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

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.

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.

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.

What is the purpose of the disease-control (stabilisation) phase before definitive treatment?

To remove active disease and arrest progression (caries removal, non-surgical periodontal therapy, oral hygiene instruction, smoking cessation) so that definitive restorative work is placed on a stable, healthy foundation.

What is meant by holistic, patient-centred treatment planning?

Planning that considers the whole patient — their wishes, expectations, values, finances, social circumstances, general health and risk factors — rather than treating individual teeth in isolation, with shared decision-making and informed consent.

What factors are assessed when determining the prognosis of an individual tooth?

Periodontal support/bone level and mobility, caries and remaining tooth structure, endodontic status, ferrule and restorability, crown-to-root ratio, root morphology, occlusal load, and patient factors (oral hygiene, smoking, diabetes).

What is a ferrule and why is it important to restorative prognosis?

A ferrule is a 360-degree band of sound dentine (ideally at least 1.5 to 2 mm in height) encircled by a crown margin; it resists fracture and improves the long-term prognosis of endodontically treated, post-restored teeth.

How should complex multidisciplinary care be sequenced?

Resolve pain/infection first, then establish periodontal and caries stability, then orthodontic/surgical/implant groundwork, followed by definitive restorative and prosthetic work, and finally maintenance — with disciplines coordinated so each step does not compromise later ones.

Why must options including no treatment always be discussed with a patient?

Valid informed consent requires the patient to understand all reasonable options, their risks, benefits and costs, including the consequences of doing nothing; offering the no-treatment outcome is a legal and ethical requirement (Montgomery principle).

What did the Montgomery v Lanarkshire (2015) ruling establish about consent?

Clinicians must disclose any material risks a reasonable patient in that position would attach significance to, plus reasonable alternatives. The standard is patient-centred (what the patient would want to know), not solely what a body of clinicians would disclose (Bolam).

What are the three key principles of radiation protection under IRMER?

Justification (the benefit outweighs the detriment), Optimisation/ALARP (doses kept as low as reasonably practicable), and Limitation (dose limits for staff and public). For patients, justification and optimisation are central.

Under IR(ME)R, who are the referrer, practitioner and operator?

Referrer: the registered professional who requests the exposure and supplies clinical information. Practitioner: the professional who justifies the exposure. Operator: any person carrying out practical aspects (e.g. taking the radiograph).

What does the radiation protection principle ALARP stand for and require?

As Low As Reasonably Practicable; doses to patients and staff should be minimised through optimisation — correct technique, collimation, fast image receptors, rectangular collimation, and appropriate exposure factors — without compromising diagnostic yield.

What are common faults that cause foreshortening and elongation in periapical radiographs?

Foreshortening: excessive vertical angulation of the X-ray beam. Elongation: insufficient vertical angulation. Both arise when the bisecting-angle technique is used incorrectly; the paralleling technique with a beam-aiming device minimises these errors.

What causes 'cone cut' on an intra-oral radiograph?

Misalignment of the X-ray beam (collimator/cone) with the image receptor, so part of the receptor is not exposed, producing a clear unexposed area with a curved border.

What is the advantage of the paralleling technique over the bisecting-angle technique for periapical radiographs?

The paralleling technique places the receptor parallel to the long axis of the tooth with the beam at right angles, producing a geometrically accurate, undistorted image with minimal magnification, foreshortening or elongation.

List common faults seen on panoramic (OPG/DPT) radiographs from patient positioning errors.

Chin too high (reverse smile, flat/inverted occlusal plane), chin too low (exaggerated smile, condyles off film), patient too far forward (narrow, blurred anterior teeth), too far back (wide, magnified anteriors), and a twisted/rotated head causing unequal magnification.

What are recognised indications for cone beam CT (CBCT) in dentistry?

Assessment of impacted teeth and their relation to vital structures (e.g. inferior alveolar nerve), complex endodontics, dental implant planning, evaluation of bony pathology/cysts, dento-alveolar trauma, and assessment of root resorption — when conventional radiographs are insufficient.

What are the main limitations of CBCT compared with conventional radiographs?

Higher radiation dose, greater cost, scatter and artefact (especially from metal restorations), limited soft-tissue contrast, smaller field of view, and the need for proper justification; it must not be used as a routine first-line investigation.

On a panoramic radiograph, what normal anatomical structures are commonly identified in the mandible?

Inferior alveolar (mandibular) canal, mental foramen, mandibular foramen and lingula, mylohyoid ridge, external/internal oblique ridges, coronoid and condylar processes, and the angle of the mandible.

How does a periapical (apical) abscess typically appear radiographically?

A well- or ill-defined radiolucency at the root apex associated with a non-vital tooth, often with loss of the lamina dura; in early/acute cases there may be no radiographic change, while chronic lesions show a defined periapical radiolucency.

How can a radicular cyst be distinguished radiographically from a periapical granuloma?

Both are periapical radiolucencies on non-vital teeth; cysts tend to be larger (often greater than 1 to 1.5 cm), well-defined and corticated, whereas granulomas are usually smaller. Definitive distinction requires histopathology, not radiography alone.

What is the radiographic appearance of internal versus external root resorption?

Internal resorption: a smooth, oval radiolucent enlargement within the root canal that the canal outline passes through and is lost. External resorption: an irregular radiolucency on the root surface with the canal outline remaining visible/intact through the defect.

What is a problem-oriented approach to forming a diagnosis from clinical findings?

Gather data (history, examination, investigations), group findings into a problem list, generate differential diagnoses for each, test them against the evidence, and arrive at a working diagnosis that guides the staged treatment plan.

What special investigations help differentiate odontogenic from non-odontogenic facial pain?

Sensibility/vitality testing, percussion and bite tests, periapical radiographs to identify a dental cause; if teeth respond normally and imaging is clear, non-odontogenic causes (TMD, neuropathic, sinus, neurovascular) should be considered.

What clinical and radiographic features suggest a poor (hopeless) periodontal prognosis for a tooth?

Advanced attachment/bone loss (greater than 75 percent), grade III mobility, furcation involvement (grade III), persistent deep pockets despite therapy, and unfavourable crown-to-root ratio, especially in a smoker with poor plaque control.

What is the BEWE index and what does it assess?

The Basic Erosive Wear Examination — a partial-mouth scoring system (scores 0 to 3 per sextant, summed) used to grade the severity of tooth surface loss from erosion and guide management thresholds.

Why is rectangular collimation recommended for intra-oral radiography?

It limits the beam to approximately the size of the receptor, substantially reducing the patient's effective dose (by up to about 50 percent compared with circular collimation) while improving image contrast by reducing scatter — a key optimisation measure.

What is the recommended approach when a lesion shows features of dysplasia on biopsy?

Refer to/manage within a specialist oral medicine or maxillofacial setting; options include excision, close clinical and photographic monitoring, removal of risk factors (tobacco/alcohol cessation), and regular review, as dysplasia carries malignant transformation risk.