STATION 1

A 60-year-old retired farmer and his wife have both come to register for dental treatment, having
just moved into the area. You have finished examining the wife. You ask the husband to come into
the clinic. The husband slowly makes his way to the dental chair; he looks exhausted. He tells you he
has a pain in the upper right lateral incisor.

Dentist: Hi good morning.i am Dr Nasuha your dentist for today, first of all may I confirm your name
and age? **intonation

Patient: I am bla blaa

Dentist: And how would you like me to address you?

Pt : …..

Me : Nice to meet you. How are you today? Is there any problem that I can help with?

Pt : I have this pain on my upper tooth

Me : Im sorry to hear that, I must be a distressing situation for you. But please be assure that I will
do my best to help you today. Are you okay to proceed

Pt : …

Me : Great, I will begin by asking a few question to help me understand your condition today. Are
you okay with that?

Pt : okay no problem

Me : When do you start having it

Is this the first time it happened

Can you describe the pain?

Is it constant or come and go

Did it radiate to any other part of your body?

Did you notice anything that trigger the pain or aggravating the pain

What did you do to relieve it?

Do you notice any associated symptom with the pain?

From scale of 1 to 10 how would you rate the pain like 0 is no pain at all and 10 is most painful
pain experience in your life

Did you get any treatment for the pain prior to coming here

I need to move to your medical history, Do you have any medical illnesses

When was it diagnosed,

Is it well controlled?
What treatment are you receiving currently for that

Have you been hospitalised before

Do you take any medication currently? Prescribe or over the counter

Do you have any allergies, what reaction do you have to that substance

Can you recall any of your family member having medical illness, bleeding, diabetes or hypertension

Alright we move on to your dental experience, are you so far?

When was the last time you visit your dentist

How do you feel when you visit your dentist

What treatment are you receiving previously

Have been any complication before regarding the dental treatment?

Can you tell me how you take care of your oral hygiene at the moment

May I know what did you do for a living

What about your diet, do you take balance and enough meal

Can you describe your sugar intake

Do you have habit of smoking,? How many cigarette you take per day

Are you intested in quitting? I can refer you to smoking clinic.They will help you to achieve that

Do you take alcohol. How many unit

Okay thank you for your cooperation.

1. Its clear that you have given this a lot of thought and it would be helpful to hear what
you think might be going on

2. What is your number one concern regarding this problem at the moment?

3. What were you hoping I’d be able to do for you today?

What I think right now u might be having bacterial infection in your nerve of part of your tooth called
irreversible pulpitis, sorry for the dental jargon.

I will proceed with an examination of your oral condition and may conduct a test called pulp
sensibility test for you. It is to check your nerve reaction of the tooth. One more I will order xray
investigation the see the condition of the root tip to see any sign of infection happened in there.

Don’t worry as both of them are routine and completely painless.

So after doing all the the test and we get a final diagnosis and I will discuss treatment plan with you.
Its very important that we control your pain and make sure you are comfortable, this is the utmost
important of the visit today.

If I noticed it’s a cavity during examination and the investigation result and test come out as
normal, treatment option would be decay removal followed by a filling.We would removed the
decay and place a filling.I will review you after 1 week.

If during examination, I found huge decay and investigation showed bacterial infection, the
treatment option would be root canal treatment where I will removed the nerve part of your tooth
and put some medication in it in order to relieve the pain. You need to come for 2 nd visit to complete
the treatment after 1 week.

The third option is extraction, it is usually done if the tooth is extensively broken down and filling
would be a poor outcome.We will take out under numbing medication to make sure it painless.

How does that sound, are you happy to proceed?

Do you have any question to ask

STATION 2

You enter the OSCE examination room to be faced with a middle-aged lady. The actor/patient has

attended for an extraction of a tooth that has been causing her discomfort for some time and she
would

like this extraction to be completed today. She does have a relevant medical history with items of

note.

Question

Can you extract the patient’s tooth today?

Hi good morning im Dr Nasuha your dentist for today session. First of all, may I confirm your name
and date of birth madam

How would you like me to address you?

I were informed that you are here for dental extraction, may I know what was the reason you want
to extract the tooth? (PAIN VS MOBILITY)

PAIN -SOCRATES

MOBILITY- When noted, Which, Pain?, Uncomfortable, gradually?,

Now I’d like to discuss your past medical history and medication you take

1.Do you have any medical condition/ illnesses ( Liver, kidney,clotting disorder)

Liver impairment – When diagnosed, what tx are you receiving now, where follow up, any surgical
intervention

Kidney failure- When diagnosed, what tx you are receiving, where follow up, surgical intervention

Blood clotting- What type, tx , where followup

3.Do you have any allergies/ what kind of reaction to the substance (Penicilin)

4.Are you taking any medication( warfarin )

-Why you took warfarin

-When was the last time you took your INR reading (last week)

Any other illnesses? Heart, muscle, skin, diabetes, hypertension?

DENTAL HISTORY
Okay we move on to your dental history
1.When was the last time you visit you dentist?-Are you a regular attendee
2.What do you feel when visiting your dentist
3. What tx have been done previously – how do you feel about the tx
 Can you tell me how a bit how you look after your oral hygiene at the moment

 Toothbrushing: frequency, duration, time of day, type of brush used, type of toothpaste

used and use of rinsing.
 Interdental cleaning: frequency, devices used (e.g. floss), interdental brushes, single-
tufted brushes and toothpicks.
 Mouth rinse: frequency and time of use (e.g. after brushing).

FAMILY HISTORY
1.Do your immediate family member have medical ilnesess

SOCIAL HISTORY
Do you spending a couple of minutes talking about
1. Smoking – past or current , how many per day
2. Record the frequency, type and amount of alcohol consumed (

Thank you for your cooperation.

Madam X, I understand that you really want to have your tooth to be extracted today but im sorry to
informed you that the extraction cannot be done until we have record your latest INR reading. This is
because we don’t want to have you exposed to risk of post-extraction bleeding if we continue
without taking account of the reading. For INR, we would like the number to be in range of 2-4 to be
considered it safe for you and the bleeding would be controllable.

According to what you told me, your last INR reading was 3 weeks ago..for dental extraction to be
safe, I need the value taken ideally 72 hours prior todays extraction. But if you still want the
extraction to be done today, I recommended that you visit your GMP and get the INR reading for
today.If it is in the acceptable range then we can proceed

Antibiotic??

Im sorry I cannot prescribed to you antibiotic since there is lack of evidence that antibiotic will help
your condition today and we don’t want you to develop antibiotic resistance

What if I stop taking warfarin, can you exceed with the extraction?

It is really unadvised that you stopped taking the warfarin, as this might pose you the risk of
blockage in your blood vessel. If blockage are in brain, you might have stroke, if it happen in lung you
will have trouble breathing, if it happen in lower extremites you might have DVT.

What if I caught pain after this?

Don’t worry, I wil prescribed you painkiller paracetamol for few days until you can get your INR
reading. This is the safest painkiller for you at current being as you are having liver and kidney
impairment.

Do you have any question or other concern?