MJDF Part 1 - Membership of Joint Dental Faculties Oral Medicine and Pathology Questions and Answers — Questions and Answers
Question 1: A 65-year-old male, who is a heavy smoker, presents with a painless, speckled red and white patch (erythroleukoplakia) on the floor of his mouth, which he first noticed 4 weeks ago. According to NICE guideline [NG12] 'Suspected cancer: recognition and referral', what is the most appropriate immediate action?
- Review the patient in 2 weeks after providing smoking cessation advice.
- Refer the patient via a 'two-week wait' suspected cancer pathway. (Correct answer)
- Prescribe a topical corticosteroid and review in 4 weeks.
- Perform an incisional biopsy in the primary care setting.
Correct answer: Refer the patient via a 'two-week wait' suspected cancer pathway.
The clinical presentation of a red and white patch (erythroleukoplakia) is considered a high-risk sign for oral dysplasia or squamous cell carcinoma. NICE guideline [NG12] specifically recommends an urgent referral for a patient to be seen within 2 weeks if they present with a red or red and white patch in the oral cavity consistent with erythroplakia or erythroleukoplakia. Observation, topical steroids, or biopsy in primary care would cause an unacceptable delay in diagnosis and management by a specialist team.
Question 2: Which of the following clinical presentations is most characteristic of the reticular form of oral lichen planus?
- Multiple, painful, well-defined ulcers on non-keratinised mucosa.
- A single, large, non-healing ulcer with indurated, rolled edges.
- Widespread, erythematous, and desquamating attached gingivae.
- Bilateral, asymptomatic, white, lace-like striae on the buccal mucosa. (Correct answer)
Correct answer: Bilateral, asymptomatic, white, lace-like striae on the buccal mucosa.
Reticular oral lichen planus classically presents as bilateral, symmetrical, white, keratotic striae (known as Wickham's striae) that form a lace-like or annular pattern. This form is often asymptomatic and is most commonly found on the posterior buccal mucosa. While desquamative gingivitis can be a feature of lichen planus, the bilateral lace-like pattern is the most pathognomonic sign of the reticular type.
Question 3: A 55-year-old female patient complains of a persistently dry mouth and gritty-feeling eyes for the past year. Which of the following investigation findings would most strongly support a diagnosis of primary Sjögren's syndrome?
- An elevated Erythrocyte Sedimentation Rate (ESR).
- A positive test for Rheumatoid Factor.
- Presence of anti-Ro (SSA) and/or anti-La (SSB) autoantibodies in serum. (Correct answer)
- An unstimulated whole salivary flow rate of <0.2 mL/min.
Correct answer: Presence of anti-Ro (SSA) and/or anti-La (SSB) autoantibodies in serum.
Primary Sjögren's syndrome is an autoimmune disease targeting exocrine glands. According to the internationally used ACR-EULAR classification criteria, the presence of specific autoantibodies, particularly anti-Ro (SSA), is a key serological marker with a high weighting for diagnosis. While a reduced salivary flow rate is also a criterion, it is less specific. Elevated ESR and positive Rheumatoid Factor are non-specific findings that can be present in many inflammatory or autoimmune conditions.
Question 4: A 68-year-old patient describes a sudden onset of severe, unilateral, shooting pain on the right side of her chin and lower lip. The pain lasts for only a few seconds per episode but occurs multiple times a day. It is triggered by light touch, such as washing her face or a cool breeze. A thorough dental examination and radiographs reveal no abnormalities. What is the most likely diagnosis?
- Trigeminal neuralgia (Correct answer)
- Atypical odontalgia
- Temporomandibular disorder (TMD)
- Burning mouth syndrome
Correct answer: Trigeminal neuralgia
The patient's report of unilateral, brief, severe, electric shock-like pain confined to a trigeminal nerve distribution (in this case, the mandibular branch) and initiated by innocuous stimuli (allodynia) is the classic presentation of trigeminal neuralgia. The other conditions present differently: atypical odontalgia is a persistent, dull ache in a seemingly normal tooth; TMD pain is muscular and related to jaw function; burning mouth syndrome is a constant burning sensation, often bilateral.
Question 5: A routine panoramic radiograph of an asymptomatic 19-year-old reveals a well-defined, unilocular radiolucency surrounding the crown of the impacted mandibular left third molar (LL8). The radiolucency appears to be attached at the cemento-enamel junction of the tooth. Which of the following is the most probable diagnosis?
- Radicular cyst
- Ameloblastoma
- Odontogenic keratocyst
- Dentigerous cyst (Correct answer)
Correct answer: Dentigerous cyst
A dentigerous (or follicular) cyst is a developmental cyst that originates from the reduced enamel epithelium around the crown of an unerupted tooth. Its hallmark radiographic feature is a well-circumscribed, unilocular radiolucency attached to the cemento-enamel junction of an impacted tooth. A radicular cyst is associated with the apex of a non-vital tooth. While an odontogenic keratocyst or ameloblastoma can occur in this location, the classic description provided is most indicative of a dentigerous cyst.
Question 6: An 80-year-old patient who wears a complete upper denture presents with soreness and redness of the palate. Clinical examination reveals diffuse erythema of the mucosa that is directly covered by the denture. This condition, known as denture-related stomatitis, is most commonly caused by an overgrowth of which microorganism?
- Staphylococcus aureus
- Streptococcus mutans
- Candida albicans (Correct answer)
- Herpes simplex virus
Correct answer: Candida albicans
Denture-related stomatitis is the most common form of oral candidosis. The environment under a denture prosthesis, especially if worn continuously, promotes the colonisation of yeast. *Candida albicans* is the predominant causative organism in the vast majority of cases. *Streptococcus mutans* is associated with caries, *Staphylococcus aureus* is more commonly implicated in angular cheilitis, and Herpes simplex virus causes vesicular eruptions.
MJDF Part 1 - Membership of Joint Dental Faculties Oral Medicine and Pathology Questions and Answers
A 65-year-old male, who is a heavy smoker, presents with a painless, speckled red and white patch (erythroleukoplakia) on the floor of his mouth, which he first noticed 4 weeks ago.
According to NICE guideline [NG12] 'Suspected cancer: recognition and referral', what is the most appropriate immediate action?