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BDS4 EXAM PREP > PMHP > Flashcards

PMHP Flashcards

1
Q

d3mft

A

obvious decay into dentine of tooth (using visual methods only)

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2
Q

3 fluoride population level deliveries

A

water fluoridation
fluoridated salt
fluoridated milk

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3
Q

components of clinical governance

6

A

Risk management
Education
Audit
Research
Clinical effectiveness
Openess

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4
Q

audit cycle

A

identify topic and set standards
obeserve practise and collect data
analyse data
implement changes
re-audit

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5
Q

PICO

A

population
intervention
comparison
outcome

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6
Q

RCT aspects

A

blinding of particpants and researchers
random allocation - computer generated
preordained outcome measures
inclusion and exclusion criteria

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7
Q

Risk ratio value of no difference

A

1

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8
Q

absolute risk difference value of no difference

A

0

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9
Q

things to consider when analysing a study

A

size of study
duration of study
population investigated in study

confounding variables

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10
Q

clinical governance

A

systematic approach to maintaing and improving the standard of pt care in a health system

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11
Q

dimensions of healthcare

6

A

Pt centered
Efficient
Equitable
Effective
Timely
Safe

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12
Q

3 dimensions of healthcare in NHS dental services

A

primary care - general practice and public dental service
secondary care - hospital

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13
Q

CPD hours in 5 year cycle

A

100 verifiable hours

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14
Q

CPD core subjects

A

10 medical emegency
5 radiology and radiation protection
5 decontamination and disinfection

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15
Q

GDC standards

A
  1. Put pt interests first
  2. communicate effectively with pt
  3. obtain valid consent
  4. protect pt inforamtion
  5. have a clear and easy complaints procedure
  6. work with colleagues in pt best interests
  7. maintain, develop and work within own skills
  8. raise concerns if pt are at risk
  9. behave professionally and maintain protect confidence in you and the profession
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16
Q

pillars of ethics

A
  1. non malicence
  2. beneficence
  3. justice
  4. pt autonomy
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17
Q

negligence

A

omission to do something which a reasonable practitioner would do, or doing something which a reaonsable practitioner would not do

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18
Q

how long should notes be kept for

A

10 years
or until child is 25

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19
Q

notes should be

7

A

confidential
accurate
legilible
complete
retrievable
current
retained

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20
Q

who is on the GDC board

A

1 chair
6 dental professionals
6 lay people

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21
Q

audit

A

quality improvement process that seeks to improve pt care and outcomes through systematic review of care against explicit criteria and the implementation of change

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22
Q

uses of audit

A

observe gaps in knowledge
learning
attitudes
protocol
training

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23
Q

audit cycle

A

identify problem and set standard
observe practice and collect data
analyse data
compare with set standards
implement change and re audit

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24
Q

factors that make up consent

A

informed
valid
capacity
voluntary
non-manipulative
non-coerced

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25
Q

discuss prior to consent

A

knowledge of purpose of tx
risks and beneftis fo tx
alternatives
no tx - risks and benefits
success rate

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26
Q

valid consent

3

A

recently obtained
specific to tx
remains current/continuous

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27
Q

legal consent

A

have capacity
has information
made and communicated freely - non coerced, non manipulated

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28
Q

study that gives highest level of evidence

A

systematic review of RCTs
cochrane review

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29
Q

4 aspects of RCTs

A

randomised
inclusion/exclusion criteria
control
blinding

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30
Q

cohort study

A

prospective
type of longitudinal study—an approach that follows research participants over a period of time
often share a characteristc

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31
Q

case control study

A

retrospective
observational study. It looks at 2 sets of participants. One group has the condition you are interested in (the cases) and one group does not have it (the controls). In other respects, the participants in both groups are similar.

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32
Q

case studt

A

one pt
detailed study of a specific subject

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33
Q

incidence

A

number of new cases over a specific time

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34
Q

prevalance

A

nummber of cases at a time

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35
Q

SIMD

A

scottish index of multiple depreivation - area based

tool for identifying area of poverty and inequality across scotland to support policy and decision making
ranks in order of dep (1 is most dep)

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36
Q

factors influenceing deprivation

A

unemployment/employment status
income
housing
education
access to healtcare
enviorment
crime

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37
Q

Adults with incapcaity act 2000

principles

A

Benefit
Minimal intervention
Wishes of pt
Others consulted
Residual capacity

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38
Q

Capacist

A

Assess option
Make decision
Communicate decision
Understand decision
Retain memory of decsision

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39
Q

who can consent under AWI 2000

A

welfare POA
welfare guardianship

or need section 47 certificate signed by adequately trained person

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40
Q

adv of split mouth design

A

both control and intervention exposed to same evironment

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41
Q

disadv of split mouth design

A

pt cannot be blinded

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42
Q

confidence interval

A

representation fo study findings to real world propulation
worked out using the effect size and the sample size relative to the true population

95% likelihood of repeat results

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43
Q

p-value

A

statistical significance of results,
usually null hypotheses
<0.05 is significant?

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44
Q

aetiology of DFA

A

parent/peer output
media
pain expectation
previous negative experience
uneducated on modern techniques

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45
Q

anxious presentation

A

negative
low pain threshold/flinching
fidgets
sweating
needing to go to toilet/making excuses
lack eye contact

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46
Q

cycle of behaviour change

A

precontemplation
contemplation
preparation
action
maintenance

with progress or relapse at any stage

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47
Q

management techniques for anxious pts

A

densensitisation
acclimatisation
CBT
progressive relaxation
tell show do
mediaction - anxiolytic meds or sedation
distraction
control

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48
Q

primary appraisal in stress

A

initial assessment of stressor

1 - irrelevant
2 - benign
3 - harmful/threat
4 - harmful/challenge

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49
Q

seondary appraisal in stress

A

reaction to primary appraisal
1 - harm
2 - resistance
3 - exhaustaion

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50
Q

reponses to stress

A

direct action, seek information, do nothing or coping

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51
Q

burnout

A

disengagment and exhaustation

often negative and dissatisfied (

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52
Q

coping mechanisms for stress

A

work life balance
exercise
education on stress
set own goals
know own limits

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53
Q

recommend alcohol per week

A

14units
2 alchol free days
2-3 units per day

54
Q

screen for alcholoism

A

CAGE
cut down
annoyed at critisim/aggressive
guilty
early morning drinking

55
Q

alcohol intervantion

A

FRAMES
Feedback
Responsibilty
Advice
Menu of options
Empathetic
Self efficacy

56
Q

smoking pack years

A

20/day is 1 pack year

number per day/years

57
Q

smoking intervention

A

5As
Ask
Advise
Assist
Assess
Arrange

58
Q

sharing/disclosing info when

A

Consent from the patient: patient provides explicit consent for the disclosure of their information, the dentist is allowed to share the relevant information with the specified party or parties.

Legal requirement: e.g in response to a court order, subpoena, or other legal processes. Disclose only the minimum necessary information required by law and should seek legal advice if in doubt.

Public interest: compelling reason to believe that the disclosure of patient information is necessary to protect public health or prevent serious harm to others e.g cases of serious communicable diseases or instances where the patient poses a risk to the safety of others.

Safeguarding concerns: concerns about a patient’s safety or suspects abuse, they may be required to disclose confidential information to social services or the police, in order to protect the patient or others

Clinical audit or research: done in a way that protects patient confidentiality e.ganonymizing or aggregating the data so that individual patients cannot be identified.

Sharing information with other healthcare professionals: involved in the patient’s care, such as physicians, specialists, or other members of the dental team. Done on a need-to-know basis, and the shared information should be relevant to the patient’s treatment or care.

59
Q

consent not required when

A

Emergency arises in clinical setting and it is not possible to find out pt wishes
* Tx you provide must be least restrictive for pt future needs

for as long as the px lacks capacity, you should provide ongoing care and if the patient regains capacity then explain what has been done and why

60
Q

non technical reasons for adverse events

A

team management
team working
situration awareness
decsision making

70%
rest are clinical and structural factors

61
Q

diversity

A

acknowledgment of alterity amoung people in terms of their community, culture, beliefs, life experiences and individuality

62
Q

equality

A

faireness of oppurtunity and observing the rights of people to do so

63
Q

equity

A

tx people justly, which doesnt mean tx everyone the same - those with an unfair disadvantage may required additional aid - quality of being fair and impartial

64
Q

disabled person

A

has a physical or mental impairment
the impairment has a substantial and long term adverse effect on their ability to carry out nornmal daily activities

DDA 2004

65
Q

protected characteristics

A

age
gender - identity, expression, reassignment
sexual orientation
marital status
disabilty
race
pregnancy or materinity
religious belif

equality act 2010

66
Q

categories of discrimination

A

direct
indirect
associative
perceived
harrasment
victimisation
instruction to discrimination

67
Q

oral cavity cancer areas

A

lip
tongue
gum
FOM
palate

68
Q

oropharyngeal cancer areas

A

base of tongue
lingual tonsil
tonsil
oropharynx
pharynx

69
Q

OCC incidence

A

More common in males by far
Incidence rises around 45 yrs, peaks around 70
Far more common in deprived areas

Oral cancers
* Males 1.8 times more likely
* 65-70 yrs 3.7 times more likely than younger
* SIMD 1 2.7 times more likely

70
Q

risk factors for oral cancer

7

A

Smoking (if never drank, 2.13 times more likely) – duration worse than high quantity
* More laynx

Alcohol (if never smoked, 2.04 times more likely) – quantity worse than duration
* More oral cavity/pharynx
* Alcohol reduction in cancer risk emerges after 20 years

Interaction: PAR for tobacco and alcohol = 72% (61 - 79)
* 4% alcohol alone, 33% tobacco alone, and 35% combined

Genetics

**Diet/BMI
**
**Oral health **and dental care

Socioeconomic status

HPV 16 and 18 are ocogenic
* 25% oral cancer HPV infection, 80% oropharyngeal caner

71
Q

smoking and perio

A

Anerobic bacteria high in smokers (p.ging, t.denticola)
Delayed wound healing
Vasoconstriction - mask gingival irritation
Impaired chemotaxis of immune cells
Cytokine production reduced
Enzyme catlase prodcution effected - bone loss higher

CAL
stain teeth

72
Q

benefits of quitting smoking

4

A

Initial reduction in MI risk after 24hrs, then continues to drop
* Drop to ½ that of a smoker at a year
* 15 years same risk as someone not smoked

Improvement in respiratory health within 72hrs (bronchial tubes reduced inflammation)
Improvement in lung function 1-9months (cilia regrowth)

Reduction in cancer after 2-5years (1/2 of active smoker) – oral and lung
Reduction to never smoker in 20years

48hrs improvement in sense of smell and taste

73
Q

negligence claims have a basis when

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

74
Q

key principles of EBD

A

Ask
Align
Acquire
Appraise
Apply

75
Q

PICO

A

population
intervention
comparison
outcome

76
Q

case report/ series

A

Report on a single pt/series of pts with an outcome of interest

disadv - No control used

Can be used to ID new disease outcomes and generate hypotheses

77
Q

case-control stude

A

Study involving people with a disease and a suitable control group of people without 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

78
Q

case-control study

A

Study involving people with a disease and a suitable control group of people without disease, look back in time to a particular risk factor in both groups and can be used to look at potential cause of disease

dusadv - Confounding bias, recall/selection bias, selection of controls, time relationships

79
Q

cross sectional study

A

An observation of a defined population at a single point in time (or time interval)
Exposure and outcome are determined and measures at the same time
Used to estimate disease prevalence and to investigate potential risk factors

disadv - Causality, confounding bias and recall bias

80
Q

cohort study

A

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

disadv - Controls difficult to identify, confounding bias, difficulty blinding, very expensive/time consuming, large numbers required (difficult for rare diseases)

81
Q

RCT

A

clinical trial - GOLD standard for effectiveness and efficacy
specification of particpants (inc/excl criteria), control randomisation and blinding

diadv - difficult to design and conduct, not suitable for all research questions

82
Q

systematic review or meta-analysis

A

compiling data from multiple RCTs
most scietifically sound form of research paper as results from mutliple different papers investigating same topic are collated, noted and analysed

83
Q

absolute risk

A

incidence of disease amoungst people exposed to agent, assumes no risk to those not exposed

84
Q

attibutable risk

A

difference between incidence rates in exposed and non-exposed groups, risks attributes to factor being investigated

85
Q

relative risk

A

ratio of incidence in exposed group Vs non-exposed group

measurement of proportionate/realtive inc in disease rates of exposed groups
makes allowance for frequency of disease amoungst people not exposed to harmful agent

86
Q

risk factor

A

environmental, behavioural or biological factor (confirmed by temporal sequence), usually increasing the probability of a disease occurring and if absent/removed, reduces probability

87
Q

causative agent

A

external factor which results in disease in susceptible individuals

88
Q

determinant

A

Attribute/circumstance which affects the liability of an individual to be exposed or when exposed to develop disease

89
Q

confounding variable

A

minor variable which is left uncontrolled which may/may not have an effect on results

90
Q

absolute risk difference

A

difference risk between groups

value of no difference ARD=0
indicating no benefit/risk to either group
* E.g. ARD 2.2 [-1.1 to 3.3] = not statistically significant as it overlaps 0; ARD 3.5 [1.1-6.0] = statistically significant as it doesn’t overlap 0
* When CI overlaps 0 indicates insufficient evidence for a difference between tx and control groups (evidence not statistically significant)

91
Q

confidence interval

A

Range of values that the ARD will take in population

95% of time will contain true mean

overlaps the ‘value of no difference’ between treatments indicates that there is insufficient evidence for a difference between the treatment and control group in the population

92
Q

number needed to treat

A

Number of pts that have to be trated to prevent ne pt from developing the disease/condition/outcome
1/ARD

93
Q

risk ratio is

A

robability of outcome in exposed group Vs probability of outcome in nonexposed group

**Value of no difference is 1 **
E.g. RR 2.2 [1.1-3.3] = statistically significant as it doesn’t overlap 1; RR 1.5 [0.3-3.6]=not statistically significant as it does overlap 1

Sufficient evidence if CI do not overlap 1

94
Q

types of epidemilogical study

3

A

descriptive
analytical
interventional/experimental

95
Q

key roles of epidemiology

4

A

measure amount of disease
meansure distribution of disease
measure distribution of natural history of disease
assess peoples risk of disease, healthcare needs, assessment and service planning

96
Q

prevalence

A

number of diseases cases in population at a given time
estimates can be obtained from cross-sectional studies or derived from registers

97
Q

incidence

A

number of new disease cases developing over a specific period of time in a defined population
estimates can be obtained from longitudinal studies or derviced from registers

98
Q

properties of ideal index

6

A

Clear and unambiguous
Objective
Reproducible
Not time consuming
Acceptable to pt
Amendable to statistical analysis

99
Q

healthpromotion
framework
4 strategy types

A

Framework
1. Identify needs and priorities
2. Set aims and objectives
3. Decide best ways to achieve the aims
4. Identify resources
5. Plan evaluation methods
6. Set an action plan
7. ACTION – implement plan

Upstream policy – public place smoking ban, sugar tax
Midstream policy – dental health support workers, social prescribing
Downstream policy – chair side clinical prevention, smoking cessation services
Common risk factor approach - addresses risk factors common to many chronic conditions within the context of the wider socio-environmental milieu. Oral health is determined by diet, hygiene, smoking, alcohol use, stress and trauma.

100
Q

symptoms of smoking withdrawl

A

irritability, depression, restless, poor concentration, inc appetite (weight gain), sleep disruption, light headedness

101
Q

e-cigs

A

stimulate tobacco smoking through vaporised nicotine delivery without burning conventional tobacco

Adv – thought to be less toxic, successful in helping quit smoking as hand-to-mouth habit maintained as well as psychosocial aspect of addiction

Disadv – no long term studies so effects unknown, possible gateway to smoking/renormalisation of it

Only advised to current smokers that are trying to quit

102
Q

resilience

A

process of adapting well in the face of adversity, trauma, tragedy and threats

103
Q

general dental service people

3

A

principals
associates
traning grades (VT)

104
Q

public dental service people

4

A

dental officers
senior dental officers
specialist dental officers
clincal directors/chief administrative dental officers (island boards)

105
Q

secondary care (hospitals) people

4

A

core training
training grades (inc higher specialisty trainees)
associate specialists/speciliast dentists
consultants

106
Q

vulnervable child

3

A

under 5
medically compromised
irregular attenders (only in pain)

107
Q

signs of non-accidental injury

5

A
  • Symmetrical
  • Triangle of danger or involving ears/eyes
  • Story doesn’t match up/keeps changing
  • Different injuries at different points of healing
  • Delay in seeking help
108
Q

child abuse needs to be

3

A

significant harm
carer has responsibilty for harm
significant connection between carer and harm to child

109
Q

categories of child abuse

5

A

physical
emotional
sexual
neglect
non-nutritional failure to thrive

110
Q

UN convention on the rights of child 1989

A

Respected
Informed
Protected from abuse, neglect, exploitation
Secure - be and feel
Start in life
Say in life

111
Q

Child and Young Peoples act 2014

A

GIRFEC – shared approach
* Named person for every child for single point of contact

SHANARRI wellbeing wheel
* Safe, health, active, nurtured, achieving, respected, responsible, included

112
Q

protection of children (scotland) act 2003

A

PVG - list individuals unsuitable to work with children

113
Q

national guidance for child protection in scotland

A

See
* Injury
* Mark
* Bruise
* Presentation – dirty, clothing
* Parent behaviour – hostile, aggressive to you, staff, child
Hear
* Parent interacts with child
* Comment in waiting rooms
* Told
* Third hand

DOING NOTHING IS NOT AN OPTION

114
Q

management of child neglect

A

One department – preventative dental team management
Multi department – involving health visitor, GP, school
Referral to child protection department

Voice concerns to parent – don’t blame
Offer support – OHI help, money concerns
Set targets
Record in notes what have seen, heard or been told using the exact words.

Immediate danger -> Police: child protection removal and fill in form after(e.g.hit, illegal 2020)

115
Q

referring and recording child protection issues or dom abuse issues

A

Discuss immediately with senior if available

Notification of concern (NOC)
Tell pt, unless cannot get hold of or immediate danger

Duty SW (social work)

Advice and support

Role of wider health team (healthcare visitors)

Recording of concerns and actions

Outcome from NOC

Dissent form decision made- seek advice

Domestic Abuse – NICE guidelines; NHS Gender Based Violence Action Plan

116
Q

vulnerable adult

A

unable to safeguard their own interests through disability, metnal disorder, illness or physical or mental infirmity, and who is at risk of harm or self-harm, including neglect”

Adult support and protection (Scotland) Act 2007

Consider whether a referral needs to be made on their behalf

117
Q

AVDR

A

ask
validate
document
refer

adult support and protection act 2007

118
Q

short term effects of child neglect

A

physical health
emotional health
social and cognitive development

119
Q

long term effects of child neglect

A

mental health problems - major depression
suicide
substance abuse
heart disease and diabetes
jail

120
Q

adverse childhood experiences

A

potentially traumatic events that occur in childhood (0-17 years).

For example: experiencing violence, abuse, or neglect. witnessing violence in the home or community.

121
Q

dental neglect

A

persistent failure to meet childs basic oral health needs, resulting in serious impairment in the child’ oral health and general health
* Failure/delay to present (obvious dental disease)
* Impact on child – bullied, sleep disturbance, disturbed eating
* Care offered but child not returned

122
Q

sharps injury management

A

apply pressure and allow to bleed
wash don’t scrub
assess type of injury
risk assess source of blood
establish contact - occupational health, datix

AWARE

123
Q

spikes protocol

A

setting
perception
invitation
knowledge
empathy
summary and strategy

breaking bad news

124
Q

fluoride and caries

A

dose response relationship with caries reduction

125
Q

F varnsih

A

22600ppm
4xyearly

126
Q

water fluoridation

A

1ppm

127
Q

toothpaste for 0-3

A

smear
1000ppm

128
Q

toothpaste 3-6

A

1450ppm pea

129
Q

toothpaste 10+ high risk

A

2800ppm pea 0.619%
sodium fluorride

130
Q

toothpaste 16+ high risk

A

5000ppm pea 1.1% soidum fluoride

131
Q

fluoride mouthwash

A

225ppm
0.05% sodium fluoride

at least 6+ need to be able to rinse and spint

BDS4 EXAM PREP (25 decks)

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