l, ritha Lakhani Saravana (ogeti FACULTY OF DENTAL SURGERY THE ROYAL COLLEGE OF SURGEONS OF ENGLAND REVISION MANUAL NOT TO BE CIRCULATED. COPYRIGHT OF FDSRCSENG.OSCE STATION 3 PRESCRIPTION CANDIDATE INSTRUCTION DPT (Dental Panoramic Tomography) of a patient in late mixed dentition is provided: T Which tooth/teeth is/are deciduous? T Mark Upper left and right C (deciduous canine) Circle the Permanent canine on the radiograph. T Mark Marked on the radiograph What is this condition called? 1 Mark Ectopic positioning of permanent canine OR Impacted canine If the permanent canine is left in situ (in the same position) what damage can it cause? (List 3) 1 Mark = Cystic changes of canine follicle = Resorption of adjacent permanent teeth (ie Incisors) "Resorption of the unerupted tooth itself What is the IOTN score for this malocclusion? T Mark 3i What is the management of this condition? (List 3) 1 Mark * Orthodontic alignment (following exposure of the ectopic tooth) * Surgical removal of the ectopic canine + Transplantation of the ectopic tooth Examiner notes: ‘This station assesses the candidate’s ability to: * Identify and analyse a Dental Panoramic Tomography (DPT) * recognize and diagnose malocclusions; describe features of a malocclusion * be able to assess the IOTN (for a referral to specialist) "Know of the general types of orthodontic treatments available OSCE materials: * DPF (Dental Panoramic Tomography) "IOTN rater © OTN sheetOSCE STATION 5: MARKING SHEET CANDIDATE NUMBER: ‘Your next patient is a 38 year old man requiring the extraction of the lower-right first molar retained roots. T ‘On the paper provided, please draw the flap you would use to access the surgical site, 2 Give 3 reasons considerations when faising this flap. a. Good exposure b. Wide base to promote exposure c. Avoiding damage to neuro vascular structures 3 Which of the available instraments would you use to raise the flap? (indicate number) 1. Howarths 3. Wards ‘Which instrament would you use to retzact the flap? (indicate number) 12. Bowdler henry retractor / rake Having divided the roots, which instrament would you use to deliver the roots? (indicate number) 11. eryers 6. couplands ‘What instruments would you use to close the flap? (etter/s) 2. Gillies tooth forcep 8 Gillies needles holder What suture material will you choose? = 3.0/4.0 Vieryl = 3.0/4.0 Vicryl Rapide =[STATION 8: MARKING SHEET CANDIDATE INSTRUCTION Please look at the copied film showing 5 intra oral images, A, B, C, D, E. Each film shows a particular film fault. Examine each film and then complete the answer sheet provided. For each film identify 1. The obvious film fault or error 2. ‘The cause of the fault or error ‘Two marks are allocated for each film, one mark for the error and one mark for the cause. Lead foil pattern showing or/pale | Film back to front film or/ poor contrast (wrong way round) B Cone cut or/ edge of film not Incorrect tube/beam aligament ‘exposed NB. Film is positioned correctly, answers that suggest not are wrong. c ‘Overlapped contact points Incorrect horizontal beam angel D Film too dark = Accept one or following, = Overexposed # Overdeveloped = Develop temperature too high * Out of date film " Fogging from unsafe light * Too high concentration of developer E Blurred image MovementPicture for Radiology‘OSCE STATION 13: MARKING SHEET _| CANDIDATE NUMBER: An 8 years old healthy male falls off his skateboard and sustains a dental injury as shown below. Please describe what you can see in this clinical photograph? ‘Question 1 _] Describe what you can see in the above clinical 3 Marks photograph? Answer |" Describe teeth present = Describe injuries, UR1 Enamel-dentine fracture " UL1 complicated enamel-dentine fracture ‘Question | What in particular would you ask about the teeth in the | 2 Marke history of the dental injury based on the diagnosis? Answer __| Did you locate the other fragments? To exclude the need for further investigations e.g. soft tissue radiograph or chest x-ray ‘Question 3 | Prior fo coming to this diagnosis what further Marks investigations would you carry out? Answer | * Periapicals of UR2, URI, UL1, UL2. = Upper standard occlusal. = Ethyl chloride [thermal pulp test] + EPT [electric pulp test] ‘Question 4 | Tf there was pulp involvement what is your immediate | 5 Marks clinical management? 8Answer Cvek pulpotor = Administer LA. = Isolate with rubber dam. * Minimal pulpotomy explained. = Medicament NS [non-setting |Ca(OH)2 mentioned Question 5 | What is the success rate of this procedure? 2 Marks Answer | 95% if carried out within 24 hrs of dental injury ‘Question 6 | How would you restore the coronal aspect? [2 Marks Answer = Fragment reattachment = Composite restoration (composite build up) Question 7 | What advice would you give to parents in the short term? | 2 Marks * Soft diet Answer |= Pain relief Question 8 | What is the aim of the short term management? T Mark Answer | To maintain vitality of the tooth and apexogenesis, Question 2 | What is your long-term review management? 4 Marks Answer = 1 month, 3 months, 6 months, yearly with radiographs. "Sensibility testing with ethyl chloride and EPT Question 9 | What is the potential sequelae? 2 Marks Answer |= Remains vital = Non-vital ‘Question 10 | What would you do if the tooth becomes non-vital and [3 Marks what is this procedure called? Answer * Commence root canal treatment. «= Extirpate pulp and dress with non-setting calcium. hydroxide as an interim. "Carry out apexification and use MTA to form an apical barrier —=--"— ‘CANDIDATE MARKS: 0‘OSCE STATION 15: ‘CANDIDATE NUMBER: Dietary Analysis Sheet - 24 Hour Recall — 10 year old Jessica Adams Before Breakfast Unsweetened still contains 9% sugar Breakfast 815 | Star? cereal Bow! | Contain sugae, brown same as white, extra sugar honey and glucose syrup Peanut butter on Savoury but contains sugar toast Morning, 945 | Raisins Snack Box | High sugar and sticky (64%) 10.30 | Strawberry milkshake (powder) | Glass High sugar 11.15 | Harvest erunch bar Sugar - brown and honey Mid-Day 1.00 | Spaghetti on toast Contains sugar but OK as part of Natural fruityoguet | Carton meal Milk Glass 45 tspoons sugar per carton ‘Afternoon 250 | nuit chews Packet Sugar 4.00 | Orange squash Ghass Low, reduced — watch out for type Plain biscuits 2 Contain as much sugar as sweet biscuits choc digestives = 28.5% custard creams = 30.2%, Fch te 22.5% —_— Evening Meal | 6.00 | Fish fingers 7 Mashed potato Peas 2tbspoons _| sugar tbspoon 22% sugar Cup tsp Evening 7.30 Twpoon “paturaP sugar but not safe Mug High sugar 8.00. | Savoury cheese — biscuits with cheese spread 2 Contain sugar Night 935 | Cough inetus 2ispoons Fligh sugar content, sticky check if brush after Bold and underline = sugar atack cf Stephan curve Question 7 What diet advice can you give to Jessica? 3 Marks Answer 1.Reduce the frequency and amount of sugar 2. Reduce sugar intake to mealtimes 3. Avoid in between meal snacking. 4, Can take safe snacks like cheese, peanuts "# f 5. Limit consumption of foods and drinks with added sugars to four times a day 6. Sugars (excluding those present in natural fruit) should Provide less than 10% of total energy in the diet or 60g per person. For children this is 33g ‘Question 2 Which study proves relationship between caties and sugar? 2 Marks Answer + Vipcholm Study = ‘Turku sugar study Question 3 | What were the findings in the study? Marks Answer 1.Vipcholm study This study was done to investigate the association between sugar consumption and dental caries. It concluded that- a. Consumption of sugary food is associated with a higher caries incidence. b. Increasing the frequency of sugar intake increases caries incidence ¢. Lowering sugar intake reduces caries incidence, 4, Consuraption of sticky sugat-containing between meal products can be associated with high caties risk. e. Several dietary factors are associated with caries incidence: = Amount of fermentable carbohydrate consumed = Sugar concentration of food + Physical form of carbohydrate + Oral retentiveness + Frequency of eating meals and snacks + Length of interval between eating "Sequence of food consumption 2.Turku Study ‘A longitudinal study to evaluate the caties incidence as affected by partial substitution of dieta with xylitol (9), the . effects of $- or X-contiming chewing gums ee during one year, The results show a profound difference in the caries rate between the two groups. The findings clearly indicate a therapeutic, caties inhibitory effect of xylitol. 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In order to localise its position you have now taken a periapical radiograph which has not covered the full extent of the broken file and tooth. You have to let the patient know what has gone wrong with the radiograph and take his/her permission to take a second radiograph. Patient X is not happy about this as another radiograph is needed since the first one was not correct. Patient X has undergone radiotherapy in the past for a medical illness and does not want to be radiated as this can be harmful to the body. Council and reassure the patient about the low risk regarding the dose from dental tadiographs giving reasons to support your answer. Actor Instruction Your dentist hasten radiograph as he/she has separated a piece of instrument within your tooth. You are not happy about taking x-rays as it causes harm to the body. You have had radiotherapy in the past (5 years ago) for a medical illness and it was not a pleasant experience. You have read in the newspaper that too much radiation causes cancer. Dentist wants to take a second radiograph as the first one has not covered the full extent of the broken instrument. Marks ‘Scores 1 | Greeting and Professionalism/Introduces themselves _| 1 mark 2 | Handles the situation and apologises for the error in | 1 mark the radiograph 3 _| Explains the reason for the error in the radiograph 2 marks 4 | Explains about Dental X — Ray radiation and how itis_| 2 marks different from radiotherapy 5 | Gives explanation on background radiation 2700,Sv | 3 marks per year and exposure from periapical is only 1-8.3 pSv or less Or2 days of back ground radiation © | Gives comparison flying distance — short haul return | 3 marks flights from London to Spain(within Europe) as equivalent to a pair of periapicals 7 | Gives the Annual limit of effective dose-1mSv for | 1 mark public according to the IRR. 99 Gives the Dose constfain of 0.3 mSv / per annum | 1 mark fot public according to the I 9 | Gets consent from the patient for second radiograph __| 1 mark 10 | Communications skills- displays empaphy and ‘2 marks understanding Total 17 19CANDIDATE INSTRUCTION A patient presents to you for a regular check up with his mother. The child has just had a dental radiograph. ‘You need to discuss with the patent the normal radiographic findings, any unusual findings and mark it on the radiograph, the approximate patient’s age as well as ‘management and treatment options. 10 Marks ‘Done ‘Not Done T_| Introduces themselves to the parent T 0 2 | Asks what are the concerns? 1 0 3 | Able to identify the patient’s age from dental T 0 radiograph: any age from 8 to 10 y.o. is acceptable 4 | Able to explain radiographic findings to the parent: T 0 radiograph in mixed dentition, presence of primary and permanent teeth 5 _| Able to recognise un-erapted upper left central incisor | 7 0 and supernumerary tooth and explain to parent 6 | Avoid use of jargon I 0 7 _| Able to ask for more radiographs: Upper standard 1 0 occlusal ot periapical radiograph for parallax technique 8 | Shows empathy throughout 1 0 9° | Discussed treatment plan: primary and supernumerary | 1 0 tooth removal, possible expose and bond of the permanent incisor 10 | Management option LA, IS or GA 1 0 Total Marks 10 ‘NOTES FOR EXAMINER Make sute candidates show empathy and explain term in a user friendly way. Happy for the candidate to elaborate more on the types of supernumerary teeth 20‘The arrow indicates the supernumerary tooth A: The un-erupted permanent central left incisor B: The retained primary central left incisor a‘OSCE STATION 10: MARKING SHEET _| CANDIDATE NUMBER: * Picture Question 1 [ Name each radiographic view. ‘a. Dental panoramic tomograph, panoramic, 3 Masks (Sectional) DPT b. Periapical ULS ¢. Upper standard occlusal, USO Question 2 | What age is this patient? 2 Marks ‘Around 15-17 years old Question 3 | Localise the upper left canine. 2 Marks Palatal ‘Question 4 | What potential problems could occur as a result of this | 3 Marks impaction? 3 marks = Dentigerous cyst formation around UL3 = Resorption of adjacent teeth/ roots = Aesthetic imbalance = Need for surgical/ orthodontic intervention = Infection/ periodontal disease if partially erupted = Loss of vitality UL2 = Expansion of the jaw = Expansion in the palate = Pain = Swelling = Loss of standing teeth = Enlargement of the lesion = Ankylosis of the ULC 2OSCE STATION 20: MARKING SHEET ANDIDATE NUMBER: x Posterior Anterior (PA) Jaws/PA Mandible T Mark B Reverse Townes T Mark 0° Occipitomental (0° OM) T Mark D 30° Occipitomental (30° OM) T Mark = Submentovertex (SMV) 1 Mark F Lateral Skull 1 Mark PyOSCE STATION 20 : MARKING SHEET | CANDIDATE NUMBER: CANDIDATE INSTRUCTION DPT (Dental Panoramic Tomography) of a patient in late mixed dentition is provided: T Which tooth/teeth is/are deciduous? 1 Mark ‘Upper left and right C (deciduous canine) 2 | Gircle the Permanent canine on the radiograph. 1 Mark ‘Marked on the radiograph 3. | Whatis this condition called? 1 Mark Ectopic positioning of permanent canine OR Impacted canine 4 | Tfthe permanent canine is left in situ (in the same 7 Mark position) what damage can it cause? (List 3) = Cystic changes of canine follicle * Resorption of adjacent permanent teeth (ie Incisors) * Resorption of the unerupted tooth itself 5 ‘What is the IOTN score for this malocclusion? 1 Mark 6 | Whats the management of this condition? (List 3) i Mark * Orthodontic alignment (following exposure of the ectopic tooth) = Surgical removal of the ectopic canine = Transplantation of the ectopic tooth Examiner notes: This station assesses the candidate's ability to: * Identify and analyse a Dental Panoramic Tomography (DPT) * recognize and diagnose malocclusions; describe features of a malocclusion * be able to assess the IOTN (for a zefetsal to specialist) = Know of the general types of orthodontic treatments available OSCE materials: + DPT Dental Panoramic Tomography) * IOTN ruber = OTN sheet 2627MEDICAL EMERGENCY ‘OSCE STATION 1: MARKING SHEET CANDIDATE NUMBER: ‘You artive at your dental practice earlier than usual and found your receptionist collapsed on the floor. There is no one else in the practice. Demonstrate and explain how you would manage the situation on your own using the props provided. Done ‘Not Done “Assess for danger Check responsiveness. Shake and shout Shout for help [stay with patient] ‘Open airway fhead tilt / chin lift 7 jaw thrust] 2lafe)y yr] Check for normal breathing [up to 10 seconds] Look/Listen/Feel T T T 1 T “Telephone/Summon help and get AED immediately Dial 999- listen to them make call = Ask for the ambulance service (NB 999 = police, fire and ambulance) Situation Tam (name) "Calling from (address including postcode) My contact telephone number is. =| Tam calling about a collapsed person who is not breathing Assessment Tam suspecting a cardiac arrest Recommendation # "Tneed you to please send an ambulance and in the meantime ‘w Lam going to start CPR on my own’ Ask receiver to repeat key information to ensure understanding 3 7, | 30 chest compressions {heel of hand over mid point of the chest/stermum] * Rate at least 100-120/min Depth of compression at least Sem 0 8. | 2rescue breaths = 11sec each * (wait for the chest to deflate before giving 2! breath) = No more than 5 seconds total interruption in chest __compressions fe 0 9. | 30 chest compressions 10.__[2 rescue breaths (Stop the candidate at this stage TL. | Q. Ask the candidate when are they going to stop the CPR? ) Breath normally & ») Signs of recover: Speaking; opening eyes; cough; purposeful movement 0 Total Marks NOTES FOR EXAMINER To pass the candidates must score 15. All points must be mentioned but not necessarily in the correct order, Wipe dummy’s mouth between students, 28 lure to resuscitate patient must be graded as a failure. Inform candidate he has 5 minutes for the task and only 1 attempt can be made.OSCE STATION : MARKING SHEET ‘CANDIDATE NUMBER: CANDIDATE INSTRUCTION Please place an IV canula into one of the veins in the arm provided ‘The patient has consented and has agreed to the procedure. Please explain to the examiner what you are doing during the procedure Marks Done ‘Not Done T_ | Washes hands and puts on gloves, T 0 2 | Prepares the cannula 7 0 3 | Applies a tourniquet above the antecubital fossa i 0 4 | Explains to lower arm below the heart and ask the i 0 patient to clench to enlarge the veins. Tapping the veins also helps to improve vessel dilatation 5 | Holds the cannula correctly 1 0 © | Chooses appropriate vessel, cleans sutface with alcohol | 1 0 swab and stretches the skin accordingly over the vessel 7 | Approaches the vessel at the conect angle and gains | 1 0 access to vessel judged by fluid flash back 8 | Needle withdrawn and cannula left in situ, secured with | 1 0 tape 9 | Removes tourniquet and disposes of needle and gloves | 2 0 and wipe in clinical waste Total Marks 29OSCE STATION 14: MARKING SHEET _| CANDIDATE NUMBER: CANDIDATE INSTRUCTION You are an Emergency dentist and attending Mr. Jones in your practice who had an extraction of UR6 cattied out at another dental practice eatlier today. He has presented with petsistent bleeding from the socket 9 hours after the extraction. Please take apptopriate history to determine the cause of the bleeding. Acror’s Props Anticoagulant Clinic Record Book (Yellow book) box of Propanolol box of Warfarrin box of Ibuprofen Gauze pack Written instructions after extraction Paper work (consent, ITA) AcTOR’s (PATIENT) INFORMATION: = Full Name: Mr. Victor Jones = DoB: 22/11/44 (66yrs) * Address: 1 Lame Street, Palmers Green NZ1 1XC DENTAL History: * Brush twice daily (afternoon and before going to bed) Flosses every evening at 10pm Visit dentist every 6months * Diet: Low Sugar (1 tsp in a cup of tea twice daily) + Last dental treatment: Extraction of an un-restorable tooth Upper Right first molar (chunky tooth at the back on the top right side) Doesn't wear denture. * Never had filling or extraction before in life. "Happy with Smile & appearance of teeth. ‘MEDICAL HISTORY: "Atrial Fibrillation «Mild Osteoarthritis "Hypertension (Well under control) Visit GP for repeat prescription only when necessary. ALLERGIES: Shell fish (rash) DRUG History: Warfarin 5mgs (INR 2-3) * Propanolol 10mgs «Ibuprofen 200mgs ‘ Visit anti-coagulant clinic every week. (Last visit was yesterday and INR was 2.9)FAMILY History: NIL SociaL History: Marital Status: Widowed (no children) Lives on his own in a flat. ‘Smoke: 5-10/day (for past 35yrs-don't want to quit) Alcohol: teetotal ‘Occupation: Retired Civil Worker PATIENT INSTRUCTION You are the above named patient and has extraction done 9 hours ago at another dentist. Since the extraction you have been bleeding (oozing out of the socket) and there is no pain. You have tried biting on gauze for 30 mins and did it twice but in vain. You are very annoyed and frustrated. You have already smoked 2 cigarettes, 4 hours after the extraction and rinsed your mouth thrice with cold water to stop the bleeding and get rid of the bad taste inside the mouth. The dentist gave you the written and verbal instructions and as far as you know you tried following them. Your INR was done yesterday afternoon and it was 2.9 at the hospital in anticoagulant clinic, usually your INR stays within the range of 2-3. You couldn't eat anything since then and you are concerned. about the blood loss and would like to know the likely cause of the bleeding. You have been taking Ibuprofen for the last 4 days as your joints ate hurting, Only give the yellow book and list/boxes of medication if candidate asks for it. You will also have some paper work & gauze, just give everything with above. Some people will start talking about the treatment but you may need to drag them back to the cause of the bleeding as the questions specifically asks for finding out the cause of the bleeding socket. You need to ask them: Why am I bleeding continuously? Is it because of rinsing/smoking that I am bleeding? Am I bleeding because of Warfarin? Am I bleeding because of Ibuprofen? Have I lost a lot of blood? Do I need to stop taking Warfarin /Thuprofen? aMarks 76 Done | Not Done Introduces themselves fully and uses patient's name. 2. | Invites questions and dialogue & determines the nature of the problem. sh 3. | Takes a concise history of the problem. " When was the extraction done * Patient Smoked & Rinsed * Patient followed Post Operative Instructions * Asks for the Anticoagulant Clinic Record (Yellow Book) 4. | Establishes patient is on Warfarin and Ibuprofen from the medical history. 5. | Establishes and discusses the cause of bleeding with the patient using appropriate language (no jargon)? 6. | Invites questions from the patient & answers them with sound clinical knowledge. 7. | Cause of bleeding in this case is the adjuctive action of Ibuprofen and Warfarin 8._| Patients on Warfarin should NOT be prescribed Ibuprofen 9._ | Shows empathy towards patient? Actor's Mark (Good=3, Satisfactory=2, Partially=1, Poor=0) 10. [ Was the candidate able to produce sympathetic relationship 3 swith you? 11. | Do you feel that you understood the explanation 7 3 information given? 12. | Did the candidate address your anxieties appropriately? 3 Total Marks 2‘OSCE STATION 5: MARKING SHEET | CANDIDATE NUMBER: CANDIDATE INSTRUCTION ‘You ate a dentist in general practice. A 63 year old female patient presents to your surgery. She is very distressed and complains of a recent onset of intense facial pain. You need to take a thorough pain history, provide a differential diagnosis and discuss farther management of the patient. EXAMINER INSTRUCTION Examiner will play the anxious patient in the absence of an actor. Candidate needs to demonstrate the ability to be empathetic to the patient, take a thorough history of the presenting complaint, and explain a differential diagnosis. ACTOR INSTRUCTION ‘You are the distressed patient; you have had a two week history of intense, stabbing pain located in the region of your right cheek. The pain is intense, electric shock or stabbing in nature, lasts seconds, is triggered by touching the area, washing face, applying make up. You can not stand the area to be touched; sometimes even cating moving your mouth can bring on the pain. The pain is affecting your life, causes you to stop all activity until the pain resolves. The pain does not radiate anywhere, it is very well localised over your right cheek. You are medically fit and well, have not recently had any dental work performed, have not felt otherwise unwell and have never had symptoms like this previously. You would like to know the cause of this pain. “Marks Done Not Done T Candidate reassures patient. T 0 2 ‘Asks patient about the location of the pain and iFit radiates. | T 0 3 ‘Asks about how long the patient has experienced this pain. 2 0 Asks the duration and frequency of episodes of pain. 4 ‘Asks the patient to describe the pain, and asks the severity of _ | 2 0 the pain — may use a pain score. 3 ‘Asks the patient if there are any precipitating/relieving factors. | 1 0 ‘Asks if analgesics have been used and if they are effective. 6 Discusses if the patient has experienced symptoms like this, T 0 before, if they have sought any other opinion regarding this pain. 7 Discusses with patient a differential diagnosis of T 0 trigeminal ne (most likely) /persistent idiopathic facial pain (atypical facial pain) /post-herpetic neuralgia/. 8 Discusses referral (0 an oral maxillofacial surgery/oral med T 0 clinic/ oral surgery clinic/GP. “Total Marks 3aOSCE STATION 1: MARKING SHEET CANDIDATE NUMBER: CANDIDATE INSTRUCTION You ate approached by a colleague who informs you that while working on a patient, his bur slipped and cut the patients lip. There is some bleeding and slight discomfort. However the patient did not experience any pain. Explain how you would proceed from here with regards to patient management and risk management. Marks Done | Not Done ‘Advise colleague to stop working and inform patient of the injury T 0 ‘Assess the injury; how deep is i, is there any breach of the skin, advise patient on extent of injury and on plan of management Management of the bleeding using pressure pack , local aseptic agents, suturing ‘Advise patient of possible problems, risks, and complications and their likely management (Pain, swelling, bleeding, infection, scarring) Continue or defer dental treatment (discuss with patient) Tf the injury is sufficiently deep to require more than very basic suturing, consider advice and possible referral from Maxillofacial Unit. (do not send patient to hospital before calling the team) Make a detailed record of the incident in the patient's notes along with photographs , list of witnesses and discussions with patient Record incident in practice's /department’s accident record logbook or fill incident form. Inform patient of practice’s complaint policy and his rights in case he would like to make a complaint 10 Inform dental indemnity provider i Carty out regular audits for incident analysis and record it in practice clinical governance folder 12 Ensure regular training for the team to minimise frequency of accidents. 34OSCE STATION 1: MARKING SHEET CANDIDATE NUMBER: CANDIDATE INSTRUCTION While clearing up after the last patient, and with the patient still on the premises, your nurse has sustained a needlestick injury through her glove from a used dental needle. Explain to the examiner what stages you would go through to comply with Health and Safety Law and current guidelines, “Marks Done ‘Not Done Reassure the nurse that the tisk of infection is minimal, but that you are required to follow the practice protocol for needlestick injury for her/his peace of mind. “Assess the injury; how deep is it, s there any breach of the skin, has the needle entered the patient’s blood vessel, is the injured area bleeding? Remove glove, wash the injured area with running water and soap , donot scrub-or suck-on-the-wauad, encourage bleeding by applying gentle pressure to the punctured area Explain what has happened to the patient in an area that ensures privacy. Assess the patient's risk factors; ‘medical history form up-to-date. Advise them that their full cooperation would be of great help and any information entirely confidential. Ensure that the patient is asked to complete the confidential risk assessment questionnaire (HIV, HepB/HepC) and ask if they would be prepared to give a blood sample so that appropriate post-exposure prophylaxis may be offered to the nurse. Trhigh tisk, arrange for nurse to urgently attend local occupational health department (ideally within one hour), for advice and further management, eg: prophylaxis, virology ‘Make a record of the incident in the practice’s/department’s accident record logbook and report via RIDDOR if the donor blood is from a high tisk patient “Maximise usage of devices such as sheath holders and single use disposable syringe systems Ensure that Hep B immunisation status is up-to-date for everyone in the practice 10 ‘Ensure regular training for the team, and regular auditing of incident forms in order to minimise frequency of accidents 35EXTRA OSCE STATION 19: ‘CANDIDATE NUMBER: CANDIDATE INSTRUCTION This is Michael Brown, a 22 year old chemistry student. He has come to see you because of pain in his face. The pain is associated with area in front of his ear. It is mainly on the left hand side but can occur on the right as well. The pain is worse in the morning, at the end of the day. It also gets painful when he eats some meals and sometimes he will wake because of the pain. He has visited his dentist in the past who have investigated his teeth and have found no dental pathology. He has had a click in his jaw for the last 3 years and occasionally feels his opening is limited but can open mouth filly. Take a concise history and explain to the patient what you think the likely diagnosis is, and your outline your management plan to him. PATIENT BRIEF Your name is Michael Brown. You are a 22 year old chemistry student. You have been experiencing pain on left hand side of face. It is centred just in front of your cat on left but occasionally you have noticed it on the right as well, but not as frequently. ‘The pain is worse in morning and at the end of the day. Eating also exacerbates the pain and occasionally it will wake you from sleep. ‘The pain began 6 months ago at the time when you were diagnosed with Non- Hodgkins Lymphoma. You recognise that you grind your teeth at night. NSAIDS or antibiotics have not helped. ‘The symptoms are not related to hot, cold or sweet foods/drinks. ‘There has been no injury to the area or jaw and there was no previous history. There arc no other medical issues of medications being taken. You are waking early in the morning since the diagnosis and your apetite is poor and deteriorated. Your mood does vary during the day and you have less energy than normal. You recognise you have been stressed since the diagnosis and treatment for NHL. You also know that your mouth has been dry and that a white line has appeared ‘on your cheeks on both sides, and you have noticed your tongue has small indentations along the side. Your dentist has not found any other causes after investigations on your teeth involving X-rays and applying something cold to each tooth. You also remember something to do with “small electric current”. ‘You have had a click for the last 3 years and although you an open your mouth fully , occasionally it feels it restricted /limted in how far it opens. 36OSCE 19 Continued Marks ‘Not Done T_ | Tntroduces themselves fully and uses patient’s name 2 | Determines the nature of problem Aching, morning, left side>right side, worse on chewing 3, | Takes a concise history of problem; Started 6 months ago when he was diagnosed and when he began treatment for non-hodgkins lymphoma ‘Worse am, has been told he has started to grind his teeth at night NSAIDS, not much help, antibioties no help No hot, cold, sweet symptoms No trauma Never had problem before | Establishes patient is not on any medication and has no relevant medical history e.g arthritis, trauma 3 | Establishes a stress/depression background Early morning wakening, reduced apetite, mood variation and loss libido © | Outlines management based upon the history taken Examination EO and IO features Crenation, occlusal wear and linea alba, dry mouth Role of X tays/imaging 7 | Explains this to patient without using jargon likely Facial Arthomylagia (‘TMD acceptable) 8 | Advises = Conservative .—~ * Remove occlusal interferences if relevant ~~ ™ Soft diet * No opening wide — ™ Analgesises and heat * Review * Possible Bite guard or antidepressants ~~ 0 9. | Performs the above empathically - acknowledges patient’s concern, particularly over the risk of cancer ‘And uses no jargon and asks if any questions? Total Marks a7[OSCE STATION : MARKING SHEET _[ CANDIDATE NUMBER: CANDIDATE INSTRUCTION A 75 year old regular patient of yours (Mr/Mrs Scholes) attends for an appointment relating to his/her LR6. The tooth was restored with an MOD direct composite restoration 5 years ago and has fractured a cusp approximately 6 months ago. In the last few days the tooth has started to cause a spontaneous, long-lasting pain which has kept the patient awake at night. ‘The patient also has: * no relevant medical history except Osteoporosis and has no allergies. He/she has been medicated with a Bisphosphonate (Fosamax®) 10mg orally taken once daily since 2000. * a LRG which has a large MOD composite restoration and a missing mesio- lingual cusp. It has a negative response to warm gutta percha, ethyl chloride spray and electric pulp testing. However, the tooth has ne tenderness to percussion, and pressure over its apices. = an otherwise mildly restored dentition, no periodontal diseases and excellent oral hygiene Please provide this patient with the options for this tooth and advantages and disadvantages. Done Not Done 1_| Uses appropriate greeting 1 0 w Explains that LRO Acute Apical Periodontitis and [1 0 thus needs RCT or extraction 3, | Explains that the patient is on oral 7 0 Bisphosphonates so she’s- at a very slight risk of osteonecrosis of the jaws, explains what is Osteonecrosis, and explains why extraction should be avoided whenever possible. The incidence of ON} in the general population is unknown. Estimates of ONJ in patients taking bisphosphonates range from 1 in 10,000 to <1 ip \ 100,000 persons per years’ exposure (Ref: Scottish guidelines) ~—— —— © | Explains that stopping the medication will not i 0 reduce the risk of osteonecrosis of the jaws 7 | Explains advantages of root canal treatmenteg. | 1 0 maintains the tooth & relatively high success rate 8 | Explains disadvantages of root cafial treatment e.g | 1 0 several appointments, longer appointments & the tooth will need a cast restoration. Es9” [If patient prefers extraction, then candidate should [1 0 explain that it will be done as atraumatic as possible and the patient needs to maintain superior oral hygiene and needs to strictly follow the post extraction instructions given T0 [In case of extraction patient will need to be|1 0 reviewed weekly for 4 weeks, if thete’s any sign of inappropriate healing, then the patient will have to be referred to a specialist 11 | When patient asks about Antibiotics, the answer is [1 0 NO as there is no evidence that it reduces the ti ae ere KS nO evidence that It reduces the as of BONT, 12 | Check that the patient understands 1 0 13 | Talks empathetically and does not use jargon 1 0 Total Marks PATIENT INSTRUCTION You are Mr/Mrs Scholes a 75 year old regular patient of this dentist. You are attending a non-emergency appointment relating to your lower right first molar. ‘The tooth was restored by this dentist approximately 5 years ago with a large “white filling”. A part of this tooth fractured 6 months ago but it did not cause you any problems so you have been monitoring it. In the last few days, however, the tooth has started to cause a spontaneous, long-lasting pain which has disturbed your sleep. The pain is not worse with hot of cold, but mainly on biting ‘The pain spreads to your right ear, is not associated with any swelling and is temporarily alleviated with simple painkillers, You also have no relevant medical history except Osteoporosis and you have no allergies. You have been medicated with a Bisphosphonate (Fosamax®) 10mg orally taken once daily since 2000. You have read that this medication can limit what dental procedures that you can have. You would like specific details on: what exactly the problem is what the options are for the tooth what are the chances of getting osteonecrosis of the jaws should you stop taking you medication the advantages and disadvantages of root canal treatment whether antibiotics can help or not avaene 39OSCE STATION 19: ORAL HYGIENE FOR | CANDIDATE NUMBER: Kips CANDIDATE INSTRUCTION ‘A.3 year old patient presents to you for the first time with his mother. The child has never seen a dentist before and has no prior experience of having dental treatment. ‘You need to discuss preventive advice with the parent and management options. PATIENT INSTRUCTION You ate the parent of a 3 year old child who has decay as shown in the photograph. You are going to see a dentist for the first time to seek treatment. The candidate is expected to discuss the cause of the decay without the use of technical terms and discuss ways in which this could be prevented in the future and treatment options. They should also show empathy.19 continued 10 Marks Done ‘Not Done T_ | Introduces themselves to the parent i 0 2 | Asks what concems are T 0 3 | Able to recognise nursing caries and explain to parent | 1 0 4_| Discusses causes ie. bottle of milk or comforter at 1 0 night, lack of saliva production at night therefore increasing risk 5 | Avoid use of jargon 1 0 © | Stop bottle of milk at night. Discuss alternativesie. | 1 0 water in bottle, gradual weaning off bottle to cup 7 | Discusses OHT ie. brushing 2 x days. High cone. I 0 fluoride toothpaste. Supervised 8 | Shows empathy throughout. T 0 ‘9 | Discussed treatment options Le. no treatment, T 0 restoration of teeth or extraction 10 | Management option LA, RA or GA T 0 Total Marks i0 NOTES FOR EXAMINER Make sure candidates show empathy and explain term in a user friendly way. Mina is happy to add mote on fluoride dosages for 3 yenr old etc if need be “[OSCE StaTIoN: ROKEN FILE CANDIDATE NUMBER: CANDIDATE INSTRUCTION ‘This is Mr/Mrs Black. He/She has been referred to you by your colleague who is away ‘on maternity leave. You have to obturate the upper right 6. As you look at the x-rays of ‘URG you come across an x-ray with a broken file. Please explain to the patient options and management. PATIENT BRIEF You are Mr/Mrs Black, 61 years of age attending this dentist for the first time to get a ‘upper tight 6 tooth treated as your dentist is on matemity leave and could not complete the treatment. There is a broken instrument (used to clean the canals of the tooth) in the tooth but you are not aware of the broken file. As the dentist explains about the broken instrument to you, you are shocked and distressed that you were not told about foreign body left in your tooth. You are worried about possible harmful effects such as cancer, infection or poisoning. The dentist should offer various treatment options namely refer to a specialist for the removal of the instrument, completing the treatment by trying to bypass the instrument, trying to remove it, sealing the tooth leaving the instrument behind or extraction and replacement options. The dentist should also let you know that the referral to specialist will not guarantee success of treatment or removal of file. The dentist also warns you about possible worsening of the prognosis of the tooth due to broken instrument. You select to have your treatment completed. Done ‘Not Done T_ | Introduces themselves 1 0 2 | Communicates empathetically i 0 3 | Explains about the broken file, 7 0 4 _| Shows the broken file on the x-ray to the patient. 7 0 5 | Apologises on behalf of the colleague and offers to find [7 0 ‘out as to why the patient was not told. 6 | Reassures pt about pis fear of 1 0 cancer/poisoning/infection 7 | Explains various treatment options. i 0 8 | Offers a specialist referral. i 0 9” | Warns about fature complications T 0 10 | Thanks the patient 1 0‘OSCE STATION 11: CANDIDATE NUMBER: Tooth |Mesial | Distal Radiographic ‘Treatment Surface | Surface _| Diagnosis URT__|x x No caries URG |v x Reversible pulpitis Restoration URS__ |x Reversible pulpitis Restoration URS x Texeversible pulpitis Endodontics/Extraction UR3__|x 5 IR4 |x No caries TR5__[x Reversible pulpitis Restoration TRO |v v Reversible pulpitis Restoration IRT_ |x x No caries Question 1 | Which caries risk category is this patient? High caries risk Question 2 | What tooth paste would you prescribe for this patient? Fluoridated tooth paste with 130ppm of fluoride \38 50pm of fluoride _ Question 3” | What is the concentration of fluoride varnish advised for this patient? How often should this be applied? Fluoride Varnish 2.2% F to be applied twice yearly ‘Question 4 | What mouth wash would you prescribe for this patient? Fluoride mouthwash 0.05%NaFat different times and nenn x O27 * ‘Question 5 | TFactive carious Tesions are visible what advice would you give the patient advised? Use fluoridated tooth paste with 2,800 or 5,000ppm of fluoride. Brush twice daily and last thing at consumption ight, Diet analysis with reduced sugar Fig B: Patient has an 8 month old restoration on the UR6. He/She has discomfort in the tooth since one month. He is in pain since last three days and unable to bite on the side. ‘Question |_| What is your diagnosis? Irreversible Pulpitis ‘Question 2 | What treatment option can you offer? Do nothing Endodontic Treatment Extraction Reference: Delivering Better Oral Health hup://wwwdhgow.uk/ptod consum dh/groups/dh digitalassets/documents/digitalaset/dh_102982.pd £ ryOSCE STATION 10 MARKING SHEET CANDIDATE NUMBER: CANDIDATE INSTRUCTION Mr/Mrs White required an extraction of his/her upper left first molar (UL6). This tooth was previously root canal filled, approximately 10 yrs ago and has subsequently fractured vettically. A month ago he/she had an infection associated with the UL6 whilst on a business trip for which antibiotics were prescribed by an emergency dentist. Mr/Mrs White decided to have the UL6 extracted before flying for his/her next business trip. You attempted the extraction and successfully managed to remove both buccal roots but unfortunately pushed the palatal root in the maxillary sinus. You then noticed blood bubbling in the socket and took a DPT that showed the palatal root in the maxillary sinus. Please explain to the patient: "What has happened? * The next steps in your management including further treatment option/s. PATIENT BRIEF ‘You are Mr/Mrs White, 41 years of age attending this dentist for extraction of a fractured upper left first molar which was root canal filled 10 years ago. You had an infection associated with this tooth for the past approximately 1 month ago for which you were presctibed antibiotics (7 days course) by an emergency dentist. You would now like to have the tooth removed before next business trip in 3 weeks. Today this dentist tried to take the tooth out (which has 3 roots) and only takes Zzoots out completely. The 3" root has been displaced into the space above your top teeth (maxillary sinus). You had another X-tay taken and now you are waiting to hear from the dentist what has happened. You are not yet aware of the situation and the dentist will explain about the infected root being displaced in your sinus. On hearing this you will get shocked and distressed. You are now worried about possible effects of the root not being taken out such as pain, infection, the root causing damage to other teeth and not being able to get the root out. What to expect from the candidate ‘The dentist should be able to inform you of the situation honestly and use the radiograph taken to explain further. Provide reassurance and explain his surgical limitation and offer referral to specialist Oral and Maxillofacial Surgery Unit for the removal of the root from sinus. Inform you of the immediate measures he/she will take, The dentist should be able to offer a brief explanation of what will be done to remove the root at the hospital. He/she should give instructions on Do’s and Don'ts. Once they have explained everything, you accept their apology & select to be referred for specialist services.‘Not Done | Done 1 | Addresses the pt with empathy & explains the situation ie, palatal 1 0 root getting pushed into the sinus 2. | Apologises & informs the patient of this uncommon but known “ 1 0 complication. 3_| Uses radiograph to explain the situation. 1 0 4 _| Explains not being able to get the root out himself/herself 1 0 5 | Reassures them regarding pain/infection|patients main concerns > 0 while abroad}, the root causing damage to other teeth Explains to patient structured immediate management: * Promote good blood clot by approximating gingival margins closely or placement of physical agents in socket to stop excess bleeding (‘Surgize) along with suturing the socket if needed. g | % Prescribes amtibioties (ey i (Clarthrescin a . ° seni saal detongestins Set ws OF nae CORREA Tasal decongestants such as OA0iie (oy lameTaROTNG + Kavises steam inhalation or saline nasal douches - * Advises warm salt water rinses and OHI + Ravises on analgesia and what t0 expect in terms of swelln, ‘ind sie Discusses with the patient Do’s and Don'ts and offers a written leaflet summarising this Do's Don’t "Follow the instructigns |" Smoke + 7 | Finish course of —* | * Blow Nose 3 0 antibiotics ‘ "Use nasal drops. + "Sneeze with open mouth g_| Offers a specialist referral and explains superficially what treatment 2 0 will be carried eut ly the specialist. 10 | Thank the patient for being understanding and enquire if they have | ° any further questions 41 | Actor marks: empathy, explanation of treatment options and | 0 outcomes. Total Marks 720 45OSCE STATION 6: GINGIVITIS / ORAL HYGIENE ‘CANDIDATE NUMBER: CANDIDATE INSTRUCTION A regular 30 year old patient of yours (Mr/Ms Rooney) has attended for his/her annual check up. ‘The patient has: ¢ no relevant medical history, has never smoked and is does not consume alcohol the following teeth present 7654321 | 1234567 7654321 |*1234567 * moderate oral hygiene with obvious supra-gingival and inter-proximal plaque. He/she also has BPE (Basic Periodontal Examination) scores of 144 ajafa * no other clinical or radiographic evidence of pathology (caries, bone loss et elerd) Please obtain an appropriate history with regard to the patienit’s oral hygiene regime and then modify this using the equipment provided. before closin; *Picture Done Not Done 1 | Uses appropriate greeting, and intreduces self to 7 0 patient 2 | Asks about the current regime including tooth 7 0 brushing (electric or manual, frequency and duration of brushing, size of head & stiffness of bristles} 3 | Asks about adjuncts including inter-proximal 1, [0 cleaning aids (flossing, bottle brushes & inter-space brushes) and mouthwash use 4 | Advises of diagnosis: gingivitis (reversible 1 0 periodontal inflammation) NOT periodontitis 5_ [Deals empathetically with fears of losing teeth T 0 6 | Explains that mouthwash ot antibiotics will not 1 0 prevent gingivitis in the long-term 7 | Shows the modified bass technique with emphasis on [1 0 plaque removal from tooth/gingivae interface - 8 | Explains about proximal brushes eg, TePe, Vision or | 1 0 interspace toothbrushes J 9 | Explains about floss and an appropriate technique 1 0 eg. loop technique _ 10 | Does not use jargon and checks understanding, 1 0 46OSCE STATION 6 CONTINUED PATIENT INSTRUCTION You are Mr/Ms Rooney, a 30 year old patient of this dentist. You have been a regular attendee on an annual basis and you have never required any dental treatment apart from a “scale and polish”, You: = have no relevant medical history, have never smoked and ate teetotal "have all your teeth present except your wisdom/thisd molar teeth which were never present "brush your teeth for about a minute twice daily with a manual toothbrush * floss once in a while which causes some gum bleeding "use no mouthwash or interdental cleaning aids (e.g, TePe brushes) You have specific questions about: = what the diagnosis is = whether you will lose your teeth = whether you need a long-term mouthwash or antibiotics = what you can do to improve your oral hygiene = what you can use to clean between your teeth * what you can do about the tight spaces at the front of your mouth NOTES FOR EXAMINER ‘The candidate will require: = a set of upper and/or lower models to demonstrate oth brushing. * Zmanual toothb: For the modified Bass technique the toothbrush should be: * held horizontally for buccal surfaces and more vertically for lingual surfaces * aimed at the gingival margin with the bristles at approximately 45 degrees to the long axis of the tooth to provide subgingival plaque removal * used in small circular motions with a roll towards the occlusal surfaces * used in a systematic fashion e.g. posterior to anterior in each quadrant ‘The candidate should also instruct the actor to scrub the occlusal surfaces of the teeth and that it will take approximately 2 minutes twice daily arPERICORONITIS/TEETH REMOVED CANDIDATE NUMBER: CANDIDATE INSTRUCTION This is Miss Jones. She has had 3 episodes of pericotonitis associated with both her lower third molars, two of which needed antibiotic prescription. You decide to remove both her lower mesially impacted and partially erupted lower third molar teeth. Both of the teeth have roots in close relationship to the inferior dental nerve canal. Explain to the patient why she needs to have these teeth removed and an outline of the surgery and the problems associated with removal of these teeth. PATIENT BRIEF ‘You are Miss Jones, 33, attending you dentist to seek explanation as to how your dentist, will remove your wisdom teeth and what problems may arise after the surgery. You would like to know an outline of the surgery itself, and also what problems will there be after the surgery. It is important that the dentist makes you aware not only of the pain and swelling that will follow but also the risk of damage to the inferior dental nerve and lingual nerve. If he does mention this then you should try and establish how Jong the effects will last, where will the numbness be most noticeable. You ate medically healthy, with no allergies and you are not taking any other medication. Marks Done Not Done 1 | Uses patient’s name 7 0 2 | Communicates empathetically i 0 3 | Avoids jargon 1 0 4 | Explains the reasons for the surgery referring to NICE | 1 0 guidelines as evidence 3 | Explains surgical methods 1 0 6 | Warns of pain and swelling i 0 7 | Warns of inferior dental nerve injury and gives 1 0 incidence 8 | Warns of lingual nerve injury and gives incidence 7 0 9” | Explains need for analgesics and discusses antibiotics | 1 0 10 | Checks the patients understands 1 0 Total Marks 48(OSCE STATION 1: MARKING SHEET _| CANDIDATE NUMBER: CANDIDATE INSTRUCTION Kevin Sellers is 7 years old and has mixed dentition. However, all his first permanent molars are decayed and several of his deciduous molars are extracted because of decay. His mother is quite worried and has come to you for advice on fluoride supplements. PATIENT BRIEF You are Mrs Sellers and visiting the dentist today to seek advice about fluoride supplements for your son Kevin who is 7 years old. Kevin has many decayed teeth and has lost some of his baby teeth carly because of decay. He brushes once in the morning using “baby teeth toothpaste”, and you don’t know if it contains fluoride or not. Your neighbour suggested that you give him fluoride to make his teeth stronger as the ‘water in your area has no fluoride (candidate must ask specifically about water fluoridation). You need a professional opinion as you read on the internet that fluoride can be poisonous, and you're wortied whether it might also cause cancet. . Criteria ‘Not done Introduce yourself ‘Ask about the problem Ask about water Fluoridation Explain why fluotide is important for the teeth ae F PPP Advise on tablets Img/day -at different time than brushing cillowed to dissolve in mouth slowly Fluoride varnish 3-4 times a year “Answer questions about poising (only in excessive amounts) and cancer (no risk of cancer) Avoid Jargon Ask if patient has any questions Thank the patient Total Marks