dental

ANATOMY & PHYSIOLOGY Question 1: What are the 4 branches of the trigeminal nerve? Answer: Ophthalmic (V1), Maxillary (V2), Mandibular (V3), and the main trunk Question 2: Which cranial nerve provides motor function to the tongue? Answer: Hypoglossal nerve (CN XII) Question 3: What cranial nerve provides taste to the anterior 2/3 of the tongue? Answer: Facial nerve (CN VII) via chorda tympani Question 4: Name the 3 pairs of major salivary glands. Answer: Parotid, submandibular, and sublingual Question 5: What muscle elevates the mandible during mastication? Answer: Masseter, temporalis, and medial pterygoid muscles Question 6: What muscle depresses the mandible? Answer: Lateral pterygoid muscle Question 7: What are the 4 types of papillae on the tongue? Answer: Filiform, fungiform, circumvallate, and foliate Question 8: Which papillae do NOT contain taste buds? Answer: Filiform papillae Question 9: What is the normal resting heart rate for adults? Answer: 60-100 beats per minute Question 10: What is normal blood pressure for adults? Answer: Less than 120/80 mmHg Question 11: What are the primary lymph nodes of the head and neck? Answer: Submandibular, submental, cervical chain, occipital, preauricular, postauricular Question 12: What does the parotid gland secrete? Answer: Serous saliva (watery) Question 13: What do submandibular and sublingual glands secrete? Answer: Mixed serous and mucous saliva Question 14: How many permanent teeth are there? Answer: 32 teeth Question 15: How many primary teeth are there? Answer: 20 teeth ----- ## MICROBIOLOGY & IMMUNOLOGY Question 16: What bacteria is primarily associated with dental caries? Answer: Streptococcus mutans Question 17: What bacteria are associated with periodontal disease? Answer: P. gingivalis, T. forsythia, T. denticola (red complex) Question 18: What is the difference between gram-positive and gram-negative bacteria? Answer: Gram-positive have thick peptidoglycan wall (purple stain), gram-negative have thin wall with outer membrane (pink stain) Question 19: What type of immunity involves antibodies? Answer: Humoral immunity (B cells) Question 20: What type of immunity involves direct cell attack? Answer: Cell-mediated immunity (T cells) Question 21: What is the most common oral fungal infection? Answer: Candidiasis (caused by Candida albicans) Question 22: What virus causes herpes labialis (cold sores)? Answer: Herpes simplex virus type 1 (HSV-1) Question 23: What virus causes chickenpox and shingles? Answer: Varicella-zoster virus (VZV) Question 24: What are the stages of biofilm formation? Answer: 1) Pellicle formation 2) Initial colonization 3) Co-aggregation 4) Maturation Question 25: What bacteria are early colonizers of dental plaque? Answer: Streptococcus species (S. sanguis, S. mitis) Question 26: What is the incubation period for hepatitis B? Answer: 45-180 days (average 60-90 days) Question 27: What disease shows “strawberry tongue”? Answer: Scarlet fever Question 28: What disease shows “koplik spots”? Answer: Measles Question 29: Which hepatitis virus is transmitted fecal-oral? Answer: Hepatitis A Question 30: What is the window period for HIV testing? Answer: 3-12 weeks after exposure ----- ## PATHOLOGY Question 31: What is leukoplakia? Answer: White patch or plaque that cannot be scraped off or diagnosed as another lesion Question 32: What is erythroplakia? Answer: Red patch that cannot be diagnosed as another condition (higher malignant potential than leukoplakia) Question 33: What is the most common oral cancer? Answer: Squamous cell carcinoma (90% of oral cancers) Question 34: What are common locations for oral cancer? Answer: Lateral border of tongue, floor of mouth, soft palate Question 35: What is a mucocele? Answer: Fluid-filled swelling caused by trauma to salivary duct (usually lower lip) Question 36: What is a ranula? Answer: Mucocele on the floor of mouth from sublingual gland Question 37: What causes aphthous ulcers (canker sores)? Answer: Unknown etiology; associated with stress, hormones, trauma, nutritional deficiency Question 38: How do you differentiate aphthous ulcers from herpetic lesions? Answer: Aphthous: non-contagious, inside mouth only; Herpetic: contagious, vesicles, keratinized tissue Question 39: What is lichen planus? Answer: Chronic autoimmune condition with white lacy patterns (Wickham’s striae) Question 40: What is pemphigus vulgaris? Answer: Autoimmune blistering disease affecting skin and mucosa Question 41: What is torus palatinus? Answer: Benign bony growth in midline of hard palate Question 42: What is torus mandibularis? Answer: Benign bony growth on lingual surface of mandible near premolars Question 43: What is amelogenesis imperfecta? Answer: Hereditary defect in enamel formation Question 44: What is dentinogenesis imperfecta? Answer: Hereditary defect in dentin formation causing amber/blue-gray teeth Question 45: What causes tetracycline staining? Answer: Tetracycline antibiotic taken during tooth development (pregnancy through age 8) ----- ## PHARMACOLOGY Question 46: What is the maximum dose of lidocaine for healthy adult? Answer: 4.4 mg/kg (max 300 mg) Question 47: What is the maximum dose of lidocaine with epinephrine? Answer: 7 mg/kg (max 500 mg) Question 48: What does ASA classification stand for? Answer: American Society of Anesthesiologists physical status classification Question 49: What is ASA I? Answer: Normal healthy patient Question 50: What is ASA II? Answer: Patient with mild systemic disease Question 51: What is ASA III? Answer: Patient with severe systemic disease Question 52: What medications require antibiotic prophylaxis before dental treatment? Answer: Certain cardiac conditions (prosthetic valves, previous endocarditis, specific congenital heart defects, cardiac transplant) Question 53: What is the antibiotic prophylaxis regimen? Answer: Amoxicillin 2g orally 30-60 minutes before procedure Question 54: What is the alternative if patient is allergic to penicillin? Answer: Clindamycin 600mg, azithromycin 500mg, or cephalexin 2g Question 55: What class of drugs can cause gingival hyperplasia? Answer: Calcium channel blockers, phenytoin (anticonvulsant), cyclosporine (immunosuppressant) Question 56: What class of drugs can cause xerostomia? Answer: Anticholinergics, antihistamines, antidepressants, antihypertensives Question 57: What is the antidote for local anesthetic overdose? Answer: Supportive care, oxygen, benzodiazepines for seizures Question 58: What is the antidote for opioid overdose? Answer: Naloxone (Narcan) Question 59: What is the antidote for benzodiazepine overdose? Answer: Flumazenil Question 60: What are signs of local anesthetic toxicity? Answer: CNS: talkativeness, anxiety, seizures; CVS: hypotension, bradycardia, arrhythmia Question 61: What drug interactions should you know with epinephrine? Answer: Non-selective beta blockers, tricyclic antidepressants (can cause hypertensive crisis) Question 62: What is nitrous oxide concentration for dental sedation? Answer: 25-50% nitrous oxide with oxygen Question 63: What are contraindications for nitrous oxide? Answer: Pregnancy (1st trimester), COPD, recent eye surgery, middle ear obstruction Question 64: What analgesic is safest during pregnancy? Answer: Acetaminophen (Category B) Question 65: What antibiotics are safe during pregnancy? Answer: Penicillin and cephalosporins (avoid tetracycline) ----- ## PERIODONTICS Question 66: What is the definition of gingivitis? Answer: Inflammation of gingiva without loss of attachment or bone Question 67: What is the definition of periodontitis? Answer: Inflammation with loss of attachment and alveolar bone Question 68: What is normal sulcus depth? Answer: 1-3 mm Question 69: What depth is considered a periodontal pocket? Answer: 4 mm or greater with attachment loss Question 70: What is a pseudopocket? Answer: Increased probing depth without attachment loss (due to gingival enlargement) Question 71: What are the stages of periodontal disease (2017 classification)? Answer: Stage I (Initial), Stage II (Moderate), Stage III (Severe), Stage IV (Very Severe) Question 72: What are the grades of periodontal disease? Answer: Grade A (Slow), Grade B (Moderate), Grade C (Rapid progression) Question 73: What is clinical attachment level (CAL)? Answer: Distance from CEJ to base of pocket Question 74: What are signs of healthy gingiva? Answer: Pink, firm, stippled, knife-edged margins, no bleeding on probing Question 75: What are signs of inflamed gingiva? Answer: Red, swollen, smooth/shiny, bleeds easily, rolled margins Question 76: What is the difference between supragingival and subgingival calculus? Answer: Supragingival: above gumline, yellow/white; Subgingival: below gumline, dark brown/black Question 77: What mineral source forms supragingival calculus? Answer: Saliva Question 78: What mineral source forms subgingival calculus? Answer: Gingival crevicular fluid Question 79: What bacteria are associated with aggressive periodontitis? Answer: Aggregatibacter actinomycetemcomitans (Aa) Question 80: What is necrotizing ulcerative gingivitis (NUG)? Answer: Acute painful infection with necrosis of interdental papillae (punched-out appearance) Question 81: What are signs of NUG? Answer: Punched-out papillae, pseudomembrane, pain, bleeding, halitosis, fever Question 82: What systemic conditions are associated with periodontitis? Answer: Diabetes, cardiovascular disease, adverse pregnancy outcomes, respiratory disease Question 83: What is the goal of scaling and root planing? Answer: Remove calculus, plaque, and diseased cementum to create smooth root surface Question 84: What is the difference between scaling and root planing? Answer: Scaling removes calculus; root planing smooths root surface Question 85: What is maintenance interval for periodontal patients? Answer: Every 3-4 months (individualized based on disease severity) ----- ## RADIOLOGY Question 86: What does radiolucent mean? Answer: Dark/black on radiograph (less dense, allows x-rays through) Question 87: What does radiopaque mean? Answer: White/light on radiograph (more dense, blocks x-rays) Question 88: What is the most radiopaque structure in the body? Answer: Enamel Question 89: Order of radiographic density from most to least radiopaque? Answer: Enamel, Dentin, Bone, Soft tissue Question 90: What does ALARA stand for? Answer: As Low As Reasonably Achievable (radiation protection principle) Question 91: What is the maximum permissible dose for occupational exposure? Answer: 5 rem (50 mSv) per year Question 92: What is the maximum permissible dose for general public? Answer: 0.1 rem (1 mSv) per year Question 93: What causes elongation error on radiographs? Answer: Insufficient vertical angulation (too flat) Question 94: What causes foreshortening error? Answer: Excessive vertical angulation (too steep) Question 95: What causes overlapping on radiographs? Answer: Incorrect horizontal angulation Question 96: What is a periapical radiograph used for? Answer: Shows entire tooth from crown to apex plus surrounding bone Question 97: What is a bitewing radiograph used for? Answer: Shows crowns and interproximal areas (detects caries and bone levels) Question 98: What is a panoramic radiograph used for? Answer: Shows entire maxilla and mandible, TMJ, sinuses (broad overview) Question 99: What appears as a radiolucency at apex of non-vital tooth? Answer: Periapical abscess or granuloma Question 100: What is the most common odontogenic cyst? Answer: Periapical (radicular) cyst Question 101: What is a dentigerous cyst? Answer: Cyst surrounding crown of unerupted tooth Question 102: What does periodontal disease look like on radiographs? Answer: Horizontal or vertical bone loss, widened PDL space, furcation involvement Question 103: How often should bitewings be taken for high caries risk? Answer: Every 6 months Question 104: How often should bitewings be taken for low caries risk? Answer: Every 18-24 months Question 105: What protective equipment is required during x-ray exposure? Answer: Lead apron with thyroid collar for patient; operator stands 6 feet away behind barrier ----- ## DENTAL HYGIENE PROCEDURES Question 106: What are universal precautions? Answer: Treat all blood and body fluids as potentially infectious Question 107: What are standard precautions? Answer: Expanded universal precautions including respiratory hygiene and safe injection practices Question 108: What level of disinfection is required for dental instruments? Answer: Critical items: sterilization; Semi-critical: high-level disinfection or sterilization; Non-critical: low-level disinfection Question 109: What is the correct order for instrument processing? Answer: 1) Pre-clean 2) Clean/ultrasonic 3) Rinse 4) Dry 5) Package 6) Sterilize 7) Store Question 110: What temperature/time for steam autoclave sterilization? Answer: 250°F (121°C) for 30 minutes or 270°F (132°C) for 15 minutes Question 111: What are the 3 types of sterilization monitoring? Answer: 1) Mechanical (gauges) 2) Chemical (indicators) 3) Biological (spore tests) Question 112: How often should biological monitoring be performed? Answer: Weekly (or every cycle for implantable devices) Question 113: What is the recommended sharpening angle for scalers/curettes? Answer: 70-80 degrees between face and stone Question 114: What are the parts of a curette? Answer: Terminal shank, working end (face, lateral sides, back, toe), lower shank, functional shank, handle Question 115: What is the difference between universal and Gracey curettes? Answer: Universal: two cutting edges per end; Gracey: one cutting edge per end, area-specific Question 116: What is correct patient positioning? Answer: Supine (reclined flat) with feet level or slightly higher than head Question 117: What is the correct operator position? Answer: 9-12 o’clock position (right-handed), balanced posture, feet flat on floor Question 118: What is the fulcrum (finger rest)? Answer: Stabilization point for instrument control, usually ring finger on tooth surface Question 119: What is the correct angulation for scaling? Answer: 45-90 degrees (ideally 60-80 degrees) Question 120: What is the correct angulation for assessment? Answer: 0-40 degrees Question 121: What are the stroke types? Answer: Exploratory (light), working (moderate-firm), assessment (light) Question 122: What is the grasp for instruments? Answer: Modified pen grasp (thumb, index, middle finger) Question 123: What is selective polishing? Answer: Polishing only stained areas rather than all tooth surfaces Question 124: What grit of polishing paste should be used first? Answer: Coarse grit first, then medium, then fine (when needed) Question 125: What are contraindications for polishing? Answer: Exposed dentin/cementum, sensitive teeth, no stain present, recently erupted teeth Question 126: What is the purpose of fluoride application? Answer: Prevents decay by remineralization, inhibiting bacterial metabolism, making enamel more resistant to acid Question 127: What types of professional fluoride are available? Answer: Varnish (5% NaF), gel (1.23% APF or 2% NaF), foam Question 128: What is the recommended fluoride concentration for mouth rinse? Answer: 0.05% NaF daily or 0.2% NaF weekly Question 129: What are pit and fissure sealants? Answer: Resin material placed in occlusal grooves to prevent decay Question 130: What teeth are best for sealants? Answer: Newly erupted permanent molars and premolars with deep grooves Question 131: What is the retention rate for sealants? Answer: 85% at 1 year, 60% at 5 years (check and repair as needed) Question 132: What are contraindications for sealants? Answer: Existing decay in tooth, inability to isolate/keep dry, open/coalescent pits Question 133: What is the most critical step in sealant placement? Answer: Adequate moisture control and isolation Question 134: What is the difference between air polishing and traditional polishing? Answer: Air polishing uses powder/water/air stream; gentler, faster, reaches difficult areas Question 135: What powders are used for air polishing? Answer: Sodium bicarbonate, glycine, erythritol ----- ## NUTRITION Question 136: What nutrient is most associated with dental caries? Answer: Fermentable carbohydrates (sugars) Question 137: What is the Stephan Curve? Answer: Graph showing pH drop after sugar exposure and recovery time (20-40 minutes) Question 138: What pH is considered critical for enamel demineralization? Answer: 5.5 or below Question 139: What vitamin deficiency causes bleeding gums? Answer: Vitamin C (scurvy) Question 140: What vitamin deficiency causes angular cheilitis? Answer: B vitamins (especially B2-riboflavin) Question 141: What mineral is essential for bone and tooth formation? Answer: Calcium and phosphorus Question 142: What vitamin is needed for calcium absorption? Answer: Vitamin D Question 143: What are cariogenic foods? Answer: Foods that promote tooth decay (sugary, sticky, acidic) Question 144: What are cariostatic foods? Answer: Foods that don’t promote decay (proteins, fats, most vegetables) Question 145: What are anticariogenic foods? Answer: Foods that prevent decay (cheese, xylitol, fibrous vegetables) Question 146: Why is xylitol beneficial? Answer: Sugar alcohol that reduces S. mutans, stimulates saliva, doesn’t lower pH Question 147: What eating pattern is most cariogenic? Answer: Frequent snacking (constant acid attacks) Question 148: What is the MyPlate recommendation? Answer: 50% fruits/vegetables, 25% grains, 25% protein, plus dairy Question 149: What is the role of saliva in caries prevention? Answer: Buffering capacity, remineralization, antimicrobial properties, clearance Question 150: What medications can affect nutrition? Answer: Those causing xerostomia, altered taste, nausea, or GI issues Question 151: What nutritional counseling should you provide? Answer: Limit sugar frequency, choose nutritious foods, read labels, drink water Question 152: What is baby bottle tooth decay? Answer: Rampant caries in primary teeth from prolonged bottle/sippy cup use with sugary liquids Question 153: What teeth are affected by baby bottle decay? Answer: Maxillary incisors primarily (lower incisors protected by tongue) Question 154: What causes erosion from nutrition? Answer: Acidic foods/drinks (citrus, soda, sports drinks, wine) Question 155: What eating disorder causes palatal erosion? Answer: Bulimia nervosa (from vomiting) ----- ## COMMUNITY HEALTH Question 156: What is epidemiology? Answer: Study of distribution and determinants of disease in populations Question 157: What is prevalence? Answer: Total number of cases (existing) in a population at a given time Question 158: What is incidence? Answer: Number of new cases in a population over a specific time period Question 159: What is the DMF/DMFT index? Answer: Decayed, Missing, Filled Teeth (measures caries experience in permanent teeth) Question 160: What is the def/deft index? Answer: Decayed, extracted/indicated for extraction, filled teeth (for primary teeth) Question 161: What does a DMF of 0 mean? Answer: No caries experience (caries-free) Question 162: What is the Community Periodontal Index (CPI)? Answer: Measures periodontal status using: 0=healthy, 1=bleeding, 2=calculus, 3=4-5mm pocket, 4=6+mm pocket Question 163: What is the Plaque Index? Answer: Measures plaque accumulation (0=no plaque to 3=abundance of plaque) Question 164: What is the Gingival Index? Answer: Measures gingival inflammation (0=normal to 3=severe inflammation) Question 165: What is primary prevention? Answer: Prevents disease before it occurs (fluoride, sealants, education) Question 166: What is secondary prevention? Answer: Early detection and treatment (screenings, early caries treatment) Question 167: What is tertiary prevention? Answer: Manage existing disease, prevent complications (periodontal maintenance) Question 168: What is community water fluoridation level? Answer: 0.7 ppm (parts per million) Question 169: What percentage of caries reduction from water fluoridation? Answer: 25-40% reduction in children and adults Question 170: What is fluorosis? Answer: Enamel defect from excessive fluoride during tooth development Question 171: What causes dental fluorosis? Answer: Excessive fluoride intake (over 2 ppm) during enamel formation (under age 8) Question 172: What is the Dean’s Fluorosis Index? Answer: Classifies fluorosis: Normal, Questionable, Very Mild, Mild, Moderate, Severe Question 173: What are school-based sealant programs? Answer: Public health programs providing sealants to high-risk children in schools Question 174: What is the Healthy People 2030 goal for oral health? Answer: Increase access to preventive services and reduce oral disease disparities Question 175: What populations are at high risk for oral disease? Answer: Low income, elderly, racial/ethnic minorities, disabled, rural communities Question 176: What is health literacy? Answer: Ability to obtain, understand, and use health information to make decisions Question 177: What is cultural competence? Answer: Ability to interact effectively with people of different cultures Question 178: What is motivational interviewing? Answer: Patient-centered counseling to enhance motivation for behavior change Question 179: What are social determinants of health? Answer: Economic stability, education, healthcare access, neighborhood/environment, social context Question 180: What is the Oral Health Workforce? Answer: Dentists, dental hygienists, dental assistants, dental therapists, community health workers Question 181: What are barriers to dental care access? Answer: Cost, lack of insurance, transportation, provider shortage, fear/anxiety Question 182: What is Medicaid? Answer: Federal-state program providing healthcare coverage for low-income individuals Question 183: What is EPSDT? Answer: Early Periodic Screening, Diagnosis, and Treatment (Medicaid for children) Question 184: What is CHIP? Answer: Children’s Health Insurance Program for families who earn too much for Medicaid Question 185: What is Medicare? Answer: Federal program for adults 65+ (limited dental coverage) Question 186: What grants support community oral health? Answer: HRSA grants, state/local health departments, foundations Question 187: What is needs assessment? Answer: Process of identifying health problems and resources in a community Question 188: What are program evaluation components? Answer: Structure, process, outcome evaluation Question 189: What is evidence-based practice? Answer: Integration of best research evidence, clinical expertise, and patient values Question 190: What are the steps of evidence-based practice? Answer: 1) Ask question 2) Search evidence 3) Appraise evidence 4) Apply findings 5) Assess outcomes Question 191: What is the hierarchy of evidence? Answer: Systematic reviews, RCTs, Cohort studies, Case-control, Case series, Expert opinion Question 192: What is a randomized controlled trial (RCT)? Answer: Experimental study where subjects are randomly assigned to treatment or control groups Question 193: What is a cohort study? Answer: Observational study following groups over time to assess outcomes Question 194: What is a case-control study? Answer: Observational study comparing those with disease (cases) to those without (controls) Question 195: What is statistical significance (p-value)? Answer: p less than 0.05 typically indicates results unlikely due to chance ----- ## ETHICS & JURISPRUDENCE Question 196: What are the 4 principles of biomedical ethics? Answer: Autonomy, Beneficence, Non-maleficence, Justice Question 197: What is autonomy? Answer: Patient’s right to make their own healthcare decisions (informed consent) Question 198: What is beneficence? Answer: Obligation to do good and act in patient’s best interest Question 199: What is non-maleficence? Answer: Obligation to do no harm (“first, do no harm”) Question 200: What is justice? Answer: Fair and equitable treatment of all patients Question 201: What is informed consent? Answer: Patient’s voluntary agreement to treatment after receiving adequate information Question 202: What elements are required for informed consent? Answer: 1) Disclosure of information 2) Patient comprehension 3) Voluntary agreement 4) Competence Question 203: What is the scope of practice? Answer: Legal limits of what a dental hygienist can perform based on state law Question 204: What is direct supervision? Answer: Dentist must be physically present while hygienist works Question 205: What is indirect supervision? Answer: Dentist must be in facility but not in operatory Question 206: What is general supervision? Answer: Dentist authorizes work but doesn’t need to be present (varies by state) Question 207: What is HIPAA? Answer: Health Insurance Portability and Accountability Act (protects patient privacy) Question 208: What is PHI? Answer: Protected Health Information (any identifiable patient health information) Question 209: When can you disclose PHI without consent? Answer: Treatment/payment/operations, legal requirements, public health, abuse reporting Question 210: What is mandated reporting? Answer: Legal requirement to report suspected child/elder abuse or neglect Question 211: What are signs of child abuse? Answer: Unexplained injuries (especially head/face/neck), burns, bruises in various stages, behavioral changes Question 212: What is negligence/malpractice? Answer: Failure to provide standard of care resulting in patient harm Question 213: What are the 4 D’s of malpractice? Answer: Duty, Dereliction (breach), Direct cause, Damages Question 214: What is standard of care? Answer: Level of care that a reasonable, prudent professional would provide in similar circumstances Question 215: What is the difference between licensure and certification? Answer: Licensure: legal permission to practice; Certification: voluntary credential showing competency Question 216: What is continuing education (CE)? Answer: Ongoing education required to maintain licensure (requirements vary by state) Question 217: What is the dental hygiene code of ethics? Answer: Professional standards of conduct for dental hygienists (ADHA Code of Ethics) Question 218: What is veracity? Answer: Truthfulness and honesty in patient care and documentation Question 219: What is confidentiality? Answer: Obligation to protect patient information from unauthorized disclosure Question 220: What is the role of state dental boards? Answer: Regulate dental professionals, issue licenses, investigate complaints, enforce laws ----- ## SPECIAL NEEDS PATIENTS Question 221: What modifications are needed for pregnant patients? Answer: Avoid supine position in 3rd trimester, defer elective treatment to 2nd trimester, use left lateral tilt Question 222: What is the safest time for dental treatment during pregnancy? Answer: Second trimester (weeks 14-20) Question 223: What radiographs are safe during pregnancy? Answer: Necessary radiographs with lead apron and thyroid collar (radiation risk is minimal) Question 224: What considerations for elderly patients? Answer: Polypharmacy, xerostomia, mobility issues, cognitive changes, root caries risk Question 225: What is xerostomia? Answer: Dry mouth (reduced salivary flow) Question 226: What causes xerostomia? Answer: Medications (most common), radiation therapy, Sjögren’s syndrome, aging, dehydration Question 227: How do you manage xerostomia? Answer: Saliva substitutes, sugar-free gum/mints, frequent water sips, fluoride treatments, avoid alcohol/caffeine Question 228: What modifications for wheelchair users? Answer: Transfer to dental chair if possible, or treat in wheelchair with headrest, maintain accessibility Question 229: What is autism spectrum disorder (ASD)? Answer: Developmental disorder affecting communication and behavior Question 230: How do you treat patients with ASD? Answer: Short appointments, consistent routine, visual aids, desensitization, minimal sensory stimulation Question 231: What is Down syndrome? Answer: Genetic disorder (trisomy 21) with intellectual disability and characteristic features Question 232: What oral manifestations of Down syndrome? Answer: Increased periodontal disease, delayed eruption, macroglossia, geographic tongue Question 233: What is cerebral palsy? Answer: Movement disorder from brain injury affecting muscle tone and coordination Question 234: What dental considerations for cerebral palsy? Answer: Gag reflex issues, difficulty with oral hygiene, muscle spasms, may need sedation Question 235: What is epilepsy? Answer: Neurological disorder causing seizures Question 236: What are dental considerations for epilepsy patients? Answer: Avoid triggers (stress, flashing lights), phenytoin may cause gingival hyperplasia, seizure precautions Question 237: What do you do if a patient has a seizure in the dental chair? Answer: Protect from injury, turn on side, don’t restrain, clear airway, DO NOT put anything in mouth, call 911 if prolonged Question 238: What is diabetes mellitus? Answer: Metabolic disorder affecting blood glucose regulation (Type 1, Type 2, gestational) Question 239: What are oral manifestations of diabetes? Answer: Increased periodontal disease, xerostomia, delayed healing, candidiasis, increased caries risk Question 240: What is normal blood glucose range? Answer: Fasting: 70-100 mg/dL; Random: less than 140 mg/dL Question 241: What are signs of hypoglycemia? Answer: Shakiness, sweating, confusion, rapid heartbeat, hunger, irritability Question 242: How do you treat hypoglycemia? Answer: Give glucose immediately (juice, candy, glucose tablets), recheck in 15 minutes Question 243: What are signs of hyperglycemia? Answer: Frequent urination, excessive thirst, blurred vision, fatigue, fruity breath Question 244: When should diabetic patients schedule appointments? Answer: Mid-morning after breakfast and medication (when glucose is stable) Question 245: What cardiovascular considerations for dental treatment? Answer: Check blood pressure, manage stress/anxiety, limit epinephrine, monitor for symptoms Question 246: What is hypertension classification? Answer: Normal less than 120/80; Elevated 120-129/less than 80; Stage 1: 130-139/80-89; Stage 2: 140 or higher/90 or higher Question 247: When should you defer treatment based on blood pressure? Answer: Defer if systolic 180 or higher or diastolic 110 or higher (refer to physician) Question 248: What patients need stress reduction protocol? Answer: Cardiovascular disease, uncontrolled hypertension, anxiety, recent MI or stroke Question 249: What is stress reduction protocol? Answer: Morning appointments, adequate anesthesia, minimize waiting, nitrous oxide if needed, short appointments Question 250: What are contraindications to epinephrine? Answer: Uncontrolled hypertension, recent MI (within 6 months), uncontrolled hyperthyroidism, some drug interactions ----- ## MEDICAL EMERGENCIES Question 251: What emergency equipment is required in dental office? Answer: Oxygen, AED, emergency drug kit, blood pressure cuff, stethoscope, suction Question 252: What drugs should be in emergency kit? Answer: Epinephrine, aspirin, nitroglycerin, glucose, albuterol inhaler, diphenhydramine, ammonia inhalants Question 253: What is syncope? Answer: Fainting (most common dental emergency) Question 254: What causes syncope? Answer: Vasovagal response (stress, anxiety, pain), hypotension Question 255: How do you treat syncope? Answer: Position supine with legs elevated, loosen tight clothing, cold compress, ammonia inhalant if needed Question 256: What is orthostatic hypotension? Answer: Drop in blood pressure when standing (dizziness, lightheadedness) Question 257: How do you prevent orthostatic hypotension? Answer: Raise chair slowly, have patient sit upright for a minute before standing Question 258: What is anaphylaxis? Answer: Severe, life-threatening allergic reaction Question 259: What are signs of anaphylaxis? Answer: Difficulty breathing, hives, swelling, hypotension, rapid pulse, loss of consciousness Question 260: How do you treat anaphylaxis? Answer: Call 911, epinephrine (EpiPen) 0.3mg IM, position supine with legs elevated, oxygen, CPR if needed Question 261: What is an asthma attack? Answer: Bronchospasm causing difficulty breathing, wheezing Question 262: How do you treat asthma attack? Answer: Upright position, albuterol inhaler (2 puffs), oxygen, call 911 if no improvement Question 263: What is hyperventilation? Answer: Rapid breathing causing decreased CO2 (anxiety-related) Question 264: How do you treat hyperventilation? Answer: Calm patient, have them breathe slowly into cupped hands or paper bag, reassure Question 265: What is angina pectoris? Answer: Chest pain from insufficient blood flow to heart (often from exertion/stress) Question 266: How do you treat angina? Answer: Stop treatment, upright position, nitroglycerin 0.4mg sublingual (repeat every 5 min up to 3 doses), oxygen, call 911 if no relief Question 267: What is myocardial infarction (heart attack)? Answer: Blockage of coronary artery causing heart muscle damage Question 268: What are signs of MI? Answer: Crushing chest pain, pain radiating to arm/jaw/neck, shortness of breath, nausea, sweating Question 269: How do you treat MI? Answer: Call 911 immediately, position of comfort (usually upright), aspirin 325mg chew, oxygen, monitor vitals, CPR if needed Question 270: What is a stroke (CVA)? Answer: Interruption of blood flow to brain Question 271: What are signs of stroke (FAST)? Answer: Face drooping, Arm weakness, Speech difficulty, Time to call 911 Question 272: How do you treat stroke? Answer: Call 911 immediately, monitor vitals, position of comfort, oxygen, note time of symptom onset Question 273: What is a seizure? Answer: Abnormal electrical activity in brain causing convulsions Question 274: How long should you wait before calling 911 for a seizure? Answer: Call 911 if seizure lasts more than 5 minutes, multiple seizures, or patient is injured/pregnant/diabetic Question 275: What is the difference between rescue breathing and CPR? Answer: Rescue breathing: for patient with pulse but not breathing; CPR: for patient without pulse ----- ## INFECTION CONTROL Question 276: What is the chain of infection? Answer: 1) Infectious agent 2) Reservoir 3) Portal of exit 4) Mode of transmission 5) Portal of entry 6) Susceptible host Question 277: What are modes of disease transmission? Answer: Direct contact, indirect contact, droplet, airborne, bloodborne Question 278: What bloodborne pathogens are of concern? Answer: HIV, Hepatitis B, Hepatitis C Question 279: What is the risk of HIV transmission from needlestick? Answer: Approximately 0.3% Question 280: What is the risk of Hepatitis B transmission from needlestick? Answer: 6-30% (if source is HBsAg positive) Question 281: What is the risk of Hepatitis C transmission from needlestick? Answer: Approximately 1.8% Question 282: What should you do after a needlestick injury? Answer: Wash wound immediately, report to supervisor, document, seek medical evaluation, source testing, post-exposure prophylaxis if needed Question 283: What vaccine is available for dental workers? Answer: Hepatitis B vaccine (required by OSHA) Question 284: What is the Hepatitis B vaccine series? Answer: 3 doses: initial, 1 month later, 6 months after first dose Question 285: What PPE is required for patient care? Answer: Gloves, mask, protective eyewear, gown/jacket Question 286: When should you wash hands? Answer: Before/after gloves, before/after patient contact, after touching contaminated surfaces Question 287: What is the correct handwashing technique? Answer: 15-20 seconds with soap and water, covering all surfaces including between fingers Question 288: When can you use alcohol-based hand sanitizer? Answer: When hands are not visibly soiled (60% or higher alcohol) Question 289: What are critical instruments? Answer: Penetrate soft tissue or bone (must be sterilized) - scalpels, scalers, curettes Question 290: What are semi-critical instruments? Answer: Contact mucosa but don’t penetrate (high-level disinfection or sterilization) - mirrors, impression trays Question 291: What are non-critical instruments? Answer: Contact intact skin only (low-level disinfection) - blood pressure cuff, stethoscope Question 292: What is the difference between cleaning and disinfection? Answer: Cleaning: removes debris; Disinfection: kills most microorganisms; Sterilization: kills all microorganisms Question 293: What surfaces need disinfection between patients? Answer: All touched surfaces: light handles, chair controls, countertops, drawer handles Question 294: What disinfectant level for surfaces? Answer: Intermediate-level (tuberculocidal) EPA-registered hospital disinfectant Question 295: How do you handle contaminated sharps? Answer: Never recap needles (one-hand scoop if necessary), dispose in puncture-resistant sharps container immediately Question 296: What is the OSHA Bloodborne Pathogens Standard? Answer: Federal law requiring exposure control plan, training, PPE, Hep B vaccine, post-exposure protocol Question 297: What records must be maintained for infection control? Answer: Sterilization monitoring, employee training, exposure incidents, Hep B declination Question 298: How long should sterilization records be kept? Answer: Minimum 3 years (or per state requirements) Question 299: What is the purpose of surface barriers? Answer: Prevent contamination of surfaces, easier than disinfection between patients Question 300: When should gloves be changed? Answer: Between patients, when torn/punctured, before leaving operatory, when touching non-patient items ----- ## BONUS HIGH-YIELD CARDS Question 301: What is the primary etiologic factor of periodontal disease? Answer: Bacterial plaque biofilm Question 302: What host factors modify periodontal disease? Answer: Smoking, diabetes, genetics, stress, medications, hormones Question 303: What is the most important factor in preventing periodontal disease? Answer: Daily mechanical plaque removal (brushing and flossing) Question 304: What is the modified Bass technique? Answer: Bristles at 45-degree angle toward gingival sulcus, short back-and-forth strokes Question 305: How long should patients brush? Answer: 2 minutes minimum, twice daily Question 306: What type of toothbrush is recommended? Answer: Soft-bristled, small head, replaced every 3-4 months Question 307: What is the gold standard for interproximal cleaning? Answer: Dental floss (or interdental brushes for larger spaces) Question 308: What is the proper flossing technique? Answer: C-shape around tooth, below gumline, up and down motion, use clean section for each tooth Question 309: What is chlorhexidine? Answer: Antimicrobial mouth rinse (0.12% prescription) for short-term use (2 weeks) Question 310: What are side effects of chlorhexidine? Answer: Staining of teeth/tongue, altered taste, increased calculus Question 311: What concentration of fluoride is in OTC toothpaste? Answer: 1000-1500 ppm (0.1-0.15%) Question 312: What concentration of fluoride is in prescription toothpaste? Answer: 5000 ppm (0.5% - 1.1%) Question 313: When should children start using fluoride toothpaste? Answer: As soon as first tooth erupts (rice-sized amount under age 3) Question 314: How much toothpaste for children 3-6 years? Answer: Pea-sized amount Question 315: What is the best method for caries risk assessment? Answer: CAMBRA (Caries Management By Risk Assessment) Question 316: What factors increase caries risk? Answer: Frequent sugar intake, inadequate fluoride, xerostomia, deep pits/fissures, exposed roots, active caries Question 317: What is white spot lesion? Answer: Early caries (subsurface demineralization) that appears chalky white Question 318: Can white spot lesions be reversed? Answer: Yes, through remineralization (fluoride, calcium phosphate, good hygiene) Question 319: What is root caries? Answer: Decay on exposed root surface (cementum/dentin) Question 320: What is rampant caries? Answer: Sudden, widespread caries affecting multiple teeth Question 321: What is nursing caries? Answer: Early childhood caries from prolonged bottle/breastfeeding (especially at night) Question 322: At what age should first dental visit occur? Answer: By age 1 or within 6 months of first tooth eruption Question 323: What is the sequence of primary tooth eruption? Answer: Central incisors (6-10 mo), Lateral incisors (9-13 mo), First molars (13-19 mo), Canines (16-22 mo), Second molars (25-33 mo) Question 324: What is the sequence of permanent tooth eruption? Answer: First molars (6 yrs), Central incisors (6-7 yrs), Lateral incisors (7-8 yrs), Canines (9-12 yrs), Premolars (10-12 yrs), Second molars (11-13 yrs), Third molars (17-21 yrs) Question 325: What teeth are called “6-year molars”? Answer: First permanent molars Question 326: What is exfoliation? Answer: Normal shedding of primary teeth Question 327: What is the difference between intrinsic and extrinsic stain? Answer: Intrinsic: within tooth structure; Extrinsic: on tooth surface (can be removed) Question 328: What causes extrinsic stain? Answer: Coffee, tea, tobacco, chlorhexidine, poor hygiene Question 329: What causes intrinsic stain? Answer: Tetracycline, fluorosis, trauma, systemic conditions during development Question 330: What is dentin hypersensitivity? Answer: Sharp pain from exposed dentin responding to stimuli (cold, sweet, touch) Question 331: What causes sensitivity? Answer: Exposed dentin tubules from gingival recession, erosion, abrasion, attrition Question 332: How do you treat sensitivity? Answer: Desensitizing toothpaste (potassium nitrate), fluoride varnish, bonding agents, reduce acidic foods Question 333: What is erosion? Answer: Chemical wear from acids (not bacterial) Question 334: What is abrasion? Answer: Mechanical wear from external forces (toothbrush, toothpick) Question 335: What is attrition? Answer: Mechanical wear from tooth-to-tooth contact (grinding, chewing) Question 336: What is abfraction? Answer: Notch-like defects at cervical area from occlusal stress (flexion) Question 337: What is bruxism? Answer: Grinding or clenching of teeth (often during sleep) Question 338: How do you manage bruxism? Answer: Occlusal guard/night guard, stress reduction, address occlusal issues Question 339: What is malocclusion? Answer: Improper alignment of teeth and jaws Question 340: What is Angle’s Classification? Answer: Class I (normal), Class II (overbite/retrognathic), Class III (underbite/prognathic) Question 341: What is overjet? Answer: Horizontal overlap of anterior teeth (normal 2-3mm) Question 342: What is overbite? Answer: Vertical overlap of anterior teeth (normal 2-3mm) Question 343: What is open bite? Answer: No contact between anterior teeth when posterior teeth are together Question 344: What is crossbite? Answer: Upper teeth inside lower teeth (can be anterior or posterior) Question 345: What are indications for orthodontic treatment? Answer: Malocclusion, crowding, spacing, overbite/overjet, crossbite, functional issues Question 346: What is oral cancer screening? Answer: Visual and tactile examination of all oral tissues for abnormalities Question 347: What are risk factors for oral cancer? Answer: Tobacco, alcohol, HPV (especially HPV-16), sun exposure (lips), age over 40 Question 348: What do you do if you find a suspicious lesion? Answer: Document (size, location, appearance), refer for biopsy if doesn’t resolve in 2 weeks Question 349: What is the most common site for oral cancer metastasis? Answer: Cervical lymph nodes Question 350: What is the 5-year survival rate for oral cancer? Answer: 66% overall (higher if detected early, lower if late stage) -----

Card 1 FRONT: What are the 4 muscles of mastication? **BACK:** “My Mouth Takes Large Portions” - Masseter (strongest closer) - Medial pterygoid (closer) - Temporalis (closer, fan-shaped) - Lateral Pterygoid (ONLY opener!) ### Card 2 FRONT: What are the branches of the trigeminal nerve (CN V)? **BACK:** “Oh My, Three!” - Ophthalmic (V1) - forehead, upper eyelid - Maxillary (V2) - upper teeth, lip, cheek - Three = Mandibular (V3) - lower teeth, lip, chin ### Card 3 FRONT: What are the cranial bones? **BACK:** “Front Porch Seems Too Expensive” - Frontal, Parietal (2), Sphenoid, Temporal (2), Ethmoid ### Card 4 FRONT: What are the facial bones? **BACK:** “My New Zebra Likes Vanilla Ice Cream Pastries” - Maxilla (2), Nasal (2), Zygomatic (2), Lacrimal (2), Vomer, Inferior nasal conchae (2), Palatine (2) ### Card 5 FRONT: What are the periodontal structures? **BACK:** “Good Cats Prefer Large Bones” - Gingiva, Cementum, Periodontal Ligament, Bone (alveolar) ### Card 6 FRONT: What are the tooth surfaces? **BACK:** “My Dog Likes Fish Intestines” - Mesial, Distal, Lingual, Facial, Incisal/occlusal ### Card 7 FRONT: Permanent teeth formula per quadrant? **BACK:** 2-1-2-3 = 2 incisors, 1 canine, 2 premolars, 3 molars Total: 32 teeth ### Card 8 FRONT: Primary teeth formula per quadrant? **BACK:** 2-1-2 = 2 incisors, 1 canine, 2 molars Total: 20 teeth ### Card 9 FRONT: Which salivary glands produce what percentage of saliva? **BACK:** “People Spit Mostly Mixed Stuff” - Parotid: 25% (serous/watery) - Submandibular: 70% (mixed) - Minor glands: 5% (mucous) ### Card 10 FRONT: What are the functions of saliva? **BACK:** “Luscious Drinks Cleanse And Buffer Readily” - Lubrication, Digestion, Cleansing, Antibacterial, Buffering, Remineralization ### Card 11 FRONT: Normal saliva pH range? **BACK:** 6.7-7.3 Critical pH for enamel: 5.5 ### Card 12 FRONT: Normal vital signs? **BACK:** “98-72-16-120/80” - Temp: 98.6°F, Pulse: 72 bpm, Resp: 16/min, BP: 120/80 mmHg ### Card 13 FRONT: Blood pressure categories? **BACK:** “Normal People Hate High Blood Pressure” - Normal: <120/80 - Stage 1: 130-139/80-89 - Stage 2: ≥140/90 - Crisis: >180/120 ### Card 14 FRONT: ASA physical status classifications? **BACK:** “Healthy People Sometimes Have Serious Life-threatening Problems” - I: Healthy, II: Mild disease, III: Severe disease, IV: Life-threatening, V: Moribund, VI: Brain dead ### Card 15 FRONT: What is the temporomandibular joint? **BACK:** Only moveable joint in skull - Condyle + fossa + disc - Lateral pterygoid opens jaw - All other muscles close jaw ### Card 16 FRONT: Universal tooth numbering for adults? **BACK:** 1-32, start upper right, go clockwise - Uppers: 1-16 (right to left) - Lowers: 17-32 (left to right) ### Card 17 FRONT: Universal tooth numbering for children? **BACK:** A-T, same pattern as adults - Uppers: A-J - Lowers: K-T ### Card 18 FRONT: What is clinical attachment level (CAL)? **BACK:** CAL = Probing Depth + Recession If no recession, CAL = Probing Depth ### Card 19 FRONT: Normal daily saliva production? **BACK:** 1.0-1.5 liters per day ### Card 20 FRONT: Critical pH levels? BACK: - Enamel demineralization: 5.5 - Dentin demineralization: 6.0-6.2 ### Card 21 FRONT: Which nerve provides motor to muscles of facial expression? **BACK:** Facial nerve (CN VII) CN V provides sensory to face ### Card 22 FRONT: What are the components of acquired pellicle? **BACK:** Proteins from saliva that form within minutes of tooth cleaning ### Card 23 FRONT: Plaque formation timeline? **BACK:** “Acquired Bacterial Communities Mature” - Acquired pellicle (minutes) - Bacterial attachment (2-4 hours) - Colonization (4-24 hours) - Maturation (1-21 days) ### Card 24 FRONT: What is the gingival sulcus depth in health? **BACK:** 0.5-3.0mm with no bleeding on probing ### Card 25 FRONT: Types of gingiva? BACK: - Free gingiva: 0-1.5mm, not attached - Attached gingiva: Firmly bound to bone - Interdental papilla: Between teeth ----- ## 🦠 MICROBIOLOGY & PATHOLOGY (Cards 26-50) ### Card 26 FRONT: Main caries bacteria? **BACK:** “Sweet Stuff Loves Sugar” - Streptococcus mutans (initiates) - Streptococcus sobrinus (initiates) - Lactobacillus (progresses) ### Card 27 FRONT: Main periodontal pathogens? **BACK:** “People Are Truly Terrible” - Porphyromonas gingivalis - Aggregatibacter actinomycetemcomitans - Tannerella forsythia - Treponema denticola ### Card 28 FRONT: Which bacteria is black-pigmented? **BACK:** Porphyromonas gingivalis ### Card 29 FRONT: Which bacteria causes aggressive periodontitis? **BACK:** Aggregatibacter actinomycetemcomitans (Aa) ### Card 30 FRONT: Standard precautions mean? **BACK:** Treat all patients as potentially infectious Use same precautions for everyone ### Card 31 FRONT: PPE sequence putting on? **BACK:** “Go Make Eyes Great” - Gowns, Mask, Eyewear, Gloves ### Card 32 FRONT: PPE sequence taking off? **BACK:** “Great Eyes Make Good” - Gowns, Gloves, Eyewear, Mask (cleanest last) ### Card 33 FRONT: Sterilization methods and temperatures? **BACK:** “Steam at 250, Chemical at 270, Dry at 340” - Steam: 250°F (121°C) × 15-20 min - Chemical vapor: 270°F (132°C) × 20 min - Dry heat: 340°F (171°C) × 60 min ### Card 34 FRONT: Most common oral cancer type? **BACK:** Squamous cell carcinoma (90%) Most common location: floor of mouth, lateral tongue ### Card 35 FRONT: Leukoplakia vs erythroplakia malignant potential? **BACK:** “White Worries (5%), Red Runs (50%)” - Leukoplakia: 5% malignant potential - Erythroplakia: 50% malignant potential ### Card 36 FRONT: Oral lichen planus characteristic? **BACK:** Wickham’s striae (white striations) Autoimmune condition ### Card 37 FRONT: Most common cause of xerostomia? **BACK:** Medications (especially in elderly) ### Card 38 FRONT: Disinfection levels? **BACK:** “High Is Hot, Low Is Light” - High-level: kills all except spores (glutaraldehyde) - Intermediate: kills vegetative bacteria, most viruses (70% alcohol) - Low-level: kills vegetative bacteria, some viruses (quaternary ammonium) ### Card 39 FRONT: What is candidiasis? **BACK:** Fungal infection (yeast) Treatment: Antifungals like nystatin or fluconazole ### Card 40 FRONT: Signs of oral cancer? BACK: - Red or white patches that don’t heal - Ulcers lasting >2 weeks - Lumps or thickening - Difficulty swallowing ### Card 41 FRONT: Risk factors for oral cancer? **BACK:** “TAH” - Tobacco use - Alcohol consumption - HPV infection (especially HPV 16) ### Card 42 FRONT: Necrotizing ulcerative gingivitis (NUG) features? BACK: - Punched-out papillae - Pseudomembrane - Pain and bleeding - Halitosis ### Card 43 FRONT: Aphthous ulcers (canker sores) characteristics? BACK: - Painful, round/oval - Yellow-white center, red border - Heal in 7-14 days - Recurrent ### Card 44 FRONT: Herpes simplex virus features? BACK: - Primary: painful vesicles, fever, malaise - Secondary: cold sores, less severe - Contagious when vesicles present ### Card 45 FRONT: Fordyce granules are? **BACK:** Normal variant - ectopic sebaceous glands Yellow spots on buccal mucosa, no treatment needed ### Card 46 FRONT: Torus palatinus characteristics? BACK: - Benign bony growth on hard palate - More common in females - No treatment unless interferes with function ### Card 47 FRONT: Geographic tongue features? BACK: - Migratory patches on tongue - Red areas with white borders - Benign, no treatment needed ### Card 48 FRONT: Black hairy tongue cause? **BACK:** Poor oral hygiene, smoking, antibiotics Treatment: improve oral hygiene, tongue scraping ### Card 49 FRONT: Oral thrush appearance? **BACK:** White plaques that can be wiped off Reveals red, raw surface underneath ### Card 50 FRONT: Gingival recession classification? **BACK:** Miller Classification: - Class I: No bone/tissue loss - Class II: Extends to mucogingival junction - Class III: Beyond mucogingival junction - Class IV: Severe bone/tissue loss ----- ## 💊 PHARMACOLOGY COMPLETE (Cards 51-85) ### Card 51 FRONT: Lidocaine max dose per kg? **BACK:** 4.4 mg/kg (“Lucky 4”) ### Card 52 FRONT: Calculate: 70kg patient lidocaine max? **BACK:** 308mg max = 8.5 cartridges 70 × 4.4 = 308mg ÷ 36mg per cartridge ### Card 53 FRONT: Articaine max dose per kg? **BACK:** 7.0 mg/kg (“Awesome 7”) ### Card 54 FRONT: Mepivacaine max dose per kg? **BACK:** 4.4 mg/kg (same as lidocaine) ### Card 55 FRONT: Prilocaine max dose per kg? **BACK:** 6.0 mg/kg ### Card 56 FRONT: Local anesthetic toxicity signs? **BACK:** “Dizzy Talking Tingly Convulsing” - Dizziness, Tinnitus, Tongue numbness, Convulsions ### Card 57 FRONT: Epinephrine contraindications? **BACK:** “Heart Problems Can’t Handle Extra Pressure” - Recent MI, uncontrolled HTN, arrhythmias, hyperthyroid, pheochromocytoma ### Card 58 FRONT: Lidocaine duration without epi? **BACK:** 30-45 minutes (60-90 with epi) ### Card 59 FRONT: Articaine duration without epi? **BACK:** 45-60 minutes (75-90 with epi) ### Card 60 FRONT: Ibuprofen dosing? **BACK:** 200-800mg q6-8h, max 3200mg/day ### Card 61 FRONT: Naproxen dosing? **BACK:** 220-440mg q12h, max 1320mg/day ### Card 62 FRONT: Acetaminophen dosing? **BACK:** 325-1000mg q4-6h, max 3000-4000mg/day ### Card 63 FRONT: NSAID contraindications? **BACK:** “Bleeding Peptic Kidney Asthma” - Bleeding disorders, Peptic ulcers, Kidney disease, Asthma (aspirin) ### Card 64 FRONT: Safest pain med in pregnancy? **BACK:** Acetaminophen Avoid NSAIDs, especially 3rd trimester ### Card 65 FRONT: Acetaminophen overdose causes? **BACK:** Liver damage (hepatotoxicity) ### Card 66 FRONT: First-choice antibiotic for dental infections? **BACK:** Amoxicillin 500mg TID × 7-10 days ### Card 67 FRONT: Penicillin allergy alternative? **BACK:** Clindamycin 150-300mg QID × 7-10 days ### Card 68 FRONT: Metronidazole indication and dose? **BACK:** Anaerobic infections, 500mg BID × 7-10 days ### Card 69 FRONT: Who needs antibiotic prophylaxis? **BACK:** “PHAT Patients” - Prosthetic heart valves - History of endocarditis - Artificial joints (controversial) - Transplant with cardiac issues ### Card 70 FRONT: Standard prophylaxis regimen? **BACK:** Amoxicillin 2g, 1 hour before “2 Before 1” ### Card 71 FRONT: Prophylaxis for PCN allergy? **BACK:** Clindamycin 600mg, 1 hour before ### Card 72 FRONT: Warfarin patient concerns? **BACK:** Increased bleeding risk Check INR, apply pressure, hemostatic agents ### Card 73 FRONT: Nitrous oxide contraindications? **BACK:** “COPD Pregnancy Claustrophobia Eye/Ear” - Severe COPD, 1st trimester pregnancy, claustrophobia, recent eye/ear surgery ### Card 74 FRONT: Nitrous oxide concentration for dental procedures? **BACK:** 30-50% nitrous oxide with oxygen Never give 100% nitrous oxide ### Card 75 FRONT: Signs of nitrous oxide overdose? **BACK:** Nausea, vomiting, headache, dizziness Treatment: reduce concentration, give 100% oxygen ### Card 76 FRONT: Fluoride toxicity signs? **BACK:** “Nausea Vomiting Diarrhea Heart” - Nausea, vomiting, diarrhea, hypocalcemia, cardiac arrhythmias ### Card 77 FRONT: Acute fluoride toxicity treatment? BACK: - Calcium (milk, calcium chloride) - Supportive care - Monitor cardiac status ### Card 78 FRONT: Controlled substance schedules? BACK: - Schedule II: High abuse potential (opioids) - Schedule III: Moderate abuse potential - Schedule IV: Low abuse potential (benzodiazepines) ### Card 79 FRONT: Conscious sedation monitoring? **BACK:** Vitals, pulse oximetry, verbal response Patient must remain responsive ### Card 80 FRONT: Corticosteroid uses in dentistry? BACK: - Reduce post-surgical swelling - Lichen planus treatment - Aphthous ulcer treatment ### Card 81 FRONT: Antifungal medications? BACK: - Nystatin: Topical for oral candidiasis - Fluconazole: Systemic antifungal ### Card 82 FRONT: Drug interactions with warfarin? BACK: - Increase bleeding: Aspirin, NSAIDs, some antibiotics - Monitor INR closely ### Card 83 FRONT: Bisphosphonate considerations? **BACK:** Risk of osteonecrosis of jaw (BRONJ) Avoid extractions if possible, coordinate with physician ### Card 84 FRONT: Pregnancy drug categories? BACK: - Category A: Safe (none in dentistry) - Category B: Safe (amoxicillin, acetaminophen) - Category C: Caution (lidocaine) - Category D: Avoid (tetracycline) ### Card 85 FRONT: Local anesthetic with fastest onset? **BACK:** Articaine (crosses tissues well) ----- ## 🚨 MEDICAL EMERGENCIES COMPLETE (Cards 86-115) ### Card 86 FRONT: Most common dental emergency? **BACK:** Syncope (fainting) - 50%+ of emergencies ### Card 87 FRONT: Syncope treatment? **BACK:** “Lie Low Give Flow” - Lie supine, lift legs, give oxygen, ensure airway flow ### Card 88 FRONT: Early syncope signs? **BACK:** Pale, sweating, nausea, dizzy, weak ### Card 89 FRONT: Anaphylaxis signs? **BACK:** “BASH” - Breathing difficulty, Airway swelling, Shock, Hives ### Card 90 FRONT: Anaphylaxis treatment? **BACK:** Epinephrine 0.3mg IM FIRST, call 911, oxygen ### Card 91 FRONT: Mild allergic reaction treatment? **BACK:** Stop, antihistamine (Benadryl 25-50mg), monitor ### Card 92 FRONT: Chest pain treatment? **BACK:** “MONA” - Oxygen, Nitroglycerin, Aspirin + call 911 ### Card 93 FRONT: Heart attack signs? **BACK:** “CHEST” - Crushing pain, Heavy feeling, Extends to arm/jaw, Shortness of breath, Tingling ### Card 94 FRONT: CPR compression guidelines? BACK: - Rate: 100-120/min - Depth: 2+ inches - Location: Lower breastbone - Ratio: 30:2 ### Card 95 FRONT: AED use steps? BACK: 1. Turn on AED 1. Attach pads as shown 1. Clear area, analyze 1. Shock if advised 1. Resume CPR ### Card 96 FRONT: Seizure management? **BACK:** “Protect Time Turn” - Protect from injury, time duration, turn on side after ### Card 97 FRONT: Never do during seizure? **BACK:** Nothing in mouth, don’t restrain, no fluids ### Card 98 FRONT: When call 911 for seizure? **BACK:** >5 minutes, first seizure, injury, multiple seizures ### Card 99 FRONT: Hypoglycemia signs? **BACK:** “TIRED” - Trembling, Irritable, Rapid pulse, Excessive sweating, Drowsy ### Card 100 FRONT: Hypoglycemia treatment? **BACK:** Conscious: sugar/juice, Unconscious: 911 + NO oral glucose ### Card 101 FRONT: Hyperglycemia signs? **BACK:** “DRY” - Dehydration, Rapid deep breathing, Yawning + fruity breath, thirst ### Card 102 FRONT: Hyperglycemia treatment? **BACK:** Usually not emergency, needs insulin, NO sugar ### Card 103 FRONT: Asthma attack signs? **BACK:** “WHEEZE” - Wheezing, Hard to breathe, Exhaustion, Emotional distress ### Card 104 FRONT: Asthma treatment? **BACK:** “AIR” - Albuterol 2 puffs, Increase sitting, Remove triggers + oxygen ### Card 105 FRONT: Stroke signs? **BACK:** “FAST” - Face droop, Arm weak, Speech slurred, Time = 911 ### Card 106 FRONT: Stroke management? **BACK:** 911, head up 30°, oxygen, nothing by mouth, document time ### Card 107 FRONT: Hyperventilation signs? **BACK:** Rapid shallow breathing, dizziness, tingling hands/feet ### Card 108 FRONT: Hyperventilation treatment? **BACK:** Calm patient, slow breathing, paper bag, remove CO2 deficit ### Card 109 FRONT: Airway obstruction (choking) - conscious? **BACK:** Encourage coughing, back blows, Heimlich maneuver ### Card 110 FRONT: Airway obstruction - unconscious? **BACK:** Begin CPR immediately (compressions may dislodge object) ### Card 111 FRONT: Local anesthetic overdose treatment? BACK: - Stop injection immediately - Position supine - Oxygen 100% - Monitor vitals - Supportive care ### Card 112 FRONT: Emergency drug kit essentials? BACK: - Epinephrine, oxygen, albuterol - Antihistamine, aspirin, glucose - Nitroglycerin, atropine ### Card 113 FRONT: Orthostatic hypotension management? **BACK:** Raise chair slowly, let patient sit briefly before standing ### Card 114 FRONT: Insulin shock vs diabetic coma? BACK: - Insulin shock: Hypoglycemia, give sugar - Diabetic coma: Hyperglycemia, needs insulin ### Card 115 FRONT: Thyroid storm signs? **BACK:** High fever, rapid pulse, agitation, confusion Medical emergency - call 911 ----- ## 🏘 COMMUNITY HEALTH & RESEARCH COMPLETE (Cards 116-170) ### Card 116 FRONT: Optimal water fluoride level? **BACK:** 0.7 ppm (current CDC/ADA recommendation) ### Card 117 FRONT: Water fluoridation caries reduction? **BACK:** 20-40% (most cost-effective prevention) ### Card 118 FRONT: Water fluoridation cost? **BACK:** ~$1/person/year (large communities) ### Card 119 FRONT: Prevalence vs incidence? **BACK:** “Pool vs Flow” - Prevalence: total cases at one time - Incidence: new cases over time period ### Card 120 FRONT: Sensitivity vs specificity? **BACK:** “Sees Sickness vs Spots Soundness” - Sensitivity: finds disease (few false negatives) - Specificity: rules out disease (few false positives) ### Card 121 FRONT: Best test characteristic for screening? **BACK:** High sensitivity (catches most disease) ### Card 122 FRONT: Best test characteristic for confirmation? **BACK:** High specificity (few false positives) ### Card 123 FRONT: Four epidemiological study types? **BACK:** “Cross Cohort Case Clinical” - Cross-sectional, Cohort, Case-control, Clinical trial ### Card 124 FRONT: Which study follows people forward in time? **BACK:** Cohort study (measures incidence) ### Card 125 FRONT: Which study provides snapshot at one time? **BACK:** Cross-sectional study (measures prevalence) ### Card 126 FRONT: Which study compares cases to controls? **BACK:** Case-control study (retrospective) ### Card 127 FRONT: Gold standard for testing interventions? **BACK:** Randomized controlled trial (RCT) ### Card 128 FRONT: Health Belief Model components? **BACK:** “People Change When They Believe” - Susceptibility, severity, benefits, barriers, cues, efficacy ### Card 129 FRONT: Stages of Change? **BACK:** “People Can Prepare, Act, Maintain” - Precontemplation, Contemplation, Preparation, Action, Maintenance ### Card 130 FRONT: Social Cognitive Theory key concepts? BACK: - Self-efficacy (confidence in ability) - Observational learning (modeling) - Reciprocal determinism (person-behavior-environment interaction) ### Card 131 FRONT: Program planning steps? **BACK:** “Assess Plan Implement Evaluate” ### Card 132 FRONT: Process evaluation measures? **BACK:** “How well implemented” - participation rates, reach, fidelity ### Card 133 FRONT: Outcome evaluation measures? **BACK:** “Immediate changes” - knowledge, attitudes, behaviors ### Card 134 FRONT: Impact evaluation measures? **BACK:** “Long-term changes” - disease reduction, health status ### Card 135 FRONT: Child’s first dental visit timing? **BACK:** Age 1 OR within 6 months of first tooth (whichever first) ### Card 136 FRONT: Fluoride toothpaste amounts by age? BACK: - <3 years: Smear (rice grain) - 3-6 years: Pea-size (supervised) - 6+ years: Independent use ### Card 137 FRONT: Early Childhood Caries main cause? **BACK:** Prolonged bottle feeding with sugary liquids ### Card 138 FRONT: Sealants most cost-effective when? **BACK:** Newly erupted permanent molars, ages 6-14 ### Card 139 FRONT: Most common oral problem in elderly? **BACK:** Periodontal disease ### Card 140 FRONT: Most common cause of xerostomia? **BACK:** Medications (polypharmacy) ### Card 141 FRONT: Four core ethical principles? **BACK:** “Justice And Beneficence Never Harms” - Justice, Autonomy, Beneficence, Non-maleficence ### Card 142 FRONT: Informed consent requires? **BACK:** Understanding risks, benefits, alternatives, consequences ### Card 143 FRONT: When breach confidentiality? **BACK:** When required by law - abuse reporting, communicable disease ### Card 144 FRONT: Greatest oral health disparities? **BACK:** Minorities, low income, rural, disabled, elderly ### Card 145 FRONT: Social determinants of health? **BACK:** Income, education, access, housing, community resources ### Card 146 FRONT: School rinse programs most beneficial where? **BACK:** Non-fluoridated communities ### Card 147 FRONT: Daily school rinse concentration? **BACK:** 0.05% sodium fluoride ### Card 148 FRONT: Weekly school rinse concentration? **BACK:** 0.2% sodium fluoride ### Card 149 FRONT: What does DMFT measure? **BACK:** Decayed, Missing, Filled Teeth - caries experience index ### Card 150 FRONT: What does DMFS measure? **BACK:** Decayed, Missing, Filled Surfaces - more detailed than DMFT ### Card 151 FRONT: What is OHI-S? **BACK:** Oral Hygiene Index-Simplified - Measures debris and calculus - Scale 0-3 per surface ### Card 152 FRONT: What is Community Periodontal Index (CPI)? **BACK:** Measures periodontal status - Bleeding, calculus, shallow pockets, deep pockets ### Card 153 FRONT: What is NHANES? **BACK:** National Health and Nutrition Examination Survey Tracks US population oral health ### Card 154 FRONT: What are the types of fluoride programs? **BACK:** “Water Wins, Salt Sometimes, Milk Maybe” - Water fluoridation (most effective) - Salt fluoridation, milk fluoridation (some countries) ### Card 155 FRONT: Professional fluoride concentrations? BACK: - APF gel: 1.23% (12,300 ppm) - Neutral NaF: 2% (9,000 ppm) - Varnish: 5% NaF (22,600 ppm) ### Card 156 FRONT: What is incidence rate? **BACK:** Number of new cases ÷ person-time at risk More precise than simple incidence proportion ### Card 157 FRONT: Cost-effectiveness analysis compares what? **BACK:** Costs per unit of health outcome Examples: $/QALY, $/case prevented, $/life-year saved ### Card 158 FRONT: Diffusion of Innovations theory stages? **BACK:** “Innovators Are Early Late Laggards” - Innovators (2.5%), Arly adopters (13.5%), Early majority (34%), Late majority (34%), Laggards (16%) ### Card 159 FRONT: What is cultural competence? **BACK:** Ability to provide effective care across cultures - Awareness of own biases - Knowledge of other cultures - Cross-cultural skills - Cultural encounters ### Card 160 FRONT: Health promotion vs disease prevention? BACK: - Health promotion: Enhance well-being - Disease prevention: Prevent specific diseases ----- ## 🦷 CLINICAL SKILLS & INSTRUMENTATION (Cards 161-185) ### Card 161 FRONT: Gracey curette design features? BACK: - Area-specific (one working edge) - Offset blade at 60-70° angle - Rounded toe - Curved in two planes ### Card 162 FRONT: Universal curette vs Gracey curette? BACK: - Universal: Both cutting edges, 90° angle - Gracey: One cutting edge, 60-70° offset ### Card 163 FRONT: Which Gracey curettes for anterior teeth? **BACK:** Gracey 1-2 and 3-4 ### Card 164 FRONT: Which Gracey curettes for posterior teeth? **BACK:** Gracey 7-8, 9-10, 11-12, 13-14 ### Card 165 FRONT: Ultrasonic scaler mechanism? **BACK:** High-frequency vibrations (25,000-50,000 Hz) - Creates cavitation - Water lavage cools and flushes ### Card 166 FRONT: Ultrasonic scaler contraindications? BACK: - Cardiac pacemaker (older models) - Communicable respiratory disease - Demineralized areas - Newly erupted teeth ### Card 167 FRONT: Proper instrument grasp? **BACK:** Modified pen grasp - Thumb and index finger hold - Middle finger rest - Ring finger fulcrum ### Card 168 FRONT: Instrument sharpening test? **BACK:** Plastic test stick - Sharp instrument catches/bites - Dull instrument slides ### Card 169 FRONT: Signs of dull instruments? BACK: - Burnished calculus - Increased pressure needed - Patient discomfort - Poor tactile sensation ### Card 170 FRONT: Air polishing contraindications? BACK: - Respiratory conditions (asthma, COPD) - Infectious diseases - Soft tissue lesions - Exposed dentin/cementum ### Card 171 FRONT: Probing technique principles? BACK: - Light pressure (10-20 grams) - Walking stroke (1-2mm increments) - Parallel to tooth surface - Six measurements per tooth ### Card 172 FRONT: Bleeding on probing significance? **BACK:** Indicates inflammation - Present in gingivitis and periodontitis - May persist after clinical healing ### Card 173 FRONT: Furcation involvement classifications? BACK: - Class I: Incipient, <3mm horizontal - Class II: Partial, >3mm horizontal - Class III: Through-and-through ### Card 174 FRONT: Mobility classifications? BACK: - Class I: 0.2-1mm horizontal - Class II: >1mm horizontal - Class III: >1mm horizontal + vertical ### Card 175 FRONT: Root surface debridement goals? BACK: - Remove bacterial deposits - Smooth root surface - Remove bacterial toxins - Create biocompatible surface ### Card 176 FRONT: Post-scaling instructions? BACK: - Expect sensitivity/soreness - Warm salt water rinses - Soft diet initially - Avoid smoking/alcohol - Continue oral hygiene ### Card 177 FRONT: Healing after scaling timeline? BACK: - 1 week: Initial soft tissue healing - 2-4 weeks: Epithelial attachment - 1-3 months: Collagen maturation ### Card 178 FRONT: Maintenance interval determination? **BACK:** Based on: - Disease severity - Patient compliance - Risk factors - Response to therapy ### Card 179 FRONT: Desensitizing agents mechanism? BACK: - Nerve conduction blocking (potassium nitrate) - Tubule occlusion (fluoride, calcium) - Protein precipitation (glutaraldehyde) ### Card 180 FRONT: Pit and fissure sealant procedure? **BACK:** “Clean Etch Dry Apply Cure Check” 1. Clean surface 1. Etch 15-20 seconds 1. Dry (chalky appearance) 1. Apply sealant 1. Light cure 1. Check occlusion ### Card 181 FRONT: Sealant failure causes? BACK: - Moisture contamination - Inadequate etching - Poor isolation - Overfilling ### Card 182 FRONT: Fluoride application protocol? BACK: - Dry teeth thoroughly - Apply evenly - Contact time: 1-4 minutes - No eating/drinking 30 minutes ### Card 183 FRONT: Professional fluoride indications? BACK: - High caries risk - Root exposure - Orthodontic patients - Xerostomia patients - Special needs ### Card 184 FRONT: Dental hygiene diagnosis components? BACK: - Problem identification - Etiology - Signs and symptoms - Risk factors ### Card 185 FRONT: Treatment planning phases? BACK: - Phase I: Disease control (OH, SRP) - Phase II: Surgical/restorative - Phase III: Maintenance ----- ## 📸 RADIOGRAPHIC INTERPRETATION (Cards 186-205) ### Card 186 FRONT: Bitewing radiographs best show? **BACK:** “Caries Crown Bone Between” - Interproximal caries - Crown margins - Bone levels - Between-teeth pathology ### Card 187 FRONT: Periapical radiographs best show? **BACK:** “Root Tips And Bone Around” - Root tips and morphology - Apical pathology - Bone around entire tooth ### Card 188 FRONT: Panoramic radiographs best show? **BACK:** Overview of: - All teeth and supporting structures - TMJ - Sinuses - Pathology screening ### Card 189 FRONT: Radiolucent vs radiopaque? BACK: - Radiolucent: Dark (caries, PDL space, pulp) - Radiopaque: Light (enamel, dentin, bone, metal) ### Card 190 FRONT: Early caries appearance on radiograph? **BACK:** Triangular radiolucency - Apex points toward DEJ - Base at surface ### Card 191 FRONT: Advanced caries appearance? **BACK:** Extends into dentin - May involve pulp - Larger radiolucent area ### Card 192 FRONT: Periapical pathology appearance? **BACK:** Radiolucent area at root tip - May be well-defined or diffuse - Loss of lamina dura ### Card 193 FRONT: Bone loss patterns? BACK: - Horizontal: Even bone loss - Vertical: Angular bone loss - Localized: <30% of sites - Generalized: >30% of sites ### Card 194 FRONT: Calculus appearance on radiographs? **BACK:** Irregular radiopaque deposits - Usually interproximal - May obscure caries ### Card 195 FRONT: Overhanging restoration signs? BACK: - Excess material beyond tooth - Bone loss in area - Widened PDL space ### Card 196 FRONT: Root resorption types? BACK: - Internal: Radiolucency within root - External: Radiolucency on root surface ### Card 197 FRONT: Impacted tooth classification? BACK: - Soft tissue: Crown covered by gingiva - Partial bony: Partially in bone - Complete bony: Entirely in bone ### Card 198 FRONT: Radiation safety principles? **BACK:** “ALARA Leads Thyroid Fast Film” - ALARA principle - Lead apron - Thyroid collar - Fast film (F-speed minimum) ### Card 199 FRONT: Film positioning errors? BACK: - Cone cutting: Partial image - Overlap: Contacts overlap - Elongation: Vertical angle too steep - Foreshortening: Vertical angle too flat ### Card 200 FRONT: Digital radiography advantages? BACK: - Reduced radiation (50-90% less) - Immediate viewing - Image enhancement - No processing chemicals ### Card 201 FRONT: Bisecting angle technique? **BACK:** X-ray beam perpendicular to imaginary line - Bisects angle between tooth and film - More distortion than paralleling ### Card 202 FRONT: Paralleling technique advantages? BACK: - Less distortion - More accurate tooth length - Better image quality - Reproducible ### Card 203 FRONT: Patient positioning for panoramic? BACK: - Frankfort plane parallel to floor - Bite block positioned correctly - Tongue to palate - Still during exposure ### Card 204 FRONT: Ghost images on panoramic? **BACK:** Objects on opposite side appear higher and blurred - Remove earrings, glasses - Position patient correctly ### Card 205 FRONT: Pediatric radiographic considerations? BACK: - Smaller film sizes - Shorter exposure times - Patient cooperation techniques - Parent involvement if needed ----- ## 🥗 NUTRITION & ORAL HEALTH (Cards 206-220) ### Card 206 FRONT: Cariogenic foods characteristics? **BACK:** “Sugar Sticks Slowly” - Sugary content - Sticky consistency - Slow clearance from mouth ### Card 207 FRONT: Most cariogenic carbohydrate? **BACK:** Sucrose (table sugar) - Easily metabolized by bacteria - Forms sticky glucans ### Card 208 FRONT: Protective foods for teeth? BACK: - Cheese (calcium, protein, pH buffer) - Fibrous foods (apples, celery) - Sugar-free gum (stimulates saliva) ### Card 209 FRONT: Frequency vs amount of sugar? **BACK:** Frequency more important than amount - Multiple exposures = multiple acid attacks - Time between eating allows remineralization ### Card 210 FRONT: Critical pH duration? **BACK:** Stephan curve shows: - pH drops within minutes - Stays low for 20-40 minutes - Returns to normal gradually ### Card 211 FRONT: Dietary counseling principles? BACK: - Assess current diet - Identify risk factors - Provide alternatives - Motivate gradually ### Card 212 FRONT: Nutrients important for oral health? BACK: - Calcium/Phosphorus: Tooth structure - Vitamin D: Calcium absorption - Vitamin C: Collagen synthesis - Protein: Tissue repair ### Card 213 FRONT: Eating disorder oral signs? BACK: - Enamel erosion (lingual surfaces) - Xerostomia - Enlarged salivary glands - Increased caries ### Card 214 FRONT: Sugar alcohols (polyols) examples? **BACK:** Xylitol, sorbitol, mannitol - Non-cariogenic - May reduce caries (xylitol) ### Card 215 FRONT: Xylitol benefits? BACK: - Reduces S. mutans levels - Stimulates saliva - Remineralization effects - Non-fermentable by bacteria ### Card 216 FRONT: Baby bottle tooth decay prevention? BACK: - No bottles in bed - Water only in nighttime bottles - Wean by age 1 - Clean gums/teeth after feeding ### Card 217 FRONT: Dietary analysis methods? BACK: - 24-hour recall - Food diary (3-7 days) - Food frequency questionnaire ### Card 218 FRONT: Snacking recommendations? BACK: - Limit frequency - Choose non-cariogenic foods - Rinse with water after eating - Brush/floss when possible ### Card 219 FRONT: Sports drinks and teeth? BACK: - High sugar content - Low pH (acidic) - Prolonged contact during sports - Rinse with water after use ### Card 220 FRONT: Artificial sweeteners and oral health? BACK: - Non-cariogenic (aspartame, acesulfame-K, sucralose) - Safe for teeth - May reduce caries risk ----- ## ⚖ LEGAL & ETHICAL ISSUES (Cards 221-235) ### Card 221 FRONT: Scope of practice definition? **BACK:** Legal description of procedures dental hygienist can perform Varies by state ### Card 222 FRONT: Direct vs indirect supervision? BACK: - Direct: Dentist present in facility - Indirect: Dentist available, not present - General: Dentist available by phone ### Card 223 FRONT: Informed consent elements? **BACK:** “Risk Benefit Alternative Consequence” - Risks of treatment - Benefits of treatment - Alternatives available - Consequences of no treatment ### Card 224 FRONT: Informed refusal requirements? BACK: - Document patient’s refusal - Explain consequences of refusing - Have patient sign refusal form - Continue to offer appropriate care ### Card 225 FRONT: Patient abandonment definition? **BACK:** Terminating care without adequate notice Must provide reasonable notice and emergency care ### Card 226 FRONT: Professional negligence elements? **BACK:** “Duty Breach Cause Damage” - Duty of care existed - Breach of standard of care - Causation (breach caused harm) - Damages occurred ### Card 227 FRONT: Standard of care definition? **BACK:** Level of care that reasonably competent practitioner would provide In similar circumstances ### Card 228 FRONT: Statute of limitations? **BACK:** Time limit for filing malpractice lawsuit Varies by state (1-6 years typically) ### Card 229 FRONT: Respondeat superior? **BACK:** “Let the master answer” Employer liable for employee’s actions within scope of employment ### Card 230 FRONT: Defamation types? BACK: - Libel: Written false statements - Slander: Spoken false statements Both damage reputation ### Card 231 FRONT: HIPAA compliance requires? BACK: - Privacy of health information - Security safeguards - Patient rights to access records - Business associate agreements ### Card 232 FRONT: Mandatory reporting requirements? BACK: - Child abuse/neglect - Elder abuse - Communicable diseases - Gunshot wounds (some states) ### Card 233 FRONT: Abandoned patient procedure? BACK: 1. Written notice (certified mail) 1. Continue emergency care during notice period 1. Transfer records when requested 1. Document all steps taken ### Card 234 FRONT: Risk management strategies? BACK: - Complete documentation - Maintain competency - Communicate effectively - Follow protocols - Professional liability insurance ### Card 235 FRONT: Ethical decision-making model? BACK: 1. Identify the problem 1. Gather information 1. List options 1. Apply ethical principles 1. Choose course of action 1. Implement and evaluate ----- ## 📊 RESEARCH & BIOSTATISTICS (Cards 236-250) ### Card 236 FRONT: Types of variables? BACK: - Independent: What you manipulate - Dependent: What you measure - Confounding: Uncontrolled factors ### Card 237 FRONT: Levels of measurement? **BACK:** “No Order In Ratio” - Nominal (categories) - Ordinal (ranked order) - Interval (equal intervals) - Ratio (true zero point) ### Card 238 FRONT: Measures of central tendency? BACK: - Mean: Average - Median: Middle value - Mode: Most frequent value ### Card 239 FRONT: Statistical significance (p-value)? **BACK:** Probability results due to chance - p < 0.05: Statistically significant - p < 0.01: Highly significant ### Card 240 FRONT: Type I vs Type II error? BACK: - Type I: False positive (reject true null hypothesis) - Type II: False negative (accept false null hypothesis) ### Card 241 FRONT: Confidence interval meaning? **BACK:** Range of values likely to contain true population parameter 95% CI means 95% confident true value in range ### Card 242 FRONT: Correlation vs causation? BACK: - Correlation: Variables change together - Causation: One variable causes change in another Correlation does not imply causation ### Card 243 FRONT: Sampling methods? BACK: - Random: Every unit has equal chance - Systematic: Every nth unit - Stratified: Subgroups represented - Convenience: Easy to obtain ### Card 244 FRONT: Bias types in research? BACK: - Selection bias: Sample not representative - Information bias: Data collection errors - Confounding bias: Unmeasured variables ### Card 245 FRONT: Validity types? BACK: - Internal: Study measures what intended - External: Results generalizable - Construct: Measures theoretical concept ### Card 246 FRONT: Reliability vs validity? BACK: - Reliability: Consistency of measurements - Validity: Accuracy of measurements Can be reliable but not valid ### Card 247 FRONT: Blinding in clinical trials? BACK: - Single-blind: Subject doesn’t know treatment - Double-blind: Neither subject nor investigator knows - Triple-blind: Subject, investigator, analyst don’t know ### Card 248 FRONT: Intention-to-treat analysis? **BACK:** Analyze subjects in originally assigned groups Regardless of compliance or dropouts ### Card 249 FRONT: Meta-analysis definition? **BACK:** Statistical combination of results from multiple studies Increases statistical power ### Card 250 FRONT: Evidence hierarchy (strongest to weakest)? BACK: 1. Systematic reviews/Meta-analyses 1. Randomized controlled trials 1. Cohort studies 1. Case-control studies 1. Case series/Expert opinion ----- ## ⚖ ETHICS DETAILED (Cards 251-260) ### Card 251 FRONT: What does the ethical principle of JUSTICE mean? **BACK:** Fairness in distributing benefits, risks, and costs - Equal access to care regardless of race, income, status - Fair treatment for all patients - Example: Not refusing care based on ability to pay ### Card 252 FRONT: What does the ethical principle of AUTONOMY mean? **BACK:** Respecting patient’s right to make their own decisions - Informed consent required - Respect patient’s refusal of treatment - Patient must be competent, informed, free from coercion ### Card 253 FRONT: What does the ethical principle of BENEFICENCE mean? **BACK:** Acting in patient’s best interest - “doing good” - Recommend treatments that benefit patient - Example: Suggesting fluoride for high-caries-risk patient - May conflict with autonomy ### Card 254 FRONT: What does the ethical principle of NON-MALEFICENCE mean? **BACK:** “First, do no harm” - avoiding actions that cause harm - Use proper technique and sterile instruments - Don’t perform procedures you’re not trained for - Often takes precedence over beneficence ### Card 255 FRONT: Ethical conflict: Patient wants harmful treatment? **BACK:** Non-maleficence usually overrides autonomy - Explain risks clearly - Offer alternatives - May refuse to provide harmful treatment - Document discussion ### Card 256 FRONT: Ethical conflict: Beneficial treatment vs patient autonomy? **BACK:** Respect patient autonomy after informed consent - Ensure patient truly understands consequences - Provide complete information - Respect informed refusal - Continue to offer appropriate care ### Card 257 FRONT: Justice in dental practice examples? BACK: - Equal quality care regardless of insurance - Same waiting times for all patients - No discrimination based on race, religion, lifestyle - Fair scheduling practices ### Card 258 FRONT: Autonomy requirements for valid consent? **BACK:** Patient must be: - Competent (mentally capable) - Informed (understands risks/benefits) - Voluntary (free from coercion) - Legal age or have guardian consent ### Card 259 FRONT: When can you override patient autonomy? **BACK:** Limited circumstances: - Patient lacks capacity (mental incapacity) - Life-threatening emergency (unconscious patient) - Legal requirements (mandatory reporting) - Harm to others (infectious disease) ### Card 260 FRONT: Beneficence vs non-maleficence conflict? **BACK:** Non-maleficence typically takes priority - “First, do no harm” is primary - Don’t cause harm to create benefit - Example: Don’t extract healthy tooth for orthodontics ----- ## 🦷 G.V. BLACK CLASSIFICATION (Cards 261-268) ### Card 261 FRONT: G.V. Black Class I caries location? **BACK:** Pits and fissures - Occlusal surfaces of posterior teeth - Lingual pits of anterior teeth - Most preventable with sealants ### Card 262 FRONT: G.V. Black Class II caries location? **BACK:** Proximal surfaces of posterior teeth - Mesial or distal of premolars and molars - Best detected with bitewing radiographs - Often involves marginal ridge ### Card 263 FRONT: G.V. Black Class III caries location? **BACK:** Proximal surfaces of anterior teeth - Mesial or distal of incisors and canines - Excludes incisal angle (that’s Class IV) - Usually accessed from lingual ### Card 264 FRONT: G.V. Black Class IV caries location? **BACK:** Proximal surfaces including incisal angle - Anterior teeth involving incisal edge - Most complex restoration - Affects esthetics and function ### Card 265 FRONT: G.V. Black Class V caries location? **BACK:** Cervical/gingival third - Facial or lingual cervical areas - Any tooth can be affected - Often with gingival recession ### Card 266 FRONT: G.V. Black Class VI caries location? **BACK:** Incisal edges and cusp tips - Biting surfaces worn down - Attrition, abrasion, erosion - Modern addition to classification ### Card 267 FRONT: Which Black classification is most preventable? **BACK:** Class I (pit and fissure caries) Prevented with dental sealants ### Card 268 FRONT: Which Black classification best detected with bitewings? **BACK:** Class II (proximal posterior caries) Bitewings show interproximal areas clearly ----- ## 🦠 HEPATITIS DETAILED (Cards 269-276) ### Card 269 FRONT: Hepatitis A transmission and dental risk? BACK: - Transmission: Fecal-oral route - Dental risk: Low (not bloodborne) - Vaccine: Available - Course: Acute, self-limiting ### Card 270 FRONT: Hepatitis B transmission and dental risk? BACK: - Transmission: Blood, saliva, sexual contact - Dental risk: HIGH - major concern - Infectivity: 50-100x more than HIV - Vaccine: Available and required for dental workers ### Card 271 FRONT: Hepatitis C transmission and dental risk? BACK: - Transmission: Primarily blood-to-blood - Dental risk: Moderate - Vaccine: None available - Chronic: Often becomes chronic ### Card 272 FRONT: Which hepatitis is most infectious? **BACK:** Hepatitis B 50-100 times more infectious than HIV ### Card 273 FRONT: Which hepatitis vaccine is required for dental workers? **BACK:** Hepatitis B vaccine OSHA requires employers to offer free HBV vaccine ### Card 274 FRONT: Hepatitis B post-exposure prophylaxis? BACK: - Within 24 hours: HBV vaccine + HBIG - Test source if possible - Follow-up testing at 1, 3, 6 months - Document exposure incident ### Card 275 FRONT: Signs of chronic hepatitis? BACK: - Fatigue, weakness - Abdominal pain - Jaundice (yellowing) - Dark urine, pale stools - Spider angiomas ### Card 276 FRONT: Dental precautions for hepatitis patients? BACK: - Standard precautions for all patients - No special precautions needed beyond standard - Proper sterilization of instruments - Careful handling of sharps ----- ## 💊 VITAMINS DETAILED (Cards 277-286) ### Card 277 FRONT: Fat-soluble vitamins? **BACK:** A, D, E, K “All Dogs Eat Kibble” - stored in body fat ### Card 278 FRONT: Water-soluble vitamins? **BACK:** B-complex and C Not stored in body, need regular intake ### Card 279 FRONT: Vitamin A function and oral health? BACK: - Function: Epithelial tissue maintenance - Deficiency: Poor wound healing, infection risk - Sources: Liver, dairy, orange vegetables ### Card 280 FRONT: Vitamin D function and oral health? BACK: - Function: Calcium absorption, bone/tooth formation - Deficiency: Rickets, delayed tooth eruption - Sources: Sunlight, fortified milk, fatty fish ### Card 281 FRONT: Vitamin C function and oral health? BACK: - Function: Collagen synthesis, wound healing - Deficiency: Scurvy (bleeding gums, loose teeth) - Sources: Citrus fruits, berries, vegetables ### Card 282 FRONT: Vitamin K function and oral health? BACK: - Function: Blood clotting - Deficiency: Bleeding disorders, poor wound healing - Sources: Leafy greens, gut bacteria synthesis ### Card 283 FRONT: Scurvy oral signs? BACK: - Bleeding, swollen gums - Loose teeth - Poor wound healing - Petechial hemorrhages ### Card 284 FRONT: B2 (Riboflavin) deficiency oral signs? **BACK:** Angular cheilitis Cracks and fissures at corners of mouth ### Card 285 FRONT: B12 deficiency oral signs? **BACK:** Glossitis - Red, smooth, painful tongue - Associated with pernicious anemia ### Card 286 FRONT: Which vitamin is most important for wound healing? **BACK:** Vitamin C (Ascorbic acid) Essential for collagen synthesis ----- ## 🧪 DENTAL MATERIALS (Cards 287-294) ### Card 287 FRONT: What is imbibition in dental materials? **BACK:** Absorption of water causing swelling - Material dimensions increase - Problem: Impression distortion - Example: Alginate impressions absorb water ### Card 288 FRONT: What is syneresis in dental materials? **BACK:** Loss of water causing shrinkage - Material dimensions decrease - Problem: Loss of accuracy over time - Example: Alginate impressions shrink ### Card 289 FRONT: What is retardation in dental materials? **BACK:** Slowing the setting reaction - Causes: Low temperature, certain chemicals - Use: Extend working time - Example: Cool water slows alginate setting ### Card 290 FRONT: What is acceleration in dental materials? **BACK:** Speeding the setting reaction - Causes: High temperature, catalysts - Use: Reduce setting time - Example: Warm water speeds alginate setting ### Card 291 FRONT: Why should alginate impressions be poured immediately? **BACK:** To prevent imbibition and syneresis - Imbibition: Absorbs water and swells - Syneresis: Loses water and shrinks - Both cause dimensional changes and inaccuracy ### Card 292 FRONT: How does temperature affect alginate setting time? BACK: - Cool water: Retards setting (longer working time) - Warm water: Accelerates setting (shorter working time) - Room temperature: Normal setting time ### Card 293 FRONT: What happens if alginate impression sits too long? BACK: - Syneresis: Loses water and shrinks - Imbibition: May absorb water and swell - Result: Inaccurate cast/model ### Card 294 FRONT: Optimal alginate impression storage? BACK: - Pour immediately (best option) - If delayed: Humid environment, sealed bag - Maximum delay: 1 hour - Never: Store in water (causes imbibition) ----- ## 🩸 DIABETES DETAILED (Cards 295-310) ### Card 295 FRONT: Normal fasting blood glucose level? **BACK:** 70-100 mg/dL Fasting = no food for 8+ hours ### Card 296 FRONT: Normal random blood glucose level? **BACK:** <140 mg/dL Random = any time of day ### Card 297 FRONT: Pre-diabetes fasting glucose range? **BACK:** 100-125 mg/dL At risk for developing diabetes ### Card 298 FRONT: Diabetes diagnosis fasting glucose level? **BACK:** ≥126 mg/dL On two separate occasions ### Card 299 FRONT: Hypoglycemia blood glucose level? **BACK:** <70 mg/dL Emergency if <50 mg/dL or unconscious ### Card 300 FRONT: Hypoglycemia signs and treatment? BACK: - Signs: Sweating, trembling, confusion, irritability - Treatment: Fast-acting glucose (juice, glucose gel) - If unconscious: Call 911, NO oral glucose ### Card 301 FRONT: Hyperglycemia blood glucose levels? BACK: - Mild: >180 mg/dL - Severe: >300 mg/dL - Emergency: Diabetic ketoacidosis (DKA) ### Card 302 FRONT: Hyperglycemia signs? **BACK:** “DRY and Thirsty” - Dehydration - Rapid deep breathing (Kussmaul) - Yawning/fatigue - Excessive thirst, fruity breath ### Card 303 FRONT: What is HbA1c and normal range? BACK: - Hemoglobin A1c - 3-month glucose average - Normal: <5.7% - Pre-diabetes: 5.7-6.4% - Diabetes: ≥6.5% ### Card 304 FRONT: HbA1c levels for diabetes control? BACK: - Good control: <7% - Acceptable: 7-8% - Poor control: >8% (delay dental treatment) ### Card 305 FRONT: When to delay dental treatment for diabetic? BACK: - HbA1c >8% (poor control) - Recent hospitalization for diabetes - Frequent hypoglycemic episodes - Uncontrolled hyperglycemia ### Card 306 FRONT: Diabetes complications affecting oral health? BACK: - Periodontal disease (more severe) - Poor wound healing - Increased infection risk - Xerostomia (dry mouth) - Oral candidiasis ### Card 307 FRONT: Pre-appointment instructions for diabetic patients? BACK: - Take medications as prescribed - Eat normal meals - Monitor blood glucose - Bring glucose source to appointment ### Card 308 FRONT: Signs patient may be hypoglycemic during treatment? BACK: - Sweating, trembling - Confusion, irritability - Slurred speech - Rapid heartbeat - Weakness ### Card 309 FRONT: Emergency management of hypoglycemic patient? BACK: - If conscious: Glucose gel, juice, candy - If unconscious: Call 911, NO oral glucose - Position: Recovery position - Monitor: Vital signs ### Card 310 FRONT: Two-hour post-meal glucose levels? BACK: - Normal: <140 mg/dL - Pre-diabetes: 140-199 mg/dL - Diabetes: ≥200 mg/dL