Overseas Registration Exam (ORE) Prevention, Public Health and Medical Emergencies Syllabus

Prevention, Public Health and Medical Emergencies syllabus — full chapter and topic list

Expand any chapter to see its topics and sub-topics. This is the whole examinable outline for Prevention, Public Health and Medical Emergencies in Overseas Registration Exam (ORE), not a summary of it.

1. 1

   Dental Public Health and Epidemiology

   4 topics

   • Determinants of Oral Health and Health Inequalities
   • Epidemiology and Indices of Oral Disease
   • Water Fluoridation and Population Prevention
   • Evidence-Based Dentistry and Critical Appraisal
2. 2

   Preventive Dentistry in Practice

   4 topics

   • Delivering Better Oral Health Evidence-Based Toolkit
   • Dietary Analysis and Caries Prevention
   • Tobacco Cessation and Alcohol Brief Advice
   • Oral Hygiene Methods and Behaviour Change
3. 3

   Infection Prevention and Control

   4 topics

   • Decontamination and Sterilisation
     • HTM 01-05 decontamination guidance
     • Instrument reprocessing and the sterilisation cycle
   • Standard Precautions and PPE
   • Waste Management and Sharps Safety
   • Blood-Borne Viruses and Occupational Exposure
4. 4

   Medical Emergencies in the Dental Setting

   3 topics

   • Recognition and Management of Emergencies
     • Anaphylaxis, asthma and hypoglycaemia
     • Syncope, seizures and cardiac arrest
   • Resuscitation and Life Support
     • Basic life support and AED use
     • Resuscitation Council UK guidelines
   • Emergency Drugs and Equipment Requirements

Prevention, Public Health and Medical Emergencies flashcards for Overseas Registration Exam (ORE)

22 of 59 cards from the Prevention, Public Health and Medical Emergencies deck — real questions with worked answers.

1. What is the WHO definition of health, and how does it frame oral health?

   Health is a state of complete physical, mental and social well-being, not merely the absence of disease or infirmity. Oral health is integral to general health and well-being, enabling eating, speaking and socialising without pain, discomfort or embarrassment.

2. Name the main categories of determinants of oral health in Dahlgren and Whitehead's model.

   From innermost outward: fixed factors (age, sex, constitution); individual lifestyle factors; social and community networks; living and working conditions (housing, education, employment, healthcare, water/sanitation); and general socio-economic, cultural and environmental conditions.

3. Define a health inequality versus a health inequity.

   A health inequality is any measurable difference in health between population groups. A health inequity is a difference that is unfair, avoidable and unjust (e.g. caries gradient by social class), arising from the unequal distribution of the social determinants of health.

4. What is the 'inverse care law' as it applies to dentistry?

   The availability of good medical/dental care tends to vary inversely with the need of the population served — those with the greatest need (deprived groups) often have the poorest access to and uptake of care.

5. Distinguish proportionate universalism from a purely targeted approach to reducing oral health inequalities.

   Proportionate universalism (Marmot) delivers actions universally but with a scale and intensity proportionate to need, addressing the whole social gradient. A purely targeted approach focuses only on the highest-risk groups and can miss the bulk of disease that occurs in the larger middle of the gradient.

6. Define prevalence and incidence in oral epidemiology.

   Prevalence is the proportion of a population with a condition at a given point (or period) in time. Incidence is the number of new cases occurring in a defined population over a specified period (rate of new disease).

7. What does the DMFT index measure, and what do the letters stand for?

   DMFT measures caries experience in the permanent dentition, counting Decayed, Missing (due to caries) and Filled Teeth. DMFS uses tooth surfaces. Lowercase dmft/dmfs is used for the primary dentition.

8. State the formula for the Significant Caries (SiC) Index and its purpose.

   The SiC Index is the mean DMFT of the worst-affected third of the population: rank individuals by DMFT, take the highest one-third, and calculate their mean DMFT. It highlights the high-caries subgroup that an overall mean can mask. The WHO global goal was a SiC Index $< 3$ at age 12.

9. What does the Community Periodontal Index of Treatment Needs (CPITN/BPE) score 0 to 4 represent?

   0 = healthy; 1 = bleeding on probing; 2 = calculus or defective margins, probing depth $\leq 3.5$ mm; 3 = pocket $3.5\text{–}5.5$ mm (black band partly visible); 4 = pocket $\geq 6$ mm (black band disappears). A '*' denotes furcation or other features.

10. Define sensitivity and specificity of a diagnostic test.

    Sensitivity = proportion of truly diseased people who test positive, $\text{Sensitivity}=\frac{TP}{TP+FN}$. Specificity = proportion of truly healthy people who test negative, $\text{Specificity}=\frac{TN}{TN+FP}$.

11. Give the formula for positive predictive value (PPV).

    $$\text{PPV}=\frac{TP}{TP+FP}$$ It is the probability that a person with a positive test truly has the disease, and it falls as disease prevalence decreases.

12. What is the optimal concentration of fluoride in artificially fluoridated water supplies in the UK?

    $1\ \text{ppm}$ (1 mg/L, i.e. 1 part per million) is the target concentration; UK schemes operate around $1\ \text{mg/L}$, adjusted in warmer climates where water intake is higher.

13. By roughly how much does water fluoridation reduce caries, and what is its key equity advantage?

    Water fluoridation reduces caries experience by approximately 25–35% (and reduces the proportion of caries-free children). Its key advantage is that it benefits the whole population passively, requiring no individual behaviour change, and thus narrows oral health inequalities.

14. What is dental fluorosis and the main developmental risk window?

    Dental fluorosis is enamel hypomineralisation from excess fluoride ingestion during tooth development, ranging from faint white flecks to brown staining and pitting. The critical risk period for the aesthetically important upper incisors is roughly the first 3 years of life (enamel maturation up to ~6–8 years overall).

15. State the main mechanism of action of fluoride against caries.

    Fluoride acts mainly topically/post-eruptively: it promotes remineralisation, inhibits demineralisation by forming acid-resistant fluorapatite, and inhibits bacterial metabolism (enolase). Systemic incorporation into developing enamel is a minor effect.

16. What are the five steps of evidence-based practice (the 'five A's')?

    1. Ask (form an answerable clinical question), 2. Acquire (search for evidence), 3. Appraise (critically evaluate validity and relevance), 4. Apply (integrate with clinical expertise and patient values), 5. Assess/Audit (evaluate performance and outcomes).

17. What does the PICO framework stand for in formulating a clinical question?

    P = Population/Patient/Problem, I = Intervention, C = Comparison/Control, O = Outcome. (Sometimes extended to PICOT with T = Time.)

18. Rank the levels of the evidence hierarchy from strongest to weakest for therapy questions.

    Systematic reviews/meta-analyses of RCTs > individual randomised controlled trials > cohort studies > case-control studies > cross-sectional/case series > case reports > expert opinion/bench research.

19. Define relative risk (RR) and give its formula.

    Relative risk is the ratio of the risk of an outcome in the exposed group to the risk in the unexposed group. $$\text{RR}=\frac{a/(a+b)}{c/(c+d)}$$ $\text{RR}=1$ means no association; $>1$ increased risk; $<1$ protective.

20. Define the odds ratio and when it is typically used.

    The odds ratio is the ratio of the odds of exposure in cases to the odds in controls, $$\text{OR}=\frac{a\times d}{b\times c}$$ It is the standard measure of association in case-control studies and approximates the RR when the disease is rare.

21. What are the Number Needed to Treat (NNT) and its formula?

    NNT is the number of patients who must be treated to prevent one additional adverse outcome. $$\text{NNT}=\frac{1}{\text{ARR}}$$ where ARR (absolute risk reduction) $=$ control event rate $-$ experimental event rate. A smaller NNT means a more effective treatment.

22. What does a 95% confidence interval tell you, and how does it indicate statistical significance?

    It is the range within which the true population value is expected to lie with 95% confidence. For a ratio (RR/OR) a result is statistically significant if the CI does NOT include 1; for a difference of means, if the CI does not include 0.

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