A LDS Part 2 station on MedMock, start to finish
This is an illustrative LDS Part 2 station written by MedMock to show what the station is like: the brief, everything the examiner says, the candidate’s answers and the feedback were all written by us, not recorded from a real session. The feedback is laid out the way MedMock marks this exam. It is here to show the format and the standard, not as a model answer to learn by heart.
The brief
Candidate instructions (15-minute examiner oral after 3 minutes of reading time): You have taken a history from Mr David Miller, aged 58, who attended with bleeding gums, drifting upper front teeth and a broken lower left first molar (LL6). He is a current smoker (20 cigarettes/day for 30 years) with type 2 diabetes mellitus (latest HbA1c 72 mmol/mol) and takes ramipril and metformin. Examination and special investigations show: BPE scores 4* in all sextants; generalised probing depths of 6–8 mm with bleeding on probing 65% and furcation Grade III involvement of UR6 and UL7 (both Grade III mobile); panoramic and periapical radiographs show generalised horizontal bone loss of 50–70% over 58 years, caries into the pulp chamber of LL6 with a periapical radiolucency and 40% bone loss. Present your diagnoses, prognoses and phased treatment plan to the examiners.
Diagnostic & Treatment Planning — Examiner Oral: the full transcript
Please state your diagnoses for Mr Miller based on the clinical history, periodontal charting and radiographs.
Using the 2017 World Workshop Periodontal Classification implemented in the BSP UK clinical guidelines, my primary diagnosis is Generalised Periodontitis, Stage IV, Grade C, currently unstable, with two major modifying risk factors: current smoking of 20 cigarettes per day and suboptimally controlled type 2 diabetes mellitus with an HbA1c of 72 millimoles per mole. It is Stage IV because there is severe attachment and radiographic bone loss extending to the apical third with Grade III furcation involvement, Grade III hypermobility and secondary occlusal trauma/drifting of the anterior dentition. It is Grade C because the percentage bone loss divided by age exceeds 1.0 and because of his smoking and glycaemic control. Secondly, LL6 has gross coronal caries with chronic apical periodontitis.
How do you assess the tooth-by-tooth prognosis, particularly for UR6, UL7 and LL6?
UR6 and UL7 both have a hopeless—irrational to treat—prognosis due to advanced bone loss into the apical third, through-and-through Grade III furcation involvement and Grade III mobility. LL6 has a questionable to poor prognosis depending on restorable ferrule once caries is removed, given 40 per cent periodontal bone loss and periapical pathology; if restorable and strategic for lower arch stability it could undergo root canal treatment and cuspal coverage, or extraction if unrestorable. The remaining dentition has a guarded prognosis that depends on smoking cessation, improved diabetic control and plaque control.
Talk us through your phased treatment plan in line with the BSP S3-level periodontal treatment guidelines.
I will structure his care in four phases following the BSP S3-level stepwise approach. In the Urgent and Stabilisation Phase, I will address LL6 by removing caries to assess restorability—performing extirpation and temporisation if restorable, or extraction if unrestorable—and extract the hopeless UR6 and UL7 with full consent. In Step 1 of Periodontal Therapy, I will explain his diagnosis, provide tailored oral hygiene instruction with interdental brushes, remove supragingival plaque and retentive factors, deliver Very Brief Advice (VBA) and referral to NHS Stop Smoking Services, and liaise with his GP regarding diabetic optimisation, plus high-fluoride caries prevention under Delivering Better Oral Health. In Step 2, I will perform subgingival professional mechanical plaque removal (PMPR) under local anaesthesia across all pockets of four millimetres or deeper, then conduct a full six-point periodontal reassessment at eight to twelve weeks. In Step 3, any residual pockets of six millimetres or deeper in compliant sites will receive repeated subgingival instrumentation or specialist periodontal referral, alongside definitive restorative or removable prosthetic replacement once periodontal stability is achieved, followed by Step 4 supportive periodontal care every three months.
Thank you. That is the end of the station.
Example feedback
92 / 100
Synthesised the BPE, 6-point pocket/bleeding chart, radiographs and medical/social history into an exact BSP Stage IV Grade C periodontal diagnosis and endodontic diagnosis for LL6.
Identified UR6 and UL7 as hopeless/irrational to treat and assessed LL6 restorability against periodontal support and systemic modifiers.
Presented a logical Urgent + BSP Step 1–4 treatment plan incorporating smoking cessation, glycaemic liaison and periodontal reassessment before definitive prosthodontics.
What went well
- Applied the BSP 2017 Periodontal Classification accurately (Generalised Periodontitis, Stage IV, Grade C, currently unstable, naming both smoking and HbA1c 72 mmol/mol as risk factors).
- Assigned clear, defensible tooth-by-tooth prognoses for the Grade III mobile/furcated molars (UR6, UL7) and the endodontically involved LL6.
- Structured management through the BSP S3-level Step 1–4 pathway, integrating Urgent/Stabilisation care, Very Brief Advice smoking cessation, GP diabetes liaison, subgingival PMPR, 8–12 week reassessment and Step 4 supportive periodontal care.
What to improve
- Mention checking whether an immediate transitional acrylic partial denture is needed if aesthetics or occlusal support are affected following extraction of the hopeless molars.
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