ORE Part 2 Patient Management 2 — Questions and Answers
Question 1: A patient discloses that they are HIV positive before treatment. How should this affect your approach to clinical care?
- Refuse treatment and refer to a specialist unit
- Treat the patient with standard infection control precautions, which should be applied to all patients equally (Correct answer)
- Require additional blood tests before proceeding
- Wear double gloves and a face shield only for HIV-positive patients
Correct answer: Treat the patient with standard infection control precautions, which should be applied to all patients equally
Standard (universal) infection control precautions should be applied to ALL patients regardless of their known or suspected infection status. This is the cornerstone of cross-infection control in dentistry. Refusing treatment based on HIV status would constitute unlawful discrimination under the Equality Act 2010. HIV-positive patients should receive the same standard of care as any other patient.
Question 2: What is the recommended action if a dental professional suspects a child is being abused or neglected?
- Confront the parent directly during the appointment
- Document the findings and refer to local safeguarding services or social care, following the practice's safeguarding policy (Correct answer)
- Wait for the child to disclose abuse before taking action
- Discuss the concern with other patients for advice
Correct answer: Document the findings and refer to local safeguarding services or social care, following the practice's safeguarding policy
Dental professionals have a duty of care to report suspected child abuse or neglect. The correct procedure is to document clinical findings objectively (including intraoral and extraoral injuries), follow the practice's safeguarding policy, and make a referral to local authority children's social care or the NSPCC. The GDC Standards require registrants to take action to protect vulnerable patients.
Question 3: What is the maximum period a dentist can prescribe a Schedule 2 controlled drug (e.g., midazolam) for in the UK?
- 7 days
- 14 days
- 28 days
- 30 days (Correct answer)
Correct answer: 30 days
In the UK, prescriptions for Schedule 2, 3, and 4 controlled drugs are valid for 28 days from the date on the prescription. The prescription must be written in indelible ink, include the patient's full name and address, the total quantity in words and figures, and be signed and dated by the prescriber. Dentists can prescribe controlled drugs within their competence.
Question 4: During a Duty of Candour disclosure, what must a dental professional communicate to a patient after a notifiable safety incident?
- Nothing — the practice's lawyer should handle all communication
- A truthful account of what happened, an apology, and what will be done to prevent recurrence (Correct answer)
- Only that an error occurred, without providing details
- Written communication only, never face-to-face
Correct answer: A truthful account of what happened, an apology, and what will be done to prevent recurrence
The professional Duty of Candour (GDC Standards, Principle 2) and the statutory Duty of Candour (for CQC-registered practices) require an honest, open, and timely account of what happened, a sincere apology (which is not an admission of liability), and an explanation of what actions will be taken to prevent recurrence. Face-to-face communication is preferred for serious incidents.
Question 5: Which medical emergency drug in the dental practice emergency kit is used to treat an acute asthma attack?
- Adrenaline (epinephrine) 1:1000
- Salbutamol inhaler (100 micrograms per actuation) (Correct answer)
- Oral glucose gel
- Midazolam oromucosal solution
Correct answer: Salbutamol inhaler (100 micrograms per actuation)
Salbutamol (a short-acting beta-2 agonist) inhaler is the drug of choice for acute asthma in the dental practice. It causes bronchodilation by relaxing bronchial smooth muscle. It should be administered via a spacer device (2–10 puffs). If the patient's own inhaler is unavailable, the practice emergency kit must contain one.
Question 6: A patient attending for routine treatment mentions they are 14 weeks pregnant. Which of the following dental treatments should ideally be avoided during the first trimester?
- Dental examination and oral hygiene advice
- Emergency treatment for pain relief
- Elective radiography that is not urgently indicated (Correct answer)
- All dental treatment until after delivery
Correct answer: Elective radiography that is not urgently indicated
While dental treatment is generally safe during pregnancy, elective radiography should be avoided during the first trimester when organogenesis is occurring, unless clinically urgent. The second trimester is considered the safest period for elective dental treatment. Emergency treatment, examinations, and oral hygiene care should not be delayed at any stage of pregnancy.
ORE Part 2 Patient Management 2
A patient discloses that they are HIV positive before treatment.
How should this affect your approach to clinical care?