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Dental Anxiety Management — ORE Part 1 MCQ

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ModeratePaediatric DentistryDental Anxiety ManagementORE Part 1

A 7-year-old child has active caries requiring operative treatment. There is no pain, swelling or spreading infection. Despite acclimatisation visits, tell-show-do and an attempted local anaesthetic, the child remains too anxious to accept treatment. The carious teeth are not suitable for preventive management alone. What is the most appropriate next step?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: A — Refer to assess suitability for inhalation sedation or general anaesthesia

Explanation lettering: E = shown as D · D = shown as E

A is correct. SDCEP advises that, after pain relief, prevention, behavioural management and local anaesthesia have been attempted, a child who cannot accept necessary caries treatment should be referred to assess suitability for sedation or GA. Where prevention alone is not a safe interim strategy, the referral pathway specifically includes inhalation sedation or GA, while preventive care continues. B is too absolute: GA may be appropriate, but it should not be presumed without assessment and less invasive management options should be considered. C is inappropriate; if a child cannot cope, treatment should stop and alternatives be agreed. D risks progression to pain or infection. E is not indicated because there is no spreading infection and antibiotics do not treat dental caries.

Reference: Scottish Dental Clinical Effectiveness Programme. Prevention and Management of Dental Caries in Children: Referral for sedation and general anaesthesia, 2024. https://www.childcaries.sdcep.org.uk/guidance/referral/referral-for-sedation-and-ga/