The principle of your practice calls you into his surgery on Wednesday morning asking you to cover the evening shift 2-8pm for the day after on Thursday. The associate who is supposed to cover the shift has called in sick. You explain you cannot cover it due to having plans to watch a comedy show with friends. The principle is upset by this and proceeds to cancel the associate’s patient list on the Thursday. The next day while queuing for the comedy show, you see the associate who called in sick in the queue ahead of you enjoying his night.

A woman calls reception at the practice and demands to know if her husband has attended and also wants details of his treatment. She sounds angry!

You are working a busy Friday with an associate who is feeling very unwell. He attended a dinner with friends yesterday and since then everyone has been sick with diarrhoea and vomiting.

You see some patient notes left on the front desk of reception. Every patient that enters the practice must sign in. A patient has entered and is looking at the details of the front cover of the notes. The patient then reaches over to have a closer look at these notes. The receptionist is oblivious to this as she is taking a call. All the other associates are very busy at the time you notice this.

You are sitting in the pub opposite your practice where you observe three of the practice nurses laughing and joking about a patient that was seen today. The patient could easily be identified from the conversation that you are overhearing. What do you do?

Your Educational Supervisor (ES) has agreed to complete a DOPS (Directly Observed Procedural Skills) reflection for you on your EPDP but has not yet done so. The deadline for completion of all assessments is approaching.

The ultrasonic handpiece has stopped working in your You notice that your afternoon clinic involves several periodontal patients; all needing root surface debridement subgingivally. What do you do?

A 40 year-old mother of two children comes for treatment in the practice you work At her last visit, you referred her to the Oral Medicine department in the local hospital to assess a persistent ulcer in the floor of mouth. Her biopsy has been taken but she is still awaiting results. She is visually worried and asks you ‘’what will happen if I have cancer?’’

You have been working at the practice for 6 months, during your lunch hour you walk into your surgery to see your nurse taking impressions on another nurse. The 2 nurses are not qualified to take impressions, but when you ask them what is going on, they said they are taking impressions for their whitening trays.

You are seeing a new patient who asks if you can replace his sound silver fillings with white fillings on his posterior teeth under the NHS. He goes on to say that he will allow you to take photos of it for your portfolio and, as you are young, you will need this to promote your skills.

It is coming to the end of your DFT year – you and your colleagues are aspiring to gain associate positions in good practices. You notice one of your friends has opened a social media account posting patient photos and videos. You notice that in some photos, which include laboratory work, you can work out a patient’s full name. What do you do?

Your practice manager has asked you to refer more patients to the Hygienist, she said you are doing too many scales yourself, and she wants you to get the Hygienist book full.

Your receptionist keeps booking in an emergency patient with you at the end of the day as the other associates in the practice are refusing to see them. Some of these emergency appointments are double booked with your routine appointments. Your nurse is becoming increasingly frustrated with always finishing late, and recently you and some of your patients have noticed it, with your last patient even mentioning it to your receptionist on the way out.

You have noticed that your receptionists are discussing patients, sometimes in a negative way as soon as they leave the practice. They are doing this in front of other patients in the waiting room and are loud enough for you to be able to hear as you pass by.

Your TPD advises you on your first study day that you are not to do private work as a priority but should concentrate mostly on the NHS aspect of dentistry. However, when you start your DFT training you get the feeling your Educational Supervisor is pushing a lot of private work on you. What do you do?

You have been working with a trainee nurse as your usual nurse has gone off sick; her impression mixing is leaving a lot to be desired. In many cases, the alginate mix is too runny, or is setting too quickly causing delay for the patient and yourself.

Your nurse tells you after an appointment how bad at communicating you She says you need to speak slower, explain what you are doing methodically and if that was her she would not have felt reassured in your clinical assessment. What do you do?

Your head nurse is constantly telling you the way you do treatment is not how everyone else does. You feel like you are carrying out treatment correctly, but the nurse undermining you is making you feel less confident and is also making your patients lose faith in you. You are starting to doubt yourself.

You are 2 months into your DFT year, you have been using the same lab to make your crowns as every other associate in the practice, however the crowns you receive back aren’t as good as you would You are making too many adjustments, and in some cases having to remake the crowns altogether. You phone the lab to discuss why this is happening, with the dental technician. She tells you, in a rather abrupt manner, that your impressions are awful and if you want better crowns you need to provide better quality work.

A new patient with poor oral hygiene and some cavities asks you to whiten their teeth. What would you do?

In your third week you have received patients from an associate’s books, all of the patients seem to have a BPE recording of 2 in every sextant. Many of these patients have active Periodontal disease, and when you take the recording you are getting scores of 4, and can visibly see mobile teeth.

You are part way through your DFT year and you are really keen to secure a Dental Core Training (DCT) post for next year. With a few days left to prepare you are feeling rather overwhelmed in balancing working in practice and trying to study. The stress of the impending interview is beginning to affect your concentration levels, and is not allowing you to give your all to the patients you are seeing. So much so, that while writing up the notes for your last patient you notice you failed to diagnose fairly clear caries from the BWS taken.

You are 8 months into your DFT year. After a recent study day you realise you are substantially behind on UDA numbers in comparison to colleagues in your scheme. Although you are salaried this year, you are keen to work in practice next year as an associate. You begin to feel really stressed and overwhelmed as you consider the prospect of UDA targets, and as a result feel like you may be rushing your treatments to catch up.

You are having trouble placing your rubber dam on a patient who has attended for an RCT, you asked your ES to help, but he said that he does not use a rubber dam for RCTs and so is not completely competent in placing them.

You are midway extracting a lower right molar when the tooth breaks coronally and all you can see are the retained roots, which are embedded under the gingival level. This procedure will need surgical intervention. Your Educational Supervisor is off sick for the day. As an undergraduate, you only completed one surgical extraction and it was under supervision.

A schoolteacher arrives at reception with one of the schoolchildren as an emergency. She shows you the child’s tooth (UR1), which is in a solution in a small pot. The teacher informs you the tooth avulsed 20 minutes ago. The tooth is not fractured. This is the first time you have come across an avulsed tooth.

Once a week you are required, alongside another dental foundation colleague, to attend a tutorial with the rest of your scheme. These are mandatory tutorials. If missed, they will have to be re-attended. There is a tutorial that a DFT colleague and friend does not want to attend due to other commitments and asks if you can sign in for them. They explain that they will ‘owe you one’.

You are completing a CQC outcome report for your practice when you realise that the compliance for less abled people such as ramps into the practice and disabled toilets is poor. There is no CQC lead for “access” to the practice and the last audit done on access was over ten years ago. When you ask the practice manager why there is no disabled access or focus on this she says the owner’s ethos is not to treat disabled people. What do you do?

You have just irrigated a wisdom tooth of a patient that has pericoronitis. After the irrigation, you realise that the syringe was filled with Local Anaesthetic and not Saline as you asked The nurse has handed you the wrong equipment.

Your nurse has a nursing examination in the next week. She spends most of the day in the staff room revising rather than nursing for your patients causing you to run very late and disrupting your clinic. This is becoming a frustrating issue for yourself and your nurse does not seem to care.

Mrs Jones is a 56-year-old patient who has come in several times for severe pain regarding a root canal treated upper left first molar. You suspect a root fracture but cannot be sure by your clinical or radiographical examination. You give the option to the patient to see a specialist for a second opinion and potential root canal therapy or have the tooth extracted. You make her aware that re root treatment in this case is beyond your capabilities. Mrs. Jones disagrees – she does not want to see another dentist and she wants you to start a re-root canal treatment now. Your ES is not present and has a CPD day.

Mr Paul Jackson is a 75-year-old patient with dementia that requires several restorations to be placed. Paul usually comes in with his son Johnny and a carer to help with his mobility. His son Johnny is the legal power of attorney for Mr Jackson. Johnny means well – but does question every decision and procedure you provide two or three times at every visit. During treatment you failed to anaesthetise the ID nerve despite being successful at the second attempt. This had led to minor bruising and Johnny would like to make a formal complaint as he feels you made a mistake.

You have received a letter in the post requesting you carry out Jury Service. You are coming to the end of your DFT year and have a few patient cases you are keen to complete before you leave. You had been asked previously to carry out Jury Service but you were able to defer it as you were on holiday.

You are 4 months into your DFT year and your ES has booked a two-week holiday. He has given an associate, Carly, strict instructions on offering you support. You have always been wary of Carly and she has not been keen to help. While your ES is away, Carly has been difficult to approach; speaking rudely to you in front of patients and making you feel very stressed and uncomfortable. You walk into the staff room where you hear her telling the nurses that she is fed up of you asking her questions as she has a job to do too.

You have recently noticed that your personal issues at home have started to affect your clinical performance. Your practice manager has not told you that she has noticed a behaviour change in you. However, you notice she has started to become very abrupt and isolating towards you.

An associate has recently been undermining you and putting you down in front of other colleagues and occasionally patients. He is in a junior position, however is a valued member of the team and you are aware he is looking for more responsibility within the practice.

You have just started an examination on a new patient and asked about their medical history. They pause and give you an awkward stare. They go on to say quite aggressively they do not have to disclose their medical history and would like you to continue with the examination. The patient’s presenting complaint was intermittent pain from the LL quadrant and also said it’s been a long time since he has had a clean. 

You are finishing typing up your last patient’s notes before lunch when you hear shouting coming from the waiting room. You are the only dentist in the practice at that time and your receptionist is struggling to deal with the situation. It transpires one of your practice principal’s patients is in the waiting room and is angry because he has a tooth, which now requires extraction as a result of a failed root canal treatment. The principal is not in the practice today. What should you do?

Your ES is not at work today. The receptionist asks you to speak to a patient’s son who has turned up in the waiting room and appears angry. The patient is not present. He tells you outright that he is recording the conversation he is about to have with you for legal purposes and threatens to take ‘further action’. He has a number of questions about the way the team in the practice have treated his mother, one being if it was necessary to take 6 Radiographs. (Choose the THREE most appropriate actions to take in this situation)

You notice that your nurse and receptionist are not getting on well and it has started to affect the atmosphere in the practice. Choose the 3 most appropriate options when considered together.

Since your CQC inspection last year, standards seem to have slipped. Your dental chair has broken several times and the other day you discovered that you had no latex free gloves in the entire practice. What should you do?

You attend your induction for your new DFT job and are asked to sign an agreement never to raise concerns with bodies outside of your employing organisation. 

You are required to attend a postgraduate study day on a Friday as part of your DFT course. Your educational supervisor has asked you to work this coming Friday as he is short staffed.

A 30-year-old female attends your surgery. She has injuries to her teeth and jaws and severe lacerations to her face. She discloses that her partner has assaulted her and is very tearful. What do you do?

Your patient experiences a vaso-vagal attack in the chair. You ask your nurse for a glucose drink but she looks at you blankly and says that she does not know where the glucose is kept. What do you do?

One of your patients discloses that he has a severe drug addiction problem and has also been thinking of self-harming. What do you do?

A senior associate is away on holiday. Your educational supervisor and you are seeing the associate’s patients whilst they are away as a goodwill gesture. You go to fit a crown when the patient presents with gross caries on the prep. The crown fits well.

You look ahead in your diary to the following week and notice that you have a study day scheduled and the reception staff have booked in a full day of patients in error on the same day. Study days are mandatory but you do not want to cause issues at your practice either. What do you do?

You are seeing a family of patients at the end of your day.

You notice:

• You only have 5 minutes per child and 20 minutes for the mother;
• There are seven children attending today;
• Children range in age from 3 years to 17 years;
• These are new patients.

You are seeing a child for an initial examination. When you write up the treatment plan, the parents disagree with majority of what is outlined and demand alternatives. The majority of alternatives for the teeth in question are to do nothing, which undoubtedly will cause pain, swelling or issues in the future for this child.