Exam

Question 1

How often should a chief complaint be listed in a patient’s record?

Answer 1

Every appointment.

Question 2

What is HPI?

Answer 2

History of present illness. Chronological description of problem from first sign of symptoms up to today.

Question 3

What can a dentist code for in the initial patient exam?

Answer 3

Only up to a 99203, “detailed.” 99204 would be “comprehensive” and includes systems we can’t legally evaluate, including gynecological.

Question 4

What is the normal maximum open range of the mandible?

Answer 4

≥42 mm

Question 5

What is the normal protrusion range of the mandible?

Answer 5

≥8 mm

Question 6

What is the normal lateral excursion range of the mandible?

Answer 6

≥8 mm

Question 7

Does a simple NG affect AHI?

Answer 7

Some studies show that placement of a NG on occasion worsens AHI. Remember that any device on the teeth changes the relationship of the condyle to the fossa.

Question 8

How does facial shape affect range of motion?

Answer 8

Brachiofacial (short, square face) patients tend to have greater ROM
Dolicofacial (long, narrow) tend to have lesser ROM

Question 9

What is the “normal” orthodontic Angle classification?

Answer 9

Class I Div I

Question 10

What is a normal overjet?

Answer 10

1-2 mm

Question 11

What is the normal overbite?

Answer 11

1-2 mm

Question 12

What does Division II signify?

Answer 12

Retroclined upper incisors

Question 13

What is the normal CEJ to CEJ distance?

Answer 13

17-20 mm. In Class II Div II patients (CEJ distance of 12ish), they likely could have been treated with ortho as a child (palatal expander). The retroclined incisors trap the retrognathic mandible

Question 14

What is a normal swallow pattern?

Answer 14

Lips sealed and relaxed
Back teeth lightly together
Tongue tip at incisal papilla
Tongue lifts and seals against palate when soft palate elevates
Soft palate closes down
No cervical muscle recruitment

Question 15

What causes lateral tongue thrust?

Answer 15

Lack of masseter muscle contraction during swallowing. This can result in crossbite.

Question 16

What muscle is activated in reverse swallow that is not activate in normal swallowing?

Answer 16

The mentalis muscle. Leads to malocclusion – lower incisors retroclined.

Question 17

Besides habit, what can promote tongue thrust in a patient?

Answer 17

Enlarged tonsils can result in the tongue coming forward during swallowing to allow room for the bolus to get down the throat.

Question 18

What are two tongue conditions that result from lateral thrust?

Answer 18

Scalloped tongue and enlarged tongue. Lateral tongue thrust usually results from lack of masseter contraction during swallowing.

Question 19

What are three tongue conditions that result from being a mouth breather?

Answer 19

Coated tongue, reddened tongue, swollen or painful tongue

Question 20

What is the developmental (airway/jaws) dysfunction model of etiologies?

Answer 20

A bidirectional triangle between:
Airway obstruction (no breastfeed, soft diet, allergies)
Muscle dysfunction (resting muscle tonicity, dysfunctional swallow, parafunctional breathing)
Hard tissue abnormalities (narrow palate, narrow nasal passage, retruded mandible, retruded maxilla)

Question 21

What are the syndromes related to each of the three areas of develpmental dysfunction (airway/jaws) and how do we treat them?

Answer 21

Airway obstruction: OSA. Treatment: OAT or ortho if young
Hard tissue: TMJ. Treatment: splints, ortho, surgery
Muscle dysfunction: headaches, neckaches. Tx: myofunctional therapy, orthotics

Question 22

What are the grades of tonsil size?

Answer 22

0: not visible
1: up to tonsillar pillar but not past it (75%)