The Overseas Registration Exam (ORE) – content and format of the ORE

The Overseas Registration Exam (ORE) is designed to test the knowledge, skills and professionalism relating to the practise of dentistry expected of graduate dentists on first registration with the General Dental Council (GDC). This means that UK graduates and overseas dentists are expected to have the same basic level of knowledge and skills.

You are not expected to be familiar with the National Health Service (NHS) or British culture other than in the way it might affect how you treat patients. You should be familiar with how people in the UK might behave – you should not make assumptions about a patient based on their gender or ethnic origin, for example.

It is advisable to familiarise yourself with the GDC guidance to registrants as you will be expected to conduct yourself in line with the advice they give.

Main guidance -Standards for dental professionals;

Supplementary guidance -Principles of consent; Principles of confidentiality;Principles of dental team working; Principles of raising concerns; and Principles of complaints handling.

The following pages describe:

The level of knowledge and skills required of a successful ORE candidate;

ORE Part 1 format (including sample questions) and content

ORE Part 2 format and content

ORE blueprint

Knowledge and Skills

The overseas dentist should be able to demonstrate that his or her clinical skills and knowledge are at the level required for success in a final examination of a UK BDS/BChD programme.

You are expected to able to show competence, knowledge and familiarity in different aspects of dentistry as outlined in The First Five Years – A Framework for Undergraduate Dental Education (General Dental Council, reprinted January 2004).

As stated in paragraph 111 of TFFY, candidates should:

Be competent at: you should have a sound theoretical knowledge and understanding of the subject together with an adequate clinical experience to be able to resolve clinical problems encountered, independently, or without assistance

Have knowledge of: you should have a sound theoretical knowledge of the subject, but need have only a limited clinical/practical experience

Be familiar with: you should have a basic understanding of the subject, but need not have direct clinical experience or be expected to carry out procedures independently.

A successful ORE candidate will:

BIOMEDICAL SCIENCES AND ORAL BIOLOGY have knowledge of anatomy, physiology and biochemistry relevant to dentistry; have knowledge and understanding of biomedical sciences and of oral physiology

and craniofacial, oral and dental anatomy in the management of their patients;

BEHAVIOURAL SCIENCES be competent at communication with patients, other members of the dental

team and other health professionals; be familiar with the social and psychological issues relevant to the care of patients;

HUMAN DISEASE have knowledge of the scientific principles of sterilisation, disinfection and

antisepsis; have knowledge of the pharmacological properties of those drugs used in general

practice including their unwanted effects; be familiar with the pathological features and dental relevance of common

disorders of the major organ systems; be familiar with the role of therapeutics in the management of patients requiring

dental treatment; be familiar with the general aspects of medicine and surgery; be familiar with the main medical disorders that may impinge on dental treatment; be familiar with the work of healthcare workers; be familiar with the place of dentistry in the provision of healthcare;

MEDICAL EMERGENCIES

be competent at carrying out resuscitation techniques and immediate management of cardiac arrest, anaphylactic reaction, upper respiratory obstruction, collapse, vasovagal attack, haemorrhage, inhalation or ingestion of foreign bodies, and diabetic coma;

have knowledge of diagnosing medical emergencies and delivering suitable emergency drugs using, where appropriate, intravenous techniques;

LAW, ETHICS AND PROFESSIONALISM be competent at maintaining full, accurate clinical records; have knowledge of responsibilities of consent, duty of care and confidentiality; have knowledge of patients' rights; have knowledge of the regulatory functions of the General Dental Council; be familiar with the legal and ethical obligations of registered dental practitioners; be familiar with the obligation to practise in the best interest of the patient at all

times; be familiar with the need for lifelong learning and professional development;

HEALTH INFORMATICS be competent at using information technology; be familiar with the law as it applies to records;

INTRODUCTION TO CLINICAL DENTISTRY be competent at obtaining a detailed history of the patient's dental state; be competent at obtaining a relevant medical history; be competent at using laboratory and imaging facilities appropriately and

efficiently; be competent at clinical examination and treatment planning; be competent at arranging appropriate referrals; be competent at maintaining an aseptic technique throughout surgical procedures; be competent at obtaining informed consent; have knowledge of managing patients from different social and ethnic

backgrounds; have knowledge of dental problems that may manifest themselves in older patients

and of the principles involved in the management of such problems; have knowledge of working as part of the dental team; be familiar with the complex interactions between oral health, nutrition, general

health, drugs and diseases that can have an impact on dental care and disease;

RESTORATIVE DENTISTRY be competent at diagnosing and planning preventive, non-operative care for the

individual patient who presents with dental caries, periodontal diseases and tooth wear;

be competent at completing a periodontal examination and charting, diagnosis and treatment plan;

be competent at supragingival and subgingival scaling and root debridement, using both powered and manual instrumentation, and in stain removal and

prophylaxis; be competent at knowing when and how to prescribe appropriate anti-microbial

therapy in the management of plaque-related diseases; be competent at completing a range of procedures in restorative dentistry including

amalgam and tooth-coloured restorations, endodontic treatments of single- and

multi-rooted teeth, anterior and posterior crowns, post crowns, simple bridges, and partial and complete dentures;

be competent at deciding whether severely broken down teeth are restorable; be competent at designing effective indirect restorations and complete and partial

dentures; have knowledge of when periodontal surgery might be advised; have knowledge of how missing teeth should be replaced, choosing between the alternatives of no replacements, bridges, dentures or implants; have knowledge of the design and laboratory procedures used in the production of

crowns, bridges, partial and complete dentures and be able to make appropriate chair-side adjustment to these restorations;

be familiar with the diagnosis and management of temporomandibular joint disorders;

be familiar with dental implants as an option in replacing missing teeth;

DENTAL BIOMATERIALS SCIENCE have knowledge of the science that underpins the use of dental biomaterials; have knowledge of the limitations of dental materials; be familiar with those aspects of biomaterial safety that relate to dentistry;

PAEDIATRIC DENTISTRY be competent at diagnosing active caries and planning appropriate nonoperative

care; be competent at fissure sealing, preventive resin restorations, and pit and fissure

restorations; be competent in undertaking approximal and incisal tip restorations; have knowledge of preformed stainless steel crown and pulp therapy in primary

molar teeth; have knowledge of the role of sedation in the management of young patients; have knowledge of the management of trauma in both dentitions;

ORTHODONTICS be competent at carrying out an orthodontic assessment including an indication of

treatment need; be competent at managing appropriately all forms of orthodontic emergency

including referral when necessary; be competent at making appropriate referrals based on assessment; have the knowledge to be able to explain and discuss treatments with patients and

their parents; have the knowledge to be able to design, insert and adjust space maintainers; have the knowledge to design, insert and adjust active removable appliances to

move a single tooth or correct a crossbite; be familiar with contemporary treatment techniques; be familiar with the limitations of orthodontic treatment;

PREVENTIVE DENTISTRY be competent at oral hygiene instruction, dietary analysis, topical fluoride therapy

and fissure sealing; be familiar with an evidence-based approach to treatment;

DENTAL PUBLIC HEALTH

be familiar with the prevalence of certain dental conditions in the UK; be familiar with the importance of community-based preventive measures; be familiar with the social, cultural and environmental factors which contribute to

health or illness; be familiar with the principles of recording oral conditions and evaluating data;

COMPREHENSIVE ORAL CARE be competent at working with other members of the dental team; have knowledge of providing a comprehensive approach to oral care;

ORAL SURGERY be competent at undertaking the extraction of teeth and the removal of roots where

necessary; be competent at undertaking minor soft tissue surgery; have knowledge of the management of acute infection; be familiar with the principles of assessment and management of maxillofacial

trauma; be familiar with the diagnosis of oral cancer and the principles of tumour

management; be familiar with the principles of treatment of dento-facial anomalies including the

common orthodontic/maxillofacial procedures involved; be familiar with the basic principles of oral surgery practice;

ORAL MEDICINE have knowledge of the drugs commonly used in oral medicine and of their side

effects and drug interactions; have knowledge of appropriate special investigations and the interpretation of their

results; be familiar with the pathogenesis of common oral medical disorders and their

treatment;

ORAL PATHOLOGY AND ORAL MICROBIOLOGY have knowledge of the role of laboratory investigations in diagnosis; have knowledge of the pathogenesis and classification of oral diseases; have knowledge of the aetiology and processes of oral diseases; have knowledge of matters relating to infection control; have knowledge of the causes and effects of oral diseases needed for their

prevention, diagnosis and management;

DENTAL RADIOLOGY AND IMAGING be competent at taking and processing the various film views used in general

dental practice; be competent at radiographic interpretation and be able to write an accurate

radiographic report; have knowledge of the hazards of ionising radiation and regulations relating to

them, including radiation protection and dose reduction; be familiar with the principles which underlie dental radiographic techniques;

PAIN AND ANXIETY CONTROL be competent at infiltration and regional block analgesia in the oral cavity; be competent at when, how and where to refer a patient for general anaesthesia;

be competent at managing fear and anxiety with behavioural techniques and empathise with patients in stressful situations;

have knowledge of inhalational and intravenous conscious sedation techniques; have knowledge of conscious sedation techniques in clinical practice.

ORE Part 1 – Format

Part 1 of the test comprises two, three-hour written papers, undertaken on a computer and is made up of Extended Matching Questions (EMQs) and Multiple Choice Questions (MCQs) in the form of Single Best Answer questions (SBAs).

Extended matching questions (EMQs)Extended matching questions are grouped into themes. Each theme has a heading that tells you what the questions are about.

Within each theme there are several numbered items. These are the questions and the problems you have to solve. There are examples in the next section.

We recommend that you begin by reading carefully the instruction that precedes the numbered items.

We recommend that you consider each of the numbered items and decide what you think the answer is. You should then look for that answer in the list of options above the items (each of which is identified by a letter of the alphabet). If you cannot find the answer you have thought of, you should look for the option which, in your opinion, is the best answer to the problem posed.

For each numbered item, you must choose ONE, and only one, of the options. You may feel that there are several possible answers to an item, but you must choose the best one from the option list. If you enter more than one answer on the answer sheet you will gain no mark for the question even though you may have given the right answer along with one or more wrong ones.

On occasions you may feel that more than one option offers a credible answer. In such circumstances the examiners are looking for the single answer that is generally accepted to accord with current best practice or clinical guidelines.

In each theme there are more options than items, so not all the options will be used as answers. This is why the instruction says that some options may not be used at all. Alternatively a given option may provide the answer to more than one item. For example, for two different scenarios the most likely diagnosis could be the same. In this case the option would be used more than once. 

Example EMQs

Example 1 – appearances of oral tissueThe options provided below are diagnoses for conditions with characteristic appearances that may be recognised when examining patients’ mouths. For each clinical scenario described choose the single most likely diagnosis from the list of options. Each option may be used once, more than once, or not at all.

Options list:

A. Circumvallate papillaeB. Filiform papillaeC. Fordyce spotsD. LeukoedemaE. LeukoplakiaF. Lingual tonsilsG. Mandibular toriH. Palatal tori

Clinical scenarios

1. Sebaceous glands visible as white or cream coloured spopts up to 0.5mm diameter usually present in the labial and buccal mucosa. C

2. Bilateral raised red lumps, which enlarge during viral infections, at the lateral borders of the base of the tongue. F

3. A row of 8-12 pink/red lumps on the dorsum of the tongue at the junction of the anterior two thirds and posterior third of the tongue. A

4. A milky white translucent whitening of the oral mucosa, commoner in black races which disappears on stretching the mucosa. D

5. Bilateral bony hard swellings on the lingual aspect of the mandible in the premolar regions. G

Example 2 – Theme: use of antibiotics For each of the clinical scenarios described below, select the most appropriate antibiotic from the options list. Each might be used once, more than once, or not at all.

Options list:

A. Amoxicillin 250mg qds. for 5 daysB. Amoxicillin 500mg bd. for 7 daysC. Amoxicillin 1g intravenouslyD. Amoxicillin 3g single oral dose

E. Azithromycin 500mg single oral doseF. Clindamycin 600mg single oral doseG. Erythromycin 250mg qds for 5 daysH. Metronidazole 200mg tds for 7 daysI. Metronidazole 200mg qds for 7 daysJ. Penicillin V 125mg qds. for 5 daysK. Penicillin V 250mg qds. for 5 daysL. Tetracydine 250mg qds. for 5 days

Clinical scenarios:

1. A 50-year-old man with a prosthetic heart valve requiring a tooth extraction. There is no other relevant medical history. D

2. The same patient who requires a further dental procedure three weeks after the extraction. F

3. A 55-year-old man who is allergic to penicillin and who is unable to swallow capsules. E

4. A 60-year old woman with a previous history of endocarditis requiring scaling and root planning and who is allergic to penicillin. F

5. A 5-year-old child attends in the dental emergency clinic at the weekend, with swelling of the right side of the face resulting from an abscessed tooth. There is no significant medical history. J

6. A 23-year-old woman presents complaining of ‘sore’, red, bleeding gums and halitosis. H

7. A pyrexic 30-year-old man presents with an exacerbation of an apical infection two days after initiation of root canal therapy. K

Single Best Answer questions (SBAs)Single Best Answer questions are characterised by a question, which may be based on a clinical scenario, followed by a set of usually five possible answers. You are asked to choose what you think is the most accurate answer.

Example SBAsExample 1 - Whilst undertaking root canal preparation of a lower molar tooth anaesthetised with interior alveolar nerve block, the patient experiences pain.

Which root canal is most likely to contain sensitive tissue:

Distobuccal root canal Distolingual root canal Mesiobuccal root canal Mesiolingual root canal Distal root canal

Example 2 - You are considering your choice of local analgesia for a surgical procedure which you anticipate will be ‘difficult’.

Which one of the following agents provides the most prolonged analgesia?

Articaine Bupivicaine Lidocaine (lignocaine) Mepivicaine Prilocaine

Example 3 - A 51 year old man with chronic periodontal disease complains of polyuria, thirst and lethargy at his treatment review. Which of the following medical conditions is most likely to be associated with his presenting condition?

Angina Cushing’s syndrome Diabetes mellitus Lymphoma Tuberculosis

Example 4 - A two year old experienced trauma to her upper deciduous incisors. What is the most likely permanent consequence for the developing incisors?

Dilacerated tooth Enamel hypoplasia Geminated tooth Hutchinson’s incisor Turner’s tooth

ORE Part 1 – Content

The purpose of Part 1 is to test the candidates’ application of knowledge to clinical practice.

The ORE Part 1 consists two papers testing candidates’ knowledge of:

Paper 1Clinically applied dental science;

Click here for examples of the topics that may be covered

Clinically applied human disease; Click here for examples of the topics that may be covered

Paper 2All aspects of clinical dentistry, including law and ethics and health and safety. Click here for examples of the topics that may be covered

For more detailed information on the possible topic areas, please refer to the Knowledge and Skills section above.

You will see that some learning outcomes may be covered in either Paper 1 and/or in Paper 2. For example the applied implications of anatomy for Prosthodontics or Oral Surgery may be covered in Paper 1 while the relationship of clinical procedures to anatomical features may be covered in Paper 2. Similarly in relation to materials Paper 1 might look at clinical application from the science viewpoint while Paper 2 might relate clinical technique to the underlying science.

Examples of knowledge areas tested in ORE Part 1 papers 1 and 2. Please note that this list is not exhaustive and provides you with areas that MAY be tested. You may also be tested on areas that are not covered below.

Biomedical Sciences and Oral Biology Paper Paper 2Knowledge of anatomy, physiology and biochemistry relevant to dentistry √Knowledge and understanding of biomedical sciences and of oral physiology and craniofacial, oral and dental anatomy in the management of patients

√ √

Human DiseaseKnowledge of the scientific principles of sterilisation, disinfection and antisepsis √ √Knowledge of the pharmacological properties of drugs used in general dental practice and their unwanted effects √ √Knowledge of disease processes such as infection, inflammation, disorders of the immune system, degeneration, neoplasia, metabolic disturbances and genetic disorders

√

Familiarity with the pathological features and dental relevance of common disorders of major organ systems √Familiarity with role of therapeutics in the management of patients requiring dental treatment √ √Familiarity with general aspects of medicine and √ √Familiarity with main medical disorders that may impinge on dental treatment √ √Familiarity with the work of healthcare workers √

Medical EmergenciesCompetence in carrying out resuscitation techniques and management of cardiac arrest, anaphylactic reaction, upper respiratory obstruction, collapse, vasovagal attack, haemorrhage, inhalation or ingestion of foreign bodies, and diabetic coma

√ √

Knowledge of diagnosing medical emergencies and delivering suitable emergency drugs using, where appropriate, intravenous techniques

√ √

Law, Ethics and ProfessionalismKnowledge of responsibilities of consent, duty of care and confidentiality √Knowledge of the permitted duties of DCPs √Knowledge of the regulatory functions of the General Dental Council √Familiarity with the legal and ethical obligations of general dental practitioners √ √Familiarity with the need for lifelong learning and professional development √

Introduction to Clinical DentistryCompetence in obtaining a detailed history of a patient’s dental state – pain history, pain scenarios √Competence in obtaining a relevant medical history √Competence in using laboratory and imaging facilities appropriately and efficiently √Competence in clinical examination and treatment planning √Competence in arranging appropriate referrals √Competence in maintaining an aseptic technique during surgical procedures √Competence in obtaining informed consent – competence, when written consent required √Knowledge in managing patients from different social and ethnic backgrounds √Knowledge of dental problems that may manifest themselves in older patients and of the principles involved in the management of such problems

√

Knowledge of working as part of a dental team √Familiarity with the complex interactions between oral health, nutrition, general health, drugs and diseases that can have an impact on dental care and disease

√

Restorative DentistryCompetence in diagnosing and planning preventive, non-operative care for the individual patient with caries, periodontal disease or tooth wear

√

Competence in completing a periodontal examination and charting, diagnosis and treatment plan √Competence in supragingival and subgingival scaling and root debridement, using both powered and manual, and in stain removal and prophylaxis

√

Competence in completing a range of procedures in restorative dentistry including amalgam and tooth-coloured restorations, endodontic treatments of single- and multi-rooted teeth, anterior and posterior crowns, post crowns, simple bridges, and partial and complete dentures

√

Knowledge of when periodontal surgery may be advised √Knowledge of how missing teeth should be replaced, choosing between the alternatives of no replacement, bridges, dentures or implants

√

Knowledge of the design and laboratory procedures used in the production of crowns, bridges, partial and complete dentures and ability to make appropriate chair-side adjustment to these restorations

√

Familiarity with the diagnosis and management of temporomandibular joint disorders √Familiarity with dental implants as an option in replacing missing teeth √

Dental Biomaterials ScienceKnowledge of the science that underpins the use of dental biomaterials √ √Knowledge of the (strengths and) limitations of dental materials √ √Familiarity with those aspects of biomaterial safety that relate to dentistry √ √

Paediatric DentistryCompetence in diagnosing active caries and planning appropriate non-operative care in children √Competence in fissure sealing, preventive resin restorations, and pit and fissure restorations √Competence in undertaking approximal and incisal tip restorations √Knowledge of the preformed stainless steel crown and pulp therapy in primary molar teeth √Knowledge of the role of sedation in the management of young patients √Knowledge of the management of trauma in both dentitions √

OrthodonticsCompetence in carrying out an orthodontic assessment including an indication of treatment need √

Preventive DentistryCompetence in oral hygiene instruction, dietary analysis, topical fluoride therapy and fissure sealing √Familiarity with (Practise) an evidence-based approach to treatment √ √

Dental Public HealthFamiliarity with the prevalence of certain dental conditions in the UK √ √Familiarity with the importance of community-based preventive measures √Familiarity with the social, cultural and environmental factors which contribute to health or illness √Familiarity with the principles of recording oral conditions and evaluating data √

Oral SurgeryCompetence in undertaking the extraction of teeth and the removal of roots where necessary √Competence in undertaking minor soft tissue surgery √ √Knowledge of the management of acute infection √ √Familiarity with the principles of assessment and management of maxillofacial trauma √Familiarity with the diagnosis of oral cancer and the principles of tumour management √ √

Familiarity with the principles of treatment of dento-facial anomalies including the common orthodontic/maxillofacial procedures involved

√ √

Familiarity with the basic principles of oral surgery practice √ √

Oral MedicineKnowledge of the drugs commonly used in oral medicine and their side effects and interactions √ √Knowledge of appropriate special investigations and the interpretation of their results √ √Familiarity with the pathogenesis of common oral medical disorders and their treatment √ √

Oral Pathology and Oral MicrobiologyKnowledge of the role of laboratory investigations in diagnosis √ √Knowledge of (competence in) matters relating to infection control √Knowledge of the causes and effects of oral diseases needed for their prevention, diagnosis and management √

Dental Radiology and ImagingCompetence in taking and processing the various film views used in general dental practice √ √Competence in radiographic interpretation and ability to write an accurate radiographic report √ √Knowledge of the hazards of ionising radiation and regulations relating to them, including radiation protection and dose regulation

√ √

Familiarity with the principles that underlie dental radiographic techniques √

Pain and Anxiety ControlCompetence in infiltration and regional block analgesia in the oral cavity √Competence and knowledge of when, how and where to refer a patient for general anaesthesia √Competence in managing fear and anxiety with behavioural techniques and empathising with patients in stressful situations

√

Knowledge of inhalational and intravenous sedation techniques √ √Knowledge of conscious sedation techniques in clinical practice √

ORE Part 2 – Format and Content

The ORE part 2 consists of four practical assessments.

1. An operative test on a dental manikin. You will be required to perform three procedures over a period of three hours. These procedures will primarily involve the preparation and restoration of teeth, but may also include other procedures where appropriate simulation can allow assessment of operative skills

Commonly used instruments and materials will be made available to candidates.

2. An Observed Structured Clinical Examination (OSCE) will test candidates’ clinical skills and may include history and assessment, communication skills (such as explanation of problems and treatment plans) judgement and decision making, ethics and attitudes of candidates, clinical examination.

The series of stations may cover aspects of the following; behavioural sciences, human disease, law, ethics and professionalism, clinical dentistry, restorative dentistry, orthodontics, preventative dentistry, dental public health, comprehensive oral care, oral surgery, oral medicine, oral pathology and oral microbiology, dental radiology and imaging.

For more information see what an OSCE involves

3. A diagnostic and treatment planning examination. This involves an actor who will provide an appropriate history together with relevant additional information such as photographs, radiographs, study models or results of other special tests. The exercise might involve any aspect of clinical dentistry. You will not carry out an intra-oral examination of the actor. You will be expected to consider findings and possible treatment options

4. A practical examination in medical emergencies including cardiopulmonary resuscitation using a resuscitation manikin.

What an OSCE involves

The term OSCE is short for Objective Structured Clinical Examination, which consists of a series of up to 20 stations designed to test a range of clinical skills. Different stations present clinical scenarios and tasks designed to test different skills or combinations of skills such as history taking and assessment of a patient, simple practical procedures, communication and patient education, clinical judgement and decision making, and ethics and professional attitude.

Examples of tasks set may include taking a history from an actor patient who has been briefed on the symptoms of a particular condition, discussing treatment options and obtaining informed consent, giving oral health education advice, demonstrating on a manikin how you would take an intra-oral radiograph, or interpreting radiographic evidence and prioritising treatment. All the “patients” you meet will be actors who have been briefed with the relevant information necessary for you to complete the set task.

Each candidate starts at a different station and moves on to the next station in the circuit every six minutes, so that after 2 hours every candidate has visited each station. On arrival at each station you will have 1 minute to read instructions for the task you are asked to complete at that station. You then have 5 minutes to complete that task. You cannot leave the station if you complete the task in less than 5 minutes and there is no extension of time if you have not completed what you have been asked to do. You must move immediately to the next station at the end of the 5 minutes. There will be a small number of rest stations within the sequence.

A different examiner will observe you at each station. The examiner will assess your performance against a checklist of all the steps that are necessary to complete the task competently. In essence the examiners have, in advance of the examination, considered the components of each task that must be covered in order to demonstrate clinical competence. During the examination they observe how well you cover these. In order to obtain the maximum marks at any station you must demonstrate that you have undertaken the task in a logical step-by-step process as would be the case clinically, covering all relevant aspects and reaching a conclusion within the time allowed.