A GUIDE TO SUCCEEDING IN THE DF1

INTERVIEW
(SAMPLE PAGES ONLY)





















JAIPAL SINGH DHILLON









CONTENTS
INTRODUCTION TO DENTAL FOUNDATION TRAINING

INTERVIEW FORMAT

RESULTS 2014

NATIONAL PERSON SPECIFICATION (2014)

STATION 1: COMMUNICATION AND ROLE PLAY:
- SYSTEMATIC APPROACH
- EXAMPLE SCENARIOS
- RESOURCES
o Explanation of Dental terms to patients
o Implant Summary
o Orthodontic Referral Summary
o GA and Sedation Summary
o Dental infections Summary
o Dry Socket Summary
o Tetracycline Staining Summary
o Aggressive Periodontitis Summary
o Oro-antral Communication Summary
o Bleaching Summary
o Mercury Toxicity Summary
o Trauma Summary
o Botox Summary
o NHS Dental Charges Summary
o NICE Guidelines: Wisdom Tooth Extraction
o NICE Guidelines: Infective Endocarditis
o Management of The Pregnant Patient
o Warfarinised Patient
o Medicine and Drug interactions
o Oral Cancer and Breaking Bad News
o Smoking Cessation
o NICE Guidelines: Dental Recall
o Scoring Sheet: Examiner and Actor

- EXAMINERS SCORE SHEETS








STATION 2: PROFESSIONALISM, LEADERSHIP AND MANAGEMENT
- SYSTEMATIC APPROACH
- EXAMPLE SCENARIOS
- RESOURCES
o Clinical Governance Summary
o Clinical Audit Summary
o Consent Summary
o Confidentiality Summary
o Negligence Summary
o Truth Telling and Whistleblowing Summary
o Raising Concerns Summary
o Complaints Handling Summary
o BDA Advice on Abuse
o CHRE Guidelines on Sexual Boundaries
o Grievance Procedures Summary


- EXAMINERS SCORE SHEETS


SITUATIONAL JUDGEMENT TEST
- OVERVIEW
- STRUCTURE
- HOW TO APPROACH
- EXAMPLE SCENARIOS
- USEFUL RESOURCES
























SYSTEMATIC APPROACH

The following is a systematic list of how I approached this station:

5 minutes preparation period:
- Read the scenario 2 or 3 times
- Make sure you know exactly what the patients problem is
- Look for subtle hints in the scenario that might aid you with
diagnosing or managing the problem (keep these in mind and think
how you might approach the management of the patient)
- Just before you walk in have in your mind:
o The patients name!
o Their presenting problem/ complaint
o Any extra subtle hints that can aid / hinder management

WALK IN:

1. Greet the patient and introduce yourself:
State your name (sounds obvious but people forget)
Your position (I am a foundation dentist here at the practice and
I will be looking after you today)

2. Confirm the patients identity:
Can I confirm your address/ DOB please

3. Ask/ confirm the patients problem/problems?



















EXAMPLE SCENARIOS

1. A 39-year-old female patient attends your surgery in pain. The upper left
first premolar is decayed, however can be restored. The patient is keen to
have the tooth extracted because of the severe pain it is causing her. She is
on Warfarin and her INR 2 days ago was 3.0.


Useful tips:
- The patients pain may be swaying their judgment in this scenario. It
may be useful to get the patient out of pain first at an initial
appointment (extirpate the tooth), dependent on your diagnosis, and
then explain to the patient you will decide upon a definitive plan for
the tooth at the next appointment, at which point hopefully the patient
will not be suffering from pain and can be a non biased, reasonable
decision. Explain caries, and consider the INR also in the management
of the patient.





























DENTAL INFECTIONS
PRIMARY HERPETIC GINGIVOSTOMATITIS
Caused by the herpes simplex virus, infects the epithelium .Two phases:

SYMPTOMS
1. Prodromal phase
- Malaise
- Tiredness
- Sore throat
- Submandibular lymphadenopathy

2. Acute phase
- Small vesicles on the oral mucosa
- Vesicles break down to form shallow ulcers
- Small ulcers converge to form large areas of ulceration
- Spread to lips and skin

MANAGEMENT
- Keep hydrated
- Analgesics
- Tetracycline mouthwash to prevent secondary infection
- Infection is self limiting resolve in 7-10 days
- If immunocompromised acyclovir



CELLULITIS
Cellulitis is the term used to describe an infection that spreads into the tissue
spaces causing inflammation.

SYMPTOMS
- Local: pain, redness, inflammation, firm swelling with pus
suppuration, trismus, dysphagia
- Systemic: Temperature, malaise, lymphadenopathy, and pallor

MANAGEMENT
- Remove the cause as early as possible
- Drainage by incision or pulp extirpation. NB: Ensure continued
drainage.
- Antibiotics: Prevent further spread, Co-amoxiclav (amoxicillin
and clavulanic acid)
- Supportive Care
- Fluid, analgesia, cooling
- Severe infections may require hospital admission e.g.
marked dysphagia, airway concern, very systemically
unwell, unable to drink.

LUDWIGS ANGINA
A spreading cellulitis in the floor of the mouth. Often comes from the mandibular
molar

SYMPTOMS
- Bilateral floor of mouth oedema
- Spreading oedema down neck
- Trismus
- Marked pain e.g. on swallowing, difficulty speaking and breathing

MANAGEMENT
- Hospital admission it can be life threatening due to airway
obstruction
- IV antibiotics
- Airway management intubation
- Extra oral drainage




OSTEOMYELITIS
Spreading infection of bone marrow, commonly due to odontogenic infection

SYMPTOMS
- Deep seated pain
- Signs of infection e.g. red/swollen/pyrexia
- MOBILITY of adjacent teeth
- Lots of pus
- Necrotic bone separates moth eaten appearance on x ray after 10
days

PROCESS
1. Inflammation causes thrombosis of bone marrow vessels
2. Accumulation of pus under periosteum causes periosteal stripping
(also surgery)
3. Spreading infection, thrombosis and stripping together cause loss of
blood supply to infected area, resulting in bone necrosis

TREATMENT
Antibiotics prolonged therapy 6/8 weeks
Control of predisposing factors







AGGRESSIVE PERIODONTITIS
Defined by the 1999 International classification as a disease entity of:
Rapid attachment loss and bone destruction inconsistent with local risk factors,
and may happen over a short period of time
Non-contributory medical history not linked to other conditions, i.e. diabetes
or it is known as periodontal manifestation of systemic disease
Familial aggregation of cases
Tends to affect younger people

FEATURES
Associated with a particular type of bacteria AA and a hyperactive immune
response


CLINICALLY
Get deep perio pocketing and loss of alveolar bone
Teeth may show teeth mobility/migration
DPCs and radiographs essential


LOCALISED AGGRESSIVE PERIODONTITIS
Periodontal destruction localised to the first permanent molars and incisors
localised vertical bone loss.
Radigraphs: loacalised vertical bone loss affecting molars and incisors
Clinical appearance: can appear normal until probing is performed


GENERALISED AGGRESSIVE PERIODONTITIS
Usually affects people under 30 years old, although may be older
Generalised pocketing and interproximal attachment loss affecting at least 3
teeth other than first 6s and 1s.


TREATMENT
1) GDP may detect cases and then need to refer to a specialist (dx & tx
planning done by specialist periodontist)
3) Prescribe antibiotic therapy as scaling and RSD are ineffective in
controlling AA counts as AA invades adjacent soft tissue which can
recolonise the tooth surface after scaling.
5) Intensive OHI tailored to the patient, supra and subgingival scaling and
RSD of all pockets >4mm within a maximum of 2 weeks
6) On last treatment visit administer:
Amoxicillin 250mg TDS + Metronidazole 200mg TDS for 7 days

OR

Doxycycline 200mg loading dose (first day) then 100mg once daily for 21
days (doxycycline is a tetracycline which is bacteriostati rather than
bacteriocidal)
7) Allow 3 months for healing the assess treatment outcome
8) If there are non-responding sites consider:
Microbial sampling from deepest pocket +/- application of adjunctive
local delivery system
Additional course of non-surgical therapy
Surgical intervention for access to deepest sites






































ORAL CANCER & BREAKING BAD
NEWS

PRESENTATION
OSCC may present clinically as
- Granular ulcer with fissuring or raised exophytic margins
- Red lesion (erythroplasia)
- White lesion
- Mixed white and red lesion
- Lump, sometimes with abnormal supplying blood vessels
- Lump/ulcer which is indurated (i.e. a firm infiltration beneath the
mucosa)
- Non healing extraction socket
- Tooth mobility of a sudden onset
- Lesion fixed to deeper tissues or to overlying skin or mucosa
- Lymph node enlargement, especially if there is hardness in a lymph node
or fixation
- 2
nd
primary neoplasms in the aerodigestive tract may be seen in those
with OSCC over 3 years in up to 25% and in up to 40% of those who
continue to smoke
- Most oral cancer is carcinoma is on the lower lip; the other main site is
the posterolateral border/ventrum of the tongue.

INCIDENCE
Approx 7,000 new cases in the UK every year


5 YEAR SURVIVAL RATE
50 % 5 year survival rate


EXPLANING THE NEED FOR A BIOPSY
- We need to take a biopsy to be able to come to a diagnosis
- We are unsure of what is exactly causing ?
- We want to ensure that the diagnosis is not a serious one
- If they ask whether thats a possibility say yes there is a chance
- We want to hopefully rule out anything serious
- I can understand how scary it is to not know what is happening, but we
are going to try get to the bottom of this
- The results will then allow us to then manage whatever this is
appropriately



SYSTEMATIC APPROACH STATION 2
There are a number of main components to consider in this station regardless of
the scenario. They are as follows:
- How to manage the scenario? :
- GDC Standards (Ethical Issues)
- Practical Issues
- Legal Issues
- Governance Issues

In the 5-minute preparation period, ensure you have considered each of these 5
components and have in mind your management strategy, backed up by the GDC
regulations.

HOW TO MANAGE THE SECNARIO
- Immediate Management
- Short term Management
- Long Term Management
These are all dependent on each scenario.




























EXAMPLE SCENARIOS
1. One of the Dentists at your VT practice informs your nurse that he regularly
enjoys a glass or two of wine at lunch. Your nurse informs you of this and on
the same day you note after lunch, the colleague returns to the practice
smelling of alcohol and arrives 30minutes late for patients. Your nurse tells
you this is a regular occurrence.

Useful Tips:
- HOW TO MANAGE THE SCENARIO: Put patient safety first
o Immediately call the colleague over prior to him seeing patients.
o Discuss the issues with him and advice he not see patients today
and organize transport home, manage his afternoon bookings
either via allocation to another person or cancellations.
o Discuss the incident with principal and VT trainer and indemnity
providers.
o Log incident in practice incident report book and your own
personal professional log.
o Support the colleague and advise they speak to someone about the
issue.
o Consider how to inform patients and whether other patients the
colleague has seen need to be reviewed to assess whether optimal
care has been provided for them.

- GDC STANDARDS: (relevant ones listed)
o Putting patients interests first
o Raising Concerns
o Teamwork
o Professional Behaviour

- PRACTICAL ISSUES
o Time (constantly running late)

- LEGAL ISSUES
o Negligence
o Fitness to Practice
o Complaints handling

- GOVERNANCE ISSUES
o Policy (on lunch and alcohol)
o Audit (lunch durations)







CONSENT SUMMARY
OVERVIEW
- Remember to respect patients dignity and choices
- Must obtain consent before touching the patient or carrying out any
treatment
- Ensure the patient is competent to give consent
- Informed consent = patient has received adequate information for consent to
be valid
- Explain:
1) Why proposed treatment is necessary
2) Risks
3) Benefits
4) What may happen if treatment is not carried out
5) Other treatments that may be needed as a consequence (e.g. crown
after RCT)
6) Cost (NHS vs Private)
7) Length of procedure
- Sometimes it is a good idea to gain consent for further treatment that may
need doing. E.g. Under sedation may see another tooth that needs treating,
but you dont have consent to treat it.
- Give a written treatment plan and cost estimate
- Give the patient enough time to make the decision
- No coercion or pressure should be placed on the patient
- Accept patients choice even if it is not necessarily the right choice

CHILDREN
- In the eyes of the law a person is an adult at the age of 18

16 & 17-YEAR OLDS
- People 16+ years of age, can consent to any form of surgical, medical or
dental treatment, without regard to parents wishes.
- Consent from 16 or 17 year olds can be overridden by a court in the patients
best interests
- Courts and parents can overrule refusal of treatment by a 16 or 17 year olds

CHILDREN UNDER 16
- Can consent to treatment if deemed Fraser competent (old name: Gillick
competent)
- Fraser competent if child can achieve a sufficient understanding and
intelligence to enable him or her to understand fully what is proposed
- Courts can overrule a child <16 years of age ability to consent or refusal of
treatment
- Parents can only overrule a child <16 years of age ability to refusal of
treatment
- Parents can consent to treatment and refusal of treatment if the child <16 is
deemed not Fraser competent
- Consent only has to be acquired from one parent to proceed with
treatment if it is in the childs (<16) best interests. Though the matter can
be referred to the Official solicitor who will make an application to the court
if there is a difference in opinion.
- A court can intervene if in its opinion the parents decision is not in the
childs best interests. So the court can have overriding power over the
parents decision.


CONSENT AND THE INCOMPETENT PATIENT
A patient lacks capacity if they:
- Cannot understand relevant information
- Weigh up relevant information
- Retain relevant information long enough to make the decision
- Communicate their decision through talking, sign language etc.

Temporary incompetence: Unconscious, affected by alcohol/ other
medications
- Postpone treatment or investigations until patient is competent to consent
- Exception: if condition/illness could be potentially life threatening (act in
patients best interests)

Permanent incompetence: dementia or Alzheimers, profound learning
difficulties, certain forms of mental health
- Act in patients best interests (only if treatment to be carried out will save
their life, ensure improvement or prevent deterioration in the patients
physical or mental health)

Proxy consent to medical treatment (lasting powers of attorney Act)
- A person when competent (the donor)
- May confer authority (to the donee(s)- who must be 18+ years old)
- So that the donee can make decisions about specified matters of personal
welfare and property (if the donor becomes incompetent in the future)
- The process of conferring this authority must be properly registered
- The donee can then consent to the giving or rejection of treatment (if life
sustaining, must be specifically specified)



SITUATIONAL JUDGEMENT TEST


OVERVIEW:
56 questions in 90 minutes
Time is tight so work efficiently
6 questions for evaluation purposes only (this may have changed)
Counts for 50% of final score
Scored against a pre-determined key
SJT focuses on non-academic/ professional attributes (integrity,
empathy, resilience, team involvement)

STRUCTURE:
o Hypothetical dental scenarios you might find yourself in during
your VT year.
o Choice of options from A-E
Rank in order of which you would do first down to which
you would do last/ not do.
OR
o Choose the three most appropriate answers for the following
scenarios:
Choose the three most appropriate answers
Those which you would do first/ best for the patient