Membership of the Joint Dental Faculties (MJDF) Health Promotion, Prevention and Infection Control Syllabus

What is the difference between 'proportionate universalism' and a targeted approach to reducing oral health inequalities?

Proportionate universalism (Marmot) delivers actions universally but with intensity proportionate to need, addressing the whole social gradient; a targeted approach focuses resources only on the highest-risk groups, risking stigma and missing the broader gradient.

State the optimal concentration of fluoride in water fluoridation schemes in the UK.

$1\,\text{ppm}$ ($1\,\text{mg/L}$) fluoride is the target concentration for artificial water fluoridation in the UK.

What is dental fluorosis and at what stage of development does it occur?

Fluorosis is hypomineralisation of enamel from excess fluoride during tooth DEVELOPMENT (amelogenesis), appearing as white flecks/mottling to brown staining. It only arises before tooth eruption while enamel is forming.

Why is water fluoridation considered an effective public health measure against inequalities?

It is a population-level, passive intervention requiring no individual behaviour change, so it benefits everyone regardless of socioeconomic status and disproportionately benefits deprived groups, narrowing the inequality gap.

List examples of 'downstream', 'midstream' and 'upstream' preventive interventions.

Downstream: treating individuals (fillings, fluoride varnish). Midstream: targeting behaviours/settings (school toothbrushing schemes). Upstream: policy/structural measures (water fluoridation, sugar tax, advertising regulation).

In England, which body commissions NHS dental services and under what regulatory contract framework?

NHS commissioning of primary dental care (delegated to Integrated Care Boards since 2023, formerly NHS England) under the NHS (General Dental Services) Regulations, with activity measured in Units of Dental Activity (UDAs).

What is a UDA (Unit of Dental Activity) and how do the NHS treatment Bands map to UDAs in England?

A UDA is the measure of NHS dental activity per course of treatment. Band 1 (exam/diagnosis/prevention) = 1 UDA; Band 2 (fillings, extractions, root canal) = 3 UDAs; Band 3 (crowns, dentures, bridges) = 12 UDAs; urgent = 1.2 UDAs.

What is HTM 01-05 and to whom does it apply?

Health Technical Memorandum 01-05: 'Decontamination in primary care dental practices' — the Department of Health guidance setting standards for decontamination of reusable dental instruments in England. It defines 'essential' and 'best practice' requirements.

Distinguish the 'essential' and 'best practice' requirements of HTM 01-05.

'Essential' is the minimum mandatory standard all practices must meet. 'Best practice' represents the higher standard practices should progress towards (e.g. separate decontamination room, washer-disinfector, validated processes), aiming for full compliance over time.

List the correct sequence of stages in instrument decontamination per HTM 01-05.

1) Cleaning (manual, ultrasonic, or washer-disinfector — most effective), 2) Inspection, 3) Sterilization (usually steam autoclave), 4) Storage. Transport of dirty instruments must be safe and segregated from clean.

State the standard steam sterilization parameters (temperature, pressure, hold time) for a vacuum (Type B) autoclave.

$134\text{–}137^{\circ}\text{C}$ at approximately $2.1\,\text{bar}$ (≈$32\,\text{psi}$) for a minimum hold time of $3$ minutes. Type B vacuum autoclaves can sterilize hollow/lumened and wrapped instruments.

What is the difference between a Type N (downward displacement) and Type B (vacuum) autoclave?

Type N uses gravity/downward air displacement and only sterilizes solid, unwrapped instruments. Type B has an active vacuum phase, removing air to allow steam penetration of hollow, lumened, porous and wrapped/pouched instruments.

Define the terms 'cleaning', 'disinfection' and 'sterilization'.

Cleaning = physical removal of contamination/soil. Disinfection = reduction of viable microorganisms to a safe level (does not kill all spores). Sterilization = complete destruction/removal of all microorganisms including bacterial spores.

What are 'standard precautions' (universal precautions) in infection control?

A set of infection-control practices applied to ALL patients regardless of known infection status, treating all blood/body fluids as potentially infectious. Includes hand hygiene, PPE, safe sharps handling, surface decontamination and safe waste disposal.

List the items of personal protective equipment (PPE) routinely used in clinical dentistry.

Gloves, surgical/fluid-resistant face mask, eye protection (glasses/visor) for patient and operator, and a clinical uniform/disposable apron. Selected by risk assessment of the procedure (e.g. aerosol generation).

What is the WHO 'Five Moments for Hand Hygiene'?

1) Before touching a patient, 2) Before a clean/aseptic procedure, 3) After body fluid exposure risk, 4) After touching a patient, 5) After touching patient surroundings.

Why must sharps never be re-sheathed by hand, and what is the safer alternative?

Hand re-sheathing greatly increases needlestick injury risk. Safer alternatives: use a single-handed 'scoop' technique or a re-sheathing device/needle guard, and dispose of sharps immediately into a sharps bin at point of use.

What are the immediate first-aid steps following a sharps/inoculation injury?

Encourage bleeding by gently squeezing (do not suck), wash the wound under running water with soap (do not scrub), cover with a waterproof dressing; for splashes to eyes/mouth irrigate copiously. Then report and seek occupational health/risk assessment urgently.

After first aid for a sharps injury, what are the key management/reporting steps?

Report to supervisor and occupational health, complete an incident form (RIDDOR if reportable), risk-assess the source patient, obtain consent for source blood testing, assess need for PEP (especially HIV) urgently, and arrange recipient baseline bloods/follow-up.

Compare the approximate transmission risk per percutaneous exposure for HBV, HCV and HIV from a positive source.

Hepatitis B: up to ~$30\%$ (highest, if e-antigen positive). Hepatitis C: ~$3\%$. HIV: ~$0.3\%$ ($1$ in $300$). HBV is the most transmissible of the three via needlestick.

What is the most important protection against occupational hepatitis B for dental staff?

Hepatitis B vaccination, with confirmation of an adequate antibody response (anti-HBs $\geq 100\,\text{mIU/mL}$ indicates good response). Healthcare workers performing exposure-prone procedures must demonstrate immunity.

What does HIV post-exposure prophylaxis (PEP) involve and what is the critical timing?

A course of antiretroviral drugs (typically a 28-day regimen) started as soon as possible after exposure — ideally within 1 hour and no later than 72 hours — following risk assessment of a known/suspected HIV-positive source.

What does COSHH stand for and what does it require of a dental practice?

Control of Substances Hazardous to Health Regulations. It requires identifying hazardous substances, performing written risk assessments, controlling/eliminating exposure, providing safety data sheets, training staff, and health surveillance where indicated.

State the key mercury hygiene measures for handling dental amalgam.

Use encapsulated amalgam, work over a contained area, store amalgam waste under water/fixer in a sealed labelled container with a mercury suppressant, fit amalgam separators, avoid heat/skin contact, and clean spills with a mercury spill kit (never a vacuum cleaner).

Under EU/UK regulations, in which patient groups is dental amalgam use restricted or banned?

Amalgam must not be used (except where strictly necessary for medical reasons) in children under $15$ years and in pregnant or breastfeeding women; the UK is moving toward a wider phase-down/phase-out of amalgam.

Classify the main categories of clinical and dental waste and give an example of each.

Infectious/hazardous clinical waste (orange/yellow bags). Sharps (yellow sharps bin). Amalgam/mercury waste (white-lidded container, recycled). Gypsum, lead foil, and chemicals (e.g. developer/fixer) as special waste. Offensive/non-infectious waste (yellow/black). Domestic waste (black bag).

What do the orange and yellow clinical waste streams signify in UK colour coding?

Orange = infectious waste suitable for alternative treatment (e.g. autoclaving) before disposal. Yellow = infectious waste that must be incinerated (e.g. waste contaminated with chemicals/pharmaceuticals or anatomical waste).

Which regulations govern radiation protection in UK dental practice, and what two roles must be appointed?

IRR17 (Ionising Radiations Regulations 2017) for staff/public protection and IR(ME)R17 (Ionising Radiation (Medical Exposure) Regulations 2017) for patient protection. Required roles include the Radiation Protection Adviser (RPA) and Radiation Protection Supervisor (RPS).

Under IR(ME)R, name the duty holders and their core responsibilities.

Referrer (provides clinical justification info), Practitioner (justifies the exposure), Operator (carries out practical aspects/exposure), and Employer (provides procedures, protocols and framework). Each exposure must be justified and optimised (ALARP).

What is the 'controlled area' for a dental X-ray set and what is the standard recommended operator distance?

The controlled area is the zone where radiation dose may exceed limits — generally within $1.5\,\text{m}$ of the tube and patient and in the primary beam. The operator should stand at least $1.5\text{–}2\,\text{m}$ away and outside the primary beam (or behind a barrier).

What does the ALARP principle mean in radiation protection?

As Low As Reasonably Practicable — radiation doses to patients and staff must be kept to the minimum necessary to achieve the clinical aim, balancing risk against the benefit and practicability of further reduction.

What are the five steps of risk assessment (HSE model) applied to the dental working environment?

1) Identify the hazards, 2) Decide who might be harmed and how, 3) Evaluate the risks and decide on precautions, 4) Record findings and implement them, 5) Review the assessment and update as necessary.