PMHP Questions Flashcards
Using a graph showing D3t, mt and ft
What is D3t , mt and ft ?
- D3t = decayed deciduous teeth
- Mt = missing teeth (XLA or decayed)
- Ft = filled teeth
DMFT = in adults | dmft = in children
What is D/DMF , F/DMF and M/DMF?
D - indication of treatment need
F - indication of treatment provision
M - indication of treatment failure
Name 3 reasons why a d3mft show a difference between 2 areas? (3)
- Socioeconomic status
- Ethnicity status
- Individual health board involvement
At a population level, name 3 fluoride delivery methods? (3)
- Fluoridated water
- Fluoridated milk
- Fluoridated salt
What 3 interventions are done in scotland on a population basis? (4)
- Smoking ban in public areas
- School food policy
- Sugar tax
- Minimum wage/national living wage
What is PICO? (4)
- P = population
- I = intervention
- C = comparison
- O = outcome
Example of PICO from a chart?
- P - children with caries in primary teeth
- I - hall technique
- C - compared with standard technique
- O - Rate of failures
What is the relative risk?
- Ratio of risk of an event in the exposed group to the risk of an event in the unexposed group
- The level of increase of the disease in exposed group
If the RR is 1 = no difference in risk
No 0 values
What the confidence interval?
- The range of values the ARD will take in the population
- 95% = true population ARD
- It indicated certainty of evidence
- If overlaps 0 - null hypothesis
What are the 5 steps in clinical audits? (5)
- Identify problem or issue
- Set criteria or standards
- Observe practice and collect data
- compare performance with criteria and standards
- Implement change
What other things can be done other than audit?
- Peer review
- Quality improvement programme
- continued professional development (CPD)
What are the 6 dimensions of healthcare? explain each
- Safe - avoid harm to patients
- Timely - reduce waits and delays for patients and staff
- Efficient - avoiding waste of equipment, supplies, ideas and energy
- Equitable - providing care of same quality for everyone no matter the personal characteristics
- Effective - providing services based on scientific knowledge to all who could benefit and reframing from providing services for those who will not benefit
- Patient centered - provide care that is respectful of a responsive to individual patient preferences, needs and values
Intra oral signs of cocaine use
- Xerostomia
- Bruxism
- Attrition and erosion
- Temporomandibular joint pain
- Oronasal defects
- Chronic sinusitis
- Palatal perforation
What side effects are associated with opioid use? (5)
- addiction
- nausea
- drowsiness
- lethargy
- constipation
- paranoia
- respiratory depression
Complications of using LA with adrenaline in a patient with cocaine addiction?
- Increased adrenergic activity
- acute increase in blood pressure
- increase the risk of seizures
Cocaine effects on the body?
- increased heart rate (heart problems)
- Nausea
- Seizures
- Addiction
Side effects of heroin
- Dry mouth
- itching
- withdrawal symptoms such as headaches and anxiety/paranoia
- Cognitive impairment
What is methadone and what is it used for?
- A long acting opioid agonist that help manage withdrawal symptoms of people with dependance of opioids such as heroin
- It is also used for treatment of chronic pain
What group does methadone belong to ?
- Opioids class A drug
What is complications of methadone containing sugar?
- high caries and periodontal risk
What is the risk of sugar free preparation of methadone?
- Does not contain chloroform so could be injected
- May cause diarrhoea
What are the 3 types of consent ?
- Implied - patient actions 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
What factors relating to procedure need to be discussed with the patient to gain consent?
- Options for treatment, risks and potential benefits of all
- Risks and benefit of proposed treatment
- The prognosis
- The recommended opinion
- The cost of the proposed treatment
- What might happen if the proposed treatment in not carried out
- Whether the treatment is guaranteed and how long for
What 6 factors make up consent? (6)
- Not manipulated
- Not coerced
- voluntary
- Valid
- informed
- with capacity
What makes a consent valid? (3)
- recent
- specific
- remains appropriate
What type of person carries consent for a 3 year old?
Birth mom
What type of patient carries out consent for a 16 year old patient?
- The patient have the legal capacity to consent on their own behalf to any surgical, medical or dental procedure
You saw 2 nurses getting off the bus with their uniforms from the practice you work in
What 2 concerns would you raise with them?
- Infection control - wearing the uniform out and in the practice
- Practice and profession reputation - as nurses have uniform that show where they work
Name learning outcomes from a learning session on PPE?
- Always wear PPE when carrying out procedures
- Wear fresh PPE when cleaning
- Change PPE between patients and cleaning
- Correct disposal of PPE in orange stream waste
- Protection of hands, eyes, clothing with PPE
- Protect the patient with glasses and apron
- PPE can reduce the spread of infection
How would you ensure staff follow instructions on PPE? (3)
- Regular inspections
- Clinical audits
- Reflections
What types of studies provide the highest level of evidence?
- Cochrane reviews
- Which are systematic assessments of all relevant randomised control trials (RCTs)
List 4 aspects of Cochrane reviews?
- Randomisations - facilitates statistical analysis
- Inclusion and exclusion criteria
- Randomised Double blinding - reduce bias
- Control groups - to investigate statical significance
Give three examples of study designs other than Cochrane reviews
- Randomised control trial - effectiveness and efficacy of treatments
- Cohort studies - Prospective study (now - future)
- Case control studies - retrospective study (now - past)
- Case study - one patient report
What is incidence?
- number of new disease cases over a period of time in a defined population
- obtained from longitudinal studies or derived from registers
Incidence rate
no of new cases of disease over the number of individuals at risk of the disease in a population during a defined period
What is prevalence ?
- The number of diseases cases in a specific time in a specific population
- Obtained from cross-sectional studies or from registers
- absence or presence of disease
What SiMd?
- Scottish index of multiple deprivation
- An area based index which use a range of data to decide which neighbourhoods are most deprived
- by ranling data zones in order of deprivation from 1-10 (most to least deprived)
What factors can influence deprivation? (7)
- Employment status
- Income
- Health and healthcare services
- Geographic access to services
- Crime
- Housing, living and working conditions
- Education, skills and training
What is a split mouth study design?
- trials in which each subjects receive 2 treatments each to a separate section of the mouth
What are the advantages of a split mouth study design?
- Both control and intervention group are exposed to same environment
- Each of the 2 treatments are randomly assigned to either the right or left side of the dentition in the same environment
- Increased efficiency
- Ability to compare treatment in same individual
- reduced inter-individual variability
What are the disadvantages of split mouth study designs?
- Patients cannot be blinded
- More bias in reporting
- Incorrect reporting risk
- Contamination of one treatment by the other
What values regarding confidence interval are important?
- n = sample size - the bigger the better
- ARD
- Width of the confidence interval = the narrower the better
- Level of confidence
- 0 is the null hypothesis
What is the P value?
- It is used to determine the significance of the results
- If P value is less than 0.05 = results are statistically significant
What is the primary appraisal in stress?
Initial assessment of stressor which can be
* irrelevant
* benign
* harmful - threat
* harmful - challenge
What is secondary appraisal in stress?
- Reaction to primary appraisal
- harm
- resistance
- exhastion
Give different responses to stress (4)
- Direct action
- Seek information
- Do nothing
- Coping
What is burnout? (3)
- Disengagement of a previously committed person from work due to stress
- Associated with mental and physical exhaustion
- Negative or indifferent attitude towards life
Give examples of coping mechanisms for stress?
- Good work/life balance
- Exercise
- Setting own targets and goals
- Knowing personal limits
What are the recommended allowances for alcohol intake for males and females?
- 14 units per week with
- at least 2 alcohol free days
How may you screen for alcohol abuse? (4)
Using screening tools such as
* AUDIT : alcohol use disorder identification test (questionnaire approved by WHO)
* Take history through CAGE
* Liver function test by GDP if concerned
* Fast alcohol screening test (questionnaire)
What is involved in CAGE alcohol screening?
Questions to ask patient during taking history to screen for alcohol abuse involving
C - have you felt that you should cut down alcohol?
A - have you ever got annoyed by criticism about your drinking?
G - have you ever felt guilty about your drinking ?
E - have you ever had alcohol the first thing in the morning because of a hangover?
What brief intervention can be used for alcohol abuse?
- Alcohol brief intervention can be used
- raise the issue about their drinking
- Screen and give feedback of risks
- listen to readiness to change
- give options, information and advice (refer)
- Use FRAMES
What is FRAMES alcohol intervention?
- Feedback - about risks of alcohol
- Responsibility - it is the person own choice to decide
- Advice - 12 units per week with 2 alcohol free days
- Menu of options available
- Empathy - show empathy when talking to the patient
- Self efficacy - give a positive message such as “ you can do it!”
How do you calculate how many cigarettes pack a year?
- Used to quantify the cumulative exposure to cigarette smoking
- Number of packs per day x number of years
- there is 20 cigs in one pack
How do you offer smoking brief intervention?
- 5A’s - Ask, advice, assist, assess , arrange
- 3A’s - Ask (smoking status), advise (benefits) , Act (signpost)
- 2A1R - Ask , Advice , Refer
How would you communicate the risk ratio to a colleague?
If the value overlaps the risk ratio (1) then the results are not significant
