave shape

D. Function of the disc?

Decrease friction, facilitate movement

E. Name ligaments? And its functions?

Sphenomandibular ligament→ gives passive stability to TMJ
Stylomandibular ligament→ limit protrusive movement
Temporomandibular ligament→ limit lateral posterior movement

F. What is the fate of Meckel's cartilage?

Sphenomandibular ligament
G. Nerve supply?
Auriculotemporal nerve, Masseteric nerve, deep temporal nerve

H. Blood supply?
Superficial temporal artery + anterior tympanic branches of maxillary artery

[38]
 MFD PART 2 OSCES

OSCE 39

A. Name muscles of mastication?

Masseter muscle
digastric
Lateral pterygoid Muscle
Medial pterygoid
Temporalis muscle

B. What 3 muscles close the jaw?

Masseter, temporalis, medial pterygoid

C. What 2 muscle open the jaw?

Anterior belly of digastric
Lateral pterygoid

D. Branches of external carotid artery?

Superior thyroid, ascending pharyngeal, lingual, facial,
superficial temporal,
maxillary, posterior auricular, occipital.

E. Branches of maxillary artery?

1st part: deep auricular, anterior tympanic, middle meningeal artery,
accessory meningeal, inferior alveolar.
2nd part: deep temporal, pterygoid, masseteric, buccinator
3rd part: post. Superior alveolar, infraorbital, greater palatine, pharyngeal,
artery of pterygoid canal, sphenopalatine artery.

F. What is the muscle of mastication movement?

Elevation – temporalis, masseter, medial pterygoid
Depression – digastric, geniohyoid, mylohyoid , Lateral pterygoid ?
Retraction : geniohyoid, digastric, deep part of masseter, pos. fibers temporalis
Protraction – lateral and medial pterygoid
Side to side - medial & L . Pterygoid

[39]
 MFD PART 2 OSCES

OSCE 40

• picture of a mildly fissured tongue + periodontitis/ caries

A. mention two syndromes – conditions with fissure tongue
- Rosenthal melkerson syndrome
- Sjogren syndrome

B. name the salivary glands

- parotid gland
- submandibular gland
- sublingual gland
- minor salivary glands

C. what is the preganglionic cranial nerve supply

- parotid gland → glossopharyngeal n CN lX
- submandibular → Facial nerve CN Vll
- Sublingual → Facial Nerve CN Vll
- Minor salivary glands → facial n CN Vll

D. Mention 4 parasympathetic effects on the salivary glands

- Acinar cells increase secretion of saliva
- Duct cells will increase HCO3 –
- Co-transmitters lead to increase in blood flow to the gland
- Contraction of the myoepithelium

E. Name the parasympathetic neurotransmitter of the glands

- Acetylcholine

F. Name the receptors

- Muscarinic M3

[40]
 MFD PART 2 OSCES

OSCE 41

A. Mention 2 clinical features

- white Cauliflower-like lesion // pedunculated on the lateral surface of the tongue

B. differential diagnosis
- Fibroepithelial polyp
- Frictional keratosis
- Leukoplakia verrucous type
- Hairy leukoplakia

C. The most likely diagnosis is

- Squamous cell papilloma

D. Name the virus that cause this lesion

- HPV (human papilloma virus)

E. Mention 2 genotypes of this virus that’s related to oropharyngeal

squamous carcinoma
- HPV-16 / HPV- 18

[41]
 MFD PART 2 OSCES

OSCE 42

A. What is this?
- Implant retained over denture

B. Indication?
- Compromised stability / retention
- Increased expectation from patient for
prosthodontic treatment
- Parafunctional habits that dislodge denture
- Poor oromuscular coordination
- Increase gag reflex
- Low mucosal tolerance

C. Advantage?
- Better stability, function and support, retention, confidence,
- preserve the ridge

[42]
 MFD PART 2 OSCES

OSCE 43

A. Describe what you see?

- Coronal CT, show fracture of condyle in left side

B. What are the signs and symptom?

- Deviation of the jaw to affected site
- Restricted mandibular movement
- tender over affected condyle
- Laceration external auditory meatus, ear bleeding, swelling over
joint
- Mandible locked – condyle is impacted into glenoid fossa

C. What is the treatment?

Open reduction, internal fixation

D. What is the long-term prognosis of the TMJ?

Ankylosis, poor prognosis

[43]
 MFD PART 2 OSCES

OSCE 44

A. what is this ?
- Implant supported overdenture – with bar

B. Mention 4 indications
- Compromised denture support and retention
- Low mucosal tolerance
- High – unrealistic prosthodontics expectations from patients
- Active or high gag reflex
- Parafunctional habits that dislodge the denture
- Poor Oro muscular coordination
Overdentures are
useful in:
• Severe tooth wear
C. Mention 4 advantages • Patients with
- Improved retention hypodontia
- Improved stability • Cleft lip and palate
- Reduce bone loss patients
- Improved aesthetics , patient confidence • Motivated patients
- Improved occlusion, speech , chewing efficiency with good oral
hygiene
D. Difference between implant retained and implant supported restorations
- Implant retained – overdenture gain retention from implants but primarily from soft tissue – ridge – it
can be 3 implants , may be short bar
- Implant supported – overdenture gain full retention from the implant 4 or more implants and bar

[44]
 MFD PART 2 OSCES

OSCE 45

A. Describe what you see?

- panoramic x-ray showing fracture in the angle of left mandible in
the area of third molar left tooth and the tooth involved in the
line of fracture
B. What another radiograph view may be useful here?
- Posterior anterior, CBCT. Lateral oblique

C. What sign and symptoms this patient may suffer?

- Step deformity
- Malocclusion
- Hematoma in the floor of the mouth
- Pain
- Trismus
- Bleeding
- swelling,
- paresthesia of the lip

D. How this condition can be treated? How many plates will you use? Where
the plates should be placed? What type of fracture ? Fav or non fav ?
- Open reduction and internal fixation
1 plate in tension side, its non-favorable fracture

E. What are the possible complications?

- Nonunion, delay union, malunion, infection , wound dehiscence ,
malocclusion , nerve damage \pain swelling .hematoma formation

[45]
 MFD PART 2 OSCES

OSCE 46

• This patient has been diagnosed with trigeminal neuralgia

A. What is the characteristic feature of trigeminal neuralgia?

- Sudden unilateral, sharp recurrent pain intense stabbing
electric look like pain, have trigger zone, does not affect sleep,
more in female and affect age group of 50-70 years old

B. Primary cause?
- Vascular Compression trigeminal nerve
- idopathic

C. Secondary cause?
- Atherosclerosis
- Trauma
- vascular anomalies ‘ arteriovenous malformations ‘
- malignant lesion.
- Multiple sclerosis ‘ MS’
D. Diagnosis ?
- Diagnosis is by History
E. Treatment?
Medically:
- Carbamazepine
- Phenytoin
Surgery:
- Cryotherapy
- Nerve sectioning
F. Side effect of treatment?
- Gingival hyperplasia
- Liver dysfunction
- blurred vison
- skin rash,
- dizziness,, thrombocytopenia ..
- Lichenoid reaction ..swollen tongue ..can cause steven Johnson syndrome

[46]
 MFD PART 2 OSCES

OSCE 47

A. what is the requirement for ideal access cavity preparation?

- Permit removal of all chamber contents
- Permit complete, direct vision to pulp chamber and canal opening
- Facilitate introduction of instrument into the root canal opening
- Provide access as direct as possible to apical one third of canal for
instrumentation
- Provide a positive support for temporary filling
- Always have four walls
- No excessive removal of tooth structure ; conservative approach
B. What are the principles for cavity access prep
- Outline form
- preservation of tooth structure
- remove all caries and old restorations
- straight line access
- toilet to the cavity
C. What irrigation we use in endodontic treatment?
- Sodium hypochlorite 5%
- EDTA 17%
- Chlorohexidine 2%
- Saline 0.9%
D. What are the ideal sealer properties?
- Biocompatible
- Bacteriostatic
- Radiopaque
- easily mixed
- bond to wall non-shrinking,
- non-staining, tacky when mixed
- insoluble in tissue fluid, insoluble in solvent
- seal hermetically, good working time
E. Type of sealers with trade name?
Eugenol based : tubliseal, zycal Iodine containing paste - vita
MTA based : MTA fillapex apex , calcipast → Used in
Resin based : AH plus and Adeseal retreatment when caoh is
ineffective
Tricalcium based – calcium silicate : BioRoot , sealpex , totalFill
GI based : Ketac endo Odontopaste \ Ab+ steroids
F. What is criteria for ideal obturation? →used in case of Hyperemic
- Within 0 -2mm of the radiographic apex pulp → next visit easy Rx under
- Well condensed, no void LA
- Hermetically seal the root canal system apically ,,periodontically and coronally
G. Aims of the obturation ?
- incarceration of the residual bacteria , coronal seal , apical seal
-

[47]
 MFD PART 2 OSCES

OSCE 48

A. Asthmatic patient, what is the signs of asthma (4 points )

- Shortness breath
- expiratory wheezing
- coughing
- tightness in the chest
- Use of accessory muscle of respiration , patient unable to talk

B. Which inhaler do we use in dental practice?

- Salbutamol

C. What is the treatment of asthmatic attack? Dental management

- Place patient upright, arm forward
- Oxygen
- 2 puff of Ventolin (salbutamol), repeat every 10 minutes if necessary (by spacer device
- Check Vital sign
- Call 999 if no improvement

D. Treatment of asthma attack in hospital setup

- Upright position
- Nebulized salbutamol 5 mg with o2
- Nebulized ipratropium 500 micrograms o2
- Hydrocortisone IV access 200 mg
- Vital check ‘ Arterial blood gases , pulse oximetry
- Obtain CXR to exclude infection

• Be aware of the possibility of anaphylaxis mimicking acute asthma.

Remember adrenaline 0.5mL 1:1000 IM. ( oxford page 571 )

[48]
 MFD PART 2 OSCES

OSCE 49 11

E. Identify : and content of each foramen

- 1- Cribriform plate: olfactory nerve

2- Foramen rotundum: maxillary nerve
3- Foramen oval: mandibular nerve, accessory meningeal
artery , lesser petrosal nerve ,

- 4- Magnum: spinal cord

5- Foramen spinosum: nervous spinosus, middle meningeal artery,
6- lacerum : nerve of the pterygoid canal 9 10
7- Optic canal: optic nerve, ophthalmic artery

8- Sella turcica [pitutary gland ]

9- Jugular foramen – glossophyrngeal nerve lX , Vagus x , Xl Accessory nerve
10- internal accusotic meatus → Vll , Vlll
11-suprerior orbital fissure → 3 , 4 , 5 & 6 cranial nerves

[49]
 MFD PART 2 OSCES

OSCE 50

A. Name the appliance

- Feeding appliance NAM (nasal alveolar molding) tap [palatal obturator]

B. What is the function of this appliance?

- Improve feeding
- improved weight gain
- improve psychology of parents
- normalize of tongue function
- reduce fatigue during feeding.

C. Advantage:
- reduce the alveolar segments into proper alignment
- improve nasal symmetry in patients
- tissue expansion and elongation of columella
- correction of nasal cartilage deformity

D. When dose it happens intrauterine?

Palate: Starts 5th week and complete by 12 weeks
Formed from two structure: primary and secondary palate
lip: start in 4th week and completed by 12 weeks

E. What are the etiological factors?

Genetic: family history
Teratogenic: maternal illness, maternal smoking and alcoholic , phenytoin usage

F. Prevalence of CP \ CLP and male to female ratio ?

- Isolated cleft palate → F > M 1:2000 . 20 % is family history
- CLP → M > F 1:1000 caucasian . family history is 40%

[50]
 MFD PART 2 OSCES

OSCE 51

A. Differential diagnosis (6 points )

- Unicystic ameloblastoma
- Myxoma
- Keratocyst
- Dentigerous cyst
- Stafne bone cyst
- Central gaint cell granuloma
- Radicular cyst

B. Describe lesion criteria (4 points )

- Well defined
- Radiolucent lesion
- Unilocular
- Rounded margins , irregular
- Causing root displacement for 4 and 5

C. 4 clinical tests to know the pulpal status ?

- Thermal test
- Electric pulpal test
- Pulpal doppler flowmetry
- Pulpal oximetry
D. Difference between incisional and excional biopsy
- Excisional: means removal for the whole specimen used for begnin lesions \ less than 2 cm in
diameter
- Incisional: mean removal part of the specimen used in suspicouis lesions \ when more than 2 cm in
diameter
E. What ALARA means?
- As low as reasonably achievable

F. Mention 4 advantages of rubber dam and 4 disadvantages

- Provide a dry and clean field of work
- Harmful corrosive endodontic irrigants are contained
- Reduce the chance of swallowing instruments ‘endo ‘
- Reduce the aerosol contamination
- Decrease contamination to the pulp system
- Improved visibility with retraction for the lips and cheeks

Disadvantages
- Take time to place
- Cost of rubberdam and kit
- Latex allergy
- Reduced communication between dentist and patient
- May lead to wrong shade selection

[51]
 MFD PART 2 OSCES

OSCE 52

A. Which radiograph \ view is this ?

- Axial ct of the head
B. What are the defects in this radiograph ?
- Fracture in zygomatic arch

C. What possible signs symptoms associated with this ?

- Bruising around the eye
- Subconjunctival hemorrhage
- Diplopia
- Step deformity in orbit rim
- Unilateral epistaxis
- Tenderness around the malar region
- Limitation of lateral excrusion on mandible opening

D. What are complication associated with this ?

- Malar asymmetry
- Infraorbital paresthesia
- Persistent diplopia
- Orbital dystopia
- Retrobulbar hemorrhage
- Blindness transiet or permanent
E. Mention 2 treatment for this ?
- Gillies reduction
- Keen approach

[52]
 MFD PART 2 OSCES

OSCE 53

picture of 15-size endo k file

A. What is X point called? x

- D16

x
B. What is Y point called?
- D0

C. What is the XY distance called?

- cutting blades 16mm in length xy
Xy
D. What’s the standard taper?
- 0.02
y
E. If the taper at X point is 15mm, what’s the taper at Y point?
- 47 mm– 0.47

F. Define the working length?

- It’s the distance between the apical constriction in the root to a reference point in the crown [the
distance from the refrance point in the crown in the point in the apex in which the cleansing and
obturation end ]

G. To which anatomical landmark should the root canal filing material ends?
- Apical constriction

H. Name 4 methods to determine the WL?

- Radiographs
- Apex locator
- Tactile sensation
- Paper points – Pain

[53]
 MFD PART 2 OSCES

OSCE 54

A. Components of toothpaste, what is the function of each component?

Each tooth paste must contain :

1. Fluoride : sodium fluoride ,,sodium momofluorophosphate ..stannous fluoride { reduce caries risk
and enhance remineralization]
2. Anti-calculus agent {sodium pyreophosphate can reduce calculus formation by 50%
3. Desensetizing agent 10% stronium or potasium chloride or 1.4%
formaldehyde
4. Antibacterial agent > triclosan
5. Surfactant such as sodium lauryl sulphate
6. Sweetener and flavoures such as saccharin or sorbitol and
spearmint
7. Binders ; thickeners , prevenet liquid solid separation
B. Mention 3 ingredient to decrease dentine hypersensitivity?*
- Potassium citrate
- Potassium nitrate
- Stannous fluoride

C. Lowest fluoride concentration in adult toothpaste in ppm?

- 1350
D. Range of toothpaste concentration in the market?
For child 400-1000 ppm
For adult → low risk = 1350-1500 | High risk → 2800-5000 ppm

[54]
 MFD PART 2 OSCES

OSCE 55

An 8 years old boy with traumatic injury

A. Diagnosis
- Enamel dentin Pulp Crown Fracture/ Ellis 3

B. 4 other types of traumatic injuries?

- Intrusion, Extrusion, Lateral Luxation and Avulsion

C. 3 treatment options?
- Direct pulp capping
- Cvek’s pulpotomy
- Coronal pulpotomy.

D. What is name of the physiological procedure which is achieved by pulpotomy in order to permit
continued growth of root in an immature vital tooth?
- Apexogensis

E. What is the procedure called which is performed with calcium hydroxide in an immature non-vital
tooth to close the apex?
- Apexification

F. The prognosis will depend on ?

- Size of exposure
- Time since trauma
- Apical maturity
- any fracture in the root

G. What is the aim of apexification?

- Promote the root apex closure
- Promote formation of dentinal bridge calcification
- Formation of an apical stop

[55]
 MFD PART 2 OSCES

OSCE 56

White lesion present on the labial and buccal mucosa of lower edentulous ridge.

A. Describe the picture.

- Non homogenous white lesion on the

B. Most likely diagnosis?

- Leukoplakia

C. What is the name of its pre-malignant variant?

- Speckled leukoplakia

D. Rate of its malignant transformation?

- 12.1%

E. Management?

- OHI ,patient educating , instruction to patient to stop any bad habits ‘ smoking or tobacco sniffs
- In case of persistent lesion → pouch biopsy
- Follow up and close monitoring

[56]
 MFD PART 2 OSCES

OSCE 57

A child of 16 months suffered traumatic injury (intrusion/extrusion).

A. What can you see?

- Intrusion

B. Other types of traumatic injuries seen in primary teeth that affect PDL.
- Concussion
- Extrusion
- Lateral luxation
- Avulsion
- Intrusion

C. What needle thickness should be used while giving LA in this patient?

- 30 Gauge

D. Management?
- extraction if damaging secondary follicle otherwise wait to re-erupt for 1-6 months if fails to
erupt then extract and inform parent while waiting to re erupt that might need extraction

[57]
 MFD PART 2 OSCES

OSCE 58

A child with anterior and posterior crossbite.

A. What can you see?

- Anterior and posterior cross bite
B. What is the first thing you would investigate before managing this case?
- Whether its caused by skeletal cause or functional
- Presence of displacement , amount of displacement (can the patient get edge to
edge )
- Lateral cephalometric , opg , occlusal examination

C. 3 treatment options.

- Removable palatal expander – RPE

- Quad helix

- Hyrax appliance

D. Damaging effect on rest of the occlusion?

- Tmj problems
- Difficulty mastication
- Crowding
- Muscle pain ? Mpds ?

E. 3 components of upper removable appliance used in this case and where they are
placed? (components+location)
- Expander screw : in the midline of the palate
- Acrylic base plate : in the palatal area
- Adams clasp : in the molar

[58]
 MFD PART 2 OSCES

OSCE 59

Msx-1 – incisors

Pax9=

Linked genes for

hypodontia
A. What can you see
- Missing right central incisor

B. Which gene mutation is responsible for this condition?

- Msx-1

C. Mention the causes of failure \ delayed eruption ?

- Trauma , Dilaceration
- Presence of Pathological lesions ‘ cyst ‘
- Congential abscense
- Abnormal position of crypt
- Primary failure of eruption
- Presence of supernumery teeth
- Gingival fibromatosis (local cause )
- Hypothyroidism

D. The patient midline has shifted to right. How would you manage, give 3 treatment options?
- Space analysis
- Create space orthodontically.
- Prosthetic replacement

[59]
 MFD PART 2 OSCES

OSCE 60

A. 3 Causes:
- Increased frequency sugar intake
- Using teething rings with sugar
- prolonged bottle feeding
- Poor oral hygiene

B. Would you give space maintainer if deciduous molar is extracted?

- Yes

C. Would you give space maintainer if deciduous incisor is extracted?

- No

D. Write 3 space maintainers to prevent bilateral space loss.

- Nance appliance
- Transpalatal arch
- Lingual holding arch

[60]
 MFD PART 2 OSCES

OSCE 61

A. Write down 4 principles for post length?

- The post length should be 2/3rd of the length of the tooth root.
- should be equal to the length of the anticipated crown.
- Half of the post should be below the alveolar crest.
- 5 mm of GP should be left behind.

B. 2 principles for post width?

- The post width should be 1/3rd of the buccolingual width of the root,
- At least 1 mm of dentin should be present around the post.

C. Define ferrule effect.

- A 360 degree metal collar of the crown surrounding the parallel walls of the dentin extending coronal
to the shoulder of the preparation.

D. Function of post and core?

- Provide retention , support to the restoration
- Distribute stress along the root

E. Why ferrule effect is needed?

- The ferrule provides bracing to protect the integrity of the root.

F. Classification of posts core system

- Prefabricated , custom
- Thread , serrated , smooth
- Tapered , parallel

G. Ideal characteristic of post .

- Parallel as possible
- Adequate length
- Rough serrated
- Don’t rotate in the canal

H. How to avoid post perforation for root

- Avoid large diameter post with small canal
- Avoid long post in curved canals

[61]
 MFD PART 2 OSCES

OSCE 61

CHILD with unilateral open bite case:

A. what is the most likely etiology?

- primary failure of eruption

B. mention 3 causes of the case?

- Ankylosed primary tooth
- Primary failure of eruption
- Infraocclusion molars
- Endogenous tongue thrust
- Localized failure of alveolar growth
- Post treatment with orthodontic appliances “like twin
block “

F. Mention two chairside clinical investigation?

- check the tongue thrust type and degree “if present “
- check the degree of infraocclusion / ankylosis à ALSO percussion test for infraoccluded tooth
- check the degree of the tipping
- check for any signs of indentation on the lateral surface of the tongue

G. other special investigations ?

- Lateral cephalometric
- CBCT

H. TREATMENTS other than monitoring ?

- Tounge guard in case of tounge thrust
- Anterior bite plane
- Fixed orthodontic treatment “ utilizing elastics “
- Closing the open bite using the Fixed ortho with TAD “ temporary anchorage Devices “

[62]
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OSCE 62

Case – complicated crown fracture with 1-2 mm exposure and cvek pulpotomy was done :

A. Q1 write 6 steps of the procedure ?

1. L.A
2. Rubber Dam application
3. Removal of the 1-2 mm of the coronal pulp
4. Placement of the cotton to achieve hemostasis
5. For primary teeth à place Ferric sulphate || for permanent teeth à Non setting Caoh
6. Followed by RGMIC and Radiograph follow up and asses vitality in follow ups

B. what is the aim of this procedure ?

- Preserve the vitality of the Radicular pulp
- Apexogensis help to close the apex
- Aesthetic and Function

C. if luxation was occurred !mention 2 immediate treatments would you do in case all examinations and
radiographs was performed !?
- Reassure the patient & advice soft diet
- Flexible soft splint for two weeks ( 2 weeks )

[63]
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OSCE 64

Picture of a mouth guard

A. what is this appliance?

- Sport mouth guard

B. What is other types of mouth guards ?

- Stock
- boil and bite
- custom

C. What is the best type ?

- The customized multilayer mouth guard

D. What is the thickness in mm ?

- Thickness is 2-3 mm -→ 2-3 mm labially , 3mm occlusally

E. What are the manufacturing steps for this appliance ‘ please check this ‘
- Impression & cast
- Lab fabrication – place the thermoplastic material over the vacuum
- Adjust the borders of the mouth guard . <3mm from sulcus
- Smoothing it

F. What is the ideal properties of the mouth guard

- Properly seated
- No sharp edges
- Frenulum should be relieved
- Feel comfortable to wear

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OSCE 65

endo xray of a molar with a crown associated with a preapical radiolucent

lesion

A. What is the preapical diagnosis?

- If without symptoms = Asymptomatic preapical periodontitis
- If with symptoms = Symptomatic preapical periodontitis

B. Mention 4 clinical investigations and special tests to asses this case ?

- Vitality test
- Probing depth
- Percussion
- Mobility
- Sinus tracing with GP
- Palpation

C. Reason for the failure in this case is ?

- -Lack of the coronal seal

D. Where dose the preparation ends?

- Apical constriction

E. Mention two conventional sealers ?

- MTA BASED sealer : MTA FILLAPEX
- EUGENUOL Sealer :TUBLISEAL , ZYCAL
- Resin Sealer : AH PLUS , ADSEAL
- Tricalcium based : bioroot , calcium silicate
- GI based : Ketac endo

F. Mention 6 ideal properties of the sealer

- Biocompatible
- Easy to mix
- Adhere to the walls
- Tacky when mixed
- Bacteriostatics
- Radiopaque
- Non Staining
- Non toxic

[65]
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OSCE 66

Teeth with staining case :-

A. Mention 4 causes of staining

- Intrinisic staining =
- Tetracycline staining
- Amelogenesis imperfecta
- Dentinogensis imperfecta
- Fluorosis
- Pulp necrosis , root canal medicament
- Extrinsic Staining :
- Food
- Chromogenic bacteria
- Chlorohexidine mouth wash
- Smoking

B. Mention 4 treatment options

- Bleaching
- Mico/Macro Abrasion
- Veneers
- Crowns

[66]
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OSCE 67

Asthma attack case

C. Mention 4 clinical symptoms for asthma attack ?

- Wheezing
- Chest Tighten
- Tachycardia
- Cyanosis

D. Mention 4 management things to do when it happen in dental clinic ?

- ABCDE
- Seat the patient Upright
- Salbutamol inhaler with a spacer = 100 mg = 2 Puffs
- If non responsive call 999
- Meanwhile give O2 – 15 Liters \ minute

E. Had picture of 3 inhalers , which would you give

to the patient ?
- Blue Inhaler = Reliver = Sulbutamol

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OSCE 68

A. Mention 4 descriptions of what you see ? / clinical features of epulis

Fissuratim
- Site soft tissue overgrowth in the buccal sulcus
- Movable . displaceable
- With normal mucosa covering it
- Painless
- Can cause denture dislodgment

B. Two differential diagnosis ?

- Fibroma
- Epulis Fissuratim
- Fibroepithelial polyp

C. Definitive Diagnosis of this case ?

- Epulis Fissuratim

D. Mention 5 clinical investigations ?

- Soft tissue examination
- Size shape colour ,contour & extent of the lesion
- Intraoral photography
- Assessment of the denture
- Assessment of the opposing tooth

E. What special investigations for this case ?

- Biopsy
- ESR
- CBC
- Radiology – CBCT

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OSCE 69

Anatomy of the sagittal of the skull

A. What is the figure W and F?

- W= Sphenoidal Sinus
- F= Ethmoidal Sinus
B. Names nerves innervating this area
- Ethmoidal sinus =Anterior + post.
Ethmoidal nerve
- Sphenoidal sinus = posterior
ethmoidal nerve
C. These nerves are arising from which
division of cranial nerve 5
- Opthalamic Division V1
D. What is the area labeled S
- Sella Turcica
E. What is the important structure lies
in S ?
- Pituitary gland

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OSCE 70

A. What is the suture technique ?

- Interrupted suture
B. What instruments used to suturing ?
- Needle holder
- Scissor
- Tissue forceps
- Suturing needle
- Suturing material
C. Name 3 types of resorbable sutures ?
- Vicryl
- Monocryl
- Dexon
- Catgut
- Chromic catgut
D. NAME 3 types of non-resorbable sutures >?
- Nylon
- Polypropylene “ Prolene “
- Silk
- Polyester
E. What is the immediate management in case of needle stick injury ? NSI?
• Mention 4 things to do immediately :
- Stop the procedure and encourage bleeding at the injury site
- Wash it under running water with soap
- Don’t scrup or suck it
- Don’t apply any antiseptics
- Put water resistant plaster
• Mention two main immediate things to do ? later
- Fill the risk assessment form
- contact the occupational health – if out of hours go for ER for post exposure prophylaxis assessment
- What can be done in accordance to the guidelines ?
- Fill the incident report in the RIDDOR AND submit to HSE
F. Mention 4 things Dentist and staff should implement to prevent NSI ?
- Ensure all dental staff are trained in the Disposal of the Sharps
- Identify and dispose Off needles immedialty after usage
- Always pass instrumenets with the sharp end pointing away from any person
- Pick up instruments individually
- Don’t pass needle from hand to hand
- Don’t bend , break or recap needle
- Use of appropriate container , fill and dispose correctly
- Don’t retrive items from the sharp box !

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OSCE 71

A picture of opg → see the picture

A. Give 4 specific descriptions of what you see ?

- Multi locular lesion mixed radiopaque radiolucent lesion
- In the right side of angle of mandible [from the area next to
permolar area of the body to the angle of the right side of the
mandible
- In edentulous area
- Bubble appearance or honey comb
- Radiolucent lesion
- Well defined
- Multilocular although may be unilocular
- Irregular margins
- Adjacent teeth may be displaced
- Tooth roots are not usually resorbed
B. Give 4 differential diagnosis
- Ameloblastoma
- OKC
- Myxoma
C. Giant cell granuloma [aneurysmal bony cyst is better here as differential
diagnosis
D. See the histology slide – What is your definitive diagnosis
- OKC
E. Common site and common age ?
- Angle of the mandible , 20-30 years

F. From which structure they arise :” OKC”

- Dental lamina , remanent of the dental lamina

G. Treatment ?
- 1. Surgical excision with peripheral osseous curettage or ostectomy
- 2. Enucleation and curettage
- 3.Chemical cauterization of the bony cavity with Carnoy’s solution after cyst removal due to presence
of Daughter Cysts
- 4.OHI and prosthetic rehabilitation

H. Why there is high tendency to recurrence ?

- Due to fragile thin cyst lining
- Due to multiple finger like extensions within bone
- Often have daughter cysts

I. Mention syndrome associated with OKC ?

- Gorlin goltz syndrome

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J. Characteristics facial features of those syndromes in head and neck ?

- Frontal bossing , broad nasal root , mental retardation , calcification of the falx f
- Multiple basal cell carcinoma

K. What further radiographs investigations needed ?

- CBCT OR PA , Lateral oblique with lower occlusal

L. Histopathology of odontogenic kerato cyst :

- Uniform thickness epithelium
- Stratified epithelium
- Ribbon like appearance
- Lack of rete ridges
- Separation of the epithelium from the basement membrane
- Parakeratosis
- Folded cyst lining
- Thin fibrous wall

• If patient have a lesion in angle what xrays

will be taken and what view will show us ?

A dental panoramic radiograph, sectional dental

panoramic tomograph or oblique lateral views would
show the lesion. The mesiodistal and
superior/inferior
dimensions of the lesion would be evident as well as
association with any teeth, the inferior dental canal,
etc. A posterior—anterior (PA) view of the mandible
will show any buccolingual expansion of the
mandible.

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OSCE 72

A. What is the most likely diagnosis or each picture ?

- A is geographical tongue
- B is Squamous cell carcinoma SCC
B. Which one is more serious
- B
C. What kind of biosy for it ?
- Incisional Biopsy
D. How would you describe the lesion to confirm URGENCY when sending the biopsy ?
- Lesion persisted more than 2 – 3 weeks
- Lesion ulcerated and don’t respond to treatments
- Everted margins and indurated
- Fixed to surrounding
- What should be done right before taking the biopsy of the lesion ?
- Take the patient informed consent- LA ,- Tracing
E. Describe the lesion in the A
- Red patches on the surface of the tongue , smooth depapillation, giving the tongue map like
appearance
F. What symptoms patient might have ?
- Burning sensation or discomfort specially with spicy food , acidic
- It can be asymptomatic also !
- And patient will describe the changing appearance of the lesion in size and site and shape
G. How is it managed (4points )
- Take a through history and examination “ Geographical dose not need a treatment
- Reassure the patient its benign lesion and common
- Instruct him to avoid certain food
- Also topical analegsics mouth wash or spray ex : benzydamine hydrochloride “ Difflam “
H. What are the signs for SCC ulcer ? ( Describe clinical features ) 5 points
- Firm
- Indurated
- Granular base
- Everted margins \ raised edges
- Fixed to surrounding

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OSCE 73

Over jet = 9 mm

Patient is 20 years old

A. Mention two treatment options for this case ?

- Camouflage – Fixed orthodontics
- Orthognathic surgery

B. What is the long term risk for not treating this case ?
- Difficulty in mastication
- Difficulty in phonetics
- TMJ problems
- Stress on Jaw muscles

C. Name of this appliance in the next picture

- Lingual wire
D. What is the wire used ?
- Fixed orthodontics retention
E. For which orthodontic cases this appliance is necessary ?

- Diastema closures
- De-rotations
- Over bite corrections
F. Why we use retainer :
- Gingival and periodontal tissue require time past treatment to reorgnainzse
- Soft tissue pressures are likely to cause relapse if teeth are placed in an unstable position
- Growth post treatment may cause relapse

[74]
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OSCE 74

A. Describe what you see ?

- Giant cell multinucleated lesions
B. Differential diagnosis:
- peripheral giant cell granuloma
- central giant cell granuloma
- cherbusim ( bilateral boney enlargement
- brown tumor of hyperparathyroidism[ brown tumor ]
- Gaint cell tumors
- Aneurysmal bony cyst also is a giant cell tumor
C. Signs : - memorize all those signs

gas under pressure Single use Carcinogenic

[75]

Biohazard Radioactive ,
radiation area
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[76]
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[77]
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OSCE 75

A. Name of those muscles ?

1- PALATOGLOSSUS
2- Genioglossus
3- Hyoglossus
4- Styloglossus
- Extrinisc muscles of the tongue moves the tongue !
- Intrinsic muscles will shape the tongue !!
REF( Netters anatomy Flashcards = 8-17)

B. Name the Extrinsic muscles of the tongue?

- Genioglossus
- Hyoglossus
- Styloglossus
- Palatoglossus

C. . Which nerves innervate the Extrinsic muscles of the tongue?.

- All by Hypoglossal N. Except the Palatoglossus By the “ Pharyngeal Plexus
nerve from the Vagus N.
D. What is the somatic innervation of anterior 2/3 of tongue?
- Lingual nerve
E. Which nerve supplies the posterior 1/3 of tongue?.
- Glossophayrngeal Nerve CN lX
F. From which Pharyngeal arch posterior 1/3 derived from?
- From the 3rd Pharyngeal arch
G. Mention the intrinsic muscle of the tongue ?
- Longitudinal – superior and inferior
- Vertical
- Transverse

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OSCE 76

A. What is the name of this condition ? name the lesion on the skin ?
- Erythema multiforme , Target lesions “ iris lesions – Bull eye lesion “

B. Mention 3 drugs that causing it ?

- NSAIDS , Carbamazepine , penicillin ,sulpha drug [ most common drug ]

C. 2 infections associated with it

- HSV , Mycoplasma pneumonia

D. Mention 2 immediate treatment ?

- Withdrawing causing factor , Steriods or immunosuppressant
- IV Rehaydration and supportive therapy

E. Why this condition can be fatal ?

- Dehyadration and secondary infection .

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OSCE 77

Pic for lower molar with a sinus with also radiograph

A. Which test would you undertake?

- Gutta perccha Tracing
- Vitality test ) Btw PDL or preapical abscess (
- Mobility test
- Probing depth
- Percussion test
- Palpation test

B. What is your Pulpal diagnosis?

- Pulpal necrosis

C. What is your Periapical diagnosis?

- Chronic Apical abscess

D. What are principles of cavity preparation?

- Outline Form and initial Depth remove carious lesion
- Retention form
- Resistance form
- Convenience form
- Toilet cavity

E. what are the principles of the access cavity

- All caries and previous defective restoration should be removed
- All root canal orifices should be easily located
- Should provide straight access line to the canals
- Preserve sound tooth structure

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OSCE 78

A patient came to you after braces removed

A. What is your diagnosis?

- Decalcification, white spot lesion

B. Name the principal organism causing this?

- Streptococcus mutants

C. What are the risk factors associated with this patient?

- Poor oral hygiene
- Frequent sugar intake
- Irregular dental checks up

D. What is the disease caused by excess Fluoride?

- Fluorosis

E. Mention three mechanisms of action of Fluoride?

- Make enamel crystals larger and more stable
- Enhance the remineralization by forming fluorapatite
- Inhibition of plaque bacteria by blocking the enzyme enolase during glycolysis

F. How to prevent it
- Fluoridating mouth wash &Toothpaste
- OHI
- Frequent dental visit

G. What is the treatment?

- Micro Abrasion
- Veneers
- Composite restorations
- Resin infiltration

[81]
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OSCE 79

A picture showing a patient with overjet

A. Name the Appliance used to correct this?
- Twin block appliance \ functional appliance

B. Indications of the Twin Block Appliance? Two

- Used for class ll div 1
- Class ll div 2
- Class ll div 1 and 2 with posterior cross bite
- Retruded mandible

C. What is the ideal age to treat this condition >?

- Girls 10-12y | Boys 13-15y
➔ Active use 6-8 months full time wear \ then 4-6 months only night time
D. What is the construction of Twin Block Appliance?
- Maxillary block : bite block ,labial bow , Adam’s clasp , slow palatal expansion screw
- Mandibular block : bite block, Adam`s clasp , lingual flanges

E. What skeletal and dental changes are expected while using this appliance ?
- Skeletal :
- Restrain forward maxillary growth
- Stimulate mandible forward growth
- Increase LFH \ condylar fossa remodeling
- Dental :-
- Mesial movement of lower molar
- Distal movement of upper molar
- Retroclination of upper teeth
- Proclination of the lower teeth
F. What Ceph changes are expected while using this appliance
- Increase SNB Advantage of twin block
- Decrease SNA
- Decrease ANB 1. Correct AP \ Transverse , vertical
- Increase MMPA 2. Leaves then with tooth alignment
- Increase lower facial height only
- Decrease UI maxillary Plane 3. Avoiding the orthognathic surgery
- Increase LI Mandibular plane
G. What are Disadvantages of this appliance –
- Posterior open bite
- Difficulty in speaking and mastication
- Cannot perform complex tooth movement
- Cannot correct lower incisor crowding
H. How to overcome open bite disadvantage :-
- By reducing the bite blocks gradually
- Part time wearing appliance
-

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OSCE 80

A. Identify those appliances and mention one use for each and
mode of action?

- 1- Unilateral band and loop –unilateral space maintainer

2- Tans palatal arch TPA – bilateral space maintainer, intermolar width
fixation
3- Nance appliance – ANCHORAGE and space maintainer (Nance against the palate & intermolar
fixation, anchorage for
reinforcement)
4- Lingual arch – bilateral space maintainer (intermolar width fixation)

B. What component of appliance no. 3

- Bands on molars – acrylic button- stainless steel wire
0.9 mm

C. What is the consequence of premature loss of deciduous teeth?

Crowding, delay eruption, spacing, impaction, midline shifting

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OSCE 81

D. Give 4 differential diagnosis?

- OKC
- Ameloblastoma
- Odontogenic myxoma
- Central gaint cell granuloma

E. What is the histopathology of the lesion shown in Histology

slide?
- - thin layer of parakartin
- Folded membrane like appearance
- Satellite cells in the wall
- Epithelial lining of uniform thickness with flat basal layer
- Thin FIBROUS WALL

F. What is your diagnosis?

- OKC

G. From which cells this lesion arises from?

- Rest of Dental lamina
- What are the possible causes of recurrence ?
- Thin fragile lining
- Difficult to enucleate
- Finger like cyst extension into cancellous bone
- Satellite “ Daughter” cyst .

H. Where expansion occurs in the OKC ?

- With in the medullary spaces / anterior posterior direction

I. What is the medical condition associated with it “? Multiple OKC?

- Gorlin- Goltz syndrome
J. Three other features of this syndrome ?
- Basal cell carcinoma
- Calcification of Falx cerebri
- Frontal and temporoparietal bossing
- Hypertelorism
- Broad nasal root
- Mental retardation

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OSCE 82

A. Describe what you see in the photograph?

- Generalized Gingival recession
- Abrasion
- Plaque & calculus Deposits & stains
- Missing 36

B. Which 4 examinations would you undertake?

- BPE
- Bleeding index and Plaque index measures General causes to gingival
- Periodontal charting recession :
- Mobility testing
- Sensibility testing • Traumatic T.Brush
- Multiple preapical xray and opg • Traumatic occlusion
• Out of the arch tooth
C. What are the causes of this? • Labial orthodontic
- Aggressive tooth brushing technique movement
- Periodontal disease • Abrasive tooth paste
- Poor oral hygiene • Habits like nail biting
- Traumatic occlusion • Incorrect T brushing
- Thin gingival biotype technique

D. What may be the patient complaint?

- Dentinal Sensitivity • Mucogingival surgery to
- Esthetic concern correct Recessions :
- Mobility - Lateral pedicle graft
- malodor \ halitosis - Double papilla graft
- inability to incise the food ‘ function concern ‘ - Coronally repositioned
flap
E. Describe your management? - Free gingival graft →
- Identify the cause and treat it wider & functional zone
- Oral hygiene instruction (Avoid ,horizontal strokes in brushing use tooth brush of attached gingiva
with soft bristles ) - Thin acrylic gingival
- Scaling and root surface debridement veneer
- Oral hygiene maintaince
- RMGC restorations for abrasion and root caries
- Surgical management for gingival recession

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OSCE 83

A picture showing Kennedy’s Class III Mod 1

A. Which Kennedy’s classification is this?

- Class lll mod l

B. Other than implants what restoration would you place in this patient?
- RPD
- Fixed Bridge

C. What materials are your 2 restorations made of?

- Acrylic
- PFM,Ceramic

D. What are the 2 disadvantages of the 2 restorations you

mentioned?
- RPD

- Weak material , non-rigid , must be bulky for strength , high potential for soft tissue damage

Fixed bridge
- More Removal of sound tooth structure \ less conservative
- Increased cost
- Not suitable for long spans
E. What is the function of the RPI system ?
- Avoid the need for reciprocal arm
- Esthetic = gingival approaching arm
- Passive nature so prevents undue loading of abutments
F. Name 5 options to increase retention and stability in class l
- Maximum coverage
- Altered cast technique
- Lingual plate major connector
- Indirect retention over canines
- Maintaining occlusal harmony by using narrow table teeth

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OSCE 84

A. Describe the lesion shown in photograph?

- Scarring of conjunctiva – symplepharon
- Desquamative gingivitis ( Fiery red gingiva )

B. What is your diagnosis?

- Mucous membrane pemphigoid

C. Name 2 topical steroids with dosage you would recommend for

this patient?
- Betamethasone 500 micrograms
- Beclomethasone ( clenil modulite )50 micrograms

D. Name 2 systemic steroids with dosage you would recommend for this patient?
- Predinoslone 10-20 mgs PO
- Hydrocortisone 100 mgs IM
- Methylprednisolone 2-40 mgs PO

E. After administering Local Anesthesia and deciding the choice of biopsy. What should be done before
biopsying the lesion?
- Take the informed consent ,
- Tracing ?

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OSCE 85

A. Name the 3 restorations?

- Gold crown
- PFM ; porcelain fused to metal
- Full porcelain crown ; zirconia

B. what crown would you go for in bruxism patients out of these 3?

- Gold crown – why ? → gold more resilient more wear resistance , high elastic of modulus elasticity
, less occlusal reduction required also { more conservative}

C. How much would you prepare for functional and non-functional cusps in Gold Crown?
- Functional = 1.5mm
- Non functional = 1 mm

D. Which cement would u use for high caries risk patient?

- GIC

E. Ideal cement for All Porcelain?

- Resin cement

F. Disadvantages of gold ?
- Esthetic poor , expensive

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OSCE 86

A Patient with HIV

A. Describe the lesion shown in Photograph A?
- An intraoral clinical photograph showing corrugated white lesion with irregular margins on the lateral
border of the tongue.

B. What is your diagnosis

- Hairy leukoplakia

C. Describe the lesion shown in Photograph B?

- An intraoral clinical photograph showing small rounded blackish brown lesion on the right side of the
palate.

D. Give 2 differential diagnosis for this lesion

- Kaposi’s sarcoma
- Pigmented nevus
- Post traumatic ecchymosis

Treatment of necrotising ulcerative gingivitis:

E. Mention 4 diseases you would see in HIV Patients?
• Local measures
- Candidiasis
• Oral hygiene instruction
- OHL
• Debridement
- NUG/NUP
• Chemical plaque control, eg chlorhexidine
- Lymphoma
•
- Kaposi’s sarcoma Metronidazole 200—400 mg three times daily
- Recurrent major aphthous ulcer for 3 days if systemically unwell
•
Advice on management of risk factors, oral
hygiene instruction, nutritional advice

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OSCE 87

A. What is shown in photograph

- Facial palsy – “ of the right side of the patient “

B. Differentiate between Upper and Lower Motor Neuron lesions

- UMN lesions = the ipsilateral paralysis for lower face ,taste sensations is retained ,
corneal reflex is not affected , No atrophy in the facial muscles , Emotional movement
are not affected in unilateral cases !
- - LMN lesions = the whole side of face is affected , Bells phenomenon is present ,
corneal reflex is lost , taste is lost , Hemiplegia is corssed !

C. What are the branches of facial nerve?

- Temporal – frontalis muscle → wrinkles of the forehead -
- Zygomatic → orbicualis oculi → closing of the eye
- Buccal → buccinator → puff of the cheek
- Marginal mandible → lower lip mentalis m → kissing muscle
- Cervical → platysma muscle → shrunk or wrinkle in the neck

D. Why do we suture the eye in a patient with Facial Palsy?

- Avoid the dryness
- Avoid the trauma to the eye
- Avoid the entrance of foreign bodies

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E. Enumerate 3 extracranial and intracranial causes for this ?

- Extracranial :
- Bells palsy
- Melkersson Rosenthal syndrome
- Post parotidectomy
- Malignant parotid neoplastic
- Sarcoidosis “ Heerfordt syndrome “

- Intracranial :
- CVA “strokes”
- Intracranial tumor
- Multiple sclerosis
- HIV
- Lyme disease
- Ramsy Haunt syndrome

F. What is Ramsy haunt syndrome ? Rx ? and is it LMN or UMN ?

- It’s a herpes zoster infection in geniculate ganglion , also there will be a vesicles around the external
auditory meatus & the palate due to infection
- Its intracranial caused → LMN
- Rx by acyclovir 200-400 x 5 x 5 ,also some advocate the usage of high steroids short course

G. What is the significance of forehead wrinkling?

- It can differentiate between the Lower motor neuron lesion and Upper motor neuron lesion → the
inability to wrinkle the forehead means the patient have LMN lesion

[91]
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OSCE 88

Advantage of vaccum over non vaccum?

Vaccum autoclave Non vaccum autoclave

Less time More time
Only for solid instruments
Used for hollow , solid , perforated
instruments
Will cause rusting
Wont cause rusting to instruments
Storage time up to 1 year if wrapped 1 day in clinical area – 1 week in non
clinical areas
Wrapping insruments No wrapping
Less expensive
Expensive
Verifiable sterlizations Not as effective as Vaccum autoclave

* Optimum pressure
- 32 PSI (2.2 Bar ) for Vaccum autoclave
- 15 PSI for non vaccum autoclave
A. Optimum temperature
- 134 c for 3 mints
- 121 c for 15 mints
- 126 c for 10 mints
B. Difference between vacuum and non-vacuum autoclave in mechanism?
- Non-vacuum air is removed by displacement by steam entering the chamber-
Vacuum drowning vacuum
- Non-vacuum autoclaves do this by displacing the air, whereas vacuum autoclaves suck the air
from the chamber.
C. Optimal temperature & pressure & time for autoclave?
N type – solid non
- 134 c, (2.2 bar 32PSI), 3 minutes
wrapped , displace
D. Advantage of vacuum over non-vacuum? steam
- Less time
- Instrument can be wrapped B-type hollow ,
- No rusting of instrument wrapped Vacuum stage
- Better steam penetration S-Type :used for
- Storage time 1 year specific load set by the
- Verifiable sterilization manufacture –
E. What is the difference between sterilization and decontamination?
Cleaning: general remove of debris
Disinfection: remove most organism present on surface can cause infection or
disease
Sterilization: the killing or removal of all organism and spores

F. Criteria for hand piece sterilization

[92]
 MFD PART 2 OSCES

- Drying [ first we must wash it in water disinfector then we check for cleanliness and functionality
then dry ]
- time 3-5 minutes
- saturated steam
- temperature 134 c
- direct contact with the steam
- Vacuum > 2.2 Bar ?
G. steps for wrapped instrument sterilization process ( ref : sterilization in SDCEP)
- change gloves
- Transportation of Instruments
- STEP 2: Cleaning and Disinfection of Instruments Cleaning instruments effectively is an essential
step before
- STEP 3: Inspection and Packaging
- STEP 4: Sterilisation
- STEP 5: Storage

H. Types of autoclaves and differences

additional info

[93]
 MFD PART 2 OSCES

OSCE 89

I. Different colored areas of the mandible

A. Name the foramen coloured by red?

- Mandibular foramen

B. Name the nerve entering this foramen?

- Inferior alveolar nerve

C. Name the nerve crossing the area which is coloured by yellow?

- Lingual nerve

D. Which structures innervated by this nerve?

- Lingual gingiva of all teeth , floor of the mouth , anterior 2\3rd of the tongue sensation

E. Mylohyiod muscle attachment is coloured; name the nerve that innervates this muscle?
- Mylohyoid nerve from the mandibular division of the trigeminal nerve

F. There is a nerve going to the anterior 2/3 of the tongue; where is located the root of
this nerve?
- Chorda tympani
- Root lies in the superior salivary nucleus, Nucleus of tractus solitarius

[94]
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OSCE 90

A. What is this ?
- Dental surveyor
B. Name its parts.
- Horizontal arm
- Vertical arm
- Analyzing rod
- Surveying arm
- Level platform
- Cast holder
C. What is this ?
- Analyzing rod
D. Uses of Surveyor
- Determine path of insertion
- Determine what surfaces can be used as
Guideplanes
- Contour the wax pattern
- Blockout any undercuts
- Define the height of contour in abutment tooth
- Located undesired undercuts for blackout

Gold wrought wire → 0.75 mm

SS wrought wire → 0.5 mm
Cast Cr-Co→ 0.25 mm

Function of surveying tools

- Analysing rod – assess undercuts and angulations

- Carbon marker – mark around tooth
- Undercut gauge – measure the depth of undercut
- Wax trimmer – block out or reduce wax during blockout
-

[95]
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OSCE 91

A. Identify the Kenneyd’s classification

-
- 1 = class 1 mod 1
- 2 = class 1 mod 2
- 3= class 3 mod 1
- 4= class 3 mod 3
- 5= class 2mod 2
- 6= class 2 mod 3

[96]
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OSCE 92

7year old child with trauma to his upper central incisor with pulp exposure 1-2 mm

A. Mention factors that can affect the treatment plan ?

- Stage of root development \ Apex close – open ?
- Site , size of exposure
- Time since the trauma
- Any chance of contaminations
- Any fracture in the root

B. Management? How to asses the vitality of the tooth

- Partial pulpotomy \ electric pulp tester , thermal test

C. Steps to do this procedure?

- LA & rubberdam
- Enlarge of the access site of exposure and amputate about 1-2mm of the healthy pulp
- Arrest the bleeding using a moist sterile cotton wool
- Place a non setting calcium hydroxide / ferric sulphate in case of primary tooth
- Restore with Glass ionomer / RMGIC
- Restore with a crown

D. Aim of this procedure

- Apexogensis ( protection of the remaining pulp to help to growth root and close the apex )

E. If the same scenario but the tooth is subluxated. What is the

management?
- flexible splinting for 2 weeks
- instruction for soft diet

[97]
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OSCE 93

A. What’s the name of this prosthesis?

- Resin bonded bridge | Maryland Adhesive bridge
B. Give two advantages of it ?
- Esthetic
- Conservative
- Space maintainer
- Low cost

C. Mention 5 preparation features of it?

- 0.7mm depth for the wings
- For resistance: mesial and distal grooves
- For retention: wrap around design
- Preparation should be in enamel
- Since it is metal so chamfer but minimal
- Single path of insertion. Parallel guiding planes > eliminate undercuts > maximal surface area for
bonding (ref oxford 7th ed )

D. Mention single extra preparation requirement for Resin bonded bridge in posterior
teeth ?
- Wrap around 180 degree on occlusal surface
- Occlusal rest

E. The success rate ?

- 87.7 %
F. What are the function of the guiding plane ?
• Provide for one path of insertion.
• Provide retention and stability against horizontal rotation of the
denture.
• Eliminate food traps between abutment teeth and RPD

[98]
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OSCE 94

A. Normal number?
- 1.5 -4.5 x 10^ 9 per \L

B. From where they arise?

Megakaryocyte from Bone marrow

C. Life span ?
- 8 days
-
D. Function
- Maintain hemostasis
- Maintain Vascular integrity
- Blood coagulation – it carry coagulation factor – Platelet factor 3
- Clot retraction – contractile protein system involving thrombosthenin

E. Medical term when they decrease? And if they increased

- Thrombocytopenia , thrombocytosis

F. Two diseases in which they decrease?

- idiopathic Thrombocytopenia
- megaloblastic anemia
Proprieties of platelet :
- leukemia
- Adhesiveness
G. Two diseases in which they increase ? - Agglutination
- infections - Aggregation
- Acute blood loss
- Cancers
- Iron deficiency Structure \ unltra structure
- Anucleate cell fragment
H. Other 2 process of hemostasis? - Trilaminar membrane
- Coagulation Cascade - Dense granule – ADP
- Vasoconstriction - Alpha granule - Vwf

I. Factors for platelet adhesion?

- Activated proteins on their surface to allow them to stick to breaks in

the vessel wall and stick to each other.(adhesion )
- Change shape, extend filaments / tentacles( aggregation )
- Recruit another platelet to aid plug
- Reliant on von Willebrand Factor (vWF)

[99]
 MFD PART 2 OSCES

OSCE 95
A. What can you see?
- Desquamates gingivitis : red fiery ,smooth , inflamed shiny across the
attached gingivae : (CAWSON)
B. What are the differential diagnoses?
- Lichen planus
- Pemphigus vulgaris
- Mucous membrane pemphigoid
C. What might you see in patient’s body that has a relation to this lesion?
- Skin lesions = cutaneous lesion on flexor of wrist with minute white striae’s
- Alopecia
- Rigid nails
D. What are the clinical presentation ‘ types of lichen planus ‘
- Reticular
- Atrophic
- Erosive
- Plaque like
- Papule like
E. Age group commonly affected ? -ref SAQ
- > 40
F. Lichen planus what dose it affect?
- Mucuos membranes and skin
G. List the histological features of lichen planus ?
- Hyperkeratosis / parakeratosis
- Edema extending into basal layer leading to liquefaction
- Civatte bodies in epithleuim
- Saw tooth rete ridges
- Bands of lymphocytic infiltrations
H. If it was atrophic lesion what histology might be seen ?
- Thinning and flattening of epithelium ,
I. what serious complication can arise from Erosive lichen planus ?
- malignant change
J. mention another connective tissue disease that can lead to lesions “ intraorally “ similar to the
Lichen planus ?
- Lupus erythematous
K. What is the treatment?
- Asymptomatic = no need
- Symptomatic = chlorohexidine , benzydamine mouth wash , steroids
L. Gingival inflammation present in which syndrome
A. peutz jeghers syndrome
B. crohns disease
- Answer = crohns disease

[100]
 MFD PART 2 OSCES

OSCE 96

• Patient diagnosed with sjorgen syndrome

A. How can you differentiate between primary and secondary ?

- Primary SS → Lacrimal & salivary gland dysfunction
- Secondary SS → primary Sjorgen syndrome accompanied with Connective tissue disease ( RH
arthritis )
-
B. Mention two sites where can we take the biopsy
- Lip biopsy – minor salivary glands
- Tail of the parotid
- Cheek mucosa

C. Mention four blood investigations ?

- CBC
- Anti-SSA- RO
- Anti-SSB-LA
- Serum IGg
- ESR
D. Histology ?
- Focal lymphocytic sialdentitis -:
- Acinar atrophy
- Interstitial fibrosis
- Ductal destruction

[101]
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OSCE 97

A. Type of trauma
- Intrusion

B. Investigations?
- Preapical radiograph from 2 angles , palpation for the buccal plate

C. What are your treatment options?

- Wait for re-eruption – 6 months if not erupted → extract
• Trauma for primary tooth
- Extract if displaced lingually toward the permanent tooth buds
Concussion and subluxation: observation

D. What are the indications for extraction? Lateral luxation: if no occlusal interference, the tooth is
- Root causing damage for the permanent successor
allowed to reposition spontaneously; if occlusal interference,
- Tooth exhibit signs of ankylosis
extract.
- Alveolar fracture
- Patient demand Intrusion: if the apex is displaced toward the labial bone plate,

then leave or spontaneous repositioning. If no movement within

E. What are cases that you have to extract the primary tooth? 4 6 months, extract. in addition, if the root has perforated the
buccal plate of bone, as identified by palpating the area, extract
- Irreversible pulpitis and patient asks for extraction
- Serial extraction in orthodontics
- Gross carious non- restorable tooth
. If the apex is displaced into the developing
- Ankylosed tooth
- Over retained tooth . tooth germ, extract.

Treatment intrusion : permanent

Trauma:-
If immature apex → frequently reerupt therefore no Rx required Splinting time:-
1. Avulsion 2 weeks functional splint.
If closed apex → limited potential for re-erupt so ortho extrusion may be 2. Luxation 2-4 weeks functional splint.
required 3. Apical and middle third # 4 week
functional splint.
If Displacement is sever → more than 6 mm consider surgical repositioning 4. Coronal third 8 weeks functional splint.
“whether its closed or open “and flexible splinting for 2 weeks 5. Dento-alveolar # 3-4 weeks of rigid
splint.
Pulpal necrosis and root resorption can occur rapidly so do early RCT with 6. Intrusion open apex >7mm 8 weeks
CAOH is recommended functional splint

Pulp death is certain in closed apices “high percent “

Factors to decide whether necrosis

[102] occurred after avulsion or tooth
trauma :
1. Sensitivity testing.-
2. Tooth discoloration
 MFD PART 2 OSCES

OSCE 98

Radiograph of upper right central Incisor

A. Types of external root resorption?

- External replacement root resorption (ERR) – ankylosis
- External inflammatory root resorption (EIR)
- External surface resorption (ESR)
- External Cervical resorption (ECR)

B. The cause of root resorption in the pic?

- Due to reimplantation that led to external inflammatory root resorption in Avulsed tooth
- Or due to concussion that led to pulpal necrosis →then external root resorption

C. How you will treat it?

- Rx ; RCT followed by non-setting CAOH → then when the resorption slow down or stops → GP
obturation !
- Overall prognosis is poor

[103]
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OSCE 99

A. What is this probe

- CPTIN -C → community periodontal treatment index of treatment needs
B. What is the mark a
- 3.5-5 mm

C. What is the mark b

- 5.5-8.5 mm
-
D. What is the score from the given reading?
- BPE 4
- Probing depth >5.5mm (black band disappears, indicating a pocket of 6 mm or
more)

E. What is the treatment need of the patient according to the

score?
- OHI
- ROOT surface debridement
- Refer for specialist for complex periodontal treatments

[104]
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OSCE 100

- Swelling under the tongue of patient using denture

A. What is the differential diagnosis ?

- Ranula
- Sublingual dermoid cyst
- Osteoid of mandible

B. Four clinical features of the lesion

- Painless soft , fluctant , bluish or translucent
- Unilateral or may extend to whole floor of the mouth

C. Treatment ?
- Marsuplization and excision of related gland

[105]
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OSCE 101

A. Describe what do you see?

- Upper central is in cross bite with the lower teeth ( Single
anterior crossbite )

B. Causes for it
- Delayed exfoliation of the Deciduous (overretained primary
tooth )
- Trauma to the tooth
- Due to Ectopic position of the tooth bud

C. Treatment
C. Tongue blade therapy can be used for developing crossbite!
D. Remvable Hawley appliance with z spring
E. Fixed 2x4 appliance \ segmented fixed orthodontic

[106]
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OSCE 102

A. Picture of posterior maxilla with needle in area of posterior superior

alveolar nerve

B. What is being done in picture?

- Posterior superior alveolar nerve ‘PSA’ Block
C. Which teeth will be anesthetized?
- Maxillary 3rd 2nd molars and Distobuccal root of the 1st ‘DB’ – MB root of the 1st molar supplied
either by PSA MSA .

D. What artery at tip of needle? What vein

- Pterygoid plexus of veins and PSA artery

E. The artery at tip of needle is branch of artery that is the terminal branch of one of
important artery in neck?
- Maxillary artery branch of External Carotid artery

F. What is the other terminal branch of that artery?

- Superficial temporal artery

[107]
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OSCE 103

A. Picture of patient with Anaphylaxis…after taking Amoxicillin

B. What is diagnosis?
- Hypersensivity type 1 – Anaphylaxis reaction

C. What are the signs of Anaphyalxis reactions ?

- Skin = Urticaria, flushing, angioedema in lips, itching
- Respiratory = laryngeal edema, wheezing
- CNS = slurred speech , altered consciousness , confusion
- CVS =cyanosis , pallor ,Hypotension , carddiac arrest
- GIT= vomting , nauesa
D. What first line of treatment? Dose? Route of Adminstration?

F. First line of treatment

G. Contact the EMS
H. Place patient in supine position
I. Maintain Airway
J. Breathing
K. Circulation
L. Disability
M. Exposure
- Give patient 100% o2
- Give patient 0.5 ml of 1:1000 epinipherine IM .
Adrenaline Dose
- Monitor patient Vitals
E. Other drug used? A. For > 12 adult – 0.5 ml = 500
- Steroids – Dexamethasone 4 mg iv ,or hydrocortisone 100 mg iv micrograms
- Antihistamine B. For Child from 6-12 y = 0.3 ml or 300
- IV Fluids 500-1000 ml ins bolus for adults (NS or ringer lactate )_ micrograms
C. For child < 6 years = 0.15 ml = 150
F. What are expected complications if not treated :
micrograms
- Shock
- Carddiac arrest
- Respiratory arrest
- Airway obstructions
G. What precautions should be made to prevent anaphylaxis reaction
- Take medical history for any allergies and avoid exposing the patient to it

[108]
 MFD PART 2 OSCES

H. Name 10 drug in emergency used with their route of Administration and their
condition they use in?

ABC GSG HO
Aspirin 300 mg can be used in Myocardial infraction . PO

Epinephrine 0.5ml 1:1000in case of Anaphylaxis IM (1 mg in 1 ml)

10 mg /1ml IM → Allergy or Anaphylaxis

Chlorphenamine maleate

100% 6-8 L /mint in all cases where breathing is

Oxygen
impaired

Buccal midazolam 10 mg in case of Status epilepticus IM|IV

Glyceryl Trinitrate 0.5 mg sublingually in case of Angina pectoris

Spray → 0.4 mg
(Nitroglycerine ) GTN
Glucagon 1 mg IM in hypoglycemia
(child or weight is < 25kg = Give 0.5 mg )
Salbutamol inhaler 0.1 mg per dose INH – Asthma

Hypoglycemia 20-50% dextrose 50 ml

Glucose or sugar \
20-50% dextrose
100 mg powder with 2 ml inj = IM
Hydrocortisone sodium
Asthamaticus
succinate
in case of adrenal crisis = 100 mg IM

Naloxone Used for opioid induced apnea 0.4 mg

Ref : oxford 7th ed 621

[109]
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OSCE 104

A. What does MRONJ stands for?

N. Medication related osteonecrosis of the jaw

B. Give definition for MRONJ

O. A condition where there is nonhealing exposed bone in a patient with a history
of antiresorptive or antiangiogenic agents(inhibition for osteoclast ) in the
absence of radiation exposure to the head and neck region

C. For what medical problems these medications are used?

- Osteoporosis
- Bone malignancies → multiple myeloma , breast cancer , prostate cancer
- Paget disease

D. Stages of MRONJ 3
Stage 1 Exposed necrotic bone - Antibacterial mouth wash
NO infection No pain - Patient education
- Follow up 3-4 months

Stage 2 - Exposed necrotic bone - Antibacterial mouth wash

- Pain and infection - Antibiotics + pain
medications
Debridement
Patient education

Stage 3 Exposed necrotic bone with - Antibacterial mouth wash

one of the following : - Antiobiotic with pain
- Oroantral communication medications
- Pathological fracture - Debridement
- Extraoral fistula - Patient education
- Exposed necrotic bone
extend beyond the alveolar
bone
- Osteolysis extending to the
inferior of mandible

• Additional infos on MRONJ

[110]
 MFD PART 2 OSCES

➔ Risk is associated with high potent bisphosphonates like : Alendronate , pamidronate ,

zoledronate in High doses + Intravenously
➔ Risk is from 1% for low -risk drugs in osteoporosis to 30% in myeloma survivor at 10y ( oxford
7th ed )
➔ Always seek for the prevention in those patients , also select alternative treatments like
endodontics , coronectomy
➔ Always we should make the patient Dentally fit before Bisphosphonate treatments “ remove
any poor prognosis teeth and make the patient dentally fit “
➔ High risk –
P. patient on IV bisphosphonate more than 12 month / orally for 36 month “SAQ”
Q. Treatment as part of cancer metastasis
R. Iv bisphosphonate + corticosteroids
S. Previously diagnosed with MRONJ

[111]
 MFD PART 2 OSCES

OSCE 105

Model on articulator, there was an appliance.

A. What’s this appliance?

- Twin block

B. At what age is it used?

- Girls 10- 12
- Boys 13-15

C. What type of malocclusion is it used to treat?

- Class ll div 1
- Class ll div 2
- Class ll div 1 ,2 with posterior cross bite
- Retureded mandible

D. What changes will produce? (4 options)

T. Dental :
- Retroclination of the max incisor
- Proclination of mand incisor
- Mesial movement of lower molar
- Distal movement of upper molar
U. Skeletal :
- Stimulate forward movement of mandible
- Restrain forward movement of maxilla
- Condylar fossa remodeling

E. Disadvantages
- Difficulty in speaking or eating
- Posterior open bite
- Can’t treat lower incisors crowding
- Cannot give complex tooth movements

[112]
 MFD PART 2 OSCES

OSCE 106

Photo for maxillary flabby tissue

A. Why is it flabby tissue?

- Fibrous deposition due to chronic irritation or ill fitted denture
which will make tissue movable and displaceable, most
commonly in anterior upper region

B. what is this condition called?

- Epulis Fissuratim , flabby ridge : combination syndrome

C. Causes ?
- Rapid bone resorption
- Combination syndrome → upper edentulous against natural anterior teeth
- loose Dentures→ chronic irritations or badly constructed ‘ ill fit denture – instable denture due to
under extended \ overextended flanges .
- Not removing denture at night to give rest to the tissue .

D. Clinical Features
- this is a overgrown soft tissue in the vestibular sulcus area, or anterior of edentulous area , often red
,swell up and movable , displaceable , cause discomfort for
patients .

E. How to avoid it ?
- Modification of ill fitted dentures
- Rest of tissue , tissue stopers

F. Management?
- Conservative approach (tissue rest, soft tissue massage, modification of denture ,tissue conditioner )
- Prosthetics approach (impression : window technique , | centric occlusion record )
- Surgical approach

[113]
 MFD PART 2 OSCES

OSCE 107

A question about Post length and width and Ferrule effect with diagram.

A. Ideal post length and width

- Length should be equal to the anticipated crown
- Width should be 1\3 of Buccolingual of root
- Should be 4-5 mm of remaining guta percha
- Should be 2mm height of ferrule
- Half of the post should be below the alveolar crest

B. Definition of Ferrule it’s the

- 360 degree of metal collar of the crown that encircles the dentine and extend coronally from the
shoulder of the preparation
A ferrule is a band of
C. What is the importance of the ferrule effect ? crown
V. it will give the bracing and protect the integrity of the root material that completely
encircles the tooth and is
between the dentine—
core interface and the
cervical
crown margin.

[114]
 MFD PART 2 OSCES

OSCE 108

The opg was for adult patient and the roots was displaced rather than resorped

OPG with large cyst like lesion between lower canine and 1st premolar: adult and no root resorption

A. Describe the radiolucency

- Well defined radiolucent unilocular lesion on the
right side of mandible between roots of premolars
44 45
B. Give 6 differential diagnosis
- Dentigerous cyst
- Odontogenic fibroma
- Ameloblastoma
- Odontogenic Myxoma
- Hemangioma
- Odontogenic keratocyte
C. Give 5 radiographical features
- Unilocular
- Radiolucent
- Round margins
- well defined margins
- Causing displacement for 4 ,5
D. What is the difference between incisional and excisional biopsy
- Excisional à used for lesions that is less than 2 cm , it will remove the entire lesion
- Incisional à used for lesions that are more than 2cm , it will remove part of the lesion only
E. What other 2 plain radiographs we can we can take?
- Lateral oblique –
- Standard occlusal view –
F. ALARA
- As low as reasonably achievable

[115]
 MFD PART 2 OSCES

OSCE 109

Picture of dorsal surface of the tongue

A. What is this lesion?

- Geographical tongue , erythema migrans glossitis

B. Which skin lesion does look like/ or associated with?

- Psoriasis

C. Is it genetic?
- Yes , commonly is genetic “ ref – Churchill “

D. Mention 2 etiological factors?

- Stress
- Genetic
- Idiopathic

E. What is the treatment?

- No treatments only symptomatic relief
- Benzydiamine mouthwash 0.15% TDS
- Avoid spicy food or trigger factors
- Topical steroids can be applied Triamcinolone acetonide 0.1 %
- Zinc supplemental

[116]
 MFD PART 2 OSCES

OSCE 110

Photo of Gingival Hyperplasia! of hypertensive lady who is taking antihypertensive had a

Restorative treatment 4 years back

A. Why it happened?
- antihypertensive drugs like certain calcium channels blockers like nifedipine can lead to Drug induced
hyperplasia

B. Treatment?
- Reinforce oral hygiene
- Gingivectomy
- Consultation with patient physician to alter the drug

C. Alternative drugs:
- ACE inhibitors “Enalapril “
- Beta blocker: ‘Atenolol’

D. Other drugs that might lead to gingival hyperplasia

- Ciclosporin
- Nifedipine
- Phenytoin

[117]
 MFD PART 2 OSCES

OSCE 111

Picture of Early childhood Caries

A. What is this?
- Early childhood caries \ Nursing bottle caries \
-
B. What are the causes?
- Bottle feeding and sleeping
- Consumption of highly sweetened drinks\ high cariogenic
- Poor socioeconomic / social variable
- Hereditary / biological variable
- breast feeding on demand

C. Give 3 of your initial stage of treatment

- Diet analysis \ OHI \ educating parents to stop the habit
- Restoration with strip crowns technique – SCC for posterior teeth
- Restoration with GI fluoride \ – Follow up and Fluoride T.paste
-
D. What changes that will happen if the habit stopped?
- Caries progress will reduce
- Improving overall oral health

E. What will happen if left untreated?

- Caries will progress until pulpal involvement
- It will damage the permanent successor
- Lead to early loss of teeth à space loss à Crowding and malocclusion
- Pain can lead to psychological effect on the child and interrupt his activities

F. Method of topical fluoride application with concentration ?

- Fluoride gel or foam 1.23% = 12300 ppm
- Silver diamine fluoride 38% = 44600 ppm
- Fluoride varnish 5% NaF varnish = 22500 ppm
- Slow releasing fluoride device

G. What the advantage of silver diamine over other methods and disadvantages ?

[118]
 MFD PART 2 OSCES

• Advantage:
- Use on uncooperative child
- Quick
- Painless
- remineralization
- Antimicrobial
- Reduce hypersensitivity

• Disadvtangaes:
- Discoloration of the tooth
- Toxicity
- Fluorosis
- Bad taste

H. What is the lethal dose and toxic dose of fluoride, management?

Lethal dose = 16-32 F /kg
Toxic dose = 5 mg F/kg
Management: induce vomiting
Give milk
Refer immediately → if delay give IV calcium gluconate and an emetic

[119]
 MFD PART 2 OSCES

OSCE 112

A. What other tests to check vitality of the pulp?

W. Thermal test “ Hot gutta percha “
X. Electric pulp test
Y. Pulse doppler flowmetry
Z. Pulpal oximeter

B. Then they specified the type of pain and asked about the
diagnosis :
- Provoked pain , sharp pain , for seconds or minutes , non tender
to percussion , difficult to locate→ reversible pulpitis
- spontaneous pain , dull throbbing ,worse at night ,pulsatile in nature , it can be located “ if
inflammation spread to preapical tissue , hot Gutta percha elicits pain ,reduced or no response to EPT
, in later stages become tender to percussion TTP→ irreversible pulpitis

OSCE 108

[120]
 MFD PART 2 OSCES

A. What do you see?

- Reverse anterior bite, bilateral posterior crossbite, midline shifting → class lll with bilateral post
crossbite

B. Name the most important clinical diagnostic information you need to know. (check RCSI intensive
course )
- Is it skeletal or dental → can patient achieve edge to edge
- Prescence of displacement
- The amount of overbite

C. Name 3 causes
- Prognathic mandible
- Retrognathic maxilla
- Maxillary hypoplasia

D. Name the appliance that you can use to treat this case
- Fixed orthodontic treatment – camouflage + Quadhelix for upper
- Orthognathic surgery in case of adult patient
- Headgear with reverse pull – IN GROWING PATIENT with Quadhelix \ Hyrax \ RPE
- Removable – Removable palatal expander , removable with screw

E. What are the factors that govern the treatment of anterior cross bite?
- Type of tooth movement required ? tipping or bodily
- Amount of overbite expected
- Is reciprocal movement is required for opposing teeth
F. What are the factors will govern the Rx of Posterior cross bite ?
- Number of teeth displaced
- Wether displacement is skeletal or dental
- Inclination of teeth
- Upper arch expansion is considered more stable in case of palatal tilted
-

[121]
 MFD PART 2 OSCES

OSCE 113

Picture of generalized gingival enlargement (patient not use any drug)

A. causes for gingival enlargement ?

- Inflammatory ( chronic ,Acute )
- (Genetic) : hereditary gingival Fibromatosis
- Hormonal ( Puberty , pregnancy )
- Nutritional ( Vit C )
- Systematic conditions ( plasma cell gingivitis , sarcoidosis , wegners
granulomatosis
- Idiopathic gingival enlargement

B. Name the investigations needed?

- CBC
- Pocket depth
- Biopsy
- Plaque index , Bleeding index

C. What is your treatment?

- Non-surgical Rx
- Find the cause and treat it .
- OHI and plaque control .
- Scaling and root planning & removing irritant factors – plaque or calculus.
- Antimicrobial treatment
- Metronidazole
- Mouth wash
- Sugrical Rx
- Gingivectomy
- Maintaince Phase
- recall and evaluation.

[122]
 MFD PART 2 OSCES

Schematic for gingival enlargement diagnosis

[123]
 MFD PART 2 OSCES

OSCE 114

A. What is this clinical condition

- Sturge weber syndrome “ hamartomatous angioma affecting upper part of
face which may extend intracranially

B. The patient may have what?

- Convulsion + intellectual impairment ,paralysis on contralateral side of the
body

C. Name the drug that he may take to treat this condition?

- phenytoin, carbamazepine

D. What is the common side effect of this drug?

- Gingival enlargement, constipation, dizziness , liver dysfunction

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OSCE 115

A. What is this appliance , for what its used ?

- Nance button appliance, used for anchorage to prevent space loss or mesial migration of
molars

B. What component of this appliance?

- Molar bands, 0.9 mm wire , acrylic button

C. Name other fixed space maintainer used in upper jaw and mechanism of
their action?
- Transpalatal arch (TPA), act as anchorage & prevent mesial migration of molars ‘Intermolar
fixation’

D. What instruction you give to patient?

- Instruct patient to clean it using water and chlorhexidine | oral hygiene instructions
- Avoid sticky food as it may dislodge or distort the appliance

E. What material used to attach band?

- Silver solder with flux ( between the wire and band )
- Glass inomer ( between the band and the tooth )

F. What are the difference between nance appliance and Transpalatal arch

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- Better compatibility with soft tissue !

- Increase vertical control in TPA

G. Other space maintenance used for child lost

primary second molar E before the eruption of
the permanent molars ?
- Distal shoe space maintainer

H. Mention 2 fixed space maintainers and 2

removable space maintainers other from
mentioned :
• Fixed :
- Band and loop space maintainer
- Lingual arch
- Crown & loop appliance
• Removable :
- Acrylic partial denture
- Essix space maintainer

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OSCE 116

A. What does this picture show?

- Attrition

B. Define Abrasion and Erosion

- Abrasion: physical wear of the tooth structure done by object

“Hard tooth brushing, abrasive tooth paste, pipe smoking or nail
biting .
- Erosions: It is defined as the irreversible loss of tooth structure due to chemical dissolution by acids not
of bacterial origin → you will see the Restorations “ amalgam “ proud restorations

C. Treatment
- Is it active or stopped→ by doing a sequential study casts
and check patient needs
- Management of any cusp ,fractured edges
- Applying fluoride and desensitizing agents
- Restorative treatment including either composites , onlays , inlays , crowns , crown lenghting , splints

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OSCE 117

White lesion on the dorsum of the tongue of the patient and patient is hypertensive using Atenolol

A. Give 4 intraoral decription of what you see ?

- alveolar mucosa glazed & thin
- tongue is smooth , fissured
- no saliva pooling in the floor of the mouth
- gloves , or dental mirror will stick to the mucosa
- white lesion , cant be wiped off \ can be wipped of ? ( if it can be wiped off =
candida . ) ( in case it cannot be wiped off = it means it’s a lichenoid reaction )

B. Mention 4 questions you will ask the patient ?

- Do you use any drugs
- Do you have any other lesions extraorally – flexor , arms , wrest ( wickman stria “
- Any itching , discomfort ?
- Do you feel burning sensation ?
- Is it changing is size ?

C. Mention 4 differential diagnosis ?

- Geographical tongue
- Candidasis
- Dry mouth syndrome
- Lichenoid reaction
- Lichen planus / atrophic , erosive

D. Mention type of suggested biopsy ?

- Pouch biopsy
- Brush biopsy

E. Definitive diagnosis :
- Lciehnoid reaction

F. What microscopical features of it ( licheonoid reaction )

- Hyperkeratosis
- Bands of lymphocytes infiltrate , civatte bodies
- Saw tooth rete ridges

G. What extra oral features in “ Lichenoid reaction )

- Skin lesions = in flexor , arm , wrest , legs [ wickhman striae ]
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- Rigid nails
- Alopecia

H. Drugs can lead to lichenoid reaction

- Beta blockers ; atenolol
- Diuretics
- NSAIDS
- Oral hypoglycemia
- Anti-malaria
- Gold , carbamazepine

I. what investigations you can do ?

- biopsy
- autoantibody serum
- patch allergy test
- clinical picture

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OSCE 118

Picture of A with crown root ratio 2:3

B crown root ration 1:1

A. What relevance of this picture?

- Crown to root ratio

B. What is best one to use as abutment in fixed prosthesis

A or B?
- A

C. What is Antes law?

- Total periodontal support area of the abutment must be equal or exceed than the teeth to be replaced

D. Radiograph of missing multiple teeth consider it according to Antes law? ON which tooth you will make
Abutment
- Premolar 1st 2nd and 3rd molar

E. Can this tooth stand with fixed prothesis? (in the opg )à taken from Malek file
- No

F. What the other surgery can be performed to make prothesis?-

- Bone augmentation with implant placement

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OSCE 119

A. What is the name of radiograph?

- Lower occlusal

B. What can you see ?

- Radiopaque mass in the floor of the mouth

C. Give 4 differential diagnosis?

- Calcified lymph node
- Submandibular sialolith
- Foreign body
- Phlebolith (calcified thrombi)

D. Other 2 radiograph needed in diagnosis?

- CBCT
- Sialography
- Lateral oblique

E. What’s complication of doing surgery in this area floor of mouth?

- Damage to the lingual nerve , lingual artery , mylohyoid nerve ,submandibular gland duct ,hypoglossal
nerve

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OSCE 120

A. pt with major aphthous ulcer, he

gave history of recurrence

A. Name of the lesion ?

- Major aphthous ulcer

B. Patient have other signs like uveitis ,Genital ulcerations which syndrome he had ?
- Bechet Syndrome

C. What are the causes for ulcers

- Traumatic ulcers : Chemical burn , mechanical
- Malignancy – SCC ulcers
- Infections – Syphilis or TB ulcers
- Immunomediated – Oral pemphigus
- Systematic disease – Cronhs , ulcerative colitis

D. Patient said, this lesion is very frequent, why?

- Due to low immunity -AIDS
- Genetic predisposition (HLA -DR2)
- GIT disorders -
- Hematological defeciencies
- Stress

E. Clinical features’
- Isolated lesions in 5-10 mm In diameter
- Painful with erythematous margins
- Heal with scarring
- Reccurent and can last for weeks
- Can Affect keratinized mucosa | others dosent affect keratinized mucosa

F. Differential diagnosis
- Scc
- Traumatic ulcers , chemical burn

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G. Histopathology
- Inflammatory cells
- Neutrophils ,Lymphocytes
- Antischkow cells

H. Treatment
- Local anesthesia topical
- Steroids – hydrocortisone 1% TDS x 7d
- Benzydiamine mouth rinse (Difflam)
- In some cases azathioprine ,cyclosporine or thalidomide by (specialist) à Ref cawson essential of oral
pathology P 282
- Intralesional steroids injections (by specialist) à Ref cawson essential of oral pathology 282 p

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OSCE 121

A. Name of the ligaments

- Spheniomandibular ligaments → Pivot mandible , maintain same tension during open and close
- Stylomandibular ligaments → limit anterior protrusion of mandible
- Lateral Temporomandibular ligament → prevent lateral and posterior displacement

B. Why it’s Atypical joint ?

- Congruity ( bilateral )
- Fibrocartilagenous instead of hyaline like other joints
- Synovial fluid and synovial membrane
- Hinge type joint

C. Action of open and open wide?

- Lateral pterygoid
- Anterior belly of digastric
- Mylohyoid and geniohyoid muscle
D. Which muscles close?
- Massater
- Medial pterygoid
- Temporalis muscle

E. Nerve supply
- Auriculotemporal nerve - tmj
- Masseteric nerve – tmj
- Deep temporal nerve →temporalis m. and supply tmj also
F. Blood supply ? superficial temporal branch , deep auricular , ascending phyarngeal , maxillary artery
- Arterial supply → External carotid branches →superficial temporal branch ( also contributing deep
auricular , ascending phyarngeal , maxillary artery )

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- Venous drainage - > Superficial Temporal vein

G. Mention some TMJ movement ?
- Translation
- Hinge movement , rotation , Gliding

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OSCE 122

A Patient complain of mobile teeth and good oral hygiene

a) Which type of Periodontitis?

- Localized aggressive periodontitis (LAP)

b) Bacteria involved

- - Aggregatibacter actinomycetemcomitans
- - porphyromonas gingivalis

c) What would be your management?

Non surgical approach

- cause finding
- oral hygine
- corrective phase (supragingival plaque control ,chemical control)
- supportive
Antimicrobials →
- Metronidazole 400 mg tds 7 d
- Amoxicillin 500mg tds 7 d
- Local application of periochips
- Surgical approach – flap surgery / modified Widman flap / pin hole surgery – Regerative surgical
approach ( pink book 198 p)
- Maintenance phase – recall and evaluations

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OSCE 123

A middle age female patient reported with swelling which bleeds easily.

A. Clinical features
- Pedunculated
- sessile overgrowth of granulation tissue “ gingival
tissue “
- in interdental papilla area ,
- Red in color
- Highly vascular

B. Differential diagnosis
- pyogenic Granuloma
- peripheral giant cell granuloma
- pregnancy tumor
- peripheral ossifying Fibroma

C. Histopathology
- Multinucleated giant cell
- hemosiderin
- plasma cells
- lymphocytes

D. Treatment
- removal of the causative factor – reassurance to the patient also !
- -OHI reestablishment
- -surgical excision in some cases – with curettage in case of PGCG
- If pregnant tumor → wait until delivery it will reduce and disappear → if not → Rx with
excision

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OSCE 124

Photo of patient with facial nerve palsy: with one eye suture

A. What is this lesion?

- Left facial Paralysis “ Bells Palsy for left side “ ( LMN L)

B. What should you advise the patient to do?

- Cover the eye and keep it \ bandaged , sutured

C. What are the causes?

- infections – HSV . EPV . HZV ,
- Idiopathic , familial bells palsy
- Metabolic : DM, Hypertension
- Trauma : Facial injuries , Altitude paralysis , basal skull fractures
- Neoplastic : 7th nerve tumor , tumors of parotid
-
D. Management
- If seen within 5 days of onset – prednisolone 80 mg for 5d will increase the chance for full recovery
- Protection for the eyes
- Vit B – B12 B6
- Analgesics specially in early stages where patient having pain
-
E. How to differentiate if it is upper or lower motor neuron lesion?

UMN Lesion LMN lesion

Forehead unaffected Forehead affected

Emotional movements are not affected in Emotional movements are lost

unilateral cases

Bells phenomenon is absent Present

No atrophy of the facial muscles present in affected side

Taste sensation not affected Taste is lost

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Corneal reflex is not affected Absent

Hemiplegia is ipsilateral Hemiplegia is always crossed ?

F. Negligence case
G. Who is allowed access to the patient records?
- Dentist , Dental clinic administrator & patient ,insurance companies , solicitor \ court
H. What are the 3 points related to negligence?
- Dentist owed a duty to the patient
- There was a breach in that duty
- Direct harm resulted due to breach in duty
I. What are the time frames for making a complaint?
- Malpractice claim should brought between 6 months to 3 years ( starting from date you noticed
the harm )
- No time frame for mentally disabled patients

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OSCE 125

• Avulsed central incisor (less than 30 mins ago and the mother brought the
tooth in milk)
A. Immediate assessment and treatment for this patient
- Gently remove debris from root surface
- Xray and LA
- Debride the socket
- Reimplant the tooth slowly
- Verify position xray and clinically
- Compress buccal and lingual alveolar plates
- Soft splinting for 14 days – 2 weeks
- Antibiotics and analgesics
B. What you will do later ?
- Monitor it if it became non vital = RCT
C. You will splint the tooth ? if yes for how long ?
- Yes , for 2 weeks
• Check medical history
D. What type of splint you will use & How ? – Check SAQ book ?? • Place tooth in normal saline
remove forgien bodies . check root
- Flexible splint , orthodontic wire and composite , or orthodontic wire and brackets development
E. Factors affect prognosis of treatment? • LA
• Irrigate socket with normal saline
- Extra alveolar dry time (EADT) & extra alveolar time (EAT) • Recontour labial plate with flat
- Root maturity plastic instrument or Coupland
elevator
- Storage medium • Gently reposition the tooth
- Patient cooperation • Bend 0.6 mm stainless steel
include one tooth from each side
F. Types of Storage medium? • Rx chlorohexidine , Amoxcillin or
erythomycine in case of allergy
- HBSS : hanks balanced
• Review in 14 days
- Milk
- Saline Problem solving book

- Saliva
G. Long term complication?
- External root resorption ‘ external inflammatory resorption ‘
- Loss of vitality
- Discoloration - external inflammatory resorption →
external root resorption
- Ankylosis “ external replacement resorption “
- external replacement resorption →
H. Types of resorption ? ankylosis
surface root resorption -→ in
- External resorption - replacement, surface, cervical , inflammatory -
orthodontic high force → cases here
- internal resorption – inflammatory patient have a vital tooth
- cervical root resorption
- internal root resorption :

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OSCE 126

A. Radiograph of root filled upper 6 with small radiolucency. Patient came complain of
pain on biting.
B. Differential Diagnosis?
- symptomatic apical periodontitis
- vertical root fracture
- apical abscess
C. Clinical finding that help u to reach diagnosis?
- History
- Percussion
- Tooth sloth ,fiberoptic , pocket depth , mobility
- Pain
- Abscess location , sinus presence
- Gutta percha tracing for the sinus
- Dyes to show the root fracture

D. Expected cause may lead to failure of treatment?

- Missed canal
- Lack of coronal seal
- Inadequate condensation
- Inadequate shaping and cleaning
- Vertical root fracture

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OSCE 127

A. Which classification?
- Kennedy class l
B. Name of the major connecter?
- Lingual bar
C. What is the retention component in this RPD?
- RPI , gingival approaching clasp , mesial occlusal rest
D. How you will increase support in this case?
- Canine rest
- Increase the tissue supported denture base area ?

E. How to increase retention in the distal extention :

1. RPI system
2. Adequate extension of denture bearing area
3. Indirect retention over the canine
4. Altered cast technique
5. Maintaining occlusal harmony by using narrow table teeth and arranging the
Them in balanced occlusal zone

Stages for doing rpd

• outline saddle area

• Place rests seats
• Place clasps for direct
retentions
• Place indirect retainers
• Connect the denture

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OSCE 128

gingival recession in lower anterior teeth.

A. Why you will treat it mention 4 points?
- Poor Esthetics
- Prevent Further Periodontal Attachment loss.\ mobility
- Prevent plaque and calculus formation
- Facilitate Oral hygiene by preventing food accumulation leading to periodontal disease
- Tooth sensitivity
- Caries risk ‘ root caries ‘
- Halitosis

B. From where you will take the graft

- Autograft : palatal gingiva graft from “ 5 to 6 “

C. What important structure in this area and you have to take care while taken the graft?
- Greater and lesser palatine artery

D. The other options of treatment mention 2 points ?

- Flap surgery → coronally advance flap , double pedicle flap
- Pinhole surgery
- Extraction of teeth followed by fixed

E. Two factors may play a role in success of this procedure ?

- Gingival biotype
- Level of the Oral hygiene
- Prescence of interference ( trauma ?)

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OSCE 129

Picture of a patient of upper teeth after trauma his right central

incisor was extracted and RCT was done for the left central incisor :

A. what are the clinical consequences of extraction of upper incisor

- psychological impact (poor esthetic)
- malocclusion (crossbite)
- space loss
- drifting of adjacent tooth /over-eruption of opposite
- decrease in occlusal function
- bone loss

B. what are your options:

- single implant
- fixed prosthesis
- RPD

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OSCE 130

A. Name of the radiograph?

- On left – 3D view of CBCT
- On right – Axial Veiw of CBCT

B. Uses of this type of x ray, mention 4 points?

- To locate impacted tooth precisely
- Identify the extention of pathlogical lesions
- Used in implants placement to assess the bone
- Assessments of fractures either in face or alveolar bone

C. What is the possible cause of impaction

- Long path of eruption
- Tooth arch discrepancies
- Abnormal position of the crypt
- Trauma
- Ankylosis
- over retaining of primary teeth or early loss of primary tooth

D. How you will treat it?

- Observe and regular follow up
- Surgical exposure
- Surgical exposure and ortho retraction ‘ traction ‘
- Auto-transplantation
- Extraction in case its causing resorption for other teeth

E. What is the complication of doing surgery in this area?

- Loss of vitality to central and R lateral incisor
- Perforation to the nasal floor leading to oronasal fistula
- Injury to the incisive artery and nerve

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OSCE 131

Patient is 11year old.

A. what is this ?
- Ellis class lll fracture involving enamel dentine pulp with fractured coronal segment attached
to the tooth

B. What tests you will do?

- Xray → check for any foreign body in soft tissue ,
- Check the apical status of the tooth
- Prescence or absences of root fracture
- Vitality test

C. What is the treatment in details?

- Preapical Xray → LA → isolate with rubber dam
- Partial pulpotomy / or direct pulp capping depend on time in hours the tooth were exposed
after trauma or the amount of the exposure – using Caoh \ MTA
- Reattachment of tooth fragment with composite
- Relive tooth of occlusion
- Follow up 1,3,6,12 months

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OSCE 132

OPG of Patient in mixed dentition.

A. What is the age of the Patient?

- 8 – 9 years

B. Describe the lesion in the OPG

- Unilocular lesion
- Radiolucent lesion
- Well defined margins
- On right mandibular area involving crown 43
- Causing displacement of 42 83 84

C. Differential diagnosis
- OKC
- Central giant cell granuloma ‘ CGCG’
- Ameloblastoma
- Dentigerous cyst
- Central hemangioma
- Myxoma
- Odontogenic fibroma

D. Treatment?
- Referral to the OMFS
- Surgical excision of pathology /enucleation , marsuplization
- Re-establish oral hygiene
- Prosthetic treatment

E. Histopathology of Dentigerous cyst

- Thin lining , stratified squamous epithelium , collagenous fibrous capsule , scattered nests of
odontogenic epithelium , free from inflammatory cells

F. From where they arise ?

- Remanent of enamel organ

G. Where they are commonly maxilla and mandible ?

- Maxilla → canine region \ permanent canine
- Mandible → 3rd molar region ( posterior mandible)

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OSCE 133

A. What is the damaging effect on the occlusion?

- Bilateral Posterior cross bite + anterior open bite →
- tooth decay , gum diseases , stress on the muscles ,
headaches , chronic jaw diseases , neck shoulder back
pain

B. Draw a removable appliance to correct the crossbite

- Rapid maxillary expansion → removable at 64 ,
- Quad helix → fixed bands on 6, W shape

C. Identify picture of removable appliance

Quad helix , maxillary expansion

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OSCE 134

A. What age is this patient?

- 7-8 years

B. What is the angle classification of the molar?

- Class lll

C. What is the angle classification of the incisors?

- Class l

D. Is it favorable to extract the lower 6?

No, | 7th crown overlapped by 6 roots , lower 7 should reach bifurcation , angulation
between crypt 7 and 6 is < 30

E. What ideal time for extraction of lower 6

- When 7 furcation are forming -8-10 Y
- When 8`s are present
- When you have mod lower crowding
- Always after consulting with orthodontist

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OSCE 135 Hypoglossal → retract tongue

Styloglossus → retract and elevate

Palatoglossus → elevate posterior aspect of

A. Describe what you see tongue
- Deviation of the tongue to right side on protrusion
Genioglossus → protrude Tongue ,depress
B. Which nerve is responsible for this? Tongue , Draw tip back
- Hypoglossal nerve
C. What muscle is this ?
- 1- palatoglossus
- 2-genioglossus
- 3-hyoglossus
- 4-styloglossus
D. Name the extrinsic muscles of the tongue
- Palatoglossal
- Hyoglossal
- Genioglossus
- Styloglossus
E. Mention the intrinsic muscle of the tongue ?
- Transverse muscle
- Vertical muscle
- Superior longitudinal
- Inferior longitudinal
F. What is their motor innervation?
- All innervated by hypoglossal nerve CN Xll , except
Palatoglossus by Vagus nerve X
G. Which nerve supplies the tongue for taste sensation?
- Anterior 2\3 → chorda tympani || lingual for sensory
- Posterior 1\3 → glossopharyngeal lX

H. Motor Innervation ?
- All tongue intrinsic and extrinsic muscles are by Hypoglossal nerve
– CN Xll ( EXCEPT Palatoglossal by Vagus nerve )

-
I. What is the problem with this patient?
- Damage of Right hypoglossal nerve “ motor “

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OSCE 136

35-year-old woman complaining of discoloured lateral incisor with history

of previous trauma. X-ray shows apical radiolucency with resorption of the
apex in relation to the radiolucency

A. What is your diagnosis?\

- preapical diagnosis :chronic Asymptomatic periodontitis \ cyst?
- Pulpal diagnosis : pulpal necrosis
B. What treatment would you do?
- Surgical RCT treatment “ apicectomy “
C. Describe the steps for the treatment you mentioned above
- LA +Rubber dam
- Pulpal debridement
- Flap raising
- Apicectomy
- Retrograde obturation
- Orthograde obturation
- Suture and final restoration
- Follow up and monitoring

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OSCE 137

A. what the prevalence of cleft lip/palate in Caucasians, Asians, Africans? In

which gender is common?
Caucasians: 1/1000 - Asian 1/500 - African 1/2500
Gender common: M > F
Family history 40%

B. What is the prevalence of the cleft palate only? in which gender is common
Cleft palate only: 1/2000, common in F > M
Family History 20%

C. Causes of cleft LP :
Genetic, family history
Environmental:
Maternal illness, maternal hypoxia, maternal drugs: anticonvulsants
Maternal smoking, alcohol intake Folic acid deficiency Stress

D. Treatment in brief steps?

- Reassurance for parents – NAM Feeding
- 3-6 month → lip closure
- 6-12 months → palate closure
- 4-5 years → Velophyrengoplasty
- 8-10 Years → Expansion alveolar bone \ Graft
- 12-15 Y → Definitive orthodontic
- 18-20 Y → Orthognathic surgery
-
E. What may be needed to be carried out to aid in maxillary canine to erupt in the side
of the cleft ?
- Alveolar bone grafting using cancellous bone form tibia or or hip

F. What advantage or purpose of the alveolar bone graft?

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- Allow eruption of canine.

- may aid in Closure of Oro nasal fistula
- Stable bone base for prosthetic treatment
- Improve speak and breath –
- Provide intact bone for orthodontic movements
- Provide a bone to support the alar base of the nose

G. At what age I can make bone graft for canine tooth & how much of the root
is formed?
Around age 8.5 to 10.5 years
When the canine root is 1/2 to 2/3 formed

H. What is possible prosthetic treatment?

- Removable prothesis
- Fixed bridge or implant
- Overdentures –

I. Mention some Syndrome associated with CLP:

1. Pierre Robing.
2. Treacher-Collins.
3. Down syndrome.

J. Mention Skeletal features in CLP:

1. Class III from maxillary deficiency.
2. Reduced UFH, increased LFH, increased freeway space.

K. Mention Dental features of CLP:

1. Lateral incisors are absent, abnormal size and shape, hypoplastic.
2. Supernumerary teeth.
3. Central incisors are often rotated.

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OSCE 138

X-ray with a radiolucent area associated with a crown of impacted molar tooth with a ct axial
view showing an expansion

A. Differential Diagnosis
- Dentigerous cyst
- Ameloblastoma
- Keratocyst

B. Describe the lesion?

- Unilocular radiolucent lesion on the angle of the mandible
- Well defined margins
- Rounded margins
- Extending to the ramus area
- Involving the crown of the lower left 3
- Causing resorption of the lower 7

C. Treatment options
- Enucleation, marsuplization

When you describe a lesion on radiographic

start with this arrangement

• Site
• Size
• Shape
• Outline
• Relation to adjacent structure

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OSCE 139

Controlled diabetic patient by hypoglycemic drugs – metformin with a white lesion in his
mouth

A. Differential diagnosis
- lichen planus
- candidiasis
- leukoedema
- leukoplakia

B. What is your diagnosis ?

- Lichenoid reaction - > patient on hypoglycemic drugs

C. Treatment options
- Patient reassurance in case of asymptomatic
- In case of any irritation or pain or ulcerations - > Analgesics and topical steroids –
Prednisolone , betamethasone or topical dexamethasone
- In case of severe cases → Azathioprine , oral steroids

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OSCE 140

A. What is this Picture?

- Ulceration on the lateral surface of the tongue with everted edges , with a white slough
membrane

B. What investigation you will do to determine the lesion?

- Boispy

C. What other investigations you will do?

- CBC
- Lymph node palpation
- Ct scan to know the extent of involvement
- MRI

D. Treatment options
- Surgical excision
- chemotherapy
- radiotherapy

[156]
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OSCE 141

Cephalometric Tracing

A point (A): The point of the deepest concavity anteriorly

on the maxillary alveolus
B point (B) The point of the deepest concavity anteriorly on
the mandibular symphysis
Sella (S) The midpoint of the sella turcica (pituitary fossa)
Nasion (N) The most anterior point on the fronto-nasal
suture
Orbitale (Or) The most anterior, inferior point on the
infraorbital rim
Porion (Po) The upper midpoint point on the external auditory meatus
Anterior Nasal Spine (ANS) The tip of the anterior nasal spine
Posterior Nasal Spine (PNS) The tip of the posterior nasal spine
Gonion (Go) The most posterior, inferior point on the mandibular angle
Gnathion (Gn) The most anterior, inferior point on the mandibular symphysis
Menton (Me) The most inferior point on the mandibular symphysis
Pogonion (Pog) The most anterior point on the mandibular symphysis
SN line - The plane demonstrated by a line through the nasion and sella
Frankfort Plane -The plane demonstrated by a line through the orbitale and porion
Mandibular Plane (MnPl) - The plane demonstrated by a line through the gonion and
menton. The definition varies slightly, but the plane is used to show the plane of the
lower border of the mandible
Maxillary Plane (MxPl) -The plane demonstrated by a line through the anterior and
posterior nasal spines
SNA - This angle represents the relative anterioposterior position of the maxilla to
the cranial base
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SNB - This angle represents the relative anteroposterior position of the mandible to
the cranial base
ANB - This angle represents the relative anteroposterior position of the maxilla to
The mandible and can be used to determine skeletal class.
Inter-Incisal Angle The angle between the long axis of the maxillary incisors and
the long axis of the mandibular incisors

A. Average Values – Eastman cephalometric standard for Caucasians

Measurement Mean Value +

Standard
Deviation

SNA 81
SNB 79
ANB 3
UInc to MxPl 109
LInc to MnPl 93
Inter-incisal angle 135
MMPA 27
Facial proportion 55%

SNB AND SNA determine the anteroposterior relationship of the mandible or maxilla relative to the cranial
base

- Angle class class ll div 1 , 2 and overjet

[158]
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OSCE 142

A. What is this lesion?

- Median rhomboid glossitis

B. Differential diagnosis ? mention 3

- Chemical burn
- Candida infection \ chronic erythematous candidiasis
- Geographical tongue
- Nutritional deficiency

C. Causes ?
- Smokers
- Steroids inhalers
- Chronic dry mouth ‘ xerostomia ‘
- Iron deficiency , B12 deficiency ,or folate
- High sugar content

D. Where is the other location of this lesion commonly ?

- Kissing lesion on the palate

E. Treatment
- Reassurance ,
- Mouth wash ; Benzydiamine , chlorohexidine
- Eliminate causative factors – smoking /
- Topical or systemic antifungal application
F. Mention some presentations of candida infection to the dentist ?
- Acute atrophic candidiasis
- Chronic atrophic candidiasis
- Chronic hyperplastic candidiasis
- Chronic mucotaneous candidiasis
- Angular cheilitis
- Median rhomboid glossitis
- Chronic erythematous candidiasis
G. Drugs for candidiasis ?
- Azoles , Nystatin , Miconazole , amphotericin

[159]
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- OSCE 143

A. Name these two views?

- Opg
- Axial ct scan
-
B. What are the 2 most likely differential
diagnosis?
- Dentigerous cyst
- Ameloblastoma

C. Describe the lesion?

- Unilocular
- radiolucent lesion that is located in the mandible left posterior side
- Well defined margins
- Causing resorption for first molar roots
- Associated with unerupted crown of 3rd molar
- causing expansion of the bone in axial ct

D. Spot Diagnosis?
- Ameloblastoma

E. Histopathology :
- Epithlium basal cells with reversed polarity
- Stellate reticulum
- Fibrous tissue
- Ameloblast like cells
- Acanthomatous

D. Treatment
- Surgical excision
- Prosthetic rehabilitation
- OH reestablishment

[160]
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OSCE 144

Vertical parallex → OPG + Ant

occlusal

Horizontal Parallex → 2 Preapicals

with slob

A. What are these views?

- Upper Occlusal view , sectional opg → parallex Tech
B. Left canine location in relation to the teeth?
- Palatal

C. What is the percentage of impacted canine generally and for palatal

specifically?
- Generally 2 %
- Specifically 85% female to male 2:1

D. Why do we take these radiographs?

- To identify if the canine is palatally or labially impacted
- To identify the angle of impaction
- The extent of horizontal impaction
- The extent of vertical impaction
- To see the extent of root completion
E. Mention other methods of localization?
- Palpation
- Inclination of the lateral incisor
- Vertical , Horizontal Parallex
- CBCT
F. What is the treatment options ?

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- Monitor it & regular follow up

- Extraction
- Surgical exposure
- Orthodontic traction
- Auto trans implantation

G. Complication of canine extraction ?

- Trauma to the lateral incisors , central incsiors and loss of vitality
- OAC perforation to nasal floor
- Injury to incisive nerve and artery
- Bleeding , swelling , pain

H. Complication of no treatment
- Root resorption
- Crowding
- Displacement
- Cyst formation

I. How to take the second xray ? – occlusal upper

- Patient is seated with occlusal plane parallel to the floor ‘ with thyroid shelid ‘
- The image receptor, suitably barrier wrapped, is placed flat into the mouth on to the occlusal
surfaces of the lower teeth.
- The patient is asked to bite together gently.
- The image receptor is placed centrally in the mouth with its long axis crossways
in adults and anteroposteriorly in children.
- The X-ray tube head is positioned above the patient in the midline, aiming
downwards through the bridge of the nose at an angle of 65–70° to the image
receptor
J. Another indications for occlusal radiograph?
- Periapical assessment of the upper anterior teeth, especially in
children but also in adults unable to tolerate periapical holders.
- Detecting the presence of supernumeraries and odontomes.
- Evaluation of the size and extent of lesions such as cysts or tumors in
the anterior maxilla.
- Assessment of fractures of the anterior teeth and alveolar bone.
K. When to have a suspicious canine impaction ?
- Absence of Max canine in appropriate position orally
- Absence of canine bulge
- Deciduous canine is overretained
- Protrusion of lateral incisors
- Presence of some dental anamolies – hypodontia , malformed teeth , delayed eruption , enamel
hypoplasia

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OSCE 145

A. Which muscles affect the denture in this area upper denture

- Labial vestibule - orbicularis oris
- Distobuccal flange – Masseter
- Buccal flang – buccinator

B. Name 2 other muscles which affect the lower denture

- labial vestibule – mentalis muscles
- Lingual vestibule – genioglossus “ lingual frenulum area “
- Distbuccal – masseter ,tempolaris ?
- Distolingual – Mylohyoid
- Retromolar pad area – buccinator , superior constrictor

[163]
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OSCE 146

A. What this is picture show

- Mucocele
B. 2 differential diagnosis
- Lipoma
- Hemangioma

C. What is the difference between 2 lesions you mention from the lesion in the picture

- Lipoma are benign adipose tissue tumors

- Hemangioma benign tumors, blood, vascular
D. Treatment
- Surgical excision -
- Cryosurgery-
- Micro marsuplization -

E. Name 2 structures you would care about while doing the surgery.
- Labial branch of mental nerve

[164]
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OSCE 147

A. Special tray of complete denture

- covering hamular notch
- Body is smooth
- Handle is fixed to the body
- Handle is vertical to the body giving an area for lip to rest
- 3mm of clearance around frenulum as notches.

B. Impression material used ?

- Additional silicone ‘ Polyvinylsiloxane’ PVS – medium body putty
C. Mention 3 defects in this tray?
- Frenulum is not relieved
- No border moulding done
- Tissue stoppers are not present
D. 3 causes in impression causing pain for the patient with the denture
- Sharp periphery
- unrelieve for frenulums \ labial or buccal
- Overextension of flanges
- Unrelieved undercuts
E. Other causes for pain in Denture wearer :

[165]
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OSCE 148

A. Name the foramen a?

- Foramen ovale

B. Which branch of Trigeminal passing through it?

- V3 mandibular division of the Trigeminal nerve ‘ mixed ‘

C. Mention another 2 structures passing through it?

- Lesser petrosal n
- Branch of glossopharyngeal n
- Accessory meningeal artery

D. What is the foramen b?

- Foramen spinosum

E. Artery passing through it?

- Middle meningeal artery

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OSCE 149

A. What is the name of this appliance

- Herbest \ fixed functional appliance

B. What type of malocclusion it treats best ?

- Class ll malocclusions

C. What main advanatgae for this appliance in comparsion with other

- Its less bulkier , easy to use
- No patient compliance needed

D. What group of patients will use this appliance most ?

- Growing child and also non compliance class ll patient

E. What are the drawbacks of this appliance ?

- Breakage and increase cost

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OSCE 150

A. Picture of premature upper central incisor with open apex + one gutta
percha inside the canal
B. Describe what you see?
- Immature Maxillary incisor with open access cavity, pulp extirpated and

C. What is your aim of treatment?

- Preserve any vital pulp tissue in the apical third of the root canal to
induce
closure of the apex by formation of a calcific barrier
D. What are your objectives?
- Promote formation of calcific barrier to achieve periapical seal
Continuation of normal root growth resulting in a favourable crown to
root
ratio
E. What is the advantage of this treatment? APEXIOGENSIS
- Sustain a viable Hertwig’s root sheath to allow development of root length for favourable
crown to root ratio
- Preservation of pulp vitality in apical third of root canal to aid root development and tooth
maturation
- Better outcome after RCT due to presence of apical stop
- Tooth is retained in arch
- Favorable crown root ratio
- Preservation of alveolar bone
F. Materials used to achieve Apexification?
- Calcium hydroxide
- MTA
- Biodentin

[168]
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OSCE 151

Photos for prosthetic construction

1: Wax rims inside pt.mouth

2: 2:Facebow
3: Mirror on patient’s mouth
4: Patient wearing a device
5: Spatula inside patient mouth.

A. Which photo doesn’t relate to steps?\

- Patient wearing device ( headgear)
B. Mention 2 components of device in picture 2
- Bite fork
- U shape frame
- Orbital pointer
- Ear piece
- Spirit level
- Scale measuring
- Lock clamp
C. Put steps in sequence?
- Wax rim inside patient mouth
- Spatula inside patient mouth
- Mirror on patient mouth
- Facebow
D. Describe steps you sequenced in brief.
- Wax rim inside to check Jaw relation
- Spatula inside to flatten occlusal rim
- Mirror on patient mouth → to check the vertical dimension at rest and in occlusion .
- Facebow → take relation ship of maxillary rim to the cranial base to take it to articulator

[169]
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OSCE 152

A. Give another name of the canal.

- Nasopalatine canal

B. Which 2 foramina form the canal?

- Foramina scarpa & foramina of stensen

C. What nerves and arteries pass and anastomose through the canal?
- Nasopalatine n
- Nasopalatine artery
- Sphenopalatine artery

D. If you inject local anesthesia in the canal, what do you expect to be anesthetized?
- Palatal mucoperiosteum from canine to canine in maxilla

[170]
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OSCE 153

A. What do you see?

- Patient with swollen lip

B. Differential diagnosis?
- Crohn’s disease
- Orofacial granulomatosis OFG ( if it included bowel disease its crohns disease )
- Melkersson Rosenthal syndrome ( OFG + fissured tongue and recurrent facial palsy
- Hypersensitivity reaction type 1 ( angioedema )
- Traumatic , cellulitis
- Hereditary angioedema

C. What 3 investigation should you do?

- Blood test
- Allergy test
- Referral GIT endoscope → in Crohn’s disease
- Biopsy → in case all you want to exclude other causes (ref :CPSD page 425)
D. Describe the histology arrow?
- Cluster of granuloma -made of epithelioid macrophage surrounded by
lymphocytes, multinucleate giant cells
- Suggesting a granulomatous inflammation

E. And what is the treatment?

- Inform patient about nature of disease, also check the need for any psychological support “
due to disfiguring of lips “
- Diet adjustment by dietician “ cinnamon and benzoate → induce response in 70 % of cases
- Topical corticosteroids : Prednisolone , fluticasone Mouthwash
- Intralesional corticosteroids , systemic corticosteroids , immunosuppressant in Sever cases
F. In case the patient had a GIT complains too what are the Expected oral signs \ Diagnosis ?
- Mucosal ulcers
- Mucosal tags .
- Cobblestone appearance of mucosa
- Orofacial granulomatosis
- Diagnosis – Crohn’s disease

[171]
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OSCE 154

A. What defect you see in the x-ray

Loss of bone around the implants and implant protruding in the sinus

B. The patient complains from pain, halitosis what is the cause?

- Periimplantitis

C. What is the treatment Increase risk + :

- Resolution of inflammation , debride plaque , OHI and Antibiotic Smoking ,Inadequate OH ,Uncontrolled
- Correction of pseudopockets with flap surgery or gingivectomy diabetes ,Existed pdl disease ,thin
gingival biotype ,thin bone during the
- Re-osseintegration – decontaminate implant with citric acid placement
- Remove implant
- Implant removal followed with GBR and subsequent placement of replaced
Implant Diagnosis – xray , suppuration around
implant ,assessment the gingiva around
implant , increase probing depth around
the implant .
D. What are your instructions
- Swelling may occur following your surgical procedure and will
typically increase 2-3 days after the procedure. Treatment : - local debridement
- The Periodontal dressing should be permitted to remain in place until
Improve OH , surgery with bone grafts &
it is removed in the office at your next appointment regenerative
- Avoid excessive exertion of any type for at least 48 hours. Golf,
tennis, skiing, bowling, swimming or sun bathing should be postponed Success ratio for implant in 10 y is 90%
for a few days after surgery. But 40% may experience some extent of
- Do not smoke and Drink. periimplantitis
- Unless otherwise directed, do not brush the surgical site. You may
resume normal brushing/flossing in other areas aside from the surgical
site the following day.

[172]
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OSCE 156

- 8yrs old child with abscess and fever fatigue and no drug allergy
- Prescribe antibiotic
- Prescribe analgesic

Name age address sex weight of the patient , condition to prescribe antibiotic for

- Rx- Augmentin Syr. 228.5 mg /5ml - 1 teaspoon TDS ‘ 3 times in a day ‘for 5 days ,
after meal
- KidTab Paracetamol 2 times a day for 3 days after meals OR Ibuprofen 10mg/kg 2
times a day for 3 days after meals.
- Name , address and contact details of the dr

[173]
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OSCE 157

A. Classify this malocclusion?

- Class 3 malocclusion

B. What is the treatment in growing child?

- Headgear with reverse pull with chin cup
- Frankel 3 ‘myofascial appliance ‘
- ( in adolescent → camouflage Rx | in Adults → orthognathic surgery )

-
C. What is the treatment after permanent dentition has established?
- Fixed orthodontic treatment with extraction of teeth ‘camouflage ortho Rx ‘

D. What is the treatment in the late teens?

- Orthognathic surgery to reposition the jaw

E. What is the role of orthodontist in last treatment “from last question “?

- Decompensation of occlusion → remove occlusion interference before surgery
- Pre – orthodontic Evaluation
- Position of the correct bite during surgery
- Post-surgical orthodontics

[174]
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OSCE 158

A. What type of trauma for teeth?

avulsion

B. Initial treatment procedure?

- Clean the debris from the root
- LA and Xray
- Irrigate the socket
- Place the tooth slowly into socket
- Place the tooth in socket slowly , gently
- Check the position by xray and clinically
- Do flexible splint for the tooth for 14 days
- Antibiotics and analgesics

C. Follow-up procedure?
- Check the vitality status, if required do a RCT

D. Long term complications? (2 options)

- External root resorption \ inflammatory
- Discoloration
- Loss vitality
- Ankylosis \ replacement resorption

[175]
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OSCE 159

A. What is the lesion

- sessile gingival overgrowth
-
B. Permanent soft tissue swelling lesions example ?
- - retrocuspid papillae → lower gum in cuspid area
- - bohns nodules

C. Temporary soft tissue swelling

- Eruption cyst

[176]
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OSCE 160

Radiographic view of the maxilla

Scan of the maxilla, case says they
want to place an implant and there
is a
shaded area on the scan?

A. What is this view?

- B.Axial ct ,A sectional opg

B. what do you see?

- Reduced alveolar bone height

C. What is significance of the shaded area

- Maxillary sinus

D. What complications will occur placed implant in this area

- Oroantral communication
- Implant failure → implant unstable , bleeding , perforation of sinus
membrane
- Maxillary sinusitis
- Periimplantitis

E. Mention 4 procedures you can do before implant placement to improve

patient prognosis ?
- Sinus lift procedure / crestal sinus lift , lateral sinus lift
- Bone augmentation
- Angled implants
- Maintain healthy periodontium – OHI to patient

[177]
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OSCE 161

Female patient with intermittent clicking while eating one day suddenly she wasn’t
able to open the mouth widely ! mouth deviated to the left side , lateral excursions

A. What is the diagnosis ?

- anterior disc displacement without reduction (lockjaw) in the left side

B. What is the causes for Trismus ? mention 4

- Ankylosis
- Internal derangement
- Fracture of the mandible
- Osteoarthritis
- Postoperative removal of impacted 3rd molar |
extraarticular
- Odontogentic infection spread to the muscles |
extraarticular

C. Mention 3 causes of pain to the TMJ Area ?

- Internal derangement
- MPDS
- Osteoarthritis

D. Mention 4 investigations
- Plain radiography
- Blood tests -> for Rheumatoid
- Ultrasonography
- MRI
- Arthrography

E. Mention 4 suggested treatments

- Education and counselling
- Oral analgesia -> NSAIDS
- Warm and cold compress
- Physiotherapy , Joint mobilization
- Use of the splints
[178]
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OSCE 162

A. Describe what can you see ?

- Unilocular lesion
- Radiolucent
- Well defined margins
- Round margins

B. What is this view ?

- Lower occlusal view

C. What is the Diagnosis ?

- Residual cyst “cyst in edentulous areas

D. What is the treatment

- Surgical enucleation with cyst lining removal

[179]
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OSCE 163

You just finish preparation of a 21 for a patient and you are planning for final
full porcelain crown to be placed after 1 week . you just prepared the temporary
crown

A. What are provisional crowns \ temporary made from ?

- Resin – 1.(prefabricated )→ polycarbonate , cellulose acetate 2.r (custom)bis-
acryl composite
- Metal – 1.(preformed → aluminum , tin silver | 2.custom made : cast alloy )

B. Mention their biological advantage ?

- Pulp protection , periodontal health , positional stability , prevention fracture

C. Mention their mechanical requirements ?

- Withstand occlusal functional forces
- Be able to removed and reused
- Have a good retention

D. Mention their esthetic requirements of temporary crown ?

- Color compatibility
- Color stability

E. What are the ideal requirement for the temporary crown ?

- Adequate wear resistance and strength
- Biocompatible good dimensional stability
- Acceptable aesthetic
- Can be repaired
- Adequate working and setting time

[180]
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OSCE 164

A. What RCT error can you see in pic a ?

- Ledge formation
B. What are the causes ?
- Insertion of uncurved S\S instruments
- Forcing instruments into canal
- Not using instruments in sequential order \ skipping files
- Poor designed access cavity
C. How to recognize it ?
- When instrument don’t reach the full WL , There may be also a loss of tactile
sensation , Radiograph with instrument in place .

D. How to prevent it ?
- Copious irrigation
- Precurved files
- Incremental instrumentation – no skipping
- Preoperative and post operative xray to assess the canals curvatures

E. Mention 5 endodontic errors ?

- Ledge formation
- Canal perforation – apical , midroot , cervical
- Separated instruments in canal
- Canal blockade
- Zipping or strip

[181]
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OSCE 165

Patient who was diagnosed with HIV came to you with this :

A. Possible diagnosis(2 points)

- Kaposi sarcoma
- Non hodking lymphoma

B. What is the medical Management? 3 points

- Radiotherapy
- Surgical excision
- Cryotherapy
- Intralesional vinca alkaloid therapy
- Topical retinoids

C. Other common sites intra orally and extra oral? 3

points

- Buccal vestibule , palate , oropharyngeal mucosa

- Lower extermities
- Face , trunk , Genitalia

D. Dental management on this patient? 2 points

- Close monitoring recall every 3 months

- OHI
- Prevention of secondary infections

E. Mention 4 clinical features of Kaposi sarcoma

- Red colour or bluish

- Highly vascular
- Can be flat or form tumor mass
- Common site palate and gingiva
- Respond well to the highly active antiretroviral treatment
“HAART”

F. Staging of oral cancer?

➔ In the table

[182]
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OSCE 166

A. What is this device ?

- Apex locator

B. Mention the mechanism of action ?

- Root apex have a resistance to electrical current and this is measured
using pair of electrodes that are attached to the lip of tha ptient and to
the endodontic file

C. Which is more accurate apex locator or radiograph ?

- Electric apex locator is more accurate

D. When apex locator is preferable ?

- If patient has severe gag reflex
- Superimposition of radiograph
- Pregnant woman

E. When dose it give false reading

- In case of perforations
- dry canal
- too loose file
- In case it contact metal restorations or crowns

[183]
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OSCE 167

Patient came to you complaining of lesions on his cervical area of his upper posterior
teeth

A. What is your diagnosis ?

- Abfraction

B. Define it ?
- It’s a Type of NCTL due to occlusal stress that led to flex teeth , its wedge shape found in
cervical margins usually in labial or buccal cervical areas

C. Mention the causes ?

- Excessive occlusal forces \ stresses
- Parafunctional habits – Bruxism \ Clenching

D. Compare between abrasion and abfraction

- Abrasion : NCTL due to wear of surface of tooth caused by Foreign objects : Brushes \
Dentifrices
- Abfraction: loss of the tooth surface at cervical areas of teeth caused by tensile \
compressive forces during tooth flexure
E. Types of Non carious tooth lose ?
- Erosion
- Attrition
- Abrasion
- Abfraction
F. Type of dental restorations for NCTL ?
- Erosion → composite resins
- Abrasion → composite resin ( microfilled ) esthetic & tend to flex within tooth under load .& RGMI
- Abfraction → RMGI , Composite resin

[184]
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OSCE 168

A. What is this ?
- Fissure sealant

B. Sealant types
- Resin sealant
- GI sealant = Anti-cariogenic , less retention

C. Advantage for ligh cure sealant material

- Short setting time , no mixing is required , good working time

D. Cause of failure of sealant ?

- Main failure → moisture contamination

E. Composition of sealant?
- Specialized plastic resin / GI material
- Matrix, Filler

F. Indication?
- Deep fissure
- Newly erupted teeth
- High risk caries patients
- Children patients
- Molars with deep fissures

G. Contraindication
- Shallow fissure
- Well coalesced pits
- Low caries risk patient
- Occlusal proximal caries
- Adults

[185]
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OSCE 169

Some radiographical artifacts

Double image

Reversed film : tire track , or dotted

Pattern due to xray direct toward the foil
side

Black line :excessive bending of film

prior to placement in patient mouth

Elongated image : Low V angulation

[186]
 MFD PART 2 OSCES

Shortened image : excessive V

angulation

Low density : faint image

High density : dark film

White patch \ spot

Fixer contamination

Black spot \ patch

Developer contamination

[187]
 MFD PART 2 OSCES

Yellowish discoloration : insuffecinent

rinsing or exhausted solution

Developer cut off

Fixer cut off

Static electricity

Horizontal overlap

[188]
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OSCE 170

Patient came to you complaining of a slowly growing mass started before 1 year in sides of
his lower jaw ‘ parotid area ‘ he describes that he was a smoker but stopped before 1 year

A. Differential diagnosis ?
- Pleomorphic adenoma
- Sialosis
- Warthin tumor
- Adenoid cystic carcinoma
B. Possible diagnosis
- Warthin tumor
C. What is your management ?
- Superficial parotidectomy
D. What is the histopathological slide
- Epithelial cells with lymphoid tissue
- Well capsule present

[189]
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OSCE 171

photo of a patient with bilateral buccal crossbite with class 3 incisor relationship

A. Name 4 appliances used to treat the crossbite

- Quad helix
- Hyrax appliance
- W arch\
- Coffin appliance
- Mini expanders
- Cross elastics

B. What is the first thing you should investigate?

Presence of displacement , whether its skeletal or dental : ask the patient to bring the
teeth into edge to edge relationship

C. Mention 2 complications If left untreated?

- Teeth wear
- tmj problems
- muscle tension
- headache – tmpds

D. Identify those appliances :

[190]
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OSCE 172

A. Anatomical landmarks for the maxillary arch

B. What muscles affect the denture in the B area , D also ?

D→ orbicularis oris

B → Buccinator

[191]
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OSCE 173

• picture of analyzing rod

A. what’s this? What it’s used for?
- Analysing rod , preliminary survey of the cast , Assessment of degree of
undercut , angulation

B. A picture of graphite marker, what’s this? What it’s used for?

- mark around tooth along alveolar ridge to identify the maximum convexity
survey line

C. what is the name of that line ?

- survey line

D. The name of the area under the line?

- Undercut

E. A picture of undercut gauge, what’s this? What it’s used for?

- Undercut guage – used to measure the horizontal undercut

F. A photo for RPI System, pointing to the rest .

- Mesial rest

G. Function of it?
- SUPPORT the denture against vertical forces\
- Transmitting Vertical stresses to the long axis of the tooth
- Distribute occlusal load
- Contributes to Indirect retention

[192]
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OSCE 174

A. Bones that make up the zygomatic arch:-

- Temporal bone.
- Zygomatic bone.

B. What artery passes over it?

- Transverse facial artery

C. What are the clinical signs of fractured zygoma or zygomatic arch?

- Flattening of the zygomatic prominence. Depression in the
- zygomatic arch (flattening of cheekbone).
- Lowered lateral portion of palpebral fissure.
- Limited eye movement due to tethering of the extra-ocular
muscles.
- Mechanical interference with the coronoid process (Limited
mandibular movement).
- Unilateral epistaxis.
- Subconjunctival haemorrhage
- Circumorbital ecchymosis.
- Numbness in the inferior orbital nerve innervated area and cheek.
- Diplopia.
- Pain and swelling.

[193]
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OSCE 175

• Foramina of base of skull: - / location – content

A. Foramen rotundum, sphenoid maxillary division of trigeminal nerve.
B. Internal acoustic meatus, petrous part of temporal CN VII, VIII,
labyrinthine artery.
C. Jugular foramen, petrous part of temporal + occipital CN XI, X, XI
(spinal), inferior petrosal sinus, sigmoid sinus, posterior meningeal artery.
D. Hypoglossal canal occipital.
E. Foramen magnum medulla oblongata, vertebral arteries, spinal of
spinal accessory nerve.
F. Incisive foramen palatine process of maxilla nasopalatine nerve,
sphenopalatine artery.
G. Greater palatine foramen palatine bone (horizontal plate) Greater
palatine nerves and vessels.
H. Lesser palatine foramen palatine bone (pyramidal process) lesser
palatine nerves and vessels.
I. Foramen ovale sphenoid mandibular division of trigeminal nerve,
accessory meningeal artery, lesser petrosal nerve, emissary vein.
J. Foramen spinosum sphenoid middle meningeal vessel + meningeal
branch of mandibular division.
K. Carotid canal temporal ICA, ICN plexus (sympathetic).
L. Petrotympanic fissure temporal chorda tympani.
M. Stylomastoid foramen temporal facial nerve + stylomastoid artery.
N. Optic canal sphenoid optic nerve + ophthalmic artery.
O. Superior orbital fissure between greater and lesser wings of the
sphenoid
- Branches of ophthalmic (nasocilliary, lacrimal, frontal)
- CN III.
- CN IV
- CN VI.
- Superior and inferior ophthalmic veins.
P. Inferior orbital fissure between (the greater wing of sphenoid) and the
(orbital process of maxilla and palatine bones).
- Maxillary nerve.
- Zygomatic nerve
- Infraorbital vessel

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OSCE 176

A. What causes Desquamatous gingivitis :

• Pemphigus vulgaris.
• Mucous membrane pemphigoid.
• Lichen planus

B. What is the treatment of it?

• Improving oral hygiene.
• Minimizing irritation of the lesions.
• Specific therapies for the underlying disease where available.
• Local or systemic immunosuppressive or corticosteroid therapy.

C. Median rhomboid glossitis, describe the lesion, what are the causes, what
other lesions do you suspect to see? How would you biopsy the lesion?
• Describe → a smooth, red, flat or raised nodular area on the top part (dorsum) of the middle or
back of the tongue
• Other lesion → kissing lesion
• Biopsy → no need but in case of persistent lesion – pouch
• Causes:-
- Smoking.
- Denture wearing.
- Corticosteroid inhalers.

D. Lump in the palate, what is your differential diagnosis?

- Dental abscess.
- lymphoma NHK
- Neoplasm (salivary gland, Kaposi’s sarcoma)
- Papilloma.
- Torus palatinus.
- Unerupted teeth.

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OSCE 177

A. What are the causes of xerostomia? Clinical features?

Causes:-
• Drugs: Atropine, Antidepressents, antihypertensives, phenothiazines,
antihistamines, antireflux agents, opioids, cytotoxic drugs, retinoids,
diuretics, ephedrine.
• Radiotherapy.
• Graft-versus host disease.
• Sjogren’s syndrome.
• Dehydration.
• Psychogenic.

Clinical features:

•Difficulty in swallowing.
• Difficulty controlling dentures.
• Difficulty in peaking.
• Mouth soreness.
• Unpleasant taste.
• Lips adhere to one another.
• Dental mirror sticks to the mucosa.
• Lipstick or food debris sticking to teeth.
• Lack of usual poling of saliva in the floor of the mouth.
• Saliva not expressible from parotid duct.
• Lobulated tongue, usually red, with partial or complete depapillation.

B. Salivary substitutes:
1. Carboxymethycellulose (Glandosane).
2. Saliva Orthana (fluoride).
C. Complications of xerostomia:-
- Dental caries.
- Candidiasis
- burning sensation
- taste change
- angular stomatitis

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OSCE 178

Cranial nerve examination of CN III, IV, V, VI, VII:-

• Explain to the patient what you want to do.

• CN III (Oculomotor)+ CN IV and VI: Cover one eye and follow the pen
upwards, downwards, medially, superio-medially in an H shape, then
switch to the other eye and repeat. Use light to test for accommodation.
• CN V:
a. Touch with a cotton swab (beware not to examine too laterally in the
mandible because of C2 and C3)
b. Corneal reflex.
c. Muscles of mastication (ask to clench the jaws while palpating the
muscles of mastication).
d. Ask the patient to perform a wide range of mandibular movements
including maximum opening and lateral excrusive movements.
e. Jaw jerk reflex

• CN VII:

a. Inspect for asymmetry and involuntary movements.

b. Ask the patient to:-
1. Raise both eyebrows.
2. Frown.
3. Close both eyes tightly.
4. Smile.
5. Puff out both cheeks.
6. Pout.
c. Taste sensation

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OSCE 179

1. How do we take standard occlusal x-ray?

• Patient is seated with head supported and occlusal plane horizontal
and parallel to the floor and is asked to support a
thyroid shield.
• The image receptor (preferably wrapped) is
placed centrally with its long axis crossways (AP in
children) in the patient’s mouth and the patient is
asked to bite gently.
• X-ray tubehead is positioned above the midline
of the patient aiming downwards through the
bridge of the nose at an angle 65- 70 to the image
receptor.

2. What are the uses of bitewings?

• Detection of dental caries-
• Monitoring progression of dental caries.
• Assessment of existing restorations.
• Assessment of periodontal status

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OSCE 180

Patient came with an discoloration on the incisor and molars also

• Describe what can you see ?

- brownish , yellowish discoloration on the molar and incisors ,
distribution is
asymmetrical
• Diagnosis ?
- MIH , molar incisor hypo mineralization

• What is the cause – ?

• Unkown etiology ; possible risk factors
- Pregnancy problems
- Asthma
- Pneumonia
- Tonsillitis
- Chickenpox

• What are the expected problems with the MIH ?

- Pours enamel ; sensitivity
- Weak enamel -hypo mineralization
- Difficult to restore with composites –
- Discoloration
- Secondary caries

•management :

- identify affected teeth → resolve sensitivity and remineralization → prevention of caries

→assess the prognosis of 1st molar – extract or restore → follow up and maintaince

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OSCE 181

Causes Too dark film:

1. Overexposure:
a. Exposure time.
b. Faulty x-ray equipment.

2. Overdevelopment:
a. Too hot.
b. Development time.
c. Too concentrated

3. Fogging:
a. Poor storage.
b. Old film.
c. Faulty cassette, allowing ingress of light.
d. Faulty darkroom and or safe-light.

causes for Too pale film:

1. Underexposure:
a. Exposure time.
b. Faulty x-ray equipment.

2. Underdevelopment:
a. Too cold.
b. Development time was short.
c. Too diluted. developer
d. Exhausted developer.
e. Developer contaminated by fixer.

3. Film packet back to front (film marks)

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Low contrast:
1. Fogging (same above)
2. Processing error :
a. Underdevelopment.
b. Overdevelopment.
c. Developer contaminated by fixer.
d. Inadequate fixation time.
e. Fixer solution exhausted.

Image blurred:
1. Movement of the patient during exposure.
2. Excessive bending of the film packet.
3. Overexposure.
4. Poor positioning in OPG
Radiographic assessment of caries activity:
1. High risk every 6 months.
2. Moderate risk every 12 months.
3. Low risk:
a. Adults: 2 years.
b. Children: 12-18 months.

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OSCE 182

Median diastema: Prevalence 98% at 6 years

49 % at 11 years
7% in 12-18 years

Causes:

1. Prominent labial frenum.

2. Proclination.
3. Physiological.
4. Presence of a supernumerary tooth.
5. Missing upper lateral incisors.
6. Peg shaped upper lateral incisors.
7. Large jaw and small teeth.

What would you see if you suspect a labial frenum?

1. Blanching of incisive papilla when stretching the labial frenum.
2. P.A x-ray → V-shaped notch in the interdental bone.
3. Anterior teeth may be crowded

Management:
• Before the eruption of upper 3s:
1. If <3mm and canines are unerupted, observe and monitor after
eruption of canines.
2. If >3mm and canines are unerupted may need to approximate the
central incisors, care will be required not to resorb roots of upper 2s
against crowns of upper 3s.

• After the eruption of upper 3s:

1. Accept.
2. Orthodontics.
3. Composite.

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OSCE 183

Causes of angular cheilitis:

1. Ill-fitting dentures.
2. Chronic atrophic candidosis (denture induced
stomatitis).
3. Xerostomia.
4. Deficiency of Fe, Folate, vitamin B12 or riboflavin.
5. Immune deficiency, DM or HIV.

Investigations:
1. Salivary flow rate (Investigate for underlying xerostomia)
2. Investigate for immune deficiency.
3. CBC.
4. Crohn’s disease.

Rx
1. Instruct patients to leave dentures out at night.
2. Antifungals (miconazole and fluconazole).
3. Check dentures and fix them

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OSCE 184

• Nicotinic stomatitis picture

A. Clinical changes or features you see

- Palate is affected , diffuse whitening caused from
hyperkeratosis and inflammation of the orifices of minor salivary glands will
appear as small red dots
- Areas covered with denture not affected

B. Cause
- Due to smoking of pipe or cigar smoking → reaction to the heat

C. Histology features
- Hyperorthokeratosis acanthosis of the epithelium
- Inflammatory infiltrate in gland and around ducts
- No dysplasia

D. Investigation
- Clinical pictures \ inspection
- History of smoking
- Biopsy

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OSCE 185

• Patient with controlled epilepsy suddenly while doing the dental procedure lost
conscious before losing concious patient had thready pulse 40 per minute.. BP
was 90/40

A. What is your diagnosis? Which position, five steps you well take
- Syncope
- Supine position with raised legs

1- Maintain airway
2- Cold compress
3- Recover in 10- 20 second
4- Monitor vitals
5- If vomit suction ad place in semi supine

B. Match emergency drugs with condition you use it in

Patient with Adrenal crisis Corticosteroids
Patient suffered from epilepsy Midazolam 10 mg

Patient with hypoglycemia Dexrtose 50ml 50%

Patient with Asthma Salbutamol inh

Patient suffered from Angina Nitroglycerine – sublingual

C. Correct position of AED

- Adult → upper right side of the chest – and lower left side

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OSCE 186

• From the picture below identify

the structures

A. parotid gland
B. Facial nerve
C. Inferior alveolar nerve
D. Medial surface of ramus –
E. Coronoid notch in the mandible
F. Masseter muscle
G. Spheniomandibular ligament
H. Medial pterygoid
I. Lingual nerve
J. Pterygomandibular raphe

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OSCE 187

• patient came to clinic with a complain of a swelling in the lower lip

non painful to the patient , patient stated it appeared after biting
his lower lip

A. What is your differential diagnosis ?

- Lipoma
- Mucocele
- Hemangioma

B. What is your diagnosis

- Mucocele

C. What is the difference between 2 lesions you mentioned

- mucocele smooth surface mass ranging from afew millimeters to 2cm in
diameter in case of mucus extravasation may be associated to with a bluish
translucency in mucous retention cyst it might be painful
- lipoma :not commonly appearing in in lips ,yellowish in color ,soft and slippery
sub cutaneous
-
D. types of mucocele
Difference Mucous extravasation cyst Mucous retention cyst
Cause Damage to the duct Obstruction of the duct by
stones
Age Younger patient Elder patient

Percentage 90% of all mucocele Less common

Site Lower lip Upper lip , floor of the

mouth ,
Histopathology -no epithelium cyst lined by
compressed ductal
-inflammatory cells
epithelium
(neutrophils ,
-saliva pooled
Macrophages,
-no inflammatory cells in
lymphocytes)
C.T
-plasma cells
-pooled mucin

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OSCE 188

• patient 6 years old came with a vesicles , ulcers on the tongue , lip palate

A. what is your diagnosis ?

- Acute herpetic gingivostomatitis

B. What are the clinical features of HSV primary infection?

Fluid filled vesicles in the gingiva and other areas (lips, tongue,
buccal and
palatal mucosa).
- Fever,Headache, Malaise.
- Cervical lymphadenopathy.
- Vesicles rupture in a few hours to form painful ulcers with red inflamed
margins.
- The clinical episode runs for 14 days then ulcers heal without scarring.

C. What is the causative ?

- HSV-1

D. What is the treatment of HSV primary infection?

- Bed rest.
- Soft diet.
- Hydration.
- Paracetamol.
- Chlorhexidine.
- in severe cases of HSV infection acyclovir 200 mg 1X5X5 suspension,
under 2 years 100 mg 1X5X5.

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OSCE 189

• patient came to your clinic complaining of a tooth appearance between his centrals , he
stated it was erupted since he was 7-9 years old
A. what is this ?
- supernumery tooth – Mesiodense

B. what are the Types of supernumerary teeth:

By shape:
1. Conical.
2. Tuberculate.
3. Supplemental tooth.
4. Odontoma.
By position:
1. Distomolar.
2. Paramolar.
3. Mesiodens.

C. Effects on dentition:
1. No effect.
2. Crowding.
3. Displacement.
4. Failure of eruption
5.resorption root of
adjacent tooth , loss
of vitality

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OSCE 190

A. What is the name of the sinus A :

- Ethmoid sinus

B. What is the name of the sinus B:

- Sphenoid sinus

C. What is the name of the nerve that supply A & B :

- A→ anterior ethmoid nerve , middle ethmoidal nerve
- B→ Posterior ethmoidal nerve

D. Those nerves are branches of which Trigeminal nerve ?

- Ophthalmic nerve V1

E. What is structure C ?
- Sella Turcica

F. What important structure lie in it ?

- Pituitary gland

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OSCE 191

A. What are the 2 subtypes of CGCG ?

- Aggressive
- Non aggressive

B. The dominant cell

- Fibroblast

C. Mention 4 Other lesion with giant cell

- Aneurysmal bone cyst
- Cherubism
- Brown tumor
- Peripheral giant cell granuloma

D. Pathological mechanism of CGCG / pathogenesis ( please double check this )

- Unknown etiology / no genetic relation → Cawson

E. Histopathological features
- Multinucleated giant cell
- Spindle shape cells
- hemosiderin
- plasma cells
- neutrophils
F. How to differentiate between giant cell granuloma and brown tumor hyperparathyroidism .

G. Mention 3 Treatment :
- OHI instructions
- Non surgical approach for slow growing ‘ non aggressive ‘ – corticosteroid intralesional ,
calcitonin injections , interferon alpha , Bisphosphonate
- Curettage , surgical excision or en block resection in aggressive lesion or - recurrence in
aggressive type is– about 15%
( ref – cawson p 189 )

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OSCE 192

Local anesthesia Articaine

A. What is Articaine concentration and maximum dosage ?

- 4% - Max dose → 7mg / kg – in healthy

B. When to reduce the Anesthesia dose ?

- Liver disease
- Cardiovascular disease
- Renal failure \ or renal Dysfunction

C. What are the signs of lidocaine \ Articaine toxicity

- Minimal → talkativeness , slurred speech , dysarthria , euphoria
- Moderate → dizziness , restlessness , nervousness , metallic taste , tinnitus
- Mod to high overdose → tonic - clonic seizure activity , followed by General
CNS depression ,depressed BP , depress heart rate , depress respiratory
rate

D. How to prevent toxicity ?

- Calculate the maximum safe dose through patient weight , age , health
status “ ASA classification “ then be within the limit .
- Avoid injecting into intravascular →

E. How to prevent \ avoid allergic reaction .

- Take appropriate history

F. Mention 2 absolute contraindication and 2 relative contraindications for LA:

- Absolute :
- LA allergy , or Bisulfate allergy “ Malamed handbook LA ref “
- Relative :
- significant liver dysfunction (ASA 3- 4)
- Significant renal dysfunction (ASA3-4 )
- Significant Cardiovascular disease (ASA3- 4)
- Atypical plasma cholinesterase

G. Limitation to usage of vasoconstrictors in LA ? –

*always we weigh the severity of the case , and the benefit
- Patient with Cardiovascular disease . ASA3-4
- Patient with non CVD : thyroid dysfunction , diabetes , sulfite sensitivity
- Patient receiving MAO inhibitors , Tricyclic antidepressant , phenothiazine

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OSCE 193

A. what is the problem ?

- Patient with hemi-maxillectomy

B. What can you do for this patient ?

- Obturator with removable partial denture associated for better
phonetics , function , aesthetics also

C. What are the types of obturators ?

- Depend on time of use :
• Surgical
• Interim
• Definitive
- Depend on purpose of use ?
• Nance obturator
• Feeding obturator
• Latham device and NAM for Cleft lip palate

D. Mention 2 laboratory procedures that can produce patient comfort ?

- Reduce the weight of the prosthesis

- Permanent soft lining ‘ Malloplast – B : to reline the fitting surfaces for more retention it works by
engaging soft tissue undercut in the defect area also It act as a cushion layer between prosthesis
and tissue by it visco-elastic property

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OSCE 194

Patient rushed to the clinic 3 days after extraction his lower 2nd molar with severe throbbing pain
from the area of extraction, patient also complained his bad mouth smell , with examination you
noticed there is no clot and bone is exposed there !

A. What is your diagnosis ?

- Dry socket

B. Mention another name for this condition

- Alveolar osteitis

C. Mention 5 factors lead to this condition ?

- Oral contraceptive – estrogen lead to fibrinolysis
- Trauma
- Smoking
- LA , bone disease
- Immunodeficiency

D. This condition is more common in which area orally ?

- More common in lower posterior molar area

E. What is the treatment

- Gently irrigate the socket
- Dress the socket with alvogyl , BIPP or ZOE packs
- Prescription of Analgesics ‘ NSAIDS ‘

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OSCE 195

Patient came with his parents he is 16 years old his mom complaining from the space between his
anterior teeth you did a radiograph , his parents said he didn’t have any trauma or any extraction in that
area .

A. What is this called ?

- Hypodontia / congenital hypodontia

B. What teeth are commonly affected with this ?

- Lower 3rd 25-35%
- Upper 2 – 2%
- Lower 5 – 3%

C. Mention 2 conditions associated with teeth absence

- Down syndrome
- Ectodermal dysplasia

D. What is the prevalence in population ?

- Primary 0.1-0.9 %
- Secondary 3.5-6.5%

E. What are the possible management for this case ?

- Accept the situation and no treatment
- Space closure → either orthodontics , or by conservative approach or F-F Bridge
- Space open → orthodontically then → implant , F-F Bridge , adhesive bridge ,cantilever bridge

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OSCE 196

Patient 4 years old came to your clinic with large occlusal caries on his E lower you
removed the caries , did a pulpotomy

A. What is the best restoration in this situation ?

- Stainless steel crown ‘ SSC ‘—it’s a durable treatment for primary molars with
extensive caries

B. What are the contraindications of this restoration ?

- If there is any known allergy to nickel

C. What are the indications ?

- Severely broken primary molar
- After pulp treatment for primary molar

D. Method for the placement of the crown ?

• Conventional technique
- LA & rubber dam
- Measure MD with with dividers → crown selection
- Caries removal
- Occlusal reduction = 1mm with wheel following cuspal planes
- Proximal reduction , remove buccal and lingual bulbosities
- Select crown , check occlusion and adapt with pliers then cement with
Polycarboxylate or GI

• Basic Hall technique

- No LA – child will bite on cement filled crown
- Separators placed few days before
- Caries free primary molar and no pre-radicular pathosis
- Clear any access cement
- Any premature contacts will be corrected by dentoalveolar compensation .

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OSCE 197

• Patient thumb sucking

A. Clinical feature?
- Maxillary anterior proclination
- Mandibular anterior retroclination
- Anterior open bite AOB
- Constricted maxillary arch
- Narrow and high palate
- Posterior cross bite

B. Mention 4 categories of causes of AOB other than thumb sucking ?

- Skeletal : High MMPA \ backward growth rotation

- Habit : Mouth breather \
- Dental : Failure to erupt
- Soft tissue : Tongue thrusting

C. Mention 4 ways to break the habit ?

- Behavioral psychology support and motivate \ psychological assessment if more
than 7 y
- Reminder therapy : chemical or mechanical – hot flavoured or bad smell , Thumb
guard as mechanical
- Appliance Habit breaker – Crib removable or fixed , Oral screen ,Hay rakes
appliance ,Blue grass appliance
- Prevention – try to feed the child and not letting him hungry

D. Mention 3 cephalometric change with this case ?

- Increased MMPA
- Increased UI to maxillary plane
- Decrease LI to mandibular plane

E. What growth rotation type in this case ?

- Backward growth rotation

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OSCE 198

Patient came after 2 days complaining of bleeding in the

extraction site , patient is is hypertensive .

A. What are the types of Post operative bleeding ? and

what type is this one ?

- Immediate (primary ) bleeding : no Hemostasis at

surgery
- Reactionary : with in hours – 48 h :
- Secondary : 7 days post op – due to infection

B. Where are the bleeding source ?

- Gingival capillaries
- Socket bone vessels
- Large vessels underbone / flaps

C. What are the management ?

- Patient reassurance
- Clear area – good light suction – visibility to site of bleeding & identify it :
➔ Gingival bleeding : Packing with pressure , suturing ; Horizontal mattress suture
➔ Socket bone vessel bleeding : pack with pressure , Tranexamic acid , oxidizing
cellulose , bone wax , Gel foam

D. What diseases can lead to increase bleeding *2

- Liver diseases
- Thrombocytopenia

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OSCE 198

Implant with 5 mm diameter

A. How much MD BL is required ?

- > 8 mm MD
- BL – 1.5mm buccal and 1 mm lingual – 3.5 mm

B. What is vertical restorative space needed for cemented & for screw fit implant
restoration? * -
- 10 mm screw retained
- 8 mm cemented implant

C. Mention 3 advantage for screw retained implant?

- Retrievable
- Known retention
- No risk for leaving residual cement
- Limited interocclusal space

D. How to increase bone level ‘pneumatization ‘ in sinus

- Sinus lift
- Bone augmentation ,

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OSCE 199

• Patient came to you after 24 hours of extraction with oozing of bleeding , patient
was under aspirin and didn’t declared that !

A. What is the action of aspirin on blood ?

- Antiplatelet
B. Mention 3 types of anticoagulant drugs
- Warfarin
- Rivaroxaban
- Apixaban

C. Mention one antiplatelet drug ( other than aspirin )

- Clopidogrel

D. What is the mechanism of action of warfarin

- Vit K Antagonist

E. Mention 3 drugs may interact with warfarin dentally ?

- Fluconazole
- Erythromycin
- Metronidazole
- Omeprazole

F. What is you management in this case ?

- identify source of bleeding
- Tranexamic acid
- 8 figure suture
- Gauze pack pressure
- Bone wax

G. How to prevent such a complication

- Always take appropriate medical history of patient
- Atraumatic surgical approach . less trauma .

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OSCE 200

A. Diagnosis ?
- Angular cheilitis

B. Mention 4 factors \ causes ?

- Reduced VD
- Malnutrition
- Anemia \ Iron def , Vit B12
- Immunocompromised patient
- Poor Denture hygiene

C. Describe it clinical features ?

- Red cracked skin at the angle of the mouth , often crusted , or sometimes
ulcerated

D. mention 3 investigation to aid in diagnosis ?

- Swab – then culture
- Assess denture status \ asses also hygiene
- Complete blood count CBC

E. what is the treatment ?

- treat the cause e.g. : Iron def , Vit b12 def etc. , Denture adjustment
- Miconazole cream , Sodium Fusidate 2%
- OHI , Mouth wash

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OSCE 201

A. Mention the types of leukoplakia ?

1. Homogeneous oral leukoplakia

Most common type
• Consists of uniformly white plaques
• Occurs mainly on buccal mucosa
• Low transformation potential.
2. Non-homogeneous leukoplakia
• Speckled leukoplakia
o Less common
o More serious
o Consists of white flecks or fine nodules on an atrophic
erythematous base
o Stronger malignant potential than homogeneous leukoplakia
o Regarded as a combination of or a transition between leukoplakia
and erythroplasia.
• Nodular leukoplakia
o Small aggregated hemispherical red or white surface alterations or
excrescences
o May show a red background or substrate
o Stronger risk of dysplasia or malignant potential than in
homogeneous leukoplakia.
3. Proliferative verrocus leukoplakia
Least common type of oral leukoplakia
• High risk of intervening dysplasia and carcinoma developing
• Progressive and multifocal in nature
• High rate of recurrence and histological progression toward carcinoma.

B. mention what are the features/ changes of epithelial dysplasia:

• Drop-shaped rete processes
• Basal cell hyperplasia
• Irregular epithelial stratification
• Nuclear hyperchromatism
• Increased nuclear-cytoplasmic ratio
• Increased normal and abnormal mitosis
• Enlarged nucleoli
• Individual cell keratinization
• Loss or reduction of cellular cohesion
• Cellular pleomorphism
• Loss of basal cell polarity

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• Anisocytosis
• koilocytosis

C. what is your differential diagnosis for the image?

Erosive lichen planus
Graft versus host disease

(from Khalil Notes)

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OSCE 202

• patient 29 years old had his parotid gland removed before couple of years complaining
that he feels some sweat\ flushing appears in the area in picture after eating

A. what is this condition called ? any other name ?

- Freys syndrome , Auriculotemporal syndrome , Gustatory
sweating syndrome

B. what is the cause ?

- post parotidectomy due to damage to the auriculotemporal nerve

C. how to treat the case ?

- Injection of Botulinum toxin A
- Ointments \ creams that contain anticholinergic such as scopolamine
- Surgical resection of nerves .

D. What is this test on the picture ?

- Starch-iodine test

E. how to prevent it during surgical procedure ?

- placement of acellular dermis
- fat grafting
- use of interposition flaps : SCM muscle

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GOOD LUCK
Pray always to whom worked on this book
Its for the sake of spreading knowledge

PLEASE if you have any interesting OSCE or

Any correction
Don’t hesitate to send it to me on

[email protected]

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