Uncooperative Child GA Referral — ORE Part 1 MCQ

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EasyPaediatric DentistryUncooperative Child GA ReferralORE Part 1

A 3-year-old child requires extraction of an abscessed primary molar. The child is uncooperative and has had previous traumatic dental experiences. Inhalation sedation is not feasible. What is the next step?

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Correct answer: E — Referral for dental treatment under general anaesthesia in a hospital setting

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

The correct answer is A. An uncooperative 3-year-old with an abscessed (septic) primary molar, prior traumatic dental experiences, and proven unsuitability for inhalation sedation meets clear criteria for referral to hospital-based GA. UK guidance (NHS England, SIGN) explicitly states that GA is indicated when anxiety and/or procedural complexity preclude successful treatment with behavioural management or conscious sedation techniques. The child requires urgent definitive care; deferral (E) is clinically inappropriate for an acute abscess. Physical restraint (B) violates UK dental regulation and modern safeguarding principles. Home administration of midazolam by a parent (C) is unlicensed, unmonitored, and unsafe—sedation must be professionally administered in appropriate settings. IV sedation in a general dental surgery (D) is not compliant with UK regulatory frameworks, which restrict IV sedation in young children to specialist centres or hospital settings with appropriate facilities and expertise.

Reference: NHS England. Paediatric dentistry. https://www.england.nhs.uk/long-read/paediatric-dentistry/ (accessed 2026); SIGN Guideline No. 58: Safe Sedation of Children. https://media.gosh.nhs.uk/documents/SIGN_Safe_sedation_of_chierapeutic_procedures.pdf