2025 Edition
32 teeth make up a permanent dentition.
Incorrect answer. Please choose another answer.
Canine teeth are sometimes called "eye teeth."
Mesial is the closest proximal tooth surface toward the midline of the body.
8 premolars exist in a permanent dentition
Quadrants are the four parts when a mouth is divided into four sections: upper right, lower right, upper left and lower left.
Tooth #12 is the maxillary left first premolar.
Maxillary left second premolar is #25 when using the ISO system of tooth recording
Periodontal ligament is the connective tissue fibers that encircle the tooth, attaching the cementum to the alveolar bone.
Diagonal lines through the crown indicate a restoration made of gold material
Black ink is appropriate for charting treatment completed by a previous provider
Diastema - a space between the upper central incisors
Measure for 30 seconds, then multiply by 2, for a rate per minute.
40 mm Hg should be added to the brachial pulse rate in order to determine the inflation level during a blood pressure reading.
10-20 is the average adult respiration rate.
60-100 bpm is the normal pulse rate in a resting adult.
General dental assistant guidelines recommend that dental practices keep a signed privacy policy in a patients file for at least 6 years. Some state laws set the minimum at 5 years.
Health history review is not a part of a dental examination> However it should be considered when assessing the patient's needs.
Class V decay is smooth surface decay located on the gingival third of affected teeth.
Incisors (and canines) are the only teeth to be diagnosed with class IV decay.
CEJ - cementoenamel junction is the junction of tooth enamel with cementum at the neck or cervix of the tooth.
Epithelial attachment is the gingiva that covers alveolar bone and attaches to teeth at the margin of the gumlines.
Septum is the tissue that divides a nasal cavity through the middle into 2 parts.
Trigeminal nerve is the main nerve supply to the mouth. It has both maxillary and mandibular innervation.
Endocrine is the system which regulates glands that produce hormones, including the pituitary gland.
Supine is when the patient is lowered until almost lying down
Clock concept - dividing the treatment area into zones help to identify appropriate working positions.
A dental assistant should transfer the instrument with the working end facing themselves. This allows the dentist to receive the instrument in a way that allows immediate use without the need for adjustment.
The last 2 fingers of the hand are used for retrieving instruments from the operator
2-4 is the "time zone" that most dental assistants will spend the majority of their time in during procedures.
Assistant's stools have a foot bar for support.
The High Volume Evacuator tips should be placed slightly distal to the tooth being prepared. This frees up operator line of sight and is more efficient at saliva removal.
Dental dam is an appropriate isolation method for one or several teeth.
No. 3 hole punches are appropriate for premolar and canines when preparing a dental dam.
Moisten a dry cotton roll with water before removal, to prevent cotton from adhering to the dry mucosa in the mouth.
Anemia is not a contraindication for the use of N2O2.
Reservoir bag is the chamber that houses the 2 gases for combination prior to the patient drawing them in for a breath.
5 minutes is the appropriate length of time for patients to remain on 100% oxygen after having been administered nitrous oxide during a treatment procedure.
Both a and b are appropriate methods for needle re-capping and recommended by the CDC.
Mandibular block injections require the use of the "long" needle.
Infiltration is the technique that is used when injecting anesthetic around a tooth to affect the tissues around and near the apex of the tooth.
Joint replacement is not a health concern to be considered when selecting the form of local anesthetic to use.
Vasoconstrictors act by constricting the blood vessels thereby decreasing blood flow in the area and lengthening the amount of time that the local anesthetic is active in that location.
2-5 minutes is the appropriate length of time that a topical anesthetic should be left on the mucosa before injections for local anesthetic.
Diamond stones are added to the working surfaces of burs, to improve cutting ability.
A flame-shaped bur would be an appropriate option to place on a crown-prep tray, as it is used to help make adjustments in crown preparations.
Prophy angles are used on low speed handpieces.
A high-speed handpiece operate at up to speeds of 450,000 rpm.
Diskoid/cleoid is used to carve the amalgam into an anatomical appearance on the occlusal surface of teeth.
Fluoridation is not a step in sealant placement. Sealant placement includes isolation, preparation, conditioning, placement and curing.
Dentin is not appropriate for the use of bristle brush prophy angles because they are very abrasive on the soft dentin's surface.
Extrinsic stains are those on the outer surface of the teeth, which may be polished or scaled off.
Selective polishing - or only polishing teeth where stain is visible on the functional crown, should be polished.
A gingival retraction cord extends the impression area slightly below the finished preparation. This widens the sulcus area around the tooth and gently pushes the gums back for a more accurate impression.
Saturating the retraction cord in astringent and vasoconstrictor helps to control hemorrhage during a crown prep procedure by constricting blood vessels near the cord.
Periodontal disease which may threaten remaining teeth would contraindicate a partial denture. This is because the patient may be at risk to lose these teeth and then be in need of another appliance, such as a full denture.
A saddle is the metal mesh which extends over the alveolar ridge to support artificial teeth, and covered in acrylic.
Teeth should be wet during shade matching - teeth appear a different shade when they are completely dry and this shade would not be appropriate for matching the rest of the teeth as they will always be coated in saliva.
Core buildups are made of amalgam and used to add enough structural support to hold a fixed restoration such as a crown.
Maryland and bonded bridges are the same type of restoration, with a pontic tooth that is supported with wing-like frame extensions that are bonded to adjacent teeth.
Abutment refers to the supporting teeth.
Partial dentures are not examples of cast restorations. A cast restoration is made of porcelain or gold and fits on a prepared tooth.
Noneugenol dressing is the most commonly used periodontal dressing, because it has a smooth surface and rapid set time.
Gingivectomy is the surgical removal of diseased gingival tissue.
Ultrasonic scalers use high speed sound waves that transform into mechanical energy, allowing for the easy removal of calculus on tooth surfaces.
Sickle scalers are not appropriate for use below the gumline, they are designed for use on supragingival calculus.
Only a dentist and hygienist may measure periodontal probing depths.
Two on a scale of mobility describes moderate mobility.
Moderate periodontitis will have probing depths that are recorded in the 5-7mm range.
Gingivitis is the inflammation of gingival tissue.
30% or less of a mouth being infected is considered a localized periodontal disease infection.
Pulp caps may help save the tooth pulp by placing a covering over the exposed or nearly exposed pulp during a restorative procedure.
All of the above are reasons for performing debridement of a root canal.
After placing the dam, the next step is disinfecting the dam and clamp with an iodine solution (or a sodium hypochlorite solution may be used as well).
Formocresol is used to seal deciduous teeth.
Broaches are useful for removing pulp tissue or fragments of paper points within a root canal.
Alcohol is not an appropriate irrigation solution.
Four radiographs is the minimum number needed to complete an endodontic procedure.
Gutta percha is not a root canal sealer. It is a root canal filling material.
Paper points are used to dry the inside of endodontic canals.
Seven minutes is the appropriate length of time to scrub hands and forearms with a surgical scrub brush.
Periosteal elevator is the instrument that retracts tissue away from the bone during an extraction.
Above waist level is where hands should be kept following a surgical scrub.
Bone files are flat working instruments with large cutting blades and are used to smooth the surface of alveolar bone.
Extraction of impacted 3rd molar is not a common procedure in general dental practices.
Palm grasp is the correct grasp to use when holding forceps
A blood clot fails to form properly
Polyester fiber is not an absorbable suture material, it is non-absorbable material.
Alveoloplasty is when the bone is recontoured and smoothed in the alveolar ridge when adjacent teeth have been extracted.
Surgical instruments are all considered to be critical and all must be sterilized after use.
Avulsed is the term used when a tooth completely comes out of the socket in one piece.
Festoon means to be trimmed, but it is not the terminology used to describe a type of stainless steel crown.
Pulpotomy removes the infected area of the pulp but leaves healthy pulp tissue within the primary tooth.
All of the above are examples of preventive orthodontics offered in a pediatric dental environment.
Open treatment bays are unique to pediatric dental offices, helping children to feel less shut in than a small operatory.
Children should use a fluoride-free dentrifice until they are able to expectorate. This prevents swallowing of fluoride.
Treatment of developing permanent teeth is not an emphasis of pediatric dentistry.
T-band matrixes are copper t-shaped matrix bands commonly used on primary molars.
Stainless steel crowns are used primarily in pediatric dentistry.
Maxillary central incisors are the most frequently injured primary teeth.
Class II bites show the mesiobuccal cusp of the maxillary first molar meeting mesial to the mesiobuccal groove of the mandibular first molar
Class III bites show the mesiobuccal cusp of the maxillary first molar meeting distal to the mesiobuccal groove of the mandibular first molar
Wire ligatures are the thin wires that twist around brackets to hold an arch wire in place.
Elastics help bring about movement between maxillary and mandibular arches.
Weingart utility pliers are used to guide arch wire into place
All of the above are directions that orthodontic therapy can move a tooth.
Steel is not an ingredient in amalgam fillings.
Potassium fluoride is not a common type of cavity liner
Etch is applied to the tooth in order to prepare it for retention and bonding of material.
Luting agent is- a permanent cement which is used in a very thin coat to permanently cement casting to a tooth.
The smear layer is a thin layer of debris that remains after a tooth is prepared for treatment.
IRM, or intermediate restorative material, is the most common cement used for temporary restorations.
Glass ionomer cements release a slow flow of fluoride into the tooth, reducing risk of recurrent decay.
Calcium hydroxide is appropriate for mixing on a paper pad. Amalgam must be mixed in a machine while the other 2 materials listed must be mixed on a glass slab.
Matrix, wedge - Both necessary in order to properly create an anatomical contour for new restorations
Gingival edges are shorter than the occlusal edges, because the neck of the tooth is narrower than the occlusal crown portion.
Whiteners will remove some surface stains from restorative materials but will not remove stains or color from in a restorative material. Whiteners will only affect the tooth structure, not restorative materials.
Wedges are only used for class II, III and IV matrix systems.
Veneer is the tooth colored material that is bonded to a tooth in order to improve the overall appearance.
Clear plastic matrix are used for composite fillings on anterior teeth.
A retentive pin helps along with bonding material to restore teeth that are badly broken down.
Curing lights are not needed for the application of a varnish.
15-30 seconds is the typical time required by etch manufacturers for the material to thoroughly etch the tooth surface.
Temporary is not a type of impression. There are only 3 types of impressions and those are preliminary, final and occlusal registration
Alginate is a gelatinous material that is ideal for preliminary impressions.
Model plaster - this is used because it is easy to trim and handle
Exposure to light is not a factor that affects the setting of gypsum products. However, the others listed do affect it.
Wax bite registration is a soft, pliable material that allows the occlusion surfaces of teeth to easily be recorded.
Two scoops of alginate powder are usually needed for a mandibular impression.
Light body viscosity is used for application directly into the sulcus of the prepared tooth. This allows it to flow easily into the margins and details of the prepared area.
Alginate impressions are not used for taking final impression
Calculus is mineralized bacterial plaque
Calcium and phosphate loss results in tooth demineralization
Pellicle is the thin layer made up of glycoproteins from saliva which deposit themselves on the surfaces of teeth in a rapid manner.
Periodontitis is a more severe form of gingivitis, which affects the alveolar, or supporting bone structure around the tooth.
All of the above are risk factors for developing periodontitis.
Are less likely to cause damage to the gums and tooth structure. Bristles that are too hard can cause gum recession and toothbrush abrasion, so using a soft bristled brush helps prevent these.
Disclosing agents, usually in a tablet or liquid form, are used to color bacterial plaque and aid in proper brushing techniques that show the patient how to remove plaque more effectively.
Bass method is the most recommended method of brushing which targets plaque at and below the gingival margin.
None of the above. While there are various types of floss, research fails to show that one type is more effective at plaque removal than any of the others.
45 degrees angulation is the preferred method of brushing.
Light pressure should be used during brushing in order to reduce gum recession and tooth abrasion.
All of the above. Depending on location, natural fluoride may appear in the water and soil of certain areas. Food that is grown in these areas will also contain fluoride, or it may be found in animal meat.
Water is not a topical source of fluoride. It is a systemic source.
That the enamel will be weaker than surrounding tooth enamel is not accurate. The enamel may actually be harder than other areas once it is re-mineralized.
Fluorosis is the long-term exposure to overuse of fluoride, which causes white spots on developing teeth.
7 to 1.2 ppm is the recommended concentration of fluoride in municipal water supplies.
Children ages 6-16 are not necessarily at an increased risk to develop caries compared to other groups.
Each gram of carbohydrate supplies 4 calories and is the body's main source of energy.
Vitamin D helps the body absorb calcium, strengthening bones and teeth.
Weight is not considered a vital sign.
Syncope, otherwise known as fainting, is one of if not perhaps the most common medical emergency in a dental office, resulting from slowed blood flow to the brain.
All are risk factors for postural hypotension - a lack of blood flow to the brain that often occurs when the patient sits up quickly.
When a patient takes in too much oxygen due to frequent breaths caused by anxiety or stress.
Epilepsy is the medical condition that consists of neurologic disorders which cause recurrent seizures.
Hyperglycemia is an elevated level of blood glucose levels.
Angina pectoris is a painful occurrence when the heart is deprived of oxygen. It usually does not result in death, but it is a sign that the person may have other cardiovascular health problems.
Swelling and blockage of air passages, anaphylaxis is a common result of severe allergic reactions.
Drop in blood pressure is not a side effect of a localized allergic response.
Rubber dams contain latex and may trigger an allergic reaction in some patients
Patient nervousness is not a warning sign of a medical emergency. If a patient becomes so nervous that they begin experiencing warning signs as a result, then there should be an elevated awareness of emergency prevention.
The dentist is in charge of the emergency response protocol in a dental office.
Uneven respiration is not a symptom of a medical emergency, it is a sign. Symptoms include something the patient is experiencing which they must tell you about and cannot be observed.
Epinephrine is an emergency drug that should be kept on hand in the case of an allergic reaction.
All of the above are examples of glucose products that are appropriate to use in the case of an emergency with a hypoglycemic patient.
Be placed on 100% oxygen, and then have other vital signs monitored.
Oxygen tanks are universally green in color, to prevent a mix-up of other gases.
Administration of intravascular drugs is not part of the standard of care for dental personnel emergency training.
Call and notify patient's next of kin is not an example of a staff role during a medical emergency. Initial life support roles such as calling 911, retrieving the drug kit and assisting with CPR are specific staff roles that should be designated by the dentist should a medical emergency occur in the office.
If a patient faints, the patient should be placedin a reclined position with the head slightly lower than the feet. This encourages blood flow to the brain in an attempt to revive the patient.
Placing a prop or suction in the patient's mouth to prevent them from biting their tongue is not appropriate. Nothing should be placed inside of a person's mouth when they are experiencing a seizure.
Allow the patient to sit until pain subsides, then allow a family member to escort them home is not appropriate when responding to a patient experiencing chest pain.
Nitrous oxide tanks are universally colored blue to prevent a mix-up of other gases.
Ethics refers to what you should do in a given situation. Most boards have set forth a minimum standard for license holders. Ethics are voluntarily set standards.
Law refers to what you must do in a given situation. A behavior may be unethical and still be legal.
Direct supervision is when the auxiliary performs a procedure that is delegated by the dentist, and the dentist is still physically present inside of the building.
Following OSHA regulations is not a step of risk management in regard to malpractice suits. OSHA protects employees in the workplace.
Written consent documents the patient's consent and understanding of the treatment procedure.
Financial information is not part of a patient's dental chart.
Drawing a line through the text is the only appropriate method of correcting a patient's record.
The dentist is the owner of dental records and radiographs. Patient's may be able to request copies, but they do not technically own them.
The head and neck are involved in approximately 65% of all child abuse cases. This is why dental professionals should have an awareness and understanding of recognizing signs of abuse.
An inactive patient is a patient that has not been into the office for at least 4 or 5 years, even if they have a chart on file.
10-15 minutes is the average unit of time that is used when blocking out appointments in a computerized schedule.
HIPAA is the act that protects a patient's privacy regarding their healthcare information.
Health Insurance Portability and Accountability Act uses the acronym HIPAA
Unscheduled hygiene patients will be a result of an unmaintained recall system.
All staff members are responsible for reporting suspected child abuse victims. The responsibility does not fall on the discretion of a single individual.
The state dental board is responsible for regulating dental providers practicing within their state boundaries.
Sexually transmitted is not a mode of disease transmission. It is a type of transmitted disease.
Hep B immunization is an effective vaccine that healthcare workers should be given to prevent the risk of occupational exposure.
Legionnaire's Disease can be spread through aerosols as well as aspirating contaminated water.
Acute infections are often very quick to appear and have severe symptoms.
Oral candidasis is a yeast infection of the mouth, sometimes called "thrush."
Pathogens are organisms that are capable of causing disease conditions.
Tetanus, also called "lock jaw" is a disease that is caused by spore bacteria.
The type of bacteria does not determine how pathogenic an organism is. Virulence, Concentration, Host resistance and Portal of Entry are some of the determining influences.
Latent infections lie dormant in the body until conditions like fever or illness cause the virus to become active.
Intact skin is a natural protective barrier and is not a portal of entry for splash or splatter disease transmission.
Tuberculosis is not a bloodborne disease it is an airborne bacterial disease.
Hepatitis A is the fecal-oral transmittable form of heptatitis, and is the least serious of these viruses.
Dental suctions do not create aerosol exposures during use.
Indirect transmission is also known as cross-contamination. It happens by the indirect transferring of a pathogen by touching contaminated surfaces and then another area like the eyes or mouth.
All of the other conditions are highly contagious, and while HIV contamination should be prevented, it is not as big of a concern in regards to disease transmission in a dental office setting.
Herpes Simplex 2 is transmitted through sexual contact.
Tuberculosis is not a bloodborne disease, but all of the other viruses listed are conditions that the OSHA bloodborne pathogen standard helps employees protect themselves against.
Universal precautions are the standard in which all patients are treated as if they are infected with a bloodborne disease.
Intact skin is not considered a potentially infections mechanism of disease transmission.
Indirect is not a category of occupational exposure. Direct, percutaneous and permucosal are all categories of occupational exposure.
Percutaneous exposures are when the skin has been perforated and exposed to blood or possible infectious material.
Using a single handed re-capping technique will prevent accidental needlestick with a used needle.
Duration of employment, plus 30 years, is the recommended length of storing confidential medical records on employees. These must be stored in a secure, locked location.
Hands must be washed before gloving up, after gloving up, and any other time that a contaminated object may have accidentally have been touched.
Bar soap does not help to minimize cross-contamination. It may actually be a surface that transmits bacteria or other contaminants.
All other items listed are considered PPE.
Room clean-up will expose the employee to more contaminants than the other examples, therefore higher levels of PPE, such as gloves, should be worn.
Fluid-resistant material must be used for lab coats. This can include disposable jackets or cotton or cotton/poly blend material.
May not be taken home to be laundered. Laundering PPE that has been contaminated is the responsibility of the employer.
Surgical masks must be changed between patients.
Prescription eyewear is not an acceptable means of personal protective equipment. Glasses must have solid side shields.
Moisture reduces the filtration abilities of masks. Contact with the mouth or splatter reduces filtration.
Surgical gloves are sterile and should be worn for invasive procedures.
Utility gloves should be worn during instrument sterilization.
Nitrile gloves would be an appropriate latex-free glove option for the patient with a latex allergy.
Personal Protective Equipment (PPE) are things like masks, gloves and eyewear that protect employees from possible exposure to pathogens in the office setting.
Biohazardous waste is harmful to people and the environment, and must be disposed of properly in appropriate containers.
Implant placements are surgical, invasive procedures and sterile gloves should be worn instead of non-sterile examination gloves.
OSHA is a regulatory agency and their goal is to keep safety standards in place that protect employees from possible accident or injury.
The Bloodborne Pathogens Standard is established by OSHA to protect employees from pathogens that are bloodborne.
Latent infections are those that come and go, such as viral infections like the herpes simplex virus, which causes cold sores.
Permucosal exposures are those that come into contact with the mucous membranes like the eyes.
Active artificial immunity is when the body does not have antibodies and then develops an artificial immunity to it after having been administered a vaccine.
Routine waste like mixing pads, paper towels or headrest covers are examples of general waste that may discarded with regular waste like paper or other trash.
Pathologic waste is a type of infectious waste and should be disposed of appropriately in accordance to state and local laws.
MSDS stands for Material Safety Data Sheets and they should be kept on file for every chemical that is in the office.
Contact dermatitis is when the skin breaks out after coming into contact with something that is an irritant or allergy to the person.
Simple wedding bands are ok to wear in the dental office. Large jewelry and artificial nails, however, can harbor bacteria, which can contribute to direct or cross-contamination of the individual or others they interact with.
Overgloves are to be worn over treatment gloves to prevent cross-contamination to other areas inside of the operatory when they are needed for use.
No, it depends on what risk of exposure the procedure is. A filling does not require the use of surgical gloves, but an implant procedure would.
Employees that refuse to receive Hep B vaccination must sign a waiver to be kept on file with their employer.
The Hep B vaccine must be provided free of charge by an employer to each employee in the office if they are reasonably likely to be exposed to blood or infectious disease during the course of their work. This is a requirement of OSHA's Bloodborne Pathogens Standard.
Pathogens are disease-causing organisms. The other answers are examples of infections, viruses or infection causing organisms, but they do not cause disease.
Opportunistic infections occur in instances where someone with a depressed immune system come into contact with pathogenic bacteria and are not able to suppress an infection.
Indirect transmission is when a person comes into contact with pathogenic microorganisms by handing contaminated surfaces or equipment, which can then be spread to themselves via contact with the face, or to other people.
All biohazardous waste must be placed into specially marked separate bags with the biohazardous waste symbol, then disposed of appropriately based on local laws and regulations.
Direct contact with blood or saliva from a patient is the biggest concern to dental employees when it comes to disease transmission
Pre-rinsing with an antimicrobial mouthwash can help to reduce the number of bacteria in a patient's mouth, limiting exposure to pathogens from splatter or direct contact.
Naturally acquired immunities are those that the body develops when it has been exposed and develops a disease, heals itself, and then develops a natural immunity to the disease so that it does not become infected again.
HIPAA is not part of OSHA regulatory laws to protect the health and safety of employees in the dental office.
Exam gloves are not usually saturated in blood, nor do they cause an increased risk of exposure as sharps or blood saturated items would.
Virulent or virulence is how strong and capable a pathogenic microorganism is when it comes to causing disease.
Tissue damage is caused by infectious disease due to damage by the pathogenic microorganisms.
While enough room for appropriate equipment and supplies is needed, the size of sterilization areas is not important. That is important is that it is used only for the purpose of instrument processing and is a separate area from the rest of the office.
Utility gloves are heavy duty and help protect staff from harmful, sharp instruments on a treatment tray.
Masks are a type of PPE but they are not necessary when transporting used equipment from a treatment room to the sterilization area.
The instruments should be placed in a holding solution. This prevents residue from hardening up on instruments or the risk of them coming into contact with something or someone else.
Chemical indicators on the instrument package show when the enclosed instruments have been properly sterilized. These may be on the package already, or a separate strip placed on the package.
All instrument packages should be placed in single layers, so that the steam or chemical solution can reach them adequately.
Training, Record-keeping and Maintenance are all parts that should be considered in a quality assurance program in regards to instrument sterilization.
When hand scrubbing instruments, it may be possible to be exposed to splatter or water droplets and it is necessary to wear a mask as part of the PPE.
Exam gloves are appropriate when assembling treatment trays with sterilized instrument packets.
At any time when handling used instruments. This includes transfer of the used treatment tray to the sterilization area up to the loading of the autoclave.
The sterilization area has a contaminated area that includes counter space, sinks, holding solution and ultrasonic cleaner where the contaminated instruments are processed prior to sterilization. Nothing but soiled instruments should be placed in this area.
Holding solution is not an example of precleaning. Holding solution should only be used when there is not enough time to immediately clean and process instruments.
Hand scrubbing is the least desirable method of cleaning instruments. Hand scrubbing puts people at an increased risk for contamination due to direct contact with the instruments.
Ultrasonic machines produce sound waves that cause cavitation, resulting in the mechanical removal of debris from instruments.
The reuse of standard sterilization wraps is not approved by the FDA. Wraps should only be used once and then discarded.
The ultrasonic cleaner should be changed out at least once a day. Ultrasonic cleaning solution can become dirty very quickly, and may even need to be changed out up to twice a day.
Sterilization destroys all microbial forms. The other methods may destroy some types of bacteria, but they do not destroy all of them.
The autoclave uses steam under pressure to sterilize instruments and other heat-resistant supplies.
Steam autoclaves are able to sterilize water-based liquids, while other methods of sterilization can not.
The steam autoclave may leave instruments wet after the sterilization cycle and can cause instrument corrosion over time.
Ten hours are needed for complete sterilization to take place in a chemical liquid sterilization solution. Less than ten hours produces only disinfection.
By killing spores in a sterilization cycle, the equipment is successful. Not killing spores means failure of sterilization.
Process indicators change color once they have been exposed to a certain temperature, making it easy to determine which packages have been processed and which have not.
Th monitoring of sterilization machines should be performed at least once per week. Some states require testing more or less frequently.
When the packages are tightly against each other it prevents instrument surfaces from being reached by the sterilization agent.
Rapid heat transfer is a very quick method of sterilization that may be used only on instruments that are unwrapped.
Both barriers and disinfecting surfaces between patients may be used together to handle surface contamination. Either one is appropriate, but they may be used conjointly based on the needs of the treatment area.
Rolls or wide sticky tape are often used for buttons or handles. Plastic bags for surface barriers come in various sizes to fit things like air/water syringes. Aluminum foil may be used in some instances as it is easy to shape.
Eyewear, mask and utility gloves should all be part of PPE used when cleaning and disinfecting a treatment room, to prevent exposure to chemicals or other splatter.
All contaminated surfaces must be precleaned before they can be disinfected. This helps to remove initial bioburdens and bacteria in the working area.
Disinfection is the method of cleaning work area from disease causing organisms after the work area has already been precleaned.
Sterilization kills like forms including spores. Disinfection and precleaning do not destroy these organisms.
EPA, the Environmental Protection Agency, regulates disinfectants and chemical cleaners used in dentistry.
Iodophors are a broad-spectrum tuberculocidal cleaner that disinfects surface areas.
Syntehtic Phenol Compounds may be appropriate to use for disinfecting dental impressions, but the impression material should be checked first for compatibility.
Neither alcohol nor bleach (sodium hypochlorite and Chlorox) are appropriate surface decontaminants per the CDC and ADA.
High-level disinfectant. It can also be used as a sterilant if immersion time is long enough.
Critical instruments penetrate body tissues and bone structures, and should be heat sterilized.
Semicritical instruments have a low risk of disease transmission, but they do come into contact with mucous membranes.
Semicritical instruments should be heat sterilized. The majority of this type of instruments are heat resistant and should be placed in the autoclave with other instruments.
The x-ray tube head only comes into contact with skin, and is considered a noncritical dental instrument in regards to sterilization and disinfection.
Using a rubber dam can help reduce splatter and aerosols during dental procedures, decreasing exposure to microorganisms.
Using a city water supply can allow foreign water-borne bacteria into the water lines, which may then infect the patient and/or staff.
Low or mid-level disinfectants are appropriate for use in radiography equipment like tubeheads and processing workspaces.
Flat, smooth surfaces such as countertops do not require surface barriers because they are easily cleaned and disinfected.
Casts are the most difficult prosthodontic item to disinfect without harming the structure of it. It is important to properly disinfect the dental impression so that cross-contamination does not cause the cast to become contaminated as well.
A written program is a necessary part of hazard communications programs to maintain documentation regarding employees that have been exposed to hazardous chemicals or substances.
Chemical inventories are made up of complete lists and documentation of each chemical that is used in the dental office, and should be updated any time a new product is brought in even if it is a household cleaner.
Material safety data sheets - MSDS for short- are informational sheets that are published by chemical manufacturers and should be kept on file in a common binder with other MSDS sheets.
Stop operations immediately and excuse yourself from the treatment procedure. At that point you should begin appropriate first-aid steps.
The assistant should encourage the skin to bleed by gently squeezing any broken areas. This encourages the body to naturally flush out any microorganisms that may have been transferred during the needlestick.
Pneumonia can be caused by legionella bacteria and is known as Legionnaire's disease. Patients can contract the bacteria by inhaling water droplets that are contaminated.
All of the above may be caused by frequent exposure to hazardous chemicals over a long period of time, resulting in chronic chemical toxicity.
Because emergency kits in the dental office include many medications such as epinephrine, the kits should be inspected monthly.
OSAP, the Organization for Safety and Asepsis Procedures, classifies areas of touch surfaces in the clinical setting.
Amalgam should be disposed of in a designated, sealed container. Removed amalgam fillings contain mercury, which can be harmful to the environment. They must be kept separate from other waste and disposed of in accordance with state regulations.
Inventory of surgical instruments is not a part of a Hazard Communication Standard.
Six months after the initial exposure, it is recommended that HIV testing be conducted, even if previous tests showed negative and the employee underwent antiviral treatment.
Labeled with the biohazard symbol. While many containers are red, the biohazard symbol is what is mandated to be printed on the side of the container in order to identify it as biohazardous waste.
A new label should be placed on the 2nd container regardless of when the chemical will be used up. New labels are only needed on 2nd containers if the product will not be used up in the same 8-hour work day.
Biofilm is a layer of buildup or microbes inside of the walls in dental water lines.
At the beginning and end of each day, dental water lines should be flushed to discourage biofilm from building up inside of the tubing walls.
Flush each line with a vacuum line disinfectant and then water prior to removing traps from evacuation lines.
Saliva ejectors may allow bacteria from the evacuation line to flush back into the mouth if the patient's lips close tightly around it, creating a seal.
Microbes may penetrate the package if it is wet and allow contamination of the sterilized instruments.
All staff should have training annually and whenever new hazardous materials are added in the office. Training should be documented.
The CDC is not a regulatory agency, but their guidelines for infection control in dental health care settings establish the standard of care for US dental practitioners.
The bloodborne pathogens standard, regulated by OSHA, is the most important law in regards to infection control in dentistry. The bloodeborne pathogens standard protects healthcare workers from becoming infected with diseases transmitted by patients.
Universal precautions were expanded by the CDC to include other bodily fluids and contact with non-intact skin or mucous membranes, and re-coined "standard precautions."
The employer is responsible for providing laundry services for contaminated PPE. Many offices keep laundry facilities on site.
The hazard communication standard requires employers to use hazard communication programs in the workplace to identify hazardous chemicals for their employees.
All of the above examples are classifications of waste in the dental office. Additional classifications include Infectious or Regulated wastes.
Radiologic data is not information found on an MSDS sheet. Information found is general product info, hazardous ingredients, physical hazard, fire and explosion, health hazard, reactivity, spill or leak procedures, special protection information and special precautions.
Gloves should be the first PPE removed following routine dental treatment. This prevents the cross-contamination of microorganisms from the gloves onto other PPE, like eyewear.
The jacket is removed last. Be sure to turn the jacket or lab coat inside out so that it does not touch anything after it has been removed.
EPA - the Environmental Protection Agency regulates the categories of waste from dental offices and how each type of waste should be disposed of.
Chemical sterilants are regulated by the EPA, but anesthesia and prophy paste are not under the EPA's jurisdiction
Reducing aerosols during treatment, such as ultrasonic or high-speed handpiece use, makes the high-volume evacuation helpful in reducing the spread of microorganisms during treatment.
Biofilm cannot be completely removed from unit water lines, but some methods do reduce the rates of bacteria in the lines.
Clean, dry hands are all that is necessary for the placement of surface barriers such as headrest covers and light handle covers.
Extracted teeth are considered regulated waste. Teeth and other body tissues are potentially infectious and are to be disposed of appropriately.
The assistant should not talk frequently with the patient. This will allow the nitrous oxide to leave the patient's airway and enter the treatment area instead of the scavenger system.
A pathogenic microorganism's virulence determines whether or not the pathogen is highly pathogenic. It may not be virulent at all, and only prone to cause disease or infection in susceptible hosts, or very virulent and cause disease in anyone.
Asepsis refers to when something is free of disease causing bacteria or other germs, and is sterile.
Patients with any of these diseases should be treated based on their current health status or elective dental treatment needs, as coordinated with their primary care physician if needed.
An x-ray mounting device is considered semi-critical in regards to CDC categorization when it comes to patient care items.
Disinfecting the surface with a wipe or spray-wipe-spray technique is not adequate, nor is pre-soaking the handpiece as this could cause damage to the inside. Instead, cleaning off the outside surface and then running it through the steam autoclave is appropriate.
Five hours is the appropriate answer for disinfection time. Ten hours provides sterilization, but less time simply achieves disinfection.
Instruments cannot be cleaned immediately. This is the only time a holding solution, or pre-soak should be used. It helps prevent residue from hardening onto the instruments before they are properly cleaned.
Ultrasonic cleaners help remove debris from instruments by using high frequencies of sound waves to vibrate off layers of blood or other residue prior to the instrument being placed in the sterilizer.
Critical instruments are used for invasive procedures such as surgery or extractions. By knowing what classification the instruments belong in, the appropriate sterilization system can be used.
Non-critical dental instruments or equipment are those that only come into contact with a patient's skin, such as the lead collar.
A proper sterilization area should flow with a dirty or contaminated area, into a precleaning, packaging area, then to the sterilization and storage area.
Panoramic films allow the entire dentition to be viewed on a single, large film.
Panoramic film is not a major component of a panoramic x-ray unit. The main components are the tubehead, head positioner and exposure controls.
Electronic sensors are used in lieu of standard x-ray films when recording images of a patient's teeth. While standard films can have their image scanned into an electronic program, they are not by definition, digital x-rays.
FMX series inflict more radiation on a patient because they require multiple exposures for all 20 films. There is less radiation needed with a panoramic x-ray.
Having the patient place their tongue in the roof of their mouth during a panoramic x-ray prevents a large radiolucent area in the palate on the processed x-ray.
Sensors are more sensitive with digital radiography than traditional x-ray films, allowing the exposure time to be less, reducing radiation.
Intraoral sensors are waterproofed by the manufacturer, but because they cannot be sterilized, they must have a disposable barrier placed on them prior to use with each patient.
Parallelling allows for the most accurate imaging, making the placement method of choice for digital sensors.
Sensor size is not an advantage when it comes to digital x-rays, because they are often bulky and thick.
Inner wrap is not part of a film packet. The film packet is comprised of the outer wrap, inner black paper, film and lead foil.
Using double film packets allows 2 films to be exposed at one time, so there is a duplicate of the film without need of additional x-ray exposure or duplication.
Size 4 film is appropriate for occlusal radiographs but is too large for other intraoral radiographs.
Size 1 film is most appropriate for upper anterior PAs.
Posterior PAs and Adult BWX are appropriate uses for size 2 film.
Paralleling is one of the basic techniques for obtaining PA x-rays. The other is bisecting the angle.
Paralleling places the film parallel with the long axis of the teeth.
The x-ray beam is aimed at 90 degrees when using the parallel technique. This is because the film is parallel with the long axis of the tooth, allowing the beam to travel straight ahead.
Paralleling techniques require the use of a film-holding instrument in order to maintain the position of the film with the long axis of the tooth.
The raised dot should face the PID and toward the occlusal surface. This identifies the proper position of the film as well as prevents the raised dot from being over any structures that may need to be seen on the x-ray.
Point of entry is the position on the patient's face where the beam is aimed.
Vertical angulation, the up and down motion, must be perpendicular to the film and axis of the teeth if using the paralleling technique.
Foreshortening or elongation will occur if the beam is not perpendicular in the paralleling technique.
Improper horizontal angulation (side to side) will cause overlapping of proximal contacts in teeth.
The angle between the film and the teeth is bisected no matter how many degrees of angulation the film is placed from the tooth.
Cone cutting occurs when the x-ray beam is not centered with the x-ray film, because it prevents the beam from coming into contact with the film.
10-18 PA films with any additional BWX films are what is necessary to comprise an FMX.
The distal half of the cuspid crown should be viewable on a premolar BWX when it is placed appropriately.
Centered over the 2nd molars is the appropriate placement for molar BWX shots.
Improper horizontal angulation can cause overlapping of the proximal surfaces and lead to misdiagnosis.
Against the occlusal surfaces, with the patient gently biting down on the film, is how occlusal films are to be taken.
To locate periapical abscesses. These would be best located by taking a PA in the symptomatic area.
Toward the teeth is where the white side of intraoral film should always face. If it is placed away from the teeth, then the lead film will interfere with the x-ray beam reaching the film inside of the packet.
Superimposed images from double film exposure has left 2 angles of radiographs on one film.
Failure to remove jewelry will cause ghosting of metallic substances such as earrings onto other areas of the film.
Cone cutting is due to the beam not being centered over the x-ray film.
Elongation occurs when the beam is placed at an inadequate vertical angulation.
In this x-ray, the film was placed backward during exposure. This caused the crimping effect from the lead foil that blocked the x-ray beam.
The x-ray exhibits inadequate film placement. The patient should have bitten down against the PID so that the occlusal surface of the teeth were in line with the edge of the film.
Bending of film is evidenced on x-rays by straight lines in the corners of the film where it has been bent to fit into the patient's mouth. This interferes with diagnostic capabilities.
The probable cause is that the x-ray machine did not expose the film. If the film was not exposed, then all crystals will wash off of the film and it will come out clear.
Elongation is caused when the vertical angulation of the x-ray beam is too low.
The patient moving would cause blurred images on a film. Because x-ray beams travel straight, if the tubehead is slightly vibrating it will not cause blurred images. Old chemicals could cause clouding on the film, but not blurred images.
When possible, limit the amount of space between the film and the teeth as much as possible.
A longer PID results in less magnification. On the other hand, if a PID is shorter, then the tooth is magnified more.
kVp controls the contrast of dental x-rays
kVp settings control the density or overall darkness of an x-ray.
Folding a lead apron could cause the protective layer inside of the apron to crack, allowing radiation to penetrate through the apron to the patient.
2.75" is the appropriate and recommended size of x-ray beams that are to be targeted toward a patient's face during dental radiographs.
Cone PIDs produce scatter radiation. Other PIDs which are cylindar or rectangular do not, because they restrict the direction of x-ray beams to a straight forward direction.
Kilovoltage affects the density (overall darkness) of dental radiographs. Adjusting the kV to a lower setting would improve film contrast.
Removing the x-ray film from the fixer after 3 minutes can allow for a wet reading. It must then be returned to the fixer for the appropriate length of time and processed as normal.
Periapical film is the most appropriate radiograph when viewing the apex of teeth.
Bitewing x-rays are most appropriate for intermittent routine use when screening for possible interproximal decay.
The curve of Spee curves up toward the distal teeth. The curve of Spee aids in mounting BWX radiographs and is the occlusal line which curves up from the midline toward the more distal teeth
When using duplicate film for a patient x-ray, it should be exposed exactly the same as a normal, single film packet would be.
Bitewing radiographs should be prescribed when necessary due to patient needs and predispositions. Each patient has individual dental care needs, so exposing them to radiation all on the same basis is not appropriate.
The nerve or pulp of the tooth will appear radiolucent on x-rays because the nerve tissue does not block x-ray beams from reaching the film.
By not having the appropriate length of exposure time, fewer x-ray beams reach the film. This causes a decrease in crystals to react to radiation, which are then washed off through processing, resulting in a lighter film.
A thyroid collar Is designed to be apart from or attached to a lead apron during radiographs. This includes all gradiographs. Some lead aprons include a built in thyroid collar, but those that do not require the use of a separate thyroid collar during radiographs.
Cephalometric radiographs show the side view of the facial bones, which aid in profile analysis in orthodontic treatment.
Filtration of an x-ray beam with an aluminum disk strengthens the beam. This is due to the removal of weaker, long wavelength x-rays from the beam, leaving stronger, shorter wavelength x-rays.
Long PIDs are 16 inches long while short PIDs are 8 inches long.
kVp settings adjust the grey, black and white on dental x-rays. A higher contrast in color will result in more obvious comparison of things like fillings or pathology.
Density is the overall darkness of an x-ray, and allows proper diagnosis of anatomical areas on the film.
mA (milliamperage) controls, when adjusted, will change how dense an x-ray film's appearance will be. Higher mA will result in a darker film, lower mA a lighter film.
Contrast is the differences in shades of grey areas on the dental x-ray that show anatomy, restorations or conditions.
Processing solutions are considered to be hazardous chemicals. Processing solutions should require PPE during handling as well as appropriate disposal methods.
The developing solution softens the emulsion on the film, partially processing them.
The fixer solution removes unexposed crystals from the film, creating the clear areas on the film.
Red light bulbs are not appropriate for safe lights. A regular safelight and a source of white light safelight are appropriate.
85-105 degrees is the appropriate temperature range of developer chemicals inside of an automatic processor.
Inadequate temperature regulation is not a common cause of automatic processor breakdown. Failing to properly clean the rollers and replenish chemicals properly are.
Duplication film cannot be exposed to x-rays and should not be placed in a patient's mouth. It should only be used to copy x-rays that have already been taken.
Overexposure does not cause films to appear lighter. It would cause them to appear darker.
Underdevelopment would not cause films to appear too dark., It would cause them to appear lighter.
Incomplete wash would not cause a fogged film appearance. Stray radiation, improper use of a safelight or expired film could cause fogging.
Static electricity is noted on the appearance of x-ray films by having tree-like or lightening shaped black lines.
Dirty rollers inside of an automatic processor machine will leave line-like distortions across the surface of the film.
Splashes of fixer on the film prior to processing will remove undeveloped crystals, causing a white area on the film.
Film overlapping during processing (this particular photo shows overlapping during the developer phase of processing).
Splatter of developer prior to processing will cause dark spots on the film.
Inadequate immersion in the developer solution would result in a blank area on the film, as unprocessed crystals would be removed during the fixing and wash solutions.
As light passes through to the duplicating film, it makes it lighter, which is the opposite of dental x-ray films.
Three tanks are in automatic processors: the developer, fixer and water tanks.
If an automatic processor does not have a daylight loader, then it must be loaded in a dark room. All films should be disinfected prior to their placing into daylight loaders to prevent cross-contamination
Wiping dirty films down and then opening them over a paper towel is not part of proper infection control in regards to film processing. Dirty films should be wiped down and then placed in a clean cup. The clean cup should be transported to the developer or placed inside of the daylight loader. This prevents contamination of the processor and daylight loader.
When mounting radiographs, the ADA recommends that the embossed dot should face toward the practitioner. This allows the practitioner to determine which side of the film is face up and what side of the face it belongs to.
An FMX contains all 3 groups that radiographs are mounted in - bitewing, anterior and posterior periapicals.
Maxillary sinuses are anatomical landmarks that help determine maxillary and mandibular locations on radiographs. While the slope of the jawbone may act as a crutch when mounting films, it is not a landmark.
Mental foramen is the circular radiolucent area that is viewable on x-rays near the apex of first premolar roots.
Periodontal ligament space appears as a think radiolucent line around the tooth root.
The mandibular canal houses nerve tissue and appears as radiolucent through the mandibular molar region on x-rays.
Mandibular Coronoid Process is the bony protrusion on the jawbone that appears as radiopaque on some maxillary posterior periapical films.
Zygomatic process (the cheek bone) is this radiopaque arch area. It is thicker and more consistent in shape than the nearby nasal sinuses
External oblique ridge is the bony ridge of the mandible, near the posterior mandibular molars.
The sinuses are visible landmarks when mounting upper posterior x-rays like periapicals and some bitewing films.
Median palatine sutures are located between the anterior central incisors, where the palate fuses together in the middle during development.
The dentist owns dental radiographs even though they have been paid for by the patient as they are a diagnostic part of a patient's permanent record.
Original films should be kept by the dentist, with duplicate films sent directly to the new dentist.
All of the above examples are part of informed consent in regards to taking dental x-rays on a patient.
Decay appears as radiolucent on an x-ray film. The other restorations appear as radiopaque as they do not allow x-ray beams to travel through them and reach the film.
Enamel appears more radiopaque on an x-ray than the other structures because it is the densest.
Upper anterior periapicals of the incisors would possibly show the nasal fossa.
Ionization occurs when x-rays come into contact with tissues, disrupting their cell structure.
Photons are bundles of pure energy and have no weight or mass.
Electronmagnetic radiation includes radio, light, television and x-rays. These waves travel in a straight line with wavelike motions.
Shorter wavelengths have higher energy and penetrate matter easier than longer wavelengths.
Scatter radiation occurs when the wavelengths are bounced off of surfaces that they come into contact with, such as the patient.
Secondary radiation is less penetrating because it has become weaker after initial contact with other tissues in its path.
Primary radiation is the stream that the x-ray unit emits, also known as the central ray.
Leakage radiation is when it escapes in different directions, due to faulty equipment.
Each of the 3 choices are among others included in the traditional and SI units of measurement in regard to radiation.
The gray does not belong to the standard system of radiation measurement. It belongs to the SI, or newer system of metric equivalent.
Absorbed dose is the actual absorbed dose of radiation into tissue.
0.01 Gy is equal to 1 rad.
Sv and rem are used to measure dose equivalence to compare the effects.
0.01 Sv is equal to 1 rem.
Maximum permissible dose is also known as MPD
0.05 is the whole-body MPD for occupationally exposed persons
0.005 Sv is the maximum permissible dose for occupationally exposed pregnant women.
ALARA : As Low As Reasonably Achievable helps to reduce radiation exposure.
All of the above may be changed due to radiation exposure.
Reproductive cells have a high sensitivity to radiation. The others are medium to low sensitivity.
The latent period is the time lag between the time that x-rays are absorbed (exposed. to when the effects of radiation become evident.
MPD is the maximum permissible dose exposure limit for employees when observing radiation safety measures.
Acute radiation exposure is when large dosages are absorbed in a short amount of time. An example of an acute radiation exposure would include a nuclear accident.
Chronic radiation exposure is when small amounts of radiation are absorbed over a long period of time.
Genetic radiation effects are due to damage of reproductive cells and are passed on to future generations
Somatic radiation affects a parent but is not passed on to future generations because it has not damaged reproductive cells.
Lead aprons should be worn by every dental patient that is having dental x-rays taken. The lead apron protects vital organs from radiation exposure.
In the case of dental emergencies, x-rays on pregnant women should be selective and always use a lead apron to cover the patient's abdomen. Postpone routine x-rays for after they have given birth.
The dentist is the only person responsible for prescribing and ordering x-rays on dental patients.
Radiographs should be taken as needed. Each patient's dental needs are different and should be considered before prescribing routine x-rays.
Use of fast speed film is the single most effective measure to reduce exposure to x-rays. Fast speed film is rated in a range of A to F.
F-speed film is the fastest intraoral film available for dental x-ray use.
Size of crystals in the emulsion coating on an x-ray film is what determines the speed of the film. Larger crystals need less radiation.
Background radiation comes from natural sources like radioactive materials in the ground, or from cosmic radiation.
A lead collimator, aluminum filter and position-indicator device are needed for dental x-ray tubeheads to limit radiation exposure.
Long wavelengths are weaker and add unnecessary radiation exposure. The lead filter prevents these from reaching the patient or operator.
Filtration produces higher energy beams because they filter out weak beams, leaving only strong penetrating beams.
A collimator uses a lead plate with an opening just large enough for x-ray beams to go through in order to expose the x-ray. This reduces the size of the beam as well as exposure to radiation.
Long PIDs prevent spread of x-ray beams, leaving only straighter beams to exit the tubehead toward the dental x-ray.
Lead aprons and thyroid collars must be worn on all dental patients that are receiving x-rays in order to reduce unnecessary radiation exposure.
The parent or caregiver should hold the film for a necessary dental x-ray when a child is unable to hold it themselves. If the dental professional held the film each time this happened, they would receive long term radiation exposure.
Pocket dosimeters, also called film badges, are used to monitor and measure the amount of radiation incurred during occupational exposure.
Six feet away is the necessary distance to stand from x-ray units during use, only if a barrier is not available.
At a right angle to the primary beam will reduce exposure, as the primary beam will travel directly in front and could possibly travel directly behind.
Cathode is the tungsten filament where the electrons are generated in an x-ray tube.
Anode is the area inside o the tubehead that acts as a target for electrons.
Collimators reduce the size and shape of x-ray beams as they leave the tubehead, acting as a filter for the beam.
The milliamperage selector - mA, increases the quantity of electrons.
kV, or kilavoltage selector is used to control the penetrating abilities, or quality of an x-ray beam.
All of the above structures appear as radiolucent on dental x-rays. They are less dense, thus resulting in radiolucency on the x-ray film.
Fillings appear as radiopaque on dental x-rays, because they are denser and allow less x-ray beams to penetrate them.
MPD, or maximum permissible dose, is the limit for occupationally exposed individuals and the amount allows for very little chance of injury.
The larger the size of crystals on a film, the faster the film speed. Large crystals are more sensitive to the x-ray beam and require less radiation for exposure on the film.
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