PMHP

Question 1

2. Name three reasons which D3mft graph shows a difference between 2 areas? (3)

Answer 1

• Socioeconomic status of the area
• Access to dental care/healthcare
• Health behaviours- smoking, diet, alcohol
• Income (can affect diet etc.)
• Different area based preventative measures implemented by different health boards

Question 2

3. What does the 3 in d3 mean?

Answer 2

• Obvious decay into dentine of the tooth (using visual methods only)

Question 3

4. At population level name 3 fluoride delivery methods?

Answer 3

• Water fluoridation
• Fluoride varnish application in schools
• School water fluoridation
• School milk initiative
• Fluoridated salt

Question 4

5. What 3 health interventions are done in Scotland on a population bases?

Answer 4

• Smoking ban in public areas
• Sugar tax
• School food policy
• Alcoholic minimum unit pricing

Question 5

6. What is D3t, Mt and Ft?

Answer 5

• D3t- decayed teeth
• Mt- missing teeth (XLa due to decay)
• Ft- filled teeth

Question 6

7. What is SIMD?

Answer 6

• Scottish index of multiple deprivation
• Area based index which use a range of data from a range of sources to decide which neighbourhoods are most deprived by ranking data zones in order of deprivation from quantile/decile 1 (most deprived) to quantile 5/decile 10 (least deprived)

Question 7

8. Give 7 factors influencing deprivation?

Answer 7

• Employment status
• Income
• Health and healthcare services
• Crime
• Housing, living and working conditions
• Educations, skill and training
• Geographical access to services

Question 8

Evidence Based Dentistry & Studies-
1. What type of study provides the highest level of evidence?

Answer 8

• Cochrane review- systematic review of all the relevant randomised controlled trials

Question 9

2. List 4 aspects of this type of study?

Answer 9

• Specification or participants- Inclusion and exclusion criteria
• Control (of comparison)
• Randomisation
• Blinding

Question 10

3. Give 3 other study designs?

Answer 10

• Cohort (prospective)
• Case control (retrospective)
• Case study (one patient)

Question 11

4. What is incidence?

Answer 11

• The number of new disease cases developing over a specific period of time in a defined population
• Incidence rate= no of new cases of disease in period / no of individuals in population at risk
• Incidence estimates are obtained from longitudinal studies or derived from registers

Question 12

5. What is prevalence?

Answer 12

• The number of disease cases in a population at a given time
• Prevalence= no of affected individuals/ total number of persons in a population
• Prevalence estimates are obtained from cross-sectional studies or derived from registers which can related to attributes or to absence or presence of disease

Question 13

5. What is prevalence?

Answer 13

• The number of disease cases in a population at a given time
• Prevalence= no of affected individuals/ total number of persons in a population
• Prevalence estimates are obtained from cross-sectional studies or derived from registers which can related to attributes or to absence or presence of disease

Question 14

6. What is a case control study?

Answer 14

• Retrospective study which involves comparing one group (usually with disease) with one control (without disease) to find risk factors associated

Question 15

7. How can you reduce bias?

Answer 15

• Randomisation into groups
• Double blind. Blinding or participants and researchers

Question 16

8. What 2 things show that it was random?

Answer 16

• Randomised controlled trial
• Computer generated assignment of participants to intervention groups; ensure participants have equal chance of being allocated to either group avoiding bias and ensures fair mis of participants found in each group
• (Blinding or masking or participant or researcher/assessor)

Question 17

9. What is a PICO? (NB. May have to work out what this is from a leaflet.)

Answer 17

• Population
• Intervention
• Comparison
• Outcome

Question 18

10. What is confidence intervals?

Answer 18

Normally the confidence interval is 95% this means that 95x out of 100 if you repeat the trial that your results will be between your plus or minus variations from the mean.

• Range of values the absolute risk difference will take in the population
• 95 times out of 100 the CI will contain the true ARD- 95% sure if we repeated the trial the ARD would eb between the two numbers of the CI
• Is the value of the confidence interval for ARD overlap 0 (value of no difference) there is not sufficient evidence to support

Question 19

11. What is relative risk?

Answer 19

• Ratio of incidence rate in exposed groups (case) to incidence rates in non-exposed groups (control)
• It is a measurement of proportionate increase or decrease in disease rates of exposed groups
• AKA absolute risk ratio

Question 20

12. What would you tell the patient- were the results significant or not; given confidence intervals and risk ratio?

Answer 20

• If confidence interval overlaps value of no difference then there is insufficient evidence to support a reliable different between the two groups and the results are not significant.

• If measured using absolute risk ratio- value of no difference is 1
• Is measured using risk absolute risk difference then the value of no difference is 0
• ‘There is sufficient/insufficient evidence to suggest that (description of treatment effect) than (placebo group description) as the confidence interval straddles/does not straddle value of no different (O/1) then state value.’ Give further description if necessary

Question 21

12. What would you tell the patient- were the results significant or not; given confidence intervals and risk ratio?

Answer 21

• If confidence interval overlaps value of no difference then there is insufficient evidence to support a reliable different between the two groups and the results are not significant.

• If measured using absolute risk ratio- value of no difference is 1
• Is measured using risk absolute risk difference then the value of no difference is 0
• ‘There is sufficient/insufficient evidence to suggest that (description of treatment effect) than (placebo group description) as the confidence interval straddles/does not straddle value of no different (O/1) then state value.’ Give further description if necessary

Question 22

13. What two other things should you consider when evaluating the results of a study?

Answer 22

• Size of the study
• Duration of the study
• Population investigated in the study
• Confounding variables

Question 23

Spilt Mouth Study Design-
1. What are the advantages of split mouth study design?

Answer 23

• Each participant acts as own control which reduced inter-individual variation (same environment for control and intervention)
• Fewer participants are required to obtain the same study power as parallel non split-mouth group
• Every participant receives both intervention, therefore this is good for determining preferences

Question 24

2. What are the disadvantages? Split mouth design

Answer 24

• Carry across affect- may get carries effect from one side to the other (can’t be used for toothpaste, mouthwash etc.)
• Selection of patients (need to have matching carious teeth) might limit external validity
• Statistical analysis more sophisticated and usually not done
• Patient cannot be blinded which added more bias into the reporting

Question 25

3. What are confidence intervals?

Answer 25

* The range of values the absolute risk difference will take in the population (representation of the study finding to the real world population) * 95 times out of 100 the CI will contain the true ARD- 95% sure if we repeated the trial the ARD would eb between the two numbers of the CI

Question 26

4. What values regarding confidence interval are important?

Answer 26

* For ARD if confidence interval range overlaps 0= null hypothesis * For RR if confidence interval range overlap 1= null hypothesis

Question 27

5. What a P value?

Answer 27

* Used to determine statistical significance of your results * P value <0.05 means you reject the null hypothesis and your results are statistically significant

Question 28

Consent- 1. Give three types of consent?

Answer 28

* Implied- patients action or lack of action clearly indicated their wishes * Verbal- patient clearly states their consent for procedure * Written- patient signs declaration that they consent to procedure

Question 29

2. Give 4 factors relating to the procedure which should be discussed with the patient to gain consent?

Answer 29

* Knowledge of the purpose, nature and likely risks of reamendment including the probability of success and any alternative treatment without being subject to any unwanted to unjust pressure * All potential options for treatment including no treatment * Risks and benefits of each treatment option (including material risks) * Likely prognosis of each treatment option * Possible consequences of not having treatment * Cost of proposed treatment options * Whether treatment is guaranteed and how long for * That patient has right to change their main at any point during treatment * Your recommendations

Question 30

3. What 6 factors make up consent?

Answer 30

* Not manipulated * Valid- recent, specific to proposed treatment and remains valid (patient still agrees) * With capacity * Informed * Voluntary * Not coerced

Question 31

4. What type of person carries consent 3-year-olda patient?

Answer 31

* Birth mum has automatic consent * Birth dad only has rights if married to the mother or if the child was born after may 2006 * Other people may acquire parental rights and therefore give consent but this must be admitted by law

Question 32

5. What type of person caries consent for a 16-year-old?

Answer 32

* The patient themselves has legal capacity to consent on their own behalf unless assessed as not having capacity to understand the nature and possibility of consequences, risks, benefits etc. of the proposed treatment

Question 33

Capacity- 1. What are the principles of the adults with incapacity act 2000- when pertaining to making decision on behalf of those lacking capacity?

Answer 33

* Maximum benefit * Minimum necessary intervention * Take account of wishes of adult * Consult with relevant others * Encourage the adult to exercise residual capacity

Question 34

2. What is capacity?

Answer 34

* Someone has capacity to consent when they can * They can act (decide) * Retain the memory of a decision * Can make a reasoned decision * Can communicate a decision * Can understand a decision (repeat back in own words)

Question 35

3. Who can consent under AWI act 2000?

Answer 35

* Welfare power of attorney- person appointed by individual when they still had capacity, to make decision about their welfare medically and financially (decision made ahead of time for when they lose capacity) * Welfare guardian- person appointed by court to look after a persons welfare and make decisions for someone who never had the capacity

Question 36

4. What is the English equivalent law? 3. Who can consent under AWI act 2000?

Answer 36

* Mental capacity act 2005

Question 37

* Mental capacity act 2005 Clinical Governance- 1. What is clinical governance?

Answer 37

* Systematic approach to maintaining and improving the quality of patient care within a healthcare system * It is a framework though which NHS organisation are accountable for continuously improving the quality of their services and safeguarding high standards of care but creating an environment in which excellent care will flourish

Question 38

2. What are the 6 components of clinical governance? (6)

Answer 38

ECCRRO * Education and training * Clinical audit * Clinical effectiveness * Research and development * Risk management * Openness

Question 39

3. What are the 3 division of NHS Scotland dental services?

Answer 39

* Primary care- general dental practices * Public dental services- community services * Secondary care- hospital services

Question 40

1. What is a clinical audit?

Answer 40

* A quality improvement process that seeks to improve patient care and outcomes through systematic review of care against an explicit criterion and the implantation of change * The key component of clinical audit is that performance is reviewed to ensure that what should be doing is being done and if not, it provides the framework to enable improvement to be made

Question 41

2. What are the uses of an audit?

Answer 41

* Critical review of current practice- encourages learning about new techniques and treatments * Observation of practice- indicated gaps in knowledge, learning, attitudes, protocls and skills and allow subsequent training * Group work can help to modify attitudes and management of clinical conditions and re-enforce agreed procedures

Question 42

3. What are the 5 steps of clinical audit cycle? (5)

Answer 42

* Identify problem or issue * Set agreed standards and criteria * Observe practice and collect data * Compare performance with criteria and standards * Implement change

Question 43

4. What one other thing would you do after this cycle? (1)

Answer 43

* Repeat audit

Question 44

5. What are the 6 dimensions of healthcare quality?

Answer 44

* Safe, effective, person-centred, efficient, equitable, timely

Question 45

5. What are the 6 dimensions of healthcare quality? * Safe, effective, person-centred, efficient, equitable, timely 6. Briefly explain each?

Answer 45

* Safe- avoiding injury or harm to patients from the healthcare provided and appropriate, clean and safe environment provided for delivery of healthcare services * Effective- providing the most appropriate intervention, support and services to everyone- services based on scientific knowledge to all who could benefit and refraining from providing services to those not likely to benefit * Patient centred- partnership between patient, families and those delivering healthcare which respects individual needs and values and demonstrates compassion, continuity, clear communication and shared decision-making * Efficient- avoid wasteful or harmful variation and ensure output is maximised for the given input * Timely- appropriate treatment, support and services provided at the right time for everyone * Equitable- providing high quality services and care to everyone that does not vary in quality because of personal characteristics such as gender, ethnicity, location and socioeconomic status and ensure all patients are fairly treated and distribution of care is based on need

Question 46

7. Name 2 other things you can do other than audit

Answer 46

* Peer review * Quality improvement project * Practice based research project * Continued professional development * Enhanced significant event analysis- critical incident review

Question 47

Significant Event Analysis- 1. What are the stages of significant event analysis?

Answer 47

* Identify event (awareness and prioritisation of a significant event) * Collect information (information gathering) * Set meeting to discuss (facilitated team-based meeting) * Meet and analyse (analysis of significant event) * Implement changes and monitor (agree, implement and monitor change) * Write up SEA (write it up) * Seek external feedback (report, share and review)

Question 48

As a member of the dental profession, CPD is one of the standards of practice. 1. How many hours of CPD should be completed each cycle- how many must be verifiable?

Answer 48

* 100 hours verifiable CPD within 5-year cycle and at least 10 hours verifiable every 2 years?

Question 49

2. What are the core CPD topic requirements and how many hours are advised?

Answer 49

* Medical emergencies- at least 10 hours every cycle (5 years) and at least 2hrs every year * Disinfection and decontamination- at least 5 hours every cycle * Radiography and radiation protection- at least 5 hours every cycle * Also recommended keep up to date by doing CPD in legal or ethical issues, complaints handling, oral cancer- early detection and safeguarding children and young people/ safeguarding vulnerable adults

Question 50

3. What is CPD?

Answer 50

* The GDC consider that it is the ethical duty of dentists to continue to undertake appropriate continuing education for the duration of their professional practice * CPD refer to the process mof tracking and documenting the skills, knowledge and experience that you gain both formally and informally throughout tour carer, beyond any initial training to advance your professional development * It provides NHS staff the opportunity to continuously update skills and knowledge and to identify training needs across professions to aid clinical team-working * Should result in delivery of modern, effective and high-quality care to patients * May take format of courses, lectures, training days, peer review, clinical audit, reading journals, attending conferences and E-learning activities

Question 51

1. Give 6 members of the dental team that have to be registered with the GDC?

Answer 51

* Dentist * Clinical dental technician * Dental hygienist * Dental nurse * Dental technician * Dental therapist * Orthodontic therapist

Question 52

2. List the 9 GDC standard for dental professionals?

Answer 52

* Put patient’s interest first * Communicate effectively with patients * Obtain valid consent * Maintain and protect patient’s information * Have a clear and effective complaints procedure * Work with colleagues in a way that is in your patients best interest - Maintain develop and work within your professional knowledge and skill * Raise concerns if your patient are at risk * Make sure you personal behaviour maintains patient’s confidence in you and the dental profession

Question 53

3. Who is on the GDC board?

Answer 53

* 12 members- 6 appointed registrants (including chair) and 6 lay members

Question 54

1. What are the 4 pillars of ethics?

Answer 54

* Non-maleficence * Beneficence * Justice * Autonomy ## Footnote In Medicine, autonomy means that a patient has the ultimate decision-making responsibility for their own treatment. A medical practitioner cannot impose treatment on a patient. Beneficence is defined as an act of charity, mercy, and kindness with a strong connotation of doing good to others including moral obligation.

Question 55

2. What is negligence?

Answer 55

* The omission to do something which a reasonable practitioner would do, or doing something which a reasonable practitioner would not do

Question 56

3. What is the criteria for clinical negligence?

Answer 56

* Dentist owed a duty of care * Duty was breached * The breach caused or materially contributed to damage * The harm or damage was reasonably foreseeable and had negative consequences and effects

Question 57

4. How long should notes be kept for?

Answer 57

* Minimum of 8 years after last treatment

Question 58

5. What should clinical notes be?

Answer 58

* Confidential * Concise * Accurate * Legible * Complete * Retrievable * Current * Retained

Question 59

Fear and Anxiety- 1. Give 4 factors in the aeitology of fear?

Answer 59

* Previous adverse dental or medical experiences * Attitude and previous experience of family and peer groups (infection from others) * Poor understanding of dental procedures and techniques (analgesia) * Expectation of pain and discomfort * Emotional development delay * Psychological factors * Social media influence/representation

Question 60

2. How may an anxious patient present?

Answer 60

* High neuroticism and trait anxiety * Pessimism and negative expectation * Proneness to somatisation * Low pain threshold * Co-morbid anxiety or depressive disorder * Withdraw, depressive, sweating, fidgeting, upset or crying

Question 61

3. What is the cycle of behaviour change?

Answer 61

* Pre-contemplation * Contemplation * Preparation * Action * Maintenance * (progress or relapse at any stage)

Question 62

4. Give 4 management techniques for anxious patients?

Answer 62

* Systematic desensitisation * Acclimatisation * Cognitive behaviour therapy (CBT) * Progressive relaxation * Tell show do * Medication e.g. benzodiazepines (muscle relaxants) * Distraction * Enhanced control

Question 63

Stress- 1. What is primary appraisal in stress?

Answer 63

* Determining whether a stressor poses a threat (initial assessment)- irrelevant, benign, harmful threat or harmful challenge

Question 64

2. What is secondary appraisal?

Answer 64

* Reaction to primary appraisal(evaluation of resources of coping strategies for addressing perceived threats)- hard, resistance or exhaustion

Question 65

3. Give 4 responses to stress?

Answer 65

* Direct action * Seek information * Do nothing * Coping

Question 66

4. What is burnout?

Answer 66

* Process whereby a previously committed professional disengages from his or her work in response to stress and strain experienced in the job * The person will be exhausted mentally and physically causing them to develop a negative, indifferent or cynical attitude towards patients and colleges

Question 67

5. Give 4 examples of coping mechanisms for stress?

Answer 67

* Understanding and managing a good work/ life balance * Exercise * Education and coping CBT mechanisms on stress * Knowing personal limits * Set own goals and targets

Question 68

Alcohol and Smoking Use- 1. What are the recommended allowances for alcohol intake for male and females?

Answer 68

* 14 units per week with at least 2 alcohol free days * Spreading units of alcohol out; 2-3 units/day

Question 69

2. How may you screen for alcohol abuse?

Answer 69

* Through history after gaining rapport with patient * CAGE- have you ever though to cut down on alcohol use, do you get annoyed at criticism of your drinking and makes excuses, do you ever feel guilty about your drinking, do you ever take an early morning drink first thing in the morning to get the day started or eliminate the shakes? (yes, sometimes or often to 2 or more may indicated alcohol problem)

Question 70

3. How may you offer brief intervention in alcohol abuse?

Answer 70

* Raise the issue about is they drink * Screen and give feedback of risks * Listen for readiness to change * Suitable referral/information and advice approach * Should be short, non-judgemental and motivational * FRAMES- feedback (about behaviour) , responsibility (for change placed on patient), advice (to change given by practitioner), menu of options (for self-directed change or treatment is offered), epithetic (style using warmth, respect and understanding) , self-efficacy (is engendered to encourage change

Question 71

4. Regarding smoking how do you calculate pack years?

Answer 71

* 20/day= 1 pack year (e.g. 20/day for 20 years= 20 pack years)

Question 72

5. How do you offer brief advice for smoking?

Answer 72

* 5 A’s- ask, advice, assist, assess arrange follow up * 2A’s & 1R- ask, advice, refer * 3A’s- ask (smoking status), advice (benefits of stopping), act (signpost)