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Canadian NDEB 2012 Clinical Judgment Practice

Discussion in 'International Dental' started by Dandani, 04.06.12.


  1. Thanks to Crack the NBDE
  1. Dandani

    Dandani

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    SDN Members don't see this ad. (About Ads)
    Hi,
    I am starting a new thread for preparation of NDEB 2012 Clinical Judgment.
    Therefore, I request all to participate to answer & complete all questions that has appeared on NDEB website.
    Some important point to follow:
    1)It is better to get the answer from a well known Textbook (preferably recommended textbook if you have) Give your references. e.g. Dental Decks 2010 (DD2010) etc.
    2) Some of Ans are very simple, just mention it once to prevent repetition. There may be other ans forgotten.
    3) Be short & up to the point. Mention Key Points(KP.) for easy recall.
    4)If Not Sure of your Ans. then note (NS). on your ans.
    5)Questions will be 1, 2,... & sub Ques A, B,C....
    6) We write all possible conditions for that Q, sub Q
    I will post all Q & sub Q one after another.
    If you have any idea to improve this, you are most welcome.

    Good luck for all.:xf::thumbup:
    F.A Dandani
  2. Dandani

    Dandani

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    .Question: 1 (Select ONE OR MORE correct answers.) .
    .In addition to periodontal probing and palpation, which of the following is/are indicated to establish a diagnosis for this patient?
    .

    .(Or when we Use these investigations)
    .

    .A. Periapical radiograph(s). .. .
    .B. Bitewing radiograph(s). ...
    .C. Panoramic radiograph. ...
    .D. Tooth percussion. .
    .E. Application of pressure on individual cusps. .
    .F. Assessment of tooth mobility. .
    .G. Electric pulp testing. .
    .H. Thermal test(s). .
    .I. Evaluation of the occlusion. .
    .J. Selective local anesthesia. .
    .K. Blood testing. .
    .L. Microbial testing. .
    .M. Cytological smear. .
    .N. Incisional biopsy. .
    .O. Excisional biopsy. .
  3. Dandani

    Dandani

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    .A) Periapical radiograph
    To see: Detail of tooth, crown ,root length & periapical pathology. Periodontal area, Bone, Anomaly of teeth, supernumerary tooth. Localization of other object ( Buccal object rule SLOB).
    Pt. records documentation.

    B) Bitewing
    Proximal caries, Occl. caries, Crest of alveolar bone(NS) .

    DD2007-8
    any thing else?/
    .
  4. tigger1986

    tigger1986

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    You do see crest of alveolar height in bitewings - it is more accurate in bitewings than in periapicals, (Oral Radiology, White and Pharoah 4th edition)
  5. Dandani

    Dandani

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    I did not have X-ray books
    Thanks a lot
  6. tigger1986

    tigger1986

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    Your welcome, Do you know what the management is for Recurrent Apthous Ulceration - minor, major, herpetiform is? Can't find the answer in dental decks. I think its topical steroids, but not sure
  7. Dandani

    Dandani

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    We will come to this topics later but for your info.

    Cause Unknown but evidence of focal immune dysfunction >>T lymphocytes
    No definitive Tx. But Topical Steroids suggested
    Triamcinolone (kenalog) oralbase 0.1% (DD2007-8)

    In severe cases systemic steroids in low doses (10–20 mg prednisone) for four
    to eight days can reduce the symptoms dramatically.(Pocket Atlas of Oral Diseases
    George Laskaris, 2nd revised and enlarged edition)
  8. Dandani

    Dandani

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    Panoramic radiograph
    Dx of oral ptho that may not see on PA X-ray or oral cavity
    Tx. planning (ortho)
    Evaluation of anomalies
    Surgery & trauma cases follow up
    Edentulous Pt. b4 full dentures contraction (DD2007-8)
    Pt. unable to tolerate PA & uncooperative Pt.

    3rd Molar Ext. surgery
    Missing & supernumerary tooth/teeth (myself)

    any thing else??
  9. tigger1986

    tigger1986

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    I think thats everything. I had assess jaw/dental development but I think that comes under ortho tx planning
  10. tigger1986

    tigger1986

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    Tooth percussion
    if positive – indicates tooth is extruded due to exudates in apical/lateral periodontal tissues (oxford handbook of clinical dentistry – Laura Mitchell)

    Dental Decks 2011-2012:
    Percussion Test:
    • Does not indicate the health of the pulp
    • Sensitivity of proprioceptive fibres does reveal inflammation of the apical PDL
    • Positive response to percussion - indicates presence of inflammation of PDL, and extent of inflammatory process
    • A tooth with percussion sensitivtiy could just need caries control with a sedative temporary filling or occlusal adjustment (which can cause reversible pulpitis as well)

    - Signs/symptoms of pulpal disease (Pulplal Necrosis) – late stages of irreversible pulpitis, acute periapical abscess, chronic periapical abscess (maybe slight TTP) Phoenix abscess, granuloma, radicular cyst, trauma to teeth e.g. concussion (DD11/12)
    - Trauma from occlusion (DD11/12)
    - Signs/symptoms of periodontal infection – Periodontal abscess? – haven’t found a reference but I think it is TTP
  11. Dandani

    Dandani

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    That is Cephalo X-ray primary objective.
  12. Domident

    Domident

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    Hi there, is anybody you know taking the exam at McGill?

    Please reply :)
  13. tigger1986

    tigger1986

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    No, But I am taking it at University of Montreal
  14. Dandani

    Dandani

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    Any one wants to answer E & F?
  15. tigger1986

    tigger1986

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    do you have anything to add to D:tooth percussion?
  16. tigger1986

    tigger1986

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    I dont have much for E and F. From my own knowledge

    E. Application of pressure on individual cusps:
    - test for cracked cusps

    F. Assessment of tooth mobility
    - Periodontal disease
    - Tooth fractures
    - Malignant disease (mobility is often a manifestation)
  17. Domident

    Domident

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    Ok, I am looking for someone to split the cost of hotel (female).....
  18. Domident

    Domident

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    I'm looking for a female to split hotel costs in montreal...
  19. tigger1986

    tigger1986

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    Sorry, My husband is going to be driving me to Montreal and staying with me till the exams are done. If I know of anyone, will let you know.
  20. Domident

    Domident

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    I. Evaluation of the occlusion: To assess if occlusion is the cause the tooth is tender to percussion, to see if occlusion is the cause of periodontal breakdown\
    J. Selective anesthesia :I don't know, any ideas?
  21. Domident

    Domident

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    Ok, thanks I would greatly appreciate it....
  22. tigger1986

    tigger1986

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    J: Selective Anaesthesia: I think this means not anaesthetizing the tooth you suspect is the problem. Like 'Test Cavity'. This is used as a last resort if unable to determine the problematic tooth. You drill a cavity into the tooth to determine if it is vital or not. If a patient doesn't feel anything as you are drilling, its most likely non-vital.
  23. prismatic

    prismatic

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    selective anesthesia: for suspected "referred"pain...due to nerve anastomosis...
  24. tigger1986

    tigger1986

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    I was totally off lol, Do you have a reference for that?
  25. Dandani

    Dandani

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    Nothing much. it can be used too roll out preapical & periodontal pathology of specific tooth.
  26. Dandani

    Dandani

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    For F: to assess trauma of occlusion (overfilling, highpoint filling/restoration)
  27. Dandani

    Dandani

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    J: Selective Anaesthesia: To anaesthetizing a particular tooth you suspect is the problem or source of pain, if pain disappear >>> help to localized & identify the suspect tooth/teeth. This is particularly useful for referred pain in oral cavity. Usually infiltration or intraligament injection used
  28. Dandani

    Dandani

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    .K. Blood testing.
    These test are routinely request for preoperative workup for Pt admitted in hospital for surgery. General anesthesia (GA)
    .

    • .Complete Blood Cont (CBC).
    • .Total WBC count.
    • .Assessment of circulating Platelets.
    • .Urinalysis (DD2007-8).
    . Pt. with systemic condition, blood.. ..cell ..dyscrasias & malfunction, for Minor Surgery & Ext. also blood workup needed. (My note, NS)

    anything else ?...
    .
  29. JVP

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    i think if the patient's chief complaint is tooth pain due to caries, letters a.d.e.f.g.h.i are needed to be done in order to come up with proper diagnosis. if patient has perio problem, letter b is important to assess bone loss. f and i are also important. selective anes could be chosen probably if it is indicated that patient could not pinpoint where pain is coming from. blood test if medical history reveals systemic conditions or if there are no known disease by patient and theres presence of spontaneous gingival bleeding (to diagnose certain possible diseases).. i think microbial could be chosen if patient presents severe infection and antibiotic is not working.. microbial tests are recommended for proper antibiotic prescription. for patients presenting with leukoplakia or erythroplakia, biopsy is recommended especially if it says in the history that patient smokes. incisional biopsy if it is big, excisional if small.. but im not sure if you can do this for hemangiomas.. for fibromas and other exophytic lesion, biopsy also..

    not sure about cytologic smear.. any idea?
  30. JVP

    JVP

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    is anyone taking the clinical judgement in toronto? did they open a test center in toronto? i am from toronto and took AFK in toronto convention center.. when i registered for judgement, no toronto venue was available.. :( will be travelling to montreal for the judgement exam...

    is there anyone here who have taken the clinical judgement already? how was it? and just wondering, how many questions would there be???
  31. tigger1986

    tigger1986

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    I am taking the clinical judgement and clinical skills in Montreal too. Are you taking clinical skills aswell?
    I experienced the same problem, I wanted either UWO,London or UofT but both were full when I went to register.
  32. tigger1986

    tigger1986

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    Cytological smear:
    - Adjunct to biopsy
    - Monitor large mucosal areas for dysplastic change
    Herpes
    Pemphigus
    Candida

    Dental Decks (11/12)
  33. tigger1986

    tigger1986

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    check INR for patients on warfarin
  34. tigger1986

    tigger1986

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    Prior to prescribing antiobiotics or other antimicrobials
    i.e when patient presents with signs/symptoms of infection
    - abscesses with systemic involvement
    - cellulitis
    - osteomyelitis
    - Ludwig's angina

    anything else to add?
  35. kelantan

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  36. JVP

    JVP

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    Are you taking clinical judgement?
  37. JVP

    JVP

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    Hi Tigger!:) i'm only taking the clinical judgement.. Are you taking both? I registered like 11am during the first day of registration, i dunno if toronto venues got full right away or if they didn't open one in toronto..
    Based on your username, you're in your 20's..?
  38. JVP

    JVP

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    Thanks tigger!!:)
  39. JVP

    JVP

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    Another parameter: when previously prescribed antibiotics are not taking effect
  40. tigger1986

    tigger1986

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    Does anyone know what the maximum daily dosage for Ibuprofen is? Finding different answers everywhere! :(
  41. tigger1986

    tigger1986

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    Yes I am taking both (dont know if that was a wise choice or not :s) I registered at 9.05am that morning and no option was present for toronto or UWO. Yes I am in my 20's.
  42. JVP

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    Wonder why they didnt open in toronto.. Now we have to travel and spend another couple of dollars..:( good luck for the clinical skills:) what are you reviewing for the judgement? Im reading books now and it's kind of time consuming, haha! Do you have any idea how much items would there be, and feedback from the last batch as well?
  43. tigger1986

    tigger1986

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    They did open in Toronto, and UWO they just got filled very quickly! For clinical judgement I am not reviewing anything in particular, just going through the questions, and referring to any texts I have on hand to get the answers. Books are time consuming for me right now. I have no idea on the format of the exam and how many questions there will be. How comes you are not taking the clinical skills?
  44. tigger1986

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    N. Incisional biopsy
    - lesion >1cm in diameter
    - hazardous location
    - suspicion of malignancy

    O. Excisional biopsy
    - lesion <1cm in diameter
    - benign
  45. tigger1986

    tigger1986

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    there are 42 questions to go through plus the few from radiography, at the speed this forum is going, I dont think all these questions will be covered! - (Worries) I have just finished question 1 - lets move on!
  46. JVP

    JVP

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    I just want to focus first on one exam, clinical skills is too expensive for me not to put 100% focus.. Im also referring to any texts now, but i read oral path (regezi) for the questions with photo and diagnosis.. Now im reading contemporary orth (proffit).. Chapter 6 is helpful for the ortho questions..
  47. Dandani

    Dandani

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    Dear friends & participants
    I start this thread for answering the Questions that published on NDEB web site last year. PLEASE use the other pages of this forum for other stuff you may need. As you know time is short & lots of Qs has to be answer. Please be focused as this assessment appears to be more difficult than it looks.
    Please Do Not waste your Time & Money
    These Qs can be found at
    http://www.ndeb.ca/sites/default/files/Case%20Diagnosis%20Templates%20for%20Website%20-%20All%20With%20Ortho.pdf

    Good luck.
    Last edited: 04.20.12
  48. Dandani

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    Thanks Tigger. That was Ans to "M"

    Any one , any thing else to add?
  49. Dandani

    Dandani

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    Agree whit you 100%
    Lets do it fast & accurate.
  50. JVP

    JVP

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    question #2 which should be included in tx plan:

    A. no special consideration

    B. prophylactic antibiotic
    - http://www.nsdental.org/media_uploads/pdf/37.pdf (page 4-6 has tables)

    C. short appointment
    -anxious patients
    -with systemmic condition: DM, history of angina, MI, stroke, HF, COPD, epilepsy.. etc.

    D. anxiolytic admin
    -very anxious patients
    -optional: to reduce anxiety that may trigger attack: patient with history of MI, angina, stroke, heart failure, asthma (stress induced), epilepsy.. etc

    E. prophylactic nitroglycerin
    -unstable angina
    -MI: only if directed by physician

    F. Avoid NSAID
    -allergies
    -on anticoagulant
    -has defect in blood clotting
    -peptic ulcer
    -impaired kidney or liver
    -asthmatic patients

    G. Avoid opioid
    -allergies
    -significant respiratory disease
    -current substance abuse
    -pregnancy(unless benefits>risks)

    H. avoid epi
    -allergic to epi
    -narrow angle glaucoma
    -thyrotoxicosis
    -hypertensives (max of 0.04mg)
    -hyperthyroid
    -shock

    I. minimize epi
    -hypertensives (max of 0.04mg)
    -hyperthyroid

    J. avoid local anes
    -pateints needing gen anes.. patients with disabilities??
    -NOT FAMILIAR.. KINDLY ADD..

    K. adust current meds

    L. stop current meds prior to appointment

    M. delay routine tx
    -unstable angina
    -MI < 6 months
    -pregnant esp 1st and 3rd semester

    N. treat at end of day
    -COPD patients

    O. must tx in hospital

    please feel free to correct or add on the answers.. thanks!!
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