Questions and Answers for Dental Nurses. Carole Hollins

is m).As the patient is located in the waiting area the mains operated surgery suction unit cannot be utilised to clear the vomit. A portable suction device is emergency equipment that should be held by all dental workplaces and is best kept with the emergency drugs kit in a centralised area of the workplace, with appropriate signage displayed for easy location.

      1 Following a scale and polish procedure, a patient begins to feel unwell and complains of pains in his chest and arm. On checking his medical history record on the computer, he is found to suffer from angina and is given oxygen using a pocket face mask system. Which one of the options listed is the other item most likely to be required to assist the casualty?

      The correct answer is g).Glyceryl trinitrate (GTN) spray should be held in the emergency drugs kit and should be administered to any patient suspected of having an angina attack. Patients usually carry their own supply, but that of the workplace will be in date, a full container and easily located so is best used in an emergency situation. It is sprayed under the casualty’s tongue where the thin mucous membrane allows the active drug to be rapidly absorbed into the blood stream and carried to the heart. The spray can be administered several times to ease the angina symptoms, but repeat applications may indicate the casualty is veering towards a cardiac arrest.

      1 A known epileptic patient has attended the practice for dental treatment but becomes unwell while having radiographs taken. The staff believe the audible alarm of the machine has triggered a seizure, and the patient continues fitting for more than 5 minutes. Which one of the options listed is the item most likely to be required to assist the casualty?

The correct answer is h).A prolonged seizure (5 minutes plus) or repeat seizures occurring without the casualty regaining consciousness indicate status epilepticus – a very serious medical emergency that requires professional support for the dental team. While awaiting paramedics, midazolam buccal gel should be administered into the buccal sulcus of the casualty by the rescuer, where it will be rapidly absorbed into the blood stream. Use the buccal sulcus closest to the floor (with the casualty lying on their side) so that the gel does not trickle into their oropharynx and cause choking.

       Topic: Disease prevention and health advice

      For each of the following disease prevention and health advice questions, select the requested number of most appropriate answers from the option list. Each option might be used once, more than once or not at all.

      1 1450 ppm

      2 5000 ppm

      3 22,600 ppm

      4 Crowded teeth

      5 Hydrogen peroxide

      6 Mouth breathing

      7 Sodium fluoride

      8 Stannous fluoride

      9 Unbalanced occlusion

      1 A young mother is concerned to learn that her 5‐year‐old son has several areas of demineralisation and two cavities in his deciduous teeth when checked by the dentist, as she ensures his teeth are brushed twice daily with ‘milk teeth’ type toothpaste. The dentist explains that this type of toothpaste has too little fluoride for children over 3 years of age. Which two of the options listed are the most likely fluoride concentrations that the dentist will recommend for regular toothbrushing and use for topical fluoride applications to the child, in ppm?

      The correct answers are a) and c).All children over 3 years of age should be using toothpastes with the adult concentration of fluoride at 1450 ppm, to provide the maximum level of protection to their deciduous teeth and then their permanent teeth as they erupt. At each recall appointment, the child should also have a fluoride gel applied to all his teeth to help strengthen them against further carious attack. The gels are typically a fluoride strength of 22,600 ppm.

      1 Modern toothpastes contain many different constituents, and some patients may find it difficult to determine which product is best for their specific oral health needs. The dental team are well placed to advise patients about the most suitable products available for their particular needs, depending whether they require products to combat dental caries or periodontal disease. Which two of the options listed are constituents that may be found in a toothpaste designed to protect against caries and relieve sensitivity?

The correct answers are g) and h).Fluoride is the ingredient present to protect against dental caries, and many toothpastes contain it as sodium fluoride at 1450 ppm. Stannous fluoride is present in some ‘sensitivity’ toothpastes to help reduce the electric shock‐type sensation that some patients experience with cold drinks, foods or when breathing in cold air.

Objective Structured Clinical Examination

      For the sake of completeness, an overview of the practical element of the National Diploma examination is given here to assist candidates in readying themselves for the final part of the examination. More detailed information is given in the textbook Levison’s Textbook for Dental Nurses 12th Edition. The OSCEs are usually held several weeks after each round of written examinations has been completed, with only those candidates who pass the written section being eligible to then enter for the OSCEs.

      The OSCEs provide an accurate and fair assessment of all candidates while carrying out various practical or clinical tasks. As the full name suggests, the examination style is both objective and structured in the way that candidates are assessed while undertaking OSCEs. The examiner does not ask any questions of the candidate during each section of the examination (so they are objective and not subjective, or rather, not based on the examiner’s opinion after having asked the candidate any random questions), and the examiner grades each candidate’s practical/clinical performance against set criteria as they carry out the required task. The set criteria are exactly the same for every candidate at whichever examination centre they attend and are followed by every examiner, so the OSCEs are a structured examination.

      Each examination sitting will have up to 15 OSCE stations that every candidate must go through, and they are usually timed at 5 minutes each. Other than to welcome candidates to each test area and ask if they have read the ‘candidate instructions’ for the individual test beforehand, the examiner does not speak to the candidate but merely observes their performance within the 5‐minute timing.

      There are four general types of practical assessment that the OSCEs will cover, and each is designed to test both the professional and practical skills of the candidate.

       Communication skills – such as giving specific oral hygiene advice or post‐operative advice to a patient (the patient will be a professional actor)

       Medical emergency – such as an asthma attack scenario with a professional actor as the patient

       Mixing skills – any dental material from within the NEBDN curriculum

       Clinical skills – such as setting up instruments for a certain procedure or completing a charting exercise.

      The candidate instructions will state the scenario relevant to the OSCE station, and the candidate is able to read these instructions before the 5‐minute timing starts. The instructions will be clear and concise, so that the task to be carried out by the candidate will be obvious to them. Where a patient (actor) is involved in the scenario, the candidate will be scored objectively by both the examiner and the patient for that OSCE station.

To ensure that every candidate is assessed objectively, the following system is strictly followed.

       Every examination centre will carry out exactly the same OSCE assessments, using exactly the same resources.

       All candidates and patient instructions will be worded exactly the same, in every examination centre.

       All candidates will be marked against the same performance criteria and in the same way, as the examiners have been trained and calibrated to each other.

       All