Darby Dental Hygiene Process of Care

1. The dental hygiene process of care provides a logical system for:

a. Determining the health and disease of a patient

b. Selecting appropriate interventions to address patient needs

c. Measuring treatment outcomes and modifying the treatment plan accordingly

d. Determining the health and disease of a patient, selecting appropriate interventions, and measuring treatment outcomes

d. The process of care is a systematic approach that involves assessing and diagnosing a patient to determine their health status so that an evidence-based plan of action can be developed and implemented to achieve outcomes that are measurable.

. The health history form provides information about a patient’s health used for establishing medical and dental diagnoses. Completion and review of a patient’s health history falls under the assessment phase of the process of care.

a. Both statements are TRUE

b. Both statements are FALSE

c. The first statement is TRUE. The second statement is FALSE

d. The first statement is FALSE. The second statement is TRUE

a. Both statements are TRUE

a.     The health history form allows for information about the patient’s past and present health to be collected, used for establishing medical and dental diagnoses. Completion and review of the health history is considered data collection and documentation, a component of the assessment phase of the process of care.

3. What blood pressure category is represented by the reading 135/85 mm Hg?

a. Normal

b. Elevated

c. Stage I

d. Stage II

c. Stage I

Stage I is 130-139 or 80-89 mm Hg

4. When performing the intraoral assessment, all of the following structures are assessed using palpation techniques along with visual inspection EXCEPT one. Which is the EXCEPTION?

a. The tongue

b. The soft palate

c. The floor of the mouth

d. The hard palate

b. The soft palate

a.     The soft palate is examined by visual inspection only. Palpating the soft palate could trigger the gag reflex.

5. All of the following relate to proper management of the adult patient with diabetes EXCEPT one. Which is the EXCEPTION?

a. Requesting A1c levels

b. Treating the patient with a blood glucose level of 245

c. Scheduling appointments after the patient has taken medication and eaten

d. Requesting blood glucose levels

b. Treating the patient with a blood glucose level of 245

A patient with a blood glucose level of 245 is uncontrolled and should not be treated. The patient should be referred to a physician.

6. Formulating the dental hygiene diagnosis statement involves:

a. Identification of the condition/problem, contributing factors, and signs/symptoms

b. Identification of the condition/problem and contributing factors

c. Identification of the factors contributing to a problem and signs/symptoms

d. Identification of the signs/symptoms of a condition/problem

a. Identification of the condition/problem, contributing factors, and signs/symptoms

7. In patients with a blood pressure reading that is categorized as elevated hypertension, dental hygiene care should not be performed. In patients presenting with a blood pressure reading that is categorized as hypertensive crisis, dental hygiene care should be performed.

a. Both statements are TRUE

b. Both statements are FALSE

c. The first statement is TRUE. The second statement is FALSE

d. The first statement is FALSE. The second statement is TRUE.

b. Both statements are FALSE

These statements are both false. Dental hygiene care can be performed on the patient with elevated hypertension (systolic 120-129 and diastolic reading <80 mmHg). Dental hygiene care should not be performed under any circumstance for the patient with hypertensive crisis (systolic reading >180 and/or diastolic reading >120 mmHg).

8. Tooth #2 is severely mobile, can be moved in all directions, and can be depressed into the socket. Which mobility class does this represent?

a. Class 0

b. Class I

c. Class II

d. Class III

d. Class III

severe mobility where the tooth can move in all directions and can be depressed into the socket.

9. All of the following are classic symptoms of diabetes EXCEPT one. Which one is the EXCEPTION?

a. Excessive hunger

b. Excessive thirst

c. Excessive urination

d. Excessive joint pain

d. Excessive joint pain

10. The comprehensive and systematic collection of data used to identify a patient’s needs, oral health status, and general health and well-being defines:

a. The assessment phase of the dental hygiene process of care

b. The diagnosis phase of the dental hygiene process of care

c. The planning phase of the dental hygiene process of care

d. The implementation phase of the dental hygiene process of care

a. The assessment phase of the dental hygiene process of care

11. The informed consent form is to be completed and signed before implementation of the care plan. The informed consent form is to be signed by the clinician only.

a. Both statements are TRUE

b. Both statements are FALSE

c. The first statement is TRUE. The second statement is FALSE

d. The first statement is FALSE. The second statement is TRUE

c. The first statement is TRUE. The second statement is FALSE

12. The preliminary phase of dental care planning focuses on which of the following?

a. Controlling risk factors

b. Surgical care

c. Treating periodontal or dental emergency needs

d. Long-term periodontal maintenance therapy

c. Treating periodontal or dental emergency needs

13. All of the following are included on an informed refusal form EXCEPT one. Which one is the EXCEPTION?

a. Planned dental hygiene care

b. The patient’s vital signs

c. Risks involved without treatment

d. Signature of the patient, dental hygienist, and a witness

b. The patient’s vital signs

14. A risk factor for caries development is:

a. Optimal fluoride exposure

b. Frequent exposure to sugary and starchy foods

c. Adequate salivary flow

d. Well coalesced pits and fissures

b. Frequent exposure to sugary and starchy foods

15. Dental hygienists should use current best evidence when providing care. Evidence-based decision making integrates clinical expertise, patient values and circumstances, and best evidence.

a. Both statements are TRUE

b. Both statements are FALSE

c. The first statement is TRUE. The second statement is FALSE

d. The first statement is FALSE. The second statement is TRUE

a. Both statements are TRUE

16. According to G.V. Black’s classification of dental restorations, what type of restoration is an amalgam filling located on the occlusal surface of tooth #15?

a. Class I

b. Class II

c. Class III

d. Class IV

a. Class I

17. All of the following are elements of an evidence-based question EXCEPT one. Which one is the EXCEPTION?

a. Patient, or problem

b. Intervention, cause, or prognosis

c. Caries risk

d. Outcome, or outcomes

c. Caries risk

18. Prediction of duration, course, and termination of disease and response to treatment is defined as:

a. Diagnosis

b. Prognosis

c. Evaluation

d. Documentation

b. Prognosis

19. A systematic and comprehensive periodontal examination should be performed on every patient. Performing a systematic and comprehensive periodontal examination allows the clinician to determine the type of periodontal therapy/treatment indicated.

a. Both statements are TRUE

b. Both statements are FALSE

c. The first statement is TRUE. The second statement is FALSE

d. The first statement is FALSE. The second statement is TRUE

a. Both statements are TRUE

20. Using the American Society of Anesthesiologists (ASA) physical status classification system, what is the classification for a healthy patient with extreme dental anxiety?

a. ASA P1

b. ASA P2

c. ASA P3

d. ASA P4

b. ASA P2

21. What phase of the dental hygiene process of care comes immediately before implementation?

a. Assessment

b. Diagnosis

c. Planning

d. Evaluation

c. Planning

22. Dental hygiene treatment should be postponed when a patient presents with all of the following conditions EXCEPT one. Which one is the EXCEPTION?

a. Controlled diabetes, an A1c level of 6.5, a blood glucose level of 160 taken one hour after breakfast, and no other medical conditions

b. An active herpetic lesion

c. Active tuberculosis

d. A blood pressure reading of 165/100 mm Hg

a. Controlled diabetes, an A1c level of 6.5, a blood glucose level of 160 taken one hour after breakfast, and no other medical conditions

23. Presentation of assessment data that includes the dental diagnosis, dental hygiene diagnosis, and proposed care plan is called:

a. The case presentation

b. Informed consent

c. Informed refusal

d. Documentation

a. The case presentation

24. Maintenance therapy is a term used for interventions directed at sustaining oral health and controlling disease progression. The application of occlusal sealants is an example of maintenance therapy.

a. Both statements are TRUE

b. Both statements are FALSE

c. The first statement is TRUE. The second statement is FALSE

d. The first statement is FALSE. The second statement is TRUE

a. Both statements are TRUE

25. The continued-care (recare) schedule is determined by:

a. Patient preferences

b. The electronic health record software

c. Patient needs, degree of risk for oral disease, and disease progression

d. Degree of risk for oral disease

c. Patient needs, degree of risk for oral disease, and disease progression

26. All of the following are components to consider when completing the written care plan EXCEPT one. Which one is the EXCEPTION?

a. Goals and evaluation measures

b. The priorities for care established by the patient, dental hygienist, and dentist

c. Interventions that address the dental hygiene diagnosis

d. Collecting information about the patient’s social determinants of health

d. Collecting information about the patient’s social determinants of health

27. Communicating the care plan to the patient is necessary prior to the implementation phase of the process of care. As long as the care plan is explained to the patient, the dental hygienist can proceed with all preventive and therapeutic procedures identified regardless of the patient accepting the planned care.

a. Both statements are TRUE

b. Both statements are FALSE

c. The first statement is TRUE. The second statement is FALSE

d. The first statement is FALSE. The second statement is TRUE

c. The first statement is TRUE. The second statement is FALSE

28. Antibiotic premedication is indicated for which of the following?

a. Mitral valve prolapse

b. History of infective endocarditis

c. Heart murmur

d. Rheumatic heart disease

b. History of infective endocarditis

29. The delivery of preventive and therapeutic procedures specified in the care plan to meet a patient’s needs defines:

a. The diagnosis phase of the dental hygiene process of care

b. The planning phase of the dental hygiene process of care

c. The implementation phase of the dental hygiene process of care

d. The evaluation phase of the dental hygiene process of care

c. The implementation phase of the dental hygiene process of care

30. Dental procedures that require antibiotic premedication are those that involve the manipulation of gingival tissues or the periapical region of teeth, or perforation of the oral mucosa. The extraoral and intraoral examination is an example of a procedure that requires antibiotic premedication.

a. Both statements are TRUE

b. Both statements are FALSE

c. The first statement is TRUE. The second statement is FALSE

d. The first statement is FALSE. The second statement is TRUE

c. The first statement is TRUE. The second statement is FALSE

Case A

A 30-year-old female presents for her 6-month recare dental hygiene appointment. The updated health history reveals that the patient is 5 months pregnant.

Her dental records indicate that she has a history of slight generalized marginal inflammation, minimal bleeding on probing, light generalized plaque biofilm, and 1 to 2 mm of gingival recession in the posterior sextants. Existing restorations include amalgams on #18MO and #30O. Slight bone loss localized to the molar regions in addition to a restoration overhang on #18M are evident on the radiographs. Good home care practices were documented.

During the current recare appointment, the patient complains that her “gums” bleed when she brushes. Since being pregnant she has frequently been eating cookies and drinking apple juice. She has only been brushing once a day and has not been flossing because she is tired. During the periodontal assessment, the dental hygienist records moderate generalized gingival inflammation, moderate generalized plaque biofilm and subgingival calculus deposits, generalized bleed on probing, 2 to 4 mm probing depths, and a 5 mm probing depth on the mesiolingual of #18. A protrusive, red, soft, circular, 6 mm mass is found on the labial gingiva between tooth #9 and tooth #10.

31. What is the patient’s ASA physical status classification?

a. ASA P1

b. ASA P2

c. ASA P3

d. ASA P4

b. ASA P2

Case A

A 30-year-old female presents for her 6-month recare dental hygiene appointment. The updated health history reveals that the patient is 5 months pregnant.

Her dental records indicate that she has a history of slight generalized marginal inflammation, minimal bleeding on probing, light generalized plaque biofilm, and 1 to 2 mm of gingival recession in the posterior sextants. Existing restorations include amalgams on #18MO and #30O. Slight bone loss localized to the molar regions in addition to a restoration overhang on #18M are evident on the radiographs. Good home care practices were documented.

During the current recare appointment, the patient complains that her “gums” bleed when she brushes. Since being pregnant she has frequently been eating cookies and drinking apple juice. She has only been brushing once a day and has not been flossing because she is tired. During the periodontal assessment, the dental hygienist records moderate generalized gingival inflammation, moderate generalized plaque biofilm and subgingival calculus deposits, generalized bleed on probing, 2 to 4 mm probing depths, and a 5 mm probing depth on the mesiolingual of #18. A protrusive, red, soft, circular, 6 mm mass is found on the labial gingiva between tooth #9 and tooth #10.

32. The overhang on tooth #18 allows for accumulation of bacterial plaque biofilm. The harboring of bacterial plaque biofilm around the overhang is most likely the cause of the 5 mm probing depth on mesiolingual of tooth #18.

a. Both statements are TRUE

b. Both statements are FALSE

c. The first statement is TRUE. The second statement is FALSE

d. The first statement is FALSE. The second statement is TRUE

a. Both statements are TRUE

Case A

A 30-year-old female presents for her 6-month recare dental hygiene appointment. The updated health history reveals that the patient is 5 months pregnant.

Her dental records indicate that she has a history of slight generalized marginal inflammation, minimal bleeding on probing, light generalized plaque biofilm, and 1 to 2 mm of gingival recession in the posterior sextants. Existing restorations include amalgams on #18MO and #30O. Slight bone loss localized to the molar regions in addition to a restoration overhang on #18M are evident on the radiographs. Good home care practices were documented.

During the current recare appointment, the patient complains that her “gums” bleed when she brushes. Since being pregnant she has frequently been eating cookies and drinking apple juice. She has only been brushing once a day and has not been flossing because she is tired. During the periodontal assessment, the dental hygienist records moderate generalized gingival inflammation, moderate generalized plaque biofilm and subgingival calculus deposits, generalized bleed on probing, 2 to 4 mm probing depths, and a 5 mm probing depth on the mesiolingual of #18. A protrusive, red, soft, circular, 6 mm mass is found on the labial gingiva between tooth #9 and tooth #10.

33. According to G.V. Black’s classification of dental restorations, the amalgam on tooth #18 is:

a. A class I restoration

b. A class II restoration

c. A class III restoration

d. A class IV restoration

b. A class II restoration

Case A

A 30-year-old female presents for her 6-month recare dental hygiene appointment. The updated health history reveals that the patient is 5 months pregnant.

Her dental records indicate that she has a history of slight generalized marginal inflammation, minimal bleeding on probing, light generalized plaque biofilm, and 1 to 2 mm of gingival recession in the posterior sextants. Existing restorations include amalgams on #18MO and #30O. Slight bone loss localized to the molar regions in addition to a restoration overhang on #18M are evident on the radiographs. Good home care practices were documented.

During the current recare appointment, the patient complains that her “gums” bleed when she brushes. Since being pregnant she has frequently been eating cookies and drinking apple juice. She has only been brushing once a day and has not been flossing because she is tired. During the periodontal assessment, the dental hygienist records moderate generalized gingival inflammation, moderate generalized plaque biofilm and subgingival calculus deposits, generalized bleed on probing, 2 to 4 mm probing depths, and a 5 mm probing depth on the mesiolingual of #18. A protrusive, red, soft, circular, 6 mm mass is found on the labial gingiva between tooth #9 and tooth #10.

34. All of the following are factors that can contribute to the patient’s increased gingival inflammation EXCEPT one. Which one is the EXCEPTION?

a. Pregnancy

b. Inadequate brushing and flossing

c. The presence of biofilm

d. Evidence of radiographic bone loss

d. Evidence of radiographic bone loss

Case A

A 30-year-old female presents for her 6-month recare dental hygiene appointment. The updated health history reveals that the patient is 5 months pregnant.

Her dental records indicate that she has a history of slight generalized marginal inflammation, minimal bleeding on probing, light generalized plaque biofilm, and 1 to 2 mm of gingival recession in the posterior sextants. Existing restorations include amalgams on #18MO and #30O. Slight bone loss localized to the molar regions in addition to a restoration overhang on #18M are evident on the radiographs. Good home care practices were documented.

During the current recare appointment, the patient complains that her “gums” bleed when she brushes. Since being pregnant she has frequently been eating cookies and drinking apple juice. She has only been brushing once a day and has not been flossing because she is tired. During the periodontal assessment, the dental hygienist records moderate generalized gingival inflammation, moderate generalized plaque biofilm and subgingival calculus deposits, generalized bleed on probing, 2 to 4 mm probing depths, and a 5 mm probing depth on the mesiolingual of #18. A protrusive, red, soft, circular, 6 mm mass is found on the labial gingiva between tooth #9 and tooth #10.

35. Which best defines the protrusive, red, soft, circular, 6mm mass found on the labial gingiva between teeth #9 and #10?

a. Pyogenic granuloma

b. Verruca vulgaris

c. Primary herpetic gingivostomatitis

d. Mucocele

a. Pyogenic granuloma

Case A

A 30-year-old female presents for her 6-month recare dental hygiene appointment. The updated health history reveals that the patient is 5 months pregnant.

Her dental records indicate that she has a history of slight generalized marginal inflammation, minimal bleeding on probing, light generalized plaque biofilm, and 1 to 2 mm of gingival recession in the posterior sextants. Existing restorations include amalgams on #18MO and #30O. Slight bone loss localized to the molar regions in addition to a restoration overhang on #18M are evident on the radiographs. Good home care practices were documented.

During the current recare appointment, the patient complains that her “gums” bleed when she brushes. Since being pregnant she has frequently been eating cookies and drinking apple juice. She has only been brushing once a day and has not been flossing because she is tired. During the periodontal assessment, the dental hygienist records moderate generalized gingival inflammation, moderate generalized plaque biofilm and subgingival calculus deposits, generalized bleed on probing, 2 to 4 mm probing depths, and a 5 mm probing depth on the mesiolingual of #18. A protrusive, red, soft, circular, 6 mm mass is found on the labial gingiva between tooth #9 and tooth #10.

36. Which answer choice best explains the prognosis for the mass found on the labial gingiva between teeth #9 and #10?

a. The mass may resolve when the hormone levels return to normal

b. The mass may resolve after using 0.12% chlorhexidine rinse for a week

c. The mass may resolve after brushing twice a day for two weeks

d. The mass may resolve after using an interproximal brush for 5 days

a. The mass may resolve when the hormone levels return to normal

Case A

A 30-year-old female presents for her 6-month recare dental hygiene appointment. The updated health history reveals that the patient is 5 months pregnant.

Her dental records indicate that she has a history of slight generalized marginal inflammation, minimal bleeding on probing, light generalized plaque biofilm, and 1 to 2 mm of gingival recession in the posterior sextants. Existing restorations include amalgams on #18MO and #30O. Slight bone loss localized to the molar regions in addition to a restoration overhang on #18M are evident on the radiographs. Good home care practices were documented.

During the current recare appointment, the patient complains that her “gums” bleed when she brushes. Since being pregnant she has frequently been eating cookies and drinking apple juice. She has only been brushing once a day and has not been flossing because she is tired. During the periodontal assessment, the dental hygienist records moderate generalized gingival inflammation, moderate generalized plaque biofilm and subgingival calculus deposits, generalized bleed on probing, 2 to 4 mm probing depths, and a 5 mm probing depth on the mesiolingual of #18. A protrusive, red, soft, circular, 6 mm mass is found on the labial gingiva between tooth #9 and tooth #10.

37. Reviewing the health history as well as examining the dentition, periodontal conditions, and home care practices of the patient are all components of the assessment phase of the dental hygiene process of care. Interpretation of the data collected during the assessment phase is not needed to develop a dental hygiene diagnosis.

a. Both statements are TRUE

b. Both statements are FALSE

c. The first statement is TRUE. The second statement is FALSE

d. The first statement is FALSE. The second statement is TRUE

c. The first statement is TRUE. The second statement is FALSE

Case A

A 30-year-old female presents for her 6-month recare dental hygiene appointment. The updated health history reveals that the patient is 5 months pregnant.

Her dental records indicate that she has a history of slight generalized marginal inflammation, minimal bleeding on probing, light generalized plaque biofilm, and 1 to 2 mm of gingival recession in the posterior sextants. Existing restorations include amalgams on #18MO and #30O. Slight bone loss localized to the molar regions in addition to a restoration overhang on #18M are evident on the radiographs. Good home care practices were documented.

During the current recare appointment, the patient complains that her “gums” bleed when she brushes. Since being pregnant she has frequently been eating cookies and drinking apple juice. She has only been brushing once a day and has not been flossing because she is tired. During the periodontal assessment, the dental hygienist records moderate generalized gingival inflammation, moderate generalized plaque biofilm and subgingival calculus deposits, generalized bleed on probing, 2 to 4 mm probing depths, and a 5 mm probing depth on the mesiolingual of #18. A protrusive, red, soft, circular, 6 mm mass is found on the labial gingiva between tooth #9 and tooth #10.

38. All of the following are factors that place the patient at risk for developing caries EXCEPT one. Which one is the EXCEPTION?

a. Visible plaque biofilm

b. Having a dental home

c. Plaque retentive factors

d. Frequent exposure to sugary foods and beverages

b. Having a dental home

Case A

A 30-year-old female presents for her 6-month recare dental hygiene appointment. The updated health history reveals that the patient is 5 months pregnant.

Her dental records indicate that she has a history of slight generalized marginal inflammation, minimal bleeding on probing, light generalized plaque biofilm, and 1 to 2 mm of gingival recession in the posterior sextants. Existing restorations include amalgams on #18MO and #30O. Slight bone loss localized to the molar regions in addition to a restoration overhang on #18M are evident on the radiographs. Good home care practices were documented.

During the current recare appointment, the patient complains that her “gums” bleed when she brushes. Since being pregnant she has frequently been eating cookies and drinking apple juice. She has only been brushing once a day and has not been flossing because she is tired. During the periodontal assessment, the dental hygienist records moderate generalized gingival inflammation, moderate generalized plaque biofilm and subgingival calculus deposits, generalized bleed on probing, 2 to 4 mm probing depths, and a 5 mm probing depth on the mesiolingual of #18. A protrusive, red, soft, circular, 6 mm mass is found on the labial gingiva between tooth #9 and tooth #10.

39. The patient inquires about tooth whitening. Tooth whitening is contraindicated because:

a. The patient has amalgam restorations that will not lighten

b. The patient has not been flossing

c. The patient is pregnant

d. The patient has slight localized bone loss

c. The patient is pregnant

Case A

A 30-year-old female presents for her 6-month recare dental hygiene appointment. The updated health history reveals that the patient is 5 months pregnant.

Her dental records indicate that she has a history of slight generalized marginal inflammation, minimal bleeding on probing, light generalized plaque biofilm, and 1 to 2 mm of gingival recession in the posterior sextants. Existing restorations include amalgams on #18MO and #30O. Slight bone loss localized to the molar regions in addition to a restoration overhang on #18M are evident on the radiographs. Good home care practices were documented.

During the current recare appointment, the patient complains that her “gums” bleed when she brushes. Since being pregnant she has frequently been eating cookies and drinking apple juice. She has only been brushing once a day and has not been flossing because she is tired. During the periodontal assessment, the dental hygienist records moderate generalized gingival inflammation, moderate generalized plaque biofilm and subgingival calculus deposits, generalized bleed on probing, 2 to 4 mm probing depths, and a 5 mm probing depth on the mesiolingual of #18. A protrusive, red, soft, circular, 6 mm mass is found on the labial gingiva between tooth #9 and tooth #10.

40. All of the following are patient education topics and home care instructions to be discussed with the patient EXCEPT one. Which one is the EXCEPTION?

a. The connection between pregnancy and periodontal disease

b. Dietary risk factors for dental caries

c. Daily use of an interproximal cleaning aid

d. Brushing twice a day using the Fones method

d. Brushing twice a day using the Fones method

Case B

Patient Information

Age: 55

Sex: M

Height: 5’9”

Weight: 185 lbs

Medical History

Patient has a history of myocardial infarction and is under the care of his cardiologist.

Social History

Patient is an attorney at an extremely busy law firm; patient has a stressful position.

Patient smokes approximately 5 cigarettes a day.

Dental History

History of nonsurgical periodontal therapy. Since nonsurgical periodontal therapy has been completed, the patient visits the office once every 4 months.

Current Medications

Plavix 75 mg once daily

Vital Signs

Blood pressure: 125/75 mm Hg

Pulse rate: 70 bpm

Respiration: 18 rpm

Chief Complaints

Sensitivity to cold on upper left

Discomfort around temporomandibular joint

Food gets caught between last two teeth on lower right

Oral Assessment

Bilateral crepitus of TMJ

Dental and Restorative Assessment

3rd molars were extracted due to impaction; all other teeth are present

Attrition on posterior teeth

Open contact between teeth #30 and #31

Existing restorations include #31MO and #30DO

Periodontal Assessment

Gingival recession of 2 mm on direct buccal surfaces of teeth #12 and #13

Interdental CAL of 1–2 mm

Probing depths 4 mm or lessRadiographic bone loss extending to the coronal third of root on less than 15% of teeth

Mostly horizontal bone loss

No evidence of attachment loss in over 5 years

Light generalized inflammation

Deposit Present

Light generalized plaque biofilm

41. Smoking is a risk factor for all of the following EXCEPT one. Which one is the EXCEPTION?

a. Oral cancer

b. Cardiovascular disease

c. Periodontal disease

d. TMJ disorders

d. TMJ disorders

Case B

Patient Information

Age: 55

Sex: M

Height: 5’9”

Weight: 185 lbs

Medical History

Patient has a history of myocardial infarction and is under the care of his cardiologist.

Social History

Patient is an attorney at an extremely busy law firm; patient has a stressful position.

Patient smokes approximately 5 cigarettes a day.

Dental History

History of nonsurgical periodontal therapy. Since nonsurgical periodontal therapy has been completed, the patient visits the office once every 4 months.

Current Medications

Plavix 75 mg once daily

Vital Signs

Blood pressure: 125/75 mm Hg

Pulse rate: 70 bpm

Respiration: 18 rpm

Chief Complaints

Sensitivity to cold on upper left

Discomfort around temporomandibular joint

Food gets caught between last two teeth on lower right

Oral Assessment

Bilateral crepitus of TMJ

Dental and Restorative Assessment

3rd molars were extracted due to impaction; all other teeth are present

Attrition on posterior teeth

Open contact between teeth #30 and #31

Existing restorations include #31MO and #30DO

Periodontal Assessment

Gingival recession of 2 mm on direct buccal surfaces of teeth #12 and #13

Interdental CAL of 1–2 mm

Probing depths 4 mm or lessRadiographic bone loss extending to the coronal third of root on less than 15% of teeth

Mostly horizontal bone loss

No evidence of attachment loss in over 5 years

Light generalized inflammation

Deposit Present

Light generalized plaque biofilm

42. The patient is taking Plavix to prevent blood clots from forming. Since the patient is taking Plavix, bleeding should be closely monitored while providing dental hygiene care.

a. Both statements are TRUE

b. Both statements are FALSE

c. The first statement is TRUE. The second statement is FALSE

d. The first statement is FALSE. The second statement is TRUE

a. Both statements are TRUE

Case B

Patient Information

Age: 55

Sex: M

Height: 5’9”

Weight: 185 lbs

Medical History

Patient has a history of myocardial infarction and is under the care of his cardiologist.

Social History

Patient is an attorney at an extremely busy law firm; patient has a stressful position.

Patient smokes approximately 5 cigarettes a day.

Dental History

History of nonsurgical periodontal therapy. Since nonsurgical periodontal therapy has been completed, the patient visits the office once every 4 months.

Current Medications

Plavix 75 mg once daily

Vital Signs

Blood pressure: 125/75 mm Hg

Pulse rate: 70 bpm

Respiration: 18 rpm

Chief Complaints

Sensitivity to cold on upper left

Discomfort around temporomandibular joint

Food gets caught between last two teeth on lower right

Oral Assessment

Bilateral crepitus of TMJ

Dental and Restorative Assessment

3rd molars were extracted due to impaction; all other teeth are present

Attrition on posterior teeth

Open contact between teeth #30 and #31

Existing restorations include #31MO and #30DO

Periodontal Assessment

Gingival recession of 2 mm on direct buccal surfaces of teeth #12 and #13

Interdental CAL of 1–2 mm

Probing depths 4 mm or lessRadiographic bone loss extending to the coronal third of root on less than 15% of teeth

Mostly horizontal bone loss

No evidence of attachment loss in over 5 years

Light generalized inflammation

Deposit Present

Light generalized plaque biofilm

43. What is the patient’s periodontal classification?

a. Stage I Grade A

b. Stage I Grade B

c. Stage II Grade B

d. Stage III Grade C

b. Stage I Grade B

Case B

Patient Information

Age: 55

Sex: M

Height: 5’9”

Weight: 185 lbs

Medical History

Patient has a history of myocardial infarction and is under the care of his cardiologist.

Social History

Patient is an attorney at an extremely busy law firm; patient has a stressful position.

Patient smokes approximately 5 cigarettes a day.

Dental History

History of nonsurgical periodontal therapy. Since nonsurgical periodontal therapy has been completed, the patient visits the office once every 4 months.

Current Medications

Plavix 75 mg once daily

Vital Signs

Blood pressure: 125/75 mm Hg

Pulse rate: 70 bpm

Respiration: 18 rpm

Chief Complaints

Sensitivity to cold on upper left

Discomfort around temporomandibular joint

Food gets caught between last two teeth on lower right

Oral Assessment

Bilateral crepitus of TMJ

Dental and Restorative Assessment

3rd molars were extracted due to impaction; all other teeth are present

Attrition on posterior teeth

Open contact between teeth #30 and #31

Existing restorations include #31MO and #30DO

Periodontal Assessment

Gingival recession of 2 mm on direct buccal surfaces of teeth #12 and #13

Interdental CAL of 1–2 mm

Probing depths 4 mm or lessRadiographic bone loss extending to the coronal third of root on less than 15% of teeth

Mostly horizontal bone loss

No evidence of attachment loss in over 5 years

Light generalized inflammation

Deposit Present

Light generalized plaque biofilm

44. Given the blood pressure reading, what does appropriate patient management consist of?

a. Advise patient of blood pressure status, recommend follow-up with physician and lifestyle management, and recheck at recare visit

b. Seek medical consultation prior to dental hygiene treatment

c. Recheck blood pressure in 5 minutes, if reading remains the same continue with noninvasive care only

d. Recheck blood pressure in 5 minutes, if reading remains the same refer to hospital for immediate evaluation

a. Advise patient of blood pressure status, recommend follow-up with physician and lifestyle management, and recheck at recare visit

Case B

Patient Information

Age: 55

Sex: M

Height: 5’9”

Weight: 185 lbs

Medical History

Patient has a history of myocardial infarction and is under the care of his cardiologist.

Social History

Patient is an attorney at an extremely busy law firm; patient has a stressful position.

Patient smokes approximately 5 cigarettes a day.

Dental History

History of nonsurgical periodontal therapy. Since nonsurgical periodontal therapy has been completed, the patient visits the office once every 4 months.

Current Medications

Plavix 75 mg once daily

Vital Signs

Blood pressure: 125/75 mm Hg

Pulse rate: 70 bpm

Respiration: 18 rpm

Chief Complaints

Sensitivity to cold on upper left

Discomfort around temporomandibular joint

Food gets caught between last two teeth on lower right

Oral Assessment

Bilateral crepitus of TMJ

Dental and Restorative Assessment

3rd molars were extracted due to impaction; all other teeth are present

Attrition on posterior teeth

Open contact between teeth #30 and #31

Existing restorations include #31MO and #30DO

Periodontal Assessment

Gingival recession of 2 mm on direct buccal surfaces of teeth #12 and #13

Interdental CAL of 1–2 mm

Probing depths 4 mm or lessRadiographic bone loss extending to the coronal third of root on less than 15% of teeth

Mostly horizontal bone loss

No evidence of attachment loss in over 5 years

Light generalized inflammation

Deposit Present

Light generalized plaque biofilm

45. All of the following are interventions included in the dental hygiene care plan EXCEPT one. Which one is the EXCEPTION?

a. Implementation of tobacco cessation strategies

b. Application of desensitizing agent

c. Educate the patient about the benefits of using a night guard

d. Record probing depths on periodontal chart

d. Record probing depths on periodontal chart

Case B

Patient Information

Age: 55

Sex: M

Height: 5’9”

Weight: 185 lbs

Medical History

Patient has a history of myocardial infarction and is under the care of his cardiologist.

Social History

Patient is an attorney at an extremely busy law firm; patient has a stressful position.

Patient smokes approximately 5 cigarettes a day.

Dental History

History of nonsurgical periodontal therapy. Since nonsurgical periodontal therapy has been completed, the patient visits the office once every 4 months.

Current Medications

Plavix 75 mg once daily

Vital Signs

Blood pressure: 125/75 mm Hg

Pulse rate: 70 bpm

Respiration: 18 rpm

Chief Complaints

Sensitivity to cold on upper left

Discomfort around temporomandibular joint

Food gets caught between last two teeth on lower right

Oral Assessment

Bilateral crepitus of TMJ

Dental and Restorative Assessment

3rd molars were extracted due to impaction; all other teeth are present

Attrition on posterior teeth

Open contact between teeth #30 and #31

Existing restorations include #31MO and #30DO

Periodontal Assessment

Gingival recession of 2 mm on direct buccal surfaces of teeth #12 and #13

Interdental CAL of 1–2 mm

Probing depths 4 mm or lessRadiographic bone loss extending to the coronal third of root on less than 15% of teeth

Mostly horizontal bone loss

No evidence of attachment loss in over 5 years

Light generalized inflammation

Deposit Present

Light generalized plaque biofilm

46. Which of the following is most likely the cause of sensitivity?

a. Plaque biofilm

b. Gingival recession

c. 4 mm probing depths

d. The existing restorations

b. Gingival recession

Case B

Patient Information

Age: 55

Sex: M

Height: 5’9”

Weight: 185 lbs

Medical History

Patient has a history of myocardial infarction and is under the care of his cardiologist.

Social History

Patient is an attorney at an extremely busy law firm; patient has a stressful position.

Patient smokes approximately 5 cigarettes a day.

Dental History

History of nonsurgical periodontal therapy. Since nonsurgical periodontal therapy has been completed, the patient visits the office once every 4 months.

Current Medications

Plavix 75 mg once daily

Vital Signs

Blood pressure: 125/75 mm Hg

Pulse rate: 70 bpm

Respiration: 18 rpm

Chief Complaints

Sensitivity to cold on upper left

Discomfort around temporomandibular joint

Food gets caught between last two teeth on lower right

Oral Assessment

Bilateral crepitus of TMJ

Dental and Restorative Assessment

3rd molars were extracted due to impaction; all other teeth are present

Attrition on posterior teeth

Open contact between teeth #30 and #31

Existing restorations include #31MO and #30DO

Periodontal Assessment

Gingival recession of 2 mm on direct buccal surfaces of teeth #12 and #13

Interdental CAL of 1–2 mm

Probing depths 4 mm or lessRadiographic bone loss extending to the coronal third of root on less than 15% of teeth

Mostly horizontal bone loss

No evidence of attachment loss in over 5 years

Light generalized inflammation

Deposit Present

Light generalized plaque biofilm

47. The attrition present on the posterior teeth is most likely caused by:

a. Aggressive toothbrushing habits

b. Bruxism

c. Bone loss

d. Food impaction

b. Bruxism

Case B

Patient Information

Age: 55

Sex: M

Height: 5’9”

Weight: 185 lbs

Medical History

Patient has a history of myocardial infarction and is under the care of his cardiologist.

Social History

Patient is an attorney at an extremely busy law firm; patient has a stressful position.

Patient smokes approximately 5 cigarettes a day.

Dental History

History of nonsurgical periodontal therapy. Since nonsurgical periodontal therapy has been completed, the patient visits the office once every 4 months.

Current Medications

Plavix 75 mg once daily

Vital Signs

Blood pressure: 125/75 mm Hg

Pulse rate: 70 bpm

Respiration: 18 rpm

Chief Complaints

Sensitivity to cold on upper left

Discomfort around temporomandibular joint

Food gets caught between last two teeth on lower right

Oral Assessment

Bilateral crepitus of TMJ

Dental and Restorative Assessment

3rd molars were extracted due to impaction; all other teeth are present

Attrition on posterior teeth

Open contact between teeth #30 and #31

Existing restorations include #31MO and #30DO

Periodontal Assessment

Gingival recession of 2 mm on direct buccal surfaces of teeth #12 and #13

Interdental CAL of 1–2 mm

Probing depths 4 mm or lessRadiographic bone loss extending to the coronal third of root on less than 15% of teeth

Mostly horizontal bone loss

No evidence of attachment loss in over 5 years

Light generalized inflammation

Deposit Present

Light generalized plaque biofilm

48. All of the following are appropriate diagnostic statements for this case EXCEPT one. Which one is the EXCEPTION?

a. Potential for increased pocket depth related to food accumulation in open contact between teeth #30 and #31.

b. Potential for root exposure related gingival recession

c. Sensitivity related to exposed root surfaces

d. TMJ discomfort related to bruxism

b. Potential for root exposure related gingival recession

Case B

Patient Information

Age: 55

Sex: M

Height: 5’9”

Weight: 185 lbs

Medical History

Patient has a history of myocardial infarction and is under the care of his cardiologist.

Social History

Patient is an attorney at an extremely busy law firm; patient has a stressful position.

Patient smokes approximately 5 cigarettes a day.

Dental History

History of nonsurgical periodontal therapy. Since nonsurgical periodontal therapy has been completed, the patient visits the office once every 4 months.

Current Medications

Plavix 75 mg once daily

Vital Signs

Blood pressure: 125/75 mm Hg

Pulse rate: 70 bpm

Respiration: 18 rpm

Chief Complaints

Sensitivity to cold on upper left

Discomfort around temporomandibular joint

Food gets caught between last two teeth on lower right

Oral Assessment

Bilateral crepitus of TMJ

Dental and Restorative Assessment

3rd molars were extracted due to impaction; all other teeth are present

Attrition on posterior teeth

Open contact between teeth #30 and #31

Existing restorations include #31MO and #30DO

Periodontal Assessment

Gingival recession of 2 mm on direct buccal surfaces of teeth #12 and #13

Interdental CAL of 1–2 mm

Probing depths 4 mm or lessRadiographic bone loss extending to the coronal third of root on less than 15% of teeth

Mostly horizontal bone loss

No evidence of attachment loss in over 5 years

Light generalized inflammation

Deposit Present

Light generalized plaque biofilm

49. Some cardiac conditions call for antibiotic premedication to be taken prior to invasive dental hygiene procedures. The patient in this case needs to take antibiotic premedication because of his history of myocardial infarction.

a. Both statements are TRUE

b. Both statements are FALSE

c. The first statement is TRUE. The second statement is FALSE

d. The first statement is FALSE. The second statement is TRUE

c. The first statement is TRUE. The second statement is FALSE

Case B

Patient Information

Age: 55

Sex: M

Height: 5’9”

Weight: 185 lbs

Medical History

Patient has a history of myocardial infarction and is under the care of his cardiologist.

Social History

Patient is an attorney at an extremely busy law firm; patient has a stressful position.

Patient smokes approximately 5 cigarettes a day.

Dental History

History of nonsurgical periodontal therapy. Since nonsurgical periodontal therapy has been completed, the patient visits the office once every 4 months.

Current Medications

Plavix 75 mg once daily

Vital Signs

Blood pressure: 125/75 mm Hg

Pulse rate: 70 bpm

Respiration: 18 rpm

Chief Complaints

Sensitivity to cold on upper left

Discomfort around temporomandibular joint

Food gets caught between last two teeth on lower right

Oral Assessment

Bilateral crepitus of TMJ

Dental and Restorative Assessment

3rd molars were extracted due to impaction; all other teeth are present

Attrition on posterior teeth

Open contact between teeth #30 and #31

Existing restorations include #31MO and #30DO

Periodontal Assessment

Gingival recession of 2 mm on direct buccal surfaces of teeth #12 and #13

Interdental CAL of 1–2 mm

Probing depths 4 mm or lessRadiographic bone loss extending to the coronal third of root on less than 15% of teeth

Mostly horizontal bone loss

No evidence of attachment loss in over 5 years

Light generalized inflammation

Deposit Present

Light generalized plaque biofilm

50. Today’s 3-month appointment is best defined as:

a. Surgical therapy

b. Periodontal maintenance

c. Restorative therapy

d. Preliminary therapy

b. Periodontal maintenance