INBDE Diagnosis & Treatment Planning (Integrated) practice questions

Question 1

A 52-year-old male presents with a chief complaint of 'a painful bump on my lower right gums.' Clinical examination reveals a parulis associated with tooth #30, which has a large disto-occlusal composite with recurrent decay and a 9mm periodontal pocket on the buccal. Radiographs show a furcation radiolucency. The patient also has uncontrolled Type 2 Diabetes (HbA1c: 9.2%). What is the first priority in the treatment plan?

Accepted Answer

Perform an incision and drainage or pulpal debridement to manage the acute infection.

Answer

Perform Scaling and Root Planing (SRP) to address the 9mm pocket.

Answer

Prescribe a 10-day course of Amoxicillin and refer to a physician for glucose management.

Answer

Extract tooth #30 immediately due to the poor prognosis and diabetic status.

Question 2

A 68-year-old female presents for a comprehensive exam. Her medical history includes hypertension (controlled by Lisinopril) and osteoporosis (treated with oral Alendronate for 5 years). She requires the extraction of tooth #15 due to vertical root fracture. What is the most appropriate next step regarding her medication?

Accepted Answer

Perform the extraction using a minimally invasive technique without altering her medication.

Answer

Instruct the patient to discontinue Alendronate for 3 months prior to the extraction (drug holiday).

Answer

Request a C-terminal telopeptide (CTX) test to determine the risk of MRONJ before proceeding.

Answer

Refer the patient to an oral surgeon for a hyperbaric oxygen protocol prior to the extraction.

Question 3

A 45-year-old patient with generalized Stage III Grade B periodontitis and multiple missing teeth wishes to have a fixed partial denture (FPD) from #18 to #20. Tooth #19 is missing. Tooth #18 has 50% bone loss but is stable. At which stage of the treatment plan should the final FPD be fabricated?

Accepted Answer

The Definitive Phase, after evaluating the response to periodontal therapy.

Answer

The Systemic Phase, to ensure the patient is medically cleared for the procedure.

Answer

The Disease Control Phase, immediately after scaling and root planing.

Answer

The Maintenance Phase, to monitor the bridge's success over time.

Question 4

A 24-year-old patient presents with several small interproximal carious lesions (E1 and E2 level) on the bitewing radiographs. The patient has a high caries risk due to frequent soda consumption. What is the most appropriate management for these specific lesions in the Disease Control Phase?

Accepted Answer

Dietary counseling and topical fluoride application with radiographic monitoring.

Answer

Immediate Class II resin composite restorations for all affected teeth.

Answer

Extraction of the most severely affected teeth to prevent spread.

Answer

Placement of silver diamine fluoride (SDF) followed by full-coverage crowns.

Question 5

A patient presents with a blood pressure of 165/102 mmHg during the initial examination. He has no history of hypertension and feels 'fine.' What is the most appropriate action according to current clinical guidelines?

Accepted Answer

Re-measure the blood pressure after 5 minutes and, if still elevated, refer for medical evaluation before elective care.

Answer

Proceed with elective dental treatment but avoid using epinephrine in the local anesthetic.

Answer

Immediately call 911 as the patient is in a hypertensive crisis.

Answer

Perform only the 'Emergency Phase' treatments and prescribe an antihypertensive.

Question 6

During the re-evaluation of periodontal therapy (4-6 weeks after SRP), you note that tooth #3 has a persistent 7mm pocket with bleeding on probing and Grade II furcation involvement. The tooth was originally given a 'guarded' prognosis. How should this affect the treatment plan?

Accepted Answer

Refer the patient to a periodontist for surgical consideration before moving to the Definitive Phase.

Answer

Immediately change the prognosis to 'hopeless' and schedule an extraction.

Answer

Proceed with the planned crown in the Definitive Phase since the pocket is stable.

Answer

Skip the Maintenance Phase and repeat the SRP every month until the pocket is 3mm.

Question 7

Which of the following describes the correct sequencing for a patient needing a comprehensive treatment plan including: 1. Maxillary complete denture, 2. Extraction of hopeless teeth, 3. Tobacco cessation counseling, 4. Immediate denture for the transition?

Accepted Answer

3, 2, 4, 1

Answer

2, 3, 1, 4

Answer

1, 2, 4, 3

Answer

4, 2, 3, 1

Question 8

A patient presents for a 'second opinion' on tooth #14. The previous dentist recommended a crown. You observe a large MOD amalgam with a crack on the mesial marginal ridge, but the tooth is asymptomatic and responds normally to pulp testing. What is the most appropriate next step?

Accepted Answer

Perform a 'clench' test (bite stick) to check for Crack Tooth Syndrome symptoms.

Answer

Inform the patient the previous dentist was wrong and no treatment is needed.

Answer

Recommend immediate Root Canal Treatment because cracks always lead to pulpitis.

Answer

Apply a stainless steel crown as a long-term provisional.

Question 9

In a patient with a complex medical history, including daily use of Warfarin for atrial fibrillation, the most recent INR is 3.8. The patient requires a simple extraction of a mobile, periodontally involved tooth. What is the best course of action?

Accepted Answer

Delay the extraction and refer to a physician for medical management of the high INR.

Answer

Proceed with the extraction and use local hemostatic agents (e.g., Gelfoam).

Answer

Ask the patient to stop taking Warfarin for 3 days before the extraction.

Answer

Consult the physician to lower the INR to below 2.5 before any dental work.

Question 10

A 15-year-old patient has generalized white spot lesions and several cavitated lesions. The patient's mother states they do not use fluoridated toothpaste. Which phase of the treatment plan is the 'fluoride varnish application and oral hygiene instruction' categorized under?

Accepted Answer

Disease Control Phase

Answer

Systemic Phase

Answer

Definitive Phase

Answer

Maintenance Phase

INBDE Diagnosis & Treatment Planning (Integrated) practice questions

A 45-year-old patient with generalized Stage III Grade B periodontitis and multiple missing teeth wishes to have a fixed partial denture (FPD) from #18 to #20. Tooth #19 is missing. Tooth #18 has 50% bone loss but is stable. At which stage of the treatment plan should the final FPD be fabricated?

A 24-year-old patient presents with several small interproximal carious lesions (E1 and E2 level) on the bitewing radiographs. The patient has a high caries risk due to frequent soda consumption. What is the most appropriate management for these specific lesions in the Disease Control Phase?

A patient presents with a blood pressure of 165/102 mmHg during the initial examination. He has no history of hypertension and feels 'fine.' What is the most appropriate action according to current clinical guidelines?

During the re-evaluation of periodontal therapy (4-6 weeks after SRP), you note that tooth #3 has a persistent 7mm pocket with bleeding on probing and Grade II furcation involvement. The tooth was originally given a 'guarded' prognosis. How should this affect the treatment plan?

Which of the following describes the correct sequencing for a patient needing a comprehensive treatment plan including: 1. Maxillary complete denture, 2. Extraction of hopeless teeth, 3. Tobacco cessation counseling, 4. Immediate denture for the transition?

A patient presents for a 'second opinion' on tooth #14. The previous dentist recommended a crown. You observe a large MOD amalgam with a crack on the mesial marginal ridge, but the tooth is asymptomatic and responds normally to pulp testing. What is the most appropriate next step?

In a patient with a complex medical history, including daily use of Warfarin for atrial fibrillation, the most recent INR is 3.8. The patient requires a simple extraction of a mobile, periodontally involved tooth. What is the best course of action?

A 15-year-old patient has generalized white spot lesions and several cavitated lesions. The patient's mother states they do not use fluoridated toothpaste. Which phase of the treatment plan is the 'fluoride varnish application and oral hygiene instruction' categorized under?

The first 10 are free. 9 more below.

Which clinical finding would most significantly worsen the prognosis of a tooth being considered as an abutment for a fixed bridge?

A 35-year-old male smoker with poorly controlled diabetes (HbA1c 8.8%) wants to replace his missing #19 with a dental implant. What is the most appropriate communication regarding his risk?

A patient with severe dental anxiety and a history of stable angina presents with an urgent need for an extraction. Which of the following is the best management strategy for the 'Systemic Phase' of his plan?

A patient presents with a deep carious lesion on tooth #31. A radiograph shows the decay is very close to the pulp, but the tooth is asymptomatic and the pulp is vital. What is the preferred 'Disease Control' approach to preserve pulp vitality?

During a case review, you note a patient has generalized 5-6mm pockets, but also has a fractured maxillary central incisor that is esthetically concerning. Which is the correct sequence for these treatments?

A patient returns for a 6-month recall. You observe that their plaque control has regressed, and several new 'white spot' lesions have appeared. What is the most appropriate management according to the treatment planning cycle?

A 10-year-old child presents with a traumatized #8 that was avulsed and replanted by the parent 20 minutes after the accident. The tooth is splinted. Which of the following is a critical part of the 'Maintenance/Follow-up' phase for this patient?

A patient requires multiple extractions and a transition to a mandibular removable partial denture (RPD). Several teeth are to be used as abutments. When should the 'rest seats' and 'guide planes' be prepared?

A patient presents with a history of intravenous bisphosphonate therapy (Zoledronic acid) for bone metastasis. They have a non-restorable tooth #19 with a periapical abscess. What is the most appropriate treatment strategy?