Infection Prevention & Decontamination
14%of exam
HTM 01-05Autoclave Type BStandard PrecautionsSharps Injury ProtocolAmalgam Waste Mercury
Dental & Regional Anatomy
9%of exam
FDI NotationPrimary vs Permanent TeethTrigeminal Nerve V1-V3Periodontal Ligament
Oral Disease & Pathology
10%of exam
Medical Emergencies
11%of exam
BLS 30:2Anaphylaxis AdrenalineAsthma SalbutamolHypoglycaemia GlucagonMI Aspirin 300mgSeizure Midazolam
Radiography & Patient Assessment
8%of exam
IRMER 2017 Patient RulesIRR 2017 StaffBitewing RadiographBPE Scores 0-4
Restorative Dentistry & Materials
13%of exam
Amalgam Composition37% Phosphoric EtchGIC Fluoride ReleaseComposite Cure 450-470nmGutta-Percha ObturationRubber Dam Isolation
Prevention & Oral Health Promotion
7%of exam
Fluoride 1350-1500ppmSpit Don't RinseFissure SealantsSugar Frequency Risk
Professionalism, Law & Ethics
11%of exam
GDC 9 StandardsGillick CompetenceValid ConsentCPD 50hr/5yr Nurse
Pain & Anxiety Control
7%of exam
Lidocaine 2% + AdrenalineN2O/O2 SedationFlumazenil ReversalConscious Sedation Definition
Quick Facts
- Exam Body
- National Examining Board for Dental Nurses
- Written Exam
- 100 MCQ + EMQ questions, 2hrs
- OSCE
- 12 stations (7 workbook + 5 live)
- Pass Order
- Written exam must pass before OSCE
- Registration
- GDC registration as dental nurse
- Highest-Weight Domain
- Health, Safety & Infection Control, 14%
- Nurse CPD
- 50 verifiable hours per 5-year cycle
- Autoclave Standard
- Vacuum Type B, 134-137°C / 3 min
Decontamination Order
Clean then Inspect then Sterilise then Store always
CleanInspectSteriliseStore
Type B vs Type N Autoclave
Type B (vacuum)
- Vacuum removes air first
- Sterilises hollow instruments
- 134-137°C, 3 min
Type N
- No vacuum stage
- Solid instruments only
- Not for handpieces
Type B best for hollow instruments
Decontamination Sequence
- Instrument used on patient→Clean to remove debris(Before sterilising)
- After cleaning→Inspect for damage, residue(Check under light)
- Instrument passes inspection→Sterilise in vacuum autoclave(134-137°C, 3 min hold)
- After sterilisation→Store in clean, dry area(Away from contamination)
- Sharps injury occurs→Bleed, wash, dry, cover(Report immediately)
- Suspected reusable-instrument fault→Remove from service, report(Do not reuse)
Decontamination & PPE
- HTM 01-05
- Primary care decon standard
- Decon order
- Clean, inspect, sterilise, store
- Vacuum type B
- 134-137°C, 3 min hold
- Standard precautions
- All fluids treated infectious
- Sharps first aid
- Bleed, wash, dry, cover, report
- Amalgam waste
- Mercury suppressant, licensed collection
- Hand hygiene
- Most effective cross-infection measure
Tooth Notation & Structures
- FDI tooth 16
- Upper right first molar
- Primary dentition
- 20 teeth, no premolars
- Permanent dentition
- 32 teeth total
- Trigeminal nerve
- V1 ophthalmic, V2 maxillary, V3 mandibular
- LA target nerves
- V2 and V3 branches
- Periodontal ligament
- Anchors cementum to bone
- PDL function
- Proprioception, shock absorption
Gingivitis vs Periodontitis
Gingivitis
- Reversible inflammation
- No attachment loss
- Bleeding on probing
Periodontitis
- Irreversible bone loss
- PDL destruction occurs
- Needs periodontal therapy
Attachment loss marks periodontitis
Caries & Periodontal Disease
- Critical pH
- 5.5 demineralises enamel
- Stephan curve
- Plaque pH drop post-sugar
- Gingivitis
- Reversible, no attachment loss
- Periodontitis
- Irreversible bone and PDL loss
- Oral cancer red flag
- Ulcer >3 weeks, rolled margins
- Cancer risk factors
- Tobacco and alcohol synergy
- Plaque
- Soft bacterial biofilm
- Calculus
- Mineralised plaque, needs scaling
Plaque vs Calculus
Plaque
- Soft biofilm
- Removable by brushing
- Causes caries
Calculus
- Mineralised plaque
- Hard deposit
- Removed by scaling
Calculus is mineralised, needs scaling
BLS Key Numbers
30 compressions, 2 breaths, 100-120 per minute, 5-6cm deep
30:2100-120/min5-6cm
Medical Emergency Recognition
- Wheeze, breathless, tight chest→Salbutamol inhaler via spacer(Repeat if needed)
- Swelling, rash, breathing difficulty→IM adrenaline 500mcg 1:1000(Call 999, repeat 5 min)
- Shaky, sweaty, confused, conscious→Oral fast-acting glucose(Recheck in 10 minutes)
- Unconscious, known diabetic→IM glucagon 1mg(Then call 999)
- Chest pain, suspected MI→Aspirin 300mg chewed(Oxygen, reassure, call 999)
- Seizure over 5 minutes→Buccal midazolam(Protect from injury, call 999)
- Sudden collapse, unresponsive→Start BLS 30:2(100-120/min, 5-6cm depth)
Emergency Drugs & Doses
- BLS ratio
- 30 compressions, 2 breaths
- BLS rate/depth
- 100-120/min, 5-6cm deep
- Anaphylaxis drug
- IM adrenaline 1:1000
- Anaphylaxis dose
- 500mcg, repeat after 5 min
- Asthma
- Salbutamol inhaler via spacer
- Hypoglycaemia (conscious)
- Oral fast-acting glucose
- Hypoglycaemia (unconscious)
- IM glucagon 1mg
- Suspected MI
- Aspirin 300mg, chewed
- Seizure >5 min
- Buccal midazolam, call 999
IRMER 2017 vs IRR 2017
IRMER 2017
- Protects the patient
- Justifies each exposure
- Defines referrer/practitioner/operator
IRR 2017
- Protects staff, public
- Radiation safety at work
- Dose limits, monitoring
IRMER protects patients, IRR protects staff
Radiography & Screening
- IRMER 2017
- Protects the patient
- IRR 2017
- Protects staff and public
- Bitewing
- Interproximal caries, crestal bone
- BPE score 4
- 6mm+ pocket, advanced disease
- BPE range
- 0 healthy to 4 severe
- Warfarin flag
- Bleeding risk, check INR
Composite vs Amalgam
Composite
- Tooth-coloured, light-cured
- Needs acid etch
- Bonds micromechanically
Amalgam
- Silver-coloured, self-cure
- No bonding agent
- Mechanical retention only
Composite bonds, amalgam is mechanical
Dental Materials
- Amalgam
- Mercury, silver, tin, copper
- Etchant
- 37% phosphoric acid
- Etch purpose
- Removes smear layer, bonds composite
- GIC
- Bonds tooth, releases fluoride
- Composite cure light
- 450-470nm blue wavelength
- Gutta-percha
- Root canal obturation material
- Rubber dam
- Isolation, airway protection
GIC vs Composite
GIC
- Releases fluoride
- Chemically bonds tooth
- Good caries-risk choice
Composite
- Stronger, aesthetic
- No fluoride release
- Needs etch and bond
GIC releases fluoride, composite doesn't
Toothpaste Fluoride Levels
Under 3 a smear, age 3 to 6 pea-sized
<3: smear3-6: pea-size1000ppm+
Prevention & Fluoride
- Adult toothpaste
- 1350-1500ppm fluoride
- Under-3 toothpaste
- Smear, 1000ppm+ fluoride
- Age 3-6 toothpaste
- Pea-sized, 1000ppm+ fluoride
- Spit don't rinse
- Keeps fluoride on teeth
- Caries risk driver
- Sugar frequency over amount
- Fissure sealant
- Seals posterior pits, fissures
GDC First Principle
Patients' interests always come first before anything else
Principle 1Patient-centredGDC Standards
Consent & Capacity Check
- Patient is an adult→Assume capacity unless evidence(Confirm voluntary, informed choice)
- Patient under 16→Assess Gillick competence(Case-by-case clinician judgement)
- Child not Gillick competent→Obtain parental/guardian consent(Person with parental responsibility)
- Adult lacks capacity→Apply best-interests decision(Mental Capacity Act 2005)
- Unsure about capacity→Seek senior/GDC guidance(Document reasoning clearly)
GDC & Consent
- GDC Principle 1
- Put patients' interests first
- Registration body
- GDC, not NEBDN
- Gillick competence
- Under-16 consents if understands
- Valid consent
- Voluntary, capacity, informed
- Nurse CPD
- 50 hours per 5 years
- SAR response time
- One month, usually free
Inhalation vs IV Sedation
Inhalation (N2O/O2)
- No reversal needed
- Rapid onset/offset
- Patient titrates own level
IV (midazolam)
- Flumazenil reverses it
- Needs IV access
- More monitoring required
IV sedation needs flumazenil reversal available
LA & Sedation
- Standard LA
- Lidocaine 2% + adrenaline 1:80,000
- Sedation gas
- Titrated N2O/O2 mixture
- Conscious sedation
- Responsive to verbal command
- Midazolam reversal
- Flumazenil, IV sedation only
- IHS purpose
- Relaxation, patient stays conscious
Common Traps
GDC vs NEBDN Confusion
NEBDN awards qualification ≠ GDC registers the professional
Gingivitis Reversibility Myth
Gingivitis itself is reversible ≠ Periodontitis damage is not
Autoclave Temperature Mix-Up
Correct: 134-137°C, 3 min ≠ Wrong: assuming 121°C standard
IRMER vs IRR Swap
IRMER protects the patient ≠ IRR protects staff, public
Consent Age Assumption
Under-16s can still consent ≠ If Gillick competent, applies
Spit Don't Rinse Reasoning
Rinsing removes fluoride residue ≠ Not just about mess
Anaphylaxis Dose Confusion
Adult IM dose: 500mcg ≠ Not the IV dose
Last Minute
- 1.Written exam: 100 questions, 2 hours
- 2.OSCE: 12 stations after written pass
- 3.Autoclave: 134-137°C for 3 minutes
- 4.Anaphylaxis: IM adrenaline 500mcg, 1:1000
- 5.BLS: 30 compressions, 2 breaths
- 6.GDC registers nurses; NEBDN awards diploma
- 7.Fluoride toothpaste: 1350-1500ppm for adults
- 8.Spit out, don't rinse after brushing
- 9.Gillick competence: under-16 consent test
- 10.CPD: 50 hours per 5-year cycle
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