LDEK: Dental Medicine: Integrated Clinical Decision-Making

The LDEK dental medicine domain tests whether you can combine cariology, endodontics, periodontology, oral surgery and trauma, prosthodontics and oral medicine into one clinical decision. Items are scenario-based and ask for the most appropriate next step. Lithuanian practice follows current European consensus, so answers reflect evidence-based guidelines.

Caries and pulpal diagnosis

Record lesions with ICDAS/DMFT and take bitewings for proximal caries. Sensibility tests (cold, EPT) assess nerve response, not blood supply: a traumatised tooth may not respond yet remain vital. Chart percussion, mobility and bleeding on probing before planning.

Endodontics

Working length comes from an apex locator confirmed radiographically. Sodium hypochlorite 1 to 5.25% is the principal irrigant, EDTA removes the smear layer, calcium hydroxide is the inter-appointment dressing. Obturate only when the tooth is asymptomatic, the canal dry and no sinus tract is present.

Periodontology

The 2017 classification separates stage (I to IV: severity from CAL, PPD, bone loss, tooth loss, complexity) from grade (A to C: progression from bone loss/age, smoking, HbA1c). Full-mouth charting and risk-factor control precede subgingival instrumentation.

Trauma

Avulsion: replant immediately; if that is impossible, store the tooth in milk, saline or HBSS, because dry time beyond 60 minutes worsens prognosis. Flexible splint for 2 weeks, systemic antibiotics, tetanus check, and root canal treatment within 2 weeks when the apex is closed.

Oral medicine red flags

An ulcer or white or red patch persisting beyond 2 weeks, especially with induration, unilateral numbness or lymphadenopathy, needs referral for biopsy, not empirical antifungal or antiseptic treatment.

Worked example

A 45-year-old smoker has PPD 6 mm and CAL 5 mm on 16 MB, 40% bone loss, HbA1c 7.5% and two teeth lost to periodontitis; bone loss/age is roughly 0.9. That is stage III (CAL 5 mm or more, up to 4 teeth lost) and grade C (rapid progression, smoking, diabetes). Correct answer: risk-factor counselling and glycaemic control first, then subgingival instrumentation; antibiotics alone are wrong.

Traps

Common mark-losers: calling a non-responding traumatised tooth necrotic; staging periodontitis from radiographs alone; prescribing antibiotics for irreversible pulpitis; rigid splinting or delayed replantation of an avulsed tooth; treating a persistent ulcer with mouthwash.