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MJDF OSCE Sta,ons

Reena Wadia

OSCE 1
You arrive at your dental prac=ce earlier than usual
and nd your nurse collapsed on the oor. There is no
one else in the prac=ce. Demonstrate and explain how
you would manage the situa=on on your own using
the props provided.

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Sequence
1. Assess for danger

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Sequence
2. Check for responsiveness shout and shake
3. Shout for help

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Sequence
4. Open airway
5. Check for normal breathing

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Sequence
6. Telephone for help:

Dial 999, ask for ambulance service
Situa=on I am name calling from address and my
contact telephone number is number
Background I am calling about a collapsed pa=ent
who is not breathing
Assessment Possible cardiac arrest
Recommenda=on I need you to send me an
ambulance and in the mean=me I will start CPR on my
own
Check understood (repeat)

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Sequence
7. Start CPR

30 Chest compressions
Depth 5 cm

Heel of hand over

mid point of chest

Rate 100-120/min

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Sequence
2 Rescue breaths

1 second each

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Sequence
8. Repeat

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Sequence
9. When will you stop?

Breathing normally
Signs of recovery

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OSCE 2
You have just consented your pa=ent for the
extrac=on of the lower leg rst molar. Having
administered an ID block, whilst ahemp=ng to re-
sheath the needle, you suer from a needles=ck
injury. Act out in front of the pa=ent and describe to
the examiner your management of this accident.

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Sequence
1. Stop all procedures/treatment
2. Assess the injury

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Sequence
3. Wash the injured area with running water and soap,
do not scrub or suck on the wound
4. Encourage bleeding by applying gentle pressure to
punctured area

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Sequence
5. Assess the pa=ents risk factors:

Up-to-date medical history
HIV/HBV/HCV infec=on
Blood transfusion
IV drug use
Sexual history

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Sequence
6. Explain what has happened to the pa=ent and
arrange for another appointment

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Sequence
7. If high risk, urgently ahend your occupa=onal
health department for further management e.g.
prophylaxis

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Sequence
8. Make a record of the incident in the
prac=ces/departments accident logbook

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Sequence
9. Long term management:

Maximise use of sheath holders and single-
use disposable syringe systems
Ensure all immunisa=ons are up-to-date
Regular audi=ng and training

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OSCE 3
You have just taken a set of full mouth
periapical radiographs on your pa=ent.
Please examine the radiographs and mount
them in the correct anatomical
arrangement.

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Tips
1. Usually 15-18 periapicals
2. Pick all the radiographs up and go one by one
3. Dont spend more than 5 seconds to read a
radiograph
4. If you are struggling, put the radiograph at the
bohom of the pack and keep going
5. Start with the posterior as the radiographic
anatomy is easier to locate

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Tips
6. Raised dot orientated should be upward for
bitewings and towards incisal/occlusal edges for
periapicals
7. Avoid rechecking if you have already checked the
dot!

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Tips
8. Some radiographs might show repe==on of some
teeth as they might be taken for dierent reasons
9. Once nished, re-check order, from midline to
either sides
10.Any incorrect lm = fail
11.Comfortable with iden=fying: ID canal, mental
foramen, incisive foraman, maxillary antrum, nasal
oor, external oblique ridge

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Recommended Reading

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OSCE 4
Sarah is a 21 year old insulin-dependent
diabe=c. Her diabetes was only recently
diagnosed. She comes to your prac=ce for
an extrac=on. She has her BM-s=x and is
happy to proceed.

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As you begin to prepare for the extrac=on, she tells you that she is feeling
faint. She informs you that she thought she needed to be starved from
midnight but has taken her insulin.

You quickly no=ce she begins to sweat, becomes agitated and her speech
becomes slurred. You check her blood glucose using the nger-prick
equipment and her BM is 2.1.

You start preparing a glucose drink and but Sarah stops talking and slumps in
the chair. What has happened and how will you manage this?

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Diagnosis

Acute hypoglycaemic event

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Whats in your medical emergency kit?

Oral glucose solu=on/tablets/gel/powder
Glucagon injec=on 1 mg
GTN spray 400g/dose
Adrenaline injec=on 1:1000 1mg/ml
Aspirin dispersible 300 mg
Salbutamol aerosol inhaler 100g/actua=on
Midazolam 10 mg buccal
Oxygen

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Sequence
1. Check ABC!
2. Select glucagon from emergency drug box
3. Check dosage and expiry date of drug

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Sequence
4. Administer IM injec=on
Select and assemble syringe and correct needles:
Green (40 mm, 21 gauge) for withdrawing
Green/Blue (25 mm, 23 gauge) for administering
Draw up safely, expel air
Change needle

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Sequence
4. Administer IM injec=on
Stretch skin
Hold syringe like a pen to insert in a dart-like
mo=on, to reduce accidental depression of plunger
(Plotkin et al 2008). Inject at 90 degrees to skin,
aspirate before injec=ng
Green needle should be inserted 2/3rds. No needle
should be inserted to hub as this is the weakest
point

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Sequence
5. Safe disposal of sharps
6. Give glucose drink
7. Re-check BM and monitor before sending home
may need to advise pa=ent to see GP

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OSCE 5
A 12 year old boy presents to you at the end of the day
ager falling o his scooter 20 minutes ago. He has
knocked out his UL1 and his mother has the tooth in a
cup of milk. The pa=ent is medically t and well. Re-
implant the tooth in the model and apply a splint.

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Sequence
1. Goggles, wash hands, gloves
2. LA, check socket and irrigate with saline
to remove blood clots
3. Carefully handle tooth by the crown
4. Clean the root by irriga=ng with saline
5. Measure the length of the root
6. Make sure the tooth is in the correct
orienta=on, push back into the socket
and get the pa=ent to bite on gauze

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Sequence
7. Select wire
8. Cut wire to correct length non-rigid splint
ahached to 1 tooth either side of the avulsed tooth
9. Mid-labial placement
10.Placement of composite (red wax)

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OSCE 6
Mr Jones is missing his UR2. He is very concerned about
aesthe=cs and would like the missing tooth to be replaced.

Provide Mr Jones with treatment op=ons including advantages
and disadvantages of each.

The informa=on should help enable you to gain informed
consent.

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Consider
Op=ons:
a. Removable par=al denture acrylic or CoCr
b. Resin retained bridge
c. Implant-retained crown
Explain advantages and disadvantages
Describe procedural aspects
Risks

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Discussions
Introduce yourself
Use the pa=ents name
Build a rapport
Avoid jargon
Be empathe=c
Logical
Keep calm

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OSCE 7
Mrs Brown is a 72 year old pa=ent of yours. In the last few
days, her LL7 has been causing her spontaneous long-las=ng
severe pain which is worse on bi=ng. The tooth was previously
restored with a large amalgam restora=on.

Medical history:
Osteoporosis Fosamax 10 mg orally ID since 2000
OE: LL7 Large MOD amalgam, fractured mesio-lingual cusp,
TTP++, -ve to EC and EPT


Discuss the op=ons for this tooth with your pa=ent

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Consider
Diagnosis will determine op=ons
Medical history bisphosphonates

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Sequence
1.
Greet pa=ent appropriately
2.
Explain LL7 has acute periapical periodon==s
3.
Treatment op=ons RCT or extrac=on
4.
Explain that pa=ents on oral bisphosphonates are
at a very slightly increased risk of osteonecrosis of
the jaws (1 in 10,000 1 in 100,000). Depends on
dose and dura=on.
5. Explain osteonecrosis is more likely with IV meds
6. Note that stopping the medica=on will not reduce
the risk
Pa=ent opts for RCT

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Sequence
7. Discuss advantages of RCT save the tooth
8. Discuss disadvantages of RCT several
appointments, long appointments, tooth will ideally
require cast restora=on
9. Check the pa=ent understands
10.Be empathe=c, avoid jargon and be concise

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OSCE 8
You are to perform an incisional biopsy of the
lesion marked out. You are then required to
close the resul=ng wound with the sutures
provided.

Assume the pa=ent has been consented, the
area has been cleaned and anaesthe=sed.

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Provided with

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Procedure
1. Check LA!
2. Mark the biopsy site appropriately, ellip=cal shape
(minimum 5 x 3 x 2 mm)
3. Correct angula=on of blade, no undercuts, down to
correct level
4. Marker suture at apex prior to placing in specimen
bohle ( Histopathology)
5. Evert edges, correct bite, angula=on, one bite at a =me
6. Knot-tying
7. Correct posi=oning of knot and everted edges
8. Safe instrument handling

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Knot-tying technique

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Tip
Try to stay as calm as possible

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OSCE 9
You are a den=st in general prac=ce. A 53 year old
female pa=ent presents to you, very distressed and
complaining of a recent onset of intense facial pain.

You need to take a thorough pain history, provide a
dieren=al diagnosis and discuss further management.

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Consider
Importance of empathy
Thorough pain history
Explaining dieren=al diagnosis

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Sequence
1. Reassure pa=ent
2. Ask pa=ent about the loca=on of the pain and if it radiates
3. Ask how long the pa=ent has experienced this pain. Consider
dura=on and frequency
4. Ask the pa=ent to describe the pain including its severity (pain
score)
5. Precipita=ng and relieving factors. Eec=veness of analgesics
6. Discuss if the pa=ent has experienced symptoms like this
before, if they have sought any other opinion regarding the
pain
7. Discuss a dieren=al diagnosis
8. Discuss referral to oral maxillofacial surgery/oral med/oral
surgery/GP
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Dieren=al diagnoses for intense

facial pain
1. Trigeminal neuralgia
2. Persistent idiopathic facial pain (atypical facial pain)
3. Post-herpe=c neuralgia

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Tip
If you have a check list in your head (e.g. pain history),
make it sound natural!

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OSCE 10
Look at the radiographs given and iden=fy the fault
as well as the cause of the fault or error.

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Examples

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Examples

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Examples

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OSCE 11
Your prac=ce is Address

John Golde, sees you today for pain associated with his lower leg wisdom
tooth. He tells you the pain has increased over the past week and has not
sehled with basic oral hygiene. He is otherwise


He is systemically well and there is no trismus. The tooth is mesioangularly
impacted and you have already referred him for an extrac=on. The
operculum of the tooth is quite inamed and you diagnose .
You decide to prescribe him a .

Please write a prescrip=on.

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OSCE 12
The equipment displayed on the tray has been used
on a pa=ent. Please assign the ar=cles to the
appropriate trays/bags/containers in accordance to
the infec=on control guidelines.

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Clinical waste Municipal waste Autoclave/Sterilise Clinical Sharps Wipe

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Possible Q&A
1. Where should bags of clinical waste be stored before
collec=on?
Securely in a dedicated ven=lated and secure area where
only designated people can come into contact with it
Unlikely to contaminate anything else
2. Who collects these wastes?
Licensed waste facility
Transfer note must be given for each consignment
Kept for a minimum of 3 years

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OSCE 13

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Possible Q&A
1. Iden=fy the prosthesis

Dental implant LL6
2. What is the process of tooth to bone union known as?
Osseointegra=on
3. What type of consent would you take for this treatment
op=on?
Wrihen informed consent
4. What are the components of the nished prosthesis
replacing a tooth?
Implant, abutment, crown
5. What anatomical structures in the maxilla complicate
placement of this prosthesis?
Maxillary and nasal sinuses, nasopala=ne foramen
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Good luck!

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