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BOARDs > Practice Management > Flashcards

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
Q

Types of Behavioral Learning

A

Classical Conditioning

Operant Conditioning

Observational Learning

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26
Q

Classical Conditioning

A

Based on Stimuli
*ex: Pavlov’s dog

Condition a neutral stimulus using an unconditioned stimulus

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27
Q

Operant Conditioning

A

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

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28
Q

Observational Learning

A

Based on Modeling

=Acquire a skill by observing someone else doing it

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29
Q

Behvior Strategies

A

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)

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30
Q

Motivational Interviewing

A

=Person-centered counsel style
* assist the resolution From ambience to change

OARS:
O: Open questions
A: Affirmations
R: Reflective Listening
S: Summarizing

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31
Q

Stages of Motivational Interviewing

A
  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
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32
Q

Stress

A

Perceived threat to ones well being

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33
Q

Anxiety

A

More likely to sit still and not say much
* require more interpersonal distance to be comfortable

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34
Q

Stress Management

A

#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

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35
Q

Coping Strategies

A

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

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36
Q

Cognitive Appraisal of a threat

A

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

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37
Q

Child Behavior Management

A
  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
Q

Dental Pain

A

Anxious patients more likely to report pain & discomfort

39
Q

Behavioral Pain Management

A

Start with the Simplest and least invasive procedure first

Give pt choices

Use Hand signals

Respond immediately to signs of discomfort

40
Q

Pharmacologic Pain Management

A

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
Q

Epidemiology

A

Study of distribution & Determinants of disease

42
Q

Public Health: Define

A

Science of Preventing Disease, Prolonging life, & promoting physical health & efficeciency thought organized community efforts

43
Q

Public Health: Irreversibe & Reversible Measures

A

Irreversible Measures:
* DMFT

Reversible Measures:
* Gingival Index
* Perio index
* Simplified Oral Hygiene Index

44
Q

DMFT

A

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
Q

Gingival Index

A

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
Q

Periodontal Index

A

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
Q

Simplified oral hygiene index

A

Quantifies Debris (DI-S) and Calculus (CI-S)

Oral hygiene ranked as:
* Good
* Fair
* Poor

48
Q

Early Childhood Caries

A

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
Q

What is the most common site for Oral Cancer

A

Tongue

50
Q

Stages of Prevention for oral diseases

A

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
Q

Community Water Fuoridation

A

Most cost effective & most practical preventive measure to prevent tooth decay

IDeal: 0.7-1.2 ppm

52
Q

Schold Water Fluoridation

A

4.5x concentration of community water
Kids only at school for part of the day, so need Increased Fl

53
Q

Salt Fluoridation

A

Not recommended to combine this w/water Fl.
Too much Fl

54
Q

Fluoride Supplements

A

</= 3: Fl drops (easier to swallow)

> 3: Fl tabs & lozenges

> 6: Fl mouth rinse

55
Q

Fluoride Supplement Dosage

A

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
Q

Fluoride Toxicity

A

RULE of 5’s
* Toxic dose: 5mg/kg
* Lethal dose: 5g for adult

57
Q

Toothbrushing

A

children <6 y.o. should be monitored during brushing

58
Q

Diet

A

Frequency of sugar consumption is more important than amount (Stephan curve)

59
Q

Prevalence

A

Proportion of a given population that is affected by that condition at a given time

60
Q

Cross-sectional study

A

Survey/measurement taken to represent a snapshot in time

Measures: Prevalence

61
Q

What are the different types of Longitudinal studies?

A

Case-Control Sttudy
Prospective Cohort Study
Retrospective Cohort Study

62
Q

Cross-Sectional Study

A

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
Q

Prospective Cohort Study

A

Cohortt is followed through time to see who develops a disease

Measures: Incidence & relative risk

64
Q

Retrospective Cohort Study

A

Look back after following the cohort & decide what disease you want to look for.

65
Q

Reliability

A

PRecision

Are you getting consistent results from the tests?

66
Q

Validity

A

Accuracy

How close to the truth are the results?

67
Q

Sensitivity:

A

Test is Correctly identify the disease

2 S’s in density and disease

68
Q

Specificity

A

Test is Correctly identifying ppl who DONT have the disease (Healthy)

69
Q

P<0.05

A

Reject the null hypothesis

Statistically significant

70
Q

P>0.05

A

Accept the null hypothesis

Not statistically significant

71
Q

What type of error: If the Null hypothesis is rejected (P<0.05), but the null hypothesis is true

A

Type 1 error (alpha)

72
Q

What type of error: If the Null hypothesis is accepted (P>0.05), but the null hypothesis is false.

A

Type II Error (Beta)

73
Q

Sterilization

A

=Destroy all life forms including bacteria, viruses, and spores

74
Q

Glutaraldehyde

A

Sterilization

Cold solution used for Heat sensitive items
* requires long soak time

75
Q

Pressure Sterilization

A

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
Q

Dry Heat Sterilization

A

160C for 60 mins

77
Q

Ethylene Oxide

A

Sterilization

Low temp
* can penetrate materials to sterilize prepackaged items (PSP Plates)

78
Q

Disinfection

A

Destorys MYCOBACTERIUM TUBERCULOSIS not spores

79
Q

Antisepsis

A

Used on living tissue to decrease bacterial load

80
Q

Antisepsis: Methods

A

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
Q

Spaulding Classification System

A

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
Q

Airborne Particles

A

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
Q

Water Lines

A

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
Q

Balance Billing

A

Dentist charges the remaining balance from total fee and what insurance covered

Balance after deductible + Co-pay + Insurance coverage

85
Q

Unbunding

A

Fraud Term (Dentist)

Separating of a dental procedure into component parts

86
Q

Upcoming

A

Fraud Term (Dentist)

Reporting a more complex or higher cost procedure than what was actually preformed

87
Q

Overbilling

A

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
Q

HMO

A

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
Q

PPO

A

Preferred Provider Organization

=Panel of providers who agree to accept less than usual fees in exchange for a higher volume of patients

90
Q

Open panel plans vs Closed Panel Plans

A

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
Q

If you do not obtain informed consent, what happens?

A

Assault and Battery

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