Membership of the Joint Dental Faculties (MJDF) Clinical Examination, Diagnosis and Treatment Planning Syllabus

Clinical Examination, Diagnosis and Treatment Planning syllabus — full chapter and topic list

Expand any chapter to see its topics and sub-topics. This is the whole examinable outline for Clinical Examination, Diagnosis and Treatment Planning in Membership of the Joint Dental Faculties (MJDF), not a summary of it.

1. 1

   History Taking and Patient Assessment

   4 topics

   • Structured dental and medical history
     • Presenting complaint and history of presenting complaint
     • Past dental, medical, drug and social history
     • Family history and relevant systemic conditions
   • Extra-oral and intra-oral examination
     • Lymph node, TMJ and muscle examination
     • Soft tissue and mucosal screening
     • Periodontal and dental hard tissue assessment
   • Special investigations selection
     • Sensibility (vitality) testing methods
     • Radiographic and photographic records
     • Study models, blood tests and biopsy referral
   • Risk assessment for caries, periodontal disease and oral cancer
2. 2

   Diagnosis and Differential Diagnosis

   4 topics

   • Forming a problem list from clinical findings
   • Differential diagnosis of orofacial pain
     • Odontogenic versus non-odontogenic pain
     • Neuropathic and atypical facial pain
     • Referred pain patterns
   • Diagnosis of swellings, ulcers and white/red lesions
   • Interpreting investigation results in context
3. 3

   Treatment Planning and Sequencing

   5 topics

   • Phased treatment planning
     • Immediate, stabilisation and definitive phases
     • Maintenance and review phase
   • Holistic and patient-centred planning
   • Prognosis assessment for teeth and restorations
   • Sequencing complex multidisciplinary care
   • Treatment options, alternatives and no-treatment outcomes
4. 4

   Radiology and Radiographic Interpretation

   4 topics

   • Justification and optimisation principles (IRMER)
     • ALARP and dose reduction
     • Selection criteria for radiographs
   • Intra-oral and panoramic technique and faults
   • Cone beam CT indications and limitations
   • Recognition of normal anatomy and common pathology on films

Clinical Examination, Diagnosis and Treatment Planning flashcards for Membership of the Joint Dental Faculties (MJDF)

23 of 49 cards from the Clinical Examination, Diagnosis and Treatment Planning deck — real questions with worked answers.

1. What are the standard components of a structured dental history, in order?

   Presenting complaint (PC); History of presenting complaint (HPC); Past dental history (PDH); Past medical history (PMH); Drug/medication history; Social history; Family history. Often summarised as PC, HPC, PDH, PMH, then drug, social and family histories.

2. In pain history-taking, what does the mnemonic SOCRATES stand for?

   Site, Onset, Character, Radiation, Associations, Time course, Exacerbating/relieving factors, Severity.

3. Which key features of the medical history most directly alter dental management?

   Bleeding disorders/anticoagulants, cardiac conditions (e.g. infective endocarditis risk), allergies, bisphosphonates/antiresorptives (MRONJ risk), diabetes, immunosuppression, pregnancy, and steroid use (adrenal suppression).

4. What systematic sequence should an extra-oral examination follow?

   General appearance and skin; facial symmetry and swelling; lymph node palpation (cervical chains); temporomandibular joint and muscles of mastication; salivary glands; and cranial nerve/neurological assessment as indicated.

5. What features should be recorded when examining an intra-oral soft-tissue lesion?

   Site, size, shape, colour, surface texture, margins/definition, consistency on palpation, presence of induration, tenderness, mobility/fixation to underlying tissue, and duration.

6. List the lymph node groups palpated during an extra-oral head and neck examination.

   Submental, submandibular, pre- and post-auricular, occipital, and the superficial and deep cervical chains (jugulodigastric, jugulo-omohyoid) plus supraclavicular nodes.

7. Name common special investigations used in dental diagnosis.

   Radiographs, sensibility (vitality) testing, percussion and palpation tests, periodontal probing/charting, study models, photographs, biopsy/cytology, microbiology swabs, blood tests, and CBCT.

8. What is the difference between pulp sensibility testing and pulp vitality testing?

   Sensibility testing assesses nerve response (thermal/electric pulp test) as a proxy for pulp health; true vitality reflects blood supply. A tooth may give no sensibility response yet retain blood flow, so sensibility tests indicate but do not directly measure vascular vitality.

9. What are the principal risk factors for dental caries?

   High/frequent sugar intake, poor plaque control, low fluoride exposure, reduced salivary flow (xerostomia), past caries experience, deep fissures/exposed roots, and a cariogenic bacterial load (mutans streptococci, lactobacilli).

10. What are the main modifiable and non-modifiable risk factors for periodontal disease?

    Modifiable: smoking, poor plaque control, diabetes, stress. Non-modifiable/host: genetic susceptibility, age, certain systemic/immune conditions. Smoking and diabetes are the two strongest modifiable risk factors.

11. What are the major risk factors for oral cancer?

    Tobacco use (smoked and smokeless), alcohol (synergistic with tobacco), betel quid/areca nut, HPV (especially type 16) for oropharyngeal cancer, sunlight (lip), poor diet, and previous oral cancer.

12. What is a problem list in treatment planning and why is it used?

    A consolidated list of all diagnosed problems derived from the history, examination and investigations. It ensures every identified issue is addressed, prioritised, and linked to a management plan, supporting comprehensive rather than piecemeal care.

13. What are the broad diagnostic categories to consider in the differential diagnosis of orofacial pain?

    Odontogenic (pulpal, periapical, periodontal), musculoskeletal (TMD, myofascial), neuropathic (trigeminal neuralgia, post-herpetic), neurovascular (migraine, cluster headache), sinus/ENT, salivary gland, and referred (e.g. cardiac) pain.

14. How does the pain of reversible pulpitis differ from irreversible pulpitis?

    Reversible pulpitis: sharp pain to stimulus (cold/sweet) that subsides quickly when removed. Irreversible pulpitis: spontaneous, lingering pain often worse with heat and on lying down, poorly localised, lasting seconds to minutes after the stimulus.

15. What are the classic clinical features of trigeminal neuralgia?

    Sudden, severe, brief electric-shock-like unilateral pain in a trigeminal division, triggered by light touch of cutaneous/intraoral trigger zones (e.g. washing, shaving, chewing), with refractory periods and no objective sensory deficit.

16. What is the most important diagnostic step for a persistent oral ulcer lasting more than two to three weeks?

    Urgent referral and biopsy to exclude squamous cell carcinoma; any non-healing ulcer persisting beyond two to three weeks without obvious cause must be regarded as potentially malignant.

17. How do you clinically differentiate a benign from a potentially malignant oral ulcer?

    Benign ulcers (e.g. traumatic, aphthous) are usually tender, soft, with a clear cause and heal within two weeks. Suspicious ulcers are persistent, indurated, have rolled/raised margins, are often painless, and may be associated with a mass or lymphadenopathy.

18. What does the term leukoplakia mean diagnostically?

    A clinical descriptive term for a white patch that cannot be rubbed off and cannot be characterised clinically or pathologically as any other defined lesion; it is a diagnosis of exclusion and is potentially malignant.

19. How does erythroplakia differ from leukoplakia in malignant potential?

    Erythroplakia (a red patch not attributable to another condition) carries a substantially higher risk of dysplasia or carcinoma than leukoplakia and almost always warrants biopsy.

20. What is the diagnostic approach to a soft-tissue swelling?

    Characterise by site, size, shape, consistency (soft/firm/hard/fluctuant), surface, colour, tenderness, fixation, fluctuance, compressibility, pulsatility, and relation to anatomical structures; combine with history and imaging to form a differential.

21. What does fluctuance on palpation of a swelling indicate?

    The presence of fluid within the swelling (e.g. an abscess or cyst); fluctuance is elicited when pressure on one side transmits a fluid wave detectable on the opposite side.

22. What does it mean to interpret investigation results 'in context'?

    Investigations should be interpreted alongside the clinical picture, not in isolation; a result is only meaningful when correlated with history, examination findings, pre-test probability, and the limitations/accuracy of the test.

23. What are the typical phases of a structured (phased) treatment plan?

    Phase 1 immediate/emergency (pain, acute infection); Phase 2 stabilisation/disease control (caries, perio, OHI); Phase 3 reconstructive/definitive (restorations, prosthodontics, ortho); Phase 4 maintenance/recall. Sometimes preceded by an emergency/relief-of-pain phase.

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