Professional Documents
Culture Documents
1. expressing needs
2. stimulating motivation
3. recognizing needs
4. evaluating results
5. reinforcing learning
6. setting goals
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Identify each of the following statements that are true concerning needs and
learning.
expressing needs helps to pinpoint them for the patient and dentist w*
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3,1,2,6,7,5,4
Although each learning situation will not fol- Step 4
low these steps in exact sequence, most situa- setting goals
tions will include all of these seven steps in short-range or long-range guides to ac-
some form: tivity
must be meaningful, attractive & at-
recognizing needs tainable
expressing needs Step 5
stimulating motivation acting to achieve goals
setting goals activity is needed for learning
acting to achieve goals must be directed at specific goals
reinforcing learning Step 6
evaluating results reinforcing learning
Stepl review & repetition aid in learning re-
recognizing needs tention
dentist recognizes educational needs as treat- Step 7
ment needs are determined evaluating results
dentist helps patient recognize needs aid in judging what patient has learned
Step 2 aid in determining how effective
expressing needs dentist's teaching has been
dentist records educational needs can help clarify or redefine goals
dentist helps patient state needs
Step 3
stimulating motivation
motivation arouses & maintains interest
dentist may appeal to inner needs or use arti-
ficial stimuli
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The principal nonverbal cue that two or more persons can use to regulate ver-
bal communication is:
posture
facial expression
eye contact
gestures
proximity
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both statements are true
eye contact
Communication Listening
the process by which information is receiving & understanding messages
exchanged between 2 or more persons a good listener shows attention &
communication is essential in the interest
dentist-patient relationship listening techniques include
acceptable verbal & non-verbal paraphrasing (repeating in own
communication varies with fhfiage, sex, words)'"
ethnicity and culture of the patient intCTjrjretation (identifying the
communication is both verbal & underlying reason)
non-verbal; also includes listening preparation (allowing time for dis-
cussion & eliminating distractions)
Verbal communication
involves use of language Eye contact
choice of words is important is the principle non-verbal cue used to
delivery of speech is important regulate verbal communication
(fast vs. slow, loud vs. soft) when listening to a patient, a dentist
should maintain eye contact
Non-verbal communication a dentist should engage the patient's
involves use of body language eyes as often as is comfortable for both
conveyed by eye contact, posture, body parties
movement, hand gestures & expressions
Facilitative skills
Empathy & Rapport facilitative skills make communication
empathy (is the ability to experience the easier and help to develop trust
feelings of another person include encouraging patient questions,
jj^yjportfis a mutual sense of trust and answering questions, respondz'rcp; to re-
openness between individuals quests & 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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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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classical conditioning
Classical conditioning Observational learning
a stimulus leads to a response or modeling, is a type of learning that
a.k.a. pavlovian or respondent condi- occurs as a function of observing, re-
tioning taining and replicating behavior exe-
a process of behavior modification by cuted by others in a social context
which a subject comes to respond in a two phases: acquisition of the behavior
desired manner to a previously neutral & performance of the behavior
stimulus that has been repeatedly pre-
sented along with an unconditioned Example
stimulus that elicits the desired response Classical conditioning
before conditioning, a painful injection
Operant conditioning (unconditioned stimulus) would elicit a
process of behavior modification in fear reaction (unconditioned response)
which the likelihood of a specific be- during conditioning, the dentist with
havior is increased or decreased through syringe (neutral stimulus) is linked
positive or negative reinforcement each with the painful injection and elicits a
time the behavior is exhibited, so that fear reaction
the subject comes to associate the pleas- after conditioning, the dentist with a
ure or displeasure of the reinforcement syringe (conditioned stimulus) will en-
with the behavior courage a fear reaction (conditioned
four types: positive reinforcement, response)
negative reinforcement, punishment
& extinction
destructive a g g r e s s i o n
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Which one of the following types of patients is usually considered to be the
most difficult?
PATIENT MANAGEMENT
4,5,6,2,1,3
# Type Example
4 direct Is it easier to hold the brush this way?
question direct questions asked for a specific bit of information
C o m m u n i c a t i o n 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
neglectful parent
overprotective parent
manipulative parent
hostile parent
PATIENT MANAGEMENT
=SSSSS2X=SSSSS2~
pain) occurs.
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manipulative parent
Manipulative p a r e n t Hostile p a r e n t
is demanding questions the necessity of treatment
demands usually start with appoint- questions stem from distrust and not
ment times curiosity
may try to provide diagnosis and di-
rect the course of treatment Neglectful p a r e n t
fails to keep appointments
Overprotective p a r e n t misses recall visits
insists on remaining with child in does not oversee oral hygiene of
operatory regardless of situation or child
age of child
usually has a child who is shy, the uncooperative child
docile and manageable may be described as stubborn or
by pointing out the lack of appre- spoiled & is usually a child with
hension of the child and the impor- defiant behavior
tance of establishing a one-on-one may be hostile or angry; with this
relationship between the dentist and child, the dentist must try to iden-
child, this will usually satisfy most tify the underlying source of these
overprotective parents emotions
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Behavior shaping is also called:
aversive conditioning
successive approximation
restraining
hypnodontics
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collaborate with the dentist to determine course of action
Motivating the patient Motivating patients
reviewing home care instructions will use good communication techniques
not solve the problem, since this is not express empathy and engage the
a skills deficiency; a plan must be patient
determined to motivate this patient identify the patient's current oral
if the patient knows what to do, and hygiene status and the agree on
how to do it, members of the dental achievable goals for improvement
team must collaborate and find a way to avoid arguing; gently challenge the
motivate the patient to embrace the thought that underlies the behavior
recommended home care regimen support self-efficacy; encourage the
patient to believe that they can change
Stages of change model (SCM) the behavior and they will achieve their
1 - pre-contemplation (no admission of desired goals
problem ) develop a partnership with the patient
2 - contemplation (consideringproblem consult your patient & elicit their
& change) views , the patient will feel that their
3 - preparation (getting ready to change) voice is heard & their needs are
4 - action / willpower (changing considered
behavior) ultimately, the patient must believe
5 - maintenance (maintain behavior that the decision to follow a partic-
change) ular course of action is theirs
6 - relapse (abandon change)
successive approximation
Aversive conditioning
Behavior shaping
using a punishment or something u
a.k.a. successive approximation
pleasant to stop an unwanted behavior
shaping is used when an existing
like all forms of punishment, it may
behavior needs to be changed into a
work but is less effective than reinforc-
more appropriate or new behavior
ement
the strategy involves use of reinforce-
an example is the HOME technique
ment of successive approximations of
(Hand-Over-Mouth)
a desired behavior
immediate positive reinforcement Hypnodontics
includes verbal praise and nonverbal the application of hypnosis and
indications of approval controlled suggestion in dentistry
each approximate desired behavior that
is demonstrated is reinforced, while Restraining
behaviors that are not approximations of a dental restraint is defined as any
the desired behavior are not reinforced form of restriction of movement by a
examples of behavior shaping methods patient in the dental environment
include tell-show-do and modeling 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 boardj
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Which one of the following is a conceptual framework that describes a per-
son's health behavior as an expression of his or her health beliefs?
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Behavior modification is also known as:
behavior evaluation
behavior therapy
behavior shaping
behavior training
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health belief model
Health belief model (HBM) developed in response to the failure
is a psychological model that a of a free tuberculosis (TB) health
attempts to explain and predict screening program
health behaviors by focusing on has been adapted to explore a
the attitudes& beliefs of indivi- variety of long- and short-term
duals health behaviors, including sexual
developed in the 1950s by social risk behaviors and the transmission
psychologists working in the U.S. of HIV/AIDS
Public Health Services (suggests that individuals act to
prevent disease only when they are
. susceptible to it
INDIVIDUAL PERCEPTIONS MODIFYING FACTORS LIKELIHOOD OF ACTION
Likelihood of behavioural
Pereeiired susceptibility' Perceived threat of
change
sericiusness ofdiseas* disease
Cues to action
education
symptoms
media information
behavior therapy
Behavior modification operant conditioning
a.k.a. behavior therapy a.k.a. instrumental conditioning
type of psychotherapy that attempts to a method of learning that occurs
modify observable, maladjusted patterns through rewards & punishments for
of behavior by the substitution of a new behavior
response to a given stimulus positive & negative reinforcement
mostly used in pediatric dentistry strengthen behavior
punishment & extinction weaken
Techniques behavior
for modifying behavior
/ classical conditioning aversive conditioning
Q operant conditioning using a punishment or something
- 3 aversive conditioning unpleasant to stop unwanted behavior
<$ modeling is less effective than reinforcement
,3 systemic desensitization an example is the HOME technique
(Hand-Over-Mouth)
classical conditioning
a.k.a. pavlovian or respondent condition- modeling
SS. form of learning where individuals
a naturally occurring stimulus is paired ascertain how to act by observing
with a response another individual
- next, a previously neutral stimulus is
paired with the naturally occurring systemic desensitization
stimulus therapy for phobias, fears & aversions
- eventually, the previously neutral stim- premise is to reduce a person's anxiety
ulus comes to evoke the response with responses through counter conditioning
out the presence of the naturally occur- teaches a person to replace the feelings
ring stimulus of anxiety with feelings of relaxation
the two elements are known as condi- when the object or behavior is present
tioned stimulus & conditioned response
BS
Five techniques are used to facilitate patient dialogue: empathy, respect, re-
flection, interpretation and silence.
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Each of the following are ways to communicate effectivel y with patients
EXCEPT one. Which one is the EXCEPTION?
describe
evaluate
be specific
be responsive
pay attention
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' the first statement is true, the second is false
Facilitation j reflection
Five techniques are used to facilitate patient is~a response that restates or
dialogue: empathy, respect, reflection, in- repeats a segment of the patient's
terpretation and silence. statement
reflection encourages the patient to
empathy continue communicating
~>.:\.>>
Tsltne ability to accurately understand reflection is a subtle way of asking a
the patient's feelings question and is less intimidating than
empathy also involves being able to asking a direct question
communicate this understanding
when properly done, empathy increases interpretation
rapport, encourages expression and is the dentist's explanation and
promotes trust understanding of the patient's
the dentist must actively listen and con- comments
centrate on what the patient is trying to an interpretation may stimulate dialogue
say both verbally and nonverbally by requiring the patient to agree or to
when communicating empathically, it disagree with the statement
is helpful to respond with the same an interpretation does not need to be
feeling as the patient's statement correct in order to stimulate dialogue
respect silence
respect promotes rapport, open is iised to facilitate dialogue by
expression & trust stimulating the patient to comment
respect is communicated via the way and therefore break the silence
the dentist works with the patient when using silence, it is very important
communicate respect by regarding each to communicate interest by nodding the
patient as an individual head "yes", leaning toward the patient,
and/or maintaining eye contact
evaluate
Communications Effectively
with Patients
Do Don't
Describe Evaluate
Be specific Be general
Be responsive Be evasive
Pat attention Be distracted
Suggestions
Listen carefully Interrupt
from Patients
Make eye contact Let eyes wander
Use lay terms Use jargon
How to Reduce Anxiety
Lean forward Lean back
Prevent pain
Use gestures Fold arms
5e reassuring
Use expression Show disinterest :
Have a calm demeanor
Ask questions Presume
Provide moral support
Work efficiently
Be friendly
BS
Each of the following are considered to be aversive conditions of interaction
between the dentist and patient EXCEPT one. Which one is the EXCEPTION?
pain
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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.
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preventive oral health behavior
Aversive conditions Dental fear, anxiety & pain
any negative condition to which a per- dental fear is an unpleasant emotional
son will learn to make a response to or physiologic sensation derived from a
avoid it specific dental-related stimulus
the dentist-patient interaction seeks to dental anxiety is a non-specific uneasi-
minimize conditions that are perceived ness, apprehension or negative thoughts
as aversive about what may happen during dental
aversive conditions treatment
- psychophysiological reactions dental phobia is when dental treatment
- stress, anxiety & fear is^WiHeToFehdured with intense
-pain
dental fear & anxiety can come from
Non-aversive conditions different sources
non-aversive conditions dental fear & anxiety are often from a
- preventive oral health behavior previous bad experience, or, from
- communication hearing of a bad experience , or a gen-
- gathering information eral fear of needles
- identifying problems dental fear happens during childhood
- giving information or adolescence in approximately 50-
85% of cases
the dentist-patient interaction seeks to dental fear, anxiety & pain are all
maximize the conditions that are interrelated
perceived as non-aversive 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
veracity
documentation
autonomy
negligence
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Identify which one of the following is a false statement concerning personal
protective equipment (PPE):
2. gloves must be worn to prevent contact with blood, saliva or mucous membranes
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documentation
Risk management Documentation
refers to the policies and procedures the is essential to risk management
dentist should follow in order to reduce dental records must be thorough, con-
the chance that a patient will file legal sistent & complete
action against him or her must include actual visits, missed visits
includes issues of legal competence, & evidence of noncompliance
informed consent, liability, confiden-
tiality and documentation Documentation tips
inform the insurance carrier if an
Informed consent incident with a patient occurs
informed consent (written or oral) remember that everything written in
must be obtained by the dentist from the record can be used in court
adult patients prior to treatment always document informed consent
informed consent components never change any written entry - add
- WHO will render treatment an addendum / separate entry instead
- WHAT are the treatment options if a mistake is made - draw a single
- WHAT treatment will be done line through the error, mark it "error"
- WHEN will the treatment occur and initial & date it
- WHERE (if referring the patient) be specific - write facts only, not opinions
- WHY purpose of the procedure and be objective - avoid personal charac-
risks versus benefits terizations, state behaviors
- QUESTIONS the opportunity for the be complete
patient to ask questions & obtain info be timely
write legibly
Patient record maintain integrity of the patient record
the patient record is the property of the never sign a patient record entry for
dentist and must be retained by the dentist someone else, or vice versa
countersign carefully - you are as
responsible as original person who signed
3. the dentist or assigned office personnel may launder the clothes on-site
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Match each term with the correct definition:
PATIENT MANAGEMENT
all statements are true
Protective clothing Laundry choices
for optimal protection gowns, jackets in the dental office contaminated
or coats are required to be long laundry includes protective clothing
sleeved and high necked that is used to cover street clothes or
such clothing minimizes the potential scrubs
for exposed skin to contact blood, the dentist may choose to use an out-
saliva or other potentially infectious side laundry service
material the dentist or assigned office personnel
may launder the clothes in a washer
Disposable gowns and dryer on-site
if used, eliminates the need to launder if contaminated laundry is trans-
contaminated protective clothing ported to a laundromat the
employee or dentist must use PPE, be
Contaminated laundry trained in handling of contaminated
defined as laundry that has been laundry and transport the laundry in a
soiled with blood or OPIM (other red/orange bag that is labelled with a
potentially infectious material) biohazard symbol
a dentist who is unincorporated and is
handling of contaminated laundry the owner may take laundry home; if
includes the following: the owner is unincorporated, the owner
- handle as little as possible is not subject to OSHA regulations
- handle with appropriate PPE
- bag at location of use
- do not sort or rinse at location of use
" J f l b d J B ^ g r t b g g L g J f t a biohazard
4, 6, 5, 7, 1, 2, 3
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Match each term with the correct definition:
PATIENT MANAGEMENT
the first statement is false, the second is true
Disease transmission critical instruments
for an infection to occur by one of penetrate soft tissue or bone
these routes of transmission, the fol- must be sterilized after each use
lowing three conditions must be examples include forceps, scalpels,
present: bone chisels, scalers and surgical
- a susceptible host burs
- a pathogen with sufficient infecti- semicritical instruments
vity and numbers to cause infection contact but do not penetrate soft
- a portal of entry through which the tissue or bone
pathogen may enter the host must be sterilized after each use
effective infection control practices if the instrument can be damaged by
are intended to alter one of these heat and sterilization is not feasible,
three conditions and prevent disease a disposable one-use item is
transmission required
examples include x-ray beam align-
Classification ment devices, mirrors, amalgam
all instruments in the dental practice condensers and burs
can be classified as crjjtical^jenu- noncritical instruments
critical or noncritical "" do riot come in contact with mu-
instruments are classified depend- cous membranes
ing on the risk of transmitting infec- because there is little risk of trans-
tion & the need to sterilize between mitting infection, an intermediate
uses level or low-level disinfectant is
required between uses in different
patients
4,6,7,5,2,3
Definitions disinfectant
antiseptic a chemical agent used on inanimate
an antimicrobial agent that can objects to destroy or inhibit the
be safely applied to living tissues growth of harmful organisms; not
(e.g., alcohol); inhibits but does not considered safe for use on human
necessarily destroy microorganisms tissues (e.g., bleach); a disinfec-
tant kills some, but not all microor-
bactericidal ganisms
an agent that is capable of killing
bacteria; bactericidal agents are pasteurization
preferable over those which are to expose food to an elevated tem-
bacteriostatic perature for a period of time suffi-
cient to destroy certain disease-
bacteriostatic causing microorganisms; the target
an agent that prevents the further of pasteurization is the destruction
growth of bacteria of Mycobacterium tuberculosis
sanitization
treatment of water supplies to
reduce microbial counts to safe
public health levels
IC
Match each term with the correct definition:
4
infectious waste - t n e absence of disease-causing microorgan-
isms
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The interpretation of the Centers for Disease Control & Prevention (CDC) rec-
o m m e n d e d infection control practices in dental healthcare settings varies
from state to state; not all guidelines apply in all states.
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Identify each of the following that is a true statement regarding the pur-
pose of cleaning prior to disinfection:
3. cleaning removes blood and debris which can interfere with disinfection
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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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2,3
Cleaning Cleaning
is defined as the physical removal Results in
of debris a reduction in the number of
with aseptic technique, you must microorganisms present
clean before you disinfect the removal of blood, tissue biobur-
the cleaning step is not optional, it den and other debris that can
is required interfere with disinfection
all disinfectant products include
specific instructions for cleaning
prior to disinfection
sterilization
Sterilization Biological monitoring
defined as the destruction of all forms sterilizers must be monitored for
of microbial life proper functioning. this is done via
limiting requirement is the inactiva- the use of biological indicators (BI) or
tion of bacterial spores spore tests
proof of such destruction is the ultimate both the CDC and ADA recommend
criteria for sterilization because spores weekly spore testing of all sterilizers
are the most heat-resistant microbial
forms
per the Centers for Disease Control and Other definitions
Prevention (CDC), sterilization is disinfection
required for all instruments and the inhibition or killing of pathogens;
items that are placed in the patient's spores are not killed during disinfection
mouth
if an item cannot withstand heat sterili- pasteurization
zation, a disposable (one-time use) to expose food to an elevated tempera-
item should be used instead ture for a period of time sufficient to
heat is the most efficient and depend destroy certain disease-causing
able physical mode of achieving microorganisms; the target of pasteur-
sterilization of dental instruments; ization is the destruction of
the heat may be moist or dry Mycobacterium tuberculosis
three equipment options for heat
sterilization include the autoclave, the sanitization
chemical vapor sterilizer and the dry treatment of water supplies to reduce
heat oven rHicrobial counts to safe public health
^--'levels
X
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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For a steam autoclave, identify each of the following that lists the correct tem-
perature, pressure and time that must be used for sterilization.
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bacterial spores
Biological monitoring Spore testing
involves the processing of highly after a spore strip is processed in a
resistant bacterial spores to determine sterilizer, it is mailed to a monitoring
if they have been killed service
a biological indicator (BI) or spore in a laboratory setting, the spore strip
strip contains the spores used in is aseptically placed in a test tube of
biological monitoring culture media for 7 days
a spore strip is a small piece of paper for each of the 7 days, the tube of
that contains one or more types of culture media is inspected for cloudi-
spores - Bacillus atrophaes spores are ness
used for testing dry heat oven units and if spores are viable & have not been
Geobacillus stearothermophilus killed, the culture media appears
spores are used for testing steam and cloudy
chemical vapor units if no cloudiness is noted in the culture
the spore strip is enclosed in a media, then sterilization is confirmed
protective glassine envelope cloudiness in the culture media indi-
cates a failed test (spores were not
killed), also known as a positive biolog-
.--- 7 r
.-..S
ical spore test
ToTule~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
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.
375F, 60 minutes
320F, 60 minutes
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For a chemical vapor sterilizer, identify the correct temperature, pressure and
time that must be used for sterilization.
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320F, 120 minutes
Dry heat oven Advantages & Disadvantages
in the absence of moisture, destruction advantages
of all forms of microbial life requires - no dulling of cutting edges
conditions very different from the auto- - no corrosion of metal instruments
clave disadvantages
dry heat sterilizes much less - the long cycle time
efficiently than moist heat - poor penetration
a HIGHER TEMPERATURE & - may discolor or char items
LONGER CYCLE TIME is required - destroys heat-labile items
for sterilization to occur - cannot sterilize liquids
- not suitable for hand pieces
lmztmmmm.j!mm
the typical dry heat oven uses
- a temperature of 160 C (320 F) Forced air convection ovens
- cycle time of 120 minutes a.k.a. rapid heat transfer ovens
or another option for dry heat sterilization
- a temperature of 170 C (340 F) use a HIGHER TEMPERATURE \
- cycle time of 60 minutes and a CONTROLLED INTERNAL
AIRFLOW
the use of a commercial cooking oven uses a temperature of 190 C (375F)
is not a substitute for an FDA-app- and a cycle time of 12 minutes for
p roved sterilizer wrapped items and 6 minutes for
unwrapped items
8 hours
10 hours
12 hours
24 hours
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IC
Identify which one of the following is the most efficient way to kill microbes:
cold sterilization
heat sterilization
glutaraldehyde
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10 hours
Glutaraldehyde 2% Advantages & Disadvantages
is a liquid chemical sterilant advantages
capable of killing spores if - most potent category of chemical
sufficient contact time is provided germicide
and there is absence of extraneous - EPA registered as chemical
organic material required contact sterilant
time is 10 hours disadvantages
a.k.a. "cold sterilization" - long time period required for
if this method is used to sterilized sterilization
an instrument, after 10 hours, it - allergenic
must be rinsed with sterile water, - WgWjaaxkJtoJ^gues
dried and placed in a sterile - no way to monitor efficacy
container (if not used immediately)
Reminders
Important note CDC refers to heat sterilization as
use of a chemical sterilant in the method of choice when
dentistry is no longer considered sterilizing instruments and devices
appropriate for sterilizing heat- dental instruments must be
stable instruments appropriately cleaned, packaged &
sterilized between uses with a heat-
based, biologically monitored
process
if heat sensitive, a heat-stable
alternative or disposable item
must be used
L
heat sterilization
Heat sterilization heat sterilization as the method of
use of heat has long been recog- choice when sterilizing instruments
nized as the most efficient and and devices
reliable method of sterilization
using a steam autoclave, chemical dental instruments must be appro-
vapor sterilizer or dry heat oven priately cleaned, packaged & steril-
cell death is accomplished via ized between uses with a heat-
heat inactivation of critical based, biologically monitored
enzymes and other proteins process
within cells
moist heat destroys bacteria by if heat sensitive, it is preferable to
denaturation; the denaturation use a heat-stable alternative or
process is quickened by the use of disposable item
pressure
_dryheat destroys microorganisms
by causing coagulation of proteins
\
\ ^
IC
Identify which one of the following is a false statement concerning infection
control in the dental setting:
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Identify which one of the following is a false statement regarding potential
operator errors that may cause the failure of a spore test:
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environmental surfaces must be sterilized
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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
38
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chemical monitoring uses heat sensitive chemicals
hand gels cause more dryness than soap & water washing
39
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PATIENT MANAGEMENT
ic
Identify which one of the following is a false statement concerning the use of
disinfectants in the dental setting:
40
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PATIENT MANAGEMENT
> after donning gloves
41
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PATIENT MANAGEMENT
ic
The Occupational Safety and Health Administration's (OSHA) Bloodborne
Pathogens Standard mandates that all dental healthcare professionals re-
ceive, at a minimum, the Hepatitis B vaccination series.
The Centers for Disease Control and Prevention (CDC) mandates all other vac-
cinations.
42
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copyright 201
both statements are true
Protective coverings
the use of protective covers on
disinfected surfaces and non-critical
equipment is acceptable
The vaccination record of each employee must be kept for 30 years beyond
the employee's last day of employment in the practice.
43
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PATIENT MANAGEMENT
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.
44
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PATIENT MANAGEMENT
both statements are true
In the dental setting, who needs the What Hepatitis B vaccination documenta-
Hepatitis B vaccination? tion is required?
all employees with potential exposure according to OSHA, a vaccination
to bloodborne pathogens record is part of the employee's
front office and housekeeping staff medical record, and is required to be
should be assessed as to their exposure kept for 30 years beyond the employ-
level; if the answer to the following ees last date of employment
questions is "yes", the vaccination all part-time and temporary employ-
is needed ees are required to provide documenta-
- do they handle contaminated laundry? tion of Hep B vaccination which must
- do they enter patient treatment areas be kept for the same amount of time,
where there is potential for exposure? 30 years
- are they designated to perform first according to the CDC and OSHA 29
aid or CPR? CFR 1910.1030 (h) (1) (ii) (B), employ-
ers are required to keep accurate
When should the dentist employer offer copies of each employees Hep B
Hepatitis B vaccinations to employees? vaccination status, including the date
employers are required to provide of each dose
Hep B vaccinations to all new
employees free of charge after train- Is a post vaccination titer required?
. ing.and within 10 days of working in post vaccination titer testing must be
a position where there is potential done 1 - 2 months after the original
exposure to bloodborne pathogens vaccine series is completed
the only exception is if the employee documentation is treated like an
has previously received the vaccine employee medical record and kept for
series, and, antibody testing has 30 years from last date of employment
revealed the worker is immune
45
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PATIENT MANAGEMENT
IC
Identify each of following that is a true statement concerning providing safe
treatment for patients w i t h possible or documented latex allergy:
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
46
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PATIENT MANAGEMENT
irritant contact dermatitis
Contact dermatitis Latex allergy
contact dermatitis can develop from type I hypersensitivity to latex
frequent and repeated use of hand proteins
hygiene products, exposure to a more serious systemic allergic
chemicals and glove use reaction
contact dermatitis is classified as begins within minutes of exposure
either irritant or allergic but can sometimes occur hours
later
Irritant contact dermatitis produces varied symptoms, which
is common & nonallergic include runny nose, sneezing, itchy
develops as dry, itchy, irritated areas eyes, scratchy throat, hives & itchy
on the skin around the area of contact burning sensations
may involve more severe symptoms
Allergic,contact dermatitis including difficult breathing, cough-
type IV hypersensitivity ing spells, and wheezing; cardiovas-
can result from exposure to accelera- cular and gastrointestinal ailments
tors and other chemicals used in the in rare cases, anaphylaxis & death
manufacture of rubber gloves may occur
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
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
47
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PATIENT MANAGEMENT
ic
Identify which one of the following is an option for treating a patient with a
confirmed latex allergy:
48
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PAHENT MANAGEMENT
all of the statements are true
Hepatitis C Virus (HCV) Infection At Risk
is a contagious disease that ranges for HCV Infection
in severity from a mild illness last- current injection drug users
ing a few weeks to a serious, life- past injection drug users
long illness that attacks the liver blood, blood products & organ
results from infection with the Hep- recipients
atitis C virus which is spread hemodialysis patients
through contact with the blood of persons who received body
an infected person piercing or tattoos done with
non-sterile instruments
may be "acute" or "chronic" persons with known exposures to
the HCV
acute HCV infection - health care workers injured by
- is a short-term illness needle sticks
- occurs within the first 6 months - recipients of blood or organs from
after someone is exposed to HCV a donor who tested positive for
- often leads to chronic infection HCV
HIV-infected persons
chronic HCV infection children born to mothers with HCV
- 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
a nosocomial infection
a secondary infection
an opportunistic infection
a recurrent infection
49
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PATIENT MANAGEMENT
ic
Identify which one of the following that is not a vaccine preventable disease:
hepatitis A infection
hepatitis B infection
hepatitis C infection
50
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PATIENT MANAGEMENT
an opportunistic infection
Infection Nosocomial infection
invasion by and multiplication of a hospital acquired infection
pathogenic microorganisms in a nosocomial means originating or
bodily part or tissue, which may taking place in a hospital,
produce subsequent tissue injury especially in reference to an
and progress to overt disease infection
through a variety of cellular or toxic the term "nosocomial" comes from
mechanisms two Greek words "nosus" meaning
instance of being infected "disease" + "komeion" meaning
an agent or a contaminated "to take care of;" "nosocomial"
substance responsible for one's refers to any disease contracted by a
becoming infected patient while under medical care
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
hepatitis C infection
Anthrax Mumps*
Cervical Cancer Pertussis (Whooping Cough)*
Diphtheria* Pneumococcal
Hepatitis A Poliomyelitis (Polio)
Hepatitis B* Rabies Rotavirus
Haemophilus influenzae type b (Hib) Rubella (German Measles)*
Human Papillomavirus (HPV) Shingles (Herpes Zoster)
H1N1 Flu (Swine Flu) Smallpox
Influenza (Seasonal Flu)* Tetanus*
Japanese Encephalitis (JE) Lyme Disease Tuberculosis
Measles* Typhoid Fever
Meningococcal Varicella (Chickenpox)*
Monkeypox Yellow Fever
OSHA
What does OSHA stand for?
51
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PATIENT MANAGEMENT
OSHA
The Occupational Safety & Health Administration (OSHA) is a federal agency
that develops and enforces regulations designed to protect the:
patient
employer
employee
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PATIENT MANAGEMENT
r
Occupational Safety & Health Administration (OSHA)
employee
gowns
plastic barriers
extracted teeth
cotton rolls
53
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PATIENT MANAGEMENT
OSHA
Each one of the following is considered regulated waste EXCEPT one. Which
oneistheEXCEP770/V?
contaminated needles
gloves
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PATIENT MANAGEMENT
extracted teeth
gloves
use bleach to flush waste water lines in order to minimize the dissolution of amalgam
salvage amalgam pieces from restoration removal and recycle with amalgam waste
55
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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 Blood-
borne Pathogens Standard:
Qpxm -
information on the hepatitis B vaccine OtfrvW'i pOfcM^CHJW-M
PATIENT MANAGEMENT
salvage amalgam pieces from restoration removal
and recycle with amalgam
American Dental Association
Best Management Practices for Amalgam Waste
Do Do not
use precapsulated alloys & stock var- use bulk mercury
ious sizes put used disposable amalgam cap-
recycle used disposable amalgam sules in biohazard containers, infec-
capsules tious waste containers or regular
salvage, store & recycle scrap amal- garbage
gam put scrap amalgam in biohazard con-
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, in-
filters 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 disso- fectious 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
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PATIENT MANAGEMENT
OSHA
The OSHA Bloodborne Pathogens Standard requires that a written exposure
control plan (ECP) be reviewed:
biannually
. annually
. quarterly
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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
annually
tuberculosis
HIV disease
HBV/hepatitis B
HCV/hepatitis C
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PATIENT MANAGEMENT
OSHA
The OSHA Bloodborne Pathogens Standard is a comprehensive set of rules
and regulations that have been created to prevent the transmission of blood-
borne diseases:
to patients
to employers
to employees
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PATIENT MANAGEMENT
HIV disease
OSHA Bloodborne Pathogens Standard
HIV disease prompted the OSHA reg- all of the requirements of the OSHA
ulatory action Bloodborne Pathogens Standard can be
- in 1986, unions representing health found in Title 29 of the Code of Fed-
care workers (HCW) petitioned eral Regulations at 29 CFR 1910.1030
OSHA for an emergency rule to pro- the standard's requirements state what
tect workers from work place expos- employers must do to protect workers
ure to HIV and HBV who are occupationally exposed to
- the petition was denied but OSHA blood or OPIM (other potentially in-
created a permanent rule on exposure fectious materials)
to bloodborne pathogens; it took 5 the standard protects workers who
years to develop this rule can reasonably be anticipated to come
bloodborne pathogens are infectious into contact with blood or OPIM as a re-
microorganisms present in blood that sult of doing their job duties
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
> to employees
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OSHA
Unless the employer can establish that identification of the source individual
is infeasible or prohibited by state or local law, following an exposure inci-
dent 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
OSHA
In 1996, Universal Precautions were revised and r<snamed:
mandatory precautions
hazard precautions
standard precautions
OSHA precautions
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PATIENT MANAGEMENT
OSHA
According to the CDC, which of the following are common infection control
violations observed in the dental office:
PATIENT MANAGEMENT
standard precautions
Standard Precautions
the practice of considering that all although the OSHA Bloodborne
blood & body fluids might be con- Pathogens Standard still uses the term
taminated with blood and should be universal precautions in 1996 the
treated as infectious CDC expanded the concept of universal
all patients must be treated with the precautions and changed the term to
same infection control procedures standard precautions
because patients with bloodborne in- elements of standard precautions
fections can be asymptomatic or un- - hand washing
aware they are infected - using PPE
standard precautions must be used - proper handling of contaminated
for all patient encounters items
standard precautions apply to con- - cleaning & disinfecting of surfaces
tact with 1) blood; 2) all body fluids, - using engineering & work practice
secretions, and excretions (except controls
sweat), regardless of whether they con- - using appropriate respiratory hyg-
tain blood; 3) non-intact skin; and 4) iene/cough etiquette
mucous membranes - using safe injection practices
although standard precautions apply to
all patient encounters, the application
of standard precautions during pa-
tient care is determined by the task
being performed & the anticipated
exposure to pathogens
a mask should have a 95% filter efficiency for small particle aerosols
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OSHA
OPIM stands for.
66
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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 Tips on Choosing a Mask
the function is to protect the wearer from filtration
large droplets or spatter that may contact mu- - must meet the requirements for bacterial
cous membranes of nose, lip & mouth filtration efficiencyfXFi?,)
face masks also protect the patient from -look for 95% BFE
health-care worker oral or nasal respiratory comfort & fit
secretions - coverage of both nose & chin
masks should fit the face well, creating a light - comfortable nosepiece that easily conforms
seal over the nose and mouth & stays in place
because they only cover the nose and mouth, - snug fit over nose helps eliminate fogging
face masks should always be worn with pro- of protective eyewear
tective eyewear - earloop bands, ties, or elastic backs that
change the face mask between patients, and provide a close fit yet do not pull or apply
sooner if it becomes moist pressure
Wet masks - comfort & fit with protective eyewear in
condensation from the wearer's breath adds place
moisture to the mask material - mask design & quality of construction
when wet, resistance to the airflow through breathability
the mask increases which causes more air to - good airflow reduces moisture build-up
pass through & around the edges of the mask, within the mask
weakening the seal between mask & face cost-effectiveness
wet masks also may collapse against the - consider overall value in terms of comfort,
skin; direct contamination quickly results, fit, quality, and protection
making the mask an ineffective protective bar-
MDDS
MSSD
'MSDS
'MDSD
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OSHA
Material Safety Data Sheets (MSDS) must be readily available to employees
for all potentially hazardous chemicals used in the dental practice.
hazardous ingredients
protection information
reactivity data
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PATIENT MANAGEMENT
MSDS
Material Safety Data Sheets-^** MSDS should be obtained directly
are an important component of prod- from the manufacturer or product
uct & workplace safety distributor; to obtain the MSDS you
intended to provide employees & may contact the manufacturer or dist-
emergency personnel with procedures ributor directly or online
for handling a substance in a safe OSHA does not require that MSDS be
manner provided to purchasers of household con-
includes information such as^jShysical sumer products when the products are
data (melting-point, boiling point, flash used in the workplace in the same
pointyetc.), toxicity,Walth effects, Yfrst manner that a consumer would use
aid, reactivitystorage, disposal, prot- them (for example Windex or White
ective equipment &spill-handling Out); this exemption in OSHA's regula-
procedures tion is based, however, not upon the
MSDS formats can vary from source to chemical manufacturer's intended use
source within a country depending on of his product, but upon how it actually
national requirements is used in the workplace
OSHA requires that MSDS be read- employees who are required to work
ily available to employees for all pot- with hazardous chemicals in a manner
entially harmful substances handled that results in a duration and frequency
in the workplace under the Hazard of exposure greater than what a normal
Communication Standard consumer would experience have a right
to know about the properties of those
hazardous chemicals
the American Dental Association of-
fers MSDS information, resources, and
materials including manuals
all sharps
contaminated sharps
non-contaminated sharps
69
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OSHA
Identify each one of the following that is a true statement concerning sharps
containers.
must be puncture-resistant
must beclosable
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PATIENT MANAGEMENT
contaminated sharps
Sharps
objects that can penetrate a worker's recapping, bending, or removing needles
skin is permissible only if there is no feasible al-
includes, but not limited to needles, ternative or if such actions are required for
scalpels, broken glass, capillary tubes a specific medical or dental procedure
& the exposed ends of dental wires if recapping, bending, or removal is
if blood or OPIM are present or may necessary, employers must ensure that
be present on the sharp, it is a contamin- workers use either a mechanical device or
ated sharp & PPE must be worn a one-handed technique; the cap must not
a contaminated sharp can result in an be held in one hand while guiding the sharp
employee being infected with HIV, HBV, into it or placing it over the sharp
HCV or other bloodborne pathogens fiwAaaiteLII^ uses the
careful handling of contaminated sharps needle itself to pick up the cap, and then the
can prevent injury & reduce risk of inf- cap is pushed against a hard surface to en-
ection sure a tight fit onto the device; the cap may
employers must ensure that contami- be held with tongs or forceps and placed
nated sharps are disposed of in sharps over the needle
disposal containers immediately or as contaminated broken glass must not be
soon as feasible after use picked up by hand, but must be cleaned up
sharps disposal containers must be using mechanical means, such as a brush
readily accessible & located as close as and dust pan, tongs or forceps
feasible to the area where sharps are used
contaminated sharps must never be
sheared or broken
must be puncture-resistant
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
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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OSHA
For each employee whose job involves occupational exposure to blood and
OPIM, what must be maintained in the employee medical record by the den-
tist employer?
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both statements are true
30 seconds
45 seconds
60 seconds
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PATIENT MANAGEMENT
OSHA
Per OSHA guidelines, what is the minimum amount of time required for em-
ployers to keep employee training records?
2 years
3 years
5 years
7 years
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PATIENT MANAGEMENT
30 seconds
3 years
2 years
3 years
5 years
7 years
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PATIENT MANAGEMENT
OSHA
Per OSHA guidelines, no employee in the dental practice may decline the hep-
atitis B vaccination.
76
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PATIENT MANAGEMENT
5 years
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PATIENT MANAGEMENT
PH
Identify which one of the following is the test result that erroneously assigns
ndividual to a specific diagnostic or reference group, due to insufficient
an
exact methods of testing
78
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CDC (Centers for Disease Control & Prevention)
1DHHS| CMS,
"Department of Health & Human Services -enters for Medicare & Medicaid Services
principal agency of U.S. government for pro- administers Medicare & Medicaid programs
tecting the health of Americans that provide health services to roughly 25% of
provides essential human services Americans
involved with the delivery, funding and re-
,HRSA i
search aspects of oral health
""Health Resources & Services Administration
provides access to essential health care serv-
-enters for Disease Control & Prevention ices for people who are low-income, uninsured
1 of 13 major components of the DHHS or who live in rural or urban areas where health
monitors & maintains records of all diseases care is limited
found in U.S. & develops recommendations to
protect the health of the population IHS
formulates health care worker guidelines & T h d i a n Health Service
recommendations for prevention of infectious focuses on raising the health status of Native
diseases Americans & Native Alaskans
FDA
^ ml
1
promotes & protects public health by helping National Institutes of Health
safe & effective products reach the market in a premier medical r^sjjarch organization
timely way NIDCR (National Institute of Dental &
monitors products for continued safety after in Craniofacial Research) is part of NIH
^ M M M M I ...
use IAHRQ
AHRQJ
provides public with accurate, science-based Agency for Healthcare Research & Quality
info needed to improve health supports research on health care systems,
EcFl health care quality and cost issues
Administration for Children & Families supports research on access to health care, &
responsible for federal programs that promote effectiveness of medical treatments
the economic & social well-being of families,
children, individuals & communities
responsible for the Head Start program
true negatives
those who test negative and are nega-
tive
false negatives
those who test negative but are positive
PH
Identify which one of the following is defined as the percent of persons with-
out the disease who are correctly classified as not having the disease:
specificity
sensitivity
reliability
validity
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PATIENT MANAGEMENT
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
80
opyright 2013-2014 - Dental Decks
' specificity
Definitions
Validity p value
refers to whether questions asked by the is a probability
study are answered by the method answer calculated by a statistical test of a hy-
a valid test is sensitive, specific & unbiased pothesis (HQ or null hypothesis)
its magnitude informs the researcher as to the
Reliability validity of the hypothesis
is the repeatability & reproducibility of test
< .05 (5%), reject the H 0
produces very similar results when used to
results are statistically significant
measure a variable at different times
> .05 (5%), accept the HQ
Sensitivity results are not statistically significant
percent of persons with the disease who are
correctly classified asliaving the disease Correlation/correlation coefficient (r)
- true positive (IP) those who have the dis- quantifies relationship between variables
ease (x andy)
- false negative (FN) those who incorrectly
Multiple regression
are classified as not having the disease
"""provides a mathematical model of linear re-
Specificity lationship between a dependent & two or more
percent of persons without the disease who independent or predictor variables
are correctly classified as not having disease Chi-square
- true negative (TN) those who do not have a test commonly used to compare observed
the disease data with data we would expect to obtain ac-
- false positive (FP) those who have the dis- cording to a specific hypothesis
ease but not identified by the test
T-test
Inferential statistics "^"used to analyze the statistical difference be-
used to make claims about the populations tween two means
that give rise to the data collected
allow generalizations to be made from sample
data to a larger group
quality assessment
PI (periodontal index)
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PATIENT MANAGEMENT
PH
If the major purpose of an epidemiologist's study is to determine caries sus-
ceptibility instead of immediate treatment needs, the best caries index to use
is:
TSIF
PSR
. DMFT
. CPITN
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PATIENT MANAGEMENT
r
PDI (periodontal disease index)
PI (periodontal index)
s=&iH-:,fo;SBi.^&e,-'.,-jH;0L^,
DMFT
1.0
Tooth #14
1.5 surface scores
2.0 buccal 2
lingual 1
2.5
mesial 2
distal 3
83
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PATIENT MANAGEMENT
PH
Identify which one of the following describes the gingival index (Gl):
reversible index
irreversible index
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PATIENT MANAGEMENT
2.0
Plaque Index for tooth #14: Scores Criteria for Plaque Index
2 + 1 + 2 + 3 / 4 = 2.
0 no plaque
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 relation-
ship between prevalence & severity of
periodontal disease is with oral hy-
siene & age
.. , ...-a.,V'^'-i'";^':";'
reversible index
first-party dentistry
second-party dentistry
third-party dentistry
fourth-party dentistry
85
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PATIENT MANAGEMENT
PH
The major objective of public health programs is:
prevention
cost efficiency
teamwork
86
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' third-party dentistry
Third-Party Reimbursement
usual, customary & reasonable (UCR) fee Capitation
- reimbursement based on the dentist's usual - dentist is paid a fixed amount, usually on
charge, unless the charge exceeds certain pa- a monthly basis, directly by the capitation
rameters plan
- in order to determine UCR fees, a dentist - for this fixed payment, the dentist agrees to
must become a participating provider with a provide specified dental services for patients
plan & agree to file fees periodically who present and who are assigned to the
practice by the capitation plan
Table of allowances
- a third-party payer determines what fees it
will pay for each procedure Panel of providers
- a participating dentist agrees to charge plan closed panel - dental services provided by
members these pre-negotiated fees as pay- salaried dentists at specified locations only
ment in full open panel - dental services provided by
any dentist willing to accept third party pay-
Fee schedules
ment
- a list of fees established by a dentist for de-
livery of specific dental services
- fee schedule usually presents payment in Fee-for-service
full, whereas table of allowances may not dentistry is financed mainly through fee-
for-service self-pay
- example is Medicaid
56% of all dental expenses are paid out-
Reduced fee for service of- pocket by the patient
- commonly associated with Preferred third-party payers represented by private
Provider Organization (PPO) plans insurance pay approximately 33% of total
- participating dentist agrees to provide care dental expenses, followed by government-
for fees usually lower than other dentists in a financed or public programs (Medicaid,
particular geographic area Veterans Affairs)
prevention
Fluoride mouth rinses are the most popular school-based fluoride regimen in
the United States.
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PATIENT MANAGEMENT
PH
In regards to reporting child abuse, a dentist is:
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PATIENT MANAGEMENT
r
incidence
prevalence
epidemiology
frequency
89
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PH
Random assignment and blinding are methods used in clinical trials to en-
hance study validity and
increase bias
decrease bias
90
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PATIENT MANAGEMENT
prevalence
Prevalence V ^ Oral Cancer
is the proportion of a population with most oral & pharyngeal cancers are squa-
a problem at a desigriafed'time **' * mous cell carcinoma (SCC)
it depends on both the incidence and the SCC is twice as common in males as in fe-
duration of the problem males ^/fr
prevalence is more relevant than incidence SCC causes nearly twice as many deaths in
when assessing the impact of a problem within males as in females
a community & to assess the needs SCC is closely related to advancecrage, alco-
expressed as percentage of the population hol consumption and'smoking
Incidence SCC of the lip and oral cavity account for
""^ferCumulative incidence 2/3 of all new oral & pharyngeal cancers
is the number of new cases of a disease that the tongue is the most common site of can-
occurs in a population at risk of the disease cers of the oral cavity
during a specific time period survival rates vary depending on the cancer
expressed as a rate site, gender and race
. (l>*-year survival rate for oral & pharyngeal
Frequency cancers is about 50%
is a count 5-year survival rates for cancer of the lip are
Epidemiology about 90%; of the tongue it is about half that
study of the distribution & cause of disease erythroplakia, rather than leukoplakia, may
groups are studied to answer questions about be the first sign of cancerous change in a le-
etiology of diseases, prevention, disease pat- sion
terns & allocation of resources
communicable disease is one that is trans-
mitted 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 envi-
ronmental reservoir
decrease bias
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PH
As used in epidemiology, the term MORTALITY refers to:
disease
lifespan
death
birth
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promotion of health through organized community effort
a public health problem must meet the is concerned with the dental health
following criteria: education of the public, with applied
- a condition or situation that is wide- dental research, with administra-
spread and has an actual or potential tion of group dental care programs
cause of morbidity or mortality as well as the prevention and control
- there is a perception on the part of the of dental disease on a community
public, government, or public health au- basis
thorities that the condition is a public
health problem
death
capitation fee
fixed fee
contractual fee
managed fee
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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
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capitation fee
Dental Managed Care Capitation Fee
an arrangement whereby a third-party payer payment to the dentist for these managed-
(insurance company, federal government or cor- care programs (D-HMO, D-PPO, D-IPA) is
poration) mediates between doctors & pa- usually made on a capitation basis
tients, negotiating fees for services & oversees capitation fee is usually a fixed monthly
the types of treatment given payment paid by a carrier to a dentist based
examples include D-HMO, D-PPO & D-IPA on the number of patients assigned to the
D-HMO dentist for treatment
fee is the same regardless of how much or
Dental Health Maintenance Organization
how little care is delivered
plan most commonly associated with dental
managed care
Delivery Model
usually a self-contained staff model practice
staff model usually has one or more den-
where no distinction is made between providers
tal offices that use salaried staff dentists
of insurance and providers of care
network model uses multiple dental of-
also called a capitation dental plan
fices in various locations and is the most
participants are limited in dentist selection
common method of delivering dental bene-
-%-"'!.e-.,-?
,'. ,!*., .
D-PPO & D-IPA fits in managed dental care
Dental Preferred Provider Organization closed model (a.k.a. Exclusive Provider
Dental Individual Practice Association Organization) is where the patients have a
represent groups of doctors who practice in the limited choice of offices where they can go
community and are distinct from the insurance to obtain dental care
provider
an insurance agency contracts with the provid-
ers 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
maleficence
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PH
A descriptive epidemiological study helps to define the of disease
in a population.
cause
cure
extent
mortality
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a person with HIV is not protected by the ADA
extent
Epidemiological Studies can be organized into - cross-sectional study - looks at both the ex-
three categories posure of interest & disease outcome at the
descriptive epidemiology - used to quantify same point in time
disease status in the community; major param- - case-control study - identifies subjects on
eters of interest are prevalence and incidence the basis of whether disease of interest is pres-
ent and then, by a history, looks for association
- prevalence is the proportion of existing cases between the disease and one or more past ex-
of a disease in a population at one point in time posures
or during a specified period of time; expressed - cohort study - identifies subjects according
as percentage from 0 % -100% to if they have a particular exposure of interest
Prevalence = # of people with disease & then follows them over time to see if an as-
total # of people at risk sociation exists between exposure & develop-
ment of disease
- incidence is the number of new cases of a dis-
ease that occur in a population at risk of the experimental epidemiology - used in inter-
disease during a specified time period vention studies'; once etiology is established, re-
Incidence = # of new cases of disease searchers determine effectiveness of a program
total # of people at risk of prevention; may be clinical or community tri-
als
analytical epidemiology - also called "obser- - clinical trials - conducted to test new pre-
vational epidemiology", is used to assess the re- ventive or therapeutic agents, with subjects as-
lationship between exposures and disease by signed by the investigator to different treatment
observing exposure-disease associations as they groups, usually by random assignment; well-
naturally occur in the population under study; designed clinical trials use a double-blind de-
the three main types are as follows: cross-sec- sign
tional study, case-control study and cohort - community trials - in situations in which an
study 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
methods
results
discussion
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PH
Identify which one of the following is described as the presentation, organi-
zation and summarization of data:
inferential statistics
descriptive statistics
informative statistics
reliability statistics
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introduction & literature review
Definitions
Jjiostatistics is the mathematics of collec- skewed distribution is symmetrical with
tion, organization, and interpretation of nu- dispersion skewed to the left or right of the
meric data having to do with living organisms median; dispersion skewed to the right is said
statistics is the practice, study, or result of to be positive with the mean being greater
the application of mathematical functions than the mode and median
to collections of data in order to summa- mean or average is the value obtained by
rize or extrapolate the data adding all the measurements and dividing by
statistics can be used to describe data and the number of measurements
to make inferences from them median is the middle measurement in a set
descriptive statistics is a way of summa- of data where half the data is above and half
rizing data or letting" one number stand for a the data is below the number
group of numbers; three ways we can sum- mode is the most frequent measurement in
marize data: a set of data
- tabular representation of data range is the difference between the highest
- graphical representation of data and lowest value in the distribution
- numerical representation of data variance & standard deviation measure
variability within a distribution
inferential statistics allow someone to gen- standard deviation is a number that indi-
eralize from the sample of data to a larger cates how much on average each value in the
group of subjects distribution deviates from the mean of the dis-
frequency distributions is a tabulation of tribution
values that one or more variables take m a variance measures the same thing as stan-
sample dard deviation (dispersion of scores in a dis-
normal distribution is a random variation tribution); variance is the square of the
that conforms to a particular probability dis- standard deviation
tribution; is the most commonly observed
probability distribution; the shape resembles a
bell and is referred to as a "bell curve"
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
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coinsurance
Definitions
deductible is the amount of eligible expenses a reasonable & customary (R & C) is a term used
covered person or family must pay each year from to refer to the commonly charged fees for dental
his/her own pocket before the plan will make pay- services within a geographic area; a fee is generally
ment for eligible expenses; on family policies, de- considered to be reasonable if it falls within the pa-
ductibles are typically per person and usually have rameters of the commonly charged fee for the par-
a maximum of 2 or 3 family members that will need ticular service within that specific community
to meet the deductible preferred provider organization (PPO) is a den-
copayment is a cost-sharing arrangement in tal care delivery arrangement which offers access
which an insured pays a specified charge for a spec- to participating providers at reduced costs; PPOs
ified service, such as $25 for an office visit; the in- provide insured incentives, such as lower de-
sured is usually responsible for payment at the time ductibles and copayments, to use providers in the
the service is rendered; if a plan has copayments on network; network providers agree to negotiated fees
dental office visits, this charge typically does not in exchange for their preferred provider status
count toward coinsurance and deductible payments point-of-service plan (POS) is a dental insurance
because the service is covered before the deductible plan that offers members options for different de-
and coinsurance livery systems such as DMO &, PPO
coordination of benefits (COB) is a provision in participating provider is a provider who has
ffie contract that applies when a person is covered been contracted to render dental services to the in-
under more than one dental plan; it requires that sured at a pre-negotiated fee
payment of benefits be coordinated by all plans to out-of-network provider is a dental care provider
eliminate over-insurance or duplication of benefits with whom a managed care organization does not
coinsurance is the portion of covered dental care have a contract to provide dental care services; be-
costs for which the covered person has a financial cause the beneficiary must pay either all of the costs
responsibility, usually a fixed percentage; coinsur- of care from an out-of-network provider or their
ance usually applies after the insured meets his/her cost-sharing requirements are greatly increased
deductible network is a list of dentists who provide dental
balance billing is the (usually) illegal practice of care services to the beneficiaries of a specific man-
dental offices and other medical facilities billing pa- aged care organization
tients for the balance between what they want to
charge their patients for services and what the in-
surance company has already reimbursed them