Diploma of the Faculty of Dental Surgery (MFDS) Clinical Dentistry and Patient Management Syllabus

What are the clinical features distinguishing reversible from irreversible pulpitis?

Reversible pulpitis: short, sharp pain to stimulus (cold/sweet) that stops when stimulus removed; pulp can recover. Irreversible pulpitis: spontaneous, lingering, often throbbing pain, may be worse on lying down or to heat, relieved by cold in late stages; requires pulp removal.

List the periapical diagnoses commonly used in endodontics.

Normal apical tissues, symptomatic apical periodontitis, asymptomatic apical periodontitis, acute (or chronic) apical abscess, and condensing osteitis.

What special tests are used to determine pulpal status?

Thermal tests (cold e.g. Endo-Ice, heat), electric pulp test (EPT — assesses sensibility/nerve), percussion and palpation (periapical status), mobility, periodontal probing, and selective radiographs; pulp oximetry/laser Doppler assess true vitality (blood flow).

How many canals are typically found in maxillary first molars?

Usually three roots with three to four canals: mesiobuccal (often two — MB1 and MB2), distobuccal, and palatal canals. MB2 is frequently missed.

What are the objectives of endodontic access cavity preparation?

Achieve straight-line access to canal orifices, remove the entire pulp chamber roof, conserve sound tooth structure, locate all canals, and avoid gouging/perforation.

What is the primary irrigant in root canal treatment and its functions?

Sodium hypochlorite ($\ce{NaOCl}$, 0.5–6%), which dissolves organic/necrotic tissue, lubricates, and is antibacterial. EDTA (17%) removes the inorganic smear layer; chlorhexidine is an adjunct.

What is the 'smear layer' and how is it removed?

A layer of organic and inorganic debris produced on canal walls during instrumentation. It is removed using EDTA (17%) which chelates the inorganic component, usually alternated with $\ce{NaOCl}$.

What is the purpose of chemo-mechanical preparation in endodontics?

To shape the canal (mechanical instrumentation) and disinfect it (chemical irrigation), reducing the bacterial load and creating a tapered form that allows irrigation and three-dimensional obturation.

What materials are used for root canal obturation?

Gutta-percha (core material) combined with a root canal sealer (e.g. zinc-oxide eugenol, resin, calcium silicate/bioceramic). Common techniques include cold lateral compaction and warm vertical compaction.

Why is the coronal seal important after root canal treatment?

A good coronal seal (definitive restoration/crown) prevents coronal microleakage and bacterial recontamination of the obturated canal, which is a major cause of endodontic failure — the coronal restoration quality strongly influences endodontic success.

List common endodontic procedural complications.

Instrument (file) fracture/separation, ledging, perforation, canal transportation/zipping, blockage, sodium hypochlorite extrusion ('hypochlorite accident'), overfilling, and missed canals.

What is the working length in endodontics and how is it determined?

The distance from a coronal reference point to the apical termination of preparation (ideally the apical constriction, ~0.5–1 mm short of the radiographic apex). Determined using an electronic apex locator confirmed with radiographs.

What is vital pulp therapy, and name two procedures.

Treatment that preserves pulp vitality in teeth with reversible/limited pulpal damage. Procedures include indirect/direct pulp capping and pulpotomy (partial or full coronal pulp removal) using calcium hydroxide or calcium silicate cements (e.g. MTA, Biodentine).

What is regenerative endodontics?

Biologically based procedures (revascularisation) designed to replace damaged pulp-dentine tissue in immature, necrotic teeth, promoting continued root development by inducing a blood clot scaffold and using disinfection rather than conventional obturation.

What is the Kennedy classification of partially edentulous arches?

Class I: bilateral free-end saddles (edentulous posterior to natural teeth on both sides). Class II: unilateral free-end saddle. Class III: unilateral bounded saddle (teeth anterior and posterior). Class IV: single anterior bounded saddle crossing the midline.

What are the components of a removable partial denture (RPD)?

Major connector, minor connectors, rests (occlusal/cingulum), retainers/clasps (direct and indirect retention), denture base, and artificial teeth.

Define 'retention', 'support', and 'stability' for dentures.

Retention: resistance to vertical displacement away from tissues. Support: resistance to vertical displacement towards tissues (forces along the path of insertion). Stability: resistance to horizontal/lateral displacement.

What is the difference between a bridge abutment, pontic, and retainer?

Abutment: the tooth/implant supporting the bridge. Retainer: the component cemented to the abutment (e.g. crown or wing). Pontic: the artificial tooth replacing the missing tooth/teeth.

Compare a conventional (fixed-fixed) bridge with a cantilever bridge.

Fixed-fixed: retainers on abutments at both ends of the pontic, rigid. Cantilever: pontic supported by a retainer at one end only; simpler, conserves tooth, but exerts greater leverage on the single abutment. Resin-bonded cantilevers are now often preferred anteriorly.

Define centric relation (CR) and intercuspal position (ICP).

Centric relation: a reproducible jaw relationship where the condyles are in their most superoanterior position in the glenoid fossae, independent of tooth contact. ICP (centric occlusion): the position of maximum cuspal interdigitation of the teeth.

What is the difference between canine guidance and group function?

Canine guidance: during lateral excursion only the canines on the working side contact, disoccluding posterior teeth. Group function: multiple teeth on the working side share contact during lateral excursion.

What is the 'freeway space' in occlusion?

The interocclusal distance/rest space — the gap between upper and lower teeth when the mandible is in physiological rest position, typically about 2–4 mm. It equals the difference between rest vertical dimension and occlusal vertical dimension.

What are the basic components of a dental implant restoration?

The implant fixture (osseointegrated in bone), the abutment (connects fixture to restoration), and the prosthesis/crown (screw- or cement-retained). Osseointegration is direct structural/functional bone-to-implant contact.

What is osseointegration?

A direct structural and functional connection between living, ordered bone and the surface of a load-bearing implant, without intervening fibrous tissue — the basis of implant stability (Brånemark).

How is the edentulous patient assessed for complete dentures?

Assess ridge form/resorption, mucosa quality, saliva, inter-arch space and relationship, existing denture function, neuromuscular control, and patient expectations. Key records: primary and secondary impressions, jaw registration (OVD, CR), and try-in.

What is the Basic Periodontal Examination (BPE) and its score codes?

A screening tool using a WHO probe per sextant. 0: healthy. 1: bleeding on probing, no calculus/pockets. 2: calculus or plaque-retentive factors, pocket <3.5 mm. 3: pocket 3.5–5.5 mm. 4: pocket >5.5 mm. *: furcation involvement.

What management is indicated by BPE codes 3 and 4?

Code 3: OHI, root surface debridement, and review with 6-point pocket charting of that sextant after initial therapy. Code 4: OHI plus full 6-point pocket charting and radiographs, comprehensive periodontal assessment, and possible specialist referral.

List the main risk factors for periodontal disease.

Modifiable: dental plaque biofilm (primary aetiology), smoking, poorly controlled diabetes, stress, obesity. Non-modifiable: genetic susceptibility, age. Local: calculus, overhangs, malpositioned teeth.

What is non-surgical periodontal therapy and its goal?

Subgingival instrumentation (scaling and root surface debridement) plus oral hygiene instruction and risk-factor control, aiming to disrupt the subgingival biofilm, reduce inflammation, pocket depths, and bleeding, and arrest attachment loss.

Differentiate necrotising gingivitis from a periodontal abscess.

Necrotising (ulcerative) gingivitis: painful, punched-out ulcerated interdental papillae, grey pseudomembrane, halitosis, bleeding, often in stressed/smoking/immunocompromised patients; managed with debridement, OHI, and metronidazole if systemic involvement. Periodontal abscess: localised purulent collection in an existing pocket, swelling, tenderness, mobility; managed by drainage and debridement.

What is supportive periodontal care (maintenance) and why is it essential?

Regular, individualised recall appointments after active therapy involving monitoring (BPE/pocket charting, bleeding), reinforcement of OHI, professional biofilm removal, and risk-factor management. It is essential because periodontitis is chronic and recurs without ongoing maintenance, preserving the results of active treatment.