MJDF Part 1 - Membership of Joint Dental Faculties Pharmacology and Therapeutics Questions and Answers — Questions and Answers
Question 1: A 28-year-old patient presents with a painful, localised dentoalveolar abscess associated with the lower left first molar. There are no signs of systemic involvement or spreading infection. After establishing drainage, you consider prescribing an analgesic. According to the dental pain ladder in the UK, which of the following is the most appropriate first-line oral analgesic for this patient, assuming no contraindications?
- Paracetamol 1g and Ibuprofen 400mg combined
- Co-codamol 30/500 (30mg codeine phosphate, 500mg paracetamol)
- Paracetamol 1g alone
- Ibuprofen 400mg alone (Correct answer)
Correct answer: Ibuprofen 400mg alone
According to UK prescribing guidelines, such as those referenced in the British National Formulary (BNF), a non-steroidal anti-inflammatory drug (NSAID) like ibuprofen is the first-line choice for dental pain due to its anti-inflammatory properties, provided there are no contraindications (e.g., asthma, gastric issues). Paracetamol is an effective alternative if NSAIDs are contraindicated. Combining paracetamol and ibuprofen is reserved for more severe pain that is not managed by a single agent. Co-codamol is higher up the pain ladder and should be reserved for when NSAIDs and/or paracetamol are ineffective or contraindicated.
Question 2: A 45-year-old patient requires a routine dental extraction and reports taking alendronic acid 70mg once weekly for the past six years for osteoporosis. According to the Scottish Dental Clinical Effectiveness Programme (SDCEP) guidance, what is the primary pharmacological risk that must be considered and managed for this patient?
- Increased risk of post-operative bleeding
- Delayed wound healing due to immunosuppression
- Medication-Related Osteonecrosis of the Jaw (MRONJ) (Correct answer)
- Adrenal crisis due to steroid suppression
Correct answer: Medication-Related Osteonecrosis of the Jaw (MRONJ)
Alendronic acid is an oral bisphosphonate. Patients taking anti-resorptive drugs, such as bisphosphonates, are at an increased risk of developing Medication-Related Osteonecrosis of the Jaw (MRONJ) following invasive dental procedures like extractions. The SDCEP provides specific guidance for risk assessing and managing these patients to minimise the chance of MRONJ developing.
Question 3: A 35-year-old adult patient suddenly develops signs of a severe anaphylactic reaction in the dental chair after the administration of a local anaesthetic. According to the Resuscitation Council UK guidelines, what is the correct first-line drug, dose, and route of administration?
- Adrenaline 1:10,000, 300 micrograms, Intravenous (IV)
- Hydrocortisone 100mg, Intramuscular (IM)
- Salbutamol 5mg, Nebulised
- Adrenaline 1:1000, 500 micrograms, Intramuscular (IM) (Correct answer)
Correct answer: Adrenaline 1:1000, 500 micrograms, Intramuscular (IM)
The Resuscitation Council UK guidelines clearly state that the first-line treatment for anaphylaxis in an adult is an intramuscular injection of 500 micrograms of adrenaline (0.5ml of 1:1000 solution) into the anterolateral aspect of the thigh. Other drugs like hydrocortisone and salbutamol are second-line treatments and should not delay the administration of adrenaline. Intravenous adrenaline is reserved for specialist use in refractory cases.
Question 4: A dentist prescribes a course of metronidazole 400mg three times daily for a patient with acute necrotising ulcerative gingivitis (ANUG). Which of the following pieces of advice is critical to give the patient to avoid a significant adverse reaction?
- Avoid taking ibuprofen concurrently
- Take the medication with a glass of milk to prevent gastric upset
- Avoid consuming alcohol during treatment and for 48-72 hours after (Correct answer)
- Avoid direct sunlight as the drug can cause photosensitivity
Correct answer: Avoid consuming alcohol during treatment and for 48-72 hours after
Metronidazole can cause a disulfiram-like reaction when taken with alcohol. This reaction can include severe nausea, vomiting, flushing, tachycardia, and headache. The British National Formulary (BNF) and other UK guidelines strongly advise patients to avoid all alcohol during the course of metronidazole and for at least 48-72 hours after finishing the course.
Question 5: A patient with a known, documented allergy to procaine (an ester-type local anaesthetic) requires restorative treatment. Which of the following local anaesthetic agents would be considered safe to use for this patient?
- Articaine (Correct answer)
- Benzocaine
- Amethocaine
- Cocaine
Correct answer: Articaine
Local anaesthetics are broadly classified into amides and esters. True allergic reactions are much more common with esters, as their metabolism produces para-aminobenzoic acid (PABA), a known allergen. A true allergy to one ester contraindicates the use of all esters (like procaine, benzocaine, amethocaine). Amide local anaesthetics (like lidocaine, prilocaine, and articaine) are structurally different and do not produce PABA. Therefore, an amide agent is the safe choice. Articaine, while having an ester group, is classified as an amide and is metabolised differently, making it safe in cases of ester allergy.
Question 6: A 24-year-old patient presents with severe pericoronitis associated with a partially erupted lower third molar, showing signs of systemic involvement including a fever of 38.5°C and localised lymphadenopathy. According to the Faculty of General Dental Practice (UK) 'Antimicrobial Prescribing in Dentistry' guidelines, what is the first-choice antibiotic to prescribe?
- Amoxicillin 500mg TDS
- Clindamycin 300mg QDS
- Metronidazole 400mg TDS (Correct answer)
- Erythromycin 500mg QDS
Correct answer: Metronidazole 400mg TDS
UK guidelines, such as those from the FGDP (now College of General Dentistry), recommend that antibiotics for pericoronitis are only indicated when there is evidence of systemic infection or spreading cellulitis. In such cases, the first-line drug of choice is metronidazole, due to its effectiveness against the anaerobic bacteria commonly responsible for this condition. Amoxicillin is a common alternative, but metronidazole is typically preferred first-line for this specific indication.
MJDF Part 1 - Membership of Joint Dental Faculties Pharmacology and Therapeutics Questions and Answers
A 28-year-old patient presents with a painful, localised dentoalveolar abscess associated with the lower left first molar.
There are no signs of systemic involvement or spreading infection.
After establishing drainage, you consider prescribing an analgesic.
According to the dental pain ladder in the UK, which of the following is the most appropriate first-line oral analgesic for this patient, assuming no contraindications?