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Question 1Primary care dentistry (content domains not enumerated in source)

Which permanent tooth typically erupts first into the oral cavity?

  1. Mandibular first molar Correct answer.
  2. Maxillary central incisor
  3. Mandibular central incisor
  4. Maxillary first molar

Explanation

The mandibular first molar is usually the first permanent tooth to erupt, appearing around 6 years of age behind the primary molars. The permanent incisors erupt shortly afterward.

Question 2Primary care dentistry (content domains not enumerated in source)

What is the normal range for a healthy adult resting plaque pH before any fermentable carbohydrate challenge?

  1. Approximately 6.5 to 7.0 Correct answer.
  2. Approximately 3.0 to 3.5
  3. Approximately 5.0 to 5.5
  4. Approximately 4.0 to 4.5

Explanation

Resting plaque pH in a healthy mouth is close to neutral, around 6.5 to 7.0. It falls after sugar exposure as bacteria ferment carbohydrate to acid.

Question 3Primary care dentistry (content domains not enumerated in source)

Which fluoride concentration is typical of a standard over-the-counter adult fluoride toothpaste in many markets?

  1. 5000 ppm
  2. 250 ppm
  3. 1000 to 1500 ppm Correct answer.
  4. 500 ppm

Explanation

Standard adult fluoride toothpastes generally contain 1000 to 1500 ppm fluoride. Higher concentrations such as 5000 ppm are prescription products for high caries risk.

Question 4Primary care dentistry (content domains not enumerated in source)

Which instrument is most appropriate for removing supragingival calculus from a tooth surface during a routine scaling?

  1. Amalgam carrier
  2. Periodontal probe
  3. Excavator
  4. Sickle scaler Correct answer.

Explanation

A sickle scaler has a pointed tip and straight cutting edges designed for supragingival calculus removal. It should not be used subgingivally because of the risk of tissue trauma.

Question 5Primary care dentistry (content domains not enumerated in source)

What is the recommended minimum duration of toothbrushing with a fluoride toothpaste for an adult?

  1. 5 minutes
  2. 1 minute
  3. 30 seconds
  4. 2 minutes Correct answer.

Explanation

Two minutes of brushing with fluoride toothpaste is the generally recommended minimum to allow adequate plaque removal and fluoride exposure. Brushing for shorter periods tends to leave plaque behind.

Question 6Primary care dentistry (content domains not enumerated in source)

Which local anaesthetic is most commonly used in UK primary care dentistry for routine infiltration anaesthesia?

  1. Articaine 4% with adrenaline 1:400,000
  2. Prilocaine 4% plain
  3. Bupivacaine 0.5%
  4. Lidocaine 2% with adrenaline 1:80,000 Correct answer.

Explanation

Lidocaine 2% with adrenaline 1:80,000 is the standard first-line local anaesthetic for routine dentistry because of its reliable onset and safety profile. Other agents are reserved for specific indications.

Question 7Primary care dentistry (content domains not enumerated in source)

Which of the following best describes the purpose of a fissure sealant?

  1. To improve the aesthetics of stained enamel
  2. To reduce dentine hypersensitivity
  3. To restore lost tooth structure in a carious pit
  4. To prevent caries by sealing susceptible pits and fissures Correct answer.

Explanation

Fissure sealants create a physical barrier over susceptible pits and fissures, preventing plaque accumulation and caries initiation. They are a preventive rather than restorative measure.

Question 8Primary care dentistry (content domains not enumerated in source)

Which tooth surface is most commonly affected by early childhood caries in a young child?

  1. Mandibular incisor labial surfaces
  2. Maxillary central incisor labial surfaces Correct answer.
  3. Maxillary incisor palatal surfaces
  4. Mandibular molar occlusal surfaces

Explanation

Early childhood caries characteristically affects the maxillary primary incisors, particularly the labial surfaces near the gingival margin. Mandibular incisors are relatively spared because of salivary clearance.

Question 9Primary care dentistry (content domains not enumerated in source)

A patient reports bleeding gums when brushing but has no pocketing and no attachment loss. What is the most likely diagnosis?

  1. Plaque-induced gingivitis Correct answer.
  2. Pericoronitis
  3. Generalised periodontitis
  4. Dental abscess

Explanation

Bleeding on brushing without pocketing or attachment loss is characteristic of plaque-induced gingivitis. Periodontitis requires clinical attachment loss in addition to inflammation.

Question 10Primary care dentistry (content domains not enumerated in source)

Which of the following is the most appropriate initial management for a patient with a high caries risk and multiple active lesions?

  1. Extract all teeth with restorations
  2. Prescribe 5000 ppm fluoride toothpaste and intensify preventive care Correct answer.
  3. Review in 12 months with routine advice
  4. Place crowns on all posterior teeth

Explanation

High caries risk with active lesions warrants intensified prevention, including high-fluoride toothpaste and frequent review. Routine 12-month recall is inadequate for active disease.

Question 11Primary care dentistry (content domains not enumerated in source)

A patient on warfarin with an INR of 3.5 requires a simple extraction. What is the most appropriate action?

  1. Refer for assessment of anticoagulation before extraction Correct answer.
  2. Proceed without checking the INR
  3. Double the warfarin dose before the procedure
  4. Stop warfarin for one week

Explanation

An INR of 3.5 is above the usual safe range for simple extractions in primary care, so liaison with the patient's anticoagulation service is needed before proceeding. Altering anticoagulation is a medical decision.

Question 12Primary care dentistry (content domains not enumerated in source)

Which of the following is the most reliable clinical indicator of periodontal disease progression?

  1. Presence of supragingival calculus
  2. Clinical attachment loss over time Correct answer.
  3. Tooth mobility alone
  4. Bleeding on probing alone

Explanation

Progressive clinical attachment loss is the defining feature of periodontitis and indicates disease progression. Bleeding and calculus alone do not confirm attachment loss.

Question 13Primary care dentistry (content domains not enumerated in source)

A patient reports a sharp, short-lived pain in a tooth when drinking cold water, which resolves within seconds of removing the stimulus. What is the most likely diagnosis?

  1. Pulp necrosis
  2. Periapical abscess
  3. Irreversible pulpitis
  4. Reversible pulpitis Correct answer.

Explanation

Pain that is sharp, provoked by a stimulus and resolves quickly after removal suggests reversible pulpitis. Irreversible pulpitis typically produces prolonged or spontaneous pain.

Question 14Primary care dentistry (content domains not enumerated in source)

Which of the following is an appropriate first-line measure for a patient with dentine hypersensitivity?

  1. Full coverage crown
  2. Immediate endodontic treatment
  3. Use of a desensitising toothpaste containing potassium nitrate or stannous fluoride Correct answer.
  4. Extraction of the affected tooth

Explanation

Desensitising toothpastes containing agents such as potassium nitrate or stannous fluoride are a first-line management for dentine hypersensitivity. More invasive options are reserved for refractory cases.

Question 15Primary care dentistry (content domains not enumerated in source)

What is the main purpose of using a rubber dam during endodontic treatment?

  1. To improve access to the canal orifices
  2. To isolate the tooth and prevent ingestion of instruments and irrigants Correct answer.
  3. To speed up obturation
  4. To reduce the need for local anaesthesia

Explanation

A rubber dam isolates the operative field, protects the airway from instruments and irrigants, and maintains a clean, dry environment. It is a safety and asepsis measure.

Question 16Primary care dentistry (content domains not enumerated in source)

Which of the following patients is at greatest risk of osteoradionecrosis after extraction?

  1. A patient taking a statin
  2. A patient with mild gingivitis
  3. A patient with well-controlled type 2 diabetes
  4. A patient who had head and neck radiotherapy within the past 12 months Correct answer.

Explanation

Previous head and neck radiotherapy, particularly within the first year, significantly increases the risk of osteoradionecrosis after extraction. Such cases require specialist assessment and planning.

Question 17Primary care dentistry (content domains not enumerated in source)

Which of the following best describes the role of a fluoride varnish application in caries prevention?

  1. It promotes remineralisation and inhibits demineralisation of enamel Correct answer.
  2. It replaces the need for toothbrushing
  3. It permanently seals all pits and fissures
  4. It sterilises the oral cavity

Explanation

Fluoride varnish increases fluoride availability at the tooth surface, promoting remineralisation and reducing demineralisation. It is applied as part of a broader preventive regimen.

Question 18Primary care dentistry (content domains not enumerated in source)

A child presents with a recently avulsed permanent maxillary central incisor that has been out of the socket for 20 minutes and stored in milk. What is the most appropriate immediate action?

  1. Discard the tooth and plan an implant
  2. Replant the tooth and seek urgent dental assessment Correct answer.
  3. Scrub the root with a toothbrush before replanting
  4. Place the tooth in water and wait for a routine appointment

Explanation

Replanting an avulsed permanent tooth as soon as possible improves the chance of survival, especially when the tooth has been stored in a suitable medium such as milk. Urgent dental assessment follows replantation.

Question 19Primary care dentistry (content domains not enumerated in source)

Which of the following is the most appropriate advice for a patient who has just had a tooth extracted?

  1. Vigorous rinsing with mouthwash for the first 24 hours
  2. Eat a hot meal immediately after the appointment
  3. Remove the clot to inspect the socket
  4. Avoid rinsing, smoking and hot drinks for the first 24 hours Correct answer.

Explanation

After extraction, avoiding rinsing, smoking and hot drinks for the first 24 hours helps protect the blood clot and reduces the risk of dry socket. The clot is essential for healing.

Question 20Primary care dentistry (content domains not enumerated in source)

Which of the following is a recognised advantage of using a two-week recall for a patient with acute periodontal problems?

  1. It allows monitoring of response to initial therapy Correct answer.
  2. It confirms the need for extraction
  3. It removes the need for radiographs
  4. It replaces the need for oral hygiene instruction

Explanation

Short-interval review after initial periodontal therapy allows assessment of healing, plaque control and response to treatment. It does not replace oral hygiene instruction or other assessments.

Question 21Primary care dentistry (content domains not enumerated in source)

A patient with a history of anaphylaxis to penicillin requires a prophylactic antibiotic before a dental procedure. Which agent is generally recommended?

  1. Amoxicillin
  2. Erythromycin
  3. Clindamycin Correct answer.
  4. Penicillin V

Explanation

For patients with a true penicillin allergy requiring prophylaxis, clindamycin has traditionally been used, although local guidelines should always be followed. Penicillins and amoxicillin are contraindicated.

Question 22Primary care dentistry (content domains not enumerated in source)

A patient presents with a painless, firm, well-defined swelling of the upper lip that has been present for several months. What is the most appropriate initial step?

  1. Biopsy the lesion in primary care without further assessment
  2. Prescribe antibiotics and review in a week
  3. Refer for urgent specialist assessment Correct answer.
  4. Reassure and review in 12 months

Explanation

A persistent, firm swelling of uncertain aetiology warrants urgent referral for specialist assessment to exclude malignancy. Delay in referral can worsen outcomes.

Question 23Primary care dentistry (content domains not enumerated in source)

Which of the following best explains why a patient with poorly controlled diabetes may have delayed healing after periodontal surgery?

  1. Increased salivary flow
  2. Reduced need for local anaesthesia
  3. Excessive fluoride uptake in bone
  4. Reduced collagen synthesis and impaired immune function Correct answer.

Explanation

Poor glycaemic control impairs collagen synthesis, immune function and microvascular healing, delaying wound repair. This underlies the need for good glycaemic control before elective surgery.

Question 24Primary care dentistry (content domains not enumerated in source)

A patient taking methotrexate for rheumatoid arthritis requires a course of antibiotics for a dental infection. Why is caution needed?

  1. Some antibiotics can increase methotrexate toxicity Correct answer.
  2. Methotrexate prevents antibiotic absorption
  3. Methotrexate has no interactions with antibiotics
  4. Antibiotics reduce the efficacy of methotrexate

Explanation

Certain antibiotics can interact with methotrexate and increase its toxicity, so liaison with the patient's physician is important. Antibiotic choice should be made with this interaction in mind.

Question 25Primary care dentistry (content domains not enumerated in source)

A patient with a history of infective endocarditis requires a dental extraction. Which of the following is the most appropriate approach?

  1. Proceed without any consideration of endocarditis risk
  2. Assess the need for antibiotic prophylaxis according to current guidelines Correct answer.
  3. Prescribe antibiotics after the procedure only
  4. Avoid all dental treatment indefinitely

Explanation

Patients with a history of infective endocarditis may require antibiotic prophylaxis depending on current national guidance and the procedure. Assessment should follow the relevant guidelines.

Question 26Primary care dentistry (content domains not enumerated in source)

Which instrument is most appropriate for removing supragingival calculus from a lower incisor during a routine scale?

  1. Universal curette
  2. Sickle scaler Correct answer.
  3. Dental explorer
  4. Periodontal probe

Explanation

Sickle scalers are designed with a pointed tip and two cutting edges for removing supragingival calculus, especially in anterior regions. Curettes are finer and intended for subgingival debridement, while probes and explorers are diagnostic only.

Question 27Primary care dentistry (content domains not enumerated in source)

Which of the following best describes the main clinical benefit of using a fluoride-releasing glass ionomer restoration in a high caries risk patient?

  1. It has a higher compressive strength than amalgam
  2. It bonds chemically to enamel but not to dentine
  3. It eliminates the need for any further preventive advice
  4. It provides a sustained local fluoride reservoir around the restoration margins Correct answer.

Explanation

Glass ionomer cements release fluoride over time and can act as a local reservoir that may inhibit demineralisation at the margins. Their strength is lower than amalgam and they bond to both enamel and dentine, so the other options misstate their properties.

Question 28Primary care dentistry (content domains not enumerated in source)

A patient brushes twice daily with a 1450 ppm fluoride toothpaste but has active caries. What is the most appropriate first change to their oral hygiene advice?

  1. Advise using a fluoride-free toothpaste alongside
  2. Recommend rinsing immediately after brushing with water
  3. Recommend using a 5000 ppm fluoride toothpaste Correct answer.
  4. Advise brushing once daily for longer

Explanation

For patients with active caries, a higher-fluoride toothpaste (2800–5000 ppm) is a recognised step when standard 1450 ppm toothpaste is insufficient. Rinsing after brushing washes away fluoride, and reducing brushing frequency or removing fluoride would worsen risk.

Question 29Primary care dentistry (content domains not enumerated in source)

Which of the following is the most appropriate method for assessing a patient's dietary sugar exposure during a caries risk assessment?

  1. Ask only about the number of sugary snacks per week
  2. Use a 3-day diet diary recording timing and frequency of sugar intake Correct answer.
  3. Measure salivary pH immediately after lunch
  4. Ask whether the patient likes sweet foods

Explanation

A diet diary captures the frequency and timing of fermentable carbohydrate exposure, which drives caries risk more than total quantity alone. Frequency and timing of sugar intake are the key variables in caries risk assessment.

Question 30Primary care dentistry (content domains not enumerated in source)

A patient has a probing depth of 5 mm with bleeding on probing at a single site but no radiographic bone loss. What is the most appropriate interpretation?

  1. A periodontal pocket that requires monitoring and further assessment Correct answer.
  2. Normal periodontal health
  3. A gingival recession defect
  4. Definite periodontitis requiring immediate referral

Explanation

A single 5 mm pocket with bleeding but without confirmed attachment or bone loss should be monitored and reassessed rather than labelled periodontitis. Diagnosis of periodontitis requires evidence of attachment loss, often supported by radiographs.

Question 31Primary care dentistry (content domains not enumerated in source)

Which of the following is the most appropriate initial management for a patient with recurrent aphthous ulceration and no systemic symptoms?

  1. Immediate referral for biopsy
  2. Topical corticosteroid and review Correct answer.
  3. Extraction of adjacent teeth
  4. Long-term systemic antibiotics

Explanation

Recurrent aphthous ulcers are usually managed with topical corticosteroids and symptomatic measures, with review to confirm healing. Biopsy is reserved for persistent or suspicious lesions, and antibiotics or extractions are not indicated.

Question 32Primary care dentistry (content domains not enumerated in source)

Which of the following best describes the purpose of a bitewing radiograph in a patient at moderate caries risk?

  1. To measure root canal length
  2. To evaluate the temporomandibular joint
  3. To assess the periodontal ligament space of all teeth
  4. To detect approximal caries and monitor existing restorations Correct answer.

Explanation

Bitewing radiographs are used to detect approximal caries and to monitor the margins of existing restorations. They do not assess the TMJ, root canal length, or the full periodontal ligament of all teeth.

Question 33Primary care dentistry (content domains not enumerated in source)

A patient with a history of angina reports chest pain during a dental appointment. What is the most appropriate initial action?

  1. Continue treatment and reassure the patient
  2. Give a local anaesthetic containing adrenaline immediately
  3. Stop treatment, sit the patient upright, and give GTN as prescribed Correct answer.
  4. Lay the patient flat and give aspirin

Explanation

For suspected angina during treatment, stop treatment, position the patient comfortably upright, and assist with their prescribed glyceryl trinitrate. If pain persists, emergency services should be called.

Question 34Primary care dentistry (content domains not enumerated in source)

Which of the following is the most appropriate way to manage a patient who is anxious about dental treatment and has avoided care for years?

  1. Prescribe sedatives without discussion
  2. Proceed with all treatment in one long appointment
  3. Use a structured behavioural approach with short familiarisation visits Correct answer.
  4. Tell the patient to return only when in pain

Explanation

A structured behavioural approach, including short familiarisation visits and gradual exposure, is effective for dental anxiety. Forcing long appointments or dismissing the patient worsens avoidance, and sedatives require proper assessment and consent.

Question 35Primary care dentistry (content domains not enumerated in source)

Which of the following is the most appropriate advice for a patient with a newly fitted complete upper denture regarding denture hygiene?

  1. Rinse only with water once weekly
  2. Sleep with the denture in place to maintain fit
  3. Remove the denture at night and clean it mechanically with a soft brush Correct answer.
  4. Clean the denture with abrasive household cleaner daily

Explanation

Dentures should be removed at night to allow tissues to rest and cleaned mechanically with a soft brush to remove plaque. Abrasive cleaners damage the denture surface, and sleeping in dentures increases the risk of denture stomatitis.

Question 36Primary care dentistry (content domains not enumerated in source)

A patient with type 2 diabetes has a fasting blood glucose of 12 mmol/L and requires a simple extraction. What is the most appropriate action?

  1. Proceed with the extraction without further consideration
  2. Defer elective treatment and liaise with the patient's GP about glycaemic control Correct answer.
  3. Prescribe antibiotics and proceed
  4. Double the local anaesthetic dose and proceed

Explanation

Poorly controlled diabetes increases the risk of infection and delayed healing, so elective treatment should be deferred while glycaemic control is optimised with the GP. Proceeding without addressing control or giving unnecessary antibiotics is not appropriate.

Question 37Primary care dentistry (content domains not enumerated in source)

Which of the following is the most appropriate antibiotic regimen for a patient with a dental abscess who requires antibiotics and has no allergies?

  1. Amoxicillin 500 mg three times daily for 5 days Correct answer.
  2. Erythromycin 500 mg four times daily for 10 days
  3. Penicillin V 250 mg once daily for 2 days
  4. Metronidazole 400 mg three times daily for 14 days

Explanation

Amoxicillin 500 mg three times daily for 5 days is a standard regimen for odontogenic infection in patients without penicillin allergy. Antibiotics are an adjunct and drainage remains essential.

Question 38Primary care dentistry (content domains not enumerated in source)

Which of the following best explains why a patient with xerostomia is at increased risk of caries?

  1. Saliva has no role in caries prevention
  2. Xerostomia directly causes enamel hypoplasia
  3. Reduced salivary flow impairs buffering and clearance of dietary acids Correct answer.
  4. Increased salivary flow washes away protective minerals

Explanation

Saliva provides buffering, clearance, and remineralising ions; reduced flow impairs these protective functions and raises caries risk. Saliva is protective, and xerostomia does not cause enamel hypoplasia.

Question 39Primary care dentistry (content domains not enumerated in source)

Which of the following is the most appropriate first-line management for a patient with a localized periodontal abscess in a previously untreated pocket?

  1. Drainage and debridement of the pocket with review Correct answer.
  2. Immediate extraction of the tooth
  3. Long-term systemic antibiotics alone
  4. Application of topical fluoride

Explanation

A periodontal abscess is managed by drainage and debridement of the affected pocket, followed by review and reassessment. Extraction is not first-line, antibiotics alone are insufficient, and fluoride does not treat infection.

Question 40Primary care dentistry (content domains not enumerated in source)

Which of the following best describes the principle of minimum intervention dentistry?

  1. Using the largest possible restoration for durability
  2. Removing all suspect tooth tissue to prevent recurrence
  3. Preserving tooth structure and controlling disease through prevention and minimally invasive care Correct answer.
  4. Extracting teeth at the first sign of caries

Explanation

Minimum intervention dentistry aims to preserve tooth structure, control caries through prevention, and use minimally invasive techniques. It does not involve indiscriminate removal or early extraction.

Question 41Primary care dentistry (content domains not enumerated in source)

A patient reports a dull, aching pain in a lower molar that worsens on biting and has a history of a large restoration. Which of the following is the most likely diagnosis?

  1. Dentine hypersensitivity
  2. Trigeminal neuralgia
  3. Acute apical periodontitis Correct answer.
  4. Reversible pulpitis

Explanation

Pain on biting with a dull ache in a heavily restored tooth suggests apical periodontitis, often following pulp necrosis. Reversible pulpitis is typically provoked by thermal stimuli and resolves quickly, while hypersensitivity is sharp and short-lived.

Question 42Primary care dentistry (content domains not enumerated in source)

Which of the following is the most appropriate method for confirming the working length during root canal treatment?

  1. Using a periodontal probe in the canal
  2. Electronic apex locator combined with a periapical radiograph Correct answer.
  3. Measuring the crown length only
  4. Feeling the apex with a file by hand alone

Explanation

Working length is best confirmed with an electronic apex locator, often supplemented by a periapical radiograph. Hand feel alone is unreliable, and a periodontal probe or crown length does not determine canal length.

Question 43Primary care dentistry (content domains not enumerated in source)

A patient has a fractured anterior tooth with a small enamel-dentine chip and no pulp exposure. What is the most appropriate immediate management?

  1. Extract the tooth
  2. Perform immediate root canal treatment
  3. Apply a crown without further assessment
  4. Restore the defect and review pulpal status Correct answer.

Explanation

A small enamel-dentine fracture without pulp exposure is managed by restoring the defect and reviewing pulpal vitality. Root canal treatment is not indicated without pulpal involvement, and extraction or crowning is excessive.

Question 44Primary care dentistry (content domains not enumerated in source)

Which of the following is the most appropriate advice for a patient using a chlorhexidine mouthwash as an adjunct to periodontal treatment?

  1. Use it undiluted continuously for six months
  2. Use it short-term because prolonged use can cause staining and taste disturbance Correct answer.
  3. Use it long-term as the sole means of plaque control
  4. Use it instead of mechanical brushing

Explanation

Chlorhexidine is effective short-term as an adjunct but prolonged use causes staining, taste disturbance, and calculus formation. It should not replace mechanical plaque control.

Question 45Primary care dentistry (content domains not enumerated in source)

Which of the following best explains why a patient with a history of head and neck radiotherapy may require a fluoride regimen?

  1. Radiotherapy can reduce salivary flow and increase caries risk Correct answer.
  2. Radiotherapy directly whitens teeth
  3. Radiotherapy removes the need for oral hygiene
  4. Radiotherapy increases salivary flow

Explanation

Head and neck radiotherapy often damages salivary glands, reducing flow and buffering capacity, which raises caries risk and makes fluoride regimens important. It does not increase salivary flow or remove the need for hygiene.

Question 46Primary care dentistry (content domains not enumerated in source)

A patient has a suspected allergy to latex and requires a dental procedure. What is the most appropriate action?

  1. Proceed with latex gloves and monitor the patient
  2. Cancel all dental treatment permanently
  3. Use latex-free gloves and a latex-free environment Correct answer.
  4. Use latex gloves but double-glove

Explanation

For suspected latex allergy, latex-free gloves and a latex-free environment are required to prevent reactions. Double-gloving with latex or proceeding with latex risks an allergic response, and permanent cancellation is unnecessary.

Question 47Primary care dentistry (content domains not enumerated in source)

Which of the following is the most appropriate way to manage a patient who is taking an anticoagulant and requires a simple extraction with an INR within the therapeutic range?

  1. Refer for hospital extraction in all cases
  2. Proceed with local measures to control bleeding without altering the anticoagulant Correct answer.
  3. Give fresh frozen plasma before extraction
  4. Stop the anticoagulant for a week before extraction

Explanation

When the INR is within the therapeutic range, simple extractions can usually proceed with local haemostatic measures such as sutures and pressure. Anticoagulants should not be stopped without medical advice, and hospital referral is not routine.

Question 48Primary care dentistry (content domains not enumerated in source)

A patient presents with a persistent, non-healing ulcer on the lateral border of the tongue lasting six weeks. What is the most appropriate action?

  1. Advise the patient to stop smoking and return if it persists
  2. Reassure and review in six months
  3. Urgent referral for investigation of a suspected malignancy Correct answer.
  4. Prescribe topical steroid and review in three months

Explanation

An ulcer persisting beyond two to three weeks, especially on the lateral tongue, is a red flag for oral cancer and requires urgent referral. Reassurance, delayed review, or lifestyle advice alone risks delay in diagnosis.

Question 49Primary care dentistry (content domains not enumerated in source)

Which of the following is the most appropriate management for a patient with a retained root fragment in the maxilla that is asymptomatic and not associated with pathology?

  1. Immediate surgical removal in all cases
  2. Prescribe antibiotics prophylactically
  3. Monitor with radiographs and discuss risks and benefits Correct answer.
  4. Extract the adjacent tooth

Explanation

An asymptomatic retained root without pathology may be monitored with radiographs after discussing risks and benefits, particularly if removal would risk damage to adjacent structures. Routine removal or prophylactic antibiotics are not always indicated.

Question 50Primary care dentistry (content domains not enumerated in source)

Which of the following best describes the role of a clinical audit in primary care dentistry?

  1. To provide a legal defence for all complaints
  2. To determine the fee for treatment
  3. To replace continuing professional development
  4. To compare practice against a defined standard and improve quality Correct answer.

Explanation

Clinical audit measures practice against an agreed standard, identifies shortfalls, and drives improvement through a cycle of change. It does not replace CPD, provide blanket legal defence, or set fees.