Six months later, the same patient returns. His…
Paediatric dentistry questions combine clinical management with age-appropriate considerations — LA dosing by weight, behaviour management. This exam-level vignette tests your ability to work through clinical details and arrive at the correct management.
A 72-year-old patient with moderate Alzheimer's disease presents for extraction of a symptomatic tooth. His daughter holds an enduring power of attorney for health matters. The patient can follow simple instructions, appears to understand that a tooth will be removed, and nods when asked if he wants the pain to stop. However, he cannot articulate the risks of the procedure or describe alternatives. Six months later, the same patient returns. His Alzheimer's has progressed and he now becomes agitated during dental examinations. His daughter consents to treatment under intravenous sedation. According to the Code, the dentist should ALSO consider:
- A. Whether the treatment is consistent with what the patient would have wanted when they had capacity, and whether the benefits outweigh the additional risks of sedation
- B. Whether the daughter's enduring power of attorney is legally valid for dental sedation procedures specifically, since powers of attorney may have scope limitations and dental sedation might fall outside the authorised treatment categories specified in the original document
- C. Whether the practice's professional indemnity insurance policy specifically covers the administration of intravenous sedation to patients with documented Alzheimer's disease, as failure to verify coverage could expose the practitioner to uninsured liability
- D. Whether to obtain a second opinion from another dentist before proceeding, as the Code requires peer review for high-risk procedures
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When working with patients who lack capacity, the Code requires acting in the patient's best interests (Section 3.5d) and considering whether the proposed course of action is consistent with the patient's known wishes and values. The addition of sedation increases both benefit (treatment possible) and risk (sedation in elderly dementia patient), requiring careful weighing. Option B raises a valid practical concern but is not the Code's primary ethical requirement — the Code addresses the practitioner's ethical obligations, not the technical scope of power of attorney documents. Option C is an administrative concern, not an ethical obligation under the Code. Option D fabricates a peer review requirement for high-risk procedures that does not exist in the Code.
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