OSCE prep - osce preparation notes PDF

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Osce (objective structured clinical examination)

Station 1 – PPE Put on: AMEG Put off: GAME What PPE is placed on a patient in normal clinic? Eye protection and apron What does PPE stand for? Personal Protective Equipment Full PPE should be worn if:   

Any risk of BFE Any procedure where you use a handpiece Where aerosol splatter or splashes are produced

Station 2 – instrument identification Basic Examination Kit:     

Straight probe – general detection of caries, calculus, defective pits and fissures, deficient margins and restorations Briault probe – detection of caries interdentally KCL probe (WHO probe) double ended probe – used to measure depth of gym pockets – used for checking the depth of the gum pocket College tweezers – picking up small objects -putting things in the mouth/retrieving things Dental mouth mirror – provides indirect vision -reflects light onto area -for retraction and protection of oral tissues -for magnification

Restorative kit: Contains all BEK except Briault probe- plus:     

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Millers forceps – to secure the articulating paper in place when checking the occlusion Double ended Excavator – for spooning out dental caries from a cavity preparation Double ended Flat plastic – to deliver materials to the cavity and to remove excess materials Double ended Amalgam plugger/packer – pack and condense amalgam into cavity preparation Double ended Pear burnisher- polish and smooth amalgam/composite once condensed in prepared cavity -types include ball shaped burnisher and pear shaped burnisher Double ended half Hollenback carver – used to carve and shape the amalgam restoration for correct anatomy and occlusion

Perodental Kit: don’t need to know for year 1 For removing calculus (hardened plaque)      

Black – AE Gracey 11-12 root explorer Yellow – AE universal 311-312 sickle scaler (universal supra gingival) Yellow – AE universal scandette (universal curette – sub gingival because the tip is more rounded) Green – AE Gracey deep pocket 7-8 (used anteriorly) – same as scandette but more curvature and site specific and used to remove calculus from root of the front teeth Orange – standard AE Gracey 11-12 (used posteriorly-mesial) – used to remove calculus from the mesial surface of the posterior teeth Blue – AE Gracey 13-14 (used posteriorly-distal) – used to remove calculus from the distal surfaces of the posterior teeth

Station 3 – Waste    

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Domestic (black) – papers, paper towel Clinical waste (orange) – all clinical waste except those that belong in sharps Bicycler (green) – to recycle Sharps bin (yellow box) – anything that can pierce a clinical bag e.g. needles, micro brushes, wedges, dappens pot – never can be more than 2/3 full, always drop sharps in box and don’t push it in Decontamination areas to put contaminated instruments Amalgam disposals in amalgam disposal bin Lab model drum bin for plaster casts

Station 4 – hand washing How to wash your hands – Modified Ayliffe technique    

Remove wrist wear and stoned rings Nails must be kept short and no nail extensions worn Broken skin and wounds should be covered with waterproof dressings Bare below the elbow

When is hand washing applicable – after visiting toilet, before eating, after blowing your nose, coughing or sneezing, when hands are visibly soiled, before and after clinical procedures, between caring for different patients, after contact with bodily fluids e.g. urine faeces vomit and blood Station 5 – charting Know amalgam filling, composite, missing teeth, crown, fissure sealent, fracture

What are the 2 types of tooth notation charts UK – upper right, upper left, lower left, lower right 1 to 8 (Zsigmondy-palmer system) FDI – 1,2,3,4 1 to 8 (upper right 1, upper left 2, lower left 3, lower left 4) ( deciduous teeth upper right 5, upper left 6, lower left 7, lower right 8) How is a mesio-occlusal cavity charted Where in the mouth is the labial surface found

Station 6 – materials Dental material Alginate

Uses   

Zinc oxide and Eugenol

Used to take impressions. It’s made from powder and water. Alginate is set with cold water to increase the setting time for ease of mixing

Made by mixing zinc oxide powder and a few drops of eugenol (clove oil)  Temporary fillings  Non-irritant lining for deep cavities  sedative dressing for painful carious teeth  Cementing crowns  Impression pastes  Root filling material during root canal treatment

Advantages  It can be used in undercut areas without getting fractured or distorted  Easy to use because of its elasticity  Cheap  Can be used for all impressions – partial or edentulous

 Too soft so isn’t permanent  Zinc oxide and eugenol are both soothing and nonirritant to the pulp  Can be safely used in deep cavities

Disadvantages - Special care required as can undergo dimensional changes if theres delayed wet gauze covering or no air tight bag - This means the model needs to be cast immediately - Need to beat out air bubbles - Not compatible with composite fillings because it reduces the bond strength - Some patients are allergic to eugenol - Too soft and slow setting to be used as permanent filling - Bad taste

Polycarboxylate cement

Prepared by mixing powder and distilled water. It can be made thicker for temps or thin luting mix for cementing

Glass ionomer cement

Powder and liquid – powder is a glass like mixture of aluminosilicates and the liquid contains polyacrylic acid  Permanent fillings  Cavity lining  Adhesive cements  Fissure sealants

 Less irritant  More adhesive to the dentine  Operator can use cement inlays, crowns and orthodontic bands  Releases fluoride over time which prevents recurrence of caries in cavity  Bonds directly to enamel dentine and cementum without acid etching  Ideal for class 5 cavities  Has excellent marginal seal  Better aesthetics than amalgam

Station 7 – zoning Describe the high risk zones of a surgery – Bracket table and spittoon and light An area of low risk is used to place dental records One way system means you can only take items from low to high risk Low risk includes computer, notes, handwashing sink Wipe from low to high:   

Dental unit surfaces and worktops Dental chair bottom to top Light

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Stains composite Can be difficult to manipulate as its adhesive to instruments

Has low strength compared to amalgam and composites Can be ruined by moisture contamination Very exact handling required for placement Mix must have exact proportion for optimal set

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3 in 1 syringe and lead Bracket table, surfaces, handles and switches All hand piece connector and leads Suction connectors Sink and tap controls Spittoon (outside first then inside)

Gloves should be used for high risk and patients only

Station 8 – setting up dental chair At the beginning of the treatment session: All without gloves on   

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Switch the unit on Wash your hands Follow orotol instructions for the suction -fill orotol bottle with 2L of water and flush 1 litre through suction -hold yellow cap with gloved hand and clear bottle with ungloved hand Get the unit water bottle and after putting an ICX tablet (to prevent biofilm build up), fill with drinking water and secure the bottle to the unit Turn the dynamic module on

Flushing water lines:      

Wash or sanitise hands and put on gloves Flush all the air lines – air rota, slow speed hand piece and ultrasonic scaler Get the 3-in-1 syringe and the water lines and put them in the sink Flush lines for 40 seconds Remove gloves and wash hands again In between patients, flush for 15 seconds (clinell then flush)

Pre-operative cleaning:   

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Put on a fresh pair of gloves All surfaces need to be cleaned with disinfectant Clinell wipes Surfaces are cleaned from low to high risk in the following order in s shape: 1. Dental unit surfaces, computer area, sinks and taps controls 2. All surfaces of the dental chair from low to high 3. Dental light, light handles and switches 4. The 3-in-1 syringe and lead 5. Bracket table, handle and switches 6. All hand piece connectors and leads 7. Suction connectors 8. Spittoon – outside before inside Remove gloves and wash hands Barrier cover the necessary surfaces to reduce bacterial load and for more effective cleaning (Bracket table surfaces and handles, light handles, head rest, lines)

Cleaning after patient treatment session: (between patients)

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Make sure to keep your PPE on and discard of all sharps in the yellow sharps bin Put all contaminated equipment back in the tray for dispatch Remove all contaminated barrier coverings and put in clinical waste orange bin Remove PPE in GAME order and put in clinical waste orange bin Wash hands and put a new pair of gloves on Clean all surfaces and dental chair using Clinell wipes Clean reusable equipment Remove gloves and wash hands Barrier cover the necessary surfaces

At the end of treatment session: 

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Dry flush: 1. Turn off the dynamic module 2. Unscrew the unit water bottle and empty the bottle 3. Screw the unit water bottle back onto the unit 4. Turn on the dynamic module 5. Get the 3-in-1 syringe and hand piece connectors and water lines and place in sink 6. Dry flush 7. Turn the dynamic module off 8. Take off the unit water bottle and put back in the carrier Follow orotol instructions – at start of the day just use water and at end of day use 2 cups of orotol solution

Station 9 – MCQ 1. Define the term infection control – Infection control is the prevention of transmission of potentially pathogenic microogranisms in a dental environment e.g. waterborne legionella and pseudomonas, blood borne Hep B and Hep C, HIV 2. Who is responsible for infection control? – dentist, dental nurse, other staff 3. Why is good had hygiene essential – good hygiene is a method of infection control that decontaminates to prevent the transmission of potentially pathogenic organisms 4. What are clinell wipes – Clinell wipes are both a detergent and a disinfectant 5. In the event of a needle stick injury, describe the first procedures you would take :  (follow instructions in red BFE folder)  Stop dental procedures and contact a member of staff  Rinse area under running water and encourage bleeding  Wash with alcoholic chlorhexidine/ soap but do not scrub  Dress wound with waterproof dressing  If eye splash irrigate with copius amounts of water or 0.9% saline solution for 1 minute  Rinse mouth if water splash for a minute with tap water  Arrange for completion of dental procedure on another day or with another dentist  Do net let source patient leave until risk assessment is done  Inform OHD and visit them giving details of event and the patient  OHD assess risk and check for HIV – patient must be counselled prior to HIV testing  OHD will take blood from recipitent to check for hep B immunisation effectiveness

 Member of dental staff arrange to blood test source patient for HIV, Hep B, and hep C  If source patient is high risk then recipitent should start post exposure prophylaxis 6. The brown stripes on an instrument pack indicate what – the package has been sterilised 7. When should cleaning and disinfecting commence – setting up dental bay, in between patients, when there has been spillage, closing dental bay 8. What does FDI mean – the international Dental Federation serves as the principal representative body for dentists developing health policy and education programmes and speaks as a unified voice for dentistry 9. What does BPE stand for – Basic periodontal Examination 10. what does BFE stand for Body fluid Exposure - percutaneous BFE – skin is cut or penetrated by needle - Mucocutaenous BFE – eyes, inside of nose or mouth contaminated with blood or other body fluid - Significant BFE – includes both exposures above to blood or body fluids 11. What information is required on a patients record sheet  Date  Time  Your name in capitals and group number  Your signature  Your job title  Patients name  Hospital number  Date of birth 12. Why is accurate dental record keeping important  Records provide information relative to the individual patient  Medical history and examinations  A history of past present and future dental treatment plans  Dental records are a legal requirement and are legally binding 13. Name one principle of the GDC - GDC regulate dentists dental nurses technicians  Put patient interest first  Communicate effectively with patients  Obtain valid consent  Maintain and protect patient records  Have a clear and effective complaints procedure  Work with colleague in a way that’s in the patients best interest  Maintain, develop and work within your professional knowledge and skills  Raise concerns if patients are at risk  Make sure your personal behaviour maintains patients confidence in you and the dental profession 14. Why is communication important in dentistry – good communication ensures patients receive full, clear and accurate information that can be understood before, during and after dental treatment so they can give informed valid consent 15. What is the role of the dentist diagnose disease, prepare and carry out treatment plans, carry out necessary procedures 16. Who is the most important person in the dental team the patient 17. What is the role of the dental nurse  Prepare and maintain clinical environment by carrying out infection control

 Record dental charting and oral tissue assessments  Prepare, mix and handle dental materials  Provide chairside support to the operator during treatment  Support patients and colleagues 18. Patient confidentiality only broken in purpose of education and in patient best interest and in best interest of public safety 19. Define infectious disease – damages or injures person as a result of pathogenic microbial agents – transmitted through contact with an infected indivudiual, inhalation, inculation, ingestion, infestation 20. What classes of micro organisms are potentially transferred during dental procedures Hepatitis viruses, TB, MRSA, HIV Prions, coliforms, herpes and other viruses waterborne pathogens including Legionella and pseudomonas 21. Why are dentists and their staff at risk from transmittable disease risk of inoculation by sharp injury, inhalation of aersois 22. What levels of fluoride are in mouthwash 250ppm (normal), 500ppm (duraphat mouthwash) 23. What is RIDDOR Reporting of injuries, diseases and dangerous occurences regulations – law to report accidents and deaths at work 24. What is COSHH – control of substances hazardous to health = employers duty to protect workers at work by risk assessment and safety procedures 25. What is the purpose of having shoes with leather, foot coverage to avoid a sharps injury 26. What are the levels of fluoride in normal toothpaste 1450ppm 27. What is the percentage of chlorhexidine (active ingredient in mouthwash to reduce plaque) in mouthwash – 0.2% 28. What is the maximum amount of fluoride in a toothpaste can a dentist prescribe 5000 duraphat toothpaste for high caries risk patient 29. How much fluoride is in children toothpaste 1000 30. How many parts per million of fluoride is added to fluoridated water 0.7-1 ppm – can be sodium fluoride, flurosilicilic acid, or sodium flurosilicate 31. What type of bacteria is found in plaque Bacteria S. Mutans 32. What is the critical mouth pH 5.5 for enamel, 6.5 for dentine 33. Cocci is a type of what - bacteria 34. What type of microorganism does sterilisation not always remove prions 35. What nerves innervate the teeth trigeminal nerves 36. What nerves innervate movement of the back of the tongue Glossopharyngeal nerves 37. What nerves innervate the anterior of the tongue – facial nerves 38. What nerves innervate the masseter muscles – trigeminal nerves 39. Who cannot be held to account in a breach of confidence in a dental team receptionist 40. what type of sugars are the most plaque causing glucose and sucrose 41. what is the best way to avoid plaque brush 2x a day, and good diet 42. how long is the sterilisation cycle at 134 degrees 10 minutes 43. how are amalgam teeth medically disposed in a special amalgam waste bin for removal by external specialised company 44. what is the correct seating position for the dental nurse 2 o clock to 4 o clock 45. what is the correct seating position for the dentist 8 to 12 o clock 46. what is the first thing to do upon a sharps injury/needle stick/inoculation -rub gently under running water to encourage bleeding 47. what comes after packaging in decontamination sterilisation

48. what is the active ingredient and relative concentration in clinell wipes sodium hypochlorite 5% 49. what patient information must be kept confidential  patient identifiable information  simple safeguard  patients written information  conversation about patients 50. how do we prevent BFE  risk assessment  careful and accurate technique  organisation and teamwork  avoiding time pressure  wearing correct PPE  safe disposal of waste 51. barrier coverings on which high risk items:  light handles  headrest  tubing and connectors  bracket table and handles  controls and buttons (switches, 3-in-1 buttons, suction tubes)  equipment – curing lights, x-rays 52. how to correctly sit on dental chair  feet flat on the floor  thighs parallel to the floor  knees pointing down slightly  back straight and well supported  elbows down, and forearms raised upwards dental nurse chair should be 4-6 inches higher than dentist 53. universal standards (infection control precautions):  clinical waste disposal  instrument cleaning  hand hygiene  zoning  surface cleaning  barrier covering  PPE  Uniform Single use items>>sterilisable items>>disinfectable items

54. Ethical and legal requirements:  GDC  Guidance from ‘professional bodies’  Employer policies  Research articles and books

 Taught ‘good practice’  Unethical to refuse to treat someone because they have a blood borne virus or any other transmissible disease/infection

55. Who are the general dental council:  Regulating body for dentists and DCP’s (dental care professionals)- set the 9 principals  Illegal to work as a dentist in UK without GDC registration  Protect patients  Their aim is to promote confidence in the profession, quality assure education and ensure dental professionals keep knowledge up to date (CPD)...