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Practice Management Flashcards

1
Q

What are the ADA’s Principles of Ethics?

A

Autonomy: Self-governance

Nonmaleficence: Do no harm

Beneficence: Do good

Justice: Fairness

Veracity: Truthfulness

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2
Q

Autonomy

A

Self Governance
* Pt’s right to self determination & privacy

Tx: Pt’s desires w/in the bounds of acceptable tx
* Obligated to involve pt in their won decision

  • Safeguard confidentiality of pt records (HIPAA Privacy Rule)
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3
Q

Informed Consent

A

Autonomy

Dentist is required to share info with the pt & obtain consent
* nature of procedure
* Benefits vs risks
* alternative tx options (include no tx)
* Not cost of tx

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4
Q

Minors:

A

Autonomy

<18: can give implied consent, or assent, but NOT actual consent

Exception: if emancipated or Emergency situation
*Married
* Pregnant
* Parent
* Military

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5
Q

Patient Records

A

Autonomy

Charts/X-rays
* owned and kept by the dentist
* Keep as long as possible
* Legally: 7 years after pt is out of your practice
* Pt has the right to copies of charts/x-rays

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6
Q

Risk Management

A

Autonomy

Always weigh risk vs Benefits for your practice

Documentation=most essential component
* Specific
* Objective
* Complete
* Timely
* Written by yourself, for your own Tx
* Never delete or change records–> Make addendums & strikethroughs
* Dont write anything you dont want to be read out loud in court

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7
Q

Nonmaleficience

A

Do No Harm

Keep skills & knowledge up to date w/CE
* Know limits and refer difficult cases to a specialist

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8
Q

Beneficence

A

Do Good

Act for the benefit of others
* Promote patient welfare

Same ethical standards no matter what the financial arrangement is

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9
Q

Justice

A

Fairness

Be Fair in dealing w/pt, colleagues, & Society
*deal w/patients justly
* deliver care w/o prejudice

Never Slander another dentist

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10
Q

Veracity

A

Truthfulness

Be Honest & Trustworthy w/public
* respect trust in dentist-patient relationship

Must not represent:
* Care being rendered
* Fees charged
* any form of advertising in a false or misleading way

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11
Q

Statute of Limitations

A

Laws that set the max time after an event that legal proceedings can start

Occurrence Rule: SOL starts after the event occurred

Discovery Rule SOL starts after the event is discovered

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12
Q

Witnesses

A

Expert Testimony: expert in dentistry
* testify to existing Standard of care and how it was breached

Fact Witness: Someone who was there

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13
Q

Good Samaritan Act

A

Legal Protection to:
health professionals & others that assist people who are
* injured
* ill
* in peril
* Incapacitated

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14
Q

Active Listening

A

Listen:
* w/no distraction
* Ask questions

Paraphrase
Lean forward
Maintain good eye contact

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15
Q

Rapport

A

Mutual Sense of trust & Openness
* Be human
* ask about pt’s interests

Disclose personal info when appropriate

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16
Q

Empathy

A

Ability to understand and share the feelings of others
* acknowledge their concerns and be open minded

DO NOT:
* share personal experiences
* reroute the focus on yourself

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17
Q

Nonverbal Communication

A

Continuous, automatic, & informative

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18
Q

What is the most common nonverbal reaction of discomfort?

A

Eye & eyebrow movement=1st & most common run of discomfort

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19
Q

Verbal Communication:

A

Simple, specific, & direct

Help pt make informed decision:
* Don’t just advise

Don’t falsely reassure!
* Say “Everything will be fine, don’t worry”

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20
Q

Clinical Interviewing

A

Ask open ended Q’s
* pt explains what important to them
* Closed Questions: Elicit more speicific info

Probing: gather additional info
Laundry List: Ask pt to respond from a list of choices

Leading questions=Bad
* directs the pt to respond a certain way

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21
Q

Treatment planning

A

Present in descending order of desire
* only present options that are consistent w/your standard of care
* Verify pts understanding (Teach-back method)

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22
Q

ABC Model Of Behavior Change

A

A=Antecedent:
* Factor that Facilitates behavior
* ex: Food stuck b/w your teeth

B=Behavior itself
* ex: flossing your teeth to get food out

C=Consequences of behavior
* ex: relief

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23
Q

Stages of Behavior Change

A
  1. Precontemplation:
    * Not considering change
  2. Contemplation:
    * **Considering change
  3. Preparation:
    * Preparing to take steps
    * Desire to change
  4. Action:
    * taking action towards behavior change
    *requires support
  5. Maintenance:
    * maintain changed behavior
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24
Q

Social Cognitive Theory

A

=motivation to change is influenced by several factors

  1. Self-Efficacy:
    * Cognitive Perception that YOU can execute behaviors necessary for a situation
    * Positive Affirmation-tell yourself you can do something
  2. Behavioral Modeling:
    * Learn proper behavior from models
  3. Social Reinforcement:
    * Positive social consequences
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25
Types of Behavioral Learning
Classical Conditioning Operant Conditioning Observational Learning
26
Classical Conditioning
Based on Stimuli *ex: Pavlov's dog Condition a neutral stimulus using an unconditioned stimulus
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Operant Conditioning
Based on consequences Positive Reinforcement: * Do a good thing, get rewarded Negative Reinforcement: * Do a good thing, remove bad stimulus Positive Punishment: * Do a bad thing, get punished Negative Punishment: * Do a bad thing, remove a good stimulus
28
Observational Learning
Based on Modeling =Acquire a skill by observing someone else doing it
29
Behvior Strategies
Change the antecedent (Class floss on the nightstand as a reminder) Alter consequences * reward yourself w/videogames after your floss SHAPING: Set small attainable goals PREEMACK PRINCIPLE: Make a behavior that has a higher probability of being formed contingent on a behavior w/a lower probability of being performed Ability to change depends on Lucas of control (Internal & external motivation)
30
Motivational Interviewing
=Person-centered counsel style * assist the resolution **From ambience to change** OARS: O: Open questions A: Affirmations R: Reflective Listening S: Summarizing
31
Stages of Motivational Interviewing
1. Engaging: * Forming a **Relationship** 2. focusing: * Explore **Motivation, goals, and values** 3. Evoking: * **Eliciting their own motivations** 4. Planning: * **Exploring how one might move toward change** * Sustain talk: not ready to change * Change talk: Favors change * Commitment talk: Ready to change
32
Stress
Perceived threat to ones well being
33
Anxiety
**More likely to sit still and not say much** * require **more interpersonal distance** to be comfortable
34
Stress Management
**#1: TRUST**: Give pt a sense of control * tell pt what to expect beforehand * Develop hand signals * Time structuring-count down injections **Comfort**: * Knowledge the pts experience * Empathetic & tactful in initial response **Coping**: * cognitive behavioral interventions
35
Coping Strategies
Diaphragmatic breathing: * Deep Breathing triggers physiologic relaxed response Progressive Muscle Relaxation: Guided Imagery: Hypnosis Rehearsal Systematic Desensitization/Graded Exposure Distraction Tell-Show-Do Habituation Rational Response/Reframing/Cognitive coping
36
Cognitive Appraisal of a threat
How we asses a threat **Controllability**: *how controllable the situation seems to be **Familiarity** * how familiar the situation is **Predictability**: * how predictable the situation is **Imminence**: * situation seems to be approaching
37
Child Behavior Management
1. Create a child-oriented ENVIROMENT * Toys & Books in waiting area * Hang posters * ask about interests * Silent parent in room 2. Ask them to be a helper 3. Tell-Show-Do 4. Ask about fears 5. Count
38
Dental Pain
**Anxious patients more likely to report pain & discomfort**
39
Behavioral Pain Management
Start with the **Simplest and least invasive procedure first** **Give pt choices** Use **Hand signals** Respond immediately to signs of discomfort
40
Pharmacologic Pain Management
rx: * Mild: Ibuprofen or Acetaminophen * Moderate: Ibuprofen + Acetaminophen * Severe: Ibuprofen + Acetaminophen +/- Opioid Nitrous Oxide: * Sedation before onset=TINGLING * Side Effects: NAUSEA * **CONTRAINDICATIONS**: COPDS IV Sedation
41
Epidemiology
Study of distribution & Determinants of disease
42
Public Health: Define
Science of Preventing Disease, Prolonging life, & promoting physical health & efficeciency thought organized community efforts
43
Public Health: Irreversibe & Reversible Measures
Irreversible Measures: * DMFT Reversible Measures: * Gingival Index * Perio index * Simplified Oral Hygiene Index
44
DMFT
**Define dental caries in a population** DMFT: Decayed, Missing and filled **permanent teeth** as a result of caries DMFS: Decayed, Missing and filled **Surfaces** due to caries DEFT: Decayed, **extracted** and filled teeth due to **Caries** dmfs: Decayed, Missing, or filled **primary teeth** as a result of caries
45
Gingival Index
**Uses 4 surfaces on 6 indicator teeth** 0=Normal gingiva 1=Mild inflammation 2=Moderate inflammation 3=Severe inflammation, ulcerated tissue w/tendency toward spontaneous bleeding
46
Periodontal Index
A lot of different indices CPITN: Community Periodontal Index of Treatment needs 0=Healthy 1= BOP 2: Calculus 3: Shallow pockets 4: Deep Pocket doesn't account for recession, so CAL is inaccurate
47
Simplified oral hygiene index
Quantifies Debris (DI-S) and Calculus (CI-S) Oral hygiene ranked as: * Good * Fair * Poor
48
Early Childhood Caries
Aka baby bottle tooth decay Define as: **1+ wmfs b/w birth & 72 months old (6 Years)** * most occurs from 3-5 yrs * Mainly involves MAX INCISORS & PREMOLARS
49
What is the most common site for Oral Cancer
Tongue
50
Stages of Prevention for oral diseases
Primary Prevention: * Prevent disease before it occurs * Ex: Sealants, Fl in water Secondary Prevention: * Eliminates or Decreases after it occurs * Ex: Restorations Tertiary Prevention: * Rehab a pt after a disease has occured * ex: Prosth
51
Community Water Fuoridation
**Most cost effective & most practical** preventive measure to prevent tooth decay IDeal: **0.7-1.2 ppm**
52
Schold Water Fluoridation
4.5x concentration of community water **Kids only at school for part of the day, so need Increased Fl**
53
Salt Fluoridation
**Not recommended to combine this w/water Fl.** Too much Fl
54
Fluoride Supplements
3: Fl tabs & lozenges > 6: Fl mouth rinse
55
Fluoride Supplement Dosage
Rule of 6's: No supplemental systemic Fl if: **Fl level in drinking water is >0.6 ppm** **Pt is < 6 most old** **Pt is > 16 y.o.**
56
Fluoride Toxicity
RULE of 5's * Toxic dose: **5mg/kg** * Lethal dose: **5g for adult**
57
Toothbrushing
**children <6 y.o. should be monitored during brushing**
58
Diet
**Frequency of sugar consumption is more important than amount (Stephan curve)**
59
Prevalence
Proportion of a given population that is affected by that condition at a given time
60
Cross-sectional study
**Survey/measurement taken to represent a snapshot in time** Measures: Prevalence
61
What are the different types of Longitudinal studies?
Case-Control Sttudy Prospective Cohort Study Retrospective Cohort Study
62
Cross-Sectional Study
**People w/a condition(cases) are compared to people without it (Control) in the past** (Retrospective study) **Risk of getting. disease w/already known exposure factors** Measures: Odd Ratio
63
Prospective Cohort Study
**Cohortt is followed through time** to see who develops a disease Measures: Incidence & relative risk
64
Retrospective Cohort Study
**Look back after following the cohort & decide what disease you want to look for.**
65
Reliability
**PRecision** Are you getting consistent results from the tests?
66
Validity
**Accuracy** How close to the truth are the results?
67
Sensitivity:
Test is **Correctly identify the disease** **2 S's in density and disease**
68
Specificity
Test is **Correctly identifying ppl who DONT have the disease (Healthy)**
69
P<0.05
Reject the null hypothesis Statistically significant
70
P>0.05
Accept the null hypothesis Not statistically significant
71
What type of error: If the Null hypothesis is rejected (P<0.05), but the null hypothesis is true
Type 1 error (alpha)
72
What type of error: If the Null hypothesis is accepted (P>0.05), but the null hypothesis is false.
Type II Error (Beta)
73
Sterilization
=Destroy all life forms including bacteria, viruses, and **spores**
74
Glutaraldehyde
Sterilization Cold solution used for **Heat sensitive items** * requires **long soak time**
75
Pressure Sterilization
Aka Autoclave **121C at 15 PSI for 20 mins** Biologic monitors: * Test strips w. spores to test efficacy * **weekly** Process Indicators: * Temp and Pressure * **With each load**
76
Dry Heat Sterilization
**160C for 60 mins**
77
Ethylene Oxide
Sterilization Low temp * can penetrate materials to sterilize prepackaged items (PSP Plates)
78
Disinfection
**Destorys MYCOBACTERIUM TUBERCULOSIS not spores**
79
Antisepsis
Used on **living tissue to decrease bacterial load**
80
Antisepsis: Methods
Alcohol: Most common Chlorhexidine: **Substantivity** (Continuous long lasting effect) Detergents: loosen & removes microbes from surface Quaternary ammonium compounds (Quats): **Does not Kill endospores, TB, or non-enveloped viruses**
81
Spaulding Classification System
Critical: **Contacts sterile tissue or vascular system** *requires sterilization * ex: needles Semi-Critical: **Contacts mucosa** * Minimum oh high-level disinfection * if heat stable material=Sterilization * Ex: Mouth mirror Non-Critical: **Contacts Skin** * requires disinfection ex: BP cuff
82
Airborne Particles
**Splatter**: * visible >/= 50 um * falls w/in 3 ft of pts mouth * can carry blood borne pathogens (HIV, HEP B/C) **Aerosols** * invisible, < 50 um * remain floating in air for hours * can only carry respiratory infections (TB)
83
Water Lines
**Do NOT recommend flushing lines at beginning of clinic. DOESNT MAKE A DIFFERENCE** **Anti-retraction valves** *prevent retraction of fluid from a pt into hand piece and water spray
84
Balance Billing
Dentist charges the remaining balance from total fee and what insurance covered **Balance after deductible + Co-pay + Insurance coverage**
85
Unbunding
Fraud Term (Dentist) Separating of a dental procedure into component parts
86
Upcoming
Fraud Term (Dentist) Reporting a more complex or higher cost procedure than what was actually preformed
87
Overbilling
Fraud Term (Dentist) Charging more than legally or ethically acceptable *Dentist doesn't charge the copay to the pt, but still bills the insurance company the full fee
88
HMO
Health Maintenance Organization Insurance option that: * **Limits coverage to care provided through specific providers** who are under contract * Drs are paid on CAPITATION PLAN
89
PPO
Preferred Provider Organization =Panel of **providers who agree to accept less than usual fees in exchange for a higher volume of patients**
90
Open panel plans vs Closed Panel Plans
Open Panel Plans: * **Dentist can see any pt in addition to ppl in the organization system** Closed Panel Plans: * **Dentist is contracted and can ONLY see patients who are members of the HMO.**
91
If you do not obtain informed consent, what happens?
Assault and Battery

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