1|Page
50 MFDS/MJDF OSCE
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Scenario - You are a GDP and have obtained the results for a biopsy you performed on
a floor of mouth white patch a week ago. Your patient is a heavy drinker and smoker.
He returns for the results and says the area is now ulcerated. The histopathology reveals
dysplasia and a plasma cell infiltrate. Tell the patient what the results mean and what
you will do next
1) In traduce yourself to the patient
2) Explain the pt about the biopsy result
As you are aware that last time a sample was taken from your mouth to do some tests, I have received the results
of the tests.
The good thing about the result is that it’s not cancerous but the bad thing about the report is that it’s not
something normal as well it’s called something as dysplasia
3) Explain the pt about dysplasia
I will explain you what is dysplasia. Assume at 1 end is the normal oral mucosa and the other end is cancerous
lesion, something in between is called as dysplasia. This means that your oral mucosa is not normal and it’s not
cancerous as well.
4) Explain the pt about removing the risk factors
So you see it is in your hand weather this dysplasia goes towards cancer or it comes back to the normal side. To
make this condition stop progressing towards cancer you have to remove the factors which can help in getting
this condition worse
The two factors are your smoking habit and your drinking habit. You have to quit smoking completely and
reduce your alcohol consumption to minimum. By doing this you are helping yourself in making this condition
better
5) Offer referral for quit smoking services
If you want I can refer you to quit smoking services who are trained people to help you get rid of this habit
5) Explain the pt about other measures
Apart from quitting smoking and reducing alcohol consumption, you have to see that you take care of ypur
mouth properly by brushing your teeth twice daily and keeping ypur mouth clean all the time
6) Explain management to the pt
For this problem you have 2 options
Either you get it removed surgically for which I can refer you to specialist or
You can just keep an eye on it and we will monitor it regularly and at any time if you noticed it is getting worse
or causing any problems you can come to us and we will refer you for surgical removal
7) Have you got any questions
Scenario - Mr Norman is a heavy smoker with advanced periodontal disease. You had
to counsel and advice regarding behavioural change—specifically giving up cigarettes
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1) Introduce yourself to the pt
2) Take a concise history about the smoking habit
- How many cigarette you smoke every day and for how long you are smoking.
-How soon after waking up you smoke your first cigarette?
-Do you want to quit smoking for good now or in future?
-Have you tried to quit before?
-Do you want help with your attempt to quit smoking?
-What is the reason for your smoking is it a habit or do you smoke when you are stress or do you smoke
socially?
3) Explain the pt link between smoking and periodontitis
As you are aware that you suffer from gum disease, and for every problem there is a reason. Your smoking habit
is a risk factor for this gum problem. Smoking reduces your body ability to fight infections, smokers shows less
response to treatment and they have reduced blood supply to gums.
3) Explain the pt about the advantages of quitting smoking by putting some facts in front of the pt
-First I want to congratulate you for showing interest in quitting smoke
-Just to let you know that smoking is the largest single preventable cause of death and disability in U.K. Each
year smoking kills 120,000 people.
- Stopping smoking is the single most effective step you could take to improve your present state of health
- Smoking affects your oral as well as general health
4) Explain the pt about disadvantages if the pt continues to smoke
- It says that half of current smokers will die of smoking related diseases
- It can cause stained teeth, bad breath and oral cancer. It says smokers are 4 times likely to suffer from oral
cancer than non smokers.
- It can cause lung cancer and heart disease to name a few.
- And people around you will be affected by the smoke as well
5) Give the pt some tips on quitting smoking
- You should not feel dejected by your past failures in quitting smoking.
But it actually improve your chances of quitting smoking as people who keep on trying to quit are more likely to
quit smoking in the end.
- Try to set up a deadline and stick to it.
- I will suggest you to take help from your family and friends in this matter.
6) Offer referral for quit smoking services
- I can refer you to NHS stop smoking service.
- NHS stop smoking service trained adviser will work with you either in group or one to one session to advise
you about nicotine replacement product like nicotine patch or other stop smoking medicines.
- During the sessions you can share your or listen or other people experience which is really helpful.
, 4|Page
- Or you can refer yourself for which I will give you the telephone number.
7) Have you got any questions for me?
Scenario – You have taken a periapical radiograph for Mrs Green but unfortunately its
cone cut. So take consent for a repeat radiograph from Mrs Green who is not happy
because of extra radiation with a repeat radiograph.
1) Introduce yourself to the pt
2) Explain the pt why you want to take a repeat radiograph
- I am sorry to say that we have to take one more radiograph as the last one which was taken is not of good
quality as the part of tooth which we need to visualise is missing.
- If we don’t take the radiograph it will be difficult for us to diagnose your problem and if we are not able to
diagnose it properly then we won’t be able to treat it effectively as well.
3) Address pt concerns
- I totally understand your concern about the effect of the extra radiograph. I will try to put some facts in front of
you.
- I just want to say you that as a health care provide we always try to work in the best interest of our patient and
we will never do anything which will harm our patient or put them under any risk.
- First of all before we take any radiograph we follow the recommendations put forward by international
commission on radiological protection, and they say that
There should be a justification to take radiograph and in your case we need it to diagnose your problem and treat
accordingly
The radiation dose should be kept as low as possible. To achieve this we use latest x-ray machines, fast x-ray
films and direct the radiation on the area of interest only
- Regarding your concern of cancer, the risk of getting cancer is very low, its 1 in 2 million to 1 in 20 million for
IOPA
4) Explain the pt that dose of 1 radiograph is very negligible
- According to ionising radiation medical exposure regulation, any patient should not be exposed to more than
(1msv) amount of radiation in 1 year. This is equivalent to more than 125 intra oral, so you can see by taking 1
extra radiograph will not cause you any problem
- Secondly the amount of background radiation we receive in this country every year (2.6msv) from travelling in
a car, sitting in front of television, using mobile and laptop is equivalent to more than 350 intra oral radiograph,
so you can see the dose of an extra radiograph is very minimal
5) Explain the pt the measures you are going to take to prevent this happening again
- I again apologize to you for taking a repeat radiograph. To prevent this happening in the future we take some
measures.
50 MFDS/MJDF OSCE
,2|Page
Scenario - You are a GDP and have obtained the results for a biopsy you performed on
a floor of mouth white patch a week ago. Your patient is a heavy drinker and smoker.
He returns for the results and says the area is now ulcerated. The histopathology reveals
dysplasia and a plasma cell infiltrate. Tell the patient what the results mean and what
you will do next
1) In traduce yourself to the patient
2) Explain the pt about the biopsy result
As you are aware that last time a sample was taken from your mouth to do some tests, I have received the results
of the tests.
The good thing about the result is that it’s not cancerous but the bad thing about the report is that it’s not
something normal as well it’s called something as dysplasia
3) Explain the pt about dysplasia
I will explain you what is dysplasia. Assume at 1 end is the normal oral mucosa and the other end is cancerous
lesion, something in between is called as dysplasia. This means that your oral mucosa is not normal and it’s not
cancerous as well.
4) Explain the pt about removing the risk factors
So you see it is in your hand weather this dysplasia goes towards cancer or it comes back to the normal side. To
make this condition stop progressing towards cancer you have to remove the factors which can help in getting
this condition worse
The two factors are your smoking habit and your drinking habit. You have to quit smoking completely and
reduce your alcohol consumption to minimum. By doing this you are helping yourself in making this condition
better
5) Offer referral for quit smoking services
If you want I can refer you to quit smoking services who are trained people to help you get rid of this habit
5) Explain the pt about other measures
Apart from quitting smoking and reducing alcohol consumption, you have to see that you take care of ypur
mouth properly by brushing your teeth twice daily and keeping ypur mouth clean all the time
6) Explain management to the pt
For this problem you have 2 options
Either you get it removed surgically for which I can refer you to specialist or
You can just keep an eye on it and we will monitor it regularly and at any time if you noticed it is getting worse
or causing any problems you can come to us and we will refer you for surgical removal
7) Have you got any questions
Scenario - Mr Norman is a heavy smoker with advanced periodontal disease. You had
to counsel and advice regarding behavioural change—specifically giving up cigarettes
,3|Page
1) Introduce yourself to the pt
2) Take a concise history about the smoking habit
- How many cigarette you smoke every day and for how long you are smoking.
-How soon after waking up you smoke your first cigarette?
-Do you want to quit smoking for good now or in future?
-Have you tried to quit before?
-Do you want help with your attempt to quit smoking?
-What is the reason for your smoking is it a habit or do you smoke when you are stress or do you smoke
socially?
3) Explain the pt link between smoking and periodontitis
As you are aware that you suffer from gum disease, and for every problem there is a reason. Your smoking habit
is a risk factor for this gum problem. Smoking reduces your body ability to fight infections, smokers shows less
response to treatment and they have reduced blood supply to gums.
3) Explain the pt about the advantages of quitting smoking by putting some facts in front of the pt
-First I want to congratulate you for showing interest in quitting smoke
-Just to let you know that smoking is the largest single preventable cause of death and disability in U.K. Each
year smoking kills 120,000 people.
- Stopping smoking is the single most effective step you could take to improve your present state of health
- Smoking affects your oral as well as general health
4) Explain the pt about disadvantages if the pt continues to smoke
- It says that half of current smokers will die of smoking related diseases
- It can cause stained teeth, bad breath and oral cancer. It says smokers are 4 times likely to suffer from oral
cancer than non smokers.
- It can cause lung cancer and heart disease to name a few.
- And people around you will be affected by the smoke as well
5) Give the pt some tips on quitting smoking
- You should not feel dejected by your past failures in quitting smoking.
But it actually improve your chances of quitting smoking as people who keep on trying to quit are more likely to
quit smoking in the end.
- Try to set up a deadline and stick to it.
- I will suggest you to take help from your family and friends in this matter.
6) Offer referral for quit smoking services
- I can refer you to NHS stop smoking service.
- NHS stop smoking service trained adviser will work with you either in group or one to one session to advise
you about nicotine replacement product like nicotine patch or other stop smoking medicines.
- During the sessions you can share your or listen or other people experience which is really helpful.
, 4|Page
- Or you can refer yourself for which I will give you the telephone number.
7) Have you got any questions for me?
Scenario – You have taken a periapical radiograph for Mrs Green but unfortunately its
cone cut. So take consent for a repeat radiograph from Mrs Green who is not happy
because of extra radiation with a repeat radiograph.
1) Introduce yourself to the pt
2) Explain the pt why you want to take a repeat radiograph
- I am sorry to say that we have to take one more radiograph as the last one which was taken is not of good
quality as the part of tooth which we need to visualise is missing.
- If we don’t take the radiograph it will be difficult for us to diagnose your problem and if we are not able to
diagnose it properly then we won’t be able to treat it effectively as well.
3) Address pt concerns
- I totally understand your concern about the effect of the extra radiograph. I will try to put some facts in front of
you.
- I just want to say you that as a health care provide we always try to work in the best interest of our patient and
we will never do anything which will harm our patient or put them under any risk.
- First of all before we take any radiograph we follow the recommendations put forward by international
commission on radiological protection, and they say that
There should be a justification to take radiograph and in your case we need it to diagnose your problem and treat
accordingly
The radiation dose should be kept as low as possible. To achieve this we use latest x-ray machines, fast x-ray
films and direct the radiation on the area of interest only
- Regarding your concern of cancer, the risk of getting cancer is very low, its 1 in 2 million to 1 in 20 million for
IOPA
4) Explain the pt that dose of 1 radiograph is very negligible
- According to ionising radiation medical exposure regulation, any patient should not be exposed to more than
(1msv) amount of radiation in 1 year. This is equivalent to more than 125 intra oral, so you can see by taking 1
extra radiograph will not cause you any problem
- Secondly the amount of background radiation we receive in this country every year (2.6msv) from travelling in
a car, sitting in front of television, using mobile and laptop is equivalent to more than 350 intra oral radiograph,
so you can see the dose of an extra radiograph is very minimal
5) Explain the pt the measures you are going to take to prevent this happening again
- I again apologize to you for taking a repeat radiograph. To prevent this happening in the future we take some
measures.
