Membership in General Dental Surgery (MGDS, RCSI, Ireland)

A 62-year-old man with stable angina on bisoprolol and aspirin presents for crown preparation on tooth 36. Blood pressure is 168/94 mmHg seated. Which pre-operative action is most appropriate before elective dental treatment?

• AProceed without modification because blood pressure is below 180/110 mmHg
• BPrescribe prophylactic amoxicillin because of cardiac disease
• CAdminister oral diazepam 10 mg and proceed immediately
• DPostpone elective treatment and refer for medical review because systolic pressure exceed…

Which cranial nerve provides general sensory innervation to the anterior two-thirds of the tongue (excluding taste)?

• AFacial nerve (CN VII)
• BGlossopharyngeal nerve (CN IX)
• CTrigeminal nerve (CN V) via the lingual branch
• DVagus nerve (CN X)

A patient on warfarin with INR 3.8 requires extraction of a non-restorable lower molar. There is no active bleeding and no significant liver disease. What is the most appropriate management?

• AExtract without alteration and use local haemostatic measures
• BStop warfarin for 5 days before extraction without bridging
• CBridge with low-molecular-weight heparin and stop warfarin
• DPostpone indefinitely until INR is below 1.5

Which laboratory finding is most consistent with iron-deficiency anaemia rather than anaemia of chronic disease?

• ALow serum ferritin with low mean corpuscular volume (MCV)
• BNormal ferritin with low MCV
• CHigh ferritin with low MCV
• DHigh ferritin with high MCV

During inferior alveolar nerve block anaesthesia, a patient develops sudden ipsilateral eyelid drooping and conjunctival injection without loss of consciousness. What is the most likely explanation?

• AIntra-arterial injection of local anaesthetic
• BHematoma of the pterygomandibular space
• CTransient facial nerve (CN VII) paralysis from diffusion of solution
• DVasovagal syncope

Which statement best describes the mechanism of bisphosphonate-related osteonecrosis of the jaw (BRONJ)?

• ADirect hepatotoxicity reducing vitamin D activation
• BAllergic hypersensitivity to nitrogen-containing compounds in the jaw
• CStimulation of osteoblast overactivity causing sclerotic bone fracture
• DInhibition of osteoclast-mediated bone remodelling impairing mucosal healing after trauma

A diabetic patient reports polyuria, confusion, and sweating during a long restorative appointment. Capillary blood glucose reads 2.8 mmol/L. What is the immediate first step?

• AAdminister intramuscular glucagon 1 mg
• BAdminister subcutaneous insulin
• CStart intravenous 5% dextrose infusion
• DGive oral fast-acting carbohydrate (e.g. glucose gel or sugary drink) if conscious and ab…

Which salivary gland is most commonly affected by sialolithiasis?

• AParotid gland
• BMinor labial glands
• CSublingual gland
• DSubmandibular gland

Spread of infection from a mandibular molar periapical abscess may track to the submandibular space via which anatomical route?

• AThrough the mental foramen directly into the buccal space
• BThrough the incisive canal into the hard palate
• CVia the pterygopalatine fossa into the infratemporal space
• DAlong the root apices and through the cortical plate into the submandibular compartment

Which ECG change is most characteristic of acute hyperkalaemia relevant to dental emergency management?

• AST elevation in anterior leads
• BPathological Q waves
• CPeaked T waves and widened QRS complexes
• DSinus bradycardia with prolonged PR only

According to the ICDAS II system, code 3 on an occlusal surface indicates:

• AA distinct visual change in enamel only with no cavitation
• BExtensive distinct cavitation with visible dentine
• CLocalized enamel breakdown with exposed dentine
• DLocalized enamel breakdown without visible dentine

A 14-year-old with fixed orthodontic appliances has multiple white spot lesions. Which preventive strategy has the strongest evidence for lesion reversal in this context?

• ADaily 0.05% chlorhexidine mouthrinse as sole therapy
• BComplete removal of all brackets immediately
• CTopical fluoride varnish applied at recall intervals combined with dietary counselling
• DPrescription of systemic fluoride tablets only

Which BEWE score range indicates severe tooth wear requiring specialist referral consideration?

• AScore 1
• BScore 2
• CScore 3
• DAny score above 0

In periodontal prevention, what is the primary purpose of interdental cleaning for patients with closed contacts and healthy gingiva?

• ATo replace toothbrushing in posterior regions
• BTo eliminate the need for professional prophylaxis
• CTo deliver systemic antibiotics to the gingival sulcus
• DTo disrupt interproximal plaque that a toothbrush cannot reliably reach

A water supply is non-fluoridated. For a high-caries-risk adult, which fluoride regimen is most appropriate as an adjunct to toothpaste?

• A0.05% sodium fluoride mouthrinse daily
• B225 ppm fluoride toothpaste only
• CNo additional fluoride because adult enamel is fully formed
• DTopical stannous fluoride gel at 24-hour intervals indefinitely without assessment

Which factor most strongly increases caries risk in a patient with xerostomia following head and neck radiotherapy?

• AReduced salivary buffering and clearance of fermentable carbohydrates
• BIncreased enamel hardness
• CEnhanced remineralisation from raised salivary calcium
• DReduced oral fungal colonisation

When delivering oral health promotion in general practice, which approach aligns best with the Health Belief Model?

• AAssessing perceived susceptibility and severity while building self-efficacy for behaviou…
• BProviding only technical instructions without exploring patient beliefs
• CUsing fear appeals as the sole motivational strategy
• DFocusing exclusively on punitive financial consequences of disease

A patient with Stage III Grade B periodontitis has a 6 mm pocket on the mesial of tooth 16 with bleeding on probing and radiographic bone loss extending to the mid-root. What is the most appropriate initial periodontal therapy?

• AImmediate extraction because pocket depth exceeds 5 mm
• BSystemic metronidazole for 6 months without mechanical debridement
• CCause-related therapy including scaling and root planing with oral hygiene instruction
• DReferral for gingivectomy as first-line treatment

During root canal treatment of tooth 46, a size 25 .06 rotary file separates in the apical third. The canal was negotiable to working length before separation and periapical radiolucency is present. What is the most appropriate next step?

• ALeave the fragment and obturate short of the separated instrument
• BPrescribe antibiotics alone and postpone any further endodontic intervention
• CExtract the tooth immediately without further attempts at conservation
• DAttempt removal or bypass of the fragment under magnification; refer if beyond scope

Which occlusal scheme is most appropriate for a Kennedy Class I removable partial denture with bilateral distal extension bases?

• AAnterior guidance with zero posterior contact in all excursions
• BUnilateral balanced occlusion on the side of the major connector only
• CBilateral balanced occlusion in centric and eccentric movements
• DGroup function on the edentulous side

A 10-year-old presents 30 minutes after avulsion of a permanent maxillary central incisor stored dry since injury. The root appears closed. What is the most appropriate treatment?

• AReplant immediately without any root surface treatment
• BExtract the contralateral incisor to maintain symmetry
• CSplint the empty socket and wait for spontaneous eruption of a replacement tooth
• DExplain poor prognosis; discuss replantation after root surface conditioning and splintin…

Which feature most strongly favours referral for surgical removal of an impacted lower third molar rather than coronectomy?

• APatient age 22 with pericoronitis and no inferior alveolar nerve contact on CBCT
• BDeep impaction with root apex in direct relation to the inferior alveolar canal and high…
• CVertically impacted tooth with adequate clearance and favourable root morphology
• DAsymptomatic horizontal impaction in a 55-year-old with no pathology

A patient with a Class II Division 2 malocclusion shows increased overbite and retroclined upper incisors. Which interceptive consideration is most relevant in an adolescent?

• AImmediate extraction of all four first permanent molars
• BPlacement of a lower lingual arch without orthodontic assessment
• CAssessment of growth, arch length, and potential need for orthodontic referral for increa…
• DNo referral because Class II malocclusions never require treatment

Which luting agent is generally preferred for cementation of a full-coverage zirconia crown when conventional resin bonding is not planned?

• AZinc phosphate cement
• BCalcium hydroxide lining as definitive luting material
• CZinc oxide eugenol permanent cement
• DResin-modified glass ionomer or self-adhesive resin cement per manufacturer protocol

A cracked tooth syndrome is suspected on tooth 26. The patient reports sharp pain on release of biting pressure. Which test is most helpful to localise the crack?

• AElectric pulp test on all teeth
• BThermal test with hot water only
• CTooth slooth or bite test on individual cusps
• DPeriapical radiograph alone

Which pulp cap material has the best evidence for long-term success when performing a direct pulp cap on a cariously exposed permanent molar with a closed apex?

• ACalcium hydroxide only
• BFormocresol
• CZinc oxide eugenol
• DMineral trioxide aggregate (MTA) or bioceramic material

A patient presents with trismus, fever, and swelling spreading to the submandibular and sublingual spaces with elevation of the tongue. Which diagnosis is most likely?

• ALudwig angina
• BAcute pericoronitis only
• CBell palsy
• DTemporomandibular joint disc displacement without reduction

When planning a resin composite restoration in a high-stress posterior region, which factor most reduces polymerisation shrinkage stress?

• ABulk filling in one increment with maximum light intensity
• BUsing only flowable composite without an adhesive layer
• CIncremental layering with oblique placement and appropriate curing
• DDelaying curing for 10 minutes after placement

Which sign is most consistent with a necrotic pulp in a traumatised tooth that previously tested vital?

• APositive response to cold testing
• BBleeding on probing only
• CTransient pain to hot that resolves within seconds
• DNo response to cold and electric pulp testing with periapical radiolucency developing

For a patient with a resin-bonded bridge replacing upper lateral incisor 22, which factor most improves long-term retention?

• AMinimal enamel preparation with maximum enamel bonding surface on abutment teeth
• BFull coverage crowns on both abutments regardless of vitality
• CUsing zinc phosphate cement for easier debonding
• DPlacing the retainer only on a single abutment without framework rigidity

A mucocele on the lower lip in a 25-year-old is recurrent after previous drainage. What is the definitive treatment?

• ARepeated aspiration only
• BSystemic antifungal therapy
• CSurgical excision of the lesion including associated minor salivary glands
• DTopical corticosteroid gel alone

Why is silane coupling agent applied to the intaglio surface of a lithium disilicate restoration before resin cementation?

• ATo etch the ceramic with hydrofluoric acid substitute
• BTo prevent moisture contamination during try-in only
• CTo increase ceramic flexural strength permanently
• DTo promote chemical bonding between the ceramic and resin cement

Which property of type IV dental stone makes it preferable for fabricating working casts for removable prostheses?

• ALow compressive strength and high expansion
• BRapid setting with high solubility in water
• CHigh compressive strength and controlled expansion with minimal porosity
• DHigh organic content for flexibility

Amalgam restorations in load-bearing areas rely primarily on which retention mechanism?

• AChemical adhesion to enamel prisms
• BOsseointegration with surrounding bone
• CHydrogen bonding to dentine collagen
• DMechanical undercuts and groove retention in the cavity preparation

Which impression material is most appropriate when maximum dimensional stability over several days before pouring is required?

• AAlginate
• BCondensation silicone without proper storage
• CAddition silicone (polyvinyl siloxane)
• DImpression compound only

In resin composite selection, a high filler content generally produces which clinical effect?

• AIncreased polymerisation shrinkage and lower wear resistance
• BFaster auto-polymerisation without light activation
• CComplete elimination of the need for adhesive bonding
• DReduced polymerisation shrinkage and improved wear resistance but potentially reduced pol…

Titanium implant fixtures achieve primary stability immediately after placement primarily through:

• AChemical fusion to enamel at the coronal margin
• BResin tags in the gingival sulcus
• CMechanical engagement in cortical bone
• DGlass ionomer luting at the bone interface

When disinfecting alginate impressions, which approach minimises distortion while reducing cross-infection risk?

• AImmersion in glutaraldehyde for 60 minutes before rinsing
• BNo disinfection because alginate is single-patient use only
• CAutoclaving the impression at 134°C
• DShort exposure to an approved disinfectant spray or dip per manufacturer instructions fol…

A patient collapses in the dental chair, is unresponsive, and has absent central pulse. What is the immediate priority according to basic life support protocols?

• AAdminister intramuscular adrenaline 0.5 mg
• BPlace the patient in the recovery position and observe
• CStart chest compressions and call for the automated external defibrillator and emergency…
• DAdminister oral glucose

Which dose of intramuscular adrenaline is appropriate for an adult with anaphylaxis in dental practice?

• A0.15 mg IM (0.15 mL of 1:1000)
• B0.5 mg sublingual
• C1 mg intravenous bolus
• D0.5 mg IM (0.5 mL of 1:1000)

A patient develops acute asthma with wheeze and SpO2 91% after a dental procedure. Salbutamol inhaler gives partial relief. What is the next most appropriate action?

• ADischarge home without further treatment
• BPrescribe antibiotics for bacterial asthma
• CAdminister oxygen, repeat bronchodilator, and arrange urgent medical transfer if not impr…
• DAdminister IV midazolam sedation

Persistent post-extraction bleeding 2 hours after removal of tooth 38 in a patient on therapeutic apixaban. Local measures with gauze have failed. What is most appropriate?

• AReassure and send home without further intervention
• BPrescribe aspirin to improve clot stability
• CAdminister prophylactic IV heparin
• DApply haemostatic measures (suturing, haemostatic agents), compress the socket, and conta…

Which sign distinguishes epileptic tonic-clonic seizure from vasovagal syncope?

• AProlonged post-ictal confusion with tongue biting to the lateral aspect
• BBrief pallor with rapid complete recovery and no post-ictal phase
• CBradycardia with sweating triggered by anxiety
• DIsolated eyelid ptosis resolving in 30 minutes

A patient develops sudden facial swelling, stridor, and wheeze within minutes of amoxicillin administration. Priority action after IM adrenaline is:

• AOral antihistamine only and send home
• BComplete the planned extraction under local anaesthesia
• CCall emergency services, administer oxygen, and prepare for further treatment including p…
• DAdminister oral penicillin to confirm allergy

For acute pericoronitis with trismus but no spreading cellulitis, initial management in general practice includes:

• AImmediate admission to hospital for IV antibiotics only
• BApplication of formocresol to the operculum
• CSystemic antifungal therapy
• DOperculum irrigation, oral hygiene instruction, analgesia, and consideration of operculec…

Which emergency drug should be readily available in dental practice for management of severe hypoglycaemia when IV access is not established and the patient is unconscious?

• AGlucagon injection
• BFlumazenil
• CNaloxone only
• DAtropine

A 45-year-old with moderate intellectual disability and autism requires multiple restorations but cannot tolerate conventional treatment. What is the most appropriate first step?

• AGeneral anaesthesia without behavioural assessment or caries stabilisation planning
• BRefuse treatment until the patient can cooperate like other adults
• CBehavioural assessment, desensitisation where possible, caries risk reduction, and discus…
• DExtract all carious teeth without consent discussion