MJDF Part 1 - Membership of Joint Dental Faculties Paediatric Dentistry Principles Questions and Answers — Questions and Answers
Question 1: A 4-year-old child attends for their first dental visit. They are assessed as having a high risk of developing caries. According to Public Health England's 'Delivering Better Oral Health' toolkit, what is the recommended frequency for applying 2.2% fluoride varnish for this child?
- Annually
- Every 6 months
- 3 to 4 times per year (Correct answer)
- Every 2 years
Correct answer: 3 to 4 times per year
The 'Delivering Better Oral Health' toolkit recommends that for children from the age of 3 who are assessed as being at high risk for caries, fluoride varnish (2.2% NaF) should be applied three to four times a year. For children not at high risk, the recommendation is twice a year.
Question 2: A 7-year-old child presents with a carious, asymptomatic lower left first primary molar (LLE). Radiographs reveal caries extending into the distal dentine but no evidence of periapical pathology or furcal involvement. The child is anxious. Which of the following is the most appropriate management option according to current UK guidelines?
- Pulpotomy and stainless steel crown
- Extraction of the LLE
- Hall Technique placement of a preformed metal crown (Correct answer)
- Conventional glass ionomer restoration after caries removal
Correct answer: Hall Technique placement of a preformed metal crown
The Hall Technique is a minimally invasive procedure indicated for carious primary molars that are asymptomatic or show signs of reversible pulpitis. It involves cementing a preformed metal crown over the tooth without local anaesthetic, caries removal, or tooth preparation. Given the child's anxiety and the clinical/radiographic findings, it is the most appropriate evidence-based option as per SDCEP guidance.
Question 3: A 9-year-old child attends your practice 45 minutes after avulsing their upper right permanent central incisor (UR1) during a fall. The tooth has been kept dry in a tissue. What is the most critical first step in managing this situation clinically?
- Soak the tooth in a solution of tetracycline before replantation.
- Gently clean the root surface with saline and replant the tooth with digital pressure. (Correct answer)
- Immediately take a periapical radiograph to check for alveolar fracture.
- Delay replantation and create a space maintainer.
Correct answer: Gently clean the root surface with saline and replant the tooth with digital pressure.
According to the International Association of Dental Traumatology (IADT) guidelines, which are followed in the UK, the primary goal is to replant the tooth as soon as possible. The root surface should be gently cleansed with saline before replantation. The extra-oral dry time is critical (prognosis worsens significantly after 60 minutes), making immediate action essential. A radiograph is needed, but only after replantation or to aid it if it is difficult.
Question 4: A 10-year-old patient in the mixed dentition is assessed as having a high risk of developing caries. Their posterior contacts are closed. According to the Faculty of General Dental Practice (UK) 'Selection Criteria for Dental Radiography', what is the recommended maximum interval for taking posterior bitewing radiographs for this patient?
- 24-36 months
- 18-24 months
- 6-12 months (Correct answer)
- Only when there is clinical evidence of caries
Correct answer: 6-12 months
The FGDP(UK) guidelines, supported by sources like the SDCEP, state that for a child or adolescent assessed as being at high caries risk, posterior bitewing radiographs are recommended at 6-12 month intervals once the posterior contacts are closed. This allows for the timely detection of interproximal lesions.
Question 5: A 14-year-old patient, who attends alone, requires an extraction of a premolar for orthodontic reasons. The dentist assesses the patient and is confident they fully understand the procedure, risks, benefits, and alternatives. The patient consents to the treatment. The patient's mother phones later and expressly forbids the extraction. What is the most appropriate course of action?
- Proceed with the extraction as the patient has provided valid consent.
- Refuse to treat until the patient is 16 and can consent for themselves.
- Follow the mother's wishes as she holds parental responsibility.
- Postpone the treatment and arrange a discussion with both the patient and the mother. (Correct answer)
Correct answer: Postpone the treatment and arrange a discussion with both the patient and the mother.
While the 14-year-old may be 'Gillick competent' and able to provide valid consent, proceeding against a parent's express wishes for non-urgent treatment can lead to a serious breakdown in trust and a potential complaint. The most prudent and professional action is to postpone the treatment and facilitate a discussion to try and reach a consensus, respecting both the child's developing autonomy and the parent's responsibility. This aligns with GDC principles of communication.
Question 6: Which of the following is a characteristic clinical feature that helps differentiate Molar Incisor Hypomineralisation (MIH) from other enamel defects such as fluorosis or amelogenesis imperfecta?
- Symmetrical and generalised pitting affecting all teeth in both dentitions.
- An asymmetrical distribution, typically affecting one to four first permanent molars and often incisors. (Correct answer)
- Chalky white bands that follow the incremental lines of enamel formation.
- A clear familial or genetic link is always present.
Correct answer: An asymmetrical distribution, typically affecting one to four first permanent molars and often incisors.
Molar Incisor Hypomineralisation (MIH) is defined by the hypomineralisation of systemic origin of one to four first permanent molars, frequently associated with affected incisors. Its asymmetrical and sporadic distribution is a key diagnostic feature, distinguishing it from more generalised and often symmetrical conditions like amelogenesis imperfecta or fluorosis.
MJDF Part 1 - Membership of Joint Dental Faculties Paediatric Dentistry Principles Questions and Answers
A 4-year-old child attends for their first dental visit.
They are assessed as having a high risk of developing caries.
According to Public Health England's 'Delivering Better Oral Health' toolkit, what is the recommended frequency for applying 2.2% fluoride varnish for this child?