OCSE prep

Paediatric consent

• What to do if someone who can’t give consent brings a child

• what to do if consent has already been given and the child is brought by someone else

• Who can consent for a child

• When to proceed without relevant consent - when delaying treatment would pose a significant risk

• Extraction consent form - description of treatment, intended benefits and complications.

Infection control

• Which instruments/equipment goes in which bin

• Doffing PPE

• Donning PPE

• Cleaning a bay

• What can and can’t be touched with gloves

Operative knowledge

• Dental materials pros and cons (amalgam, composite, GIC, RMGIC, SDFm CaOH, ZOE

• Pregnant patient management (not lying patient flat due to IVC compression, Tx approach varying depending on trimester

• FV doses

• BEWE codes

• Anaesthetic options (pros and cons of LA, GA, IHS, IVS, La technique and dose)

Caries related conditions

• Temporary restorations

• Definitive restorations

• Fissure sealant

• Prevention (DBOH toolkit) - fluoride, sugar, amount of toothpaste

• Extractions of primary dentition

• Direct pulp cap (only if iatrogenic damage has occured)

• Indirect pulp cap

• Pulpotomy (on primary tooth)

Perio related conditions

• Recognising periodontal and peri-implant conditions and how to manage them (peri-implant mucositis vs peri-implantitis) ANUG, desquamative gingivitis, periodontal abscess.

• Recognising sites requiring SUB PMPR (scores with 4+bleeding or 5 and above

• BSP guidelines

  • Stage 1 - build foundations for optimal treatment outcomes

  • Stage 2 - Sub PMPR

  • Stage 3 - Managing non-responsive sites

  • Stage 4 - Maintenance and recall

Paeds

• Recognising the extent of decay and/or trauma (e.g. by interpreting radiographs)

• SDCEP guidance - how to manage carious lesions of varying degrees

• Managing an avulsed tooth

  • How extraoral dry time impacts prognosis (>60min <60mins)

  • Guidance on re-implanting at the scene of the incident (toothSOS app)

• Recognising safeguarding issues and how to manage them

• Dental anomalies

• Paeds XLA: procedure, POI, during and post operative complications and how to manage them. (e.g. tissue tear, fracture etc)

Oral medicine

• Describing lesions (site, shape, colour, distribution, texture, consistency, outline)

• Making a differential diagnosis

• Oral med mind maps

• Asking for a recommendation e.g biopsy

• How to write a ref letter →

  • Ref GDP info

  • Pt info

  • NHS/relevant hospital number

  • Presenting complaint (HPC and urgency)

  • Clinical findings

  • RMH

  • Provisional diagnosis

  • What you want the practitioner to do (second opinion or management)

Medications

• Meds with oral manifestations

• Calcium channel blockers (gingival hyperplasia)

• SSRIs and TCAs (xerostomia)

• Tetracyclines (staining)

• Corticosteroids (candidiasis)

Medications

• Asthma - FV contraindicated due to colophony content

• Statins - avoid us with azole antifungals

• Bisphosphonates and RANKL inhibitors - MRONJ risk

• DOACs, NOACs, antiplatelet

• Commonly prescribed medication which are contraindicated with other emds

ME

• Recognising different ME

• ABCDE approach

• Management - DRS ABC

• ME drugs - Dose, route of administration, Dose frequency

SOP

• You must be able to recognise something outside of your scope of practice.

• Under prescription of the dentist → Tooth whitening, inhalation sedation and non-surgical cosmetic injectables. Assume you don’t unless told otherwise.

Patient communication

• History taking (SOCRATES) - differential diagnosis and explain to pt.

• Explaining Tx options - pros and cons

• Methods of anxiety management - behavioural and pharmacological methods

• Mistakes - communicate with pts when a mistake has been made.

Other areas

• Complaints → outline stages and features of the complaints procedure

• Radiology → Be able to recognise radiographic errors and how you would correct them. Doses for radiology

• GDC principles

• DBOH

• Sharps → Know the correct protocol for a sharps injury

• Whistleblowing → Know who to report wrongdoing to and how this would be handled/escalated

• Protected characteristics → Equality Act 2010

Example scenario 1

You are a dental therapist working in practice. John aged 7 arrives with his grandmother for the extraction of his URD under LA. John would normally be brought in by his mother but she is working today. There was a rush at the end of the last appointment, so the extraction consent form has not been filled out. John’s grandmother does not have parental responsibility or any other documentation that would indicated she has a formal duty of care. John is not in pain, would you still carry out the extraction?

Questions

1. Can johns grandmother consent to the extraction today?

2. Who can consent to a child’s treatment

3. In what situation(s) would it be acceptable to proceed with treatment on a child without the relevant consent

Example scenario 2

You are working as a dental therapist in a dental practice. A patient attends for a composite restoration on one of their lower molars. On examination you notice the lesion as shown and the pt explains it has been present for a week, is painful and isn’t the first time they’ve noticed lesions of this description.

Questions

1. Write a ref letter

Example scenario 3

A patient attended this morning for an appointment with you for the restoration of several abrasion cavities. You are on your lunch break and get notified by reception that one of them has fallen out. The patient is very annoyed and wants to speak to you about the situation.

Questions

1. Have a conversation with this patient about the issue.

Here are some relevant scenario-based questions based on the provided notes:

1. Scenario 1: John aged 7 arrives with his grandmother for the extraction of his URD under LA. John’s permission has not been documented, and his grandmother lacks formal duty of care.

   • Can John’s grandmother consent to the extraction today?

   • Who can consent to a child’s treatment?

   • In what situation(s) would it be acceptable to proceed with treatment on a child without the relevant consent?

2. Scenario 2: A patient presents for a composite restoration on a lower molar, reporting a painful lesion that has been present for a week.

   • What steps would you take regarding the patient’s lesion upon examination?

   • Write a referral letter for a specialist. What key information should you include?

3. Scenario 3: After a lunch break, you are notified that a restoration has fallen out from a patient you treated earlier, leading to their frustration.

   • How would you communicate with this patient about the issue?

   • What are the steps you should take to address the patient’s concerns and ensure satisfaction?

4. Scenario 4: A 5-year-old child is brought in for a routine check-up by their father. The child is very anxious and reluctant to cooperate during the examination.

   • How would you approach the examination of this anxious child?

   • What methods of anxiety management can you employ to help the child feel more comfortable?

5. Scenario 5: During a dental procedure, you notice signs of gingival hyperplasia in a patient currently taking calcium channel blockers.

   • How should you communicate your findings to the patient?

   • What additional considerations should be taken into account regarding their medication?

6. Scenario 6: A parent brings in their child with a complaint of toothache. Upon examination, you find a deep cavity and suspect a possible pulpal involvement.

   • What are the steps you would take in managing this case, including possible interventions?

   • What information should you provide to the parent regarding treatment options and potential outcomes?

7. Scenario 7: A patient presents with a history of frequent dental visits for decay management but has been non-compliant with fluoride use at home.

   • How can you effectively communicate the importance of preventive measures to this patient?

   • What strategies can you suggest to encourage better compliance with home care routines?

8. Scenario 8: You are managing a case of a pediatric patient with a suspected dental anomaly that requires referral to a specialist.

   • What details should be included in your referral letter to ensure a smooth transition of care?

   • How would you explain the referral process to the parent and the rationale behind it?