Dental Council Ireland Exam cheat sheet

Permanent tooth eruption sequence (mandibular first): 6-1-2-3-4-5-7-8 per quadrant; mandibular central incisor erupts ~6-7 years, second molar ~12 years, third molar ~17-21 years.

Primary dentition eruption: mandibular central incisor first at ~6-10 months; complete primary dentition ~2.5-3 years; first primary molar precedes canine.

Caries risk assessment uses DMFT/dmft, plaque and dietary sugar frequency, fluoride exposure, saliva flow, and socio-behavioural factors; recall interval is set by risk, not a fixed 6 months.

Basic periodontal examination (BPE) sextants scored 0-4; code * denotes furcation involvement and code 4 indicates probing depth ≥5.5 mm requiring full periodontal charting.

Pulp diagnosis categories: reversible pulpitis, symptomatic/asymptomatic irreversible pulpitis, pulp necrosis, previously treated, previously initiated; apical diagnosis: symptomatic/asymptomatic apical periodontitis, acute/chronic apical abscess, condensing osteitis.

Local anaesthetic maximum doses: lidocaine 2% with 1:80,000 adrenaline ~4.4 mg/kg (max ~300 mg); articaine 4% ~7 mg/kg (max ~500 mg); prilocaine 4% ~6 mg/kg; calculate cartridge count from mg per 1.8 mL cartridge.

Antibiotics are not indicated for irreversible pulpitis or dentoalveolar abscess without systemic involvement; definitive treatment is pulpectomy or drainage.

Dental trauma: avulsed permanent tooth is replanted immediately if extraoral dry time <60 minutes; store in milk, saline, or saliva; splint flexibly 2 weeks and refer for root canal if apex closed.

Occlusal caries detection combines visual-tactile (ICDAS), bitewing radiographs for approximal lesions, and transillumination; radiographic threshold for restorative intervention is typically into dentine.

Four ethical principles: autonomy (patient's informed choice), beneficence (act in patient's interest), non-maleficence (do no harm), justice (fair access and resource use); veracity and confidentiality are supporting duties.

Valid consent requires capacity, adequate information (material risks, alternatives, consequences of no treatment), and voluntariness; consent is a process, not a signature.

Capacity is presumed in adults; assess understanding, retention, weighing, and communication of decision; a patient with capacity may refuse treatment even if refusal risks harm or death.

Confidentiality may be breached only where required by law, court order, or where a serious public-health or third-party risk exists; disclose the minimum necessary information.

Duty to report concerns about impaired or unfit colleagues to the regulator; patient safety overrides collegial loyalty.

Boundary rules: avoid treating family or close friends where objectivity may be compromised; chaperone for intimate examinations; no personal or financial relationships with current patients.

Gifts and inducements must not influence clinical decisions; declare conflicts of interest; advertising must be truthful, not misleading, and must not make comparative claims of superiority.

Record keeping: contemporaneous, legible, signed and dated notes; retain records per local statutory period; patients have a right of access to their records under data protection law.

Mandatory reporting of child or vulnerable adult abuse where statutory duty exists; follow local safeguarding pathways and document decisions.

Hand hygiene: WHO five moments; alcohol-based hand rub for visibly clean hands, soap and water when visibly soiled or after contact with spore-forming organisms (e.g., C. difficile).

Personal protective equipment: gloves, mask, eye protection, and gown/apron for every exposure-prone procedure; change gloves between patients and after contamination; perform hand hygiene before donning and after doffing.

Sharps: never recap by hand; use a single-handed scoop or a recapping device; dispose immediately into a sharps container filled to no more than three-quarters.

Instrument reprocessing: pre-cleaning, washer-disinfector, inspection, packaging, and autoclave at 134-137 °C for 3 minutes (or 121 °C for 15 minutes); log each cycle and validate with indicators and periodic biological spore testing.

Single-use items (needles, local anaesthetic cartridges, matrix bands) are never reused; handpieces must be cleaned, lubricated, and sterilised between patients.

Impression and prosthesis transport: disinfect with a compatible disinfectant before sending to the laboratory; use a sealed container and a documented transport chain.

Vaccination: hepatitis B immunisation with post-vaccination surface antibody titre; staff should be immune to measles, mumps, rubella, varicella, and TB screening per local policy.

Needlestick injury: encourage bleeding, wash with soap and water, do not suck; report immediately; assess source and recipient status for HIV, HBV, HCV; PEP within hours if indicated.

Health and safety: COSHH risk assessment for all chemicals; safety data sheets available; mercury amalgam handled with amalgam separator and mercury spill kit; radiography areas controlled under local radiation rules.

Justification, optimisation (ALARA/ALADA), and dose limitation are the three principles of radiation protection; every exposure must have a clinical indication and no exposure is justified for screening alone.

Selection criteria: bitewings for approximal caries at intervals based on individual risk; panoramic radiograph for third molars, trauma, or orthodontic assessment; CBCT only when 2D imaging is insufficient.

Doses (approximate effective, µSv): intraoral periapical ~1-8; bitewing ~1-5; panoramic ~10-25; CBCT (small FOV) ~30-100; chest radiograph ~20 for comparison.

Pregnancy: radiographs are justified if clinically necessary; use lead apron and thyroid collar; elective radiography deferred where possible; inform patient of low fetal risk.

Children: use paediatric settings, rectangular collimation, and the lowest exposure parameters; thyroid collar and lead apron where appropriate.

Quality assurance: regular equipment checks, film/sensor calibration, collimation and filtration tests, and dose audit; keep records of all QA and training.

Operator protection: stand behind a protective barrier or at least 2 m from the tube head at 90° to the beam; never hold the film/sensor for a patient; use a holder.

Reporting: statutory notification of equipment and staff dose monitoring where required; keep records of exposure and training.

ABCDE approach for any collapse: airway, breathing, circulation, disability (neurological), exposure; call for help and start CPR if unresponsive and not breathing normally.

Syncope: lay flat, raise legs, loosen clothing, monitor; recovery is usually rapid; if not, consider other causes.

Anaphylaxis: adrenaline 0.5 mg IM (0.5 mL of 1:1,000) adult into anterolateral thigh; repeat every 5 minutes if needed; call emergency services; oxygen and IV fluids.

Hypoglycaemia in a conscious patient: oral glucose 15-20 g; if unconscious, do not give oral fluids; use glucagon 1 mg IM or IV glucose per protocol and call emergency services.

Asthma: sit upright, oxygen, salbutamol inhaler (100 µg per puff) up to 10 puffs via spacer; if no response, call emergency services and consider ipratropium and steroids.

Angina/myocardial infarction: stop procedure, sit upright, oxygen, GTN sublingual, aspirin 300 mg chewed if not contraindicated, call emergency services.

Sedation: conscious sedation is a drug-induced depression of consciousness where verbal contact is maintained; only trained, competent operators with appropriate monitoring, oxygen, suction, and reversal agents.

Sedation agents: midazolam titrated in small increments (e.g., 1 mg every 60 seconds, max ~7.5 mg in healthy adult); flumazenil is the reversal agent; capnography recommended for moderate sedation.

Emergency kit: oxygen, suction, airway adjuncts, bag-valve-mask, AED, adrenaline, GTN, salbutamol, glucose, glucagon, aspirin, antihistamine, and flumazenil; check expiry dates regularly.

Prescription elements: patient name, address, date, drug name (generic), dose, frequency, duration, route, quantity, and prescriber signature; include 'no substitution' only where clinically necessary.

Amoxicillin is first-line for odontogenic infection (e.g., 500 mg three times daily for 5 days in adults); use only when systemic involvement, spreading infection, or immunocompromise.

Penicillin allergy: use metronidazole (400 mg three times daily) or clindamycin (300 mg four times daily) per local guidance; avoid clindamycin as first-line due to C. difficile risk.

Analgesia: paracetamol 1 g four times daily (max 4 g/day) and ibuprofen 400 mg three times daily (max 1.2 g/day OTC); avoid ibuprofen in renal impairment, peptic ulcer, and third trimester of pregnancy.

Antibiotic prophylaxis: consider for patients with prosthetic heart valves or previous infective endocarditis undergoing invasive dental procedures; follow current national guidance, not blanket prophylaxis.

Warfarin and DOACs: check INR where relevant; avoid NSAIDs; local measures to control bleeding; liaise with the patient's anticoagulation clinic if unsure.

Pregnancy: avoid tetracyclines and high-dose NSAIDs; paracetamol preferred; lidocaine with adrenaline is acceptable; defer elective treatment in the first trimester where possible.

Controlled drugs: store securely, keep a register, record all transactions, and destroy witnessed; follow local misuse of drugs regulations.

Medication review: check interactions (e.g., metronidazole with warfarin, erythromycin with statins), renal and hepatic function, and allergies before prescribing.

Scope of practice: provide only treatment for which you are trained, competent, and indemnified; refer when the clinical situation exceeds your competence.

CPD: maintain a documented personal development plan; record verifiable CPD hours with evidence; meet the regulator's annual requirement and audit cycle.

Indemnity: maintain professional indemnity cover for all areas of practice; check that it covers the full scope of your work.

Fees: provide a written treatment plan and estimate before treatment; explain NHS/private options; obtain consent for any change in cost; keep records of financial discussions.

Patient information: give clear, accurate, and timely information about diagnosis, options, risks, benefits, and costs; use interpreters or accessible formats where needed.

Advertising and social media: comply with professional standards; no patient-identifiable images without written consent; no misleading claims or testimonials that breach guidance.

Complaints: acknowledge promptly, investigate, respond in writing, and use the outcome to improve care; signpost to the regulator or ombudsman if unresolved.

Teamwork and delegation: only delegate to staff trained and competent for the task; retain overall responsibility for the patient's care.

Professional boundaries and wellbeing: recognise fatigue and burnout; seek support; do not practise when unfit; report concerns about self or colleagues.

Endodontic working length determination: use apex locator confirmed by radiograph; irrigate with sodium hypochlorite (0.5-5.25%) with rubber dam; avoid extrusion into vital structures.

Periodontal treatment: initial therapy is scaling and root surface debridement with oral hygiene instruction; re-evaluate at 6-12 weeks; surgical therapy only after non-surgical phase.

Prosthodontics: tooth preparation should preserve as much sound tissue as possible; margin design and occlusal clearance determine longevity; verify with a try-in.

Orthodontics: assess skeletal vs dental pattern; interceptive treatment for habits and crossbites; fixed appliances require excellent oral hygiene and compliance.

Paediatric dentistry: use tell-show-do, behaviour management, and fluoride varnish (22,600 ppm) for caries prevention in at-risk children twice yearly.

Oral medicine: persistent ulcers >3 weeks, red or white patches, and unexplained bleeding require urgent referral for suspected malignancy.

Restorative materials: amalgam has high compressive strength but is being phased down; composite requires moisture control and adequate light curing; glass ionomer releases fluoride.

Informed refusal: document the discussion, the patient's decision, and the alternatives offered; continue to offer care and review.

Consent for children: assess Gillick competence where applicable; parents or guardians usually consent; the child's views should be considered according to age and understanding.

Delegation and supervision: the dentist remains accountable for delegated tasks; ensure the team member is trained and competent.

Research and teaching: obtain ethics approval, informed consent, and protect patient anonymity; declare conflicts of interest.

Environmental cleaning: use detergent and disinfectant on surfaces between patients; blood and body fluid spills cleaned with chlorine-releasing agent at appropriate concentration.

Waste segregation: clinical waste (including sharps) in yellow containers; domestic waste separate; hazardous waste per local regulations.

Water lines: flush and disinfect dental unit water lines; monitor for biofilm and Legionella per local guidance.

Staff health: report sharps injuries and infectious illness; exclusion periods for communicable diseases; immunisation records kept.

Image quality: optimal exposure, correct positioning, and collimation reduce retakes; retakes should be audited and justified.

Radiation risk: stochastic effects (cancer, hereditary) have no threshold; deterministic effects (skin erythema, cataract) have thresholds and are avoided by dose limits.

IR(ME)R principles: justification, authorisation, and optimisation by trained and competent staff; keep records of justification and dose.

Patient communication: explain the benefit and risk of radiographs in plain language; record the discussion.

Choking: encourage coughing; if ineffective, back blows and abdominal thrusts; call emergency services if unresolved.

Stroke: use FAST (face, arms, speech, time); call emergency services immediately; note symptom onset time.

Epilepsy: protect from injury, do not restrain, time the seizure; if >5 minutes or repeated, call emergency services and use buccal midazolam if trained.

Sedation records: document consent, fasting status, drugs and doses, monitoring, and recovery; discharge with a responsible escort.

Topical fluoride: 22,600 ppm varnish for caries prevention; 5,000 ppm toothpaste for high-risk patients; avoid in children under the age for which it is not indicated.

Chlorhexidine 0.2% mouthwash for short-term plaque control; causes staining and taste disturbance; avoid prolonged use.

Dry mouth: sugar-free chewing gum, saliva substitutes, and fluoride; review medications that cause xerostomia.

Antifungals: nystatin or miconazole for oral candidiasis; check for inhaled steroid use and denture hygiene; miconazole interacts with warfarin.

Consent and capacity: follow the principles of the relevant mental capacity legislation; act in the patient's best interests where capacity is lacking.

Records and data protection: store records securely, share only with consent or legal authority, and respond to subject access requests within statutory timeframes.

Equality and diversity: provide care without discrimination; make reasonable adjustments for disability and language needs.

Continuing professional development: reflect on incidents and complaints; use appraisal and audit to improve quality.