PHMP and decontamination

Question 1

What is PICO?

Answer 1

Population

intervention

comparison

outcome

Question 2

What is confidence intervals and relative risk?

Answer 2

Confidence interval:
the range of values that the absolute risk difference will take in the population
A confidence interval that overlaps with the value of no difference is insufficient evidence for a difference between treated group an the control group.

relative risk:
the ratio of;
Probability of an outcome in exposed group: Probability of an outcome in an unexposed group.

Question 3

What are the 5 steps/cycle of clinical audits?

Answer 3

Identify problem or issue

Set criteria and standards

Observe practice/data collection

Compare performance with criteria and standards

Implementing change

Question 4

Name 2 other things you can do other than audit? (5)

Answer 4

Peer review- Getting groups of dentists together to share experiences on the aspects of practice.

Enhanced Significant Event Analysis- Meet and analyse an event to implement changes from what we have learned.

Practice based research project- Participation in an approve research project with Scottish Dental practice Based Research Network.

Quality improvement project- specific methodologies and training required for this.

Question 5

What are the 6 dimensions of healthcare? briefly explain each

Answer 5

Safe – ensure no avoidable harm to patients and that healthcare is delivered in a clean and safe environment.

Effective – ensure that most appropriate services, interventions and support are provided to everyone.

Person centred – partnership between patients and those delivering healthcare, ensures individual needs/values are met via communication, compassion, continuity and shared decision making

Timely – ensures that the most appropriate services, treatment and support are delivered at the correct time for everyone

Efficient – ensure that input maximises output = avoiding waste of equipment, supplies, ideas and energy.

Equitable – Ensures high quality care is provided to everyone regardless of personal characteristics such as gender, ethnicity, location and socioeconomic status.

Question 6

What 3 head, neck and oral features can occur with cocaine use? (7)

Answer 6

Perforation of nasal septum and palate

Gingival lesions &ulceration

Erosion and attrition of tooth surfaces

TMJD

Orofacial pain +/- cluster headaches

GORD

Nasal drip

Question 7

What are 4 side effects of opioid use? (6)

Answer 7

Addiction/dependency
Infective endocarditis risk
Enhances sedative agents
Hyposalivation

In large quantities;
Respiratory depression
Hypotension

Question 8

What chemical class of drugs does methadone belong to?

Answer 8

Opiod receptor agonist

Question 9

5 Methadone can be taken orally. Two formulas exist, one which contains sugar and an alternative formula which is sugar-free.

(a) List two environmental or lifestyle factors which increase the risk of dental caries for an individual who is prescribed methadone.

Answer 9

• Environmental: SIMD – employment status (unemployed), Crime rates (high), income (low)
• Lifestyle: high sugar, poor OH

Question 10

What is the risk of sugar free preparation of methadone?

Answer 10

• More acidic - erosion
• Sugar free methadone lacks chloroform- less of an irritant if injected. The patient could inject this- increasing the risk of adverse side effects e.g. HIV transmission through reusing needles.

Question 11

Consent
- Give 3 types of consent?

Answer 11

Implied – patients action or lack of action clearly indicates their wishes

Verbal – patient clearly states their consent for procedure

Written – patient signs declaration that they consent to procedure

Question 12

What factors must we discuss with the patient to ensure informed consent? (8)

Answer 12

Why tx is justified
What is involved in the procedure
The risks and benefits of tx
Alternatives to tx
Consequences of no tx
prognosis/outcome
time
cost

Question 13

What 6 factors make up consent?

Answer 13

It must be

Valid
-Recently obtained
-Remain current and appropriate (pt still agrees)
-Specific to the proposed treatment.

Legal
-Ability (patient needs to have the capacity to make an informed condition )
Informed- Pt needs enough information to make the decision.
Voluntary- Pt has made the decision (not manipulated or coerced)

Question 14

What type of person carries consent for a 3 year old patient (4)

Answer 14

Those with parental responsibility

• Biological mother
• Childs father if he is married to biological mother
• The childs father (if not married) as long as his name is on the birth certificate after 4th May 2006
• court appointed people with parental rights (e.g. adoptive parents)

Question 15

What type of person carries consent for a 16 year old patient

Answer 15

In Scotland those 16 or over can consent for themselves as long as they have capacity

Or welfare guardian.
Or dentist with AWI certificate.

Question 16

You are working at a dental practice as a dentist, you arrived exceptionally early and saw 2 nurses getting off the bus in their uniforms.
- Name 2 concerns you would raise with the nurses?

Answer 16

Infection control/cross infection

practice and professional reputation

Question 17

You are working at a dental practice as a dentist, you arrived exceptionally early and saw 2 nurses getting off the bus in their uniforms.
Name 6 key learning outcomes from a learning session on PPE?

Answer 17

Wear PPE at times when dealing with clinical procedures

Change/Wear PPE when cleaning up

Change PPE between patients

Correct disposal PPE after usage and soiling - in orange stream

Use of PPE During decontamination

Use of PPE: Protect eyes, hands and clothing

Use of PPE: Protect the patient: eyes, hands and clothing

Question 18

You are working at a dental practice as a dentist, you arrived exceptionally early and saw 2 nurses getting off the bus in their uniforms.
Identify 4 Key steps you would follow when conducting an audit to ensure staff follow instructions on PPE? (4)

Answer 18

Clinical Audits are a quality improvement report.

The key steps of an audit cycle are:
* Identify the problem or issue.
* Set criteria & standards
* Observe practice/collect data.
* Compare the performance with criteria and standards
* Implement change.

Question 19

Decontamination
- Why do we need to clean? (4 examples)

Q said manual cleaning but manual cleaning is being phased out

Answer 19

1. Incase of biological contamination Contamination with deposits prevents direct contact between the steam and surfaces of the instruments that is necessary for effective sterilisation. - e.g. biopsy devices may become contaminated with previous patient materials (resulting in a misdiagnosis)

2. -Functionality of the instrument (biological debris may clog the hinges in forceps and impair function of cutting tools such as burs or endodontic files)

3. Removes organic material:
Any restorative material left on instruments can adhere to the instruments (during sterilisation) making them more difficult to clean & can encourage microorganism growth. These should be removed if possible at chairside.

4. Legal requirements- It is a requirement under the medical devices directive for effective cleaning prior to sterilisation.

Question 20

Why do we need to test the washer disinfector/steriliser? (4)

Answer 20

Legal requirement

Testing helps detect procedural errors and equipment malfunctions

It is important to protect the patient by making sure the machine has carried out all parameters as set up during installation or validation.

Ensure the equipment is working to its optimum and to the correct standard

Ensure validity of the cycle ( Validation is completed by a qualified personell- also does periodontic testing/maintenance)

Question 21

Describe the 5 steps of the washer disinfector

Answer 21

Cleaning stages - prewash, main wash and rinse-

Flush/prewash - saturates the contaminated instruments
< 35 degrees (to prevent coagulation of proteins)

Main wash - Detergents are used at this stage to increase the effectiveness
Depends on the chemicals used (generally 45-65 degrees)

Rinse - removes residue (biological or chemical)
< 65 degrees

Removing prions/vCDJ:
Thermal disinfection - actively killing microorganisms with heated water
Between 90 - 95 degrees for a minimum of 1 minute

Drying - removes moisture before sterilisation
No specific temperature but its usually between 90 - 110 degrees

Question 22

What are the differences between type B and type N sterilisers?

Answer 22

Type N:
No vacuum = Work by filling the chamber with steam and passively forcing air out of the chamber.

Cannot process wrapped, channelled or lumened instruments or hinged (due to the lack of vacuum capabilities)

instruments cannot be stored and must be used directly after sterilisation

Type B Sterilisers:
Pre-vacuum - Remove air by vacuum pump to create a negative pressure
Then chamber fills with air - allows all surfaces of the instruments to be sterilised (even wrapped instruments)
Post-vacuum - removes remaining moisture to ensure the product is not saturated

Processes wrapped, channeled and lumened instruments and porous items i.e. cotton wool swabs

Since it can process wrapped instruments the instruments will be sterile at the time of use and can be stored (for long periods of time)

Question 23

Name 4 key personnel involved in the decontamination process and give a
description of each of their roles

Answer 23

Manager (generally the practice owner):
Person who is ultimately responsible for decontamination
define staff roles and responsibilities, ensure training records are present etc

Operator/user:
Person designated by the manager with the authority to operate a steriliser/washer disinfector
This includes those involved in noting of device reading and housekeeping duties

competent/Test person:
Records Test cycle readings from the machine to ensure that the parts of the machine are working correctly and that the equipment taking temperature/pressure readings are providing accurate values
Periodic testing, Maintenance and validation of equipment:
We have the equipment tested and validated by a qualified personnel so that we are assured that the decontamination responsibilities are being carried out to the correct standard.

Authorising Engineer (decontamination)
AE(D) ensure the work being done by you and the service partner are up to standard.
- Can sign off validation reports carried out by CP(D)
- Can advice if the testing is being carrying out correctly or not

Question 24

What type of water is used for the final rinse in the AWD cycle and why use this as opposed to mains water?

Answer 24

Pure water is used. This has all the particulate filtered out and has a very low bacterial/fungal presence. (Conductivity of PW is 4.3 microsiemens)

Mains water cannot be used as we want a conductivity of less than 30 microsiemens.
Conductivity is a measure of all the particulate water has come in contact (silicates/metals/minerals) . Mains water can leave a residue on the instrument surface

Tap water cannot be used for sterilisers, have to use water of less than 30us (micro-siemens)- pure water.

Pure Water:
Distilled
Deionised
Reverse osmosis
Sterile

Question 25

What is CPD? (3)

Answer 25

Continuing professional development: - process of tracking and documenting the skills, knowledge and experience that you gained throughout your career - It is a requirement by the GDC that a registered member must adhere to 100 hours of verified CPD training every 5 years to stay registered. - CPD helps maintaining and updating their skills, knowledge and behaviour throughout their working life, contributing to delivery of good quality care and service provision, that patients and the public trust.

Question 26

How many hours of CPD are to be done in a 5 year cycle and how many are to be verifiable?

Answer 26

At least 100 hours of Verifiable CPD every 5 years At least 10 hours every 2 years (want to spread the CPD)

Question 27

Give 3 suggested CPD topics and the hours per cycle

Answer 27

Medical emergencies (At least 10 hours) Disinfection and decontamination (at least 5 hours) Radiography/radiation protection (At least 5 hours)

Question 28

What are the 6 components of clinical governance?

Answer 28

Clinical audit Openness (to poor performance and practice) Risk management (to patients and practitioners) Clinical effectiveness - evidence based practice Education and training (CPD) Research and development

Question 29

What is an audit? what is the purpose of a clinical audit? (3) List the stages of a clinical audit cycle (6)

Answer 29

It is a quality improvement process that seeks to improve patient care and outcome through systematic review of care against explicit criteria and the implantation of change. It is used to : Review what should be done is being done Highlight gaps in knowledge, learning, attitudes, protocols and training To produce a framework for implementing change Cycle: -Identify problem or issue -Set criteria and standards -Observe practice/data collection -analyse and compare performance with criteria and standards -Implementing change -re-audit

Question 30

What are the stages of significant event analysis (SEA)? (7)

Answer 30

Step 1 – identify significant event Step 2 – collect and collate as much information as possible relating to the event Step 3 – convene a meeting – non-threatening, no blame – educational focus Step 4 – undertake a structured analysis Step 5 – implement changes and monitor progress of all actions agreed upon Step 6 – write up event analysis Step 7 – seek educational feedback – peer review

Question 31

List stages in the chain of infection (6)

Answer 31

Infectious agent reservoir portal of exit mode of transport portal of entry susceptible hosts

Question 32

state the name and concentration of chlorine releasing agent

Answer 32

sodium hypochlorite (actichlor) – 10,000ppm – 3-5mins

Question 33

How long is the chlorine releasing agent left for?

Answer 33

3-5mins

Question 34

Give waste streams and an example for each?

Answer 34

Waste streams: 1. Black 2. Orange 3. Yellow 4. Red Black stream: Household/domestic waste/non-infected waste e.g. paper towels, wrappers Disposal = put in an outdoor bin and collected by the council for landfill Orange stream: Low risk items that come into contact with the patient e.g. PPE, swabs Disposal = secured with ratchet tag, removed by specialise services to be heat disinfected Yellow stream: High risk/HAZARDOUS items e.g. teeth (no amalgam), SHARPS, contaminated metal instruments, drugs and medicines disposal = removed by specialist services for incineration Red stream: e.g. Amalgam, teeth containing amalgam fillings, lead foils disposal = removed by specialist services and undergoes specialised waste reprocessing and centrifuging so that the mercury does not harm the environment Brown confidential - confidential documents e.g. letters, px notes

Question 35

Tooth with extracted amalgam what stream does it go into?

Answer 35

red stream disposal = removed by specialist services and undergoes specialised waste reprocessing and centrifuging so that the mercury does not harm the environment Amalgam Disposal ● Amalgam waste is put in a rigid white container which is has a screw top (red) lid and is spill proof ● It contains a mercury vapour suppressant ● it is clearly labelled as amalgam and is easily distinguished from other waste streams ● Amalgam waste is centrifuged to remove mercury (which is recycled) Amalgam licensing law: consignment note - kept for 3 years

Question 36

What document is a legal/GDC requirement that needs to be kept regarding waste disposal? How long does this need to be kept for? What information has to be recorded? (5)

Answer 36

consignment note - kept for 3 years Description of waste Quantity of waste Destination of waste Origin of waste Transport of waste

Question 37

Describe clinical governance.

Answer 37

It is a systematic approach to maintaining and improving the standard of patient care within the health system.

Question 38

What are the divisions of NHS Scotland dental services?

Answer 38

1. Primary care general dental services/practices Public dental services – community services 2. Secondary care – hospital/dental hospital services

Question 39

List the 9 GDC standards for dental professionals

Answer 39

Put patient’s interests first Communicate effectively with patients Obtain valid consent Maintain and protect patients information Have a clear and effective complaints procedure Work with colleagues in a way that is in patients best interests 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

Question 40

List the sinner circle (5)

Answer 40

Time Over time blood or biological matter can dry in and adhere to the instrument. Limit time between use and processing. Chemical: Detergent depends on purpose: Enclosed process- High and low alkaline detergent (not touching skin) Ultrasonic- enzymatic detergent Manual washing- pH neutral detergent (less harmful for operator skin) Chemicals must be validated against the cycle and revalidated if they are altered. Temperature Influenced by the chemicals used/ stage of AWD (wash stage <65 degrees & thermal disinfection (90-95 degrees) Energy - The force applied when cleaning Manual = brush Ultrasonic = cavitation via sound waves Washer disinfect = high pressure jet sprays Since the force generated in the WD is less than the others we have to add stronger chemicals i.e. high/low alkaline (this can be used as its an enclosed process). Also, Water - Various types can be used; Potable/tap water can be used for; Ultrasonic (hot or cold) Manual washing (hot or cold) Washer disinfect (hot or cold) Tap water cannot be used for sterilisers, have to use water of less than 30us (micro-siemens)- pure water.

Question 41

Name the 10 SiCPs

Answer 41

patient placement and assessment for infection risk hand hygiene PPE respiratory & cough etiquette safe management of linen safe management of blood & bodily fluids spillages safe management of care environment safe management of care equipment safe waste disposal (including SHARPS) Occupational safety - prevention and exposure management of SHARPS

Question 42

What are the 4 pillars of ethics?

Answer 42

o Respect for autonomy o Non-maleficence o Beneficence o Justice

Question 43

What is negligence?

Answer 43

The omission to do something which a reasonable practitioner would do (something which a reasonable practitioner would not do) Dentist fails to meet standards of ordinary care which can ultimately result in px harm. Negligence could be not doing something or doing something you shouldn’t have done.

Question 44

What is the criteria for clinical negligence? (4)

Answer 44

1. The dentist** owes the patient a duty of care** (if he has accepted the person as a patient- if you have not accepted the person you have no duty of care towards them) 2. Duty of care is **breached**. This would be if your practice has not met the accepted standards (taken from expert witnesses e.g. other dentists) 3. as a result of the breach, **harm** has been caused i.e. damage. 4. The damage has to be **reasonably foreseeable** and have had negative consequences and effects. Therefore, the dentist should have seen that this could happen and so put measures in place to prevent it from happening.

Question 45

How long should Notes be kept for - adults and children.

Answer 45

Adults = A minimum of 2 years and up to 10 years Children = 10 years or up to the 25th/26th birthday rule. (whichever is longer for children)

Question 46

What should Notes be? (8)

Answer 46

Confidential Concise Accurate Legible Complete Current Retrievable Retained

Question 47

What type of study provides the highest level of evidence? List 4 aspects of this type of study?

Answer 47

We thinking Randomised Control Trial randomised, inclusion/exclusion criteria, control group, double blinding. Systematic reviews/meta analysis of RCT - Cochrane review * Well formulated question (PICO) * Comprehensive data search - using electronic databases/ongoing/unpublished non english studies * Unbiased selection and abstraction process- at least 2 reviewers & a data extraction form to select relevant papers * Assessment of papers- at least 2 reviews assessing quality (components of study) and risk of bias * Synthesis of data- metanalysis calculates the treatment effect based on the pooled data.

Question 48

Give 3 other study designs (other than the one with the highest evidence).

Answer 48

Cohort study - prospective case control study - retrospective cross sectional study case study - one patient ecological study

Question 49

What is SiMD?

Answer 49

Scottish index of multiple deprivation Area based index which uses data zones to rank neighbourhoods based on social determinants i.e employment status, crime, housing conditions, income, education (skills, training), geographic access to services, health/healthcare services 1-5 (1= poor area, 5 = affluent)

Question 50

Give 7 factors influencing deprivation?

Answer 50

employment status crime housing conditions income education (skills, training) geographic access to services health/healthcare services

Question 51

Split mouth study designs - What are the advantages of a split mouth study design? (2)

Answer 51

Both control and intervention group are exposed to same environment. Each of the 2 treatments are randomly assigned to either the right or left halves of the dentition in the same environment.

Question 52

What are the disadvantages of a split mouth study design (3)

Answer 52

Patient can not be blinded Adds more bias into the reporting Incorrect reporting risk

Question 53

What is a P value?****

Answer 53

Used to determine the significance of your results. (Hypothesis testing) P value is a probability P <0.05 is used to indicate statistical significance This would mean you reject the null hypothesis & your results are statistically significant.

Question 54

Describe the decontamination cycle? (9)

Answer 54

acquitisation (buying them) cleaning disinfection inspection packaging sterilisation transport storage use

Question 55

Name 4 legislations for decontamination.

Answer 55

SDCEP health & safety - practice support manual SHTM 0101 BSEN - British standards European norm MDR

Question 56

Give 5 common reasons for Handpiece faults

Answer 56

1. Incorrect compression setting and lack of maintenance 2. Damaged/oversized bur fitted 3. Incorrect use/not used for its intended use 4. Poor/inadequate cleaning and incorrect processing 5. Incorrect/inadequate lubrication (most common)

Question 57

Briefly describe manual washing (2) - PPE, Process, Drying

Answer 57

Requires PPE: Apron Face shield Nitrile rubber gloves and heavy duty gloves over the top of them. Immersion: Dedicated sink for manual washing and Separate sink for rinsing Water cannot > 35 degrees C proteins coagulate above this temp and can also damage the chemicals we are using to clean Chemical detergent with a neutral pH Follow manufactures guidelines Usually in ml/L i.e. 5ml per 1 litre Use a long handled, soft bristled, non-metallic brush which can be processed through a thermal washing cycle. Scrub the instruments below the surface of the water Increases the contact of the instrument and the detergent in the water It minimises splashing Prevents aerosols being produced Using sterile, dry, non linting disposable towel to aid drying process. Non-immersion: Used for likened hand pieces and items that would be damaged or inhibit sterilisation by immersion technique Non limiting disposable wipes are used to wipe down instruments

Question 58

Briefly describe ultrasonic bath

Answer 58

Uses sound waves at a high frequency to generate microbubbles. The fluctuation in pressures generated by the waves causes the bubbles to expand and then collapse which has a scouring effect against the surface of the instruments = cavitation

Question 59

What maintenance and tests are carried out for an AWD?

Answer 59

 Checking the spray arms rotate and spray jets are not blocked  Checking the door seal for damage or contamination  Verifying the condition of the load carrier  Checking there are no instruments (parts) from pervious cycles  Making sure the strainer/filter is clear  Making sure there is enough chemical  Carrying out a protein detection test and soil test  Noting disinfection temperatures on daily cycles  Carrying out a full ACT (automatic control test - weekly)

Question 60

What temp, pressure and time is sterilisation carried out (Sterilisers)?

Answer 60

134-137 degrees and must be maintained for 3 minutes 2.05-2.35 bar

Question 61

What maintenance and tests are carried out for sterilisers - daily and weekly? (3 each)

Answer 61

Daily: ACT drain and fill the reservoir (standing water is the perfect place for harbouring bacteria) Steam penetration test (bowie dick- checmical indicator to see that steam penetrates ) weekly: ACT - automatic control test Air leakage test (sucking all the air out to check chamber integrity- that no air can get back in) Air Detector Function tests- puposefully puts air in to check the machine can detect it.

Question 62

Give 4 factors in the aetiology of fear?

Answer 62

Past negative medical/dental experiences. e.g. painful, frightening, embarrassing. Influence of family/peers. (transference) Expectation of pain. Media representations. Poor knowledge of the dental environment/procedures

Question 63

How may an anxious patient present? (7)

Answer 63

High neuroticism pessimism and negative expectations/outcomes fidgeting stuttering Low pain threshold hypervigilant poor concentration Physiological & Somatic sensations: Breathlessness Perspiration Palpitations Feelings of unease Tell them that this is a normal response for someone who is worried/nervous Cognitive Features Interference in concentration Hypervirgilance (looking around all the time) Inability to remember certain events whilst anxious Imagining the worst outcome Behavioural Reactions Avoidance Escape Aggressive behaviour

Question 64

What is the cycle of behaviour change? (5)

Answer 64

precontemplation - not interested in change at this moment contemplation - keen for change in the future preparation - wants to make change now action maintenance (relapse can occur at any stage)

Question 65

Give 4 management techniques for anxious patients? (10+)

Answer 65

1. Reducing anxiety via general attitude/try to reduce anxiety via your treatment style; - Explain the fight or flight response - Let the patient know that they are in control. - Establish trust. - Provide realistic information. - Provide a high level of predictability - i.e. at the start of the appointment tell the patient exactly what you have planned, ask them their thoughts and concerns. - Can also establish stop/rest signals - Positive reinforcement - Tell, show, do - Acclimatisation - voice control 2. Teach them coping strategies: Relaxation exercises Distraction activities = Pleasant/relaxing thoughts, counting. Moderate/severe dental anxiety: 3. Exposure based treatment programmes = systematic desensitisation. 4. Pharmacological Support: They can prescribe an oral sedative e.g. benzodiazepines from GP referral - May need professional psychological/psychiatrist treatment where the anxiety is a manifestation of underlying emotional problems/serious mental difficulties.

Question 66

What is primary appraisal in stress?

Answer 66

interpretation/evaluation of stressors - is it significant - harmful / threat or - irrelevant / a challenge

Question 67

What is secondary appraisal?

Answer 67

Reaction to primary appraisal to adress any percieved threats. 1. alarm stage (initation of fight or flight) 2. Resistance - if it continues the body stays activated but this cannot be maintained 3. Exhaustion.- prolonged exposure to the stressor depletes the body's resources (leading to a variety of health issues)

Question 68

Give 4 responses to stress?

Answer 68

1. Direct action 2. Seek information 3. Do nothing 4. Coping

Question 69

What is burnout?

Answer 69

A process whereby a previously committed professional disengages from his or her work in response to stress and strain experienced in the job Maslach burnout inventory: Scale: 1. Emotional exhaustion measures feelings of being emotionally overextended and exhausted by one's work 2. Depersonalization measures an unfeeling and impersonal response toward recipients of one's service, care treatment, or instruction 3. Personal accomplishment measures feelings of competence and successful achievement in one's work

Question 70

Give 4 examples of coping mechanisms for stress?

Answer 70

Work/life balance exercise education on stress set own goals know own limits.

Question 71

What are the recommended allowances for alcohol intake for Male and females?

Answer 71

14 units spread evenly across 3 days with 2 alcohol free days per week

Question 72

How may you screen for alcohol abuse?

Answer 72

using screening tools like; AUDIT - (gold standard) isn’t recommended in the GDP setting as it is time consuming FAST - (recommended) the most practical and relevant in the GDP setting CAGE - can be used in GDP but not on young people CRAFFT - can be used in GDP specifically on young people

Question 73

What brief intervention can be used for alcohol abuse?

Answer 73

We use behaviour change counselling We should be non-judgemental Should last between 5 - 2 minutes We should encourage people to recognise their conflicting feelings towards their actual and ideal behaviour We should encourage people to recognise that the responsibility of change lies with them A one off intervention: Short Non-judgemental Motivational Aimed at changing behaviour conversation FRAMES Framework: F-eedback is given to patient about their drinking R-esponsibility for change is placed on the patient A-dvice for change is given to the patient M-enu of options -Self directed change options are given E-mpathetic style using warmth, respect and understanding S-elf-efficacy to encourage change - empowering the patient

Question 74

How do you calculate how many packs of cigarettes smoked per year?

Answer 74

20 cigs in 1 pack number of packs per day x number of years smoked

Question 75

How do you offer smoking brief intervention?

Answer 75

The 3 A’s Ask: Establish and record smoking status Is the patent a non/current/ex? how many per day? how long for? what products? quitting attempts? desire to quit now/future? Advise: Personal benefits - use what you've found in the mouth to provide supporting evidence Act: Offer to help and signpost services Phone trained advisor that will provide advice, Specialist services, Pharmacy services or The 5 A’s Ask: Establish and record smoking status (as above) Advise: Personal benefits - use what you've found in the mouth to provide supporting evidence Assess: Assist: Arrange follow up:

Question 76

What are the 6 criteria that make up consent?

Answer 76

It must be Valid -Recently obtained -Remain current (pt still agrees) -Specific to the proposed treatment. Legal -Ability (patient needs to have the capacity to make an informed condition ) Informed- Pt needs enough information to make the decision. Voluntary- Pt has made the decision (not manipulated or coerced)

Question 77

List 6 things you should tell the patient for valid consent?

Answer 77

o Options for treatment, their risks and potential benefits o Why you think a particular treatment is necessary and appropriate for them? o The consequences, risks and benefits of the treatment you propose o The likely prognosis o Your recommended option o The cost of proposed treatment o What might happen if the proposed treatment Is not carried out o Whether the treatment is guaranteed, how long it is guaranteed for and nay exclusions that apply

Question 78

what are the principles of waste disposal? (4)

Answer 78

Segregation Storage Disposal Document

Question 79

What are the 2 next steps after an audit?

Answer 79

Implement changes, Repeat the audit

Question 80

What do we dry instruments with and why?

Answer 80

a sterile non-linting disposable towel (doesn't shed fabric/material)

Question 81

List the dimensions of healthcare(6)

Answer 81

Person centred Safe Effective Efficient Equitable Timely. PSEEET

Question 82

What 3 factors makes consent valid.

Answer 82

obtained recently consent is specific consent remains appropriate

Question 83

Define incidence and prevalence.

Answer 83

Incidence: Number of new cases over a specific period of time. prevalence: Number of cases at a point in time. (snapshot)

Question 84

A patient with Alzheimer’s attends your clinic. What are the signs and symptoms? (7)

Answer 84

- Short term memory loss - Inability to manage everyday tasks - Confusion/poor judgement - Communication problems (Gradual loss of speech) - Distress aggression/anger/mood changes/ frustration - Risk of wandering/leaving taps running/cooking unattended. - Increased physical frality - Difficulty eating and swallowing (causing weight loss) - Social withdrawl - Apathy (lack of interest) - Loss of confidence

Question 85

What are the signs and symptoms of Parkinson’s? (4)

Answer 85

bradykinesia (Slow movement and initiation of movement) rigidity (increased muscle tone- causing pt to be stiffer & move in jerks) resting tremor mask like appearance Drooling (problems with swallowing) Cognitive changes/hallucination

Question 86

What are the principles of the Adults With Incapacity Act 2000?

Answer 86

Benefit Minimum necessary intervention Take account of the wishes/past wishes of the adult Consult with relevant others i.e. family members, friends, carers Encourage the adult to exercise what capacity they have (residual capacity)

Question 87

What is capacity?

Answer 87

The ability to; * Give consent * Make reasoned and informed decisions * Understand decisions (Understand the tx, benefits&risks, consequences of no tx and alternatives) * Communicate decisions (Tell you what they want e.g. language barrier) * Retain memory of decisions

Question 88

Who can consent under the AWI 2000?

Answer 88

welfare POA welfare guardian Medical and dental practitioners - who have has specific training - under section 47 of AWI act with general authority to treat.

Question 89

what is the equivalent of AWI 2000 in England?

Answer 89

Mental Capacity Act 2005

Question 90

How do the symptoms of parkinsons complicate dental treatment? (5)

Answer 90

problems with consent - lack of capacity Swallowing problems Impaired use of upper limbs. Tremor at rest- often reduces on purposeful movements- but patient may need iV sedation wth midazolam for muscle relaxation to reduce movement and enable safe provision of dentistry. Problems with tx compliance and communication Dry mouth from the anticholinergic side effects of the drugs Drug interactions hard to recognise pain

Question 91

Cleaning of reusable surgical instruments is an essential pre-requisite to ensure effective disinfection and or sterilisation. Give 4 reasons why.

Answer 91

-Functionality of the instrument (biological debris may clog the hinges in forceps and impair function of cutting tools such as burs or endodontic files) -Incase of biological contamination (Biopsy devices may become contaminated with previous patient materials. This can result in a mis-diagnosis. -Restorative materials- cements can adhere to the instruments making them more difficult to clean. Cements and restorative materials should be removed at chairside. -Legal requirements- It is a requirement under the medical devices directive for effective cleaning prior to sterilisation.

Question 92

What are the 5 stages of the washer disinfection cycle. Explain why each stage is important and what the effect is at each stage.

Answer 92

**Prewash **- remove easy to remove contamination **Wash**- to remove difficult to remove contamination & to wash the instruments and inside of the machine. ** rinse**- to remove detergents from previous stage **Thermal disinfection**- to disinfect the instruments and inside of the machine **Drying**- to drain and dry the instruments and the inside of the machine ready for the next load.

Question 93

Aims: The aim of this study was to evaluate the effectiveness of Shiny Sheen smokers’ toothpaste compared to the brand market leader. Methods: This single centre study was carried out on 48 consecutive patients who smoked. Participants had a baseline tooth-cleaning and were randomly allocated to 1 of 2 products. After one month outcomes were assessed including whether there was any tooth staining. The outcome assessor was unaware of product allocation. Results: Shiny Sheen was more effective at preventing tooth staining than the brand market leader: Risk Ratio (RR) [95% Confidence interval] =0.91 [0.74 to 1.14]. State the research question using the PICO framework. | 2020 p1

Answer 93

- P – population = smokers - I – intervention = shiny sheen - C – comparison = brand market leader - O - outcome = tooth staining prevention

Question 94

Aims: The aim of this study was to evaluate the effectiveness of Shiny Sheen smokers’ toothpaste compared to the brand market leader. Methods: This single centre study was carried out on 48 consecutive patients who smoked. Participants had a baseline tooth-cleaning and were randomly allocated to 1 of 2 products. After one month outcomes were assessed including whether there was any tooth staining. The outcome assessor was unaware of product allocation. Results: Shiny Sheen was more effective at preventing tooth staining than the brand market leader: Risk Ratio (RR) [95% Confidence interval] =0.91 [0.74 to 1.14]. What kind of study is this? | 2020 p1

Answer 94

Randomised control trial

Question 95

Aims: The aim of this study was to evaluate the effectiveness of Shiny Sheen smokers’ toothpaste compared to the brand market leader. Methods: This single centre study was carried out on 48 consecutive patients who smoked. Participants had a baseline tooth-cleaning and were randomly allocated to 1 of 2 products. After one month outcomes were assessed including whether there was any tooth staining. The outcome assessor was unaware of product allocation. Results: Shiny Sheen was more effective at preventing tooth staining than the brand market leader: Risk Ratio (RR) [95% Confidence interval] =0.91 [0.74 to 1.14]. **What 2 steps have been taken to minimise bias in this study (1). Explain why these minimise bias (1)** | 2020 p1

Answer 95

- Random allocation of the toothpaste. - Blinding of the person assessing the level of tooth staining after. - Randomisation prevents the researcher picking patients they think will do better/ provide better results. - Blinding of the assessor- They are not aware of which toothpaste is causing the result (prevents assessor being more lenient to achieve the result they want)

Question 96

Provide two safety features of amalgam waste conditioners | 2020 p1

Answer 96

- Amalgam waste is put in a rigid white container which is has a screw top (red) lid and is spill proof - It contains a mercury vapour suppressant - (it is clearly labelled as amalgam and is easily distinguished from other waste streams)

Question 97

Aims: The aim of this study was to evaluate the effectiveness of Shiny Sheen smokers’ toothpaste compared to the brand market leader. Methods: This single centre study was carried out on 48 consecutive patients who smoked. Participants had a baseline tooth-cleaning and were randomly allocated to 1 of 2 products. After one month outcomes were assessed including whether there was any tooth staining. The outcome assessor was unaware of product allocation. Results: Shiny Sheen was more effective at preventing tooth staining than the brand market leader: Risk Ratio (RR) [95% Confidence interval] =0.91 [0.74 to 1.14]. How would you communicate the risk ratio (RR) to a colleague? | 2020 p1

Answer 97

This gives us the effect of the intervention.

Question 98

Aims: The aim of this study was to evaluate the effectiveness of Shiny Sheen smokers’ toothpaste compared to the brand market leader. Methods: This single centre study was carried out on 48 consecutive patients who smoked. Participants had a baseline tooth-cleaning and were randomly allocated to 1 of 2 products. After one month outcomes were assessed including whether there was any tooth staining. The outcome assessor was unaware of product allocation. Results: Shiny Sheen was more effective at preventing tooth staining than the brand market leader: Risk Ratio (RR) [95% Confidence interval] =0.91 [0.74 to 1.14]. Is there sufficient evidence that shiny sheen is effective at preventing tooth staining in the population of smokers?(1) Justify your answer (1) | 2020 p1

Answer 98

No The risk ratio overlaps the value of 1, therefore not significant.

Question 99

Aims: The aim of this study was to evaluate the effectiveness of Shiny Sheen smokers’ toothpaste compared to the brand market leader. Methods: This single centre study was carried out on 48 consecutive patients who smoked. Participants had a baseline tooth-cleaning and were randomly allocated to 1 of 2 products. After one month outcomes were assessed including whether there was any tooth staining. The outcome assessor was unaware of product allocation. Results: Shiny Sheen was more effective at preventing tooth staining than the brand market leader: Risk Ratio (RR) [95% Confidence interval] =0.91 [0.74 to 1.14]. List four additional pieces of information you would wish to know before drawing firm conclusions on whether or not you would consider recommending Shiny Sheen as a smokers’ toothpaste. (2 marks)

Answer 99

- Who funded the research- was it shiny sheen (could there be a conflict of interest)? - Drop outs- was this equal on both sides (could indicate another problem with the toothpaste making patients non-complaint. - What was the inclusion exclusion criteria o Smoker- but what? How long for? o Anything else that may have impacted their shade- Coffee/ previous whitening) - When was the toothpaste used? Were they both used the same amount of times i.e. twice daily. | 2020 p1

Question 100

2 List two complications that may arise in the dental surgery if local anaesthetic with adrenaline is administered to a patient who has recently abused cocaine?

Answer 100

- Increase in blood pressure - Risk of heart attack

Question 101

Practice principal is concern about sharps injury policy and ask you to investigate it - Describe how would you investigate it (5)

Answer 101

1.Identify problem/ issue 2.Set criteria & standards 3. Observe practice (collect data) 4. Compare performance with criteria and standards 5. Implement change | Audit cycle came up twice.

Question 102

A nurse sustains sharps injury from patient with Hepatitis B - Initial management of the injury (2)

Answer 102

1.Apply pressure and allow it to bleed (Squeeze) 2. Wash don't scrub (soap and water) 3. Assess type of injury- High risk material (blood/bodily fluid) Significant injury (Through the skin/ superficial graze) 4. Risk of blood source- is the patient known to have HIV/HEP B/C 5. Establish contact- senior member of staff/ occupational health/ record injury.

Question 103

A nurse sustains sharps injury from patient with Hepatitis B - What is the component of hepatitis B in the vaccine (1)

Answer 103

The patient is given Hepatitis B surface antigens (active immunisation) but antibody levels need to be checked to see the response. -Adjuvants are also in the vaccine to enhance the immune reponse to vaccine antigens e.g. aluminium adjuvant/ syththetic adjuvant

Question 104

A nurse sustains sharps injury from patient with Hepatitis B Nurse is vaccinated with Hep B surface antibody of 320, What would you inform the nurse about the risk of getting hepatitis B (1)

Answer 104

The nurse should be at virtually no risk of infection (according to the CDC) surface antibody level >12 is classed as effective so very small risk of contracting the disease. | I don't know what surface antibody 320 means? Type/ level?

Question 105

A nurse sustains sharps injury from patient with Hepatitis B To where the nurse should be referred to (1)

Answer 105

Occupational health.