Overseas Registration Examination (ORE)

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What is the Overseas Registration Examination (ORE)?

ORE means Overseas Registration Examination. It is an exam that overseas qualified dentists have to pass because their dental bachelor degrees are not recognised by GDC. After passing ORE, a dentist can get registration in GDC and he or she will be allowed to practise dentistry unsupervised in the UK. The ORE tests the clinical skills and knowledge of overseas dentists who  are referred to as a candidate. Candidates are expected to be at equal or above the standard of a ‘just passed’ UK BDS graduate. A candidate should be able to show competence, knowledge and familiarity in the different aspects of dentistry in the exam. 

The ORE has two parts

The​ Part 1 is designed in such a way that it tests candidates’ application of knowledge to clinical practice. ORE part 1 consists of two computer-based exam papers:

Paper A covers clinically applied dental science and clinically applied human disease. Basically it will check your ability to apply your knowledge of non clinical subjects to understand its role in human diseases.

Paper B covers aspects of clinical dentistry, including law, ethics, health and safety. It means paper B will check your ability to treat patients taking care of existing laws of the UK, ethics, and safety. Each paper lasts three hours and is made up of multiple short answer questions. They will contain extended matching questions and single best answer questions. A candidate is expected to be able to show competence, knowledge and familiarity in the different aspects of dentistry.

You need to achieve a minimum 50% marks in each paper to pass the part 1 of ORE. There are a maximum of 200 places available at each examination period. You must pass both papers in order to progress to Part 2. 

Location and Cost of Overseas Registration Examination

The Part 1 exam is held at King’s College London and costs £806. There are currently no confirmed dates for 2021. Your exam results will be sent to you by email. Generally it is declared within 20 working days of the examination. You will be given a percentage mark out of 100 for paper 1 as well as paper 2. Also, you will get an overall pass or fail award. Approximately 40 working days after the examination, the Part 1 Supplier, King’s College London, will provide you with result feedback. Upon passing Part 1, your name will be added to the Part 2 candidate list. You will be allowed four attempts for Part 1. 

Part 2 of ORE 

Part 2 is designed for candidates to demonstrate practical clinical skills. For each examination period, a maximum of 144 candidates are able to undertake the Part 2 exam. The current cost of the examination is £2,929 per candidate, payable at the time of booking. 

Part 2 Examination Dates: 

There are currently no confirmed dates for 2021 part 2.

Four Components of Part 2 of the ORE:

  1. DM,
  2. OSCE,
  3. DTP &
  4. EM 

First component is An operative test on a dental manikin: Candidates are required to perform three procedures over a period of three hours. These procedures primarily involve the preparation and restoration of teeth, but may also include other procedures where appropriate simulation can allow assessment of operative skills. 

Second component is An objective structured clinical examination (OSCE).  This is where candidates visit a series of ‘stations’ which test their clinical skills. These may include history-taking and assessment, communication skills such as an explanation of problems and treatment plans, judgement and decision making, ethics and attitudes, and clinical examination. The series of stations will cover aspects of behavioural sciences, human disease, law, ethics, professionalism, clinical dentistry, restorative dentistry, paediatric dentistry, orthodontics, preventive dentistry, dental public health, comprehensive oral care, oral surgery, oral medicine, oral pathology, oral microbiology, dental radiology and imaging.

Third component is A diagnostic and treatment planning exercise (DTP):  This involves an actor who will provide an appropriate history. You will be provided relevant additional information such as photographs, radiographs, study models or results of other special tests. You will not examine the actor. The exercise may involve any of the above aspects of clinical dentistry I just mentioned.

Fourth component is a practical examination in medical emergencies (ME).  This assessment consists of two parts: First is a structured scenario-based oral and the second is a demonstration of single handed basic life support. This will include cardiopulmonary resuscitation using a resuscitation manikin. You will be allowed four attempts for Part 2. Your exam results will be sent to you by email. The result will be declared within 20 working days of the exam. If you only fail the medical emergencies exercise during the ORE Part 2 , you will be able to re-sit this component only at a future exam. Sitting the ME only exam costs £300. If you pass the ME component at this sitting, you will have passed Part 2 of the ORE. If you fail, you will need to retake the full ORE Part 2 exam, if you are eligible to do so. The ME only exam is held at the same time as the full Part 2 exam. Once you have passed Part 2, you will be able to apply for registration with the GDC.   

Books Recommended for ORE Preparation

  • Oxford Handbook of Applied Dental Science
  • Oxford Handbook of Clinical Dentistry 6
  • Scully’s Medical Problems in Dentistry, 7 e
  • Master Dentistry: Volume 1
  • Master Dentistry: Volume 2
  •  Essentials of Dental Radiography and Radiology-Eric Whaites
  • Vanders Physiology
  • BD Chaurasia for Anatomy

 

 

Odontogenic Keratocyst

 

 

 

Image Source: Recurrence of odontogenic keratocysts and possible prognostic factors: Review of 455 patients (researchgate.net)

Dentigerous/Follicular Cysts

Dentigerous (Follicular) Cysts are the second most commonly occurring odontogenic cysts after periapical cyst and the most common developmental cysts of the jaws. By definition, a dentigerous cyst is attached to the tooth cervix (enamel-cementum junction) and encloses the crown of the unerupted tooth.

image dentigerous cyst
Photograph: Dentigerous cyst surrounding the crown of right mandibular third molar and going upward in ascending ramus. [1]

Etiology and Pathogenesis of Dentigerous Cyst 

A dentigerous cyst originates from the enamel organ remnant or reduced enamel epithelium. The expansion of the dentigerous cyst is related to epithelial proliferation, release of bone-resorbing factors, and an increase in cyst fluid osmolality. 

Clinical Features of Dentigerous Cyst 

Dentigerous cysts are most commonly seen associated with third molars and maxillary Canines. The peak incidence of dentigerous cysts occurs between twenty to 40 years. Males have more predilection with a ratio of l.6 to 1.  

Dentigerous cysts are generally symptomless. The delayed eruption is the most common indication of dentigerous cyst formation. This cyst can achieve significant size, occasionally causes cortical bone expansion but rarely reaches a size that predisposes the patient to a pathologic fracture. 

Radiographically, a dentigerous cyst manifests as a well-defined, unilocular or sometimes multilocular radiolucency with corticated margins in attached with the crown of an unerupted tooth. The concerned unerupted tooth is mostly displaced. In the mandible the related radiolucency may extend superiorly from the third molar site into the ramus or anteriorly and inferiorly along the body of the mandible. In maxillary dentigerous cysts in the canine region, extension into the maxillary sinus or to the orbital floor may be seen.

image dentigerous cyst
OPG radiograph showing dentigerous cyst associated with right mandibular third extending in to the ramus and ascending body. [2}

Histopathology.

The cyst is lined by stratified squamous epithelium. In a noninflamed dentigerous cyst the epithelial lining is nonkeratinized. It remains approximately four to six cell layers thick. Sometimes, numerous mucous cells, ciliated cells, and rarely, sebaceous cells may be found in the lining of the epithelium. The epithelium-connective tissue junction is generally flat. But when secondary inflammation established, epithelial hyperplasia may be noted.

image histopathology of dentigerous cyst
Microscopic structure of Dentigerous cyst [4]

Differential diagnosis

When it is small, it is difficult to differentiate a dentigerous cyst from a large but normal dental follicle. When larger, the differential is essential that of lytic lesions of the jaw and includes:

  1. periapical cyst
  2. aneurysmal bone cyst
  3. ameloblastoma
  4. odontogenic keratocyst
  5. fibrous dysplasia
  6. Stafne cyst

Treatment

Removal of the associated tooth and enucleation of the soft tissue part is definitive therapy in most cases. When cysts affect significant portions of the mandible, exteriorization or marsupialization of the cyst is done to allow for decompression and subsequent shrinkage of the lesion followed by surgical enucleation. 

Ref:

  1. J Can Dent Assoc 2012;78:c59
  2. https://radiopaedia.org/cases/dentigerous-cyst-9
  3. https://www.pathologyoutlines.com/topic/mandiblemaxilladentigerous.html
  4. https://www.nature.com/articles/modpathol2016191

Periapical/Radicular Cyst

A cyst is defined as “an epithelial lined pathologic cavity”. The periapical/radicular cyst is an odontogenic cyst. The classification of the cysts can be seen HERE.t is important to read for ADC Exams or NEET MDS purpose.

Periapical/Radicular cyst

Periapical cysts are inflammatory cysts. Their epithelial lining originates from the odontogenic epithelium of the tooth buds that remains within periodontal ligaments (epithelial rests of Malassez) after completion of tooth maturation. Due to inflammatory response, the epithelial rests of Malassez start proliferating and provide cystic lining. (more…)

ADC Exam: Written & Practical explained

Introduction

The Australian Dental Council conducts a series of assessment exams for accreditation of the scientific knowledge, technical and clinical skills and ability to make a clinical judgement in relation to patient care of an overseas dentist whose dental graduate degree is not recognised by the Dental Board of Australia.

Once an overseas dentist successfully clears the assessment process, he or she can register with DBA as a GP and can practice Dentistry in Australia.

Australian Dental Council assessment process is a three-stage process. The first is the initial assessment that I have already explained in the episode 1 of our video series. Now, in episode 2 of the video series, I shall explain written as well as practical exams. After going through this video, you will become familiar and confident with every aspect of the exams.

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