Patient Management Flashcards
A patient is sitting in the chair immediately
following an extraction. She says, “Thank you.
That wasn’t as bad as I expected, but my sister
told me that the first night after having a tooth
pulled is very painful. What if the medication
you’re giving me isn’t strong enough?” Choose
the most appropriate response.
A. “Did she make you feel worried about that?”
B. “It sounds like you’re worried that you might not
have enough pain relief when you’re home.”
C. “I understand your concern.”
D. “Don’t worry. I’ll give you plenty of pain
medicine.”
E. “It sounds like your sister had a unusually bad
experience. Don’t believe what others tell you,
and certainly don’t let that worry you. You’ll be
fine.”
B. Of the options given, the best response would be
to interpret what the patient is trying to commu-
nicate and reflect the communication back to
him or her. This will gently encourage the patient
to openly express and discuss the concern with
the clinician. It also serves to establish an envi-
ronment of openness and acceptance.
During admission, a patient interrupts you on
a number of occasions with stories about past
dental experiences while you are attempting to
take a complete medical history. Your best
response would be _____.
A. Say nothing, listen to the patient, and finish your
intake as best you can.
B. Say, “I’d like to focus on your present
experience and right now I need to know your
medical history.”
C. Say, “It seems like you’ve had some important
experiences and I would like to hear more
about them, but first, let’s discuss this health
questionnaire before we address it, okay?”
D. Say, “I don’t need to know the details of your
dental history. Please inform me of the
experiences asked about in the questionnaire.”
E. Say, “We have about 30 minutes to complete
this questionnaire and get started in your
examination, so let’s focus on that.”
C. Of the options given, it is best to acknowledge
that the patient is trying to convey information that
is important to him or her and establish that there
will be a time to talk about those issues, while
gently redirecting him or her to the task at hand.
A 7-year-old child has a history of recurrent
pain and discomfort in a second molar, which
has a necrotic pulp. You present the treatment
options to the parents. “There are several ways
in which we can treat this problem. We could
do a pulpectomy in which we . . . . We could
do something called a pulpotomy, which
involves. . . . We could apply a pulp cap which
is . . . . We could remove the tooth. Or we could
leave the tooth untreated for now and see how
things go.” You have phrased the options so
that they are in what you believe to be the order
of descending desirability and you have
indicated that to the patient. Which option is
most likely to be chosen by the parents?
A. Pulpectomy
B. Pulpotomy
C. Pulp cap
D. Extraction
E. No treatment
A. When a number of alternatives are presented
and the first on the list is more desirable, there is
a tendency for individuals to select the first
option and view the successive options as less
desirable.
Which statement is false regarding motivation?
A. Motivation is strengthened when a person
succeeds and is weakened when a person fails
to achieve his/her goals.
B. Motivation is increased when the patient
focuses on long-term goals.
C. Motivating a patient can be achieved by
generating interest, showing your concern, and
providing information.
D. Encourage a sense of personal acceptance in
the face of the inevitable difficulties involved in
breaking old habits and establishing new ones.
E. Help a patient cope with relapses by
emphasizing the knowledge gained.
B. Focusing on long-term goals is not only a poor
motivator, it is often a pitfall in the effort to change
behavior, as patients are less motivated when goals
seem too big, impossible, or far from their current
circumstances.
Which statement is false about behavioral con-
tracts?
A. It is a legal and binding agreement between
health care professional and patient.
B. It helps solidify an agreement with a patient.
C. It should always be open to modification.
D. It helps clarify agreements.
E. The clinician should give a copy to thepatient
and keep one for himself or herself.
A. Although the behavioral contract is not a legal
document, it can be a useful approach in solidi-
fying behavioral strategies and goals.
A 6-year-old patient likes to tell you stories
about school. Each time he begins a story, you
stop working to listen. After three long sessions,
you realize that the child is attempting to avoid
or delay the dental work by telling stories. You
decide that from this point on you are going to
continue working while engaged in conversation
with the patient. At first, the child tells you more
stories about school and, further, tries other
strategies to get your attention and stop your
work. He eventually settles down and allows
you to work, whether or not you are engaged in
conversation. This is an example of _____.
A. Shaping
B. Extinction
C. Modeling
D. Stimulus control
E. Power
B. Extinction is the process of identifying all positive
reinforcements (in this case, the dentist ceasing
work on the child’s teeth) that maintain a behavior
and ceasing or withholding these.
Which of the following is not a factor in the
appraisal of stress?
A. Familiarity—how familiar the situation is; the
less familiar, the more stressful it may seem.
B. Predictability—how predictable the situation is;
the less predictable, the more stressful it may
seem.
C. Controllability—how controllable the situation
seems to be; the less controllable, the more
stressful it may seem.
D. Imminence—the more imminent the situation
is, the more stressful it may seem.
E. Positive or negative valence—whether the
situation is positive or negative; positive
situations (e.g., a wedding) are typically
experienced as less stressful than are negative
situations (e.g., a divorce).
E. Both positive and negative events or situations
are experienced as stress.
The substitution of a relaxation response for
an anxiety response (using a relaxation strat-
egy such as diaphragmatic breathing) when
one is exposed to a hierarchy of feared stimuli is called \_\_\_\_\_. A. Progressive muscle relaxation B. Habituation C. Flooding D. Systematic desensitization E. Biofeedback
D. Systematic desensitization is the process of sys-
tematically pairing a relaxation response with a
hierarchy of feared stimuli.
Which statement is false regarding the relation-
ship between pain and fear?
A. Fear initially inhibits pain due to a release of
endorphins from the pituitary, resulting in an
analgesic effect.
B. Although muscle tension contributes to the
experience of anxiety, it does not contribute to
the perception of pain.
C. Any autonomic activation causes one to have a
lower pain threshold.
D. Catastrophic thinking and a perceived lack of
control are common factors that influence pain
perceptions.
E. Misattribution occurs when patients identify an
event as painful because they can identify a
fearful stimulus.
B. Muscle tension is associated with the experience
of anxiety. Heightened anxiety contributes to
lower pain thresholds/sensitivity to the percep-
tion of pain.
Which of the following is an example of a cog-
nitive strategy that may be useful in pain man-
agement?
A. Address expectations by providing information
and addressing any questions and/or concerns.
B. Suggest to patients that they learn to identify,
evaluate, and eliminate maladaptive thinking.
C. Encourage patient efforts to address their
anxiety and pain management.
D. Suggest to patients that they learn to generate,
evaluate, and apply more realistic thinking.
E. All of the above.
E. All of the strategies listed may be considered
appropriate cognitive interventions in pain man-
agement.
- Which of the following scenarios is an example
of classical conditioning?
A. You teach a dentally-anxious patient
diaphragmatic breathing unconditional stimulus
(US), which naturally induces the physiological
relaxation response unconditional response
(UR). You seat that anxious patient in the dental
chair for an examination conditional stimulus
(CS) and ask them to use their breathing skills
during the exam (US). While using the breathing
skills, the patient will feel more relaxed
conditional response (CR).
B. You teach a dentally-anxious patient
diaphragmatic breathing (US), which naturally
induces the physiological relaxation response
(UR). You ask the patient to practice that
technique at home (CS) and also use it during
procedures to reduce the subjective experience
of anxiety (CR).
C. You teach a dentally-anxious patient
diaphragmatic breathing (US), which naturally
induces the physiological relaxation response
(UR). You seat that anxious patient in the dental
chair for an examination (CS) and ask them to
use their breathing skills during the exam (US).
The focus on breathing serves as a distraction
(US) from what the patient feels is threatening
and fearful (CR), and, therefore reports less
anxiety (CR).
D. You teach a dentally-anxious patient
diaphragmatic breathing (US), which naturally
induces the physiological relaxation response
(UR). You seat that anxious patient in the dental
chair for an examination (CS) and ask them to
use their breathing skills during the exam (US).
After a number of these experiences, the patient
will feel relaxed during the exam while using
the breathing technique (UR) and without using
it at all (CR).
E. None of the above.
D. Classical conditioning (also known as respondent
or Pavlovian conditioning) occurs when a neutral
stimulus, one that is not associated with a particular
response, is paired with an unconditioned stimulus
([US]; one that naturally elicits a particular
response [UR]). After a number of pairings, the
neutral stimulus (CS) elicits a conditioned response
(CR), which is essentially a weaker form of the UR)
without the presence of the US.
The best strategy for addressing dental fear
that is based upon distrust of the dentist is to
_____.
A. Use distraction techniques
B. Use cognitive coping strategies
C. Enhance informational and behavioral control
D. Teach diaphragmatic breathing
E. Reassure the patient that he or she can trust
you
C. Providing the patient with information and
control over his or her environment is likely to
contribute to increased trust over time. Avoiding
the issue of trust or providing reassurance that
the patient can trust you without evidence is
likely to maintain poor trust.
What behavior can you typically expect from
an anxious patient in the dental chair?
A. He or she is more likely to sit still, hands clasped
together.
B. He or she is more likely to sit casually, legs
crossed, reading a magazine.
C. He or she is more likely to keep to himself or
herself and not speak unless spoken to.
D. He or she is more likely to fidget in the chair,
moving his or her hands and feet.
E. Both A and C.
E. Contrary to their behavior in the waiting room,
anxious patients are typically more likely to sit
very still, often holding onto the arms of the den-
tal chair, and engage in minimal verbal commu-
nication unless encouraged by the clinician.
With no other intervention or instruction,
which is most likely to trigger a physiological
relaxation response?
A. Observing one’s own physiological responses
(e.g., heart rate, blood pressure)
B. Muscle tensing
C. Reassurance
D. Thought stopping
E. Diaphragmatic breathing
E. Diaphragmatic breathing naturally activates the
parasympathetic nervous system, producing a
relaxation response.
A 32-year-old male patient is fearful of receiv-
ing injections. You decide to use a cognitive
behavioral strategy with him to help him
through an injection. You have already
instructed him in diaphragmatic breathing and
ask him to practice this skill throughout the
procedure. First, you show him the syringe. You
talk about the characteristics of the needle.
You then place the needle in his mouth with the
cap on. Then, you simulate the procedure with
the cap on. You then simulate the procedure
with the cap off. Eventually, you proceed with
the injection. What does this procedure exem-
plify?
A. Habituation B. Cognitive control C. Flooding D. Systematic desensitization E. Behavior modification
D. Systematic desensitization is the systematic
process of exposing the patient to a hierarchy of
increasingly anxiety-provoking stimuli while the
patient uses relaxation skills such as diaphragmatic
breathing exercises.
Principles of operant conditioning teach us
that _____.
A. If you praise your 5-year-old patient and reward
him for keeping his legs still while you are
drilling, this will make the child happy and more
likely to like you and less likely to resist your
requests.
B. If you praise your 5-year-old patient and reward
him for keeping his legs still while you are
drilling, this will increase the likelihood that he
will remain still in similar situations in the future.
C. If you make the dental environment a child-
friendly place, your young patient will be more
comfortable.
D. If you pair the dental chair with having a parent
present, the child will be less likely to be
anxious.
E. None of the above.
B. Operant conditioning posits that behavior is
largely influenced by the consequences associ-
ated with the particular behavior.
According to anxiety disorders research, it has
been suggested that which of the following is
the most important component of systematic
desensitization?
A. Cognitive restructuring
B. Progressive muscle relaxation
C. Diaphragmatic breathing
D. Exposure
E. Psychoeducation
D. Research suggests that the most integral compo-
nent of the treatment of anxiety is exposure to
the feared stimulus.
Sarah S. is a young child who consistently pres-
ents as anxious, hypervigilant, and upset during
dental visits. Sarah is often accompanied by her
parent, who appears to be very concerned about
the child and wants to be involved at all times in
her evaluation and treatment. During this visit,
Sarah’s treatment requires an injection and a
rubber dam application, which you anticipate
may lead to increased anxiety. Which strategy
would be the least effective in completing the
rubber dam application?
A. Tell-Show-Do
B. Distraction
C. Ask the child to be a helper
D. Structure time
E. Rehearsals
B. Of the choices, distraction would most likely be
the least effective approach—the attention of a
very anxious individual cannot typically be easily
diverted. In such cases, distraction can have
detrimental effects such as compromising rap-
port and/or increasing anxiety by failing to pro-
vide a positive coping experience. Providing
education and coping strategies—increasing pre-
dictability, familiarity, and controllability—are
typically more effective strategies in working with
anxious patients.
Which of the following factors are involved in
the cognitive appraisal of a threat?
A. Interference, adaptability, longevity, and reactance
B. Adaptability, preventability, inevitability, and
constancy
C. Controllability, familiarity, predictability, and
imminence
D. Validity, reliability, adaptability, and predictability
E. Accountability, reliability, validity, and familiarity
C. Controllability, familiarity, predictability, and
imminence are significant factors influencing the
cognitive appraisal of stress.
A patient has difficulty inhibiting the gag reflex
during x-ray procedures. You suggest that the
patient take several x-ray packets home and pra-
ctice holding the packets in his or her mouth for
increasingly longer periods of time. Which of the
following techniques does this best exemplify?
A. Reinforcement
B. Graded exposure
C. Modeling
D. Behavioral control
E. Systematic desensitization
B. Graded exposure is the systematic process of
exposing the patient to a hierarchy of increas-
ingly anxiety-provoking stimuli.
When faced with a frightened child patient,
which would be the most appropriate or most
effective response?
A. Ask the child about his or her fears.
B. Reschedule the appointment for a later date.
C. Reassure the child.
D. Tell the child that dentistry shouldn’t be frightening.
E. Chastise the child.
A. Asking the child about his or her fears will create
an environment in which the child is encouraged
to discuss any worries or concerns and to ask
questions. This will also serve to alleviate anxiety,
provide an opportunity to correct any mispercep-
tions regarding dentistry, and to further establish
or maintain trust and rapport.
Research suggests that life events and per-
ceived stress/distress _____ predictors of self-
reported health concerns.
A. Are B. Are not C. Are sometimes D. Have little to do with E. None of the above
A. Perceived stress and distress in one’s life has
been demonstrated to be a significant predictor
(positively correlated) with self-reported health
concerns.
Patients experiencing stress and anxiety typi-
cally require _____ interpersonal distance for
comfortable interaction. A. Greater B. Less C. The same as patients who are not experiencing stress and anxiety D. Individualized E. Behaviorally controlled
A. Patients who are experiencing stress and anxiety
typically feel more comfortable in having greater
interpersonal space than they normally would
when not experiencing stress and anxiety.
Which statement is true about the use of
silence as an interviewing technique?
A. It permits and encourages patient participation.
B. It is a nonverbal technique for showing interest
in the patient.
C. It is a nonverbal technique for encouraging the
patient to speak.
D. It is done by silently attending to the patient,
while maintaining eye contact.
E. All of the above.
E. The use of silence can be a useful technique to
encourage patient comment following a state-
ment or question posed to the patient.
How do people typically respond to stress?
A. Physiologically (fight-or-flight response; i.e.,
autonomic arousal)
B. Cognitively (beliefs of self-efficacy, stress
appraisal)
C. Behaviorally (e.g., disturbed sleep/appetite,
impaired attention, acting out)
D. Emotionally (e.g., anxiety, anger, fear)
E. All of the above
E. Individuals respond to stress physiologically,
behaviorally, cognitively, and emotionally.
Which of the following indices is not reversible? A. DMFT B. GI C. PI D. OHI-S E. None of the above
A. Periodontal disease (measured by the PI) and
gingival disease, measured by the GI, are
reversible processes. The amount of the debris
and calculus, measured by the OHI-S, can
decrease too. Caries is not a reversible process.
The recommended level of fluoride for commu-
nity water supply systems in the United States
ranges from \_\_\_\_\_. A. 0.2–0.5 ppm B. 0.7–1.2 mL C. 1.2–1.5 ppm D. 0.2–0.5 mL E. 0.7–1.2 ppm
E. The recommended level of fluoride for a com-
munity water supply in the United States ranges
from 0.7 to 1.2 ppm of fluoride, depending on the
mean maximum daily air temperature over a
5-year period. Thus, in a warm climate the fluo-
ride level would be lower and in a cold climate it
would be higher. In the United States, most com-
munities are fluoridated at approximately 1 ppm,
which is equivalent to 1.0 mg of fluoride per liter
of water.
The supplemental fluoride daily dosage sched-
ule for a 5-year-old child who lives in a commu-
nity where the concentration of fluoride in the
drinking water is less than 0.3 ppm is \_\_\_\_\_. A. 0 mg B. 0.10 mg C. 0.25 mg D. 0.50 mg E. 1 mg
D. Physicians and dentists can help prevent fluorosis
by prescribing dietary fluoride supplements
according to the Supplemental Fluoride Dosage
Schedule recommended by the ADA Council on
Scientific Affairs.
What type of epidemiology is primarily used in intervention studies? A. Descriptive B. Analytical C. Observational D. Experimental E. None of the above
D. Experimental epidemiology is used primarily in
intervention studies. Once etiology for a particu-
lar disease has been determined, the researchers will try to establish the effectiveness of a particu-
lar program of prevention or therapy. Descriptive
epidemiology is used to quantify disease status in
a community. Analytical epidemiology, also
called observational epidemiology, is used to
determine the etiology of a disease.
A researcher follows a group of individuals in
a population over 10 years to determine who
develops cancer, and then evaluates the factors
that affected the group. What type of study is
this?
A. Cross-sectional
B. Case control
C. Randomized
D. Prospective cohort
E. Retrospective cohort
D. In this case, the investigator chooses or defines a
sample of subjects who do not yet have the out-
come of interest: cancer. He or she measures risk
factors in each subject (such as habits that may
predict the subsequent outcome) and follows
these subjects with periodic surveys or examina-
tions to detect the outcome(s) of interest.
A group of researchers undertook a study to
assess the relationship between squamous cell
carcinoma and chewing tobacco. The resear-
chers determined past exposure records among
subjects who had been diagnosed with the dis-
ease. This type of study was a _____.
A. Clinical trial B. Community trial C. Retrospective cohort study D. Case control study E. Randomized clinical trial
C. In a retrospective cohort study, the investigator
chooses a sample of individuals who have the
outcome of interest (in this case, squamous cell
carcinoma) and then look into the past for possi-
ble variables that may have caused the disease
(e.g., chewing tobacco).
The following part of a scientific article sum-
marizes the background and focus of the study,
the population sampled, and the experimental design, findings, and conclusion. A. Introduction B. Background C. Literature review D. Methods E. Abstract
E. The abstract allows the reader to determine
whether the study is of interest. The abstract usu-
ally appears at the head of the article and is
reproduced in the literature database.
In this section of a scientific article, the resear-
cher interprets and explains the results obtained.
A. Summary and conclusion B. Results C. Discussion D. Abstract E. None of the above
C. In the results section the researcher describes the
specific findings and actual outcomes of the project
but does not interpret them. The interpretation and
analysis of the results are part of the discussion,
where the researcher attempts to explain his
results.
The following were the scores for six dental stu-
dents in their Restorative Dentistry exam: 56, 64,
68, 46, 82, 86. Therefore, the median is \_\_\_\_\_. A. 68 B. 64 C. 67 D. 40 E. 66
E. The median is the middle of a distribution: half the
scores are above the median and half are below
the median. The median is less sensitive to
extreme scores than the mean, making it a better
measure than the mean for highly skewed
distributions. For instance, the median income of
a population is usually more informative than the
mean income.
When there is an even number of numbers,
the median is the mean of the two middle num-
bers. Thus, in this case the median is (64 + 68)/2
= 66.
A correlation analysis shows that as the income
of the population increases, the number of deca-
yed teeth decreases. Therefore, an expected value
for this correlation coefficient (r) would be \_\_\_\_\_. A. 0 B. 1 C. −1 D. 2 E. −2
C. The correlation coefficient (r) quantifies the rela-
tionship between variables (x and y). A positive
correlation coefficient indicates that the variables
increase in the same direction; a negative correla-
tion coefficient indicates that the variables vary in
opposite directions. The correlation coefficient
ranges from −1 to +1.
A test result that erroneously excludes an indi-
vidual from a specific diagnostic or reference
group is called \_\_\_\_\_. A. Erroneous B. False positive C. False negative D. Mistaken E. None of the above
C. A false positive test is a test result which erro-
neously assigns an individual to a specific diag-
nostic or reference group.
Which of the following statements about trans-
missible diseases is false?
A. The risk of transmission after percutaneous
injury is higher for HBV than for HIV.
B. HCV and HIV are both caused by an RNA virus.
C. A vaccine to immunize against HBV is available.
D. The average risk of infection for HBV after a
needlestick injury falls between HCV and HIV.
E. All of the above.
D. The average risk of infection for HBV after a
needlestick injury does not fall between HCV and
HIV. For HBV, the risk of transmission after
percutaneous injury is 30%; this figure is 1.8% for
HCV and 0.3% for HIV.
In HIV diagnosis, the Western blot assay is
used to confirm the results of a positive ELISA
test. Therefore, we can say that the Western
blot test will confirm a _____.
A. True-positive result
B. True-negative result
C. False-positive result
D. False-negative result
E. None of the above
A. Very specific tests are appropriate for confirming
the existence of a disease. If the result of a highly
specific test is positive, the disease is almost cer-
tain. High specificity is required in situations where the consequences of a false-positive
diagnosis are serious or unduly alarming (e.g.,
HIV positivity).
Which of the following statement(s) about the
hepatitis B vaccination is(are) true?
A. HBV vaccine must be offered to all potentially
exposed dental workers.
B. The HBV vaccine must be free to all potentially
exposed dental workers.
C. At the time of employment, each person should
be asked to provide documentation of previous
immunizations.
D. Three doses are given to confer immunity.
E. All of the above.
E. All of these measures help ensure the safety of
dental personnel.
Which of the following terms refers specifically
to the process where an antimicrobial agent
destroys (germicide) or avoids the growth
(microbiostatic) of pathogenic microorganisms
on inanimate surfaces?
A. Antisepsis
B. Microbacterial control
C. Sterilization
D. Disinfection
E. Asepsis
D. Disinfection refers only to the inhibition or destru-
ction of pathogens. Spores are not killed during
disinfection procedures. By custom, the term
disinfection is reserved for chemicals applied to
inanimate surfaces, and the word antiseptic is
used for antimicrobial agents that are applied to
living tissues.
Which of the following is the most common method of sterilization? A. Dry heat B. Ethylene oxide C. Glutaraldehyde at 2% D. Autoclave E. Chemi-clave
D. The proper time and temperature for autoclaving is
250 ̊ F (121 ̊ C) for 15 to 20 minutes, which
yields 15 pounds pressure of steam, or 270 ̊ F
(134 ̊ C) for a minimum of 3 minutes, which
yields 30 pounds pressure of steam. Moist heat
destroys bacteria—denaturation of the high-
protein-containing bacteria.
A set of precautions designed to prevent trans-
mission of HIV, HBV, and other bloodborne
pathogens when providing first aid or health care is known as \_\_\_\_\_. A. Asepsis B. Infection control C. Sterilization D. Disinfection E. Standard infection control procedures
E. A thorough medical history, physical examination,
and laboratory tests will not always detect patients
who are carriers of infectious diseases. Therefore,
you must assume that all patients are infected with
HIV, HBV, or other bloodborne pathogens. Similar
infection control procedures must be used for all
patients, regardless of their medical history or the
type of treatment to be performed.
Which of the following chemical agents is not a disinfectant? A. Iodophors B. Sodium hypochlorite C. Synthetic phenol D. Isopropyl alcohol E. Glutaraldehyde
D. Alcohol is not an accepted disinfectant. Alcohol
evaporates too quickly to be an effective disin-
fectant. The term disinfection is reserved for
chemicals applied to inanimate surfaces, and
the word antiseptic is used for antimicrobial agents
(such as alcohol) that are applied to living tissues.
Which of the following recommendations must
be followed when handling mercury?
A. Train personnel involved in the handling of
mercury
B. Work in properly ventilated areas
C. Use high-volume evacuation systems when
finishing or removing amalgams
D. Avoid direct skin contact with the metal
E. All of the above
E. Mercury can be absorbed through the skin as
well as absorbed by inhalation. Safe handling,
resulting in part from proper training, helps
reduce the risk of exposure.
According to the CDC, the acceptable water
quality in a dental office should be _____.
A. < 125 CFU/mL
B. < 250 CFU/mL
C. < 500 CFU/mL
D. < 750 CFU/mL
E. < 1000 CFU/mL
C. The CDC recommends, at a minimum to meet
nationally recognized drinking water standards,
less than 500 colony-forming units (CFUs) of het-
erotrophic bacteria per milliliter. In 1995, the ADA
addressed the dental water concern by asking
manufacturers to provide equipment with the
ability to deliver treatment water with < 200
CFU/ml of unfiltered output from waterlines.
Which of the following ADA’s Principles of
Ethics states that a dentist has a duty to
respect the patient’s right to self-determination
and confidentiality?
A. Patient Autonomy
B. Nonmaleficence
C. Beneficence
D. Justice
E. Veracity
A. There are five principles in the ADA Principles of
Ethics:
● Patient Autonomy (“self-governance”). The
dentist has a duty to respect the patient’s rights to
self-determination and confidentiality.
● Nonmaleficence (“do no harm”). The dentist
has a duty to refrain from harming the patient.
● Beneficence (“do good”). The dentist has a
duty to promote the patient’s welfare.
● Justice (“fairness”). The dentist has a duty to
treat people fairly.
● Veracity (“truthfulness”). The dentist has a duty
to communicate truthfully.
Which of the following are characteristics of proper documentation in a dental record? A. Specific B. Objective C. Complete D. Timely E. All of the above
E. Being specific helps to avoid misinterpretation of
reports. Being objective provides the basis for
accuracy in describing events. Being complete
provides the basis for a thorough review of the facts
when reviewing the report. Being timely ensures
the best opportunity to recall all relevant events.
Which of the following is an arrangement
between a plan and a group of dentists
whereby the providers agree to accept certain
payments (usually less than their usual fees) in
anticipation of a higher volume of patients?
A. PPO
B. Capitation
C. HMO
D. IPA
E. None of the above
A. Capitation is a payment mechanism whereby the
dentist is paid a fixed amount irrespective of the
number of patients seen or services provided.
Health Maintenance Organizations (HMOs) are
also called capitation plans because of the pay-
ment mechanism they use. An Individual Practice
Association is a type of plan that combines the risk
of capitation with fee for service reimbursement.
Which of the following agencies monitors and
prevents disease outbreaks, implements dis-
ease prevention strategies, and maintains
national health statistics? A. CDC B. FDA C. DEA D. IHS E. None of the above
A. CDC is correct. The U.S. Food and Drug
Administration (FDA) is responsible for protecting
the health of the nation against impure and unsafe
foods, drugs, cosmetics, and other potential
hazards. The Drug Enforcement Administration
(DEA) determines the levels of controlled
substances that have abuse potential. The Indian
Health Services (IHS) focuses on the goal of raising
the health status of Native Americans and Native
Alaskans.
Which of the following federal agencies is the
U.S. government’s principal agency for protect-
ing the health of all Americans and providing
essential human services? A. DHHS B. NIH C. HRSA D. AHRQ E. None of the above
A. The DHHS is the U.S. government’s principal
agency for protecting the health of all Americans
and providing essential human services. DHHS
includes 11 agencies and more than 300 pro-
grams. The agencies listed in the answers are
part of the DHHS. The National Institutes of
Health (NIH) is the world’s premier medical
research organization. The Health Resources and
Services Administration (HRSA) provides access
to essential health care services for people who
are low-income, uninsured, or who live in rural
areas or urban neighborhoods where health care
is scarce. The Agency for Healthcare Research
and Quality (AHRQ) supports research on health
care systems, health care quality and cost issues,
access to health care, and effectiveness of med-
ical treatments.
Empathic understanding reflects which of the
following characteristics?
A. It accurately reflects others’ feelings.
B. It connects the feelings to concrete circumstances
that are likely to be causing the feelings.
C. It accepts the feelings as real and important.
D. It is nonjudgmental: it does not compromise the
listener’s objectivity.
E. All of the above.
E. The use of empathy serves a number of purposes,
including all of the choices given.
A 14-year-old male patient has significant plaque
build-up and one cavity. Upon inquiry, the
patient tells you that he brushes his teeth about
once a day and does not floss because it is
difficult and too time-consuming. Which of the
following would likely be the least effective way
to address his oral hygiene practices and get
him to improve his oral self-care?
A. Educate him regarding the ways in which he can
improve his oral hygiene and avoid dental
problems in the future.
B. Use a collaborative relationship to arrange for
modification of consequences.
C. Use the Premack principle.
D. Set up a behavioral contract.
E. Set up a system of positive reinforcers.
A. Although education is an essential component of
patient care overall, research indicates that, in an
effort to influence behavior change, education
alone is not nearly as effective as behavioral
intervention.
A 20-year-old woman has significant plaque
build-up. Upon inquiry, she tells you that she
brushes twice daily and flosses daily. You
determine that the patient should be educated
about optimal brushing procedures. Which
strategy might you first use in a series of steps
for improving her brushing skills?
A. Demonstrate your recommended brushing
practices.
B. Explain to her good brushing technique.
C. Tell her you don’t believe she brushes twice daily.
D. Ask her to demonstrate her teeth brushing.
E. Clean her teeth.
D. In order to initiate behavior change, one must
first fully assess the behavior. In this case, in
order to address the patient’s inadequate brush-
ing technique one should observe the patient
engaging in the behavior in order to identify the
strengths and weaknesses of the process.
Which of the following statements is false
regarding behavior change?
A. Goals are long-term targets, whereas objectives
are reachable steps/goals along the way.
B. Shaping is a behavior change strategy in which
the patient learns though the dental professional’s
demonstration of the desired behavior.
C. The basic behavioral model consists of
antecedents, behaviors, and consequences.
D. Some consequences will strengthen a behavior
whereas others will weaken it.
E. Generally, the consequences of today’s behavior
will affect the way in which we behave tomorrow.
B. This is an example of modeling. Shaping is the
process of achieving successive approximations
toward a desired behavior.
You need to inject a local anesthetic for a
10-year-old patient. You note that this patient
appears to be very anxious and frequently asks
what you are doing or are about to do. To which
technique is the patient least likely to respond
well?
A. Distraction.
B. Taking a few deep breaths.
C. Bringing his mother in the room for reassurance.
D. Provide him with age-appropriate information
about the injection.
E. Give the patient an amount of time (how long it
will take) and ask him to count.
A. Distraction is not typically a very effective tech-
nique for very anxious patients.
Which statement is false regarding child pain
management?
A. It is recommended that a dentist provide specific
direction and praise for cooperation.
B. Children do not have a fully developed sense of
time; therefore, it is recommended that one use
more concrete measures of time such as counting
or a visible timer (e.g., egg timer).
C. The Tell-Show-Do technique is no longer
recommended since it has been demonstrated to
increase anxiety and reports of pain during
treatments.
D. In order to enhance the sense of control, it is
recommended that one establish a hand signal
signifying distress and a desire for the dentist to
stop or take a break.
E. Once a child begins to complain about poor pain
control, the chances of having a successful visit
drop dramatically.
C. The Tell-Show-Do method, in which the clinician
explains, demonstrates, and allows a child (or an
adult patient) to learn and understand what will
be happening before proceeding, contributes to
decreased self-reports of anxiety and pain.
What behavior can you typically expect from an
anxious patient in the waiting room?
A. He or she is more likely to sit still, hands clasped
together.
B. He or she is more likely to sit casually, legs
crossed, reading a magazine.
C. He or she is more likely to keep to himself or
herself and not speak unless spoken to.
D. He or she is more likely to fidget in the chair,
moving his or her hands and feet.
E. Both A and C.
D. Anxious patients are typically more likely to fidget
in their chairs, unable to focus on a task such as
reading or relaxing in the waiting room.
What is the most likely consequence of the
avoidance of a feared stimulus?
A. Reinforcement of the associated anxiety.
B. Habituation to the stimulus.
C. Decreased anxiety in response to the stimulus.
D. Learned helplessness.
E. Increased coping resources.
A. Avoidance of a feared stimulus inadvertently rein-
forces the anxiety reaction, thereby maintaining
the associated anxiety.
The first time you perform a complicated dental
procedure, you feel uncomfortable and nervous.
At one point, you even think for a moment that
you will not be able to complete the procedure.
However, you stay with it, and near the end of
the procedure you feel much better. Which
concept does this best exemplify?
A. Covert conditioning
B. Systematic desensitization
C. Habituation
D. Cognitive restructuring
E. Psychoeducation
C. Habituation is the decrease in response that
occurs as a result of repeated or prolonged expo-
sure to a conditioned stimulus.
During a previous dental visit, you assisted a
patient by generating his statement, “Even if
there is some pain, it will be brief. I have ways
to cope and I’ve done well using them.” The
patient will remind himself of this during future
dental procedures. This patient’s statement
exemplifies which of the following strategies?
A. Rational response
B. Self-efficacy induction
C. Relaxation statement
D. Imagery
E. Systematic desensitization
A. A rational response is a cognitive therapy tech-
nique in which the patient develops (with or
without assistance) a more adaptive thought or
statement as a means of coping.
In clinical practice, you frequently see young
patients who are nervous about seeing the
dentist. Knowing which factors are important
influences on young patients’ comfort, you
consider which of the following to help your
patients to feel more comfortable?
A. Inviting a parent into the operatory for support.
B. Placing toys and children’s books in the waiting
room.
C. Hanging child-friendly décor in the operatory.
D. Talking to the child about his or her interests
before beginning your work.
E. All of the above.
E. Creating a child-oriented environment (e.g., hav-
ing toys and books in the waiting room, hanging
pictures on the wall and/or ceiling that a child
would find interesting), conveying interest in the
child by asking about their interests, and having
the parent present are all variables that may put
child patients more at ease.
Dental intervention studies suggest that educating patients regarding dental care (patient education) is more effective than behavioral modification (behavioral intervention) in increasing compliance. A. True. B. False. C. Sometimes. D. Both are equally effective. E. Cannot be determined.
B. Research has demonstrated that behavioral inter-
vention is typically more effective than patient
education alone. A combination of the two is
considered the most effective approach to
increasing patient compliance.
Which technique is typically not useful in
treating the anxious patient?
A. Using less structure in establishing rapport.
B. Reassuring the patient by telling the patient not to
worry.
C. Providing reasons before asking for sensitive
information.
D. Using empathy.
E. Making expectations clear.
B. Clinicians should use caution in providing pre-
mature reassurance because, if the outcomes
are inconsistent with what the clinician asserted,
trust and rapport may be compromised.
The most common site for oral cancers in the oral cavity is \_\_\_\_\_. A. Lip B. Soft palate C. Hard palate D. Tongue E. Tonsils
D. The tongue is the most common place for inci-
dent cancers in the oral cavity.
The most effective method to prevent caries on the occlusal surfaces among school-age children is \_\_\_\_\_. A. Sealants B. Community water fluoridation C. School dietary fluoride D. School fluoride mouth rinse E. School fluoridation
A. Sealants. Community water fluoridation is the
most cost-effective and economical method to
prevent dental caries. However, fluoride is
believed to be the least effective on the occlusal
surface. Most decay among school children
occurs on the chewing surfaces’ pits and surfaces.
In this type of study design, neither the subject nor the investigator knows to which group a subject belongs. A. Matching studies B. Randomized C. Double-blind D. Single-blind E. None of the above
C. Double-blind designs help prevent the potential
for a biased interpretation of a treatment effect
that might occur if either the investigator or sub-
jects know to which group the latter belong.
The following component of a scientific article provides the reader with detailed information regarding the study design. A. Introduction B. Background C. Literature review D. Methods E. Abstract
D. The Methods section organizes the research
paper and allows the reader to assess the validity
of the study and the reliability of the measures.
This section should provide the reader with spe-
cific and detailed information regarding how the
study was conducted. Based on this information,
the reader should be able to replicate the study.
The variance for data set A is 25 and for data
set B is 9. Therefore, we can conclude _____.
A. There are more items in data set A than data set B
B. The mean of data set B is smaller than the mean
for data set A
C. The items in data set A are more widely spread
about the mean value than in data set B
D. The standard deviation for data set B is larger
than for data set A
E. None of the above
C. The variance determines the way individual val-
ues are located around the mean. The larger
the variance, the more widely the data items
are spread about the mean value. Variance is
measured in squared units (s2).
The standard deviation is the square root of the
variance. The mean is expressed in the same units as the data items, but the variance is
expressed in squared units. Thus, the standard
deviation measures the average deviation from
the mean in the same units as the mean.
What route of transmission is a needlestick injury of infectious disease? A. Direct contact B. Indirect contact C. Accidental contact D. Parenteral contact E. Droplets
D. Parenteral contact is defined as the transmission
of pathogenic microorganisms by piercing the
skin or mucous membrane (e.g., intravenous,
subcutaneous, intramuscular) by an accidental
or intentional stick with a needle or other sharp
instrument that is contaminated with blood or
other body fluid.
Which of the following is/are recommendations
for the use of masks?
A. Use whenever aerosols or spatter may be
generated.
B. A new mask should be worn for each patient.
C. Masks should be changed at least once every
hour.
D. Masks should be changed more frequently in the
presence of heavy aerosol contamination.
E. All of the above.
E. Masks that cover the mouth and nose reduce
inhalation of potentially infectious aerosol parti-
cles. They also protect the mucous membranes
of the mouth and nose from direct contamina-
tion. Masks should be worn whenever aerosols
or spatter may be generated.
If a mask is worn longer than 20 minutes in an
aerosol environment, the outside surface of the
mask becomes a nidus of pathogenic bacteria
rather than a barrier. It is recommended that a
new mask be worn for each patient and that
masks be changed routinely at least once every
hour and more often in the presence of heavy
aerosol contamination.
The following definition refers specifically to the
process in which an antimicrobial agent
destroys (germicide) or inhibits the growth
(microbiostatic) of pathogenic microorganisms
on inanimate surfaces.
A. Antisepsis
B. Microbacterial control
C. Sterilization
D. Disinfection
E. Asepsis
D. Disinfection refers only to the inhibition or
destruction of pathogens. Spores are not killed
during disinfection procedures. By custom, the
term disinfection is reserved for chemicals
applied to inanimate surfaces, and the term anti-
septic is used for antimicrobial agents that are
applied to living tissues.
The following biological test is used to check the
effectiveness of the sterilization process.
A. Spore test
B. Total bacterial count test
C. Aseptic test
D. EPA test
E. Disinfection test
A. The spore test is a biological monitor. The
process consists of placing into the autoclave
bacterial spores on strips or in envelopes along
with a normal instrument load. If the autoclave is
working properly, the autoclave reaches the tem-
perature and pressure to kill the spores. Spore
testing must be conducted weekly.
Which of the following are guidelines for disinfectants used in dental practice? A. Have an EPA registration number. B. Kill the Mycobacterium tuberculosis. C. Have an ADA seal of approval. D. Must be used according to guidelines. E. All of the above.
E. A disinfectant should be able to kill the
Mycobacterium tuberculosis. This is the bench-
mark organism for disinfectants. It is much
harder to kill than most bacteria, viruses, fungi,
and protozoa. This resistance is partially due to
the waxy cell wall of Mycobacterium.
Which of the following statements about material
safety data sheets (MSDSs) is/are correct?
A. Employees have the right to know about on-
the-job hazards.
B. The MSDSs help to protect employees.
C. An MSDS contains information on hazardous
materials, substance, and wastes.
D. The MSDS describes chemical hazards and how
to work with the chemical safely.
E. All of the above.
E. The Material Safety Data Sheet (MSDS) is an easy
reference for information on hazardous sub-
stances. The MSDS must be “readily accessible”
to workers exposed to hazardous substances.
The MSDS provides information on hazardous
materials, substances, and wastes. Chemical
manufacturers develop and provide an MSDS for
each hazardous product. The distributor is
responsible for getting MSDSs to employers. At
least one copy of the MSDS should be maintained
with the chemical.
Some dental plans allow the dentist to charge
the patient any difference between what the plan
agrees to pay and the dentist’s UCR (usual,
customary, reasonable) fees. This arrangement
is called _____.
A. Payment differential
B. Balance billing
C. Prospective reimbursement
D. Managed care
E. None of the above
B. Balance billing. Prospective reimbursement is a
mechanism in which the dentist is compen-
sated before treatment is provided (i.e., in capi-
tation systems). Managed Care is an
arrangement in which a third party mediates
between providers and patients negotiating
reimbursement for certain services and over-
seeing the treatments delivered.
when is recommended to fluoridate public water?
when levels < 0.7 mg/dL
what can fluorine inhibit
enzyme phosphatase at 20-40mg/day (Ca metabolism)
what can fluorine do at higher doses
40-70 heartburn and pain in extremities
tx for F toxicity
Ca
which surfaces benefit most from F
proximal and smooth
gretatest concentration of F
outer enamel
concentration of F in school water
~1ppm (4.5x city level)
excretion of F
kidney, urine, sweat, up to 3mg/day
optimal water F
0.7-1.2 ppm
cariostatic effect of F at which stage
calcification
toothpaste F concentration
1100 ppm
F toxicity
adults 4-5g
child lethal dose 15 mg/kg
How many mg of fluoride in 1 L of water at 1 ppm:
1 mg
Patient has 1 ppm fluoride in water. What is that equal to in mg/L?
1mg/L
What ion gets replaced in hydroxyapatite by fluoride?
Hydroxyl
least soluble -
fluorapatite
F- on collagen
breaks it down
is bacteriocidal, fluoroapetite is more resistant to acid attack, decreases solubility of enamel,
excreted by kidneys, helps remineralize
Fluoride helps prevent caries in all ways except?
lower pH of the oral cavity
Where does fluoride localize/accumulates?
Outer enamel
Fluorosis does what?
Inhibits remineralization
Fluorosis does what –
inhibits remineralization (irreversible) - Fluoride induces enamel hypoplasia (hypocalification), which is a characteristic of fluorosis that is caries resistant.
fluoride on dental plaque
no effect
How do you determine the severity of fluorosis?
Look at the two worst teeth?
- Higher the fluoride level, greater degree of enamel change
ADA recommends to apply in-office fluoride foam for how long?
4 minutes
How many minutes do you place neutral sodium fluoride tray on teeth?
4 minutes
Floride supplementation is effective in: everybody, only kids, anyone but most beneficial to children.
anyone but most beneficial to children.
At what age should supplemental fluoride be started?
6 months
Minimum fluoride age?
6 months
What age does fluoride get incorporate into primary dentition?
4 months in utero
At what age does fluorosis of anterior permanent teeth occur? 4-6mo, 0-4mo, 1year, 2years and 6 years)
4-6mo
Fluoride is given to children in schools usually by rinse with what concentration? 0.05 daily, 0.2 daily, 0.05 weekly, 0.2 weekly
0.2 weekly
How do they administer Fluoride in schools?
0.2% Fluoride rinse 1x week
What happens when a kid with primary teeth ingests fluoride?
It affects their permanent teeth.
The drinking water supply of a community has a natural F level of 0.6 ppm. The F level is raised by 0.4ppm. Tooth decay is expected
to decrease by what % after 7 years?
40%
The usual metabolic path of ingested fluoride primarily involves urinary excretion with remaining portion in?
skeletal tissue
Where is the biggest storage of fluoride in tissues?
Skeletal tissues
Where does fluoride work the best?
interproximal and smooth surfaces
What is least likely to cause baby bottle caries?
a. Breast milk at night
b. Formula made with fluoridated water
c. Water with no fluoride
d. juice
c. Water with no fluoride
Early Childhood Caries (ECC) are cause by all at night except?
- bottle feeding with formula with fluoridated water
- breast feeding
- sippy cup with OJ
- bottle feeding with processed water with no fluoride
bottle feeding with processed water with no fluoride
ECC (early childhood caries) is usually in what location?
a. Max incisors and molars
b. Man incisor and molars
c. Max canine
d. Man canine and molar
a. Max incisors and molars
- Primary max incisors (B&L), then primary molars, mandibular unaffected bc tongue blocks
What determines fluoride supplementation for a city -
temperature
Usual/recommended water fluoridation-
0.7 ppm
The appropriate/optimal amount of fluoride in the community water:
0.75-1.2 ppm
What percentage of Americans have public fluoride in water: 66%, 85%,
66
- CDC 2010 reports Americans have 79.6% water fluoridation
What is percentage of community water fluoridation- 67, 85, 35
67
Fluoridation for water: effectiveness: early studies showed that it prevents 50%-70% of caries in permanent teeth, however
currently the effectiveness is
20%-40%
Effectiveness of Water fluoridation in the U.S. is
20%-40%
Fluoridation: daily use of tablet cause __ in new carious lesions
30% reduction
Pt has a white discoloration with no sensitivity near cervical region of #29, what do you do? fill, 5% fluoride, do nothing
5% fluoride
What type of fluoride is in water? fluorosilicic acid, sodium fluorosilicate, and sodium
fluoride
fluorosilicic acid,
(hydrofluorosilicate) – most commonly used
Types of Fluoride used in toothpaste: sodium fluoride, Stannous fluoride, sodium monofluorophosphate
Stannous fluoride (most effective) - Stannous fluoride may stain.
What mouthwash is good for children with caries to rinse with?
Sodium Fluoride (NaF)
What rinse is used at home for developmental disabled child to reduce of plaque? NaF, stannous fluoride, chlorohexidine
chlorohexidine
Which type of fluoride is not in toothpaste?
Acidulated fluoride
What fluoride toothpaste should not be used in a patient with multiple porcelain crowns?
Acidulated
What’s the concentration of acidulated phosphate fluoride is used in the dental office?
1.23%
Dentist places sodium fluoride on patient with GI fillings rather than acidulated fluoride because
– acid of fluoride will wear away
at GI.
What fluoride tx would you used in a pt with amalgams, PFM’s, composite restorations, implants?
1.1% NaF
Which one is not useful in managing caries in elderly?
Use of 1.1% fluoride as a standard of care
2.2 mg NaF how much F-
1 mg
A 2 y/o child has injested 20mg fluoride pill. What will likely happen? coma, nausea, renal failure, cardiac arrest
nausea
How much fluoridation supplement would you give to a 5 y/o drinking 0.75ppm F in their water?
0 ppm
3 y/o patient lives in area with 0.4 ppm fluoride. How much do you supplement?
0 ppm
4 yrs old patient lives in community w/ 0.25 ppm fluoride intake, what do you give? Give her systemic fluoride (0.5 mg/day) Apply fluoride Change diet to more fluoride intake Prescription fluoride rinse
Give her systemic fluoride (0.5 mg/day)
4 y/o pt with 0.4 ppm fluoride Supplement?
0.25mg/day
4.5 y/o child with 0.75ppm fluoride in their water requires how much fluoride to be supplement?
0 mg
7-year-old patient has no fluoride in drinking water. What do you give them systemically…? 5 mg, 1 mg, 0.25 mg
1 mg
7-year-old child lives in area with 0.2 ppm fluoridated water, what do you supplement?
1.0 mg/day
Supplementation for 10-year-old with no other fluoride source? 1 mg/day or 1 mg/week?
1 mg/day
Diabetes, can you place implant if HbA1c = 8:
No, refer to physician
Pt with hemoglobin A1C of 12%. Pt just visited the MD, what kind of TX we can do?
Consult with an MD prior to tx
Time management of diabetic patient:
Treat diabetic patient 2 hours after eating & taking insulin.
Kidney dialysis: best to do tx when
day after dialysis or inbtwn days of dialysis
give OJ
Do NOT give more insulin, blood sugar is already low enough. Give OJ.
Pt is a child and is diabetic undergoes hypoglycemia in the chair
if conscious give him orange juice (unconscious give him 50%
dextrose IV)
Child goes into insulin shock in the chair (hypoglycemia)
a. gives OJ
b. ask parent to give kid insulin shot
gives OJ
Unconscious diabetic is treated with:
50% dextrose in IV.
IV sedation for DIABETICS:
Schedule in the morning.
- If insulin-dependent, have them not eat, not take short acting insulin and take half dose of long acting insulin.
- If not dependent, no food and no meds until after the surgery.
Patient is a non-insulin dependent diabetic & needs minor oral surgery w/ IV sedation. What should he do?
clear-liquids and regular
dose of diabetes meds.
- Minor surgery: normal as long as procedure occurs within 2 hours of eating and taking meds.
Pt with insulin dependent diabetes & having sedation IV and LA. Ask the pt to take: high calorie food with insulin, low calorie food
with insulin
low calorie food with insulin (reduce dose of insulin and no food)
5 principles of ethics
Beneficence- “Do good”.
- Patient Autonomy- “Self-governance”.
- Nonmaleficence- “Do no harm”. Dentists are to keep skills and knowledge up-to-date and practice within their limits in order to protect
the pt from harm. - Justice- “Fairness”.
- Veracity- “Truthfulness”.
Pt presents with amalgam restorations in good shape and the dentist suggest to change them for composites due to systemic
toxicity of the amalgam. What ethic principle is the dentist is violating?
Veracity
What principle has to do with a patient’s self-governance & privacy?
Autonomy
Dentist keeps on current dental medicine to provide current standard of care. What part of the ethical code does this relate to?
Non-maleficence
Dentist refers a difficult case to a specialist, what ethic principle is this?
Non maleficence
- Having non-maleficence is knowing your limitations and referring patients out to specialist
QUESTION: Informed consent which ethics principle
à autonomy*
Dentist lets the patient sign informed consent -
autonomy
What you do first before getting informed consent? make sure patient can sign or has guardian, consult physician, discuss options
with relatives, etc
make sure patient can sign or has guardian,
90-year-old patient comes in with son, who has a document mentioning the guardian of the patient -
must have consent from them
to treat the patient
QUESTION: The 16 yr. old can take the decisions for the elder pts if: If the elders are deaf and dumb, if the boy makes the payment, if the
elders are over 60yrs, if the kid has the power of an attorney
if the kid has the power of an attorney
When should patient sign informed consent forms for surgery?
AFTER there has been a discussion w/ the dentist about the
surgery
Inform consent most contain all except:
cost of Tx
QUESTION: If you don’t obtain informed consent, what kind of offense is this?
Battery
What happen when patient doesn’t sign the consent?
Battery
- health care provider commits a battery if the provider performs a procedure for which the patient has not given consent.
Emancipated minor: if the kid is under 18, know exceptions of how they become emancipated minor
- Emancipated minor assumes most adult responsibilities before reaching the age of majority (usually 18). If she/he graduated from
high school, has been married, has been pregnant, or responsible for his or her own welfare and is living independently of parental
control and support.
How is FACT witness is different from expert specialist?
- fact witness = individual, who has personal knowledge of events pertaining to the case & can testify as to things they have
personally observed or witnessed. They may not offer opinions, which are the province of the expert witness - Expert witnesses offer opinions, unlike a fact witness, that may assist the judge in understanding technical knowledge in order to
support their ability to make a sound ruling in a case. An expert witness can be a credentialed specialist in fields.
Child came with a history of aggressive behavior and is crying, then should the dentist show empathy or sympathy or control
sympathy
Rapport best with: empathy; sympathy, compassion
empathy
What best characterizes rapport?
Understanding patient’s feeling and talking with patient
Definition of rapport?
mutual openness / harmonious relationship
- Rapport = mutual sense of trust and openness between individuals that, if neglected, compromises communication.
A successful practice is built on -
Good clinician-patient relationship
Empathy is not: shared personal experiences, Imagination, understanding
shared personal experiences
Which do you not need to show empathy to the patient?
a. open-mindedness
b. sharing personal experiences
c. reflection and showing understanding
b. sharing personal experiences
When should the dentist NOT use para-phrasing?
a. When trying to speak to a patient in his second language
b. When the dentist is upset with what patient says
c. when giving factual values
c. when giving factual values
Finding out whether a pt is listening:
Eye contact
Patient complains of pain in relation to a particular tooth. The best answer/reply of the dentist would be:
If you came here earlier things would not be bad
If you took more care this would not have happened
I will take care of everything
I will take care of everything
While the dentist is preparing a large carious lesion in Tooth #30 for a restoration, a pulp exposure occurs. The patient angrily
shouts at the dentist, “Your incompetent ‘creep’- -you’re responsible for this problem!”- Of the following possible responses the dentist could
make, which one is the most emphatic?
A. Calm down, I can still restore your tooth adequately.
B. Not when I’m preparing a tooth with caries like you had.
C. I can see that you’re very upset. You thought the tooth could be restored and now this problem has occurred.
D. If you took care of your mouth the way you should, I wouldn’t have been close to the pulp.
E. I’m sorry this happened, but we must get on with the procedure.
C. I can see that you’re very upset. You thought the tooth could be restored and now this problem has occurred.
When the dentist enters the operatory, the patient, who is new to the office, stands close to the wall, has his arms folded, and is
looking at the floor. The dentist should initiate communication by saying which of the following?
A. Let’s get going; I’ve got a lot to do.
B. What are you angry about?
C. Didn’t my assistant get you seated?
D. You seem uncomfortable; did you have a bad dental experience?
E. Hi, I’m Doctor Wilson, what brings you here today?
Hi, I’m Doctor Wilson, what brings you here today?
Pt complains of high fees of dentist, how should the dentist answer? Fee is fine according to the geographic area, it is fair and
reasonable, I have to make a living too
Fee is fine according to the geographic area
QUESTION: The closest a dentist should get to their patient is?
Tap their shoulder
Reason to not have parent in room with dentist and kid? communication barrier between dentist and child, OSHA violation, HIPAA
violation,
communication barrier between dentist and child
Precontemplation stage of change
are not even thinking about changing their drinking behavior. They may not see it as a problem, or they
think that others who point out the problem are exaggerating.
Contenplation:
Individuals in this stage of change are willing to consider the possibility that they have a problem, and the possibility offers hope
for change. However, people who are contemplating change are often highly ambivalent. They are on the fence. Contemplation is not a
commitment, not a decision to change.
Pt. says, “I do not have time to quit smoking.” What stage is s/he in?
A: Precontemplation, contemplation, action, denial
Precontemplation
over the counter nicotine replacement therapy
patches, gum, lozenges
inhaler and spray are prescription
buproprion uses
aka Zyban, Wellbutrin
reduce nictoine withdrawal, also depression
can be used safely with nicotine replacement
buproprion contraindications
seizure disorder, current or prior diagnosis of anorexia nervosa or bulimia, or
undergoing abrupt discontinuation of alcohol, benzodiazepines, barbiturates, and antiepileptic drugs.
varenicline use
aka chantix
reduce nictoine withdrawal, blocks effect of nicotine if starts smoking again
varenicline contraidications
Alcohol Intoxication, Depression, Increased Cardiovascular Event Risk, Coronary Artery Bypass Graft, Heart Attack,
Acute Syndrome of the Heart, Angina, Transient Ischemic Attack, Stroke, Peripheral Vascular Disease, Severe Renal
Impairment, Seizures, Feel Like Throwing Up, Schizophrenia, Manic-Depression, Having Thoughts of Suicide, Habit of
Drinking Too Much Alcohol. DON’T COMBINE WITH PATCHES
which non-nictoine replacement can be combined with nictoine replacement
buproprion only
NOT VARENICLINE
positive reinforcement
Positive consequence that increases behavior
§ you brush, you get sticker
negative reinforcement
Removal of negative consequence that increases behavior
§ Stop pain from toothache, pt realizes he should brush
positive punishment
aversive Conditioning, negative consequence that decreases negative behavior
§ everytime you don’t brush, you have to clean your room
negative punishment
Removal of positive stimulus in order to decrease an undesirable behavior
§ don’t brush, no allowance
operant extinction
child cries, don’t give attention
what is more effective, reinforcement or punishment
reinforcement is more effective than punishment because in punishment, you have resentment, you avoid the punisher,
and you are not taught positive behavior.
Most important component of systematic desensitization is
exposure to fearful stimulus
During the child’s first visit, the dentist requested that the parents wait in the reception room. The child cries moderately, but
tearfully, throughout the dental examination and prophylaxis. The dentist “gave her permission” to cry while he/she worked and then took no
notice of her crying. Her crying diminished in intensity over time and then stopped. With respect ONLY to the crying behavior, the dentist has
A. used positive reinforcement.
B. used negative reinforcement.
C. extinguished the behavior.
D. ignored the problem.
C. extinguished the behavior.
Definition of Operant extinction?
removal of reinforcements that decrease a behavior
- disappearance of a previously learned behavior when the behavior is not reinforced.
Behavior shaping:
providing positive reinforcement for approximation of behavior you are desiring
A behavior modification device (ie thumb sucking deterrent) is an example of:
POSITIVE PUNISHMENT (negative consequence that decreases negative behavior)
Patient is given oral habit reducing appliance to prevent an oral habit, what is this considered?
POSITIVE PUNISHMENT
Providing reward for desired behavior:
positive reinforcement
Eye contact, smiling, and telling pt doing good job (praising) is what type?
social reinforcement
Desensitization works if the base of the behavior problem is
fear
Main disadvantage to desensitization?
Time
classic conditioning in how a patient sees a dentist
sees dentist (stimulus) – assumes pain is coming
Conditioned stimulus?
a. Dental chair
b. High blood pressure
c. Fear
d. Anxiety
a. Dental chair
How to deal with angry patient? Listen and validate emotion, agree with patient, ignore anger then investigate after
Listen and validate emotion
How to reduce stress & dental anxiety in peds?
Tell-show-do
Based on Frank behavioral rating scale, what is the rate that indicates positive rapport with dentist?
rating 4
6-year-old int. disabled child. Treatment is a recall. Would you give sedation, antianxiolytic, voice control or positive
reinforcement?
positive
reinforcement?
- with ID, you want to be short and brief, explain things, tell-show-do, and REWARD. Positive reinforcement.
What is the best way to treat a developmentally disabled patient?
Consistency
- Disabled pt, should be treated by flatterness, permissible, consistency
Autistic kids have what characteristic?
Repetitive behavior
Disable patient comes in and not cooperative, how should you act?
Permissiveness (give patient freedom & treat in the way patient
feel comfortable)
Patients with autism will usually show?
a. decreased rate of caries
b. heightened sense of lights and sounds
c. the compassion to interact with people
b. heightened sense of lights and sounds
- Children with autism are easily overwhelmed by sensory overload, which can cause “stimming” (flapping of arms, rocking,
screaming, etc). - Autistic children are hypersensitive to loud noises, sudden movement, and things that are felt.
Child patient – you smile, tell him good job, and pat him on the shoulder. These are examples of negative reinforcement, social
reinforcement, or token reinforcement.
social
reinforcement
If kid complained and whined in the beginning but at the end, is very good: you
compliment how well they were at the end of the
procedure.
QUESTION: Voice control method used with children’s -
Aversive conditioning (punishment to deter unwanted behavior, ex. hand over mouth)
What is the purpose of the voice control technique?
Sets boundaries à Aversive conditioning
QUESTION: 8-year-old patient, 1st dental visit ever, scared of dentist? What’s the most likely answer?
a. Television
b. Parents
c. Peers
b. Parents
If a child is afraid,
allow the child to express fears
How do you treat a fearful child? use sedation, let him watch another patient,
let him watch another patient,
Young patient is scared b/c he has no control what to do?
tell him to raise his hand if he needs a break/ you to stop
A kid is on recall appointment and is not cooperative. You should do voice control followed by?
v
Patient is very young and fearful first time you meet them –
try to talk to them, go down at their height.
Patient 2 yrs old and scared, who do you ask to help position the patient?
ask parent to position patient for you
get assistant to do it
you do it yourself
ask parent to position patient for you
The restraining of uncooperative 2 yr. child should be done by. Dentist, Assistant, Parent
Parent
4-year-old kid, best position?
Knee to knee with head on dentist lap
Knee to knee with head on parent’s lap
Knee to knee with head on dentist lap
Patient comes in with 1-year-old child, how do you do exam?
parent and dentist are knee to knee, baby’s head is in dentist’s lap
8-year-old boy, when will he behave better?
Mom inside the dental office
Dad inside the dental office
Nobody inside
Nobody inside
What is a 2 yr. old most afraid of? 4 yr. old?
• 1-3 yr. old: SEPARATION
• 4-6 yr. old: UNKNOWN
- pediatric fears correlated with age
QUESTION: Uncooperative 2-year-old, what are they scared of?
separation anxiety
4-5-year boy is scared of?
Unknown
You help a child help recognize what they are afraid of and make outward positive connection:
cognitive restructuring (psychotherapeutic process of learning to identify and dispute irrational or maladaptive thoughts)
Behavior Modeling:
when the kid is afraid and you use a sibling or someone older to show how they should behave
QUESTION: A 4 yr. old child management?
empathy and respect
Replacing words like LA with sleepy juice is called as
Euphemism (relabeling)
Pedo 1st visit. Multiple carious teeth on anteriors. During anesthesia is well cooperative and doesn’t cry or move. Once begin tx, begins to cry. What do. • Keep working • Voice control • More anesthesia • Oral sed • N20
• Voice control
Fear vs anxiety:
Fear: results from anticipation of a threat arising from an external origin.
Anxiety: results from anticipation of a threat arising from an unknown or unrecognized origin.
- Anxious patients are the most difficult patients as they often cause the dentist to become anxious as well.
fear increases or decreases pain?
increases
Dental anxiety can be caused by patient’s helplessness. What would reduce it?
Telling the patient to raise her/his hand when feels
pain
A patient is going to the dentist and has never had local anesthetic. He recently got a flu vaccine and is now afraid of needles. The fear is due to what? Location Generalization Translation
Generalization
Define anxiety according to Freud and K:
aversive inner state that people seek to avoid or escape.
What do Freud and Erikson say about anxiety?
Inability to overcome a conflict in a particular stage that will lead to anxiety.
Inadequate resolution becomes anxiety
- An inadequate resolution would indicate a child’s insecurity and anxiety.
- An Adequate Resolution would mean that a child was able to overcome the conflict in each stage and develop properly. This
applies similarly to the other 8 stages.
Patient has dental fear, what is most likely due to?
previous traumatic dental procedure
What would most cause a man to have anxiety? traumatic past experience, or finances, peers, unpleasant staff
traumatic past experience
Constantly exposing the pt to get from the fear factor is .
desensitation
Systematic desensitization- 3 steps:
Construct a hierarchy, relaxation exercises, associate components of hierarchy with relaxation
state
Panic attacks usually produce a sense of unreality, a fear of impending doom, or a fear of losing control.
a fear of impending doom
What is not included in the ADA code of ethics? • Licensure by credential • Advertising • patient values • Fees
• Fees
What cannot be advertised by a general dentist?
a. Cost
b. Specialty
c. License agreement
What cannot be advertised by a general dentist?
a. Cost
b. Specialty
c. License agreement
A dentist has an ethical obligation to report a colleague in all these situations except?
a. working under substance abuse
b. advertising on electronic media
c. abusing patients
b. advertising on electronic media
if you find problems with a medical conditions occurring with a certain drug, who do you contact? OSHA, FDA, EPA
FDA
If there is an adverse reaction to a medication in the office, who do you notify? a) FDA b) CDC c) HIPPA d) OSHA e) EPA.
FDA
Asked which statement was correct for HIPPA?
Must give privacy form to pt but you don’t need confirmation of receipt, fax and
email standard, etc.
What’s not the reason for rising dental costs?
number of dental students in dental schools
medicaid vs medicare
medicaid is income based
medicare is age-based (>65 yo)
insurance pays a flat fee - patient pays the rest
co-pay
provider paid per patient not per procedure
capitation
HMO
limited to selection
– dentists are paid a fixed rate for each individual per month. Dentist is paid regardless patient was seen or not. If value of
services exceeds payments, dentist’s loss. If payment exceeds value of services, dentists gain.
PPO
group of dentists agree on certain lower fees in hopes o attract more patients
who decides how dentists are reimbursed
each state has discretion
QUESTION: What does Medicaid cover?
Extractions, one-time denture, children until 18.
What sector of government provides funding for dental care? Medicaid, Medicare, grant, HMO
Medicaid
Who pays for Medicare:
federal program that pays for covered health services for most people 65 years old and older and for
most permanently disabled individuals under the age of 65.
Government spends most of the money in Medicare, Medicaid, HMO.
Medicare
Medicare is a federal program that provide health care for elderly. It does not cover dental.
Answer: Both statements
are true
Most aid for finance: Medicaid, Medicare, and hmo
Medicaid
Most dental procedures for the elderly are paid for by
out of pocket cash.
Which of the following is the leading payer for dental treatment? Insurance or self-pay
self-pay
Who pay for most of dental care?
a. government
b. insurance
c. cash
cash
Majority of health service in USA:
private insurance.
QUESTION: who pays most of dental Tx:
56% patients, 33% third parties private insurance
73yo woman makes $23,000/year. how should she receive dental care?
- Medicaid
- Medicare
- Private insurance
• Private insurance
A 65 yr. old lady living on 40k pension per year, wants to get dental treatment. She does not have any other physical abnormality
besides tooth pain in her molars. From where does the money covered for her treatment come from?
a. Medicaid
b. Medicare.
c. Private Insurance
d. Others insurance.
c. Private Insurance - private dental IF she has it\
medicaid does not cover dental for adults
medicare does not cover dental for elders
What is the name of the federal funded medical care for the elderly and its coverage?
a. Medicare wI dental coverage
b. Medicare w/o dental coverage
c. Medicaid wI dental coverage
d. Medicaid w/o dental coverage
b. Medicare w/o dental coverage
Insurance question about adverse selection • only take pt with high risk • only take pt with low risk • take both • something about taking pt of all ages
(adverse selection deals with the idea that those at higher risk are more likely to buy an
insurance policy. If the price for the policy is the same for nonsmokers and smokers, it is more likely that smokers will buy the insurance,
because it is more “worth it” to them—because they are at higher risk for disease. This is averse to the insurance. So the prices need to be
different.
• only take pt with high risk
Know about capitation:
Dentist is paid a fixed fee to see patients enrolled in program; HMO = capitation dental plan
which is the capitation dental plan
HMO
most common dental plan
HMO
who’s usually at risk with HMO
dentist
Insurance allows pt to only see certain set of providers…. PPO, HMO, Closed panel
Closed panel
Company offers dental insurance to its employees that can go to selected dentist, what is this example of?
Closed panel
On a prepayment basis, dental patients receive care at specified facilities from a limited number of dentists. This practice plan is classified as which of the following? A. Closed panel B. Open panel C. Group practice D. Solo practice
A. Closed panel
Direct Reimbursement:
self-funded group dental plan in which the employee is reimbursed based on a percentage of dollars spent
for dental care provided, and which allows employees to seek treatment from the dentist of their choice.
If you are an employer and you provide your employee with reimbursements for dental care they received from a dentist of their
choice it is called:
direct reimbursement,
patient goes to the dentist and needs to pay something before seen:
Copayment
What happened in 1997:
SCHIP (state children insurance health program)
- SCHIP (State Children’s Health Insurance Program) provides matching funds to states for health insurance to families with children.
It covers uninsured children in families with incomes that are modest but too high to qualify for Medicaid.
1997 law passed that
state must look after children that cannot afford healthcare - State Children’s Health Insurance
Program (SCHIP) AKA Children’s Health Insurance Program (CHIP)
Unbundling -
separating of a dental procedure into component parts with each part having a charge so that the cumulative charge of the
components is greater than the total charge to patients who are not beneficiaries of a dental benefit plan for the same procedure.
Bundling -
opposite of unbundling & can occur on the insurance carrier end. It’s the systematic combining of distinct dental procedures by
third-party payers that results in a reduced benefit for the patient/beneficiary.
Upcoding or overcoding is defined by the ADA as
“reporting a more complex and/or higher cost procedure than was actually performed.”
Downcoding is defined by the ADA as
“a practice of third-party payers in which the benefit code has been changed to a less complex and/or
lower cost procedure than was reported except where delineated in contract agreements.”
Dentist did not accept a copayment and did not report it to the 3rd party (insurance)?
Overbilling
Dentist charge for $500 for a crown. insurance only covers $400. Dentist waves copayment ($100) but still let insurance knows that
he charges $500 for crown, what’s this action called?
a. Down coding
b. Overbilling
c.Price fixing
d.Unbundling
Overbilling
The dentist charges separately for core build up and the crown but the insurance company says that the core builds up is part of
crown. What is this called?
Bundling
Doctor billed insurance couple of procedures, when actually there is a global procedure that combines them all, what did he
commit?
Unbundling
Dentist does the treatment for 2 crowns but the insurance company paid for one crown, what is it?
Downcoding
You performed a two surface restoration and coded it that way. Insurance came back with coding it as only one surface restoration.
What is this called? Downcoding or upcoding
Downcoding
What is it called when a dentist charges several procedures instead of one?
a. upcoding
b. downcoding
c. unbundling
d. bundling
unbundling
The patient retires & loses health benefits. The treatment is done on the next day. The pt requests that the
dentist enter the previous day’s date and the dentist does so. What is this called?
Fraud
Child abuse sign:
- multiple untreated injuries
- lag time bt injury and tx
- comminuted facial fractures
- parents with different stories
- Most common in children under 3
abuse most common in which children
<3
Abuses that have to be reported to authorities -
colleague practicing with chemical impairment, colleague advertising falsely on media, child
abuse, domestic violence, elderly abuse
When treating elderly patients what should be your concern?
Health of patient
How often will you see child abuse
at least twice a year
It is required mandatory to report all except: child abuse, reaction to drug
reaction to drug
You suspect child abuse. Who do you call?
Social services
If there is an elderly woman in your chair & you think there might be abuse. What do you have to do? Tell family or tell human
health services
tell human
health services
Which is not true of elder abuse:
Most of the elder abuse is at victims home
Mostly it is by the victim’s relative
elder’s abuse is often over reported and exaggerated
elder’s abuse is often over reported and exaggerated
Unauthorized use of elderly’s ATM card is not a sign of abuse but in some situation, it is under consideration.
(Both are true)
Elderly abuse is often:
underreported
Dentist potential for abuse not likely due to
a. Vulnerability
b. Pressure of being perfect
c. Knowledge and access to drugs
d. Stress
Vulnerability
When opening a dental practice, what makes it more successful?
Better communication
What do general dentists report as being their biggest issue? fearful patients, business/financial issues, staff training
fearful patients
Patient is bothering the dentist, dentist got upset. The assistant drops instruments in the floor & the dentist was so piss that he had
it out with the assistant. What you you call that reaction ?
Transference
- Transference is a unconscious redirection of feelings from one person to another
Most eye injury in practice happens to who: dentist, dental assistant, hygienist, custodian
dentist
Least chance of needle injury? Setting up, Cleaning up, Recap
Setting up
When do you most likely get a puncture wound: pre procedure, during, post-proceduring cleanup, needle recapping
post-proceduring cleanup,
Most injury/percutaneous cuts happen when
recapping needles
What test for every year?
Hep B
Dentist can diagnose which of the following?
Bulimia (reflected in oral condition)
A patient comes in with rampant decay. What is the primary responsibility of the dentist?
figure out etiology of decay FIRST
Patient is in your office for a treatment plan, all of the following should be done when you explain the proposed treatment to the
patient, except? Use professional terminology explain risk of not getting a procedure done, inform on the fee of the procedure
Use professional terminology
QUESTION: First step before/in treatment planning: make sure patient doesn’t need translator, consult with physician about pre-existing
medical conditions
make sure patient doesn’t need translator
Patient is ready to hear your treatment plan, all of the following are true except?
Guarantee the success of treatment!
First step in tx planning is?
treat the initial pain and discomfort of the pt. Other choices were see how you can make a preventitive
plan, treat all restorations.
Proper order for treatment planning –
emergency care, disease control, reevaluation, definitive treatment, maintenance care
Which are the two most imp. steps for diagnosis:
History and clinical examination
Patient comes to your office, complains about how other dentists did really bad job, and tells you how you are the best dentist in
the world. What mental condition is she suffering from?
Borderline Personality Disorder
Pt comes in saying she’s been to 5 different dentists the last 6 months. A few minutes later, she’s telling you how great of a dentist
you are and that she’ll refer all of her friends to you. This example of:
Borderline. Other choices were paranoia & schizoid.
- Borderline personality disorder (BPD) is a serious mental illness marked by unstable moods, behavior, and relationships.
Patient with bipolar disease comes in for dental care, choses not to take his medication and states he is in the “manic phase,” what
do you expect from treating this patient?: he will have unpredictable reactions during the treatment, he is will be obsessed about is esthetics
he will have unpredictable reactions during the treatment,
When trying to change person, what is most important?
trying to determine whether they are willing to change
Patient who has a complex medical history that is not debilitating but will require medical management and dental modifications –
ASA 3
You have a test that is not accurate but gives consistent result: this means test is
reliable
Which of the following are necessary for a test to be accurate: Specificity, reliability, validity
validity
is verbal or nonverbal communication more reliable
verbal
Dentists have to have proper accommodations for disable people. Dentists have to treat HIV people the same as others.
Both
statements are true
American disabilities act does not include HIV:
False
One patient left, and before getting another patient, how would you clean your operatory?
Use disinfecting spray à let it sit for 10
minutes and then wipe off
Disinfection?
Destroy majority of microorganisms but not bacterial spores.
- Bacterial spores = benchmark organism for sterilization
QUESTION: Benchmark for sterilization:
bacillus spores
- I think it’s Clostriduim Botulinium
Mycobacterium is the benchmark for
disinfection
Definition of disinfectants –
Inanimate objects (non-living)
Antiseptic: can be safely applied to
tissues, but will kill most living organisms
Denaturation of the proteins - _______; Coagulation of proteins - ________
QUESTION: Denaturation of the proteins - alcohol and autoclave; Coagulation of proteins - dry heat
QUESTION: Steam Autoclave:
20 minutes at 1210C & 15 psi.
Which method of sterilization needs higher temperature:
steam
dry heat
oxide pressure
dry heat – 160 C or 3200 F
Temperatures for autoclaves is governed by:
FDA
Which method of sterilization does not corrode instruments/burs? – Dry Heat, Ethylene oxide
Dry Heat
Which method of sterilization does not dull carbide instruments?
Dry heat
Sterilization most destructive to burs & causes rusts: Steam heat, dry heat, unsaturated vapor, chemical, ethylene oxide
Steam heat
What is best to sterlize carbide burs?
DRY HEAT or unsaturated chemical vapor –> no corrode or dull
- Ethylene oxide is for heat-sensitive instruments
Anti-retraction valves -
used to prevent aspiration of patient materials into some dental handpieces and waterlines – prevent
patient to patient cross-contamination.
What’s not found on the OSHA poster?
How many days each employee is allowed to work with that chemicals
How often should OSHA be updated
once a year
What are the hep B vaccine rules by OSHA?
all must always be offered and able to get the vaccine
Once a year, you have to check for one of the following:
HIV
HEP B
HEP C
HEP B
If worker didn’t get Hep B vaccine because he is more concerned about HIV?
Tell him it’s easier to get hep B à must sign that they
legally don’t want
Who is at least risk for HEP B infection?
a) food servers
b) Down syndrome
c) drugs addicts
a) food servers
Who is in control of writing the material safety data sheet (MSDS):
Manufacturer
Hazard Communication Standard:
created by OSHA to make sure employees know about hazardous/toxic materials
Hazard Communication Standard states –
every chemical hazard has to be evaluated then reported to employer & employees
HAZARD COMMUNICATION LAW created by?
what does it control: amalgam, sharps, blood
a) created by OSHA
controls, among others, amalgam
hazardous communication regulation
train worker right after you hire; train worker when new hazardwhether the means of 2 groups are statistically different—assume that standard deviation is unknown. Small sample
sizeous material is in office
T test: used to compare
whether the means of 2 groups are statistically different—assume that standard deviation is unknown. Small sample
size
Z test: used to compare the
means of 2 groups are statistically different if the variances like standard deviation are known. Large sample size.
Chi-square test:
tests correlation b/w two independent variables
Case control study —
RETROSPECT study that compares people that have the disease to people that do not have the disease. Also, looks back
to see how the risk for the disease is compared to actually getting that disease.
- start with disease and look backwards for exposure
- ex. How did people react to the new mouthwash vs nonusers
Cohort study —
PROSPECTIVE study where there is more than one sample/cohort and evaluations are done to see how certain risk factors the
groups have are related to developing a certain disease.
- look forward from exposure to disease development, through time to see how develops disease, then looks at various factors (no
one has diease yet)
- ex. how will/does people react to using new mouthwash vs nonusers
Cross sectional study —
EPIDEMIOLOGICAL study that looks at the entire population. Not like case control, that only studies a certain group
with a specific characteristic.
- all variables measures simultaneously at one point in time
- Example: It was observed that there was less caries in certain geographic areas. Higher fluoride in water supplies was suspected
as the probable cause
Longitudinal Study —
TIMED study that looks at a certain set of people (same people) over a long period of time.
gold standard for establishing cause and effect
clinical trial
If a dentist is reading an article, where should he look for the definition of dependent and independent variables? method ,
introduction, discussion, results, summary
method
Where would you look in a scientific journal to find the dependent and independent variables • Intro • Materials • Methods • Conclusion • Summary
Methods
What section states the purpose of the research?
INTRO (ABSTRACT)
Researcher wants to find incidence of oral cancer in nursing home what study?
Cross-sectional
Which type of study determines relative risk ratio:
Cohort
QUESTION: What parameter study lets you have a risk quotient?
Cohort
Efficacy, what study would you do?
CASE CONTROL
Study among smokers & nonsmokers in a period of 6 years (2000-2006) to develop disease? Cohort, cross sectional
Cohort
- By: disease/non-disease: case control; by time: cohort
What type of studylets you find causation- analytical, cross-sectional, case-control, cohort
analytical
Myestena Gravis patients are involved in a study. The doctor is conducting a study and is trying to find out how many of these
patients has periodontitis. What study is he conducting?
Case control study
Dentist is doing research on 5 unrelated patient with different background. He record data ......etc. Dentist is doing what kind of research? a. clinical trial b. cohort c. sectional
a. clinical trial
Study group A and B give some agents for plaque control then compare which agent is more effective. Which study is that?
Clinical
trial
A study is done to determine the affectiveness of a new antihistamine .To do this, 25 allergic pt‟s are assigned to one of the two
groups ,the new drug (13 pt’s) , placebo (12 pt’s) . The pts are followed for 6 months . This study is called: Cohort, Cross-sectional, Case
controlled, historical cohort, clinical trial.
clinical trial. ( assigned or give is the clue )
A study is designed to determine the relationship between emotional stress and ulcers. To do this, the researchers used hospital
records of pt’s diagnosed with peptic ulcer disease and pt. diagnosed with other disorders over the period of time from july 1988 to july 1998 .
The amount of emotional stress each pt. is exposed to was determined from these records. This study is:
A) Cohort B)Cross-sectional C) Case-study D)Historical Cohort E)Clinical Trial
C) Case-study
A researcher conducting a research between students self studying and those attending lectures what is the independent variable?
students participating in research, material studied, Students results, Lecture of self study
- ATTENDING LECTURE or SELF STUDY (INDEPENDENT VARIABLE)
- STUDENTS RESULT (DEPENDENT VARIABLE)
QUESTION: Analyze statistical difference between two means?
T-test
Crossover study advantages:
influence of confounding covariates is reduced because each crossover patient serves as his or her
own control and are statistically efficient and so require fewer subjects than do non-crossover designs (even other repeated measures designs).
Means of caries risk assessment for 3 groups: white, black, Hispanic what test do u use to compare?
A) chi square b) variance c) t-test
c) t-test
How do you compare between 2 constant variables? Chi square, regression analysis
regression analysis
QUESTION: Two groups of 100 ppl, gave them different foods & asked how they felt afterwards. which test to compare the 2 groups answers à
chi squared test
Want to compare 2 groups of people, male and female for something, what test do you look at? Multiple regression, Chi square
Test, T-test
Chi square
QUESTION: What test measures 2 nonparametric data? Chi-square, normal distrubition, spearman, wilcoxin, kruskal wallis
Chi-square
Two common VARIABLE..what statistical test would you use? Chi-test, T-test, correlation analysis, or standard deviance
Chi-test,
QUESTION: If you have a study of confounding variable
– minimize confounding variables by randomizing
- minimize confounding variables by randomizing groups, utilizing strict controls, and sound operationalization practice all
contribute to eliminating potential third variables.
QUESTION: confounding variants
- a third variable or a mediator variable, can adversely affect the relation between the independent variable
and dependent variable. This may cause the researcher to analyze the results incorrectly. The results may show a false correlation between the
dependent and independent variables, leading to an incorrect rejectionof the null hypothesis.
- Type I Error with null hypothesis-
rejecting the null hypothesis when it is true. This is an alpha error. Another way to say this is, to reject a null that
should be accepted.
false positive
Type II Error with null hypothesis-
accepting a false null hypothesis. This is a beta error. Another way to say this is, to accept a null that should be
rejected.
false negative
what should observed probability be to reject null hypothesis
<= 0.05 (5%) – outcome is judged as no effect
when accept null hypothesos
when probability >5% –> accept null, results not statistically significant
sensitivity
people with disease correctly classified as having disease
true positive/(true positive + false negative [these have it but not recognized])
specificity
people without disease correctly classified as not having it
true negative/(true negative + false positive)
incidence
new cases
Experiment was done and error = 0.05 was the goal but when completed it was 0.01. The question asks what type of error was it?
a. Type I
b. TYPE 2
c. no error:
no error: Error of less or equal of 0.5 no statistical significance..
P-significant value is equal to 0.01, your theory should be right, so you you will ______ null hypothesis
reject
Type I – and Type II –
1 is false rejection of null hypothesis (false negative/incorrect regection) = less dangerous in terms of research
2 is false acceptance of null hypothesis (false positive/failure to regect) – less problematic bc no conclusion is made from a rejected null. But type 2
is more dangerous medically bc a patient is diagnosised as HEALTHY when they actually have the HIV.
The power of a statistical analysis is ultimately to:
reject the null
QUESTION: Incidence is when
number of people like to get disease in given time
QUESTION: Dentist in his clinic notices a new diseases this is?
incidence
What is the statistical measure for the total number of cases per population, regardless of time of onset?
prevalence
For a population, the research divides the number of disease cases by the number of people. By so doing, this investigator will have calculated which of the following rates? a. incidence b. odds ratio c. prevalence d. specificity
c. prevalence
Specificity:
Proportion of truly nondiseased persons who are so identified by a screening test (measures “how good a test is at
correctly identifying nondiseased persons).
Sensitivity tests identifying diseased persons.
Dentist finds a group of individuals are free of (do not have the) dental disease:
specificity
- Specificity (without disease) and sensitivity (with disease)
If a dentist was able to correctly ID disease free patients w/ the diagnostic study, it has?
high specificity.
Study says 95 out of 100 people had the disease what is lab value:
95% sensitivity
A study failed to report 5 cases of caries. What is this called? 1. True Positive, 2. True Negative, 3. False Positive, 4. False Negative
False Negative
QUESTION: Incidence of caries in your office this year is 300 out of 1000, last year it was 200, so what is it for this year?
10%
- Incidence refers to NEW cases so the answer is (300-200)/1000 = 100/1000 = 0.1
Dentist has 300/1000 patients with periodontitis; last year only 200 had periodontitis, what is the incidence for this year:
10%
mean, median, mode
mean (average)
median (middle number)
mode (number that shows up the most)
Which does not describe the spread of data? median, range, variance, standard deviation, standard error
median
What do you use for average Q? Mean, median, mode
Mean
Which of the following represents the variability about the mean-value of a group of observations? A. Sensitivity B. Standard deviation C. t-Statistic D. Specificity
B. Standard deviation
Histogram is used to show : mean, correlation of 2 variables, variance
variance
standard deviation
Outliers control:
a. mean
b. median
c. mode
d. standard deviation
d. standard deviation
An outlier has the biggest effect on which of the following?
Standard deviation
Your office uses perio scale 1= gingivitis 2= mild perio 3= moderate/severe etc, what type of scale is this? Nominal, ordinal, ratio,
cardinal
ordinal
mild, moderate, severe: what type of scale?
ordinal
kelvin temperature what type of scale
ratio
celsius temperature what type of ratio
interval
Best scale for gingival index?
a. ratio
b. nominal
c. interval
b. nominal
