7. PMHP

Question 1

Ethics

1. What are the 4 core principles of medical ethics

Answer 1

1. Justice (fairness), autonomy (respect for self-determination), beneficence (patients’ best interests), non-maleficence (do no harm)

Question 2

Negligence

1. How is dental negligence established
2. When would a clinical negligence claim have basis

Answer 2

1. Where a dentist’s practice fails to meet the standard in the following way: there is a usual and normal practice, the dentist did not adopt that practice, the course the dentist adopted is one which no dentist of ordinary skill would have taken if acting with ordinary care. Harm resulted from this course
2. A duty of care was owed, the duty was breached (standard of care), that breach caused or materially contributed to damage (causation), the damage was reasonably foreseeable and had negative consequences and effects

Question 3

Consent and Capacity

1. What are 6 components of consent
2. What are the 3 components of legal consent
3. What are the 3 components of valid consent
4. What are 5 components of capacity

Answer 3

1. Valid, with capacity, informed, voluntary, not coerced, not maniupuated
2. Patient has the ability to make an informed decision, the patient has enough information to make a decision, the patient has made the decision
3. Remains current, is specific to the proposed treatment only and is continuing (was obtained recently enough)
4. Patient has the ability to act (decide/give consent), make reasoned decisions, communicate decisions, understand decisions, retain the memory of decisions

Question 4

Diversity and Equality

1. What is the definition of diversity
2. What is the definition of equality
3. What is the definition of equity

Answer 4

1. Acknowledgement of alterity (otherness) among people in terms of their community, culture, beliefs, life experiences and individuality
2. Fairness of opportunity and observance of the rights of people so that their altering is not discriminated against
3. Quality of being fair and impartial

Question 5

EBD 1

1. What are the key principles of EBD (5 As)
2. What are the components of PICO and give an example for each component

Answer 5

1. Ask, align, acquire, appraise, apply
2. Population (group of individuals/patients) - child with deciduous caries
   Intervention (what is being measured/done) - Hall technique
   Comparison (what the intervention is being compared to - current practice, before/after intervention) - current practice (removal of caries and restoration of tooth)
   Outcome (desired/undesired) - improved compliance, reduced failure

Question 6

Scientific Studies

1. What is the use of a case report/series, what is 1 disadvantage and give 2 purposes of them
2. What is a cross-sectional study, give 2 purposes and 2 disadvantages
3. What is a case-control study and give 2 disadvantages
4. What is a cohort study and what are they used for. Give 3 disadvantages
5. What is an RCT, why are they good and what are the 4 key design elements
6. Give 3 disadvantages of RCT
7. What is a systematic review or meta-analysis

Answer 6

1. A report on a single patient/series of patients with an outcome of interest. No control is used. Can be used to identify new disease outcomes and generate hypotheses
2. An observation of a defined population and a single point in time (or time interval). Exposure and outcome are determined and measured at the same time. Used to estimate disease prevalence and to investigate potential risk factors. Causality, confounding bias and recall bias
3. Study involving people with a disease and a suitable control group of people without the disease. Look back in time to a particular risk factor in both groups and can be used to look at potential cause of disease. Confounding bias, recall/selection bias, selection of controls, time relationships
4. Used to measure exposure in an established group of individuals that develop disease (outcome of interest). Estimate incidence and investigate cause of disease, determine prognosis and timing and direction of events. Controls difficult to identify, confounding bias, difficulty blinding, very expensive/time consuming, large numbers required (difficult for rare diseases)
5. Clinical trial. Gold standard for effectiveness and efficacy. Specification of participants (inclusion/exclusion criteria), control, randomisation, blinding/,asking
6. Difficulty designing and conducting (ethics, feasibility, costs), some risk of bias, not suitable for all research questions
7. Compiling data from multiple RCTs. Most scientifically sound form of research paper as results from multiple different papers investigating the same topic are collated, noted and analysed

Question 7

Risk

1. What are the names and definitions of 3 types of risk

Answer 7

1. Absolute risk - incidence rate of disease amongst people exposed to agent, assumes no risk to those not exposed
   Attributable risk - difference between incidence rates in exposed and non-exposed groups, risk attributable to factor being investigated
   Relative risk - ratio of incidence rate in exposed group vs non-exposed group, measurement of proportionate/relative increase in disease rates of exposed group. Makes allowance for frequency of disease amongst people not exposed to supposed harmful agent

Question 8

EBD Definitions

What is the definition of:

1. Risk factor
2. Causative agent
3. Determinant
4. Confounding variable
5. Absolute risk difference
6. Confidence interval
7. Number needed to treat
8. Value of no difference

Answer 8

1. Environmental, behavioural or biological factor (confirmed by temporal sequence), usually increasing the probability of a disease occurring and if absent/removed, reduces probability
2. External factor which results in disease in susceptible individuals
3. Attribute/circumstance which affects the liability of an individual to be exposed, or when exposed, to develop disease
4. Minor variable which is left uncontrolled which may/may not have an effect on the results
5. Difference in risk between groups
6. Range of values that the ARD will take in a population. 95% of the time will contain the true mean
7. Number of patients that have to be treated to prevent one patient from developing the disease/condition/outcome. 1/ARD
8. When ARD = 0, indicating no benefit/risk to either group. When CI overlaps VoND, this indicates insufficient evidence for a difference between treatment and control groups (evidence not statistically significant)

Question 9

Abuse

1. Give 3 risk factors for domestic abuse
2. Give 3 health problems that may be consequences of domestic abuse
3. Give 4 signs of domestic abuse
4. How would domestic abuse be followed up on in practice
5. What is an adverse childhood event

Answer 9

1. Female, 16-24f/16-19m, LT illness/disability, mental health illness, separated, pregnant
2. Injuries, chronic pain, unwanted pregnancy, PTSD, depression, smoking, drug use, alcohol dependence
3. Injuries with unlikely explanations, facial bruising, strangulation marks, fingertip bruising on arms, neck, behind ears, low self-esteem, partner harassment, fearful, anxious, missed/frequent appointments
4. Ask, validate, document, refer/signpost (AVDR)
5. A negative incident in young life that may lead to a higher risk of various health and social issues in adulthood. They can change how the brain responds to stress. 4+ ACEs are a risk factor for violence (victim/perpetrator)

Question 10

Epidemiology and Health Inequalities

1. What are 3 types of epidemiological study
2. What are 4 key roles of epidemiology
3. What is the definition of prevalence
4. What is the definition of incidence
5. What are 3 properties of an ideal index
6. Give 2 examples of upstream, midstream and downstream public policy
7. Describe SIMD

Answer 10

1. Descriptive, analytic, intervention/experimental
2. Measure amount of disease, measure distribution of disease, measure distribution of natural history of disease, assess people’s risk of disease, healthcare needs assessment and service planning
3. The number of disease cases in a population at a given time. Estimates can be obtained from cross-sectional studies or derived from registers
4. The number of new disease cases developing over a specific period of time in a defined population. Estimates can be obtained from longitudinal studies or derived from registers
5. Clear and unambiguous, objective, reproducible, not-time consuming, acceptable to patient, amendable to statistical analysis
6. Upstream - public place smoking ban, sugar tax
   Midstream - dental health support workers, social prescribing
   Downstream - chair side clinical prevention, smoking cessation services
7. Scottish index of multiple deprivation.
   Area-based index of multiple deprivation. It is a statistical tool used to support policy and decision making. It ranks data zone (almost 7,000) in order of deprivation, where 1 is the most deprived. Datazones are often grouped into quintiles (1-5) or deciles (1-10) for analysis and intervention planning.

Level of deprivation is derived from a number of sources that measure housing, income, geographic access to services, health, education, skills and training, employment and crime.

Question 11

GDC/Dento-Legal

1. What are the 9 GDC principles

Answer 11

1. Put patients interests first
2. Communicate effectively with patients
3. Obtain valid consent
4. Maintain and protect patients’ information
5. Have a clear and effective complaints procedure
6. Work with colleagues in a way that is in patients’ best interests
7. Maintain, develop and work within your professional knowledge and skills
8. Raise concerns if patients are at risk
9. Make sure your personal behaviour maintains patients’ confidence in you and the dental profession

Question 12

Smoking

1. Give 4 techniques for smoking cessation brief advice
2. Give 4 symptoms of smoking withdrawal
3. What is the definition of second-hand smoke
4. What is the definition of third-hand smoke
5. Give 4 oral effects of smoking
6. What are e-cigarettes
7. Give 3 advantages of e-cigarettes
8. Give 3 disadvantages of e-cigarettes

Answer 12

1. 5 As – ask, advise, assess, assist, arrange follow up
   ABC – ask, brief cessation advice, cessation support for those who want it
   3 As – ask, advice, act
   Alternative (2 As + R) – ask, advise, refer
2. Irritability, depression, restless, poor concentration, increased appetite (weight gain), sleep disruption, light-headedness
3. Environmental tobacco smoke, ETS is the smoke that non-smokers are exposed to. It can be mainstream (exhaled by smoker) or side stream (wafts off cigarette end)
4. Carcinogen-laden residue that builds up on surfaces
5. Oral cancer risk, staining, halitosis, nicotinic stomatitis, smoker’s melanosis and delayed healing
6. Simulate tobacco smoking through vaporised nicotine delivery without burning conventional tobacco
7. Cheaper than cigarettes and are thought to be less toxic. They are successful in helping quit smoking as the hand-to-mouth habit and psychosocial aspect of addiction is maintained
8. Not completely safe however (no long-term studies) and the long-term effects are unknown. The effects on the oral cavity are still unknown/uncertain and there is concern the e-cigarettes are the starting step on the gateway theory into smoking as well as being involved in the renormalisation of cigarettes/smoking.

Question 13

Stress

1. Define stress
2. Define burnout
3. Define resilience

Answer 13

1. An acute pressure leading to specific reactions from the nervous/endocrine system
2. A process whereby a previously committed professional disengages from his or her work in response to stress and strain experienced in the job (mental and physical exhaustion)
3. The process of adapting well in the face of adversity, trauma, tragedy and threats