PATIENT MANAGEMENT Flashcards
___ is defined as the science and art of preventing and controlling dental diseases and promoting dental health through organized community efforts. it is that form of dental practice which serves the community as a patient rather than the individual. it is concerned with the dental education of the public, with applied dental research, and with the administration of group dental care programs as well as the prevention and control of dental diseases on a community basis
dental public health
what is a gingival index?
- loe and silness
- scoring of gingival inflammation from 0-3, with 0 being normal and 3 being ulcerated tissue with a tendency toward spontaneous bleeding
why are periodontal indices not considered the best methods to measure periodontal disease?
because they both (periodontal index and periodontal disease index) combine gingivitis and periodontitis measure into a common score
the community periodontal index of treatment needs (CPITN) combines an assessment of what 3 things?
- gingival health
- pocket depth
- presence of supragingival and subgingival calculus
which index sets forth a method of quantifying the amount of plaque and calculus in its two components, the debris index and the calculus index
simplified oral hygiene index (OHI-S)
the prevalence of caries in the US declined substantially from the early 1970s until the mid 1990s as a result of ___
fluoridation, the use of fluorides, and other preventive measures
from the mid 1990s until the most recent NHANES survey (2004), among children 2-11 years old, what happened to the incidence of caries?
it increased slightly
the current best estimate of early childhood caries prevalence in the US is approximately ___% nationwide
- 5%
- in 2005, 28% of preschool aged children had experienced tooth decay (4 million children affected nationwide)
has the prevalence of coronal caries increased or decreased in recent decades among US adults?
decreased
more than ___% of US adults over 20 years old have at least one decayed or filled tooth
90%
the prevalence of caries among dentate adults 20 years or older increases with age until ___ years old, after which it plateaus at approximately ___ decayed and filled surfaces
- 59 years old
- 30
T or F:
it has been determined that nonwhites have significantly higher coronal DFS (decayed/filled surfaces) than whites
- false (opposite)
- whites have a mean coronal DFS twice as high as african americans
approximately ___% of dentate adults older than 20 have root caries
18%
although the prevalence of root caries has decreased compared with previous national surveys, root surface caries is 3x higher among adults ___ years and older compared with adults younger than ___ years old.
- 60
- 40
- this prevalence is lower for whites compared with other racial groups
the prevalence of gingivitis among school age children has been reported to be ___%. the prevalence among the US population 20 years and older is ___%
- 40-60%
- 53%
what is the most common form of periodontitis?
chronic
the prevalence of periodontitis in adults 30 and older is about ___%
- 47%
- 64.7 million adults
according to the national cancer institute, how many new cases of oral cancer would be diagnosed, and how many people would die of cancer of the oral cavity and pharynx in 2013? most of these oral cancers are ___ and ___
- 41,380 (M:F 2:1) would be diagnosed
- 7890 would die
- epidermoid carcinomas and squamous cell carcinomas
in the US, oral cancer represents about ___% of all cancers, and about ___% of all cancer deaths
- 4%
- 2.2%
the incidence of oral and pharyngeal cancers increases with age and alcohol or tobacco use, and is uncommon before age ___
40
cancers of the ___ and ___ account for approximately 2/3 of all new oral and pharyngeal cancers, with the ___ being the most common site of incident cancers of the oral cavity
- lip and oral cavity
- tongue
which population has a higher incidence of oral and pharyngeal cancers compared to other racial groups?
whites
overall, the 5-year survival rate for oral and pharyngeal cancers is approximately ___%
63%
what is the recommended level of fluoride for a community water supply in the US?
0.7-1.2ppm
1ppm of fluoride is equivalent to ___mg of fluoride per liter of water
1
studies demonstrate that water fluoridation prevents ___% of caries in the permanent teeth of children without the addition of other fluoride products (toothpaste, rinses, etc), and is ___% with the fluoride products
- 50-70%
- 20-40%
what is the major difference between community water fluoridation and school water fluoridation?
the recommended concentration for school water fluoridation is 4.5x the concentration of fluoride recommended for community water supplies in the respective geographic area
school water fluoridation has shown a ___% reduction in caries when children have consumed school water fluoridation for 12 years
20-30%
since the early 1960s, ___ has become the most widely used fluoride compound for professional application. it has a pH of ___
- acidulated phosphate fluoride
- pH is about 3.0 (acidic)
- experimental work showed that the topical uptake of fluoride by enamel is greater in an acidic environment
___ indicates what proportion of a given population is affected by a condition at a given point in time
- prevalence
- number of people with the disease divided by the total number of people at risk
___ indicates the number of new cases that are expected to occur within a population over a period of time
- incidence
- number of new cases of the disease divided by the total number of people at risk
___ is a study in which the health conditions in a group of people who are, or are assumed to be, a sample of a particular population is assessed at one time
cross-sectional study
___ is a study in which people with a condition are compared to people without it, but who are similar in other characteristics
case-control study
___ is a study where a general population is followed through time to see who develops the disease, and the various exposure factors that affected the group are evaluated
prospective cohort study
___ is a study used to evaluate the effect that a specific exposure has had on a population
retrospective cohort study
the ___ is a method of ascertaining the way individual values are located around the mean
- variance (s^2)
- the larger the variance, the more widely the data items are spread around the mean
- the smaller the variance, the closer the data items are spread around the mean
- a variance of zero indicates no spread at all
the ___ measures the typical or average deviation from the mean
standard deviation
if p < 0.5, so you reject or accept the null? what about if p > 0.5?
- reject if p < 0.5
- accept if p > 0.5
- p is the statistical significance
the ___ quantifies the relationship between variables (x and y)
correlation coefficient (r)
a ___ provides a mathematical model of linear relationship between a dependent and two or more independent or predictor variables
multiple regression
the ___ measures the association between two categorical variables
chi-square test
the ___ is used to analyze the statistical difference between two means
t-test
the ___ analyzes whether or not the means of several groups are equal and generalizes a t-test to more than two groups
analysis of variance (ANOVA) test
___ is defined as the percent of persons WITH the disease who are correctly classified as having the disease. ___ is defined as the percent of persons WITHOUT the disease who are correctly classified as not having the disease.
- sensitivity
- specificity
what are the transmissible diseases of greatest concern to the dental professional?
hepatitis B, HIV, hepatitis C, and tuberculosis
what is the etiology of hepatitis B (HBV)?
- the disease is produced by a highly infective virus known as the Dane particle
- the intact virus consists of an inner core antigen (hepatitis B core antigen) and an outer coat surface antigen (hepatitis B surface antigen)
what is the risk of transmission of HBV after percutaneous injury from an infected patient?
30%
how is HBV diagnosed?
- physical exam, medical history, and blood tests
- blood tests include hepatitis B antigens and antibodies and hepatitis B viral DNA (HBV DNA), which detects genetic material from the HBV
is there a vaccine for hepatitis B?
- yes
- three doses
- initial dose, a second dose 1 month later, and a third dose 6 months after the first
what is the etiology of hepatitis C (HCV)?
caused by hepatitis C virus, a single stranded RNA virus that appears to have cytopathic activity
the risk of transmission of HCV after a needle stick or sharps exposure is ___%
1.8%
how is HCV diagnosed?
- med history, physical exam, and blood tests
- blood test detects antibodies or genetic material (RNA) of the virus
is there a vaccine against HCV?
- no
- prevention is vital
what is the etiology of HIV?
HIV is caused by an RNA virus
the risk of transmission of HIV from percutaneous exposures is ___% and from mucous membrane exposures is ___%
- 0.3%
- 0.09%
how is HIV diagnosed?
- diagnosed when antibodies to HIV are detected in the blood
- two primary blood tests are used: enzyme linked immunosorbent assay (ELISA) and western blot assay, which is used to confirm the result of a positive ELISA test
- HIV is diagnosed only after two or more positive ELISA tests are confirmed by western blot assay
is there a vaccine for HIV?
- no
- prevention is vital
- postexposure prophylaxis consists of antiviral drugs similar to drugs given to patients with AIDS
what is the etiology of tuberculosis?
caused by mycobacterium tuberculosis, a slow-growing bacterium that thrives in areas of the body that are rich in blood and oxygen, such as the lungs
what is the most common mode of transmission of tuberculosis?
- inhalation of infected droplet nuclei
- a rare mod of transmission is by infected urine
how is tuberculosis diagnosed?
-pulmonary tuberculosis is diagnosed based on a med history, physical exam, and sputum cultures and chest x-rays
___ is absence of all life forms
- sterilization
- this is the most important component of an infection control program
by custom, the term ___ is reserved for chemicals applied to inanimate surfaces, whereas ___ is used for antimicrobial agents that are applied to living tissues
- disinfection
- antiseptic
a major distinction between high-level disinfection and sterilization is the ability of sterilization to kill ___
- spores of spore-forming bacteria (bacillus and clostridium)
- bacillus spores are the benchmark organisms for sterilization
- if a process kills bacillus spores, it will also kill easier-to-kill bacteria, fungi, viruses, and protozoa
what is the proper time and temperature for autoclaving?
250F (121C) for 15-20 minutes (15lb pressure of steam) or 270F (134C) for a minimum of 3 minutes (30lb pressure of steam)
how does moist heat destroy bacteria?
by denaturation of the high-protein-containing bacteria
how often should spore testing be conducted?
weekly
do process indicators demonstrate that microoorganisms have been eliminated?
- no, they only demonstrate that certain physical conditions have been reached
- biologic monitors (spore tests) can indicate elimination of microorganisms
compare dry-heat sterilization to autoclaving
- dry-heat sterilization requires a higher temperature and longer time (320F [160C] for 1-2 hours) than steam autoclaving
- only glass or metal objects can be sterilized by dry heat
what is ethylene oxide (chemiclave)?
- a chemical used to sterilize medical devices
- ethylene oxide gas achieves sterilization in 2-3 hours at 120F (48.9C) followed by a lengthy aeration time
describe chemical (cold) sterilization
- used for instruments and other items that are heat-sensitive
- items are soaked in a 2% solution of gluteraldehyde for 10 hours followed by rinsing in sterile water
- does not destroy spores or hepatitis viruses
___ is a process in which an antimicrobial agent destroys (germicide) or avoids the growth of (microbiostatic) pathogenic microogranisms
disinfection
what is the benchmark organism for disinfectants?
mycobacterium tuberculosis
what is the most commonly used antiseptic to reduce the number of pathogenic microorganisms on the skin surface?
alcohol
noise-induced hearing loss is caused by any exposure regularly exceeding a daily average of ___ dB
90
the national fire protection association color and number method is used to identify information about various hazardous chemicals easily on MSDS sheets and product labels. what do the following colors correspond to: blue, red, yellow, and white
- blue = health hazard
- red = fire hazard
- yellow = reactivity or stability of a chemical
- white = required PPE when using the chemical
- the level risk for each category is indicated by the use of numbers 0-4 (the higher the number, the greater the danger)
which principle of ethics states that the dentist has a duty to respect the patient’s rights to self-determination and confidentiality?
patient autonomy
which principle of ethics states that the dentist has a duty to refrain from harming the patient?
nonmaleficence
which principle of ethics states that the dentist has a duty to promote the patient’s welfare?
beneficence
which principle of ethics states that the dentist has a duty to treat people fairly?
justice
which principle of ethics states that the dentist has a duty to communicate truthfully?
veracity
which principle of ethics is “self-governance”?
patient autonomy
which principle of ethics is “do not harm”?
nonmaleficance
which principle of ethics is “do good”?
beneficence
which principle of ethics is “fairness”?
justice
which principle of ethics is “truthfulness”?
veracity
informed consent is based on which ethical principal?
patient autonomy
