osce basics

Question 1

Define Peri-Implantitis

Answer 1

An infection around an implant which can cause inflammation and bone loss around the implant, eventually leading to failure.

Question 2

Describe the symptoms of Peri-Implantitis

Answer 2

• redness and inflammation
• bleeding of the surrounding gum tissue
• depending of periodontal pockets around the implant
• exposure and visibility of underlying implant threads
• implant loosening
• push discharging from the tissue around the implant

Question 3

Define Peri-Implant Mucositis

Answer 3

Inflammation of the soft tissues surrounding implants with NO loss of supporting bone.

Question 4

When looking to diagnose pulpal pain, what are the signs of reversible pulpitis?

Answer 4

• no pain on TTP
• no sensitivity to heat
• sensitivity to cold/sweets which goes away quickly
• sharp pain

Question 5

When looking to diagnose pulpal pain, what are the signs of irreversible pulpitis?

Answer 5

• pain on TTP
• sensitivity to heat, cold and sweets
• last more than a few seconds, even if the stimulus is removed
• throbbing, aching or sharp pain

Question 6

How to write a referral:

Answer 6

• referring and receiving dentist details
• pt details (name, DOB, RQ)

Dear Dr ___, I am writing to refer the above mentioned patient for a biopsy/assessment.

• the lesion in question is: (size, shape, margins, colour, texture, onset)
• attached RMH and photographs related to the case.

Name, signature.

Question 7

When would you refer a patient presenting with a white patch?

Answer 7

If the lesion has been present for over 2 weeks.

Question 8

When would you refer a pt who presents with a red and white patch?

Answer 8

Straight away.

Question 9

In the event of emergency tx needing to be delivered to a child without the present of the parent, what should be done?

Answer 9

Emergency tx should not be delayed if it would mean compromising the child’s health etc, even if consent can’t be gained from someone on the PR form.

Question 10

Describe Gillick Competence as outlined by the Children’s Act 1989

Answer 10

A child under 16 can consent for their own tx if they are deemed competent and aware of all benefits/risks.

Question 11

Instances of Parental Responsibility:

Answer 11

1. Both biological parents have PR if they were married at the time of the brith/marry later.
2. Father named on the birth certificate of a child born after 1st December 2003.
3. Child born before 1st December ‘03 - only mum has PR if parents are unmarried.
   - father may acquire PR if he becomes registered as the child’s father/by a court order.
4. Step-parents can acquire PR in certain circumstances.

Question 12

What can be carried out if a paeds pt presents without someone on the PR form?

Answer 12

acclimatisation or OHI

NO tx can be carried out until the presence of someone on the PR form is present.

Question 13

When would a pulpotomy be indicated?

Answer 13

• If the decay or trauma is confined to the crown of the tooth.
• if the pt has bleeding disorder
• too young to have XLA (no permanent successor present/hypodontia)
• complicated enamel-dentine fracture

Question 14

When is a pulpectomy indicated?

Answer 14

If the tooth has irreversible pulpitis/necrosis.

(may have originally been planned for a pulpotomy but started exhibiting symptoms)

Question 15

When is selective caries removal indicated?

Answer 15

shallow - moderately deep lesions

Question 16

What intervals would be used for BWs depending on caries risk?

Answer 16

high - every 6 months

moderate - 12 months

low - 18-24 months

Question 17

DBOH Guidelines - toothpaste and caries interventions

(adult vs child)

Answer 17

children:
- 0-6: 1000 ppm
- 3-6 high risk: 1350-1500 ppm
- 7-18: 1350-1500 ppm, 2800 ppm for high risk

adult:
- 1350-1500 ppm
- duraphat 5000 ppm

22,000 ppm fluoride varnish twice a year
(0.25, 0.4, 0.75 ml)

Question 18

What information is included on a prescription?

Answer 18

• name of drug
• dose
• frequency and number or days
• form of drug (encapsulated/tablets)
• total number required
• DPF (dental practitioners’ formulary)

(any contraindications included, e.g: not drinking with metronidazole)

Question 19

Signs of neglect and abuse:

Answer 19

• unexplained behaviour change
• withdrawn
• anxious
• uncharacteristically aggressive
• lack of social skills / no friends
• poor parental relationship
• inappropriate knowledge of adult issues for their age
• running away / missing
• wearing clothes to cover their body

Question 20

How would you escalate safeguarding issues?

Answer 20

• speak to practice manager
• safeguarding lead
• keep a record of everything that has happened

Question 21

What could cause non-responsive sites to RSD?

Answer 21

• brushing technique
• quality of RSD
• tooth factors such as anatomy or crowding
• incorrect diagnosis / risk factor identification

Question 22

What are the 3 A principles of smoking cessation advice?

Answer 22

Ask, Advise, Act

Question 23

What is a provisional diagnosis?

Answer 23

When a definitive diagnosis can’t be made but there is a high indication of the cause.

Question 24

Operator position for XLA

Answer 24

UR, UL, LL - in front of pt.
LR - behind pt.

Question 25

Technique to XLA **Upper Molars**

Answer 25

1. buccal movements (buccal and back to midline) 2. repeat until mobile and then deliver buccally.

Question 26

Technique to XLA **Lower Molars**

Answer 26

1. buccal movements until 45º 2. figure of 8 3. deliver buccally

Question 27

Landmarks for IDB

Answer 27

- coronoid notch - external oblique ridge - internal oblique ridge - pterygomandibular raphe - retro molar triangle - 1cm above occlusal plane

Question 28

Which tissues does IDB anaesthetise?

Answer 28

1. mandibular teeth 2. surrounding bone 3. buccal gingiva from premolars to midline, lower lip.

Question 29

Contraindications for a pulpotomy:

Answer 29

- PA pathology - unrestorable tooth or close to exfoliation - internal or external root resorption - immunocompromised pt (e.g: endocarditis) - child can tolerate rubber dam - non-vital tooth

Question 30

Post op advice for XLA:

Answer 30

- take analgesia before LA wears off - if bleeding, bite on gauze for 10 mins - don’t play with the socket - no spitting or rinsing saliva, just swallow - soft foods 14 hours - rest - this time tomorrow, start warm salty mouthwashes

Question 31

Reasons for reversible pulpitis after restoration:

Answer 31

- normal post-op sensitivity - high restoration on biting - microleakage (gaps) - polymerisation shrinkage - caries left - over etching - not sealed properly