PMHP/Decon Flashcards
What is meant by D3?
Obvious decay into dentine (using visual methods only)
What are the fluoride delivery methods at population level?
Water fluoridation
F enhanced milk in school
Fluoridated salt
What are the pillars of clinical governance?
Education and training
Clinical audit
Clinical effectiveness
R and D
Openness- report issues, evaluate errors, transparency, duty of candour
Risk management
What are the parts of the audit cycle?
Identify problem/issue
Set criteria and standards
Observe practice/data collection
Compare performance with criteria and standards
What should be done after audit cycle?
Implement change
Repeat audit
What concerns would you raise with nurses wearing uniforms in public?
Infection control
Profession reputation
What would the intended learning outcomes be from a training session on PPE?
Wear PPE when carrying out procedures
Wear PPE when cleaning up
Change PPE between patients
Correctly dispose of PPE
Protect you and patients- eyes, hands and clothing
Wear PPE when carrying out decontamination
How would you ensure staff have followed instructions?
Clinical audit
Inspection by supervisor
What are the steps in PICO?
Population
Intervention
Comparison
Outcome
What makes results significant?
If confidence interval overlaps 0 = NULL hypothesis
What can you do to randomise a study?
Blinding
Computer generated assignment
What other attributes make a study reliable?
Larger size
Longer duration
Diverse population
Why is manual cleaning carried out?
To remove gross debris, restorative material, restore function, aid disinfection, remove prions
Why must AWD and steriliser be tested?
To ensure machines are functioning as intended, medico-legal requirement
What are the 5 stages of the washer-disinfector cycle
Flush- submerges instruments in water
Wash- uses detergent to clean
Rinse- removes detergent
Disinfection- uses high temperature steam energy to kill microbes
Dry- removes moisture from instruments
Why do we not dry instruments with a paper towel?
As this is not a non-linting towel
Why is Type B better?
Creates a vacuum- removes air allowing steam to flood chamber and maintain desired temperature
-> can process porous load, wrapped instruments, channelled and lumped instruments
What is clinical governance?
Systematic approach to maintaining and improving quality of patient care within health system
What are the dimensions of healthcare?
Pt centred, safe, effective, efficient, equitable, timely
What are 3 divisions of NHS Scotland dental services?
Primary- GP
Secondary- PDS
Hospital services
How many hours of CPD must be completed in each cycle?
100 hours verifiable CPD within 5-year cycle and at least 10 hours verifiable every 2 years
What are the core CPD topics and how many hours are advised each cycle?
Medical emergencies- 10 hours every cycle (2 each year)
Decon- 5 hours every cycle
Radiation protection- 5 hours every cycle
Legal and ethical issues
Complaints handling
Oral Cancer: Early detection
Safeguarding children and young people / safeguarding vulnerable adults
What are the 9 GDC standards?
- Put patient’s interests first
- Communicate effectively with patients
- Obtain valid consent
- Protect patient information
- Have a clear and easy complaints procedure
- Work with colleagues in patient’s best interests
- Maintain, develop and work within own skills
- Raise concerns if patients are at risk
- Behave professionally and maintain patient confidence in you and the profession
Who are 6 members of the dental team who are registered with GDC?
Dentist, dental nurse, hygienist, therapist, orthodontic therapist, technicians, clinical technicians.
What chemicals are used for blood spill?
Sodium hypochlorite or sodium dichloroisocyanurate -> 10000ppm
-> applied for 3-5 mins
What are the waste streams?
Black- domestic
Orange- low risk like PPE
Sharps box- sharp
Red- hazardous like amalgam
Yellow- hazardous- teeth
What are the steps in chain of infection?
Infectious agent
Reservoir
Portal of exit
Mode of transmission
Portal of entry
Susceptible host
What are the points in sinner circle?
Time
Temperature
Chemical
Energy
What are the 10 SICPs?
- Cough ettiquete
- Hand hygiene
- Equipment management
- Waste disposal
- Body fluid management
- Linen management
- Environmental control
- Sharps exposure
- PPE
- Patient placement
What are the pillars of ethics?
- Non-maleficence
- Beneficence
- Justice
- Patient autonomy
What is negligence?
Omission to do something a reasonable practitioner would do or something a reasonable practitioner would not do
-> Dentist owed a duty of care, duty was breached, caused harm/damage, harm/damage reasonably foreseeable
What are requirements for patient notes?
Confidential
Accurate
Legible
Complete
Retrievable
Current
Retained (11yrs/age25 for children)
What is an audit?
A quality improvement process that seeks to improve patient care and outcomes through systematic review of care against explicit criteria and the implementation of change
What are the uses of audit?
Encourages learning
Indicates gaps in knowledge and skills
Modify attitudes
Reinforces agreed procedures
Opportunity for training
What factors ours make up consent?
Informed
Valid
Capacity
Voluntary
Non-manipulated
Non-coerced
What must be discussed for consent to be informed?
What the treatment/process is
Benefits
Risks- material
Alternatives
No treatment consequences
Success rates
Cost
Your recommendation
What makes consent valid?
Recent
Specific
Remain appropriate
What study provides the highest level of evidence?
Systematic review of randomised control trials
What are 4 aspects of RCT?
Randomised
Inclusion/exclusion criterua
Control group
Blinding
What is incidence?
Number of new cases offer a specific time
What is prevalence?
Number of cases of particular disease at that point in time
What is SIMD?
Scottis index of multiple deprivation
What factors influence deprivation?
Unemployment
Income
Education
Housing
Access to healthcare
Environment
Crime
What are the signs and symptoms of Alzheimers?
STML
Aphasia
Communication difficulty
Mood swings
Withdrawal
Loss of confidence
Difficulty with everyday activities
What are the signs and symptoms of Parkinson’s?
Intention termor
Bradykinesia
Mask-like face
Rigidity
Impaired gait
What are the issues when treating patients with Alzheimers and Parkinson’s?
Issues with consent/capacity
Poor OH
Tremor
Communication issues
Poor denture care
Pain goes unrecognised
What are the principles of AWI?
- Benefit
- Minimum necessary intervention
- Account for patient’s past wishes
- Consult relevant others
- Encourage residual capacity
What is capacity?
- Understand in simple language what the treatment is, its purpose
and nature and why it is being proposed - Understand its principle benefits, risks and alternatives
- Understand consequences of not receiving the proposed treatment
- Retain the memory of the decision
- Can communicate decision
-> always assume people have capacity
Who can consent on AWI?
Welfare POA
Welfare guardian
Qualified medical professionals under section 47
What is the equivalent of AWI in England?
Mental capacity act 2005
What are the advantages and disadvantages of a split mouth study?
ADV:
Control and intervention are exposed to same environment
DIS:
Patient cannot be blinded
What is a confidence interval?
Representation of study findings to real world population
-> worked out using the effect size and the sample size relative to the true population
-> 95% likelihood of repeat results
Risk ratio and absolute risk difference CI meaning:
Risk ratio- overlaps 1 (no significance)
Absolute risk difference- overlaps 1 (no significance)
What are the steps in the decontamination cycle?
(Acquisition)
Cleaning
Decontamination
Inspection (disposal)
Packaging
Sterilisation
Transport
Storage
Use
Transport
What are 4 legislations for decontamination?
COSHH 2002
Health and safety at work act
Medical devices act 2021
BS EN
SHTM 01-01
What are reasons for cleaning?
Remove organic matter
Remove restorative material
Restore function
Aids disnfection and sterilisation
Medico-legal requirement
What are 5 common handpiece faults?
How is manual washing carried out?
PPE- face shield, mask, gown, nitrile gloves and marigolds on top
Water <35 degrees
Detergent- pH neutral
Immersion and non-immersion as required
Use long handled non-metallic brush
Rinse afterwards
What does an ultrasonic bath do?
Uses ultrasound to create micro bubbles which cause cavitation when they implode having scouring effect on instruments
Done at 20-30 degrees
pH neutral detergent
Degas to remove air prior
What daily tests are done for AWD?
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 previous cycles
Making sure the strainer/filter is clear
Making sure there is a sufficient amount of chemical
Carrying out a protein detection test and soil test
Noting disinfection temperatures on daily cycles
Carrying out a full ACT
What temperature pressure and time is sterilisation carried out at?
134-137 degrees
Pressure equivalent gauge (from atmospheric) 2.05 – 2.35 bar
-> required to reach temperature
Pressure equivalent absolute (from absolute zero) 3.05 – 3.35 bar
Minimum hold time of 3 mins
What are 3 types of sterilisers and their uses?
Type B- active air removal, processes instruments wrapped and lumped
Type S- used for handpieces
Type N- passive air removal, solid steel instruments, not wrapped or lumened
What water is used for rinse stage of AWD?
Reverse osmosis - does not leave residue
What are factors in the aetiology of DFA?
Preparation from parents and peers
Expectation of pain
Previous negative experience
Media
Uneducated on modern practice
How may a patient with DFA present?
What are the steps in cycle of behavioural change?
Precontemplation
Contemplation
Preparation
Action
Maintenance
**Progress and relapse possible at each stage
What management techniques can be used for anxious patients?
Medication- benzos
Sedation
Desensitisation
Acclimatisation
CBT
Relaxation- breathing
Tell-show-do
Distraction
Stop signals- control
What is a primary appraisal in stress?
Initial assessment of stressor as:
-> Irrelevant
-> benign
-> Harmful- threat
-> Harmful- challenge
What is secondary appraisal?
Reaction to primary appraisal
-> Harm
-> resistance
-> exhaustion
What are the respsones to stress?
Direct action
Seek info
Do nothing
Coping strategies
What are coping mechanisms for stress?
Exercise
Work life balance
Mindfulness
Hobbies
Relationships/family
Travel
Art
What is burnout?
A process whereby a previously committed professional disengages from his or her work in response to stress and strain experienced in the job
-> physical and mental exhaustion
-> negative cynical, dissatisfied
What are the symptoms of stress?
Physical:
Exhaustion
GI problems
Headaches
Shortness of breath
Skin complaints
Sleeplessness
Aches/pains
Psychological:
Touchy and irritable
General lethargy
screaming/shouting,
Outbursts of anger
What is the screening test for alcohol?
CAGE:
Cut down
Annoyed at criticism
Guilty
Early morning drinking
How is brief intervention for alcohol given?
FRAMES:
Feedback
Responsibility
Advice
Menu of self directed change
Empathy
Self-efficacy
How is pack years calculated?
20 cigs per day for a year is one pack year
-> 20/day for 20 years in 20 pack years
-> 10/day for 5 years- 2.5 pack years
How is brief intervention for smoking given?
3As- ask, advise, act
5As- ask, advise, assist, assess, arrange follow up
