Clinical Scenario 1
You are a Vocational Dental Practitioner/ Dental Foundation Trainee coming
towards the end of your Vocational Training/ Foundation Training year in
practice. You are asked to see a family who have recently registered with the
practice. A 9-year-old boy, Ben, who is in a wheelchair, arrives at the surgery
accompanied by an adult male. The medical history reveals Ben has cerebral
palsy. He is the eldest of four siblings.
The adult accompanying Ben reports that Ben has indicated he has
discomfort from the upper right area of his mouth, especially when eating. He
and Ben’s mother have found it very difficult to see inside Ben’s mouth and
generally find it very hard to brush his teeth properly.
You attempt an initial examination of Ben’s mouth but find access difficult and
Ben is unable to keep his head still. From the limited examination, you can
see widespread plaque deposits and generalised gingivitis. You are able to
identify caries on some of the primary molars, including in the upper right
quadrant, and staining on the occlusal fissures of all 4 first permanent molars.
There are no obvious swellings or sinuses. Ben would not be able to co-
operate with taking diagnostically acceptable bitewing radiographs.
Clinical Scenario 2
You are a newly appointed DCT in a busy
district general hospital. You are on-call and
are called to A&E to see a 12-year-old girl
who has presented with her mother with an
avulsed upper right central incisor wrapped in
tissue.
Clinical Scenario 3
You are seeing a 67-year-old patient in your
practice for the first time today.
When they remove their poorly fitting, acrylic,
partial upper denture, you notice that the
mucosa beneath the denture is markedly red
and inflamed.
Clinical Scenario 4
You are working as a DCT1 in a Community Dental Service. You
have a new patient for assessment, called Alex. He was referred
in by his general dental practitioner for management of a carious
LRE. The medical history included in the referral is clear. The
social history provided is that his mother is anxious of dentists.
Alex is a 7-year-old boy accompanied by a man called Eric, with
whom Alex appears to get on well. They are 5 minutes late for the
appointment. Currently there is no complaint of pain.
Alex sits on the dental chair and opens adequately to see a glass
ionomer dressing in LRE and other untreated caries. Oral
hygiene is fair and Alex is in the early mixed dentition.
Clinical Scenario 5
You are a trainee and have welcomed your patient into your
surgery for a new patient examination. After a short
discussion, before any treatment has commenced, it is
clear you have found they are showing clinical Covid
symptoms, despite the Covid risk screening management in
place.
You have been wearing full PPE for the duration of your
contact with the patient.
Clinical Scenario 6
You are working in an Oral and Maxillofacial Surgery Department
and are asked to see Paul, a 50-year-old Salesman, who has been
referred by a multi-disciplinary clinic having been diagnosed with a
tonsillar carcinoma which is to be treated solely by radiotherapy at
the present time. The patient is an irregular attender and is anxious
about receiving dental treatment.
Clinical examination reveals a complete dentition aside from all 1 st
and 3rd molars, with poor oral hygiene and a number of teeth with
carious lesions.
Clinical Scenario 7
You are working in a Restorative Dentistry Department and are
asked to see Rebecca, a 75-year-old retired midwife who has been
referred from her general dental practitioner. The referral letter states
that she has a 6-month history of pain in the lower right quadrant for
which the referring practitioner can find no cause. She has extensive
conventional fixed crown and bridgework covering all of her posterior
teeth which is approximately 15 years old.
On discussion Rebecca tells you that the pain is present every day
and points to a mandibular right 3 unit bridge which has abutments at
the first premolar and molar and replaces the right second premolar.
Clinical Governance, Quality Improvement & Professional Skills 1
“Clinical Governance is a quality assurance process designed to ensure that standards of
care are maintained and improved, and that the NHS is accountable to the public.”
You are working as a dental core trainee in the hospital dental service and are starting your
new rotation within the Oral Surgery Department today. Your first patient has been booked in
at 9am even though you had an induction meeting until 9.30am, and she is already in the
waiting room. The patient (Anna) is anxious about her visit so you welcome her and reassure
her that her appointment is for an assessment only and no treatment is being carried out
today. As you undertake your examination it becomes apparent that Anna is confused about
where she is and she is slurring her words. You realise in your rush to see the patient you had
not checked her medical history and you now discover she is a diabetic. On further
questioning you conclude Anna is having a hypoglycaemic episode and you are not familiar
with the location of the medical emergency kit. Your dental nurse is familiar with its location
and the medical emergency is managed appropriately with the patient recovering well. You
are now running very late for the rest of your clinic.
You decide to write this up as a significant event analysis (SEA).
Clinical Governance, Quality Improvement & Professional Skills 2
A 9-year-old girl is referred by their GDP into the Community Dental Service for
management of caries in an uncooperative patient. You are seeing her for the initial
assessment, as a DCT1.
You hear raised voices outside your surgery and the child is yelling at the receptionist
‘’ I’m not going to let them touch me. I’ll smack them if they come near me.’’ Her
mother appears embarrassed and shouts at her about her behaviour.
You invite them into the surgery and the child runs to the corner, hiding her face with
her hands and hair and refusing to listen or sit in the chair. You discuss with her
mother what the problem is and she says that she has seen holes in her daughter’s
teeth. Further investigation reveals that she refuses to brush her teeth at all and she
will only drink apple juice and eat snack foods.
Clinical Governance, Quality Improvement & Professional Skills 3
You are working as a DCT in a Dental Hospital. Today,
a third-year dental student has been observing you in
clinic. During an informal conversation, the student
admitted to you that she does not really understand
the meaning and significance of Clinical Governance.
She has asked if you would be able to give a tutorial
to her and a couple of her fellow students, to help
them to understand better what Clinical Governance
is all about .
Clinical Governance, Quality Improvement & Professional Skills 4
You have a new role as a DCT in a multi-clinic Community
Dental Service, having previously worked in general dental
practice. In general dental practice you had good results for
paediatric bitewings with traditional films.
The manager has bought digital sensors for your clinic to use
before rolling out to other clinics. You notice the standard of
your paediatric bitewings has decreased since the digital
sensors were introduced. Your Educational Supervisor has
arranged a meeting to discuss this with you.
Clinical Governance, Quality Improvement & Professional Skills 5
You are a trainee and have just completed a composite
restoration as a Clinical ‘Directly Observed Procedural
Skill’ Supervised Learning Event.
Although you feel the procedure went safely, you are not
quite sure why but you are not entirely happy with how it
went.
Your patient has left the clinic.
You are now receiving feedback of your performance from
your Clinical Supervisor.
Clinical Governance, Quality Improvement & Professional Skills 6
Your DFT colleague and peer in your practice has undertaken a patient
satisfaction questionnaire (PSQ). They confide in you and ask your advice as to
how they may approach the issues that have arisen.
The PSQ has highlighted a number of areas of concern relating to their
interaction with patients with the feedback suggesting that patients feel chastised
when they tell them off for not maintaining good oral hygiene and shames them
by going on about it.
There are comments in the PSQ that this is not an appropriate approach.
The practice nurses have also mentioned this to you .
He is due to meet with his Educational Supervisor for formal feedback.
Clinical Governance, Quality Improvement & Professional Skills 7
You are a DCT1 in a restorative department and you are assisting a
consultant carrying out an apicectomy of the UL2 (upper left lateral
incisor). You noticed the consultant was quite stressed this morning
when they came into work as they were running behind due to their
child being ill and didn’t have time to have their normal morning
breakfast and coffee.
A gauze ribbon is used in the cystic cavity to assist with haemostasis
whilst the root-end filling is being carried out. The consultant then
sutures the flap closed and starts removing their surgical gown and
gloves as they have finished. However, you don’t think you saw the
consultant remove the ribbon gauze from the cyst cavity before
closure.
