Denture wearer with uncontrolled systemic disease requiring extraction

Correct answer: B. Because of the hyperglycaemia

• A. Proceeding without addressing either finding would be poor practice.
• B. An HbA1c of 7.5% indicates imperfect but not extreme glycaemic control, and this is the value the recall identified as the trigger for medical consultation before surgery, given impaired healing and infection risk in the diabetic surgical patient.
• C. Prophylaxis is unrelated to the decision to refer.
• D. A defensible alternative. 150/100 is Stage 2 hypertension under the 2017 ACC/AHA guideline. It is generally NOT an absolute bar to a simple extraction — the usual deferral threshold is around 180/110 — but it does warrant medical follow-up.

Note: ⚠️ Contested item. Both the glycaemic and the blood pressure findings are abnormal and arguably warrant referral. The source keyed hyperglycaemia. Note for the exam: 150/100 is Stage 2 hypertension (2017 ACC/AHA — Stage 2 begins at 140/90), and the deferral threshold for elective care is usually cited around 180/110.

Correct answer: D. Inflammatory papillary hyperplasia

• A. Nicotinic stomatitis gives a diffusely white, fissured palate studded with red dots — the inflamed openings of minor salivary gland ducts — and is caused by heat from pipe or cigar smoking.
• B. Median rhomboid glossitis is a depapillated rhomboid patch on the midline dorsal TONGUE.
• C. Epulis fissuratum is a fold of hyperplastic tissue at the denture FLANGE in the vestibule, not a papillary change in the palatal bearing area.
• D. CORRECT. INFLAMMATORY PAPILLARY HYPERPLASIA presents as multiple small, closely packed papillary projections producing a pebbly or cobblestone surface on the hard palate. It is driven by an ill-fitting prosthesis, continuous wear without nightly removal, poor denture hygiene and superimposed candidal infection.

Correct answer: C. Excessive occlusal force

• A. An over- or under-extended post dam causes retention problems or gagging, not localised burning.
• B. An unpolished or rough intaglio surface causes generalised soreness and traps plaque, but the recall specified a localised burning attributable to overload.
• C. Localised burning under a denture base most commonly reflects a focal pressure or overload area, where excessive occlusal force is concentrated on a limited area of mucosa. Relief of the pressure spot and occlusal correction resolve it.
• D. True acrylic allergy is genuinely rare. Residual monomer in an inadequately cured base can cause a burning sensation, but this is uncommon and typically generalised.

Correct answer: A. Treat the tissue condition first, then address the prosthesis

• A. CORRECT. You cannot record an accurate impression of diseased, inflamed, distorted tissue. TISSUE CONDITIONING COMES FIRST: leave the denture out (particularly at night), institute denture hygiene, treat the candidal component, and use a tissue conditioner. Severe papillary hyperplasia may require surgical excision. Only once the mucosa has recovered can definitive prosthodontics begin.
• B. Impressing inflamed tissue guarantees an inaccurate result.
• C. A new denture made over inflamed tissue will not fit once the tissue resolves.
• D. Relining over diseased tissue records a distorted, temporary form.

Note: General principle: mucosal health before impressions. This sequencing question recurs throughout removable prosthodontics.