Questions and Answers for Dental Nurses. Carole Hollins

the most effective way of giving the advice to this patient?

      2 Following the Covid‐19 pandemic of 2020, your workplace has installed a permanent glass barrier at reception to ensure the safety of staff while carrying out administrative duties, by preventing patients and visitors from encroaching into their personal space while at reception. Unfortunately, several elderly patients with hearing aids now find it hard to understand what is being said to them through the glass pane, as voices are muffled. Which one of the options listed is a technique of assisting sound transmission for these patients?

      3 While closing down the surgery at the end of a clinical session, a member of staff forgot to run the disinfectant solution through the aspiration unit to clean it. The following morning the equipment was found not to be working correctly as the debris of the previous day had solidified in the pipework. Which one of the options listed is a non‐verbal communication action that indicates the member of staff responsible for the breakdown is unconcerned about the issue when challenged by the employer?

      4 A patient has returned to the practice weeks after having a set of dentures fitted, complaining that they are still very loose and that they fall out when she tries to eat. Having had the dentures adjusted several times, she is demanding to have a full refund as she says the dentures are not fit for purpose. Which one of the options listed is the correct non‐verbal communication action to take in this situation?

      5 The practice has organised an open day to coincide with the National Smile Week, and a local Brownies club are to attend for an organised visit. Which one of the options listed is likely to be the most effective way of providing simple oral hygiene information in this circumstance?

Answers

      Multiple choice questions

      1 The correct answer is C. Describing possible dental treatment that may be necessary if children do not brush their teeth regularly and effectively, especially if words such as ‘toothache’, ‘smelly breath’ and ‘needle’ are used, is usually quite counter‐productive. Indeed, it may seem threatening to some patients. Instead, the dental team should engage children in correct brushing activities, in a friendly manner and at a communication level appropriate to their age. At this age children tend to respond well to a hands‐on, getting‐involved approach to instruction.

      2 The correct answer is C. Facing someone while they speak indicates the listener is actually listening to them, whereas most of the other options indicate the listener has mentally dismissed the speaker and is concentrating on something else. Interrupting someone while they speak, apart from being rude, also indicates the listener believes what they have to say is more important or that they disagree with what the speaker is saying.

      3 The correct answer is C. Pre‐written templates for advice, such as post‐operative instructions, or information leaflets about a new type of treatment are invaluable in reinforcing important information from the dental team to their patients. Patients should be encouraged to take the written information away and read it at their leisure so that they then follow advice correctly or understand proposed treatments better, or it prompts them to ask further questions to clarify the information.

      4 The correct answer is C. Although usually relaxing to most patients and staff (depending on the music played), any background noise may hinder partially sighted or blind patients from relaxing during a treatment session, as it makes it more difficult for them to hear the likely sounds they have been told to expect during the treatment. Instead, the clinician is far better providing almost a running commentary of the treatment as it progresses through the session, and this also helps to reinforce the patient’s trust in the team and that they are totally focussed on the patient.

      5 The correct answer is D. Sitting down while talking to someone, or while they are talking to you, indicates that they have your attention – they are being listened to and communicated with. All other options are examples of poor communication skills and that the person is being dismissive, defensive or not believing what is being said.

      6 The correct answer is B. The GDC Standards document says that the whole dental team must demonstrate good communication skills so that patients can understand what is being said to them, otherwise they cannot be said to have given consent for treatment. The document also says the team should listen to their patients, take their individual needs into consideration and promote their rights and responsibilities to make decisions about their health and care.

      7 The correct answer is C. Written protocols do not require to be learned and repeated from memory; they are always available to be referred to while talking to the patient. Their content will not change between patients or appointments and will therefore remain consistent. In addition, protocols are developed and produced by the dental team together, often during discussions at staff meetings, so the information given will have been accepted and agreed upon by all team members.

      8 The correct answer is C. If patients do not speak English it is irrelevant whether they are spoken to quickly or slowly – they will not understand either way. Non‐English NHS information leaflets, ‘Language Line’ and online translation software are all excellent methods of ensuring that all patients understand the information they are being given by the dental team and are therefore able to give consent. Interpretation by a family member is acceptable in some situations but is reliant on the knowledge level of the interpreter – often younger family members (even children) are relied on to impart sometimes complicated health information to an older family member. This is not an ideal situation.

      9 The correct answer is B. Partially deaf patients quite rightly become fed up with everyone shouting at them, believing this helps to impart information to them more effectively. Instead, many subconsciously lip read when they are being spoken to, so being able to watch a speaker’s mouth while they are talking is very important to them. Facing the patient and especially removing a mask while talking, using clear enunciation of words and talking at a regular speed all enable the team to communicate effectively with partially deaf patients. Hearing loops at enclosed reception desks are useful for patients wearing a hearing aid and, if all else fails, providing information in a suitable written format ensures a level of communication with the patient.

      10 The correct answer is B. Primary school children have short attention spans but are never happier than if they can physically take part in an activity. Good examples of dental relevance are arranging stacks of food and drink packaging as ‘good’ and ‘bad’ for teeth, toothbrushing sessions (especially if disclosed by a member of the team first, and with aprons on), relevant drawing and colouring activities and so on.

      11 The correct answer is E. As the saying goes, ’a picture paints a thousand words’, and although some clinical photographs may be used as a shock tactic, sometimes it is what is necessary to convey information. With gingivitis, poor oral hygiene, periodontitis and caries, if the photograph is actually of the patient’s own mouth and shown in a sensitive rather than accusatory manner, it is often the only way of convincing the patient that change is required.

      12 The correct answer is D. Rather than trying to describe, for example, what a crown is and how the treatment is carried out, show the patient before and after photographs of a successful case. This allows patients to visualise the improvement achieved with the treatment and relate it to themselves. It allows them to ask further questions about the procedure, and their understanding can be enhanced by the provision of further written information too.

      13 The correct answer is A. When a treatment plan has been formulated it must be discussed verbally with the patient so that the patient can accept the proposed treatment and give consent, or refuse part or all of the treatment plan and give limited or no consent, respectively. During the discussion the patient must be told of alternative treatments where appropriate, the risks and benefits of the proposed treatment, the consequences of not having the treatment where appropriate and the costs of the treatment.

      Extended matching questions

      1 The correct answer is c). Teenagers often go through a phase of being embarrassed about their bodies, especially as they go through puberty and mature. They do not respond well to being ridiculed or admonished in