A 45-year-old patient attends a special care dental service. They have breast cancer with bone and liver metastasis and are receiving palliative care palbociclib and letrozole. Their oncologist would like them to start denosumab, but they are complaining of discomfort from the UR6. On examination, the tooth is unrestorable with a periapical pathology.

What is the most appropriate next step?

1. Extract the UR6 after a pre-operative blood test
2. Prescribe antibiotics and refer to oral surgery
3. Liaise with the patient’s oncologist to plan extraction
4. Prescribe preoperative antibiotics and extract the UR6
5. Extirpate the UR6 and dress

The correct answer is C.

Justification: Liaison with the oncologist is the most appropriate next step to allow timing with the palbociclib and determine whether a drug holiday is indicated. Liaison would also allow timing of appointment with blood tests and any other oncological management.

A 36-year-old patient, who has recently been admitted to an acute psychiatric ward, is referred for a dental review. They are asymptomatic with poor plaque control, multiple carious lesions and retained roots. There is no swelling, pain or systemic infection.

What is the most appropriate next step in dental management?

A. Arrange dental treatment under general anaesthesia
B. Extract retained roots during the current admission
C. Give preventive care and arrange further review
D. Offer review only if dental symptoms develop
E. Restore all carious teeth during the admission

The correct answer is C.

Justification: This patient has chronic dental disease but no acute dental emergency. During a recent psychiatric admission, the appropriate next step is proportionate management: provide oral-health assessment and prevention, arrange planned follow-up for definitive care once mental health stability, consent, capacity and practical circumstances are clearer.

An adult with a severe learning disability attends with their family. The family report having missed appointments because the letters are written in English, which they do not read confidently; their first language is Arabic. The patient communicates via gestures and requires family support to attend appointments.

What is the most appropriate measure to support the patient to attend appointments?

A. Arrange translated accessible information, including letters, and record communication needs
B. Continue sending appointment letters, but add a reminder phone call the day before the appointment
C. Discharge back to their GDP after further missed appointments, under local policy
D. Make a safeguarding referral for repeated non-attendance, in line with hospital policy
E. Organise an in-person Arabic interpreter for all future clinical appointments

The correct answer is A.

Justification: The key barriers are organisational and communication-related. English-only correspondence is inaccessible for the family, and the patient has individual communication needs related to their severe learning disability. The most appropriate response is a service-level adjustment: provide translated accessible information, record the patient’s communication needs and ensure future care is organised around those needs.

A 65-year-old man attends for oral health risk assessment. Plaque control is poor and he wears an upper partial denture. He has 24 natural teeth, including 14 teeth with restored root caries lesions.

Which factor is the strongest indicator of future root caries risk?

A. High number of retained natural teeth
B. Older age of the patient
C. Poor plaque control
D. Presence of an upper partial denture
E. Previous restored root caries lesions

The correct answer is E.

Justification: Previous disease experience is the strongest risk indicator. This many teeth having restored root caries lesions indicates that root caries has already occurred extensively, so future disease risk is high unless causative factors are controlled. Poor plaque control, a partial denture, older age and many retained teeth all contribute to risk, but they are less discriminating than a clear history of widespread root caries.

During a domiciliary visit, a silver-modified atraumatic restorative technique restoration is placed on a root-surface lesion on a UL2. The patient is co-operative throughout. At their review visit one week later, the restoration is completely lost.

What is the most likely reason for the restoration failure?

A. Insufficient finger pressure during material setting
B. Omission of cavity conditioning before material placement
C. Overfill of the restoration without occlusal adjustment
D. Poor moisture control during restoration placement
E. Toothbrushing too soon after restoration placement

The correct answer is D.

Justification: Early complete loss of a silver-modified atraumatic restorative technique restoration is most consistent with failure of retention or adhesion during placement. Glass ionomer materials bond to tooth structure but remain vulnerable during early setting and maturation, so contamination or poor isolation can compromise the restoration.