CCE-CE-083

CASE INFORMATION

Case ID: CCE-DENT-001
Case Name: Mark Reynolds
Age: 42
Gender: Male
Indigenous Status: Non-Indigenous
Year: 2025
ICPC-2 Codes: D85 – Teeth/Gum Disease

COMPETENCY OUTCOMES

Competency DomainCompetency Element
1. Communication and Consultation Skills1.1 Establishes rapport and engages the patient
1.2 Explores the patient’s concerns, ideas, and expectations
1.3 Provides clear and structured explanations about gum disease and management
2. Clinical Information Gathering and Interpretation2.1 Takes a thorough dental, medical, and lifestyle history
2.2 Identifies risk factors contributing to gum disease
3. Diagnosis, Decision-Making and Reasoning3.1 Evaluates whether the patient has gingivitis, periodontitis, or another dental issue
4. Clinical Management and Therapeutic Reasoning4.1 Provides an appropriate treatment plan and advice for gum disease
4.2 Discusses the need for dental referral
5. Preventive and Population Health5.1 Provides patient education on oral hygiene and prevention
6. Professionalism6.1 Provides patient-centred, non-judgmental care
7. General Practice Systems and Regulatory Requirements7.1 Documents oral health assessment and referral plan
9. Managing Uncertainty9.1 Addresses patient concerns about progression and treatment
10. Identifying and Managing the Patient with Significant Illness10.1 Recognises and appropriately refers suspected advanced gum disease

CASE FEATURES

  • No previous history of significant dental issues.
  • Patient presents with bleeding gums and persistent bad breath.
  • Symptoms have worsened over the last six months.
  • Smoker with poor oral hygiene practices.
  • Concerned about losing teeth but has avoided seeing a dentist due to cost.

INSTRUCTIONS

You have 15 minutes to complete the tasks for this case.

You should treat this consultation as if it is face to face.

A patient record summary is provided for your information.

Perform the following tasks:

  1. Take an appropriate history.
  2. Outline the differential diagnosis and key investigations required.
  3. Address the patient’s concerns.
  4. Develop a safe and patient-centred management plan.

SCENARIO

Mark Reynolds, a 42-year-old warehouse worker, presents with bleeding gums, persistent bad breath, and occasional gum pain. His partner has mentioned that his breath smells bad even after brushing.

His oral health history includes:

  • Symptoms started six months ago and are getting worse.
  • Brushing once daily, does not floss.
  • Smokes one pack per day for the last 20 years.

PATIENT RECORD SUMMARY

Patient Details

Name: Mark Reynolds
Age: 42
Gender: Male
Indigenous Status: Non-Indigenous

Allergies and Adverse Reactions

  • No known drug allergies

Medications

  • None currently

Past History

  • No significant medical conditions.
  • No recent dental visits.

Social History

  • Works as a warehouse worker.
  • Smokes 20 cigarettes per day.
  • Occasionally drinks alcohol on weekends.

Preventive Activities

  • Does not floss, brushes once daily.
  • No regular dental check-ups.

ROLE PLAYER INSTRUCTIONS

Just like a consultation with a doctor, the candidate will ask you a series of questions.
The OPENING LINE is always to be said exactly as written. This is the only part of the script
which will be the same for all candidates. Where the candidate goes after the opening line is
up to them.

The remainder of the information is to be given based on the questions asked by the
candidate.

The information in the following script are core pieces of information. The core pieces of
information will not necessarily follow the order in the script but should be given when cued
by the candidate’s question.

GENERAL INFORMATION can be given relatively freely. After the opening line, most
candidates will ask an open question like “Can you tell me more about that?” You can provide
the GENERAL INFORMATION in response to that sort of question.

SPECIFIC INFORMATION should only be given when the candidate asks a relevant question.
Candidates don’t need to ask for all the information in the SPECIFIC INFORMATION section,
but all the relevant information is given there should they want to.

Each line or dot point in the SPECIFIC INFORMATION section is an appropriate chunk of
information which can be provided to the candidate when asked a relevant question.

Do not give extra information than asked.

Do not provide details which are not given in the information chunks (i.e.: do not elaborate
or ad-lib).

If the candidate asks a question that is not given in the script, the best way to respond is with
a generic response indicating there is no problem. For example:

Candidate: “How many hours do you sleep?”
Response: “I’m sleeping fine.” / “I don’t have any concerns about my sleep.”

The case may have specific QUESTIONS to ask the candidate. You can start asking the
QUESTIONS if the candidate asks about your ideas or concerns or questions.

Ask the other questions in a conversational way. You do not need to ask all the questions. The
aim should be to ask most of the questions but without interrupting the candidate.

The Patient Record Summary is also included. This is not part of the script but is included for
your general information.

If you need help in understanding any of the medical information in the script, ask the College
examiner who will be with you, and they can help to explain the terms or the conditions.

SCRIPT FOR ROLE-PLAYER

Opening Line

“Doctor, my gums keep bleeding, and my breath smells bad. What’s going on?”

General Information

Mark Reynolds is a 42-year-old warehouse worker who has never been overly concerned about his dental health but is now worried about losing his teeth. He has come to the GP because his gums bleed every time he brushes his teeth, and his partner has mentioned his breath smells bad, even after brushing.

His symptoms have been gradually worsening over the last six months, but he has been reluctant to see a dentist due to the cost.

Mark is slightly embarrassed about his dental hygiene and is feeling a little anxious about his symptoms but tries to downplay the issue initially.

Specific Information

(To be revealed only when asked)

Gum Symptoms

(Mark will provide the following details if prompted.)

  • Gums have been bleeding when brushing for at least six months.
  • Mild gum discomfort but no severe pain.
  • Persistent bad breath, noticed by his partner.
  • Gums appear red and slightly swollen but no obvious abscess.
  • No loose teeth, but feels like his gums are “receding” slightly.

Oral Hygiene Routine

(Mark will describe these habits if asked.)

  • Brushes once a day, usually in the morning, with a hard-bristled toothbrush.
  • Does not floss.
  • Uses mouthwash occasionally but not regularly.
  • Has never had a professional dental cleaning.

Smoking History

(Mark will discuss this if prompted.)

  • Smokes 20 cigarettes per day for the last 20 years.
  • Has tried quitting a few times but hasn’t succeeded.
  • Knows smoking is bad for health but hasn’t thought about its effects on his gums.

Diet and Lifestyle

(Mark will provide these details if asked.)

  • Drinks coffee and soft drinks regularly.
  • Eats processed foods often, not many fresh vegetables or fruits.
  • Occasionally drinks alcohol on weekends.
  • Very little exercise outside of work.

Emotional Cues and Responses

Mark is feeling concerned and slightly embarrassed but is open to advice if it is delivered in a non-judgmental way.

  • If the candidate explains gum disease clearly, he will feel reassured and more motivated to improve his oral health.
  • If the candidate suggests expensive dental treatment immediately, he may become resistant and reluctant to engage.
  • If the candidate dismisses his concerns, he will feel frustrated and possibly ignore the advice given.

Mark is willing to listen to practical solutions but wants to know how serious the problem is before committing to action.

Questions for the Candidate

Mark may ask some or all of the following:

  1. “How serious is this? Am I going to lose my teeth?”
  2. “Is this an infection? Do I need antibiotics?”
  3. “Can I treat this at home, or do I have to see a dentist?”
  4. “How much will this cost me?”
  5. “Does smoking make this worse?”
  6. “Will this go away if I just brush better?”
  7. “I’ve heard people say gum disease is linked to heart disease. Is that true?”

Potential Emotional Reactions Based on Candidate Performance

If the candidate provides a structured discussion and reassures Mark:

  • Mark will feel more in control and willing to improve his dental hygiene.
  • He will be more receptive to seeing a dentist if the need is explained clearly.
  • He may consider reducing or quitting smoking if linked to his gum disease.

If the candidate is vague or dismissive:

  • Mark may become defensive or frustrated, especially if he feels judged.
  • He may push back on seeing a dentist, especially if cost concerns are not addressed.
  • He might feel unsure about what actions to take and delay treatment.

Key Role-Playing Behaviour Based on Candidate Approach

If the candidate takes a non-judgmental, patient-centred approach:

  • Mark will be more open to advice and willing to discuss his concerns.
  • He will engage in a discussion about improving his oral hygiene habits.
  • He will ask more about how to prevent further issues.

If the candidate is too directive or judgmental:

  • Mark may shut down and disengage from the conversation.
  • He may become defensive about his smoking and hygiene habits.
  • He may avoid booking a dental visit out of reluctance or embarrassment.

THE COMPETENT CANDIDATE

The competent candidate should be able to:

Task 1: Take an appropriate history, including gum symptoms, dental hygiene, smoking history, and medical conditions.

The competent candidate should:

  • Elicit details about gum symptoms, including:
    • Duration (e.g., how long bleeding and bad breath have been occurring).
    • Associated symptoms (pain, swelling, gum recession, loose teeth).
    • Triggers (brushing, eating, or spontaneous bleeding).
  • Assess oral hygiene habits, including:
    • Brushing frequency and technique.
    • Flossing and use of mouthwash.
    • Past dental visits and professional cleanings.
  • Identify risk factors for gum disease, including:
    • Smoking history and frequency.
    • Dietary factors (sugar intake, acidic drinks, alcohol use).
    • General health conditions (e.g., diabetes, immunosuppression, cardiovascular risks).
  • Assess patient’s concerns and expectations, including:
    • Fear of tooth loss.
    • Concerns about cost and accessibility of dental care.

Task 2: Assess and explain whether the gum disease is gingivitis, periodontitis, or another dental condition.

The competent candidate should:

  • Differentiate between gingivitis and periodontitis:
    • Gingivitis: Reversible gum inflammation with redness, swelling, and bleeding but no bone loss.
    • Periodontitis: More advanced disease with gum recession, deep pockets, potential bone loss, and risk of tooth loss.
  • Explain findings to the patient in a clear, reassuring manner.
  • Rule out other potential causes, such as:
    • Vitamin deficiencies (scurvy, iron deficiency anaemia).
    • Medication-induced gum changes (e.g., calcium channel blockers, phenytoin).
    • Systemic conditions (e.g., uncontrolled diabetes, immune disorders).

Task 3: Provide a structured management plan, including dental referral, oral hygiene education, and risk factor modification.

The competent candidate should:

  • If gingivitis is suspected:
    • Reassure the patient that it is reversible with good oral hygiene.
    • Advise improved brushing and flossing techniques.
    • Recommend a professional dental cleaning.
  • If periodontitis is suspected:
    • Explain the need for an urgent dental assessment.
    • Discuss deep cleaning (scaling and root planing) or further specialist referral.
  • Address smoking cessation:
    • Explain how smoking worsens gum disease and delays healing.
    • Offer support for quitting, including nicotine replacement therapy and behavioural counselling.
  • Provide dietary advice:
    • Reduce sugar and acidic drink intake.
    • Increase vitamin C and calcium-rich foods to support gum health.
  • Discuss the need for regular dental visits (every 6–12 months).

Task 4: Address the patient’s concerns about cost and fear of tooth loss.

The competent candidate should:

  • Acknowledge the patient’s financial concerns.
  • Provide information on public dental services and affordable dental care options.
  • Explain that gum disease is manageable and that early intervention reduces long-term costs.
  • Offer practical self-care advice to improve oral health at home.

SUMMARY OF A COMPETENT ANSWER

  • Takes a thorough history of gum symptoms, oral hygiene, smoking, and general health.
  • Clearly differentiates between gingivitis and periodontitis.
  • Explains findings in a patient-centred, non-alarming way.
  • Provides a structured management plan, including dental referral and lifestyle advice.
  • Addresses patient concerns about cost, tooth loss, and treatment options.

PITFALLS

  • Failing to assess smoking history and its impact on gum disease.
  • Not distinguishing between gingivitis and periodontitis.
  • Overlooking the need for dental referral in suspected periodontitis.
  • Providing vague or alarmist information without reassuring the patient.
  • Ignoring cost concerns and access to affordable dental care.

REFERENCES

MARKING

Each competency area is on the following scale from 0 to 3.

☐ Competency NOT demonstrated
☐ Competency NOT CLEARLY demonstrated
☐ Competency SATISFACTORILY demonstrated
☐ Competency FULLY demonstrated

1. Communication and Consultation Skills

1.1 Communication is appropriate to the person and the sociocultural context.
1.2 Engages the patient to gather information about their symptoms, ideas, concerns, and expectations.
1.3 Provides clear and structured explanations about gum disease and management.

2. Clinical Information Gathering and Interpretation

2.1 Takes a thorough dental, medical, and lifestyle history.
2.2 Identifies risk factors contributing to gum disease.

3. Diagnosis, Decision-Making and Reasoning

3.1 Evaluates whether the patient has gingivitis, periodontitis, or another dental issue.

4. Clinical Management and Therapeutic Reasoning

4.1 Provides an appropriate treatment plan and advice for gum disease.
4.2 Discusses the need for dental referral.

5. Preventive and Population Health

5.1 Provides patient education on oral hygiene and prevention.

6. Professionalism

6.1 Provides patient-centred, non-judgmental care.

7. General Practice Systems and Regulatory Requirements

7.1 Documents oral health assessment and referral plan.

9. Managing Uncertainty

9.1 Addresses patient concerns about progression and treatment.

10. Identifying and Managing the Patient with Significant Illness

10.1 Recognises and appropriately refers suspected advanced gum disease.

Competency at Fellowship Level

☐ CLEARLY BELOW STANDARD
☐ BELOW EXPECTED STANDARD
☐ BORDERLINE
☐ AT EXPECTED STANDARD
☐ ABOVE STANDARD