PT Mgmt2013-14

ATIENT MANAGEMENT LEGEND
Topic
behavioral sciences
infection control
Cards
Topic
Cards
1-19
OSHA
51-76
public health
77-99
20-50
BS
Arrange the following steps of the educational process in correct order.
1. expressing needs
2. stimulating motivation
3. recognizing needs
4. evaluating results
5. reinforcing learning
6. setting goals
7. acting to achieve goals
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3,1,2,6,7,5,4
Although each learning situation will not follow these steps in exact sequence, most situations will include all of these seven steps in
some form:
recognizing needs
expressing needs
stimulating motivation
setting goals
acting to achieve goals
reinforcing learning
evaluating results
Step 1
recognizing needs
dentist recognizes educational needs as treatment needs are determined
dentist helps patient recognize needs
Step 2
expressing needs
dentist records educational needs
dentist helps patient state needs
Step 3
stimulating motivation
motivation arouses & maintains interest
dentist may appeal to inner needs or use artificial stimuli
Step 4
setting goals
short-range or long-range guides to activity
must be meaningful, attractive & attainable
Step 5
acting to achieve goals
activity is needed for learning
must be directed at specific goals
Step 6
reinforcing learning
review & repetition aid in learning retention
Step 7
evaluating results
aid in judging what patient has learned
aid in determining how effective
dentist's teaching has been
can help clarify or redefine goals
BS
Identify each of the following statements that are true concerning needs and
learning.
needs are driving forces that prompt a person to act

the process of learning is continuous
learning occurs as a person attempts to satisfy needs
expressing needs helps to pinpoint them for the patient and dentist
recording educational needs can be as important as recording treatment needs
all of the above statements are true
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all of the above statements are true
Needs & Learning

needs & goals may provide motivation
motivation arouses & maintains interest
motivation may be artificial or builtin
patients rarely learn without motivation
learning is continuous and occurs
when a person attempts to satisfy
needs
motivation stimulates a person to act
on needs
motivation is a fundamental part of
every learning situation
short-range goals are less remote &
more easily attained
goals should be attractive & attainable in order to be meaningful
goal-directed activity is necessary
for learning
Assessment of behavior
in order to change behavior, assessment of the behavior is needed
how to assess behavior
- identify problem
- consider motivation
- consider readiness
- consider willingness to change
- consider ability to change
- collect baseline data
- reassess behavior after implememtation
BS
Most researchers believe that changes in behavior are a prerequisite to
changes in attitude.
Behavior can be defined as a determined, purposeful unit of activity.
both statements are true

both statements are false
the first statement is true, the second is false
the first statement is false, the second is true
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Behavior
changes in behavior are a prerequisite
to changes in attitude
behavior is defined as a determined,
purposeful unit of activity
- determined
the assumption that the behavior
is lawful & has determinants
- purposeful
the assumption that the
behavior is goal-oriented, that it
seeks to achieve positive and reduce negative need or motivated
states
- unit of activity
what a person does that can be reported or described as discrete
elements
Behavior examples
a common behavior for a dentist is
to observe that a problem exists
(e.g., tooth decay)
a common behavior for a patient
is to avoid the dentist even though a
need exists & treatment is required
both of the above examples meet the

criteria of being "determined, purposeful units of human activity"
Behavior management
as described by the ADA, techniques or therapies used to alter or
control the actions of a patient who
is receiving dental treatment; examples include education or anxiety
relief techniques
the means by which the dental
health team effectively and efficiently performs treatment for the
patient, and, at the same time, instills
a positive attitude
BS
The principal nonverbal cue that two or more persons can use to regulate verbal communication is:
posture
facial expression
eye contact
gestures
proximity
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eye contact
Communication
the process by which information is
exchanged between 2 or more persons
communication is essential in the
dentist-patient relationship
acceptable verbal & non-verbal
communication varies with the age, sex,
ethnicity and culture of the patient
communication is both verbal &
non-verbal; also includes listening
Verbal communication
involves use of language
choice of words is important
delivery of speech is important
(fast vs. slow, loud vs. soft)
Non-verbal communication
involves use of body language
conveyed by eye contact, posture, body
movement, hand gestures & expressions
Empathy & Rapport
empathy is the ability to experience the
feelings of another person
rapport is a mutual sense of trust and
openness between individuals
Listening
receiving & understanding messages
a good listener shows attention &
interest
listening techniques include
- paraphrasing (repeating in own
words)
- interpretation (identifying the
underlying reason)
- preparation (allowing time for discussion & eliminating distractions)
Eye contact
is the principle non-verbal cue used to
regulate verbal communication
when listening to a patient, a dentist
should maintain eye contact
a dentist should engage the patient's
eyes as often as is comfortable for both
parties
Facilitative skills
facilitative skills make communication
easier and help to develop trust
include encouraging patient questions,
answering questions, responding to requests & communicating with warmth
BS
Which term describes a behavioral response that operates by the simple
process of association of one stimulus with another?
operant conditioning
classical conditioning
observational learning
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Classical conditioning
a stimulus leads to a response
a.k.a. pavlovian or respondent conditioning
a process of behavior modification by
which a subject comes to respond in a
desired manner to a previously neutral
stimulus that has been repeatedly presented along with an unconditioned
stimulus that elicits the desired response
Operant conditioning
process of behavior modification in
which the likelihood of a specific behavior is increased or decreased through
positive or negative reinforcement each
time the behavior is exhibited, so that
the subject comes to associate the pleasure or displeasure of the reinforcement
with the behavior
four types: positive reinforcement,
negative reinforcement, punishment
& extinction
Observational learning
or modeling, is a type of learning that
occurs as a function of observing, retaining and replicating behavior executed by others in a social context
two phases: acquisition of the behavior
& performance of the behavior
Example
Classical conditioning
before conditioning, a painful injection
(unconditioned stimulus) would elicit a
fear reaction (unconditioned response)
during conditioning, the dentist with
syringe (neutral stimulus) is linked
with the painful injection and elicits a
fear reaction
after conditioning, the dentist with a
syringe (conditioned stimulus) will encourage a fear reaction (conditioned
response)
BS
Which type of aggression is an act of hostility unnecessary for self-protection
or preservation that is directed toward an external object or person?
destructive aggression
inward aggression
constructive aggression
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destructive aggression
Destructive aggression
act of hostility
unnecessary for self-protection or
preservation
directed toward external object or
person
Constructive aggression
act of self-assertiveness
in response to a threatening action
for purpose of self-protection and
preservation
Inward aggression
destructive behavior directed
against oneself
Aggressive personality
personality with behavior patterns
characterized by irritability,
tantrums, destructiveness or violence in response to frustration
aggressive personalities are individuals whose overall "style" of interacting involves considerable, persistent, maladaptive aggression
expressed in a variety of ways and
in a wide range of circumstances
characteristics include the
following:
- seek a superior position in any
relationship or encounter
- abhor submission
- self-advancing at expense of
others
- have disdain for truth
- lack internal "brakes"
BS
Match the type of question on the left to the correct example on the right.
direct
probing
laundry list
open-ended
leading
facilitating
1.
2.
3.
4.
5.
6.
You're not afraid of needles, are you?

How are you doing with brushing & flossing?
How are you?
Is it easier to hold the brush this way?
What else did you notice about your gums?
Is the pain sharp, dull, or throbbing?
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4,5,6,2,1,3
#
Type
4 direct
question
Example
Is it easier to hold the brush this way?

direct questions asked for a specific bit of information
C probing
question
What else did you notice about your gums?
6 laundry list
question
Is the pain sharp, dull, or throbbing?

laundry list questions give the patient a list of choices
2 open-ended
question
How are you doing with brushing & flossing?

open-ended questions request information in the patient's
1 leading
You're not afraid of needles, are you?

leading questions entice a patient to answer in a specific way;
leading questions should not he used with patients
question
3 facilitating
question
probing questions ask for more specific information that the

Patient offers spontaneously
own words and specify a content area
How are you?
facilitating questions encourage the patient to say more

without specifying an area or topic
Communication hints
ask questions/never presume
carefully inquire/never interrogate
be specific/avoid being vague or abstract
provide information & educate/instead of giving advice
provide accurate information/fully discuss concerns & offer support
exhibit professionalism/it is an essential component of dentist-patient relationships
exhibit confidence, care & warmth
BS
Which one of the following types of patients is usually considered to be the
most difficult?
the "know-it-all" patient

the anxious patient
the shy patient
the talkative patient
the stubborn patient
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the anxious patient

Anxious patient
is the most difficult patient to manage

in dentistry
anxiety is defined as unpleasant negative emotional state without identifiable cause
anxiety is the feeling of apprehension,
uneasiness, agitation or uncertainty resulting from the anticipation of a threat
of danger whose source is unknown
most anxious patients have had a traumatic experience in a healthcare setting
anxiety causes patients to avoid dental
treatment & interferes with treatment
anxiety may cause problems with pain
Indicators of anxiety
affective patient is emotional, talks a
lot, talks fast
cognitive patient is not listening &
does not follow instructions
motor increase in body movement
& muscle tension
psychological increase in heart rate,
respiration, sweating & dry mouth
Management of the anxious patient

be friendly
be calm & patient
build trust; use empathy & respect
create a relaxing environment

make the patient feel welcome
convey a sincere concern for patient's
well-being
explain procedures before doing them
encourage the patient to ask questions
use understandable words
pay attention to what the patient is
saying and how it is said
forewarn patient about possible pain
watch a patient's eyes & eyebrows to
see if the patient is feeling pain
give patient control by giving option
to "raise your hand if you feel anything"
provide moral support during procedure
use headphones or TV as a distraction
use SUDS (the subjective unit of distress scale) to assess the level of patient anxiety throughout treatment; ask
the patient to rate their level of anxiety
from 0 (none) to 10 (highest level)
BS
Which type of parent has an excessively demanding attitude?
neglectful parent
overprotective parent
manipulative parent
hostile parent
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manipulative parent
Manipulative parent
is demanding
demands usually start with appointment times
may try to provide diagnosis and direct the course of treatment
Overprotective parent
insists on remaining with child in
operatory regardless of situation or
age of child
usually has a child who is shy,
docile and manageable
by pointing out the lack of apprehension of the child and the importance of establishing a one-on-one
relationship between the dentist and
child, this will usually satisfy most
overprotective parents
Hostile parent
questions the necessity of treatment
questions stem from distrust and not
curiosity
Neglectful parent
fails to keep appointments
misses recall visits
does not oversee oral hygiene of
child
the uncooperative child
may be described as stubborn or
spoiled & is usually a child with
defiant behavior
may be hostile or angry; with this
child, the dentist must try to identify the underlying source of these
emotions
BS
Dental fear is an unpleasant mental, emotional or physiologic sensation derived from a specific dental related stimulus.
Someone who experiences fear will not necessarily be anticipating a negative
event, their response will occur at the moment the unpleasant event (e.g.,
pain) occurs.

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Dental fear
refers to the fear of dentistry and
receiving dental care
is defined as an unpleasant mental,
emotional or physiologic sensation
derived from a specific dental-related stimulus
elements common to all fears
- fear of unknown
- fear of pain/bodily injury
- fear of loss of control
- fear of helplessness & dependency
understanding the above elements of
fear allows for effective planning for
the treatment of fearful & anxious
patients
when evaluating a patient's dental
fear, take note of what the patient
says and how the patient behaves &
appears while in the dental office
Dental anxiety
is defined as a non-specific uneasiness,
apprehension or negative thoughts about
what may happen during a dental
appointment
patients who are fearful or anxious
avoid dental appointments
Stress
is defined as the body's reaction to a
change that requires a physical, mental or emotional adjustment or
response
stress can be caused by physical, emotional or psychological influences
Stress, anxiety, & fear
of stress, fear & anxiety --- stress is
associated with a response
stress is the body's response to danger
fear is a feeling of uneasiness in
response to imminent danger
anxiety is a feeling of uneasiness when
no danger is present
the interaction of the intensity of an
emotional response with threat appraisal
determines the behavior that will follow
--- whether to show up to a dental
appointment, submit to an injection,
accept the need for extraction etc.
BS
A 32-year-old woman visits the dental office for a routine dental cleaning. The
dental hygienist discovers that the patient has not been following the home
care program that was recommended six months ago. The hygienist believes
that the problem is not a skills deficiency but a management deficiency instead. What is the best course of action for the hygienist?
accept that the patient might never change her habits

provide the patient with a pamphlet on periodontal disease
collaborate with the dentist to determine the course of action
go over brushing & flossing techniques
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collaborate with the dentist to determine course of action

Motivating the patient
reviewing home care instructions will
not solve the problem, since this is not
a skills deficiency; a plan must be
determined to motivate this patient
if the patient knows what to do, and
how to do it, members of the dental
team must collaborate and find a way to
motivate the patient to embrace the
recommended home care regimen
Stages of change model (SCM)
1 pre-contemplation (no admission of
problem )
2 contemplation (considering problem
& change)
3 preparation (getting ready to change)
4 action / willpower (changing
behavior)
5 maintenance (maintain behavior
change)
6 relapse (abandon change)
Motivating patients
use good communication techniques

express empathy and engage the
patient
identify the patient's current oral
hygiene status and the agree on
achievable goals for improvement
avoid arguing; gently challenge the
thought that underlies the behavior
support self-efficacy; encourage the
patient to believe that they can change
the behavior and they will achieve their
desired goals
develop a partnership with the patient
consult your patient & elicit their
views , the patient will feel that their
voice is heard & their needs are
considered
ultimately, the patient must believe
that the decision to follow a particular course of action is theirs
BS
Behavior shaping is also called:
aversive conditioning
successive approximation
restraining
hypnodontics
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successive approximation
Behavior shaping
a.k.a. successive approximation
shaping is used when an existing
behavior needs to be changed into a
more appropriate or new behavior
the strategy involves use of reinforcement of successive approximations of
a desired behavior
immediate positive reinforcement
includes verbal praise and nonverbal
indications of approval
each approximate desired behavior that
is demonstrated is reinforced, while
behaviors that are not approximations of
the desired behavior are not reinforced
examples of behavior shaping methods
include tell-show-do and modeling
Aversive conditioning
using a punishment or something u
pleasant to stop an unwanted behavior
like all forms of punishment, it may
work but is less effective than reinforcement
an example is the HOME technique
(Hand-Over-Mouth)
Hypnodontics
the application of hypnosis and
controlled suggestion in dentistry
Restraining
a dental restraint is defined as any
form of restriction of movement by a
patient in the dental environment
a dental restraint includes the following
characteristics :
- short duration
- limits movement of head & body
- prevents injury to the patient and/or
dental staff during the procedure
- provides physical control to allow
dental staff to complete treatment
- is usually well tolerated by patient
an example is papoose board
BS
Which one of the following is a conceptual framework that describes a person's health behavior as an expression of his or her health beliefs?
health maintenance model

health role model
health belief model
leading circle model
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health belief model

Health belief model (HBM)
is a psychological model that a
attempts to explain and predict
health behaviors by focusing on
the attitudes& beliefs of individuals
developed in the 1950s by social
psychologists working in the U.S.
Public Health Services
INDIVIDUAL PERCEPTIONS
developed in response to the failure

of a free tuberculosis (TB) health
screening program
has been adapted to explore a
variety of long- and short-term
health behaviors, including sexual
risk behaviors and the transmission
of HIV/AIDS
suggests that individuals act to
prevent disease only when they are
susceptible to it
MODIFYING FACTORS
LIKELIHOOD OF ACTION
Age, sex, ethnicity
Perceived bene Its
Personality
versus
So do-economics
barriers to behavioural
Knowledge
change
1
Likelihood of be
Perceived susceptibilty/
Perceived threat of
seriousness of disease
disease
Cues to action
education
s yrrpto rrts
media into ration
change
BS
Behavior modification is also known as:
behavior evaluation
behavior therapy
behavior shaping
behavior training
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behavior therapy
Behavior modification
a.k.a. behavior therapy
type of psychotherapy that attempts to
modify observable, maladjusted patterns
of behavior by the substitution of a new
response to a given stimulus
mostly used in pediatric dentistry
Techniques
for modifying behavior
modeling
systemic desensitization
a.k.a. pavlovian or respondent conditioning
a naturally occurring stimulus is paired
with a response
- next, a previously neutral stimulus is
paired with the naturally occurring
stimulus
- eventually, the previously neutral stimulus comes to evoke the response with
out the presence of the naturally occurring stimulus
the two elements are known as conditioned stimulus & conditioned response
a.k.a. instrumental conditioning
a method of learning that occurs
through rewards & punishments for
behavior
positive & negative reinforcement
strengthen behavior
punishment & extinction weaken
behavior
using a punishment or something
unpleasant to stop unwanted behavior
is less effective than reinforcement
an example is the HOME technique
(Hand-Over-Mouth)
modeling
form of learning where individuals
ascertain how to act by observing
another individual
systemic desensitization
therapy for phobias, fears & aversions
premise is to reduce a person's anxiety
responses through counter conditioning
teaches a person to replace the feelings
of anxiety with feelings of relaxation
when the object or behavior is present
BS
Five techniques are used to facilitate patient dialogue: empathy, respect, reflection, interpretation and silence.
Reflection is the explanation and understanding of the patient's comments.

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Facilitation
Five techniques are used to facilitate patient
dialogue: empathy, respect, reflection, interpretation and silence.
empathy
is the ability to accurately understand
the patient's feelings
empathy also involves being able to
communicate this understanding
when properly done, empathy increases
rapport, encourages expression and
promotes trust
the dentist must actively listen and concentrate on what the patient is trying to
say both verbally and nonverbal ly
when communicating empathically, it
is helpful to respond with the same
feeling as the patient's statement
respect
respect promotes rapport, open
expression & trust
respect is communicated via the way
the dentist works with the patient
communicate respect by regarding each
patient as an individual
reflection
is a response that restates or
repeats a segment of the patient's
statement
reflection encourages the patient to
continue communicating
reflection is a subtle way of asking a
question and is less intimidating than
asking a direct question
interpretation
is the dentist's explanation and
understanding of the patient's
comments
an interpretation may stimulate dialogue
by requiring the patient to agree or to
disagree with the statement
an interpretation does not need to be
correct in order to stimulate dialogue
silence
is used to facilitate dialogue by
stimulating the patient to comment
and therefore break the silence
when using silence, it is very important
to communicate interest by nodding the
head "yes", leaning toward the patient,
and/or maintaining eye contact
BS
Each of the following are ways to communicate effectively with patients
EXCEPT one. Which one is the EXCEPTION?
describe
evaluate
be specific
be responsive
pay attention
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evaluate
Communications Effectively
with Patients
Do
Don't
Describe
Evaluate
Be specific
Be general
Be responsive
Be evasive
Pat attention
Be distracted
Listen carefully
Interrupt
Make eye contact
Let eyes wander
Use lay terms
Use jargon
Lean forward
Lean back
Use gestures
Fold arms
Use expression
Show disinterest
Ask questions
Presume
Suggestions
from Patients
How to Reduce Anxiety
Prevent pain
Be reassuring
Have a calm demeanor
Provide moral support
Work efficiently
Be friendly
BS
Each of the following are considered to be aversive conditions of interaction
between the dentist arid patient EXCEPT one. Which one is the EXCEPTION?
psychophysiological reactions
stress, anxiety & fear
preventive oral health behavior
pain
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preventive oral health behavior

Aversive conditions
any negative condition to which a person will learn to make a response to
avoid it
the dentist-patient interaction seeks to
minimize conditions that are perceived
as aversive
aversive conditions
- psychophysiological reactions
- stress, anxiety & fear
- pain
Non-aversive conditions
non-aversive conditions
- preventive oral health behavior
- communication
- gathering information
- identifying problems
- giving information
the dentist-patient interaction seeks to
maximize the conditions that arc
perceived as non-aversive
Dental fear, anxiety & pain

dental fear is an unpleasant emotional
or physiologic sensation derived from a
specific dental-related stimulus
dental anxiety is a non-specific uneasiness, apprehension or negative thoughts
about what may happen during dental
treatment
dental phobia is when dental treatment
is avoided or endured with intense
anxiety
dental fear & anxiety can come from
different sources
dental fear & anxiety are often from a
previous bad experience, or, from
hearing of a bad experience , or a general fear of needles
dental fear happens during childhood
or adolescence in approximately 5085% of cases
dental fear, anxiety & pain are all
interrelated
fear may cause a person to endure pain
and not seek treatment
pain & anxiety
- as pain increases, anxiety increases
- as anxiety increases, pain is enhanced
& is less tolerable
BS
Which of the following suggests that change does not happen in one step and
people tend to progress through different stages on their way to successful
change.
ABC model (behavior theory model)

stages of change model (SCM)
social cognitive theory
contemporary public health model
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stages of change model (SCM)

Stages of change model (SCM)
behavior change does not happen in
one step
a person will progress through different stages on the way to successful
change
each person will progress at their own
rate
Stages of change
1 pre-contemplation
not acknowledging there is a problem that needs to be changed
2 contemplation
acknowledging problem but not
ready or sure of wanting to make a
change
3 preparation
getting ready to change
4 action/willpower
changing behavior
5 maintenance
maintaining behavior change
6 relapse
abandoning change, returning to old
behavior
Social cognitive theory

behaviors are learned through observation, modeling & motivation such
as positive reinforcement
learning is strengthened if the observer
identifies with their "model
learning is strengthened if someone
models a behavior he or she has seen
rewarded; this motivates the person
to model the behavior to get a reward
ABC model (behavior theory)
behavior has 3 components :
A= antecedents (trigger)
B = behaviors
C = consequences
"B" comes between "A" and "C"
rather than occurring in isolation,
behavior is preceded by an antecedent
that sets off the behavior and is
followed by a consequence
Contemporary community (public)
health model
a prevention model that considers social, cultural, economical & environmental factors as having significant
influence on a person's health behaviors
BS
Which of the following is an essential part of risk management?
veracity
documentation
autonomy
negligence
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documentation
Risk management
refers to the policies and procedures the
dentist should follow in order to reduce
the chance that a patient will file legal
action against him or her
includes issues of legal competence,
informed consent, liability, confidentiality and documentation
Informed consent
informed consent (written or oral)
must he obtained by the dentist from
adult patients prior to treatment
informed consent components
- WHO will render treatment
- WHAT are the treatment options
- WHAT treatment will be done
- WHEN will the treatment occur
- WHERE (if referring the patient)
- WHY purpose of the procedure and
risks versus benefits
- QUESTIONS the opportunity for the
patient to ask questions & obtain info
Patient record
the patient record is the property of the
dentist and must be retained by the dentist
Documentation
is essential to risk management
dental records must be thorough, consistent & complete
must include actual visits, missed visits
& evidence of noncompliance
Documentation tips
inform the insurance carrier if an
incident with a patient occurs
remember that everything written in
the record can be used in court
always document informed consent
never change any written entry - add
an addendum / separate entry instead
if a mistake is made - draw a single
line through the error, mark it "error"
and initial & date it
be specific - write facts only, not opinions
be objective - avoid personal characterizations, state behaviors
be complete
be timely
write legibly
maintain integrity of the patient record
never sign a patient record entry for
someone else, or vice versa
countersign carefully - you are as

responsible as original person who signed
IC
Identify which one of the following is a false statement concerning personal
protective equipment (PPE):
1. protective clothing must be worn by dental professionals when contact with

blood or other bodily fluids is anticipated
2. gloves must be worn to prevent contact with blood, saliva or mucous membranes
3. wearing gloves replaces the need for handwashing
4. protective clothing must be removed before leaving the dental office
5. masks must be changed between patients
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PATIENT MANAGEMENT
wearing gloves replaces the need for hand washing

Protective clothing
protective clothing includes gowns,

lab coats & jackets
may be disposable
is worn over existing clothing (street
clothes or scrubs)
is used to prevent skin & mucous
membrane exposure when contact
with blood or other body fluids is
anticipated
must be changed daily or more often
if visibly soiled
protective clothing must be removed

before leaving the dental office
Masks & protective eyewear
if spatter & aerosolized sprays are
likely, surgical masks & protective

eyewear, or chin-length plastic face
shields must be used
a mask must be changed between
patients or more often if it becomes
wet or moist
face shields & protective eyewear
must be washed/disinfected with
appropriate cleaning agents
Gloves
wearing gloves does not replace the
need for handwashing
dental professionals must wear gloves

to prevent skin contact with blood,
saliva or mucous membranes
new gloves must be worn for each
patient
gloves must be worn when touching
contaminated items or surfaces
non-sterile gloves are recommended
for examinations & nonsurgical

procedures
sterile gloves are recommended for
all surgical procedures
utility gloves are recommended for
cleaning and instrument processing
gloves must be changed whenever
they are torn, cut or punctured during
treatment
gloves should never be washed
before use, or, disinfected for reuse
IC
Identify each of the following that is a true statement regarding the laundering of contaminated laundry in the dental setting:
1. contaminated laundry must be handled as little as possible

2. the dentist may choose to use an outside laundry service
3. the dentist or assigned office personnel may launder the clothes on-site
4. contaminated laundry should be bagged at the location of use
5. contaminated laundry should be handled with appropriate PPE
6. if contaminated laundry is transported to a laundromat, the employee must be
trained in the handling of contaminated laundry
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PATIENT MANAGEMENT
all statements are true

Protective clothing
for optimal protection gowns, jackets
or coats are required to be long
sleeved and high necked
such clothin g, minimizes the potential
for exposed skin to contact blood,
saliva or other potentially infectious
material
Disposable gowns
if used, eliminates the need to launder
contaminated protective clothing
Contaminated laundry
defined as laundry that has been
soiled with blood or OPIM (other
potentially infectious material)

handling of contaminated laundry
includes the following:
- handle as little as possible
- handle with appropriate PPE
- bag at location of use
- do not sort or rinse at location of use
- label transport bags with a biohazard
sign
Laundry choices
in the dental office contaminated
laundry includes protective clothing
that is used to cover street clothes or
scrubs
the dentist may choose to use an outside laundry service
the dentist or assigned office personnel
may launder the clothes in a washer
and dryer on-site
if contaminated laundry is transported to a laundromat the
employee or dentist must use PPE, be
trained in handling of contaminated
laundry and transport the laundry in a
red/orange bag that is labelled with a
biohazard symbol
a dentist who is unincorporated and is
the owner may take laundry home; if
the owner is unincorporated, the owner
is not subject to OSHA regulations
IC
Match each term with the correct definition:
clinical contact surface

disinfectant
1. a disinfectant that makes the label claim

'tuberculocidal'
2. a germicide effective against HIV and HBV
disinfection
3. an agent capable of inactivating Mycobacterium tuberculosis
hospital disinfectant
4. any surface directly contaminated from

patient materials, gloved hands, blood, or OPIM
intermediate level disinfectant

low level disinfectant
tuberculocidal
5. a process which destroys a majority of, but

not all, microorganisms
6. a chemical agent used to destroy recognized
pathogens; kills some but not all microorganisms
7. a germicide effective against Salmonella
choleraesuis, Staphylococcal aureus and
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Pseudomonas aeruginosa
PATIENT MANAGEMENT
4, 6, 5, 7, 1, 2, 3
Clinical contact surface
any surface directly contaminated from
patient materials, gloved hands, blood
or OPIM (other potentially infectious
material)
these surfaces can then cross contaminate other instruments, devices, hands,
gloves & other items
Disinfectant
chemical agent used to destroy recognized pathogens; kills some but not all
microorganisms
Disinfection
a process which destroys a majority of,
but not all, microorganisms
while disinfection is lethal to some
organisms, only sterilization kills all
organisms
Hospital disinfectant
germicide effective against Salmonella
choleraesuis, Staphylococcal aureus
and Pseudomonas aeruginosa on nonliving objects
Intermediate level disinfectant

disinfectant that makes the label claim
`tuberculocidaP
Low level disinfectant
germicide effective against HIV &
HBV
Tuberculocidal
agent capable of inactivating Mycobacterium tuberculosis
Disinfectant selection
factors to consider
ability to inactivate TB, HIV and Hepatitis B
suitability for use as a cleaner and disinfectant
health hazards and precautions
contact time requirements
compatibility with equipment, devices
and materials
shelf life and storage
sensitivity to temperature
IC
antiseptic
1. pathogens present in blood that cause disease

in humans
asepsis
2. includes protective attire, gloves, mask and

eyewear
bloodborne pathogens
3. involves contact with blood or other potentially infectious materials and that results from
dental procedures
exposure incident
infectious waste
4. the absence of disease-causing microorganisms
personal protective equipment
5. measures designed to protect operators & patients from pathogens spread by blood or any
other body fluid, excretion, or secretion
standard precautions
6. a substance that inhibits the growth of bacteria

7. waste that consists of blood, blood products,
contaminated sharps or other microbiologic 23
products
PATIENT MANAGEMENT
copyright 2013-2014- Dental Decks
6, 4, 1, 3, 7, 2, 5
Basic terminology
an understanding of the terminology related
to infection control is important for the dental professional
antiseptic
a substance that inhibits the growth of
bacteria
asepsis
the absence of pathogens, or diseasecausing microorganisms
pathogens present in blood that cause
disease in humans
disinfect
the use of a chemical or physical procedure to inhibit or destroy pathogens;
highly resistant bacterial and mycotic
spores are not killed during disinfection
disinfection
the act of disinfecting
exposure incident
a specific incident that involves contact
with blood or other potentially infectious materials that results from procedures performed by the dental professional
infectious waste
waste that consists of blood, blood
products, contaminated sharps, or other
microbiologic products
occupational exposure
contact with blood or other infectious
materials that involves the skin, eye, or
mucous membranes and that results
from procedures performed by the dental professional
parenteral exposure
exposure to blood or other infectious
materials that results from piercing or
puncturing the skin barrier
personal protective equipment (PPE)
protective attire, gloves, mask and eye
wear
sharp
any object that can penetrate skin, including, but not limited to, needles and
scalpels
measures designed to protect health care
IC
The interpretation of the Centers for Disease Control & Prevention (CDC) recommended infection control practices in dental healthcare settings varies
from state to state; not all guidelines apply in all states.
The CDC recommended infection control practices in dental healthcare settings are stand-alone guidelines and are not required to be used in conjunction with OSHA practices & procedures.

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PATIENT MANAGEMENT
CDC recommended infection control

practices in dental health care settings
primary purpose of infection control
procedures is to prevent the transmission of infectious diseases
infectious diseases may be transmitted
- from patient to dental professional
- from dental professional to patient
- from one patient to another patient
use of recommended infection control guidelines greatly reduces the
transmission of infectious diseases
recommended infection control
practices are applicable to all settings in which dental treatment is
provided and must be observed
in conjunction with required
OSHA (Occupational Safety and
Health A dministration) practices
and procedures for worker protection
Recommendations
vaccination of dental professionals
use of protective attire and barrier
techniques
hand washing and care of hands
proper use and care of sharps
(instruments and needles)
sterilization of instruments
cleaning & disinfection of the
dental unit and environmental
surfaces
disinfection of the dental laboratory
use and care of hand pieces, antiretraction valves, and other devices
attached to air & water lines of dental
units
single use of disposable instruments

proper handling of biopsy specimens
proper use of extracted teeth in
dental educational settings
proper disposal of waste materials
implementation of recommendations
IC
Instruments in the dental practice can all be classified as either critical or noncritical.
For infection to occur, these three conditions must be present:
a susceptible host, a pathogen with sufficient infectivity and numbers to
cause infection, and, a portal of entry through which the pathogen may enter
the host.

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PATIENT MANAGEMENT
Disease transmission
for an infection to occur by one of
these routes of transmission, the following three conditions must be
present:
- a susceptible host
- a pathogen with sufficient infectivity and numbers to cause infection
- a portal of entry through which the
pathogen may enter the host
effective infection control practices
are intended to alter one of these
three conditions and prevent disease
transmission
Classification
all instruments in the dental practice
can be classified as critical, semicritical or noncritical
instruments are classified depending on the risk of transmitting infection & the need to sterilize between
uses
critical instruments
penetrate soft tissue or bone
must be sterilized after each use
examples include forceps, scalpels,
bone chisels, scalers and surgical
burs
semicritical instruments
contact but do not penetrate soft
tissue or bone
must be sterilized after each use
if the instrument can be damaged by
heat and sterilization is not feasible,
a disposable one-use item is
required
examples include x-ray beam alignment devices, mirrors, amalgam
condensers and burs
noncritical instruments
do not come in contact with mucous membranes
because there is little risk of transmitting infection, an intermediate
level or low-level disinfectant is
required between uses in different
patients
IC
pasteurization
1. pathogens present in blood that cause disease

in humans
sanitization
antiseptic
disinfectant
bacteriostatic
bactericidal
2. an agent that prevents further growth of bacteria

3. an agent capable of killing bacteria
4. to expose food to an elevated temperature for
a period of time sufficient to destroy certain disease-causing microorganisms
5. a chemical agent used on inanimate objects to
destroy or inhibit the growth of harmful organisms
6. treatment of water to reduce microbial counts
to safe levels
7. an antimicrobial agent that can be safely
applied to living tissues
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PATIENT MANAGEMENT
4, 6, 7, 5, 2, 3
Definitions
antiseptic
an antimicrobial agent that can
be safely applied to living tissues
(e.g., alcohol); inhibits but does not
necessarily destroy microorganisms
bactericidal
an agent that is capable of killing
bacteria; bactericidal agents are
preferable over those which are
bacteriostatic
bacteriostatic
an agent that prevents the further
growth of bacteria
disinfectant
a chemical agent used on inanimate
objects to destroy or inhibit the
growth of harmful organisms; not
considered safe for use on human
tissues (e.g., bleach); a disinfectant kills some, but not all microorganisms
pasteurization
to expose food to an elevated temperature for a period of time sufficient to destroy certain diseasecausing microorganisms; the target
of pasteurization is the destruction
of Mycobacterium tuberculosis
sanitization
treatment of water supplies to
reduce microbial counts to safe
public health levels
IC
Identify each of the following that is a true statement regarding the purpose of cleaning prior to disinfection:
1. cleaning destroys all pathogens

2. cleaning reduces the concentration of pathogens
3. cleaning removes blood and debris which can interfere with disinfection
4. cleaning is optional prior to disinfection
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PATIENT MANAGEMENT
2, 3
Cleaning
is defined as the physical removal
of debris
with aseptic technique, you must
clean before you disinfect
the cleaning step is not optional, it
is required
all disinfectant products include
specific instructions for cleaning
prior to disinfection
Cleaning
Results in
a reduction in the number of
microorganisms present
the removal of blood, tissue bioburden and other debris that can
interfere with disinfection
IC
Identify the term that BEST describes the complete destruction of all forms
of microbial life, including heat-resistant bacterial spores:
pasteurization
sanitization
sterilization
disinfection
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PATIENT MANAGEMENT
sterilization
Sterilization
defined as the destruction of all forms
of microbial life
limiting requirement is the inactivation of bacterial spores
proof of such destruction is the ultimate
criteria for sterilization because spores
are the most heat-resistant microbial
forms
per the Centers for Disease Control and
Prevention (CDC), sterilization is
required for all instruments and
items that are placed in the patient's
mouth
if an item cannot withstand heat sterilization, a disposable (one-time use)
item should be used instead
heat is the most efficient and depend
able physical mode of achieving
sterilization of dental instruments;
the heat may be moist or dry
three equipment options for heat
sterilization include the autoclave, the
chemical vapor sterilizer and the dry
heat oven
Biological monitoring
sterilizers must be monitored for
proper functioning.
this is done via
the use of biological indicators (BI) or
spore tests
both the CDC and ADA recommend
weekly spore testing of all sterilizers
Other definitions
disinfection
the inhibition or killing of pathogens;
spores are not killed during disinfection
pasteurization
to expose food to an elevated temperature for a period of time sufficient to
destroy certain disease-causing
microorganisms; the target of pasteurization is the destruction of
Mycobacterium tuberculosis
sanitization
treatment of water supplies to reduce
microbial counts to safe public health
levels
IC
Identify the type of pathogen that provides the ultimate test for efficacy of
sterilization:
fungal organisms
HIV
hepatitis B virus
bacterial spores
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PATIENT MANAGEMENT
bacterial spores
Biological monitoring
involves the processing of highly
resistant bacterial spores to determine
if they have been killed
a biological indicator (BI) or spore
strip contains the spores used in
biological monitoring
a spore strip is a small piece of paper
that contains one or more types of
spores Bacillus atrophaes spores are
used for testing dry heat oven units and
Geobacillus stearothermophilus
spores are used for testing steam and
chemical vapor units
the spore strip is enclosed in a
protective glassine envelope
Spore testing
after a spore strip is processed in a
sterilizer, it is mailed to a monitoring
service
in a laboratory setting, the spore strip
is aseptically placed in a test tube of
culture media for 7 days
for each of the 7 days, the tube of
culture media is inspected for cloudiness
if spores are viable & have not been
killed, the culture media appears
cloudy
if no cloudiness is noted in the culture
media, then sterilization is confirmed
cloudiness in the culture media indicates a failed test (spores were not
killed), also known as a positive biological spore test
to rule out contamination during testing,
a Gram stain is prepared to identify the
bacteria in the failed test
when the gram-positive Bacillus
organism is observed on the test slide,
sterilization failure is confirmed
IC
For a steam autoclave, identify each of the following that lists the correct temperature, pressure and time that must be used for sterilization.
250 F, 15 psi, 20 minutes

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PATIENT MANAGEMENT
250 F, 15 psi, 20 minutes or 270 F, 30 psi, 8 minutes

Autoclave
the use of steam heat under pre
sure remains the oldest, most common and most acceptable method
for instrument sterilization
the typical autoclave uses
- a temperature of 121 C (250 F)
- a pressure of 15 psi
- cycle time of 20 minutes
or
Advantages & Disadvantages

advantages
- a short efficient cycle time
- good penetration
- a wide range of materials can he
processed without destruction
disadvantages
- corrosion of unprotected carbon
steel instruments
- dulling of unprotected cutting edges
- packages may remain wet at the
end of a cycle
- use of hard water may leave
deposits
- possible destruction of heatsensitive materials
Autoclave problems
that may result in a failed spore test
faulty temperature gauge
faulty pressure gauge
faulty timer
faulty or dirty gasket / seal
faulty heating coil, exhaust line
faulty or clogged bleeder valve
mineral deposit build-up
IC
For a dry heat oven, identify the correct temperature and time that must be
used for sterilization.
375 F, 60 minutes
375 F, 120 minutes
320 F, 60 minutes
320 F, 120 minutes
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320 F, 120
Dry heat oven

in the absence of moisture, destruction
of all forms of microbial life requires
conditions very different from the auto-
clave
dry heat sterilizes much less
efficiently than moist heat
a HIGHER TEMPERATURE &
LONGER CYCLE TIME is required
for sterilization to occur
the typical dry heat oven uses
Or
- a temperature of
170 C (340 F)
the use of a commercial cooking oven
is not a substitute for an FDA-appproved sterilizer
minutes

advantages
- no dulling of cutting edges
- no corrosion of metal instruments
disadvantages
- the long cycle time
- poor penetration
- may discolor or char items
- destroys heat-labile items
- cannot sterilize liquids
- not suitable for hand pieces
Forced air convection ovens
a.k.a. rapid heat transfer ovens
another option for dry heat sterilization
use a HIGHER TEMPERATURE \

and a CONTROLLED INTERNAL
AIRFLOW
uses a temperature of 190 C (375F)
and a cycle time of 12 minutes for
wrapped items and 6 minutes for
unwrapped items
Dry heat oven problems
faulty timer
IC
For a chemical vapor sterilizer, identify the correct temperature, pressure and
time that must be used for sterilization.
250 F, 20 psi, 20-40 minutes

250 F, 30 psi, 40-60 minutes
270 F, 15 psi, 40-60 minutes
270 F, 20
psi,
20-40
minutes
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PATIENT MANAGEMENT
270 F, 20
Chemical vapor sterilizer
requires the use of organic solvents
(chemicals) instead of water to
produce the sterilizing vapor
psi, 20-40 minutes

advantages
- no corrosion of metal instruments
including carbon steel

- no dulling of cutting edges
the typical chemical vapor sterilizer

uses
- cycle time of 20-40 minutes
instead of distilled water (used in
steam autoclaves), a solution of
alcohol, formaldehyde, ketone,
acetone and water is used to produce
the sterilizing vapor
- suitable for orthodontic stainless

wires
disadvantages
- instruments must be completely
dried before processing
- special chemical solutions must be
used
- destroys heat sensitive plastics
- produces a strong chemical odor in
poorly ventilated areas

- cannot sterilize liquids
Chemical vapor sterilizer problems

faulty timer
faulty or dirty gasket/seal
faulty or clogged metering valve
IC
How many hours are required to kill bacterial spores when a dental instrument is placed in a 2% solution of glutaraldehyde?
8 hours
10 hours
12 hours
24 hours
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PATIENT MANAGEMENT
10 hours
Glutaraldehyde 2%
is a liquid chemical sterilant
capable of killing spores if
sufficient contact time is provided
and there is absence of extraneous
organic material required contact
time is 10 hours
a.k.a. "cold sterilization"
if this method is used to sterilized
an instrument, after 10 hours, it
must be rinsed with sterile water,
dried and placed in a sterile
container (if not used immediately)
Important note
use of a chemical sterilant in
dentistry is no longer considered
appropriate for sterilizing heatstable instruments

advantages
- most potent category of chemical
germicide
- EPA registered as chemical
sterilant
disadvantages
- long time period required for
sterilization
- allergenic
- highly toxic to tissues
- no way to monitor efficacy
Reminders
CDC refers to heat sterilization as
the method of choice when
sterilizing instruments and devices
dental instruments must be
appropriately cleaned, packaged &
sterilized between uses with a heatbased, biologically monitored
process
if heat sensitive, a heat-stable
alternative or disposable item
must be used
IC
Identify which one of the following is the most efficient way to kill microbes:
cold sterilization
heat sterilization
glutaraldehyde
all of the above
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PATIENT MANAGEMENT
heat sterilization
Heat sterilization
use of heat has long been recognized as the most efficient and
reliable method of sterilization
using a steam autoclave, chemical
vapor sterilizer or dry heat oven
cell death is accomplished via
heat inactivation of critical
enzymes and other proteins
within cells
moist heat destroys bacteria by
denaturation; the denaturation
process is quickened by the use of
pressure
dry heat destroys microorganisms
by causing coagulation of proteins
heat sterilization as the method of

choice when sterilizing instruments
and devices
dental instruments must be appropriately cleaned, packaged & sterilized between uses with a heatbased, biologically monitored
process
if heat sensitive, it is preferable to
use a heat-stable alternative or
disposable item
IC
Identify which one of the following is a false statement concerning infection
control in the dental setting:
exposure is not synonymous with infection

do not disinfect what you can sterilize
environmental surfaces must be sterilized between patients
all dental patients can be treated using standard bloodborne precautions
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PATIENT MANAGEMENT
environmental surfaces must be sterilized
it is not possible to sterilize the

environmental surfaces that
become contaminated during
patient care
thorough cleaning of the
surfaces is sufficient to break the
cycles of cross-contamination and
cross-infection
chemical disinfectants used on surfaces should:
- kill as many microbes as possible
in the shortest time possible
- not damage the surface being
decontaminated
- not be harmful to humans or
animals
- not be affected by presence of
organic material
- be compatible with soap,
detergents and other chemicals
- be inexpensive
- be stable during storage
is
Identify which one of the following is a false statement regarding potential
operator errors that may cause the failure of a spore test:
the sterilizer was overloaded

the sterilizer cycle was interrupted
improper packaging was used
inadequate time, temperature and/or pressure was used
inadequate warm up time was completed
mineral deposit build up
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PATIENT MANAGEMENT
mineral deposit build up

Operator errors
overloading
interrupting sterilization cycle
using inadequate time
using inadequate wane up time
using inadequate temperature
using inadequate pressure
using improper packaging
using expired chemical solution
Errors & Problems

A number of conditions may cause a
spore test to fail - overloading the sterilizer, inadequate temperature and/or pressure, inadequate time, or improper
packaging of instruments.
Equipment problems
faulty pressure gauge
faulty timer
faulty or dirty gasket/seal
faulty heating coil, exhaust line
faulty or clogged bleeder valve
mineral deposit build-up
faulty or clogged metering valve
Of all the errors listed in the question,

only one is not an operator error it
is an EQUIPMENT PROBLEM
"mineral deposit build up".
In the majority of cases, OPERATOR

ERROR is responsible for the failure.
IC
Identify which one of the following is a true statement concerning chemical
monitoring:
chemical monitoring is a definitive means of determining sterilization

chemical monitoring determines if critical pressure has been reached
chemical monitoring uses heat sensitive chemicals
when a chemical indicator changes color, sterilization is complete
a chemical indicator is part of the spore strip glassine envelope
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PATIENT MANAGEMENT
chemical monitoring uses heat sensitive chemicals

Chemical monitoring
uses heat sensitive chemicals (not
spores) to assess the physical conditions during the sterilization process
involves the use of indicators that
change color when exposed to
certain temperatures
examples include autoclave tape,
special markings on bags and
pouches, chemical indicator
strips, tabs or packets
a color change only indicates that
the sterilizer reached the proper
temperature but does not indicate
how long the temperature was
maintained or what pressure was
reached and maintained
confusion often exists between
biological monitoring (spore testing) & chemical monitoring
weekly testing of the sterilizer via

biological indicators is the ONLY
definitive way to verify sterilization success
a chemical indicator can serve as a
routine check for all item processed in the sterilizer
provides immediate feedback
concerning the critical sterilization temperature; identifies if the
sterilizer does not reach critical
temperature
chemical indicators should be
placed inside each sterilizer pouch
or wrapped cassette to verify the
sterilizing parameter for that indicator has been satisfied internally
these indicators should also be
placed on the outside of the
package
IC
Identify which one of the following is a false statement concerning the use
of alcohol hand gels in the dental setting:
the convenience of alcohol hand gel use helps to increase compliance with hand
washing guidelines
hand washing with an alcohol product takes less time than using soap & water
alcohol hand gels can save busy practitioners valuable time between patients
studies have shown that alcohol hand gels reduce microorganisms significantly
better than soap & water
alcohol hand gels cause more dryness than soap & water hand washing
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PATIENT MANAGEMENT
hand gels cause more dryness than soap & water washing
Hand gels
the convenience of alcohol hand gel
use helps to increase compliance
with hand washing guidelines

increasing popularity of hand gels is
due to flexibility & convenience
hand washing with an alcohol
product takes less time than water
washing and does not require a sink,
water or paper towels for drying
for the busy practitioner who has to

clean their hands often, the quickness
of hand sanitizers can save valuable
time between patients
studies have also confirmed that alcohol hand gels kill more germs; hand
gels with 60% - 70% alcohol reduce
microorganisms including bacteria,
fungi and viruses significantly better
than soap and water
there is a misguided belief that

alcohol-based hand gels will dry
out the skin, particularly with
frequent use
alcohol hand gels on the market
today contain moisturizers specifically to prevent such dryness
studies have shown that this new

generation of gels cause less dryness
and irritation than the traditional
soap and water method of hand
washing
IC
Identify which one of the following is a false statement concerning when to
use hand hygiene techniques in the dental setting:
before touching a patient

before aseptic procedures
after donning gloves
after touching a patient
after touching patient surroundings
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PATIENT MANAGEMENT
after donning gloves
Hand hygiene recommendations

soap & water hand washing
should be used when hands are
dirty or visibly soiled with blood or
other bodily fluids, before eating,
after using a restroom, and, if hands
come in contact with spores
in all other cases, alcohol based
hand gel can be used for routine
decontamination of hands
once gloves are placed on the
hands, hand gel or soap & water
should not be used on the gloves
When to clean hands...
before touching a patient
before aseptic procedures
after body fluid exposure or risk
after touching a patient
after touching patient surroundings
Techniques
soap & water hand washing
- wet hands
- apply amount of soap recommended by the manufacturer
- rub hands together for at least 15
seconds
- rinse with water and dry thoroughly with a disposable towel
- use towel to turn off faucet
- avoid use of HOT water
alcohol based hand gel
- apply the amount of gel recommended by the manufacturer to
one palm
- rub hands together, covering all
surfaces
- continue rubbing hands together
until all surfaces are dry
- if hands feel dry after 10 seconds
or less of rubbing, too little product has been used
IC
Identify which one of the following is a false statement concerning the use of
disinfectants in the dental setting:
the disinfectant used must be registered by the EPA

each practice must maintain a written schedule for surface disinfection
PPE must be used when using disinfectants
when using a disinfectant, the use of vinyl exam gloves is recommended
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PATIENT MANAGEMENT
when using a disinfectant, the use of vinyl exam gloves is recommended
Surface disinfection
surfaces without barriers must be
cleaned and disinfected with an
intermediate-level disinfectant
Manufacturer instructions
disinfecting solutions must be
prepared following manufacturer
guidelines
disinfecting solutions must be EPA
registered
manufacturer instructions for
pre-cleaning surfaces must be
followed before disinfection
the disinfectant must be applied to
the surface for the contact time
designated on the product label
Personal protection equipment
puncture and chemical resistant
utility gloves must be used when
cleaning and disinfecting surfaces
in addition to gloves, protective
clothing, eye protection & mask
must be worn when cleaning and
disinfecting surfaces
Housekeeping surface
reusable pails, bins and containers
must be regularly inspected,
cleaned and disinfected
housekeeping surfaces contaminated
with body fluids must be cleaned and
disinfected with an EPA-registered
intermediate level disinfectant
Cleaning schedule
the office must have a cleaning
schedule based on the type and
degree of contamination and location
Surface disinfection & OSHA
the office must have a written
schedule for disinfection of surfaces
as required by OSHA
IC
Between patients, all surfaces without protective coverings must be cleaned
and disinfected with an intermediate-level disinfectant.
Between patients, all protective coverings used in place of surface disinfection must be changed/replaced.

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Protective coverings
the use of protective covers on
disinfected surfaces and non-critical
equipment is acceptable
covers (barriers) must be resistant
to fluids and puncture in order to
protect surfaces from contamination
these coverings may be used instead
of surface disinfection between patients
coverings must be replaced/
changed between patients
protective covers eliminate the
need to disinfect the covered
areas between patients
areas covered with barriers during
the treatment day should be
disinfected at the end of the day
is
The Occupational Safety and Health Administration's (OSHA) Bloodborne
Pathogens Standard mandates that all dental healthcare professionals receive, at a minimum, the Hepatitis B vaccination series.
The Centers for Disease Control and Prevention (CDC) mandates all other vaccinations.

42
PATIENT MANAGEMENT
Immunizations
the Occupational Safety and Health Administration's (OSHA) Bloodborne Pathogens Standard
mandates that all dental healthcare professionals receive, at a minimum, the Hepatitis B
vaccination series
OSHA defers to the Centers for Disease
Control and Prevention (CDC) for all other
required vaccinations and screenings
the CDC recommends the following
vaccinations for dental healthcare professionals:
- influenza
- mmr
- varicella
- tdap
- hepatitis b
IC
All employees with potential exposure to bloodborne pathogens are required
to have the Hepatitis B vaccination.
The vaccination record of each employee must be kept for 30 years beyond
the employee's last day of employment in the practice.

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PATIENT MANAGEMENT

In the dental setting, who needs the
Hepatitis B vaccination?
all employees with potential exposure
to bloodborne pathogens
front office and housekeeping staff
should be assessed as to their exposure
level; if the answer to the following
questions is "yes", the vaccination
is needed
- do they handle contaminated laundry?
- do they enter patient treatment areas
where there is potential for exposure?
- are they designated to perform first
aid or CPR?
When should the dentist employer offer
Hepatitis B vaccinations to employees?
employers are required to provide
Hep B vaccinations to all new
employees free of charge after training and within 10 days of working in
a position where there is potential
exposure to bloodborne pathogens
the only exception is if the employee
has previously received the vaccine
series, and, antibody testing has
revealed the worker is immune
What Hepatitis B vaccination documentation is required?

according to OSHA, a vaccination
record is part of the employee's
medical record, and is required to be
kept for 30 years beyond the employees last date of employment
all part - time and temporary employees are required to provide documentation of Hep B vaccination which must
be kept for the same amount of time,
30 years
according to the CDC and OSHA 29
CFR 1910.1030 (h) (1) (ii) (B), employers are required to keep accurate
copies of each employees Hep B
vaccination status, including the date
of each dose
Is a post vaccination titer required?
post vaccination titer testing must be
done 1 - 2 months after the original
vaccine series is completed
documentation is treated like an
employee medical record and kept for
30 years from last date of employment
IC
A booster dose of the Hepatitis B vaccine is required.
The Hepatitis B vaccine series requires that at least 16 weeks elapse between
dose 1 and dose 3.

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PATIENT MANAGEMENT

What if a new employee has been previously
vaccinated but has no documentation?
check with employee's previous
employers per OSHA requirements, a
copy of the vaccination records should be
part of the medical record and retained
if all attempts are unsuccessful, OSHA
requires documentation verifying the
employers attempt to obtain the record
and should include a written statement
from the employee about vaccination
status and approximate dates of the
vaccinations
if original documents cannot be obtained
then the Hep B vaccination must be made
available unless the employee has titer
documentation
What if an employee started, but did not
complete the three doses of the vaccine?
if the vaccine series was interrupted after
dose I, the Hep B vaccine series should be
continued where it left off
at least 16 weeks must elapse between
doses 1 & 3
at least 8 weeks must elapse between
doses 2 & 3
if only dose 3 is delayed, it should be
administered as soon as possible
What if a titer, administered within the

proper amount of time, showed the
employee status to be negative?
repeat the three dose series and test for
anti-HBs one to two months after dose 3
if the employee is still negative after a
second vaccine series, the employee is
considered a non-responder and should be
tested for chronic HBV infection
if results are positive for infection, the
person should receive appropriate
counseling and medical management
if the person is not infected, they should
be counseled on how to protect themselves
from infection and the need to obtain Hep
B immune globulin prophylaxis for any
known or likely exposure to a Hep B
positive individual
Is a booster for Hep B vaccine required?
no
there are currently no guidelines requiring
a booster
IC
Identify which one of the following is the most common form of a glove-associated reaction seen on the hands of health care professionals:
irritant contact dermatitis

latex allergy /type I immediate hypersensitivity
allergic contact dermatitis/type IV delayed hypersensitivity
fungal infection of the cuticles
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PATIENT MANAGEMENT
irritant contact dermatitis

Contact dermatitis
contact dermatitis can develop from

frequent and repeated use of hand
hygiene products, exposure to
chemicals and glove use
contact dermatitis is classified as
either irritant or allergic
Irritant contact dermatitis
is common & nonallergic

develops as dry, itchy, irritated areas
on the skin around the area of contact
Allergic contact dermatitis
type IV hypersensitivity
can result from exposure to accelerators and other chemicals used in the
manufacture of rubber gloves
can result from exposure to other
chemicals found in the dental practice
setting
often manifests as a rash beginning
hours after contact
like irritant dermatitis, is usually

confined to the areas of contact
Latex allergy
type I hypersensitivity to latex
proteins
a more serious systemic allergic
reaction
begins within minutes of exposure
but can sometimes occur hours
later
produces varied symptoms, which

include runny nose, sneezing, itchy
eyes, scratchy throat, hives & itchy
burning sensations
may involve more severe symptoms
including difficult breathing, cough-
ing spells, and wheezing; cardiovascular and gastrointestinal ailments

in rare cases, anaphylaxis & death
may occur
IC
Identify each of following that is a true statement concerning providing safe
treatment for patients with possible or documented latex allergy:
1. be aware of common predisposing conditions (e.g., allergies to avocados, kiwis,

nuts, or bananas)
2. be familiar with the different types of hypersensitivity
immediate and delayed
3. frequently clean all working areas contaminated with latex powder/dust

4. frequently change ventilation filters and vacuum bags used in latex-contaminated
areas
5. have latex-free kits (e.g., dental treatment and emergency kits) available at all
times
6. be aware that allergic reactions can be provoked from indirect contact as well as
direct contact
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PATIENT MANAGEMENT
all of the statements are true

Considerations for patients with
latex allergy
screen all patients for latex allergy
be aware of common predisposing
conditions (e.g., allergies to avocados,
kiwis, nuts or bananas)
be familiar with the different types of
hypersensitivity
consider sources of latex other than
gloves; prophy cups, rubber dams and
ortho elastics
provide an alternative treatment area
free of latex in which no patient contact
occurs with any latex devices, materials
and products
remove all latex-containing products
from the patient's vicinity and
adequately cover/isolate any latexcontaining devices that cannot be
removed from the treatment
environment
be aware that allergens in the ambient
air can cause respiratory and or anaphylactic symptoms in people with latex
allergies
to minimize exposure to airborne latex

particles, schedule patient as the first
appointment of the day
frequently clean all working areas
contaminated with latex powder
frequently change filters and vacuum
bags used in latex-contaminated areas
have latex-free kits (e.g., dental treatment and emergency kits) available
at all times
be aware that allergic reactions can be
provoked from indirect contact as well
as direct contact (e.g., being touched by
someone who has worn latex gloves)
communicate latex allergy procedures
(e.g., verbal instructions, written
protocols, posted signs) to other
personnel
if latex-related complications occur,
manage the reaction and seek
emergency assistance as indicated
follow medical emergency response
recommendations for anaphylaxis
IC
Identify each of following that is a true statement concerning hepatitis C virus
(HCV) infection:
1. injection drug users are at risk for HCV infection

2. HCV infection is the leading indication for liver transplants in the United States
3. HCV infection signs and symptoms may include fever, fatigue, dark urine, loss of
appetite, nausea, vomiting and jaundice
4. 70-80% of persons with HCV infection are asymptomatic
5. there is no cure for HCV infection
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PATIENT MANAGEMENT
all of the statements are true
Hepatitis C Virus (HCV) Infection

is a contagious disease that ranges
in severity from a mild illness lasting a few weeks to a serious, lifelong illness that attacks the liver
results from infection with the Hepatitis C virus which is spread
through contact with the blood of
an infected person
may be "acute" or "chronic"
acute HCV infection
- is a short-term illness
- occurs within the first 6 months
after someone is exposed to HCV
- often leads to chronic infection
chronic HCV infection
- is a long-term illness
- occurs when the HCV remains in a
person's body
- can last a lifetime and lead to
serious liver problems, including
cirrhosis or liver cancer
At Risk
for HCV Infection
current injection drug users
past injection drug users
blood, blood products & organ
recipients
hemodialysis patients
persons who received body
piercing or tattoos done with
non-sterile instruments
persons with known exposures to
the HCV
- health care workers injured by
needle sticks
- recipients of blood or organs from
a donor who tested positive for
HCV
HIV-infected persons
children born to mothers with HCV
IC
Identify which one of the following is an option for treating a patient with a
confirmed latex allergy:
wear vinyl or nitrile gloves

wear hypoallergenic latex gloves
do not wear any gloves
refuse to treat the patient
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PATIENT MANAGEMENT
wear vinyl or nitrile gloves
Common glove materials

natural rubber latex (NRL)
nitrile
polyvinyl chloride (vinyl) & other
synthetics
polyethylene (plastic)
combinations of latex and/or
synthetics
Non-latex glove options
a wide variety of non-latex items
are available for use in the dental
practice
vinyl or nitrile gloves can be used
to treat patients with latex allergies;
these gloves do no cross-react with
latex allergens
hypoallergenic gloves are no
longer labeled as latex alternatives
as they contain latex with a
chemical coating over the latex
Glove types
the type of glove used should be
based upon the type of procedure to
be performed (non-sterile vs.
sterile vs. utility)
both non-sterile examination gloves
and sterile surgical gloves are
medical devices regulated by FDA
sterile surgical gloves are used for
all surgical procedures & must meet
FDA standards for sterility
assurance
utility gloves are used for house
keeping procedures (cleaning &
disinfecting) and are not FDA
regulated because they are not
promoted for medical use
IC
An infection caused by normally non-pathogenic microorganisms in a host
whose resistance has been decreased or compromised is known as:
a nosocomial infection
a secondary infection
an opportunistic infection
a recurrent infection
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PATIENT MANAGEMENT
an opportunistic infection
Infection
invasion by and multiplication of
pathogenic microorganisms in a
bodily part or tissue, which may
produce subsequent tissue injury
and progress to overt disease
through a variety of cellular or toxic
mechanisms
instance of being infected
an agent or a contaminated
substance responsible for one's
becoming infected
the pathological state resulting
from having been infected
Opportunistic
an infection by a microorganism
that normally does not cause
disease but becomes pathogenic
when the body's immune system is
impaired and unable to fight off
infection
Nosocomial infection
a hospital acquired infection
nosocomial means originating or
taking place in a hospital,
especially in reference to an
infection
the term "nosocomial" comes from
two Greek words "nosus" meaning
"disease" + "komeion" meaning
"to take care of;" "nosocomial"
refers to any disease contracted by a
patient while under medical care
IC
Identify which one of the following that is not a vaccine preventable disease:
hepatitis A infection
hepatitis B infection
hepatitis C infection
VZV (varicella zoster virus) infection
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PATIENT MANAGEMENT
hepatitis C infection
List of
Vaccine preventable diseases
Anthrax
Cervical Cancer
Diphtheria*
Hepatitis A
Hepatitis B*
Haemophilus influenzae type b (Hib)
Human Papillomavirus (HPV)
HIN1 Flu (Swine Flu)
Influenza (Seasonal Flu)*
Japanese Encephalitis (JE) Lyme Disease
Measles*
Meningococcal
Monkeypox
* recommended vaccines
for all health care professionals
Mumps*
Pertussis (Whooping Cough)*
Pneumococcal
Poliomyelitis (Polio)
Rabies Rotavirus
Rubella (German Measles)*
Shingles (Herpes Zoster)
Smallpox
Tetanus*
Tuberculosis
Typhoid Fever
Varicella (Chickenpox)*
Yellow Fever
OSHA
What does OSHA stand for?
Occupational Safety & Health Administration

Occupational Safety & Hazard Administration
Occupational Standards & Health Administration
Occupational Standards & Hazard Administration
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PATIENT MANAGEMENT
Occupational Safety & Health Administration (OSHA)

Occupational Safety &
Health Administration
OSHA is a federal agency
created in 1970
protects workers from hazards in the
work place
under the Occupational Safety &
Health Act of 1970 (OSH Act),
employers are responsible for
providing a safe and healthful work
place for their workers
OSHA and its state partners

have dramatically improved
workplace safety, reducing
work-related deaths and injuries
by more than 65 percent since
1970
Employer responsibilities under OSHA

law
employers have the responsibility to provide a safe workplace
employers must provide their workers with a workplace that does not have
serious hazards and must follow all OSHA
safety and health standards
employers must find and correct safety
and health problems
employers must first try to eliminate or
reduce hazards by making feasible changes
in working conditions rather than relying
on personal protective equipment
visit ww k os ha.gov for more information
OSHA
The Occupational Safety & Health Administration (OSHA) is a federal agency
that develops and enforces regulations designed to protect the:
patient
employer
employee
all of the above
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PATIENT MANAGEMENT
employee
Occupational Safety &
Health Administration
is a federal agency
a division of the U.S. Department of
Labor
protects employees from hazards in
the work place through standards or
regulations
employers must provide their
workers with a workplace that does
not have serious hazards and must
follow all OSHA safety and health
standards
Occupational rules & regulations

OSHA standards are rules that describe the methods that employers
must use to protect their employees
from hazards
there are OSHA standards for construction work, agriculture, maritime
operations, and general industry
standards limit the amount of hazardous chemicals workers can be exposed
to, require the use of certain safe practices and equipment, and require employers to monitor hazards and keep records
of workplace injuries and illnesses
examples of OSHA standards include
General Safety, Hazard Communication & Bloodborne Pathogens
OSHA
Identify which one of the following is considered to be "infectious" and "regulated" medical waste:
gowns
plastic barriers
extracted teeth
cotton rolls
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PATIENT MANAGEMENT
extracted teeth
Regulated medical waste
comprises 1%-2% of waste in dental setting
requires special handling, storage & disposal
in the dental setting, defined as
- liquid or semi-liquid blood or OPIM
- contaminated items that would release
blood or OPIM in a liquid or semi-liquid state if compressed
- items that are caked with dried blood or
OPIM and are capable of releasing these
materials during handling
- contaminated sharps
Types of regulated medical waste
hulk (in liquid or semi-liquid form) blood
or OPIM, including saliva
items that would release blood or OPIM
in a liquid or semi-liquid state if compressed
items that arc caked with dried blood or
OPIM and are capable of releasing these materials during handling
contaminated sharps
pathological including extracted teeth
Regulated medical waste containers

regulated medical waste must be placed
in a biohazard container that is closable
constructed to contain all contents and
prevent leakage of fluids during handling,
storage, transport or shipping
puncture resistant if discarding
contaminated sharps
marked with
fluorescent
orange or
orange-red
labels
with lettering
and
BIOHAZARD
symbols in a
contrasting color
closed prior to removal to prevent
spillage or protrusion of contents during
handling, storage, transport or shipping
Non-regulated medical waste
examples include used gloves, masks,
gowns, lightly soiled gauze or cotton
rolls, disposable plastic barriers
can be disposed of in regular trash
OSHA
Each one of the following is considered regulated waste EXCEPT one. Which
one is the EXCEPTION?
blood soaked gauze

contaminated needles
surgically removed tissue
gloves
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PATIENT MANAGEMENT
gloves
Non-regulated vs. Regulated medical
waste
studies have compared microorganisms
in residential waste with waste from
multiple health-care settings general
waste from hospitals or dental practices is no more infective than residential waste
the majority of soiled items in dental
offices arc general medical waste and
thus can be disposed of with ordinary
waste
although any item that has had contact
with blood, exudates, or secretions might
be infective, treating all as infective is
neither necessary nor practical
waste that carries a substantial risk
of causing infection during handling
and disposal is regulated medical
waste
Regulated medical waste

bulk (in liquid or semi-liquid form)
blood or OPIM, including saliva
items that would release blood or
OPIM in a liquid or semi-liquid state if
compressed
items that are caked with dried blood
or OPIM and are capable of releasing
these materials during handling
contaminated sharps
pathological including extracted teeth
Non-Regulated medical waste
examples include used gloves, masks,
gowns, lightly soiled gauze or cotton
rolls, disposable plastic barriers
can be disposed of in regular trash
OSHA
Identify which one of the following is a true statement from the American
Dental Association's Best Management Practices for Amalgam Waste?
use bleach to flush waste water lines in order to minimize the dissolution of amalgam
dispose of teeth with amalgam restorations in biohazard or sharps containers
salvage amalgam pieces from restoration removal and recycle with amalgam waste
stock bulk elemental mercury in addition to precapsulated alloys
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PATIENT MANAGEMENT
salvage amalgam pieces from restoration removal

and recycle with amalgam
American Dental Association

Best Management Practices for Amalgam Waste
Do not
Do
use precapsulated alloys & stock var use bulk mercury
ious sizes
put used disposable amalgam cap recycle used disposable amalgam
sules in biohazard containers, infeccapsules
tious waste containers or regular
salvage, store & recycle scrap amalgarbage
put scrap amalgam in biohazard congam
salvage, store & recycle amalgam
tainers, infectious waste containers or
pieces from restorations after removal
regular garbage
& recycle the amalgam waste
put removed amalgam pieces from
use chair-side traps, vacuum pump
restorations in biohazard containers, infilters and amalgam separators to retain
fectious waste containers or regular
amalgam & recycle contents
garbage
do recycle teeth that contain amalgam
rinse devices containing amalgam
restorations
over drains or sinks
manage amalgam waste through as
dispose of teeth with amalgam
much recycling as possible
restorations in biohazard containers, in use line cleaners that minimize dissofectious waste containers or regular
lution of amalgam
garbage
flush amalgam waste down the drain
or toilet
use bleach or chlorine-containing
cleaners to flush wastewater lines
OSHA
Identify each one of the following that is a true statement regarding what
must be included in the training of employees as detailed by the OSHA Bloodborne Pathogens Standard:
information on the hepatitis B vaccine

explanation of biohazard labels used in the office
a copy of the standard and explanation of its contents
opportunity for interactive questions & answers with the person conducting the training
session
explanation of the basis for selection of PPE
general explanation of the epidemiology & symptoms of bloodborne diseases
explanation of the modes of transmission of bloodborne pathogens
instructions on disposal of amalgam waste
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PATIENT MANAGEMENT
information on the hepatitis B vaccine

explanation of biohazard labels used in the office
a copy of the standard and explanation of its contents
opportunity for interactive questions & answers with the person
conducting the training session
explanation of the basis for selection of PPE
general explanation of the epidemiology & symptoms of
bloodborne diseases
explanation of the modes of transmission of bloodborne pathogens
OSHA Bloodborne Pathogens Standard
requires that all employees with occupational
exposure receive training at the time of initial
assignment & at least annually thereafter
employees must receive additional training
when changes or procedures affect the employee's exposure
Employee training must include:
copy of the current standard & explanation
of contents
general explanation of the epidemiology &
symptoms of bloodborne diseases
explanation of the modes of transmission of
explanation of the employer's exposure control
plan & how the employee can obtain a copy of
the written plan
explanation of how to recognize tasks that may
involve exposure to blood & OPIM

explanation of how to prevent or reduce exposure including engineering controls, work practices & PPE
explanation of basis for selection of PPE

info on types, proper use, location, removal,
handling, decontamination & disposal of PPE

info on hepatitis B vaccine, including efficacy,
safety, method of administration, benefits & that
it will be offered at no cost
info on actions to take & who to contact in an
emergency involving blood or OPIM
explanation of the procedure to follow if an exposure incident occurs, including the method of
reporting & what medical follow-up will be made
available
info on post-exposure evaluation & follow - up
that will be provided following an exposure incident
explanation of the biohazard signs & labels
and/or color coding required
Trainer must:
provide an opportunity for interactive questions & answers
be knowledgeable in the subject matter & how
the info relates to that workplace
OSHA
Identify which one of the following is a false statement regarding the OSHA
Bloodborne Pathogens Standard training of employees:
training must be provided at no cost to the employee

training must be conducted during normal working hours
training must be reviewed twice per year
training must take place as soon as the employee is hired
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PATIENT MANAGEMENT
training must be reviewed twice per year
OSHA
Bloodborne Pathogens Standard
Employee Training
requires that all employees with occupational exposure receive training at the
time of initial assignment
training should take place as soon as possible for all new hires
training must be reviewed and take place annually thereafter
employer must provide the training at no cost to the employee
employer must provide the training during normal working hours
employer must document attendance of the employee and maintain attendance
records for a minimum of 3 years
OSHA
The OSHA Bloodborne Pathogens Standard requires that a written exposure
control plan (ECP) be reviewed:
biannually
annually
quarterly
none of the above
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PATIENT MANAGEMENT
annually
Exposure Control Plan (ECP)
the employer shall ensure that a
provisions for the initial reporting of
written copy of the ECP is accessible

to all employees
the ECP shall be reviewed & updated
at least annually and whenever necessary to reflect new or modified
tasks and procedures which affect occupational exposure, and, to reflect
new or revised employee positions
with occupational exposure
the ECP shall reflect changes in
technology that eliminate or reduce
exposure to bloodborne pathogens
exposure incidents
hepatitis B vaccination series for un-
ECP Elements
exposure determinations
schedule & method of implementation which includes:
- methods of compliance
- hepatitis b vaccination
- post exposure ev aluation/follow up
- communication of hazards
- recordkeeping
vaccinated employees
effective procedures for
- evaluating the circumstances surrounding exposure incidents

- work practice controls
- gathering sharps injury log info
- making periodic determinations of
the frequency of use & types/brands
of sharps involved in exposure incidents
- identifying & selecting currently
available engineering control devices
- actively involving employees in the
review & update of the ECP for the
procedures they perform
OSHA
Which of the following diseases prompted OSHA to adopt the Bloodborne
Pathogens Standard for dentistry:
tuberculosis
HIV disease
HBV/hepatitis B
HCV/hepatitis C
all of the above
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PATIENT MANAGEMENT
HIV disease
OSHA Bloodborne Pathogens Standard

HIV disease prompted the OSHA regulatory action
- in 1986, unions representing health
care workers (HCW ) petitioned
OSHA for an emergency rule to protect workers from work place exposure to HIV and HBV
- the petition was denied but OSHA
created a permanent rule on exposure
to bloodborne pathogens; it took 5
years to develop this rule
bloodborne pathogens are infectious
microorganisms present in blood that
can cause disease in humans
pathogens include, but are not limited
to, HBV, HCV and HIV
workers exposed to bloodborne
pathogens are at risk for serious or
life-threatening illnesses
all of the requirements of the OSHA

Bloodborne Pathogens Standard can be
found in Title 29 of the Code of Federal Regulations at 29 CFR 1910.1030
the standard's requirements state what
employers must do to protect workers
who are occupationally exposed to
blood or OPIM (other potentially infectious materials)
the standard protects workers who
can reasonably be anticipated to come
into contact with blood or OPIM as a result of doing their job duties
OSHA
The OSHA Bloodborne Pathogens Standard is a comprehensive set of rules
and regulations that have been created to prevent the transmission of bloodborne diseases:
to patients
to employers
to employees
to all of the above
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PATIENT MANAGEMENT
to employees
Overview
bloodborne pathogens are infectious
microorganisms present in blood that
can cause disease in humans
workers exposed to bloodborne
pathogens are at risk for serious or
life-threatening illnesses
the standard's requirements state what
employers must do to PROTECT
EMPLOYEES who are occupationally exposed to blood or OPIM (other
potentially infectious materials)
all of the requirements of OSHA's
Bloodborne Pathogens Standard can be
found in Title 29 of the Code of Federal Regulations at 29 CFR 1910.1030

Requirements for Employers
establish an exposure control plan
update the plan annually
implement standard precautions
identify & use engineering controls
identify & ensure use of work practice
controls
provide PPE
make hepatitis B vaccinations available to all employees with occupational
exposure
make post-exposure evaluation available to any employee who experiences
an exposure incident
use labels & signs to communicate
hazards
provide information & training to employees
maintain employee medical & training
records
OSHA
As defined by OSHA, an exposure incident is a specific eye, mouth, other mucous membrane, non-intact skin or parenteral contact with blood or other potentially infectious materials (OPIM) which results from the performance of a
worker's duties.
An example of an exposure incident is a needle stick.

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PATIENT MANAGEMENT

Exposure incident
Is a specific eye, mouth, other mucous

membrane, non-intact skin or parenteral
contact with blood or OPIM that results
from the performance of an employee's
duties
an example of an exposure incident is a
needle stick
the employee must report the exposure incident to the designated person in
the practice as soon as possible
when an exposure incident occurs, the
steps to follow include:
- immediately report exposure
- administer basic first aid
- ensure the device involved is not
reused on the patient
- refer to an appropriate HCP as
soon as possible for evaluation & follow-up
- create exposure incident report
Exposure incident report

Each of the following must be included in
the exposure incident report, the exposed
person's confidential medical record & provide to the qualified HCP:
date & time of exposure
details of the procedure being performed,
including where & how exposure occurred
if involving a sharp device, the type of
device & how/when during its handling
the exposure occurred
details of the exposure, including the type
and amount of fluid or material and the
severity of the exposure
for percutaneous injury
depth of the
wound, gauge of the needle & whether
fluid was injected
for a skin or mucous membrane exposure - estimated volume of material, contact
duration & skin condition
details about the exposure source
whether the source material contained HBV,
HCV or HIV
if the source patient has HIV, the stage
of disease, history of therapy & viral load
vaccination info of exposed person
details about counseling, postexposure
management & follow-up
OSHA
Unless the employer can establish that identification of the source individual
is infeasible or prohibited by state or local law, following an exposure incident the source individual must be identified and the HBV and HIV status
must be determined.
If the source individual does not consent, the employer must establish that
legally required consent cannot be obtained.

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PATIENT MANAGEMENT

Source testing
follow-up includes identifying the
source individual, unless the employer
can establish that identification is infeasible or prohibited by stat or local law, and,
determining the source's HBV & HIV
status
if the status of the source individual is
not already known, the employer is required to test the source's blood as soon
as feasible, provided the source individual consents
if the source individual does not consent, the employer must establish that
legally required consent cannot be obtained
if state or local law allows testing without the source individual's consent, the
employer must test the individual's blood,
if it is available
the results of these tests must be made
available to the exposed employee & the
employee must be informed of the laws &
regulations about disclosing the source's
identity and infectious status
Evaluation & Follow-up

the employer must make immediate confidential medical evaluation & follow-up
available to the employee
must be at no cost to the employee and at
a reasonable time & place
performed by a licensed physician or other
licensed HCP
provided according to recommendations of
the U.S. Public Health Service
tests must be conducted by an accredited
laboratory at no cost to the employee
the employee may consent to have blood
drawn for infection status, but may withhold
consent for HIV testing at that time; in such
cases, the employer must ensure that the
blood sample is preserved for at least 90
days in case the employee changes decision
post-exposure prophylaxis for HIV, HBV
& HCV, when medically indicated, must be
offered to the employee
must include counseling about the possible
implications of the exposure & infection status, including the results, interpretation of all
tests & how to protect personal contacts
must include evaluation of reported illnesses that may be related to the exposure
OSHA
In 1996, Universal Precautions were revised and renamed:
mandatory precautions
hazard precautions
OSHA precautions
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PATIENT MANAGEMENT
Standard Precautions
the practice of considering that all
blood & body fluids might be contaminated with blood and should be
treated as infectious
all patients must be treated with the
same infection control procedures
because patients with bloodborne infections can be asymptomatic or unaware they are infected
standard precautions must be used
for all patient encounters
standard precautions apply to contact with 1) blood; 2) all body fluids,
secretions, and excretions (except
sweat), regardless of whether they contain blood; 3) non-intact skin; and 4)
mucous membranes
although the OSHA Bloodborne

Pathogens Standard still uses the term
universal precautions in 1996 the
CDC expanded the concept of universal
precautions and changed the term to
elements of standard precautions
- hand washing
- using PPE
- proper handling of contaminated
items
- cleaning & disinfecting of surfaces
- using engineering & work practice
controls
- using appropriate respiratory hygiene/cough etiquette
- using safe injection practices
although standard precautions apply to
all patient encounters, the application
of standard precautions during patient care is determined by the task
being performed & the anticipated
exposure to pathogens
OSHA
According to the CDC, which of the following are common infection control
violations observed in the dental office:
improper disposal of biohazardous waste

improper biological monitoring of sterilizer
improper disposal of sharps
improper hand hygiene
improper storage of dental instruments
improper flushing of dental water lines
improper disinfection of environmental surfaces
improper instrument debridement
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PATIENT MANAGEMENT
improper disposal of biohazardous waste

improper biological monitoring of sterilizer
improper flushing of dental water lines
improper disinfection of environmental surfaces
Common Violations Observed in
Dental Offices
improper disposal of biohazardous

waste
improper biological monitoring of
sterilizer
improper flushing of dental water
lines
improper disinfection of surfaces
lack of PPE
lack of written exposure control plan
failure to sterilize handpieces
lack of written protocol for instrument

processing & sterilization
lack of verification of employee hepatitis B vaccination
inability to verify instrument sterilization
repeated use of single use disposables
cross contamination of surfaces
failure to use surgical gloves when
providing surgical services
failure to use utility gloves when handling contaminated items in sterilization
area
failure to separate contaminated areas
from non-contaminated areas in the
sterilization area
OSHA
Identify each one of the following that is a true statement concerning the use
of a face mask in the dental setting:
a new mask should be used for each patient

a mask should have a 95% filter efficiency for small particle aerosols
a mask is required when spatter of blood or body fluids is likely
a mask is used to protect nose & mouth from spatter
a mask that is damp is still effective as a barrier
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a new mask should be used for each patient

a mask should have a 95% filter efficiency for small particle aerosols
a mask is required when spatter of blood or body fluids is likely
a mask is used to protect nose & mouth from spatter
Surgical mask
the function is to protect the wearer from
large droplets or spatter that may contact mucous membranes of nose, lip & mouth
face masks also protect the patient from
health-care worker oral or nasal respiratory
secretions
masks should fit the face well, creating a light
seal over the nose and mouth
because they only cover the nose and mouth,
face masks should always be worn with protective eyewear
change the face mask between patients, and
sooner if it becomes moist
Wet masks
condensation from the wearer's breath adds
moisture to the mask material
when wet, resistance to the airflow through
the mask increases which causes more air to
pass through & around the edges of the mask,
weakening the seal between mask & face
wet masks also may collapse against the
skin; direct contamination quickly results,
making the mask an ineffective protective bar-
Tips on Choosing a Mask

filtration
- must meet the requirements for bacterial
filtration efficiency(BFE)
- look for 95% BFE
comfort & fit
- coverage of both nose & chin
- comfortable nosepiece that easily conforms
& stays in place
- snug fit over nose helps eliminate fogging
of protective eyewear
- carloop bands, ties, or elastic backs that
provide a close fit yet do not pull or apply
pressure
- comfort & fit with protective eyewear in
place
- mask design & quality of construction
breathability
- good airflow reduces moisture build-up
within the mask
cost-effectiveness
- consider overall value in terms of comfort,
fit, quality, and protection
OSHA
OPIM stands for
other possibly irritating materials

only potential infectious matter
only potently infectious matter
other potentially infectious materials
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other potentially infectious materials

Other Potentially Infectious Materials
(OPIM)
is a term used by OSHA
includes human body fluids
semen, vaginal secretions, cerebrospinal fluid, synovial fluid, pleural
fluid, pericardial fluid, peritoneal
fluid, amniotic fluid
saliva in dental procedures
any body fluid that is visibly contaminated with blood
all body fluids in situations where it
is difficult or impossible to differentiate between body fluids
includes any unfixed tissue or organ
(other than intact skin) from a human
(living or dead)
includes HIV-containing cell or tissue

cultures, organ cultures, and HIV- or
HBV-containing culture medium or
other solutions
includes blood, organs, or other tissues from experimental animals infected with HIV or HBV
includes blood and tissues of experimental animals infected with bloodborne pathogens
includes any pathogenic microorganism
includes human cell lines
OSHA
Documents that contain information concerning hazardous chemicals are
called
MDDS
MSSD
MSDS
MDSD
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MSDS
Material Safety Data Sheets
are an important component of product & workplace safety

intended to provide employees &
emergency personnel with procedures
for handling a substance in a safe
manner
includes information such as physical

data (melting point, boiling point, flash
point, etc.), toxicity, health effects, first
aid, reactivity, storage, disposal, protective equipment & spill-handling
procedures
MSDS formats can vary from source to

source within a country depending on
national requirements
OSHA requires that MSDS be readily available to employees for all potentially harmful substances handled
in the workplace under the Hazard
Communication Standard
MSDS should be obtained directly

from the manufacturer or product
to obtain the MSDS you
may contact the manufacturer or distributor directly or online
OSHA does not require that MSDS be
provided to purchasers of household consumer products when the products are
distributor;
used in the workplace in the same

manner that a consumer would use
them (16r example W index or W hite
Out); this exemption in OSHA's regulation is based, however, not upon the
chemical manufacturer's intended use
of his product, but upon how it actually
is used in the workplace
employees who are required to work
in a manner
that results in a duration and frequency
of exposure greater than what a normal
consumer would experience have a right
with hazardous chemicals
to know about the properties of those

hazardous chemicals
the American Dental Association of-
fers MSDS information, resources, and

materials including manuals
OSHA
Material Safety Data Sheets (MSDS) must be readily available to employees
for all potentially hazardous chemicals used in the dental practice.
Identify each one of the following that is found on the MSDS:
fire & explosion data

hazardous ingredients
dental office contact information
chemical & common names
protection information
reactivity data
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PATIENT MANAGEMENT
fire & explosion data

chemical & common names
protection information
reactivity data
Material Safety Data Sheets
include the following information:
product identification
product name
commercial or marketing name

synonym
approved chemical name or
synonym
chemical family
group of chemicals with related
physical and chemical properties
formula
chemical formula, if applicable
physical data
boiling point, vapor pressure, etc.
tire and explosion hazard data
health hazard data

reactivity data
spill, leak & disposal procedures
protection info
handling & storage precautions
emergency & first aid procedures
date of MSDS preparation
name & address of manufacturer
OSHA
Which one of the following is regulated by OSHA?
all sharps
contaminated sharps
non-contaminated sharps
none of the above
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contaminated sharps
Sharps
if blood or OPIM are present or may

be present on the sharp, it is a contaminated sharp & PPE must be worn
a contaminated sharp can result in an
employee being infected with HIV, HBV,
HCV or other bloodborne pathogens
careful handling of contaminated sharps
can prevent injury & reduce risk of infection
employers must ensure that contaminated sharps are disposed of in sharps
recapping, bending, or removing needles

is permissible only if there is no feasible alternative or if such actions are required for
a specific medical or dental procedure
if recapping, bending, or removal is
necessary, employers must ensure that
workers use either a mechanical device or
a one-handed technique; the cap must not
be held in one hand while guiding the sharp
into it or placing it over the sharp
one-handed "scoop" technique uses the
needle itself to pick up the cap, and then the
cap is pushed against a hard surface to ensure a tight fit onto the device; the cap may
be held with tongs or forceps and placed
over the needle
disposal containers immediately or as

soon as feasible after use
contaminated broken glass must not be

picked up by hand, but must be cleaned up
sharps disposal containers must be

readily accessible & located as close as
feasible to the area where sharps are used
using mechanical means, such as a brush

and dust pan, tongs or forceps
objects that can penetrate a worker's

skin
includes, but not limited to needles,

scalpels, broken glass, capillary tubes
& the exposed ends of dental wires
contaminated sharps must never be

sheared or broken
OSHA
Identify each one of the following that is a true statement concerning sharps
containers.
must be puncture-resistant
must have sides & bottom that are leak proof
must be labeled or color-coded as hazardous
must be a reusable containers
must be closable
must be kept upright
must be replaced routinely and not be overfilled
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must have sides & bottom that are leak proof
must be labeled or color-coded as hazardous
must be closable
must be kept upright
must be replaced routinely and not be overfilled
Sharps containers
sides and the bottom must be leakproof
must be labeled or color-coded red to
warn that the contents are hazardous
must be closable
must be kept upright to keep the
sharps & any liquids from spilling out
must be replaced routinely & not
overfilled
disposal containers that are reusable
must not be opened, emptied, or
cleaned manually or in any other manner that would expose workers to the risk
of injury
Handling containers
employers must ensure that reusable
sharps that are contaminated are not
stored in a manner that requires workers
to reach by hand into the containers where
these sharps have been placed
before sharps disposal containers are removed or replaced, they must be closed
to prevent spilling the contents
if there is a chance of leakage from the
disposal container, the employer must ensure that it is placed in a secondary container that is closable, appropriately
labeled or color-coded red, and constructed to contain all contents and prevent leakage during handling, storage,
transport or shipping
OSHA
Engineering controls are controls that are intended to isolate or remove hazards in the workplace.
Work place controls are controls that are intended to reduce the likelihood of
exposure by altering the manner in which a task is performed.

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PATIENT MANAGEMENT

Percutaneous Injuries (PIs)
PIs pose the single greatest risk of
transmission of a bloodborne infection
to a dental healthcare worker

result from injuries by contaminated
needles, burs, scalpels, broken glass, exposed ends of dental wires or other
sharps that penetrate or break skin
prevention of PIs is influenced by
equipment design and technology as well
as worker knowledge, training & skill
action strategies to prevent PIs include the use of appropriate administrative controls, engineering controls and
work practice controls
Administrative Controls
safety rules implemented by the employer to help assure a safe work envi-
ronment
examples include written programs,
exposure control plan, education and
training, as well as task-specific Stan-
dard Operating Procedures designed to

minimize exposure
Engineering Controls
technology-based
used to remove or isolate hazards in
the workplace
examples include rubber dams (minimize exposure to oral fluids by creating a

dry field), needle recappers (place contaminated ends of the needles away from
DHCW hands) and sharps containers
(isolate & contain contaminated sharps
in a puncture-resistant receptacle)
Work Practice Controls
behavior-based
subject to human error & non-compliance
used to change or alter a task or procedure in order to reduce the likelihood of an exposure
greatly influences the success of other

control measures
example is using the one-handed
scoop technique to recap dental needles
& prohibiting the recapping of needles
by a two-handed technique
OSHA
For each employee whose job involves occupational exposure to blood and
OPIM, what must be maintained in the employee medical record by the dentist employer?
occupational exposure/incident records

test results pertaining to exposure incident
hepatitis B vaccine record
all of the above
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PATIENT MANAGEMENT
all of the above
Employee Medical Records

the employer must maintain a medical record for each employee whose
job involves occupational exposure to
blood or OPIM
the employee medical record must
include:
- hepatitis B vaccine documentation
- details concerning exposure incidents
- medical evaluations & opinions (regarding exposure incidents)
- test results (regarding exposure incidents)
each employee is entitled to review
his or her own medical record
Maintaining Employee Medical Records

medical records must be maintained
for the duration of the employment
plus 30 years
the record must be kept confidential
Transferring Employee
Medical Records
when selling a dental practice, the employee medical records must be transferred to the new owner
in cases where there is no new owner
of the dental practice, you must notify
the director of NIOSH (National Institute for Occupational Safety & Health)
at least 3 months prior to closing the
dental practice and offer to
transmit/transfer the employee records
to NIOSH
OSHA
Per the current CDC guidelines, dental unit water lines should be flushed at
the beginning of the day for how long?
30 seconds
45 seconds
60 seconds
none of the above
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30 seconds
Flushing of Dental Unit Water Lines

flush water lines at the beginning of
the day for 30 seconds (may temporarily reduce the level of microbes
in the water)
flush air/water through handpieces
for 20-30 seconds after each patient
(helps reduce any patient-borne microbes that may have entered the
handpiece and were "sucked hack"
down the dental unit line)
Dental Unit Water Lines

obtain & follow the dental unit manufacturer's recommendations for treating
dental unit waterlines
if recommended by manufacturer, install & maintain antiretraction valves to
prevent oral fluids from being drawn
into dental waterlines
avoid heating dental unit water;
warming the water may amplify biofilm
formation
consider using a separate water reservoir system to eliminate the inflow of
municipal water into the dental unit
use sterile solutions for surgical irrigations
educate & train oral healthcare workers on effective treatment measures
monitor scientific & technological developments to identify improved approaches as they become available
ensure that any sterile water system
or device marketed to improve dental
water quality has FDA approval
OSHA
Per OSHA guidelines, what is the minimum amount of time required for employers to keep employee training records?
2 years
3 years
5 years
7 years
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3 years
Employee Training Records

training records are completed for each employee upon completion of training
documents must be kept for at least three years
training records include:
- the dates of the training sessions
- the contents or a summary of the training sessions
- the names and qualifications of persons conducting the training
- the names and job titles of all persons attending the training sessions
employee training records are provided upon request to the employee or the employee's authorized representative
OSHA
Per OSHA guidelines, what is the minimum amount of time required for employers to keep a sharps injury log?
2 years
3 years
5 years
7 years
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5 years
Sharps Injury Log

all percutaneous injuries resulting from contaminated sharps must be recorded in a
Sharps Injury Log
all incidences must include at least:
- date of the injury
- type and brand of the device involved (syringe, suture needle)
- department or work area where the incident occurred
- explanation of how the incident occurred
this log must be reviewed as part of the annual program evaluation
must be maintained for at least five years following the end of the calendar year
covered
if a copy is requested by anyone, any personal identifiers must be removed from
the report
OSHA
Per OSHA guidelines,, no employee in the dental practice may decline the hepatitis B vaccination.
The hepatitis B vaccination is non-infectious and there is no risk of developing HBV from the vaccine.

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Declining the Hepatitis B Vaccine
any employee may decline the hepatitis B vaccine
employers must ensure that workers

who decline the vaccination sign a declination form
Statement for Declination Form
I understand that due to my occupational exposure to blood or other potentially infectious materials that I may
be at risk of acquiring hepatitis B virus
(HBV) infection.
the purpose of the form is to encourage greater participation in the vaccination program by stating that a
worker declining the vaccination remains at risk of acquiring hepatitis B

infection
the form also states that if a worker
initially declines to receive the vaccine,
but at a later date decides to accept it,
the employer is required to make it
available, at no cost, provided the
worker is still occupationally exposed
I have been given the opportunity to be

vaccinated with hepatitis B vaccine, at
no charge to myself. However, I decline
hepatitis B vaccination at this time.
I understand that by declining this vaccine, I continue to be at risk of acquiring hepatitis B, a serious disease. If in
the future I continue to have occupational exposure to blood or other potentially infectious materials and I
want to be vaccinated with hepatitis B
vaccine, I can receive the vaccination
series at no charge to me.
employee signature
date
PH
Identify which one of the following is the organization that maintains records
on all diseases that occur in the United States.
CDC (Centers for Disease Control & Prevention)

OSHA (Occupational Safety & Health Administration)
FDA (Food & Drug Administration)
EPA (Environmental Protection Agency)
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PATIENT MANAGEMENT
CDC (Centers
DHHS
Department of Health & Human Services
principal agency of U.S. government for protecting the health of Americans
provides essential human services
involved with the delivery, funding and research aspects of oral health
CDC
Centers for Disease Control & Prevention
1 of 13 major components of the DHHS
monitors & maintains records of all diseases
found in U.S. & develops recommendations to
protect the health of the population
formulates health care worker guidelines &
recommendations for prevention of infectious
diseases
FDA
promotes & protects public health by helping
safe & effective products reach the market in a
timely way
monitors products for continued safety after in
use
provides public with accurate, science-based
info needed to improve health
ACF
Administration for Children & Families
responsible for federal programs that promote
the economic & social well-being of families,
children, individuals & communities
responsible for the Head Start program
for Disease Control & Prevention)
CMS
Centers for Medicare & Medicaid Services
administers Medicare & Medicaid programs
that provide health services to roughly 25% of
Americans
HRSA
Health Resources & Services Administration
provides access to essential health care services for people who are low-income, uninsured
or who live in rural or urban areas where health
care is limited
IHS
Indian Health Service
focuses on raising the health status of Native
Americans & Native Alaskans
NIH
National Institutes of Health
premier medical research organization
NIDCR (National Institute of Dental &
Craniofacial Research) is part of NIH
AHRQ
Agency for Healthcare Research & Quality
supports research on health care systems,
health care quality and cost issues
supports research on access to health care, &
effectiveness of medical treatments
PH
Identify which one of the following is the test result that erroneously assigns
an individual to a specific diagnostic or reference group, due to insufficient
exact methods of testing:
a false negative test

a true negative test
a false positive test
a true positive test
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PATIENT MANAGEMENT
a false positive test

Types of errors
a false positive result
means that the test indicates presence
of the disease when it is absent
Categories of tested individuals

true positives
those who test positive for a condition
and are positive (have the condition)
false negative result

means that the test indicates absence
of the disease when it is present
false positives
those who test positive for a condition
but are negative (do not have condition)
true negatives
those who test negative and are negative
false negatives
those who test negative but are positive
PH
Identify which one of the following is defined as the percent of persons without the disease who are correctly classified as not having the disease:
specificity
sensitivity
reliability
validity
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PATIENT MANAGEMENT
specificity
Definitions
Validity
refers to whether questions asked by the
study are answered by the method
a valid test is sensitive, specific & unbiased
Reliability
is the repeatability & reproducibility of test
produces very similar results when used to
measure a variable at different times
Sensitivity
percent of persons with the disease who are
correctly classified as having the disease
- true positive (TP) those who have the disease
- false negative (FN) those who incorrectly
are classified as not having the disease
Specificity
percent of persons without the disease who
are correctly classified as not having disease
- true negative (TN) those who do not have
the disease
- false positive (FP) those who have the disease but not identified by the test
Inferential statistics
used to make claims about the populations
that give rise to the data collected
allow generalizations to be made from sample
data to a larger group
p value
is a probability
answer calculated by a statistical test of a hypothesis (Ho or null hypothesis)
its magnitude informs the researcher as to the
validity of the hypothesis

< .05 (5%), reject the H0
results are statistically significant
> .05 (5%), accept the H0
results are not statistically significant
Correlation/correlation coefficient (r)
quantifies relationship between variables
(x and y)
Multiple regression
provides a mathematical model of linear relationship between a dependent & two or more
independent or predictor variables
Chi - square
a test commonly used to compare observed
data with data we would expect to obtain according to a specific hypothesis
T- test
used to analyze the statistical difference between two means
PH
Identify which one of the following is defined as the measure of quality of
care provided in a particular setting:
quality assurance
quality control
quality assessment
quality inspection
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quality assessment
Quality assessment
is limited to the appraisal of whether or
not standards of quality have been met
Quality assurance
includes the action to take the necessary
corrective steps to improve the situation in
the future
is the measurement of the quality of care
PLUS the implementation of any necessary changes to either maintain or improve
the quality of care rendered
Quality assurance concepts
structure
refers to the layout and equipment of a
facility
process
involves the actual services that the dentist
and assistant perform for the patients &
how well they perform
outcome
is the change in health status that occurs as
a result of the care delivered
Informed consent
in the informed consent process for dental treatment, legally there are three components that must be addressed:
- explanation of a procedure
so that a competent adult understands
- explanation & assessment
of risks & benefits of the procedure, or
the consequences if no procedure is performed
- discussion of alternative choices
the interaction between dentist and patient is the foundation of informed consent,
not the written word
obtaining informed consent should be
viewed as good dental practice
there is a moral duty not to act against
a patient's will; a patient should not be coerced into, unduly influenced to, receive inducements to or be intimidated into having
a procedure
PH
Identify which TWO of the following indices were developed in an attempt to
provide a standardized method of measuring periodontal disease, and, are
criticized because they combine gingivitis and periodontitis measures into a
common score?
PDI
(periodontal disease index)
OHI-S
(simplified oral hygiene index)
PI (periodontal
GI
index)
(gingival index)
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PDI (periodontal disease index)

PI (periodontal index)
PI & PDI
neither is considered the best method to
measure periodontal disease
both developed in an attempt to provide a
standardized method of measuring periodontal disease among groups of people in epidemiologic studies
both combine gingivitis & periodontitis into
a single tooth score or average score for the
individual or group
PI
identifies two levels of gingivitis based on
extent and two levels of periodontitis based
on severity of destruction
total score is achieved by averaging the individual tooth scores
PDI
a modification of PI
distinguishes three levels of gingivitis based
on the extent of the inflammation & severity of the inflammation
quantitatively measures periodontitis by
loss of attachment with a periodontal probe
& defines degrees of periodontitis severity
based on the amount of attachment lost
total score is achieved by averaging the individual tooth scores
Gingival index (GI)

introduced in 1960's by Loe & Sillness
only measures gingival inflammation
widely accepted index for gingivitis
allows for clear distinction between the location/quantity of gingivitis & the severity/
quality of gingivitis
applies a four-category qualitative assessment (normal, mild, moderate or severe inflammation) to four sites (mesial, distal, buccal
and lingual surfaces) on each examined tooth
each area is scored on a 0 to 3 ordinal scale;
values can then be averaged to yield a score for
an individual
Other Indices
P-M-A(Papillary-Marginal-Attached) measurements confined to within gingiva
Plaque Index (PI)
to determine plaque accumulation
Sulcus Bleeding Index (SBI)
to determine bleeding & gingival health
OHI & OHI-S are debris indices
DMFS & DMFT are caries indices
PH
If the major purpose of an epidemiologist's study is to determine caries susceptibility instead of immediate treatment needs, the best caries index to use
is:
TSIF
PSR
DMFT
CPITN
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PATIENT MANAGEMENT
DMFT
DMFT
way to define dental caries in a population

measures either the number of teeth (DMFT)
or the number of tooth surfaces (DMFS)
that are decayed, missing or filled due to
caries
with the permanent dentition, acronyms
DMFT and DMFS are used
with the primary dentition, acronyms deft
and defs are used, with e referring to a tooth
that is indicated for extraction
is an irreversible index
results of this index indicate a group's caries
susceptibility
widely accepted & best known dental index
DMFT Limitations
values are not related to the number of
teeth at risk
index can be invalid in older adults because teeth can become lost for reasons other
than caries
index can be misleading in children whose
teeth have been extracted for orthodontic reasons
cannot be used for root caries
cannot account for sealed teeth
Dental Caries
caries prevalence in U.S. declined substantially in the 1970s & 1980s due to fluoridation, the use of fluorides and other preventive
measures
in the 1970's, the mean DMFS for U.S. children ages 5 to 17 was 7.1; in the late1980's
the value dropped to 2.5 ( a 65% reduction)
the proportion of DMFS that is either untreated caries or missing surfaces also dramatically decreased during this period
baby bottle tooth decay affects approximately 5% of U.S. infants; ethnic minority &
low socioeconomic children are at the greatest risk
coronal caries prevalence has declined
among U.S. adults under age 45
nearly all dentate U.S. adults have at least
one decayed or filled tooth
PH
According to the plaque index (PI) of Sillness & Loe, tooth #14 would have what
PI score?
1.0
1.5
2.0
2.5
Tooth #14
surface
scores
buccal
lingual
menial
distal
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PATIENT MANAGEMENT
2.0
Plaque Index for tooth #14:
2+1+2+3 / 4 = 2.
Plaque Index (PI)

Loe to be used
developed by Sillness
with the Gingival Index (GI)
same surfaces of same teeth are scored
as in the GI and a 0 to 3 scale is used
used extensively;not universally accepted
PI scores the plaque present according
to thickness at the gingival margin rather
than its coronal extent as seen with the
OHI-S
Periodontal Disease
some studies suggest 80-90% of chil-
dren have inflammatory periodontal

disease (gingivitis or periodontitis) by
age of 15
localized acute gingivitis is the most

common form
studies show the strongest relationship between prevalence & severity of

periodontal disease is with oral hygiene & age
Scores
Criteria for Plaque Index
no plaque
film of plaque adhering to free gingival

margin & adjacent area of tooth; plaque
may be seen only after application of
disclosing solution or by running a probe
across tooth surface.
moderate accumulation of soft deposits

within the gingival pocket and/or on the
tooth & gingival margin which can be seen
with the naked eye.
abundance of soft matter within the

gingival pocket and/or on the tooth &
gingival margin.
PH
Identify which one of the following describes the gingival index (GI):
reversible index
irreversible index
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PATIENT MANAGEMENT
reversible index
Dental Index
a data collection instrument
numerically expresses the oral health status of
a population
may be reversible or irreversible
- irreversible index measures conditions that
cannot be reversed; example is dental caries
- reversible index measures conditions that
can be changed; examples are plaque & bleeding
Common Indices
DMFT
- decayed-missing-filled teeth index
- irreversible index
- determines total dental caries experience, past
and present
- only used on permanent teeth
- almost universally accepted
- best known of all dental indices
GI
- gingival index
- reversible index
- measures inflammation of the gingiva
- distinguishes between location/quantity of
gingivitis and the severity/quality of the gingivitis
P-M-A
- papillary-marginal-attached
- oldest reversible index
- precursor to the GI
Common Indices (continued)

PI
- periodontal index
- reversible index
- combines gingivitis & periodontitis into a
single tooth score or average score for the
individual or group
PDI
- periodontal disease index
- reversible index
- combines gingivitis & perodontitis into a
single tooth score or average score for the
individual or group
CPITN
- community periodontal index of treatment
needs
- reversible index
- provides conclusions about the incidence of
periodontitis in a population, as well as
treatment needs
OHI-S
- simplified oral hygiene index
- reversible index
- used to measure OH status by using a debris
index & calculus index; both are combined
for a single score
PI/plaque index
- reversible index
- used to assess thickness of plaque at the
gingival margin
PH
Identify which one of the following is a system where a provider of coverage
contracts to pay for some of the patient's dental treatment:
first-party dentistry
second-party dentistry
third-party dentistry
fourth-party dentistry
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third-party dentistry
Third-Party Reimbursement
usual, customary & reasonable (UCR) fee
- reimbursement based on the dentist's usual
charge, unless the charge exceeds certain parameters
- in order to determine UCR fees, a dentist
must become a participating provider with a
plan & agree to file fees periodically
Table of allowances
- a third-party payer determines what fees it
will pay for each procedure
- a participating dentist agrees to charge plan
members these pre-negotiated fees as payment in full
Fee schedules
- a list of fees established by a dentist for delivery of specific dental services
- fee schedule usually presents payment in
full, whereas table of allowances may not
- example is Medicaid
Reduced fee for service
- commonly associated with Preferred
Provider Organization (PPO) plans
- participating dentist agrees to provide care
for fees usually lower than other dentists in a
particular geographic area
Capitation
- dentist is paid a fixed amount, usually on
a monthly basis, directly by the capitation
plan
- for this fixed payment, the dentist agrees to
provide specified dental services for patients
who present and who are assigned to the
practice by the capitation plan
Panel of providers
closed panel - dental services provided by
salaried dentists at specified locations only
open panel - dental services provided by
any dentist willing to accept third party payment
Fee-for-service
dentistry is financed mainly through feefor-service self-pay
56% of all dental expenses are paid outof- pocket by the patient
third-party payers represented by private
insurance pay approximately 33% of total
dental expenses, followed by governmentfinanced or public programs (Medicaid,
Veterans Affairs)
PH
The major objective of public health programs is:
prevention
cost efficiency
teamwork
all of the above
86
PATIENT MANAGEMENT
prevention
amalgam restoration
- tertiary prevention is limiting a disability
Fluoridation of community water

single most effective & efficient way to prevent dental caries regardless of age, race or income
defined as adjusting fluoride concentration
in community water for optimal oral health
recommended level ranges from 0.7 to 1.2
ppm of fluoride depending on the mean maximum daily air temperature over a 5-year period
most communities are fluoridated at 1 ppm
= 1.0 mg fluoride / liter of water
at this level fluoridated water is odorless, colorless and tasteless
effectiveness of community water fluoridation is 20% to 40%
from disease, or rehabilitating an individual

with disability; example is providing den-
Fluoridation of school water
Prevention
is major objective of PH programs
more ethical to prevent disease than cure it
teamwork is necessary to handle large
groups efficiently
cost efficiency plays a major role because
prevention is cheaper than a cure
may be primary, secondary or tertiary
- primary prevention is preventing disease
before it occurs; is the most effective way
to improve health & control costs; examples
include water fluoridation & sealants
- secondary prevention is controlling the
disease after it occurs; example is placing an
tures
Education
plays an important role in public health
it decreases need for government intervention; when people learn why regulations are
of value they comply
developed & tested in 1960's for use in rural

schools with an independent water supply
recommended concentration for school water
fluoridation is 4.5 times the fluoride concentration for community water
higher concentrations needed to compensate
for part-time exposure because children spend
limited time at school
caries is reduced 20% to 30% when children
consume fluoridated water at school for 12
years
PH
Fluoride supplements are available by prescription only.
Fluoride mouth rinses are the most popular school-based fluoride regimen in
the United States.

87
PATIENT MANAGEMENT

Topical Fluoride
the application of topical fluoride to teeth increases tooth resistance to caries
fluoride can be delivered either brushed on as a
varnish or in a tray as a gel
fluoride varnish
- a vehicle for holding fluoride in close contact
with tooth for a period of time
- way to use high fluoride concentrations in
small amounts of material
- useful to prevent root surface caries in older
adults with gingival recession
- useful in patients with disabilities
Fluoride Supplements
available by prescription only
intended for use by children living in non-fluoridated areas; daily supplements should be used
from 6 months to 16 years
tablets
- chew for 30 seconds, swish for 30 seconds,
then swallow
- provides systemic & topical benefits
- studies show a 30% reduction in caries with
daily use of fluoride tablets on school days
mouth rinse
- most popular school-based regimen
- studies show 25%-28% reduction in caries by
rinsing daily or weekly in school with dilute solutions of fluoride
- rinsing weekly with 0.2% neutral sodium fluoride (NaF) is more common than using a
0.05% NaF solution
Office-Based Methods
sealants
- most decay in children occurs on the chewing
surfaces
- use of fluorides & pit and fissure sealants is
needed to prevent caries
- effectiveness of dental sealants has been reported as 51% to 67%
fluoride gels
- most common fluoride used is acidulated
phosphate fluoride (APF)
- APF has a pH of about 3.0
- most common concentration is 1.23%, usually
as NaF, in orthophosphoric acid
Home-Based Methods
brushing
- use a fluoride toothpaste
- use a pea-sized amount of toothpaste
- brush 2 times per day
fluoride gels
- contain stannous fluoride (0.4%) or sodium
fluoride (1.0%)
- formulated in a nonaqueous gel base without
abrasives
- gel should remain in the mouth for 4 minutes
and then spit out
PH
In regards to reporting child abuse, a dentist is:
morally obligated to report suspected cases

ethically obligated to report suspected cases
legally obligated to report suspected cases
all of the above
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PATIENT MANAGEMENT
all of the above

Reporting Child Abuse
a dentist is morally, ethically and legally obligated to report a suspected case of child
abuse
from ADA Principles of Ethics and Code of
Professional Conduct "dentists shall be
obliged to become familiar with the signs of
abuse and neglect and to report suspected
cases to the proper authorities, consistent with
state laws" (Section 3. e. A buse and Neglect)
once an injury of a suspicious nature is observed, the dentist's first and immediate responsibility is the protection of the child
child abuse most commonly involves newborns and children up to age three
physical indicators
- fractured teeth
- oral lacerations
- fractures of the jaw
- bruising of the face
behavioral indicators
- watchfulness and fearfulness
- sullen and withdrawn demeanor
- cowering at adult displeasure
- extreme anxiousness or nervousness
- excessive need to please
- aggressive or out of control behavior
Mandatory Reporting
dentists are obligated to be well versed
in the mandatory reporting procedures in
the state in which they practice
each state has its own guidelines that
must be followed when reporting cases of
suspected abuse
in all states, however, it is standard that
once abuse is suspected against a child,
elderly or disabled patient, it must be reported to the appropriate agency
dentists must identify the appropriate
agencies within their state in which they
practice and ensure that this information
is readily available should the need arise
Reporting Domestic Violence
a dentist is ethically obligated to identify and refer cases of domestic violence
a dentist must be familiar with the physical signs of domestic violence
domestic violence injuries
- 68% involve the face
- 45% involve the eyes
- 12% involve the neck
PH
Identify which one of the following describes the proportion of existing cases
of disease in a population at one point in time, or, during a specified time:
incidence
prevalence
epidemiology
frequency
69
PATIENT MANAGEMENT
prevalence
Prevalence
is the proportion of a population with
a problem at a designated time
it depends on both the incidence and the
duration of the problem
prevalence is more relevant than incidence
when assessing the impact of a problem within
a community & to assess the needs
expressed as percentage of the population
Incidence
a.k.a. cumulative incidence
is the number of new cases of a disease that
occurs in a population at risk of the disease
during a specific time period
expressed as a rate
Frequency
is a count
Epidemiology
study of the distribution & cause of disease
groups are studied to answer questions about
etiology of diseases, prevention, disease patterns & allocation of resources
communicable disease is one that is transmitted from one to another
non-communicable disease is one that is
not transmitted from one to another; usually
caused by one's own normal flora or an environmental reservoir
Oral Cancer
most oral & pharyngeal cancers are squamous cell carcinoma (SCC)
SCC is twice as common in males as in females
SCC causes nearly twice as many deaths in
males as in females
SCC is closely related to advanced age, alcohol consumption and smoking
SCC of the lip and oral cavity account for
2/3 of all new oral & pharyngeal cancers
the tongue is the most common site of cancers of the oral cavity
survival rates vary depending on the cancer
site, gender and race
5-year survival rate for oral & pharyngeal
cancers is about 50%
5-year survival rates for cancer of the lip are
about 90%; of the tongue it is about half that
erythroplakia, rather than leukoplakia, may
be the first sign of cancerous change in a lesion
PH
Random assignment and blinding are methods used in clinical trials to enhance study validity and
increase bias
decrease bias
have no change on bias
none of the above
90
PATIENT MANAGEMENT
decrease bias
Definitions
Randomized study
all subjects have an equal chance of
being assigned to either study or control group
researchers prefer the random assignment method for placing subjects
into either the study or control group
because any uncontrolled variables influencing the outcome are likely to affect subjects in both groups equally
Blind study
subjects are unaware of whether
they are in a test or control group; one
way to achieve a blinded study is with
the use of placebos
Double blind study
neither participants nor examiners
know the group allocations (test or
control groups)
Randomized & blinded study

when a study is both randomized &
blinded, subjects have no say in their
choice of experimental treatment nor
do they have information about what
experimental treatment they are receiving
randomized & blinded studies require
justification
Dependent variable
a variable whose value depends on
those of others
in the formula x = 3y + z
x is the dependent variable
Independent variable
variable whose value determines that
of others
in the formula x = 3y + z
y & z are the independent variables
PH
The most important concept of public health as defined by C.E.A. Winslow is:
to encourage mental and physical efficiency

promotion of health through organized community effort
individuals acting alone can solve any problem
the science and art of preventing disease
91
PATIENT MANAGEMENT
promotion of health through organized community effort
Public Health
definition
- as defined by C.E.A. Winslow
- the science & art of preventing disease, prolonging life and promoting
physical health and efficiency through
organized community efforts
principles of public health
- a problem exists
- solutions to the problem exist
- the solutions to the problem are applied
a public health problem must meet the
following criteria:
- a condition or situation that is widespread and has an actual or potential
cause of morbidity or mortality
- there is a perception on the part of the
public, government, or public health authorities that the condition is a public
health problem
Dental Public Health

definition
- as defined by the American B oard
of Dental Public Health
- the science and art of preventing
and controlling dental diseases and
promoting dental health through
organized community efforts
form of dental practice which serves
the community as a patient rather
than the individual
is concerned with the dental health
education of the public, with applied
dental research, with administration of group dental care programs
as well as the prevention and control
of dental disease on a community
basis
PH
As used in epidemiology, the term MORTALITY refers to:
disease
life span
death
birth
92
PATIENT MANAGEMENT
death
Definitions
mortality (death rate) reflects the
number of deaths caused by a specific
disease; it is the ratio of the number of
deaths caused by the disease to the total
number of cases of the disease at a specific time
morbidity (illness) is the incidence
of a specific disease within a given
population
natality is the birth rate; ratio of
births to the general population
birth-death ratio (vital index) is the
number of births in a given year divided by the number of deaths in a
given year. It is an indication of the
population growth, stability or reduction
crude death rate is the ratio of the
number of deaths occurring within a
given time period and population to the
total population during that time
attack rate is the proportional number

of cases developing in the population
that was exposed to the infectious agent
endemic is a disease or other occurrence that is constantly present in a population
epidemic is a disease or other occurrence whose incidence is higher than expected
index case is the first identified case
of a disease in an outbreak or epidemic
outbreak is a cluster of cases occurring during a brief time interval and affecting a specific population; an outmay be the onset of an epidemic
pandemic is a worldwide epidemic
portal of entry is a surface or orifice
through which a disease-causing agent
enters the body
portal of exit is a surface or orifice
from which a disease-causing agent
exits and disseminates
reservoir is the natural habitat of a
disease-causing organism
PH
A method of payment for dental services in which the provider is paid a fixed
amount without regard to the actual number or nature of services provided
to each patient is called a:
capitation fee
fixed fee
contractual fee
managed fee
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PATIENT MANAGEMENT
capitation fee
Dental Managed Care
an arrangement whereby a third-party payer
(insurance company, federal government or corporation) mediates between doctors & patients, negotiating fees for services & oversees
the types of treatment given
examples include D-HMO, D-PPO & D-IPA
D-HMO
Dental Health Maintenance Organization
plan most commonly associated with dental

managed care
usually a self-contained staff model practice
where no distinction is made between providers
of insurance and providers of care
also called a capitation dental plan
participants are limited in dentist selection
D-PPO & D-IPA
Dental Preferred Provider Organization
Dental Individual Practice Association
represent groups of doctors who practice in the

community and are distinct from the insurance
provider
an insurance agency contracts with the providers for discounted rates and may refer patients
to these providers exclusively
typically involve contracts between insurers
and a number of dentists; patients can choose
from list of dentists
Capitation Fee
payment to the dentist for these managedcare programs (D-HMO, D-PPO, D-IPA ) is
usually made on a capitation basis
capitation fee is usually a fixed monthly
payment paid by a carrier to a dentist based
on the number of patients assigned to the
dentist for treatment
fee is the same regardless of how much or
how little care is delivered
Delivery Model
staff model usually has one or more den-
tal offices that use salaried staff dentists

network model uses multiple dental offices in various locations and is the most
common method of delivering dental benefits in managed dental care
closed model (a.k.a. Exclusive Provider
Organization) is where the patients have a
limited choice of offices where they can go
to obtain dental care
PH
Identify which one of the following is NOT a fundamental principle defined in
the American Dental Association Code of Professional Conduct:
justice
autonomy
beneficence
maleficence
veracity
94
PATIENT MANAGEMENT
maleficence
ADA Code
includes three main components
The Principles of Ethics

The Code of Professional Conduct
The Advisory Opinions
ADA Code
includes five fundamental principles
1. justice or "fairness" - the dentist has
a duty to treat people fairly

2. autonomy or "self-governance" - the
dentist has a duty to respect a patient's

rights to self-determination and confidential ity
3. beneficence or "do good" - the dentist has the duty to be kind and to give the
highest quality of care that one is capable of
4. nonmaleficence or "do no harm" the dentist has a duty to refrain from
harming the patient
5. veracity or "truthfulness" - the dentist has a duty to communicate truthfully
The dental profession holds a special

position of TRUST within society.
As a consequence, society affords the

profession certain privileges, in return,
the profession makes a commitment to
society that its members will adhere to
high ethical standards of conduct.
These standards are embodied in the

ADA Principles of Ethics and Code of
Professional Conduct.
The ADA CODE is a written expression of the obligations arising from the
implied contract between the dental
profession and society.
Members of the ADA voluntarily agree

to abide by the code as a condition of
membership. They recognize that continued public trust in the dental profession is based on the commitment of
individual dentists to high ethical standards of conduct.
PH
All of the following are true concerning the ADA (Americans with Disabilities
Act) EXCEPT one. Which one is the EXCEPTION?
dentist cannot deny anyone care due to a disability
dental offices must structurally allow access for the disabled

a dentist cannot dismiss an employee due to a disability
a person with HIV is not protected by the ADA
95
PATIENT MANAGEMENT
a person with HIV is not protected by the ADA

Americans with Disabilities Act (ADA)
signed into law in 1990

applies to all private and state-run businesses, employment agencies and unions
with more than fifteen employees
gives federal civil rights protections
to individuals with disabilities similar
to those provided on the basis of race,

color, sex, national origin, age and religion
guarantees equal opportunity for individuals with disabilities in public accommodations, employment, transportation,
state and local government services and
telecommunications
public accommodations such as a doctor's office may not discriminate on the
basis of disability
reasonable changes in policies, practices, and procedures must be made to
avoid discrimination
ADA Goal
to make sure that no qualified person
with any kind of disability is turned
down for a job or promotion, or re-
fused entry to a public access area
Definition
a person with a disability is legally defined as anyone who:

has a physical or mental impairment
that substantially limits one or more
major life activities
has a record of such an impairment is
regarded as having such an impairment
ADA and HIV
persons with HIV disease, both symp-
tomatic & asymptomatic, have physical

impairments that substantially limit one
or more major life activities and are protected by the ADA
persons who are discriminated against

because they are regarded as having HIV
disease are also protected by the ADA
persons who are discriminated against
because they have a known association
or relationship with an individual who
has HIV are also protected by the ADA
PH
A descriptive epidemiological study helps to define the
in a population.
of disease
cause
cure
extent
mortality
96
PATIENT MANAGEMENT
extent
Epidemiological Studies can be organized into
three categories
descriptive epidemiology - used to quantify
disease status in the community: major parameters of interest are prevalence and incidence
- prevalence is the proportion of existing cases
of a disease in a population at one point in time
or during a specified period of time; expressed
as percentage from 0 % -100%
Prevalence = # of people with disease
total # of people at risk
- incidence is the number of new cases of a disease that occur in a population at risk of the
disease during a specified time period
Incidence = # of new cases of disease
total # of people at risk
analytical epidemiology - also called "observational epidemiology", is used to assess the relationship between exposures and disease by
observing exposure-disease associations as they
naturally occur in the population under study;
the three main types are as follows: cross - sectional study, case-control study and cohort
study
- cross-sectional study - looks at both the exposure of interest & disease outcome at the
same point in time
- case - control study - identifies subjects on
the basis of whether disease of interest is present and then, by a history, looks for association
between the disease and one or more past exposures
- cohort study - identifies subjects according
to if they have a particular exposure of interest
& then follows them over time to see if an association exists between exposure & development of disease
experimental epidemiology - used in inter-
vention studies; once etiology is established, researchers determine effectiveness of a program

of prevention; may be clinical or community trials
- clinical trials - conducted to test new preventive or therapeutic agents, with subjects assigned by the investigator to different treatment
groups, usually by random assignment; welldesigned clinical trials use a double - blind design
- community trials - in situations in which an
intervention can be practically evaluated only

at the community level, a community trial can
be conducted; group as a whole is studied
rather than the individuals in it
PH
Identify which one of the following is the part of a published research study
that includes the statement of intent, theory and hypothesis:
abstract
introduction & literature review
methods
results
discussion
summary & conclusion
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PATIENT MANAGEMENT
introduction & literature review

Format of a Research Study
I. Title
- topic and focus of study
2. Abstract
- research focus
- method
- summary of results
- concluding statement
- key words
3. Introduction & literature review
- importance
- literature review
- statement of intent, theory and hypothesis
4. Methods
- sampling strategy
- measurement strategies & instruments
- experimental design
- statistical analytical procedures
5. Results
6. Discussion
- review and summary of results
- discussion of results
- comparison to theoretic presentation or hypotheses
7. Summary & Conclusion
R. Bibliography & References
PH
Identify which one of the following is described as the presentation, organization and summarization of data:
inferential statistics
descriptive statistics
informative statistics
reliability statistics
98
PATIENT MANAGEMENT
descriptive statistics
Definitions
biostatistics is the mathematics of collection, organization, and interpretation of numeric data having to do with living organisms
statistics is the practice, study, or result of
the application of mathematical functions
to collections of data in order to summarize or extrapolate the data
statistics can be used to describe data and
to make inferences from them
descriptive statistics is a way of summarizing data or letting one number stand for a
group of numbers; three ways we can summarize data:
- tabular representation of data
- graphical representation of data
- numerical representation of data
inferential statistics allow someone to generalize from the sample of data to a larger
group of subjects
frequency distributions is a tabulation of
values that one or more variables take in a
sample
normal distribution is a random variation
that conforms to a particular probability distribution; is the most commonly observed
probability distribution; the shape resembles a
bell and is referred to as a "bell curve"
skewed distribution is symmetrical with

dispersion skewed to the left or right of the
median; dispersion skewed to the right is said
to be positive with the mean being greater
than the mode and median
mean or average is the value obtained by
adding all the measurements and dividing by
the number of measurements
median is the middle measurement in a set
of data where half the data is above and half
the data is below the number
mode is the most frequent measurement in
a set of data
range is the difference between the highest
and lowest value in the distribution
variance & standard deviation measure
variability within a distribution
standard deviation is a number that indicates how much on average each value in the
distribution deviates from the mean of the distribution
variance measures the same thing as standard deviation (dispersion of scores in a distribution); variance is the square of the
standard deviation
PH
The portion of covered dental care costs for which the covered person has a
financial responsibility, usually a fixed percentage is called:
copayment
coinsurance
deductible
balance billing
99
PATIENT MANAGEMENT
coinsurance
Definitions
deductible is the amount of eligible expenses a
covered person or family must pay each year from
his/her own pocket before the plan will make payment for eligible expenses; on family policies, deductibles are typically per person and usually have
a maximum of 2 or 3 family members that will need
to meet the deductible
copayment is a cost-sharing arrangement in
which an insured pays a specified charge for a specified service, such as $25 for an office visit; the insured is usually responsible for payment at the time
the service is rendered; if a plan has copayments on
dental office visits, this charge typically does not
count toward coinsurance and deductible payments
because the service is covered before the deductible
and coinsurance
coordination of benefits (COB) is a provision in
the contract that applies when a person is covered
under more than one dental plan; it requires that
payment of benefits be coordinated by all plans to
eliminate over-insurance or duplication of benefits
coinsurance is the portion of covered dental care
costs for which the covered person has a financial
responsibility, usually a fixed percentage; coinsurance usually applies after the insured meets his/her
deductible
balance billing is the (usually) illegal practice of
dental offices and other medical facilities billing patients for the balance between what they want to
charge their patients for services and what the insurance company has already reimbursed them
reasonable & customary (R & C) is a term used

to refer to the commonly charged fees for dental
services within a geographic area; a fee is generally
considered to be reasonable if it falls within the parameters of the commonly charged fee for the particular service within that specific community
preferred provider organization (PPO) is a dental care delivery arrangement which offers access
to participating providers at reduced costs; PPOs
provide insured incentives, such as lower deductibles and copayments, to use providers in the
network; network providers agree to negotiated fees
in exchange for their preferred provider status
point-of-service plan (POS) is a dental insurance
plan that offers members options for different delivery systems such as DMO &, PPO
participating provider is a provider who has
been contracted to render dental services to the insured at a pre-negotiated fee
out-of-network provider is a dental care provider
with whom a managed care organization does not
have a contract to provide dental care services; because the beneficiary must pay either all of the costs
of care from an out-of-network provider or their
cost-sharing requirements are greatly increased
network is a list of dentists who provide dental
care services to the beneficiaries of a specific managed care organization

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ATIENT MANAGEMENT LEGEND

needs are driving forces that prompt a person to act

all of the above statements are true

Needs & Learning

both statements are true

both statements are true

both of the above examples meet the

You're not afraid of needles, are you?

Is it easier to hold the brush this way?

What else did you notice about your gums?

Is the pain sharp, dull, or throbbing?

How are you doing with brushing & flossing?

You're not afraid of needles, are you?

probing questions ask for more specific information that the

own words and specify a content area

How are you?

facilitating questions encourage the patient to say more

the "know-it-all" patient

the anxious patient

is the most difficult patient to manage

Management of the anxious patient

create a relaxing environment

both statements are true

both statements are true

accept that the patient might never change her habits

collaborate with the dentist to determine course of action

use good communication techniques

health maintenance model

health belief model

developed in response to the failure

Age, sex, ethnicity

Perceived bene Its

both statements are true

the first statement is true, the second is false

Make eye contact

Let eyes wander

Use lay terms

preventive oral health behavior

Dental fear, anxiety & pain

ABC model (behavior theory model)

stages of change model (SCM)

Social cognitive theory

countersign carefully - you are as

1. protective clothing must be worn by dental professionals when contact with

wearing gloves replaces the need for hand washing

protective clothing includes gowns,

protective clothing must be removed

likely, surgical masks & protective

dental professionals must wear gloves

for examinations & nonsurgical

1. contaminated laundry must be handled as little as possible

copyright 0 2013-2014 - Dental Decks

all statements are true

potentially infectious material)

clinical contact surface

1. a disinfectant that makes the label claim

3. an agent capable of inactivating Mycobacterium tuberculosis

4. any surface directly contaminated from

intermediate level disinfectant

5. a process which destroys a majority of, but

Intermediate level disinfectant

1. pathogens present in blood that cause disease

2. includes protective attire, gloves, mask and