✨THE DEFINITIVE Darby's Simulated NBDHE Board Exam 4

A dental hygienist recognizes all relationships require considering the values and perspectives of others before making decisions or taking actions affecting them. Which fundamental principles of the Code of Ethics for Dental Hygienists is this hygienist MOST embracing? A. The principle of universality expects that, if one individual judges an action to be right or wrong in a given situation, other people considering the same action in the same situation would make the same judgment. B. Ethics are the general standards of right and wrong that guide behavior within society. As generally accepted actions, they can be judged by determining the extent to which they promote good and minimize harm. C. The principle of complementarity recognizes that in all relationships, it requires considering the values and perspectives of others before making decisions or taking actions affecting them. D. The principle of community expresses our concern for the bond between individuals, the community, and society in general. It leads us to preserve natural resources and inspires us to show concern for the global environment.

C. The principle of complementarity recognizes that in all relationships, it requires considering the values and perspectives of others before making decisions or taking actions affecting them. RATIONALE: The principle of complementarity recognizes that in all relationships, it requires considering the values and perspectives of others before making decisions or taking actions affecting them. The principle of universality expects that, if one individual judges an action to be right or wrong in a given situation, other people considering the same action in the same situation would make the same judgment. Ethics are the general standards of right and wrong that guide behavior within society. As generally accepted actions, they can be judged by determining the extent to which they promote good and minimize harm. The principle of community expresses our concern for the bond between individuals, the community, and society in general. It leads us to preserve natural resources and inspires us to show concern for the global environment.

Sustained-release, local drug delivery systems used in conjunction with periodontal debridement for pocket reduction is preferred over systemic delivery because local delivery occurs immediately and does not require prolonged time periods. A. Both the statement and reason are correct and related. B. Both the statement and reason are correct but NOT related. C. The statement is correct, but the reason is NOT. D. The statement is NOT correct, but the reason is correct.

C. The statement is correct, but the reason is NOT. RATIONALE: In conjunction with periodontal debridement, sustained-release local drug delivery systems, also called controlled drug delivery, offer many advantages including site-specific release of a highly concentrated medication for a prolonged period, up to 14 days depending upon the manufacturer. Note that this delivery system has also been described as locally applied antimicrobials (LAA).

Older adults are at an increased risk for root surface caries (RSC) because this demographic group typically consumes a high protein diet. A. Both the statement and reason are correct and related. B. Both the statement and reason are correct but NOT related. C. The statement is correct, but the reason is NOT. D. The statement is NOT correct, but the reason is correct.

C. The statement is correct, but the reason is NOT. RATIONALE: Older age is positively associated with the prevalence of root caries for many reasons, however there is no association between root caries risk and a high protein diet. Risk factors include exposed root surface, retention of plaque biofilms, and xerostomia.

What bones form the lateral walls of the skull? A. The cranial bones B. The occipital bone C. The temporal bones D. The parietal bones

C. The temporal bones. RATIONALE: The temporal bones (paired bones) form the lateral walls of the skull. The cranial bones, or neurocranium, (eight bones) surround the brain; four singular bones, two paired bones. The occipital bone (single bone) forms the posterior portion of the skull. The parietal bones (paired bones) constitute a large part of the vault and sides of the cranium.

CASE A Age: 72 Sex: F Height: 5'5" Weight: 135 lbs/60 kg BP: 130/85 mmHg Pulse: 72 bpm Respiration: 18 rpm Medical hx: Presents with hypertension, open heart surgery within the past 5 years (aorta valve replaced and mitral valve repaired), osteoporosis, and high cholesterol. Dental Hx: Hx of perio-flap surgery. Smoked for 50 years but quit 2 years ago. Brushes 3x daily and flosses 2-3x per week. Clinical Eval: minimal plaque biofilm, limited BOP, recession, sensitivity, perio surgry, maxillary anterior bridge and mandibular posterior bridge. Overbite by ~4 mm. Meds: Metropolol, Crestor, Fosamax, Aspirin Social Hx: Retired and widowed. Has 2 children and one grandchild. The incisal edges of the anterior mandibular teeth appear to have a cervical notch. This feature is characteristic of A. abrasion. B. attrition. C. abfraction. D. erosion.

C. abfraction. RATIONALE: Attrition is the result of wearing away of a tooth as a result of mastication and other forms of tooth-to-tooth contact. The condition of the incisal edges of the mandibular anterior teeth is characteristic of damage from attrition. Abrasion, the mechanical wearing away of the tooth substance by forces other than mastication, is not evident in the photographs or history. A somewhat different mechanism of loss of tooth surface, abfraction, presents as a wedge or V-shaped cervical notch and is caused by occlusal stresses and/or tooth flexure from bruxing. The loss of tooth substance by a chemical process that affects the facial or lingual surfaces is referred to as erosion.

A tooth desensitizing agent is applied continually A. for 5 minutes. B. for 20 minutes. C. according to the manufacturer's instruction. D. until the dispenser is emptied.

C. according to the manufacturer's instruction. RATIONALE: The amount of time recommended for the application of a particular tooth desensitizing agent varies and is dependent on the manufacturer's instructions. The hygienist should carefully read and follow these directions; applications for incorrect periods of time, or utilizing the entire container may be dangerous.

A state-hired full-time public health dentist and dental hygienist are responsible for collecting data on the dental plaque rates of elementary school-aged children. Correlational studies are planned to determine strength of data between genders and among geographical locations of the elementary schools. It was decided to screen children in grades K, 2, 4, and 6 within 25 schools throughout the state. The 25 schools were chosen on the basis of geographic locations and number of students enrolled. All students within each of the chosen grades would be part of the study. Three other public health dental hygienists were hired part time to help in the data collection process. When data collection was completed, analyzed, and interpreted, the public health dentist and the dental hygienist would decide on an oral health program to best meet the needs of the elementary school-aged children of the state. The evaluation of a dental health program implemented in these elementary schools should be PRIMARILY concerned with A. program effectiveness in reducing plaque scores. B. number of children participating in the program. C. accuracy of collected data, its analysis, and its interpretation. D. cost analysis of program costs.

C. accuracy of collected data, its analysis, and its interpretation. RATIONALE: The goal for this community health program is to utilize data about plaque rates in selected groups of children to decide on an oral health program to best meet the needs of the elementary school-aged children in this state. The effectiveness in reducing plaque scores was not measured in this study, but hopefully will be a future study based upon this study's results and dissemination. While the number of children participating in this study and the cost analysis of the program are important components in the success of this program and the likelihood that subsequent programs become funded, they are contributory toward the program goal.

Torus palatinus, an inherited, autosomal dominant condition appears A. at the junction of the hard and soft palates. B. in middle age, typically around aged 50. C. as a variety of shapes — nodular, lobulated, smooth (flat), spindle. D. radiolucent and malignant in radiographs.

C. as a variety of shapes — nodular, lobulated, smooth (flat), spindle. RATIONALE: Torus palatinus appears as a variety of shapes - nodular, lobulated, smooth (flat), and/or spindle. It appears as a hard protuberance of bone in the midline of the hard palate. Torus palatinus is usually seen by the age of puberty; rarely observed in children, peak incidence occurs before 30 years; more common in females. This benign protuberance of bone appears as a dense radiopacity (radiopaque) in radiographs.

If a dental hygienist's license to practice dental hygiene is in jeopardy, the dental hygienist must first be given notice of the violation, a hearing, and an opportunity to respond before license revocation or suspension. This process exemplifies the principles of A. equal protection. B. tort law. C. due process. D. statute of limitations.

C. due process RATIONALE: The concept of due process protects the public from arbitrary actions of the state or jurisdiction. Note that an important component of due process is the requirement that a law must be reasonable, definite, and must apply equally to all persons equally. Fair procedures must be followed in enforcing the law; the state may not arbitrarily take away a license to practice dental hygiene. The hygienist must first be given notice of the violation, a hearing, and an opportunity to respond before license revocation of suspension is imposed. Tort law, a division of civil law, addresses civil wrongs and wrongful conduct committed against a person or a person's property or privacy. The length of time an aggrieved person has to enter a suit against another for an alleged injury is called a statute of limitations.

The part of an instrument's shank that allows the working end to be adapted to the tooth surface is called the A. lower (terminal) shank. B. extended lower. C. functional shank. D. simple shank.

C. functional shank. RATIONALE: The functional shank is the part of an instrument's shank that allows the working end to be adapted to the tooth surface. The lower (terminal) shank is the bent portion of the functional shank nearest to the working end. The extended lower shank is 3 mm longer than a standard lower shank and provides additional leverage, acting as a fulcrum. It is ideal for working in deep periodontal lesions. The simple shank is bent in one plane (from front to back) and used primarily on anterior teeth; also called a straight shank.

One indication for performing a gingivectomy is a(an) A. infrabony pocket. B. mucogingival defect. C. gingival overgrowth. D. dentinal hypersensitivity.

C. gingival overgrowth. RATIONALE: Among the numerous indications for gingivectomy is the removal of enlarged, overgrown gingiva to improve esthetics or access for self-care procedures. Another indication is the presence of gingival pockets composed of enlarged fibrotic tissue that are similarly shaped with horizontal bone loss. Contraindications to gingivectomy include infrabony pockets and mucogingival defects. Note that gingivectomy is not indicated to relieve dentinal hypersensitivity; in fact, gingivectomy procedures often elicit dentinal hypersensitivity.

On x-ray examination, a radiolucent, pear-shaped lesion is found distal to a patient's maxillary right lateral incisor causing divergence of the lateral and canine roots. The lesion is likely a(an) A. keratocystic odontogenic tumor. B. ranula. C. globulomaxillary cyst. D. sialolith.

C. globulomaxillary cyst RATIONALE: Classified as a developmental cyst, the pear-shaped globulomaxillary cyst arises from odontogenic epithelium between the maxillary lateral incisor and canine. Globulomaxillary cysts were previously called fissural cysts. Note that like many cysts, the globulomaxillary is named based upon its location. Keratocystic odontogenic tumors most frequently form in the posterior of the mandible. Ranulas cause blockage or obstruction in ducts of major salivary glands. Most frequently ranulas are caused by a salivary "stone" (referred to as a sialolith). Ranula is a term reserved and used for a mucocele that occurs in the floor of the mouth.

A state-hired full-time public health dentist and dental hygienist are responsible for collecting data on the dental plaque rates of elementary school-aged children. Correlational studies are planned to determine strength of data between genders and among geographical locations of the elementary schools. It was decided to screen children in grades K, 2, 4, and 6 within 25 schools throughout the state. The 25 schools were chosen on the basis of geographic locations and number of students enrolled. All students within each of the chosen grades would be part of the study. Three other public health dental hygienists were hired part time to help in the data collection process. When data collection was completed, analyzed, and interpreted, the public health dentist and the dental hygienist would decide on an oral health program to best meet the needs of the elementary school-aged children of the state. Calculation of the Oral Hygiene Index-Simplified (OHI-S) resulted in an overall mean score of 2.75 on a scale of 0 to 3. The MOST effective approach to improve the plaque scores of elementary students in this state is to A. reinforce current brushing techniques. B. educate the parents on proper oral hygiene habits at home. C. initiate a 2-year plaque control program in elementary schools. D. provide information on dental disease progression to teachers.

C. initiate a 2-year plaque control program in elementary schools. RATIONALE: Initiating a two year plaque control program is the best opportunity to succeed in making improvements in plaque scores. Rather than reinforcing current brushing techniques, demonstration of correct technique should be implemented and reinforced. Only somewhat effective, and not a wise expenditure of time and resources on a community basis is self-care education of parents. Similarly, while providing information on dental diseases to teachers is important, this is not the MOST effective approach.

CASE A Age: 72 Sex: F Height: 5'5" Weight: 135 lbs/60 kg BP: 130/85 mmHg Pulse: 72 bpm Respiration: 18 rpm Medical hx: Presents with hypertension, open heart surgery within the past 5 years (aorta valve replaced and mitral valve repaired), osteoporosis, and high cholesterol. Dental Hx: Hx of perio-flap surgery. Smoked for 50 years but quit 2 years ago. Brushes 3x daily and flosses 2-3x per week. Clinical Eval: minimal plaque biofilm, limited BOP, recession, sensitivity, perio surgry, maxillary anterior bridge and mandibular posterior bridge. Overbite by ~4 mm. Meds: Metropolol, Crestor, Fosamax, Aspirin Social Hx: Retired and widowed. Has 2 children and one grandchild. Tooth #24 is located in an abnormally forward position in the line of occlusion, whereas #25 is pathologically behind. The alignment of teeth #24 and 25 in relation to the patient's occlusion are referred to as A. linguoversion/torsoversion. B. torsoversion/labioversion. C. labioversion/linguoversion. D. infraversion/labioversion.

C. labioversion/linguoversion. RATIONALE: Tooth #24 is positioned labial to the line of occlusion and is thus considered in labioversion. By contrast, tooth #25 is in linguoversion because it is positioned lingual to the line of occlusion. Other occlusal patterns include torsoversion in which an individual tooth is turned or rotated and infraversion which results in depression of a tooth below the line of occlusion.

All of the following are prerequisites for caries development EXCEPT one. Which one is the EXCEPTION? A. Cariogenic bacteria B. Supply of substrate for acid production C. pH range of 7.2 to 9.3 D. Susceptible host

C. pH range of 7.2 to 9.3 RATIONALE: For caries production the pH must be in an acidic range (below 7.0). The range in the selection is in the basic range. Enamel demineralization occurs at pH of 4.5 - 5.5. Root surface demineralization occurs at pH of 6.0 to 6.7. Prerequisites for caries development include: a cariogenic host, adequate supply of substrate for acid production, and the availability of a susceptible host.

When treating a patient on an implant maintenance regimen, it is crucial that the dental hygienist select A. plastic and/or stainless steel instruments. B. plastic and/or carbon steel instruments. C. plastic and/or titanium instruments. D. titanium and or stainless steel instruments.

C. plastic and/or titanium instruments. RATIONALE: Special instruments are recommended for assessing and debriding implants. Plastic instruments are most commonly used because the plastic material is softer than the implant material. Titanium instruments are increasing in popularity due to their ability to remove soft and hard deposits safely from the implant surfaces. Metal instruments (stainless steel, carbon steel, and metal ultrasonic instruments) may leave scratches on the surface of the implant.

The liquid or matrix components used in both polycarboxylate and traditional glass ionomer cements is A. phosphoric acid in water. B. eugenol. C. polyacrylic acid in water. D. copolymer acid in water.

C. polyacrylic acid in water. RATIONALE: Polyacrylic acid in water is the liquid/matrix component in both polycarboxylate and conventional glass ionomer cements. Phosphoric acid in water is the liquid/matrix component for zinc phosphate (ZP) cements. Eugenol is the liquid/matrix component for zinc oxide-eugenol (ZOE) cements that are unmodified, and have limited use. copolymer acid in water. Copolymer acid in water is the liquid/matrix component for resin-modified glass ionomer cements.

A chemical, biologic, or physical agent that causes birth defects is known as a A. gestation. B. carcinogen. C. teratogen. D. free radical.

C. teratogen. RATIONALE: A teratogen is a chemical, biological or physical agent that can disturb the development of an embryo or fetus whereas a carcinogen is a cancer causing substance or agent. Known to cause both teratogens and carcinogens, a free radical is an atom or group of atoms that has at least one unpaired electron and is therefore unstable and highly reactive. Gestation refers to the period of development in utero from conception to birth.

CASE A Age: 72 Sex: F Height: 5'5" Weight: 135 lbs/60 kg BP: 130/85 mmHg Pulse: 72 bpm Respiration: 18 rpm Medical hx: Presents with hypertension, open heart surgery within the past 5 years (aorta valve replaced and mitral valve repaired), osteoporosis, and high cholesterol. Dental Hx: Hx of perio-flap surgery. Smoked for 50 years but quit 2 years ago. Brushes 3x daily and flosses 2-3x per week. Clinical Eval: minimal plaque biofilm, limited BOP, recession, sensitivity, perio surgry, maxillary anterior bridge and mandibular posterior bridge. Overbite by ~4 mm. Meds: Metropolol, Crestor, Fosamax, Aspirin Social Hx: Retired and widowed. Has 2 children and one grandchild. The gingival recession noted on tooth #3 is MOST likely caused by A. toothbrushing, erosion and medications. B. toothbrushing, attrition and medications. C. toothbrushing, smoking and attrition. D. toothbrushing, smoking and abfraction.

C. toothbrushing, smoking and attrition. RATIONALE: At first glance the recession noted tooth #3 could be attributable solely to toothbrush abrasion. However, looking more closely at the clinical data, this patient smoked for 50 years subjecting her soft tissues, bone, and tooth surfaces to damage. Couple this with the extensive attrition visible on her incisal edges and occlusal cusps. Primary and/or secondary occlusal trauma have undoubtedly occurred. Considering this combination of damaging factors: probable traumatic toothbrushing, 50 years of smoking, visible evidence of occlusal trauma - gingival recession is the likely result. Erosion, the loss of tooth substance by a chemical process may be at play, but the other factors are more likely. Abfraction is caused by occlusal stresses or tooth flexure from bruxing and appears as a wedge or V-shaped cervical notch.

A state-hired full-time public health dentist and dental hygienist are responsible for collecting data on the dental plaque rates of elementary school-aged children. Correlational studies are planned to determine strength of data between genders and among geographical locations of the elementary schools. It was decided to screen children in grades K, 2, 4, and 6 within 25 schools throughout the state. The 25 schools were chosen on the basis of geographic locations and number of students enrolled. All students within each of the chosen grades would be part of the study. Three other public health dental hygienists were hired part time to help in the data collection process. When data collection was completed, analyzed, and interpreted, the public health dentist and the dental hygienist would decide on an oral health program to best meet the needs of the elementary school-aged children of the state. What type of epidemiologic study is exemplified by this research? A. Retrospective cohort B. Cross sectional C. Case-control D. Experimental

Cross sectional RATIONALE: This research is an example of a cross-sectional study because it examines the relationship between a variable (such as dental plaque rates in males vs. females, geographic distribution) and risk factors in a defined population at one particular time. A retrospective study draws inferences based on past events or experiences whereas a prospective study follows a group of individual (cohort) forward in time. A case-control study divides subjects into at least two groups: a control group that does not experience any treatment or manipulation of variable under study and at least one case group that is subjected to the variable under study. In an experimental study, considered the gold standard of research design, the investigator controls the conditions and exposure to variables while at least two randomly selected equivalent groups are observed and measured prospectively (into the future).

A setting of 10 milliamperes (mA) with an exposure time of 3 seconds results in 30 mAs (milliamperes per second) of radiation exposure. To maintain the same density of the exposed radiograph when the mA is increased to 15, the time of exposure must be reduced to A. 0.5 second. B. 1.0 seconds. C. 1.5 seconds. D. 2.0 seconds.

D. 2.0 seconds. RATIONALE: The 30 milliamperes per second (mAs) is calculated by multiplying the milliamperes (10 mA) by the exposure time (3 seconds). If any component of this calculation is altered and the goal is to maintain the same density in the exposed radiograph, the same total milliamperes per second (mAs) must be retained. In this case, after increasing the mA to 15, the time (s) must be decreased to 2 seconds in order to retain 30 mAs. (15 mA × 2 s = 30 mAs). It follows that the remaining selections are incorrect. Note that milliamperes represent the amount of electrical current applied to the cathode and affect the number of x-rays produced in the exposure.

CASE A Age: 72 Sex: F Height: 5'5" Weight: 135 lbs/60 kg BP: 130/85 mmHg Pulse: 72 bpm Respiration: 18 rpm Medical hx: Presents with hypertension, open heart surgery within the past 5 years (aorta valve replaced and mitral valve repaired), osteoporosis, and high cholesterol. Dental Hx: Hx of perio-flap surgery. Smoked for 50 years but quit 2 years ago. Brushes 3x daily and flosses 2-3x per week. Clinical Eval: minimal plaque biofilm, limited BOP, recession, sensitivity, perio surgry, maxillary anterior bridge and mandibular posterior bridge. Overbite by ~4 mm. Meds: Metropolol, Crestor, Fosamax, Aspirin Social Hx: Retired and widowed. Has 2 children and one grandchild. Tooth #3 has a 3 mm pocket depth. Six millimeters of recession is observed on this tooth. Which of the following accurately reflects the clinical attachment level? A. 3 mm B. 5 mm C. 6 mm D. 9 mm

D. 9 mm RATIONALE: The clinical attachment level (CAL) in the presence of gingival recession is measured directly from the cementoenamel junction (CEJ) to the attached tissue. The mathematical calculus adds the 6 mm of recession to the 3 mm of pocket depth. The remaining selections incorrectly assess the CAL.

A state-hired full-time public health dentist and dental hygienist are responsible for collecting data on the dental plaque rates of elementary school-aged children. Correlational studies are planned to determine strength of data between genders and among geographical locations of the elementary schools. It was decided to screen children in grades K, 2, 4, and 6 within 25 schools throughout the state. The 25 schools were chosen on the basis of geographic locations and number of students enrolled. All students within each of the chosen grades would be part of the study. Three other public health dental hygienists were hired part time to help in the data collection process. When data collection was completed, analyzed, and interpreted, the public health dentist and the dental hygienist would decide on an oral health program to best meet the needs of the elementary school-aged children of the state. Mean scores of the correlations between the following factors were established: ● geographic location and plaque rates ● gender and plaque rates ● geographic location and gender Of the following statistical analytic techniques (methods), which is the most appropriate selection? A. Students t-test B. Chi-square C. Standard deviation D. Analysis of variance (ANOVA)

D. Analysis of variance (ANOVA) RATIONALE: Parametric inferential statistic techniques analyze mean scores to determine if a statistically significant difference exists between the scores. Analysis of Variance (ANOVA), a type of parametric statistic, analyzes differences between three or more mean scores. The intent is to determine presence or absence of statistical significance. Note that ANOVA is also used to examine the effects of two or more independent variables simultaneously. ANOVA is a perfect fit for this study which establishes at least three mean scores. The Student's t-test, another parametric inferential statistic technique, determines if a statistically difference exists between two mean scores. Note that the current study will establish at least three mean scores. Also not applicable is a chi-square test, primarily because it is a nonparametric inferential statistical technique. Nonparametric inferential statistical techniques analyze differences in frequencies, as opposed to mean scores. Standard deviation (SD) is a descriptive statistical measurement of central tendency that 'describes" the variability of scores within a distribution. Descriptive statistics do not have the power that inferential statistical techniques possess. An important distinction, descriptive statistics "describe" results; inferential statistics "infer" results. 196.

During hand-activated instrumentation (scaling), which type of immunity may be immediately conferred to a dental hygienist following an accidental curette laceration of the finger accident? A. Natural active immunity B. Natural passive immunity C. Artificial active immunity D. Artificial passive immunity

D. Artificial passive immunity RATIONALE: Artificial passive immunity is used to confer immediate protection against a disease caused by that organism as in the example of a curette laceration. Natural active immunity develops when a person is exposed to an antigen and the body produces antibodies. Note that this could develop after laceration with a curette, but it takes time. An entirely different mechanism, natural passive immunity, occurs when antibodies from a mother pass through the placenta to the developing fetus. Artificial active immunity is vaccination with killed, inactivated, or attenuated microorganisms or toxoid.

Hydrogen peroxide has been used in the oral cavity for a variety of purposes. These include all of the following EXCEPT one. Which one is the EXCEPTION? A. As a component in whitening dentifrices B. As an oxygenating agent to debride and release oxygen C. As an active ingredient of tooth whitening products D. As an essential oil

D. As an essential oil RATIONALE: While hydrogen peroxide has been employed as a component in whitening dentifrices; as an oxygenating agent to debride and release oxygen; and as an active ingredient of tooth whitening products, hydrogen peroxide is not an essential oil nor is it a component of an essential oil. Essential oils, as used in dental products, are phenol related compounds that have gained acceptance for control of both plaque biofilm and gingivitis. These products carry the ADA Seal of Acceptance (Listerine, many equivalent generic store brands).

All of the following are risk factors of a cerebrovascular accident (stroke) EXCEPT one. Which one is the EXCEPTION? A. Hypertension B. African American heritage C. Male gender D. Asthma

D. Asthma RATIONALE: Asthma is not among the risk factors for cerebrovascular accident (stroke) which include hypertension, African American heritage (as compared with Caucasians), and male gender. The likelihood of having a stroke also increases with age. Note that a cerebrovascular accident (also known as stroke or CVA) results from sudden loss of brain function resulting from interference with the blood supply to a portion of the brain.

In which type of immunopathologic disease are the cells of the body no longer tolerated and the immune system treats them as antigens? A. Hypersensitivity B. Immunodeficiency C. Opportunistic infection D. Autoimmune diseases

D. Autoimmune diseases RATIONALE: An autoimmune disease occurs when the cells of the body no longer tolerate the immune system and treats them as antigens. Also called autoallergic, an autoimmune disease occurs when "self" antigens stimulate the production of antibodies or sensitized lymphocytes. Note that this involves an antigen-antibody complex. Hypersensitivity is an undesirable reaction produced by the normal immune system whereas immunodeficiency is an innately acquired, or induced, inability to develop a normal immune response. In an opportunistic infection, opportunistic organisms take advantage of a compromised situation in the host and subsequently invade and cause infections of the oral cavity. An opportunistic microorganism is one that normally does not cause disease/infection but becomes pathogenic due to the immunodeficient, or impaired, status of the host.

Which is the correct sequence of stages of tooth development A. Bud, cap, dentinogenesis, amelogenesis, bell, appositional dentin and enamel, eruption and root development, functional stage B. Bud, cap, bell, amelogenesis, dentinogenesis, appositional dentin and enamel, eruption and root development, functional stage C. Bud, cap, amelogenesis, dentinogenesis, bell, appositional dentin and enamel, eruption and root development, functional stage D. Bud, cap, bell, dentinogenesis, amelogenesis, appositional dentin and enamel, eruption and root development, functional stage

D. Bud, cap, bell, dentinogenesis, amelogenesis, appositional dentin and enamel, eruption and root development, functional stage RATIONALE: Sequentially the stages of tooth development are: Bud stage, cap stage, bell stage, dentinogenesis, amelogenesis, appositional dentin and enamel, eruption and root development, functional stage.

All of the following agents can be delivered via a cannula/syringe into periodontal pockets EXCEPT one. Which one is this EXCEPTION? A. Minocycline hydrochloride B. Doxycycline Hyclate C. Prilocaine gel D. Chlorhexidine chip

D. Chlorhexidine chip RATIONALE: Cotton pliers are required to place an antimicrobial chlorhexidine chip within a periodontal pocket. Note that the size, shape and formulation of the chip, composed of 2.5-mg chlorhexidine gluconate in a biodegradable film, are not conducive to placement via syringe of any type. Minocycline hydrochloride and doxycycline hyclate are antimicrobial formulations delivered directly into periodontal pockets via a syringe/cannula. Also delivered into periodontal pockets, but for pain control purposes, is Prilocaine periodontal gel. This gel's trade name is Oraqix; it contains an amide anesthetic that is dispensed by proprietary syringe into periodontal pockets. This formulation is helpful for debridement procedures in adults who require limited pain control.

On a health history, a patient indicates that his ankles swell, he experiences shortness of breath after climbing a flight of stairs, and that he sleeps with a minimum of two pillows. Which one of the following diseases should be suspected? A. Angina pectoris B. Hypertension C. Diabetes mellitus D. Congestive heart failure

D. Congestive heart failure RATIONALE: Signs, symptoms, and clinical manifestations of congestive heart failure (CHF) include irregular and difficult breathing patterns (dyspnea), swollen ankles (particularly late in the day), pitting edema, ascites (fluid collection in the peritoneal cavity), cyanosis, anxiety, paleness, frothy pink or white sputum, and weak pulse. Many patients report difficulty climbing stairs and the necessity of sleeping with numerous pillows. CHF represents a complex that involves the failure of one or both ventricles (usually the left) and is the most common cause of death in the United States. Angina pectoris, hypertension, and complications of diabetes mellitus are among the numerous underlying causes of CHF.

Which of the following types of periodontal therapies heals by repair or "scar"? A. Root debridement B. Osseous surgery C. Guided tissue regeneration D. Connective tissue graft

D. Connective tissue graft RATIONALE: Connective tissue grafts heal by the repair phase of inflammation. Also referred to as the fibrous connective tissue repair process and "scarring", correction of the defect helps prevent additional recession. Root debridement and osseous surgery involve other types of healing processes whereas guided tissue regeneration attempts to regenerate new tissue; note this mechanism differs from the repair process.

Pain associated with dentinal hypersensitivity can be described by each of the following EXCEPT one. Which one is the EXCEPTION? A. Rapid onset B. Short duration C. Responsive to stimuli D. Dull pain

D. Dull pain RATIONALE: Dental hypersensitivity does not elicit dull pain. The reaction to various stimuli is described as being sharp in nature; having a rapid onset; lasting for a short duration (transient); and being responsive to stimuli (thermal, evaporative, osmotic, or chemical).

When evaluating the results of pit and fissure sealant placement, the dental hygienist should do all of the following EXCEPT one. Which one is the EXCEPTION? A. Floss to ensure contacts are free of sealant material B. Use air and an explorer to examine for surface voids C. Check for high spots with articulating paper D. Examine the sealant surface to assure a dull and chalky surface exists

D. Examine the sealant surface to assure a dull and chalky surface exists RATIONALE: After conditioning the tooth surface - prior to placement of sealants - a properly etched surface will appear dull and chalky. In contrast, successfully completed sealants appear smooth and are not dull. Flossing to ensure that contacts are free of sealant material is critical. Sealant should be examined to determine the adequacy of bond strength and the absence of voids, underextensions, overextensions, and undercuring. Detection of high spots requires the use of articulating paper.

Short-acting and long-acting β2-adrenergic agonists (sympathomimetics) prescribed to treat asthma and respiratory conditions include each of the following EXCEPT one. Which one is the EXCEPTION? A. Salmeterol and Formoterol B. Albuterol C. Metaproterenol D. Fluticasone (Flovent)

D. Fluticasone (Flovent) RATIONALE: While fluticasone (Flovent) is prescribed for acute asthma and maintenance therapy, this medication is classified as an adrenocorticosteroid. Both albuterol (Proventil, Ventolin) and metaproterenol (Alupent, Metaprel) are short-acting β2 adrenergic agonists (sympathomimetics) prescribed to treat asthma and respiratory conditions. Salmeterol (Serevent) and formoterol (Foradil Aerolizer) are long-acting β2 adrenergic agonists (sympathomimetics) prescribed to treat asthma and respiratory conditions.

All of the following accurately describe aspects of inflammatory papillary hyperplasia of the palate EXCEPT one. Which one is the EXCEPTION? A. Most often associated with partial or complete denture B. Also called palatal papillomatosis C. Varying degrees of inflammation D. Frequently becomes malignant with slight pain

D. Frequently becomes malignant with slight pain RATIONALE: Inflammatory papillary hyperplasia of the palate is most often associated with partial or complete dentures; it is considered a type of denture stomatitis. Inflammatory papillary hyperplasia of the palate is also called palatal papillomatosis. It presents with varying degrees of inflammation; typically has a rounded, smooth, glistening red surface and is granular in appearance. Inflammatory papillary hyperplasia of the palate is a benign asymptomatic condition.

All of the following are characteristics of free gingiva EXCEPT one. Which one is the EXCEPTION? A. Closely adapts around each tooth B. Connects with the attached gingiva C. Contains the free gingival groove D. Has a stippled surface

D. Has a stippled surface RATIONALE: The surface of the free gingiva is not stippled. The free gingiva, also known as the gingival margin, has a dull, smooth surface. While, free gingiva is closely adapted around each tooth, it is not actually attached, hence the adjective "free". Free gingival connects with both the attached gingiva and the free gingival groove.

CASE A Age: 72 Sex: F Height: 5'5" Weight: 135 lbs/60 kg BP: 130/85 mmHg Pulse: 72 bpm Respiration: 18 rpm Medical hx: Presents with hypertension, open heart surgery within the past 5 years (aorta valve replaced and mitral valve repaired), osteoporosis, and high cholesterol. Dental Hx: Hx of perio-flap surgery. Smoked for 50 years but quit 2 years ago. Brushes 3x daily and flosses 2-3x per week. Clinical Eval: minimal plaque biofilm, limited BOP, recession, sensitivity, perio surgry, maxillary anterior bridge and mandibular posterior bridge. Overbite by ~4 mm. Meds: Metropolol, Crestor, Fosamax, Aspirin Social Hx: Retired and widowed. Has 2 children and one grandchild. Which of the following is an advantage of the porcelain-fused-to-metal crowns observed in this patient compared with porcelain-only crowns? A. Is aesthetically pleasing B. Is susceptible to staining C. Retains luster D. Has strength to reduce brittleness

D. Has strength to reduce brittleness RATIONALE: Due to the brittle nature of porcelain, its fusion with metal provides additional strength. Subject to acceptable self-care maintenance, the more aesthetically pleasing porcelain-only crowns are equally resistant to staining and retain the same luster as porcelain-fused-to-metal crowns. Note that a factor in self-care and in-office maintenance is prevention of porcelain damage by avoiding use of abrasive and acidic agents.

A Mission of Mercy (M.O.M.) event was planned for an urban city in a southern state of the United States. This 2-day event was designed to meet the critical needs of underserved people of all ages by providing free dental care to as many adults and children as time, volunteers, and supplies would allow. Local dentists, dental hygienists, dental assistants, dental students, dental hygiene students, and dental assisting students volunteered for the event. Local politicians and two state representatives were also in attendance. Before receiving dental treatment, informed consent was required of all patients. A 10-question patient survey was distributed, and volunteers reviewed each question with patients while the patients were completing the questionnaire. Confidential questions included information on age, gender, education, family income, address, and past dental experiences. At the end of each patient's treatment and before each volunteer completed his or her shift, the patient was asked to complete an evaluation survey. There was an 88% response rate, and 79% answered that their experience was positive. Dental health in populations such as the one treated by this project is often neglected because of each of the following reasons EXCEPT one. Which one is this EXCEPTION? A. Self-perception of need B. Expense of provider services C. Undramatic nature of dental disease D. Lack of availability of preventive care

D. Lack of availability of preventive care RATIONALE: It would be incorrect to state that lack of availability of preventive services is the cause of dental neglect in urban cities because sliding scale oral health programs that are funded publicly and privately are well established. The perceived high expense of provider services is a common cause of dental neglect as are both the lack of self-perception of need and the undramatic nature of dental disease.

All of the following lesions are palpable during an intraoral exam EXCEPT one. Which one is this EXCEPTION? A. Bullae B. Nodules C. Papules D. Macules

D. Macules RATIONALE: A macule, distinguished from surrounding tissue by a color difference, is a flat, nonpalpable lesion that does not protrude. Palpable lesions include bullae, nodules, papules, and vesicles. Although bullae, papules, and vesicles are elevated, nodules can occur above, level with, or beneath skin surface. Both bullae and vesicles contain serous fluid.

On the facial aspect of tooth #6 a patient's probing depths (PPD) are 4, 4, 4. The gingival margin is 2 mm apical to the CEJ. The mucogingival junction is 3 mm apical to the gingival margin. What is the MOST likely periodontal diagnosis of this area? A. Gingival pocket B. Gingival hyperplasia C. Long junctional epithelium D. Mucogingival involvement

D. Mucogingival involvement RATIONALE: In this area, there is a mucogingival involvement/problem because the base of the 4 mm PPD extends 1 mm beyond the attached gingiva into the alveolar mucosa. Stated differently: The base of the pocket extends into the alveolar mucosa by 1 mm. Note that due to the gingival recession this patient has 6 mm of loss of attachment (LOA). This is not a gingival pocket (pseudopocket) nor is there anything that indicates the presence of hyperplasia or the formation of a long junctional epithelium.

Each of the following radiographic exposures provide images of larger areas of the head or skull and require extraoral film placement EXCEPT one. Which one is the EXCEPTION? A. Cephalometric B. Panoramic C. Skull D. Occlusal

D. Occlusal RATIONALE: Although an occlusal radiograph often requires a larger than standard film, this is an intraoral exposure and considered a smaller image. Extraoral film is placed outside the mouth for exposure of larger areas of the head or skull such as cephalometric, panoramic, or skull radiographs.

A state-hired full-time public health dentist and dental hygienist are responsible for collecting data on the dental plaque rates of elementary school-aged children. Correlational studies are planned to determine the strength of data between genders and among geographical locations of the elementary schools. It was decided to screen children in grades K, 2, 4, and 6 within 25 schools throughout the state. The 25 schools were chosen on the basis of geographic locations and the number of students enrolled. All students within each of the chosen grades would be part of the study. Three other public health dental hygienists were hired part-time to help in the data collection process. When data collection was completed, analyzed, and interpreted, the public health dentist and the dental hygienist would decide on an oral health program to best meet the needs of the elementary school-aged children of the state. Which of the following P levels associated with a test of significance would BEST indicate that the researcher's results were MOST likely caused by an independent variable rather than by chance occurrence? A. P ≥ 0.01 B. P ≥ 0.001 C. P ≤ 0.01 D. P ≤ 0.001

D. P ≤ 0.001 RATIONALE: The very low p-value (probability level) of less than or equal to (≤) .001 has the strongest level of significance of all choices provided. Probability level indicates the researcher's acceptable odds for determining the operation of chance factors in producing the obtained research result, the cutoff point used to reject or accept the null hypothesis; also known as the significance level and the alpha value. ● Small p values indicate rare chance occurrences that lead to the rejection of the null hypothesis and provide more confidence that the statistical decision is correct. ● Large p values indicate that chance occurrences are more likely to account for the result Stated differently, a smaller p-value signifies that the independent variable, which is the variable being studied, was responsible for the outcome of the study, the preferred conclusion, and NOT an outlier factor such as pure chance. Of note, the independent variable is often referred to as the outcome variable. The p-values in the remaining selections all are larger, indicating that results are more likely due to chance than to the effect of an independent variable (not the desired research outcome). Note that the selections with the "greater than" (≥) symbols represent outcomes that are highly likely due to chance than to any effects of the independent variable and are rarely seen in published research studies.

A Mission of Mercy (M.O.M.) event was planned for an urban city in a southern state of the United States. This 2-day event was designed to meet the critical needs of underserved people of all ages by providing free dental care to as many adults and children as time, volunteers, and supplies would allow. Local dentists, dental hygienists, dental assistants, dental students, dental hygiene students, and dental assisting students volunteered for the event. Local politicians and two state representatives were also in attendance. Before receiving dental treatment, informed consent was required of all patients. A 10-question patient survey was distributed, and volunteers reviewed each question with patients while the patients were completing the questionnaire. Confidential questions included information on age, gender, education, family income, address, and past dental experiences. At the end of each patient's treatment and before each volunteer completed his or her shift, the patient was asked to complete an evaluation survey. There was an 88% response rate, and 79% answered that their experience was positive. All of the following are reasons for the success of the questionnaire data collection process EXCEPT one. Which one is the EXCEPTION? A. The questionnaire was limited to 10 questions. B. Volunteers helped ensure patients' understanding of each question. C. Responses to questions were indicated as confidential. D. Participants were given a deadline to complete the questionnaire.

D. Participants were given a deadline to complete the questionnaire. RATIONALE: This questionnaire was administered at a specific point in time during the event. There was no deadline other than being completed prior to advancing to the next step in the process of care at the event. Strategies to assure a success when conducting a research questionnaire include: ● Limiting length to assure economy of time ● Providing assistance to decrease misinterpretation of questions, decrease incomplete data collection, and encourage accurate responses ● Emphasizing confidentiality of responses

Sealant material is classified by many parameters including filler content. Filler content classification for pit and fissure sealants includes each of the following types EXCEPT one. Which one is the EXCEPTION? A. Filled sealants B. Glass ionomer sealants C. Fluoride releasing sealants D. Photo-polymerizing

D. Photo-polymerizing RATIONALE: Photo-polymerizing does not apply to sealant filler type. It does, however, apply to the method of polymerization, another classification of sealant materials. Particles of glass and quartz are included in filled sealants. Salivary control is not a critical factor in glass ionomer sealants. Fluoride releasing sealants, as well as calcium phosphate sealants, promote remineralization. Note that there is a category of sealants that are "unfilled". They contain a composite resin sealant without particles and are less resistant to long-term wear.

CASE A Age: 72 Sex: F Height: 5'5" Weight: 135 lbs/60 kg BP: 130/85 mmHg Pulse: 72 bpm Respiration: 18 rpm Medical hx: Presents with hypertension, open heart surgery within the past 5 years (aorta valve replaced and mitral valve repaired), osteoporosis, and high cholesterol. Dental Hx: Hx of perio-flap surgery. Smoked for 50 years but quit 2 years ago. Brushes 3x daily and flosses 2-3x per week. Clinical Eval: minimal plaque biofilm, limited BOP, recession, sensitivity, perio surgry, maxillary anterior bridge and mandibular posterior bridge. Overbite by ~4 mm. Meds: Metropolol, Crestor, Fosamax, Aspirin Social Hx: Retired and widowed. Has 2 children and one grandchild. Aspirin has all of the following pharmacologic effects EXCEPT one. Which one is the EXCEPTION? A. Analgesic B. Antipyretic C. Anti-inflammatory D. Platelet cohesion

D. Platelet cohesion RATIONALE: Aspirin interferes with platelet adhesiveness, thus it decreases cohesion (ability to unite).The pharmacologic effects of aspirin - "the three As" - are ● Analgesic - pain reduction ● Antipyretic - reduction of body temperature ● Anti-inflammatory - higher doses reduce inflammation The mechanism of action of aspirin is primarily peripheral. It works by inhibiting the enzyme cyclooxygenase (COX) or prostaglandin synthetase. These mechanisms inhibit synthesis of prostaglandin functions.

CASE A Age: 72 Sex: F Height: 5'5" Weight: 135 lbs/60 kg BP: 130/85 mmHg Pulse: 72 bpm Respiration: 18 rpm Medical hx: Presents with hypertension, open heart surgery within the past 5 years (aorta valve replaced and mitral valve repaired), osteoporosis, and high cholesterol. Dental Hx: Hx of perio-flap surgery. Smoked for 50 years but quit 2 years ago. Brushes 3x daily and flosses 2-3x per week. Clinical Eval: minimal plaque biofilm, limited BOP, recession, sensitivity, perio surgry, maxillary anterior bridge and mandibular posterior bridge. Overbite by ~4 mm. Meds: Metropolol, Crestor, Fosamax, Aspirin Social Hx: Retired and widowed. Has 2 children and one grandchild. This patient admits that she rarely flosses under her posterior bridge because she finds it frustrating and difficult. Which of the following is the best alternative to flossing under her bridge? A. Hand held syringe irrigating device B. Water pressure-driven irrigating device C. Power-driven irrigating device with water alone D. Power-driven irrigating device with an antimicrobial agent

D. Power-driven irrigating device with an antimicrobial agent RATIONALE: Although at-home oral irrigation cannot accomplish complete plaque removal, it does accomplish subgingival penetration to 1 mm. Both water and antimicrobial agents reduce bleeding and gingivitis, but antimicrobials are more effective in removing bacterial plaque and making it less pathogenic. A caveat, the effect on periodontitis is not well documented. Hand syringes require a high level of dexterity and motivation; not recommended for most individuals.

Removal of supragingival or subgingival calculus without intentional removal of the tooth surface is referred to as A. Nonsurgical periodontal therapy B. Periodontal instrumentation C. Periodontal debridement D. Scaling

D. Scaling RATIONALE: Scaling refers to the removal of supragingival or subgingival calculus without intentional removal of the tooth surface. Nonsurgical periodontal therapy is designed to eliminate or suppress pathogenic microorganisms through the removal and control of biofilm and its retentive factors (including, but not limited to, calculus). Nonsurgical periodontal therapy relies upon the broad term, periodontal instrumentation, which includes scaling, root planing, and periodontal debridement. The term periodontal debridement refers to the treatment of periodontal disease through mechanical removal of tooth and root surface irregularities. This includes biofilm, clinically detectable calculus, and all biofilm-retentive factors. The extent of treatment depends upon the health of adjacent soft tissue.

Which of the following treatment considerations is acceptable for patients with myasthenia gravis? A. Using air polishing B. Using ultrasonic scalers C. Avoiding fluoride therapy D. Scheduling short morning appointments

D. Scheduling short morning appointments RATIONALE: Myasthenia gravis is an autoimmune neuromuscular disease characterized by variable weakness or fatigue of striated, voluntary muscles. Because the weakness of myasthenia gravis, a neuromuscular disease that leads to fluctuating muscle fatigue, increases throughout the day, short morning appointments are advised. Powered instruments such as air polishers and ultrasonic scalers are not recommended, however fluoride therapy should be implemented if needed.

Which one of the following drugs is NOT a selective serotonin reuptake inhibitor (SSRI) prescribed to reduce anxiety? A. Fluoxetine (Prozac) B. Paroxetine (Paxil) C. Sertraline (Zoloft) D. Secobarbital (Seconal)

D. Secobarbital (Seconal) RATIONALE: Secobarbital (Seconal) is not a selective serotonin reuptake inhibitor (SSRI). It is a barbiturate within the depressant category of drugs. Fluoxetine (Prozac), paroxetine (Paxal), sertraline (Zoloft) are selective serotonin reuptake inhibitors (SSRIs).

Comparing permanent maxillary first and permanent maxillary second molars, each of the following statements is accurate EXCEPT one. Which one is the EXCEPTION? A. The second molar resembles the first molar but is smaller B. From the occlusal view the second molar is more rhomboidal than the first molar C. Distolingual cusp of the second molar is smaller and sometimes absent D. Second molars have a minor cusp on the mesiolingual cusp — the cusp of Carabelli.

D. Second molars have a minor cusp on the mesiolingual cusp — the cusp of Carabelli. RATIONALE: First maxillary molars have a minor cusp, the cusp of Carabelli, on the mesiolingual cusp. The second molar resembles the first molar, but is smaller and more rhomboidal from the occlusal view. Distolingual cusp of second molar is smaller and sometimes absent; the lingual surface is narrower in the mesiodistal dimension, compared with the mandibular first molar.

Which one of the following patient factors is an indication for a dental implant? A. Poor quality and density of bone B. Osteoporosis C. Severe malocclusion D. Single missing tooth

D. Single missing tooth RATIONALE: A single missing tooth is a strong indicating factor indicated for recommendation of a dental implant. Osteoporosis and other forms of poor bone quality/density are contraindications, as is severe malocclusion.

The lingual artery, an anterior branch of the external carotid artery supplies blood to each of the following areas EXCEPT one. Which one is the EXCEPTION? A. The floor of the mouth B. The tongue C. The suprahyoid muscles D. Sublingual salivary gland

D. Sublingual salivary gland RATIONALE: Blood supply to the sublingual salivary gland is provided by the sublingual artery. Note that this artery arises from the lingual artery, an anterior branch of the external carotid artery. Blood is also supplied by the sublingual to the mylohyoid muscle and the mucous membranes of the floor of the mouth. The lingual artery, which is an anterior branch of the external carotid artery supplies blood to the floor of the mouth, the tongue and the suprahyoid muscles.

Law is divided into three categories — labor, civil and criminal. Criminal law is law established for preventing harm against society and describes a criminal act and its appropriate punishment. A. Both statements are TRUE. B. Both statements are FALSE. C. The first statement is TRUE, the second is FALSE. D. The first statement is FALSE, the second is TRUE.

D. The first statement is FALSE, the second is TRUE. RATIONALE: Law is divided into two categories — civil and criminal. Criminal law is law established for preventing harm against society and describes a criminal act and its appropriate punishment.

Which of the following forms of electromagnetic radiation has the shortest wavelength? A. Radio waves B. Infrared waves C. Ultraviolet waves D. X-rays and gamma rays

D. X-rays and gamma rays RATIONALE: The wavelengths of x-rays and gamma rays are shorter than the wavelengths of radio waves, infrared waves, and/or ultraviolet waves.

Nitroglycerin is used to treat patients experiencing A. asthma. B. congestive heart failure. C. chronic hypertension. D. angina pectoris.

D. angina pectoris. RATIONALE: Nitroglycerine, a powerful vasodilator, is used to treat the painful constriction of coronary blood vessels known as angina pectoris. While treatment of asthma, congestive heart failure, and chronic hypertension also rely upon medications with vasoconstrictive qualities, nitroglycerine is rarely indicated.

Shingles is caused by the same virus that causes A. cold sores. B. mononucleosis. C. mumps. D. chickenpox.

D. chickenpox. RATIONALE: Chickenpox and shingles represent different forms of infection by the same agent, the herpes zoster varicella virus. Cold sore is a layman term for herpes labialis which is caused by the herpes simplex virus. Mononucleosis is caused by the Epstein-Barr virus whereas both mumps and measles are caused by the paramyxovirus.

The knowledge, skills and ability to provide oral health care effectively to people who are culturally different from oneself is known as A. nonverbal communication. B. ethnicity. C. cognitive learning. D. cultural competence.

D. cultural competence. RATIONALE: Cultural competence is the ability to integrate current knowledge of oral health care within cultures different from one's own. Community groups vary and programs may need to be adapted based on culture and demographic factors. In 2010 the US Department of Health and Human Services (HHS) Oral Health Initiative recommended launching a Cultural Competency program to target oral health disparities. The goal of improving cultural competence continues to be stressed by community health advocates. The 2020 Surgeon General's Report on Oral Health has an expressed goal that seeks to identify existing knowledge gaps and articulate a vision for the future. Ethnicity refers to ethnic traits, background, allegiance, or associations whereas cognitive learning occurs through the acquisition of knowledge.

To safely manage environmental and workplace safety issues related to disposal or storage of extracted teeth with amalgam restorations such teeth should be A. heat sterilized prior to kill retained microorganisms. B. rinsed and soaked in distilled water. C. wrapped in clean gauze and placed in a biohazard waste container. D. disinfected with bleach.

D. disinfected with bleach. RATIONALE: Amalgam should never be heated. When amalgam is heated, vapors from mercury and other heavy metals generate dangerous, toxic vapors. Environmental best management practices (BMP) require that extracted teeth containing amalgam restorations be disinfected using bleach. Best management practices further recommend recycling amalgam traces by capturing particles with chairside trap waste equipment. Soaking in distilled water, and placing within biohazard waste container are not best management practices.

CASE A Age: 72 Sex: F Height: 5'5" Weight: 135 lbs/60 kg BP: 130/85 mmHg Pulse: 72 bpm Respiration: 18 rpm Medical hx: Presents with hypertension, open heart surgery within the past 5 years (aorta valve replaced and mitral valve repaired), osteoporosis, and high cholesterol. Dental Hx: Hx of perio-flap surgery. Smoked for 50 years but quit 2 years ago. Brushes 3x daily and flosses 2-3x per week. Clinical Eval: minimal plaque biofilm, limited BOP, recession, sensitivity, perio surgry, maxillary anterior bridge and mandibular posterior bridge. Overbite by ~4 mm. Meds: Metropolol, Crestor, Fosamax, Aspirin Social Hx: Retired and widowed. Has 2 children and one grandchild. The radiopaque line observed on a panoramic radiograph that runs horizontally across the maxilla from molar to molar is the A. pterygoid plates. B. floor of the maxillary sinus. C. tongue. D. palate.

D. palate. RATIONALE: This radiopaque line that runs horizontally across the maxilla from molar to molar is the image of the hard palate. An image of the nose appears more radiolucent and is located between the maxillary lateral incisors. Images of the pterygoid plate are located posterior to the maxillary molars; the floor of the maxillary sinus is not visible in the anterior region of the maxilla; and the tongue produces a radiolucent shadow superimposed over the maxillary teeth if it is not placed on the palate during exposure.

When handling and disinfecting impressions, dentures, and appliances, the primary goal of infection control is to A. prevent contamination of equipment in the dental laboratory. B. protect the patient from laboratory personnel. C. protect laboratory personnel from the patient. D. prevent cross-contamination.

D. prevent cross-contamination. RATIONALE: The prevention of cross contamination is the primary goal of infection control for impressions, dentures, and appliances. When infection control is properly implemented, cross contamination of dental equipment is prevented and patients and laboratory personnel are fully protected.

Odontogenic myxoma, an odontogenic neoplasm that originates from mesenchymal tissue of tooth germ A. form in postmenopausal women and men over age 60 B. is located in the maxilla more frequently than in the mandible. C. are aggressive malignant lesions within bone D. radiographically appears as a unilocular or multilocular radiolucency; may have a honeycomb or soap bubble appearance.

D. radiographically appears as a unilocular or multilocular radiolucency; may have a honeycomb or soap bubble appearance. RATIONALE: Radiographically an odontogenic myxoma appears as a unilocular or multi-locular radiolucency; they may have a "honeycomb" or "soap bubble" appearance. Odontogenic myxoma most often form in young adults, ages 10 to 30 years with no gender predilection. These lesions are located in the mandible more frequently than in the maxilla. Odontogenic myxoma are benign, but aggressive lesions within bone; small lesions are asymptomatic, larger lesions cause expansion of bone. Displacement of resorption of adjacent teeth may occur with odontogenic myxoma.

A Mission of Mercy (M.O.M.) event was planned for an urban city in a southern state of the United States. This 2-day event was designed to meet the critical needs of underserved people of all ages by providing free dental care to as many adults and children as time, volunteers, and supplies would allow. Local dentists, dental hygienists, dental assistants, dental students, dental hygiene students, and dental assisting students volunteered for the event. Local politicians and two state representatives were also in attendance. Before receiving dental treatment, informed consent was required of all patients. A 10-question patient survey was distributed, and volunteers reviewed each question with patients while the patients were completing the questionnaire. Confidential questions included information on age, gender, education, family income, address, and past dental experiences. At the end of each patient's treatment and before each volunteer completed his or her shift, the patient was asked to complete an evaluation survey. There was an 88% response rate, and 79% answered that their experience was positive. For collection and analysis of research data, the measurement scale characterized by equal intervals along the scale that has presence of absolute zero and is utilized in most dental indices is the A. nominal scale. B. ordinal scale. C. interval scale. D. ratio scale.

D. ratio scale. RATIONALE: The Ratio scale is the measurement scale characterized by equal intervals along the scale that has presence of absolute zero. Most dental indices are treated as ratio data. Nominal scale observations belong to mutually exclusive classes or categories (political party, gender, place of residence, address). Note that nominal data can be "named". Ordinal scaling applies to data such as age, education, and family. Note that ordinal data can be "ordered". This includes classes or categories that order (rank) characteristics in some empirical order such as Likert scales (ranging from strong agree to strongly disagree), most dental indices, periodontal classifications, social economic status (SES). Interval scale is measurement characterized by equal intervals along the scale; it has no absolute zero. Interval scale includes the Fahrenheit temperature scale. Interval scaling is generally not applicable to oral health research.

Reduction in probing depth following periodontal debridement is generally attributed to A. bone growth. B. formation of a long junctional epithelium. C. new cementum formation. D. reattachment of periodontal ligament fibers.

D. reattachment of periodontal ligament fibers. RATIONALE: A reduction in probing depth following periodontal debridement is generally due to reattachment of periodontal ligament fibers. Note that none of the following directly result in a reduction in probing depth: bone growth, cementum formation, and/or formation of a long junctional epithelium.

When a restoration is improperly placed in a patient's mouth, the dentist is not meeting the profession's A. licensure requirements. B. accreditation board. C. supervision mandates. D. standard of care.

D. standard of care. RATIONALE: Standard of care, the minimal requirements for acceptable patient care, is defined as the degree of care that a reasonably prudent professional should exercise. A dentist's failure to correctly place a restoration exemplifies failure to meet dentistry's standards of care. Licensure requirements are regulations enacted by a state that define the minimum requirements an individual must demonstrate/document prior to becoming licensed. Requirements specify scope of practice as well as regulated responsibilities. An accreditation board or governing board/commission evaluates educational standards for professionals within their jurisdiction. While supervision mandates for dental hygienists vary among states, the most common types are general, indirect, direct, personal and unsupervised.

The primitive oral cavity is/are called the A. branchial arches. B. frontal processes. C. forebrain. D. stomodeum.

D. stomodeum RATIONALE: At the beginning of the fourth week of embryonic development, five facial swellings, called branchial arches, appear on the embryo. The stomodeum (primitive oral cavity) is the first sign of facial development; the stomodeum is located between the first branchial arch and the frontal process (forebrain).

The surface of the condyle articulates with the A. external acoustic meatus. B. styloid process. C. coronoid notch. D. temporal bone.

D. temporal bone RATIONALE: The condyle articulates with temporal bone, forming the moving part of the TMJ. The external acoustic meatus is the ear canal and does not rotate within the condyle. The styloid process, a pointed piece of bone extending below the ear, projects down and forward from the inferior surface of the temporal bone. The coronoid notch, also called the coronoid process, is a concavity on the anterior border of the ramus of the mandible.

CASE A Age: 72 Sex: F Height: 5'5" Weight: 135 lbs/60 kg BP: 130/85 mmHg Pulse: 72 bpm Respiration: 18 rpm Medical hx: Presents with hypertension, open heart surgery within the past 5 years (aorta valve replaced and mitral valve repaired), osteoporosis, and high cholesterol. Dental Hx: Hx of perio-flap surgery. Smoked for 50 years but quit 2 years ago. Brushes 3x daily and flosses 2-3x per week. Clinical Eval: minimal plaque biofilm, limited BOP, recession, sensitivity, perio surgry, maxillary anterior bridge and mandibular posterior bridge. Overbite by ~4 mm. Meds: Metropolol, Crestor, Fosamax, Aspirin Social Hx: Retired and widowed. Has 2 children and one grandchild. The mandibular anterior interdental papillae appear to be missing, with the crest of the bone at the level of the CEJ. Which of the following BEST describes the contour of the interdental papillae around teeth #23, #24, #25, and #26? A. Bulbous B. Enlarged C. Cratered D. Blunted

RATIONALE: As evident in the photographs, blunted interdental papillae no longer fill the gingival embrasure because their pyramidal shape has been lost. In contrast, bulbous interdental papillae are enlarged. whereas rolled gingiva, appropriately named, manifest as enlarged marginal gingiva with a characteristic circular-like gingival prominence. An even larger open embrasure space is created by cratered interdental papilla, typically due to necrosis and ulcerations associated with NUG and ANUG.

CASE A Age: 72 Sex: F Height: 5'5" Weight: 135 lbs/60 kg BP: 130/85 mmHg Pulse: 72 bpm Respiration: 18 rpm Medical hx: Presents with hypertension, open heart surgery within the past 5 years (aorta valve replaced and mitral valve repaired), osteoporosis, and high cholesterol. Dental Hx: Hx of perio-flap surgery. Smoked for 50 years but quit 2 years ago. Brushes 3x daily and flosses 2-3x per week. Clinical Eval: minimal plaque biofilm, limited BOP, recession, sensitivity, perio surgry, maxillary anterior bridge and mandibular posterior bridge. Overbite by ~4 mm. Meds: Metropolol, Crestor, Fosamax, Aspirin Social Hx: Retired and widowed. Has 2 children and one grandchild. During endodontic therapy, the material used to seal the root canals of teeth #4, #13, and #19 is MOST likely A. phosphoric acid. B. polycarboxylate dental cement. C. gutta percha. D. calcium hydroxide.

RATIONALE: Gutta percha is commonly used to seal root canals. Phosphoric acid, often used as an etchant/conditioner in placement of dental sealants, is not used as a root canal sealant material. Polycarboxylate dental cement, too weak for use in endo therapy, is primarily used as a luting agent. Calcium hydroxide is primarily used as a liner under restorations to promote the formation of secondary dentin.

localized purulent infection involving the marginal gingiva or interdental papilla that does not involve the underlying periodontium is called A. Ludwig's angina. B. osteomyelitis. C. gingival abscess. D. pustule.

c. gingival abscess. RATIONALE: A gingival abscess is a localized purulent infection involving the marginal gingiva or interdental papilla that does not involve the underlying periodontium. There may be a bluish hue. Note that abscesses can occur in most tissues within the body. Ludwig's angina is diffuse bilateral cellulitis of the floor of the mouth and neck that rapidly spreads. Predisposing factors are infected molars and a thin lingual cortical mandibular plate. Osteomyelitis is an infection of bone or bone marrow. Small, inflamed, pus-filled, blister-like lesions on the skin surface are called pustules.

Dental sealants are indicated in teeth with incipient pit and fissure carious lesions. The presence of caries-free pits and fissures with deep and irregular grooves is an indication for sealant application. A. Both statements are TRUE. B. Both statements are FALSE. C. The first statement is TRUE, the second is FALSE. D. The first statement is FALSE, the second is TRUE.

A. Both statements are TRUE. RATIONALE: Dental sealants are indicated for deep and irregular pits and fissures that are caries free or have incipient caries.

Which of the following statements accurately describes gram-positive cell walls? A. Cell wall consists of a lipoprotein-lipopolysaccharide-phospholipid outer membrane B. An outer membrane protects cells against phagocytosis and chemicals C. Cell walls are easily broken by mechanical forces D. Cell walls consist of many layers of peptidoglycan and contain teichoic acids.

A. Cell wall consists of a lipoprotein-lipopolysaccharide-phospholipid outer membrane RATIONALE: Gram-positive cell walls consist of many layers of peptidoglycan and contain teichoic acids. Gram-negative bacteria have a lipoprotein-lipopolysaccharide-phospholipid outer membrane surrounding a thin, peptidoglycan layer. An outer membrane protects gram-negative cells from phagocytosis, penicillin, lysozymes, and other chemicals. Gram-positive cell walls consist of many layers of peptidoglycan and contain teichoic acids.

CASE A Age: 72 Sex: F Height: 5'5" Weight: 135 lbs/60 kg BP: 130/85 mmHg Pulse: 72 bpm Respiration: 18 rpm Medical hx: Presents with hypertension, open heart surgery within the past 5 years (aorta valve replaced and mitral valve repaired), osteoporosis, and high cholesterol. Dental Hx: Hx of perio-flap surgery. Smoked for 50 years but quit 2 years ago. Brushes 3x daily and flosses 2-3x per week. Clinical Eval: minimal plaque biofilm, limited BOP, recession, sensitivity, perio surgry, maxillary anterior bridge and mandibular posterior bridge. Overbite by ~4 mm. Meds: Metropolol, Crestor, Fosamax, Aspirin Social Hx: Retired and widowed. Has 2 children and one grandchild. Using G. V. Black's classification of dental caries and restorations, which of the following describes the occlusal pit restoration on tooth #3? A. Class I B. Class II C. Class III D. Class IV

A. Class I RATIONALE: The restoration present on tooth #3 is an occlusal pit Class I restoration. Note that class I restorations include the occlusal pit and fissure surface only OR the facial and lingual pit surface of molars OR the lingual pit surface of maxillary incisors. G.V. Black, known as the father of operative dentistry, categorized the remaining carious lesions and their respective restorations by the following criteria: ● Class II lesions/restorations include the proximal and occlusal surface of premolars and molars ● Class III lesions/restorations include proximal surfaces of incisors and canines that do not involve the incisal edge ● Class IV lesions/restorations include proximal surfaces of incisors or canines that do involve the incisal edge ● Class V lesions/restorations involve the cervical 1/3 of the facial or lingual surface of anterior or posterior teeth ● Class VI lesions/restorations involve the incisal edge of anterior teeth or the cup tips of posterior teeth

All of the following conditions are contraindications for dental implant placement EXCEPT one. Which one is the EXCEPTION? A. Dental caries B. Poor oral hygiene C. Uncontrolled diabetes D. Substance abuse

A. Dental caries RATIONALE: To the extent that patients with dental caries do not have plaque biofilm retention likely to negatively impact dental implant longevity, implants do not have a greater risk of failure in patients with dental caries. However, poor oral hygiene, uncontrolled diabetes, and substance abuse are contraindications.

Each of the following is true of verruca vulgaris EXCEPT one. Which one is the EXCEPTION? A. Frequently occurs intraorally B. Etiology is the papilloma virus (HPV) C. Lips are most common oral site D. It is also called the common wart

A. Frequently occurs intraorally RATIONALE: Verruca vulgaris, also called the common wart, is not normally observed intraorally. Etiology is the papilloma virus (HPV) most common types HPV-2 and HPV-4; other viral subtypes are also implicated. Lips are most common oral site; verruca vulgaris is a common skin lesion.

Which of the following clinical findings indicate failure of a dental implant? A. Implant mobility B. Absence of bleeding C. Absence of occlusal trauma D. Stable bone level height

A. Implant mobility RATIONALE: Mobility is an important criterion in the determination of a failed dental implant. In contrast, the absence of bleeding and the presence of stable bone level are indicative of success. Note that the absence of occlusal interference or trauma, a positive finding, is determined by assessing numerous factors, including lack of mobility.

Which of the following is NOT among the three classes of ventilator filters certified by The National Institute for Occupational Safety and Health Certification (NIOSH)? A. N-93% B. N-95% C. R-99% D. P-99.97%

A. N-93% RATIONALE: N-93% is not a ventilator filter certified by The National Institute for Occupational Safety and Health Certification (NIOSH). Note that the M-95 respirator is needed to protect against airborne infections (used in hospital based facilities and not commonly found in dental offices).

Transdermal systems for use in nicotine reduction systems include each of the following EXCEPT one. Which one is the EXCEPTION? A. Nicorette B. Habitrol C. Nicoderm D. Nicotrol

A. Nicorette RATIONALE: Nicorette is a chewing gum used in a type of nicotine reduction system for tobacco cessation programs. Habitrol, Nicoderm, and Nicotrol as well as Prostep are transdermal systems. The Nicorette gum as well as the transdermal systems (patches) are available without a prescription.

A health care providers' code of ethical conduct that focuses on patient needs, encourages informed consent, and provides for quality care is a referred to as the A. Professional code of ethics. B. Oath of Hippocrates. C. Principles of Medical Ethics. D. Patient's bill of rights.

A. Professional code of ethics. RATIONALE: In their Code of Ethics, the American Dental Hygienist's Association states: "The purpose of a professional code of ethics is to achieve high levels of ethical consciousness, decision making, and practice by the members of the profession". This code focuses on treating patients fairly and ethically. It includes essential components such as informed consent and quality of care. A patient's bill of rights The Patient's Bill of Rights for dental hygiene addresses these same essential behaviors and identifies ethical behaviors that patients should expect of professionals. The Oath of Hippocrates is a fifth century BC statement of principles guiding professional conduct for physicians. Perhaps its best known tenet is "Above all, do no harm." Principles of Medical Ethics is the title of a code of ethics from the American Medical Association.

Which component of the radiographic developer solutions reduces the exposed silver halide crystals to black metallic silver? A. The reducing agent (hydroquinone and elon) B. The alkalizer (sodium carbonate) C. The preservative (sodium sulfite) D. The restrainer (potassium bromide)

A. The reducing agent (hydroquinone and elon) RATIONALE: The reducing agent (hydroquinone and elon) reduces the exposed silver halide crystals to black metallic silver. The alkalizer (sodium carbonate) softens and swells the gelatin of the emulsion to allow the reducing agent to reach the silver halide crystals. The preservative (sodium sulfite) slows the oxidation of the solution to prolong its lifespan. The restrainer (potassium bromide) slows down the action of chemicals.

A patient who decides to sue a dentist for improper placement of an amalgam restoration is engaging in which legal area? A. Tort law B. Accidental violation C. Abandonment D. Defamation

A. Tort law RATIONALE: An allegation of improper placement of an amalgam restoration by a dentist is an accusation within the category of tort law. Tort law addresses civil wrongs committed against a person, a person's property, or wrongful conduct whereas an accidental violation is one that occurs unexpectedly, unintentionally, or by chance. Abandonment is failure of a health care professional to provide services to a patient of record whereas defamation is untrue communication that injures an individual's reputation. Note that defamation can be further described as libel or slander depending upon whether it is (respectively) written or spoken.

The process whereby phagocytic cells are attracted to the vicinity of pathogens is called A. chemotaxis . B. anaphylatoxin. C. complement. D. cytolysis.

A. chemotaxis. RATIONALE: The process whereby phagocytic cells are attracted to the vicinity of pathogens is called chemotaxis. Anaphylatoxin is a substance produced by complement activation that results in increased vascular permeability through release of pharmacologically active mediators from mast cells. A complement is a system of serum proteins that is primary mediator of antigen-antibody reactions. Cytolysis is the lysis (breakdown) of bacteria or of cells such as tumor cells or red blood cells by the insertion of the membrane attack complex derived from complement activation.

The type of epithelial tissue that lines the oral cavity is called A. stratified squamous epithelium. B. simple columnar epithelium. C. simple cuboidal epithelium. D. pseudo-stratified columnar epithelium.

A. stratified squamous epithelium. RATIONALE: Stratified squamous epithelium lines the cavity. Simple columnar epithelium is tall and narrow; it lines the intestines and cervix of the uterus. Simple cuboidal epithelium is cubical in shape and lines the ovaries. Note that pseudo-stratified columnar epithelium appears stratified, but is in fact, only one layer. Pseudo-stratified epithelium lines is found in the trachea.

Which of the following aspects of metabolism includes de novo synthesis and requires DNA, RNA, mRNA, and rRNA? A. Catbolism B. Anabolism C. Amino acid pool D. Nitrogen balance

B. Anabolism RATIONALE: A major step in anabolism is de novo synthesis which requires deoxyribonucleic acid (DNA), messenger ribonucleic acid (mRNA), and ribosomal ribonucleic acid (rRNA). During catabolism amino acids in excess of those needed for the synthesis of proteins and other biomolecules cannot be stored or excreted. However, they may be used as fuel for immediate energy needs or long-term storage. The amino acid pool is a collection of amino acids in a dynamic equilibrium in the liver, blood, and cells that provide the raw material for the body's protein and amino acid needs. Nitrogen balance is the comparison measurement of the amount of nitrogen ingested with the amount excreted (eg urinary nitrogen plus approximately 1 g/day for nail, hair, skin, and perspiration losses).

Which of the following types of cells/tissues is MOST radiosensitive? A. Nerve B. Lymphatic C. Erythrocyte D. Reproductive cells

B. Lymphatic RATIONALE: Lymphatic, reproductive, and erythrocyte cells are the most radiosensitive (sensitive to radiation effects). Lymphatic is the most radiosensitive cell type. The most radioresistant cell type is nerve cell. Also radioresistant are liver and muscle cells.

Which of the following is the primary cell involved in an acute inflammatory reaction? A. Monocyte B. Neutrophil C. Macrophage D. Plasma cell

B. Neutrophil RATIONALE: The neutrophil (or polymorphonuclear leukocyte PMN), a type of white blood cell (leukocyte), is the first cell to emigrate to the site of injury and is the primary cell involved in acute inflammation. The monocyte, which later becomes a macrophage, is the next leukocyte to arrive. Plasma cells (and lymphocytes) arrive later as they are more common during chronic inflammation.

When one drug reduces the absorption of another drug, what is a common strategy to minimize the interaction? A. Administration of one of the drugs by injection B. Separating administration of doses by two hours C. Withholding all drugs for 24 hours D. Withholding of one drug until therapy with other is complete

B. Separating administration of doses by two hours RATIONALE: When one drug reduces the absorption of another drug, the interaction can be minimized by taking the doses two hours apart. Administration of one drug by injection, withholding all drugs for 24 hours, and withholding one drug until therapy with the other is complete are not viable alternatives and could result in serious consequences.

Dental and dental hygiene practice acts are enacted to protect the A. profession. B. public. C. dental hygienist. D. dentist.

B. public RATIONALE: A practice act is a statute enacted by the legislature of a state or appropriate jurisdiction that defines the legal scope of practice for a profession within the geographic boundaries of that jurisdiction. The purpose is to protect the public. While practice acts may indirectly protect the profession, the dental hygienist and the dentist, this is not the primary purpose.

When reviewing a dentigerous cyst on a radiograph, the radiolucent area will A. be found in a place of a tooth. B. surround the crown of an unerupted or impacted tooth. C. surround the root apex of a fully erupted tooth. D. surround the root apex of an impacted tooth.

B. surround the crown of an unerupted or impacted tooth. RATIONALE: Radiographically a dentigerous cyst appears as a smooth, unilocular radiolucency associated with the crown of unerupted teeth. The radiolucency encircles the tooth crown down to the cemento-enamel junction (CEJ). The radiolucent area of a dentigerous cyst (follicular cyst) forms around the crown of an unerupted or developing tooth. A dentigerous cyst is not found in place of a tooth and does not surround any portion of the root.

All of the following are contraindicated for cosmetic polishing/selective polishing EXCEPT one. Which one is the EXCEPTION? A. Implants B. Decay C. Amalgam D. Porcelain

C. Amalgam RATIONALE: Cosmetic polishing, whether selective or not, is contraindicated on dental implants, areas of dental decay or demineralization, and porcelain restorations. However, polishing is recommended to reduce biofilm retention and prolong the life of amalgam restorations.

The pancreas contains enzymes that digest each of the following pancreas EXCEPT one. Which one is the EXCEPTION? A. Starch B. Glycogen C. Bile D. Protein

C. Bile RATIONALE: Bile is a digestive secretion produced in the liver that helps digest fats. Note that bile is formed within the liver by specialized cells called hepatocytes. Pancreatic secretions include digestive enzymes, insulin, and glucagon. The pancreas contains enzymes that digest ● starch, glycogen and dextrins (pancreatic amylase) ● proteins (trypsin, chymotrypsin, and carboxypeptidase) ● triglycerides (pancreatic lipase) ● nucleic acids (nucleases)

Which of the following does NOT describe likely clinical changes during Stage III gingivitis? Which of the following terms BEST describes inflammatory involvement that includes the attached gingiva, the papilla, and the free gingiva? A. Erythema or a bluish hue with sluggish blood flow, or both B. Bleeding on probing is possible C. Color changes begin in the attached gingiva, then spread to the gingival margin and papilla D. Soft and spongy consistency

C. Color changes begin in the attached gingiva, then spread to the gingival margin and papilla RATIONALE: Color changes begin in the gingival margin and papilla, then spread to the attached gingiva. Erythema (redness) or a bluish hue that colors the gingiva resulting from the proliferation of capillaries is apparent. Color changes are due to congested blood vessels, sluggish blood flow, or both. Bleeding on probing may occur due to thinning and/or ulceration of the sulcular epithelium. Gingival consistency may be soft and spongy or firm depending upon whether destructive changes or reparative changes are dominant in the gingival tissues.

Local anesthetic solutions that contain a vasoconstrictor have all of the following properties EXCEPT one. Which one is the EXCEPTION? A. Reduce systemic absorption of local anesthetic agent B. Reduce blood flow through the area (hemostasis) C. Increase risk of systemic toxicity D. Lower the dose of local anesthetic agents required

C. Increase risk of systemic toxicity RATIONALE: Properties of local anesthetic solutions that contain a vasoconstrictor do not include a risk of systemic toxicity. The opposite is true, vasoconstrictors decrease the risk of systemic toxicity by reducing blood flow through the area (hemostasis). In the same way, vasoconstrictors reduce systemic absorption of local anesthetic agents and lower the required dose of local anesthetic agents required.

Which tooth is known for its bifurcated root? A. Mandibular second premolar B. Maxillary second premolar C. Maxillary first premolar D. Mandibular first premolar

C. Maxillary first premolar RATIONALE: In about 60% of maxillary 1st premolars a bifurcation occurs in the apical third to half of the root. This bifurcation forms one facial and one lingual root. The mandibular second premolar, the maxillary second premolar, and the mandibular first premolar each have only one root.

Each of the following are descriptive of bulimia EXCEPT one. Which one is the EXCEPTION? A. Alternates between food gorging and purging B. Can involve swelling of salivary glands and esophagus C. Most often found in adolescent females who are overweight D. Associated with sensitive teeth

C. Most often found in adolescent females who are overweight RATIONALE: Bulimia is most often found in adolescent females who appear to be of normal weight. This condition of alternate food gorging and purging by self-induced vomiting can cause swelling of the salivary glands and esophagus as well destruction of enamel that results in sensitive teeth.

Each of the following is contained within cellular cytoplasm EXCEPT one. Which one is the EXCEPTION? A. Cytosol B. Cytoskeleton C. Plasma membrane D. Organelles

C. Plasma membrane RATIONALE: The plasma membrane is not contained within cellular cytoplasm. The cytoplasm consists of all cellular content between the plasma membrane and the nucleus.

Each of the following is a reason that periodontal flap procedures are commonly used in surgical procedures EXCEPT one. Which one is the EXCEPTION? A. May be used as a method of surgical curettage such as with the modified Widman flap B. May be used to eliminate pocket depth C. Repositions the soft tissue in a coronal direction D. Provides access for thorough scaling and root planing

C. Repositions the soft tissue in a coronal direction RATIONALE: By repositioning the soft tissue in an apical direction, periodontal flap procedures effectively eliminate pocket depth. Periodontal flap procedures may be used as a method of surgical curettage such as with the modified Widman flap. This commonly utilized surgical procedure provides access for thorough scaling and root planing when access is not possible through nonsurgical periodontal therapy.

Dysphagia is often associated with chronic alcoholism because xerostomia causes difficulty breathing. A. Both the statement and reason are correct and related. B. Both the statement and reason are correct but NOT related. C. The statement is correct, but the reason is NOT. D. The statement is NOT correct, but the reason is correct.

C. The statement is correct, but the reason is NOT. RATIONALE: Dysphagia, or difficulty swallowing, is often associated with alcoholism because xerostomia dehydrates oral mucosal tissues. Note that difficult breathing is referred to dyspnea.

Pellicle formation involves A. bacterial colonization. B. focal areas of mineralization. C. adhesion of salivary proteins to the tooth surface. D. organized mass of organisms.

C. adhesion of salivary proteins to the tooth surface. RATIONALE: Pellicle formation involves the adhesion of salivary proteins to the tooth surface. While organized bacterial colonization does not occur during the pellicle stage, bacteria are able to loosely attach to the pellicle. Areas of mineralization and organization of organisms do not occur during pellicle formation.

Which of the following is an accurate statement regarding Varenicline (Chantix) prescribed as an aid in smoking cessation therapy? A. Nicotine receptor blocker B. Amount of dopamine released into the brain is reduced C. Full course of therapy is usually 12 weeks Dosing for Chantix is once daily for the first 3 days, twice daily thereafter for the full course of therapy (usually 12 weeks). D. Can be used in conjunction with other smoking cessation products

D. Can be used in conjunction with other smoking cessation products RATIONALE: Varenicline (Chantix), prescribed as an aid in smoking cessation therapy, cannot be used in conjunction with other smoking cessation products. Varenicline is a Nicotine receptor blocker that reduces the amount of dopamine released into the brain. Dosing for Chantix is once daily for the first 3 days, twice daily thereafter for the full course of therapy (usually 12 weeks).

All of the following are risk factors associated with osteoporosis EXCEPT one. Which one is the EXCEPTION? A. Low calcium B. Female gender C. Cigarette smoking D. Halitosis

D. Halitosis RATIONALE: Halitosis is not among the risk factors for osteoporosis which include a calcium deficient diet, female gender, tobacco usage, and a sedentary lifestyle.

In a dental radiograph which of the following appears as a radiopaque intersection of the lateral wall of the nasal cavity and the anterior portion of the maxillary sinus? A. Nutrient canal B. Anterior nasal spine C. Zygomatic process D. Inverted Y

D. Inverted Y RATIONALE: This radiopaque intersection created by the intersection of the lateral wall of the nasal cavity and the anterior portion of the maxillary sinus is known as the inverted "Y." Nutrient canals appear as thin radiolucent lines; the anterior nasal spine is a radiopacity adjacent and superior to the incisive foramen; and the radiopaque zygomatic process is located superior to the maxillary posterior teeth.

Angular cheilitis is an oral manifestation of a deficiency in each of the following nutrients EXCEPT one. Which one is the EXCEPTION? A. Riboflavin B. Niacin C. Pyridoxine D. Pantothenic acid

D. Pantothenic acid RATIONALE: No effect is noted of an oral manifestation of a deficiency of Pantothenic acid. Angular cheilitis is an oral manifestation of a deficiency of several nutrients including riboflavin, niacin, and pyridoxine.

The attraction of new bacteria to previously attached bacteria is referred to as colonization. Extracellular polysaccharides provide structural and energy sources for plaque biofilms. A. Both statements are TRUE. B. Both statements are FALSE. C. The first statement is TRUE, the second is FALSE. D. The first statement is FALSE, the second is TRUE.

D. The first statement is FALSE, the second is TRUE. RATIONALE: Note the subtle differences - while colonization is the formation of new microcolonies, co-aggregation is the attraction of new bacteria to previously attached bacteria. To sustain colonies as well as individual bacteria, extracellular polysaccharides such as glucans, fructans, and heteropolysaccharides provide both structural and energy sources.

The most numerous type of red blood cell is/are the A. leukocytes. B. platelets. C. erythrocytes. D. plasma.

c. erythrocytes RATIONALE: Erythrocytes are the most numerous type of red blood cell (RBC). Leukocytes, both granular and nongranular, are white blood cells. Platelets are cell fragments of a specific cell type found in bone marrow; they have no nuclei. Plasma is the liquid portion of the blood.

Bacterial organisms stain differently on the basis of A. the thickness of the slime layer. B. the thickness of the glycocalyx. C. permeability of their cell walls. D. the thickness of the plaque biofilm.

c. permeability of their cell walls. RATIONALE: Bacterial organisms stain differently based on the permeability of their cell walls. An example of this is gram-positive and gram-negative bacteria. Staining characteristics of bacteria are not affected by the thickness of the slime layer (glycocalyx) or the thickness of the plaque biofilm.

Urine is composed of what percentage of water? A. 95% B. 90% C. 85% D. 75%

A. 95% RATIONALE: The composition of urine is approximately 95% water with several substances dissolved in it. (Nitrogenous wastes, electrolytes, toxins, pigments, hormones, abnormal constituents such as blood, glucose, albumin, casts, or calculi)

All of the following are considered common upper respiratory infections EXCEPT one. Which one is the EXCEPTION? A. Asthma B. Laryngitis C. Rhinitis D. Tonsillitis

A. Asthma RATIONALE: Asthma is not an infection, but is defined as a common chronic inflammatory disease of the airways characterized by variable and recurring symptoms, reversible airflow obstruction and bronchospasm. Common symptoms include wheezing, coughing, chest tightness, and shortness of breath. In contrast, laryngitis, rhinitis (inflamed nasal membranes), and tonsillitis are common upper respiratory infections.

Which of the following statements correctly describes the vital signs taken on a 25 year old patient? ● Blood pressure: 125/78 ● Pulse: 86 beats per minute ● Respiration: 13 respirations per minute A. Blood pressure should be classified as elevated B. Blood pressure should be classified as Stage I hypertension C. Pulse is elevated D. Respiration is low E. Everything is normal.

A. Blood pressure should be classified as elevated RATIONALE: This patient's blood pressure is classified as elevated because the systolic measurement is greater than 120 mm Hg. Parameters for elevated blood pressure are: Systolic measurement from 120 to 129 mm Hg and Diastolic measurement less than 80 mm Hg. Chapter 15, Table 15.4 provides details of 2017 blood pressure guidelines. Synopsis below: ● Normal - Systolic value < 120 AND Diastolic value <80 mm Hg. Routine dental management. Recheck at continued-care visits. ● Elevated - Systolic value 120-129 mm Hg AND Diastolic value <80 mm Hg. Routine dental management. Advise patient of status, recommend physician follow-up & lifestyle change. Recheck at recare visits. ● Stage 1 Hypertension - Systolic value 130 to 139 mm Hg OR diastolic value of 80 to 89 mm Hg: Routine dental management. Advise patient of status, recommend follow-up with a physician, and recommend lifestyle management. Recheck at recare visit. ● Stage 2 Hypertension - Systolic value 140-159 OR diastolic value 90-99. Monitor BP at consecutive appointments. If all exceed these guidelines, seek medical consultation. Stress reduction protocol. Recheck at recare visit. ● Stage 2 Hypertension - Systolic value 160-179 OR diastolic value 100-110. Recheck BP in 5 minutes; if BP is still elevated within this range, seek and receive medical consultation before dental hygiene therapy. Noninvasive care only. Definitive emergency care only if BP is less than 180/110 mm Hg. Stress reduction protocol. Continue to monitor BP at consecutive appointments. Recheck at each visit. ● Hypertensive Crisis - Systolic value > 180 AND/OR Diastolic value > 120. Recheck BP in 5 minutes. If still elevated, immediate medical consultation is indicated. No dental/DH care, elective or emergent until BP is decreased. Noninvasive emergency care w drugs (analgesics or antibiotics) are indicated. Refer to hospital for immediate invasive care.

In dental radiography, interpretation refers to an explanation of what is viewed on a radiograph. The term diagnosis refers to the identification of a problem, deficiency/excess, or disease by examination or analysis. A. Both statements are TRUE. B. Both statements are FALSE. C. The first statement is TRUE, the second is FALSE. D. The first statement is FALSE, the second is TRUE.

A. Both statements are TRUE. RATIONALE: Interpretation involves formulation of explanation of what is visible on a radiograph. Diagnosis, whether by examination or analysis of findings from a physical examination, interview or diagnostic data such as radiographs, refers to the identification of disease, state of health, contributing deficiency/excess or perceived problem.

The prevalence and severity of periodontal diseases increases with both type 1 and type 2 diabetes. The presence of uncontrolled diabetes increases dental caries risk as a result of reduced saliva secretion and increased glucose in saliva. A. Both statements are TRUE. B. Both statements are FALSE. C. The first statement is TRUE, the second is FALSE. D. The first statement is FALSE, the second is TRUE.

A. Both statements are TRUE. RATIONALE: Patients with both type 1 and type 2 diabetes are more likely to develop a periodontal disease. Moreover, the American Association of Periodontology (AAP) includes the presence of diabetes as a grade modifier in its newly released (2018) classification system of staging and grading periodontitis patients. Another oral complication of uncontrolled diabetes is an increased risk of dental caries. This is due to increased salivary glucose that contributes to reduced volume and quality of saliva (xerostomia).

Open communication between a dental hygienist and patient minimizes misunderstandings and reduces the likelihood of litigation because a patient who senses professionalism and expertise may not be as prone to file a lawsuit in the event of an unsuccessful procedure. A. Both the statement and reason are correct and related. B. Both the statement and reason are correct but NOT related. C. The statement is correct, but the reason is NOT. D. The statement is NOT correct, but the reason is correct.

A. Both the statement and reason are correct and related. RATIONALE: Open communication is an important risk-management tool that increases a patient's perception of professional interest, professionalism, and expertise while minimizing the potential for hygienist/patient misunderstandings. These practices combine to optimize oral care while reducing the likelihood of litigation.

Which one of the following is MOST indicative that an instrument has become dull? A. Decreased tactile sensitivity B. Less working time involved C. Light grasp required D. Decreased pressure on tooth

A. Decreased tactile sensitivity RATIONALE: A decrease in tactile sensitivity is the MOST indicative sign that an instrument has become dull. Other disadvantages include the requirements of increased working time, a firmer grasp, and increased pressure on the tooth.

A Mission of Mercy (M.O.M.) event was planned for an urban city in a southern state of the United States. This 2-day event was designed to meet the critical needs of underserved people of all ages by providing free dental care to as many adults and children as time, volunteers, and supplies would allow. Local dentists, dental hygienists, dental assistants, dental students, dental hygiene students, and dental assisting students volunteered for the event. Local politicians and two state representatives were also in attendance. Before receiving dental treatment, informed consent was required of all patients. A 10-question patient survey was distributed, and volunteers reviewed each question with patients while the patients were completing the questionnaire. Confidential questions included information on age, gender, education, family income, address, and past dental experiences. At the end of each patient's treatment and before each volunteer completed his or her shift, the patient was asked to complete an evaluation survey. There was an 88% response rate, and 79% answered that their experience was positive. Which of the following information is provided to the participant before signing the informed consent? A. Guarantee of confidentiality to each patient B. A review of the cost of each procedure C. The dental hygienists credentials D. M.O.M. statistics from other states

A. Guarantee of confidentiality to each patient RATIONALE: Informed consent provides evidence of the subject's willingness to receive the dental care. Guaranteed confidentiality is provided to each participant prior to signing the informed consent. Consenting to treatment is not based on the cost of procedures because, in this situation, there is no cost to the participant. In a more general sense, any costs of treatment are discussed and the participant has no obligation to approve treatment. Note that informed consent is sought after design and presentation of the patient's written treatment plan. The dental hygienists' credentials should be available or on display but are not necessarily included in the informed consent form. The concept of informed consent originates with the concept of battery and individual right to make choices regarding their own body. While content of legal requirements vary from state to state, in general, a patient must have information that a reasonable person would find material (important) in making a decision regarding treatment.

Which of the following wound complications should be given first consideration? A. Infection B. Edema C. Inflammation D. Erythema

A. Infection RATIONALE: Whereas edema and erythema are classic signs of the body's primary repair mechanism known as inflammation, infection is not a sign of healing. This complication should be prioritized.

A 25-year-old man with a history of gingivitis is assessed at his 6-month recare appointment. Which of the following clinical signs will MOST likely confirm that his condition has progressed to periodontitis? A. Loss of clinical attachment B. Bleeding on probing C. Change in gingival color D. Inflamed gingival tissues

A. Loss of clinical attachment RATIONALE: Loss of clinical attachment is the best indicator of progression from gingivitis to periodontitis whereas bleeding upon probing, changes in gingival color and inflammation occur in both gingivitis and periodontitis.

A university dental hygiene school received a state-funded grant to improve the oral health status of senior citizens in a rural area of the United States. The funding was for $50,000 over a 1-year period and covered expenses for salaries, equipment, supplies, and education. It was determined that high rates of root caries, root sensitivity, and gum disease were present in this population. The dental hygiene school decided to address these needs by implementing an oral health program in its clinic and to determine the effectiveness of two different types of desensitizing agents on treating root sensitivity. The hypothesis for this study states, "There is no statistically significant difference between desensitizing agent A and desensitizing agent B in the treatment of root sensitivity." What type of hypothesis does this exemplify? A. Null B. Positive C. Research D. Standard

A. Null RATIONALE: A null hypothesis assumes there is no statistically significant difference between the agents used (independent variables) in the study. This type of hypothesis minimizes researcher bias. Quite different, both a research and a positive hypothesis (can be directional or nondirectional) are stated in terms that express the opinion or prediction of the researcher. A standard hypothesis is not an actual research term.

Emergency care of a patient experiencing an epileptic seizure includes all of the following EXCEPT one. Which one is the EXCEPTION? A. Placing a bite block in the mouth to avoid fracturing of teeth B. Placing the chair in supine position with feet slightly elevated C. Monitoring vital signs D. Summoning help from other staff

A. Placing a bite block in the mouth to avoid fracturing the teeth RATIONALE: Placing a bite block or other device between the teeth is likely to cause broken teeth which may be aspirated. Placing the dental chair to a supine position with feet slightly elevated, monitoring vital signs, and summoning help from the office staff should all be implemented.f

Which teeth are MOST affected when a child has ECC? A. Primary maxillary anterior B. Permanent maxillary anterior C. Primary mandibular anterior D. Permanent mandibular anterior

A. Primary maxillary anterior RATIONALE: Although this disease can affect all teeth the primary anterior teeth are MOST affected by early childhood caries (ECC).

Which form of the x-ray beam is MOST detrimental to the patient and the operator? A. Primary radiation B. Secondary radiation C. Scatter radiation D. Useful beam

A. Primary radiation RATIONALE: Primary radiation is more detrimental to both the patient and operator than either secondary or scatter radiation. Note that scatter radiation is a type of secondary radiation that occurs when the useful beam, not an actual form of radiation, intercepts any object, causing some x-rays to be scattered. An important concept, the larger the amount of tissue the beam is allowed to irradiate, the more scatter radiation is produced. Rectangular collimation greatly reduces the amount of scatter radiation.

A state-hired full-time public health dentist and dental hygienist are responsible for collecting data on the dental plaque rates of elementary school-aged children. Correlational studies are planned to determine strength of data between genders and among geographical locations of the elementary schools. It was decided to screen children in grades K, 2, 4, and 6 within 25 schools throughout the state. The 25 schools were chosen on the basis of geographic locations and number of students enrolled. All students within each of the chosen grades would be part of the study. Three other public health dental hygienists were hired part time to help in the data collection process. When data collection was completed, analyzed, and interpreted, the public health dentist and the dental hygienist would decide on an oral health program to best meet the needs of the elementary school-aged children of the state. Based upon results of this study, if future services are directed toward treating the initial stages of disease pathogenesis, which stage of disease pathogenesis would these future services provide? A. Primary B. Secondary C. Tertiary D. Quaternary

A. Secondary RATIONALE: Services provided to interrupt the progress of the initial stages of pathogenesis are considered secondary. State another way; secondary prevention is early disease control, including early identification and prompt treatment before the individual is aware of a problem. An example is restoration of caries identified through a routine dental examination. In contrast, services that prevent initiation of disease before it occurs, or pre-pathogenesis stage, are considered primary. Placement of dental sealants provides an example of primary prevention. Following this pattern, services provided to interrupt the progress of loss of function are considered tertiary. Note that quaternary is not a term applicable to community dentistry.

The cheek bone is composed of the A. The temporal process of the zygomatic bone and the zygomatic process of the temporal bone B. The zygomatic process and the zygomatic bone C. The palatine processes D. The frontal process and the frontal bone.

A. The temporal process of the zygomatic bone and the zygomatic process of the temporal bone. RATIONALE: The zygomatic arch (cheekbone) is composed of the temporal process of the zygomatic bone and the zygomatic process of the temporal bone. The zygomatic process articulates with the zygomatic bone and completes the infraorbital rim. The palatine processes articulate with each other to form the anterior major portion of the hard palate and the median palatine suture. The frontal process articulates with the frontal bone, forming the medial orbital rim with the lacrimal bone.

Which of the following does NOT describe the process of energy storage and transfer, as it occurs during microbial metabolism and cell regulation? A. The term catabolism describes biosynthetic reactions that use energy. B. Energy may be generated through the transport of electrons C. Chemical energy is stored as ATP D. Energy is produced during oxidation-reduction reactions.

A. The term catabolism describes biosynthetic reactions that use energy. RATIONALE: The term anabolism describes biosynthetic reactions that use energy (ATP). Conversely, catabolism describes degradative reactions that release energy (ATP). Energy may be generated through the transport of electrons (electron transport system). Chemical energy is stored as ATP. [Note that mitochondria are sites of adenosine triphosphate (ATP), or energy, production.] Energy is produced during oxidation-reduction reactions. Such reactions involve both aerobic oxidation (such as respiration) as well as anaerobic oxidation (fermentation).

Each of the following is an accurate statement regarding indirect digital radiographic imaging EXCEPT one. Which one is the EXCEPTION? A. The traditional x-ray machine is no longer required B. The intraoral sensor is a reusable imaging plate coated with phosphors C. The imaging plates are reusable D. Indirect imaging is less rapid than direct digital imagining because of the laser scanning step

A. The traditional x-ray machine is no longer required RATIONALE: Both indirect and direct digital imaging processes use a traditional x-ray machine. Indirect digital imagine differs from direct in that the intraoral sensor for indirect is a reusable imaging plate coated with phosphors (often termed PSP plate). This sensor is thin and flexible, similar to an intraoral film packet. After exposure, the plate is scanned to convert the information into electronic files. Indirect imaging is less rapid than direct digital imagining because of the laser scanning step.

CASE A Age: 72 Sex: F Height: 5'5" Weight: 135 lbs/60 kg BP: 130/85 mmHg Pulse: 72 bpm Respiration: 18 rpm Medical hx: Presents with hypertension, open heart surgery within the past 5 years (aorta valve replaced and mitral valve repaired), osteoporosis, and high cholesterol. Dental Hx: Hx of perio-flap surgery. Smoked for 50 years but quit 2 years ago. Brushes 3x daily and flosses 2-3x per week. Clinical Eval: minimal plaque biofilm, limited BOP, recession, sensitivity, perio surgry, maxillary anterior bridge and mandibular posterior bridge. Overbite by ~4 mm. Meds: Metropolol, Crestor, Fosamax, Aspirin Social Hx: Retired and widowed. Has 2 children and one grandchild. The redness on the marginal gingiva of tooth #11 is MOST likely caused by A. a local irritant. B. denture flange. C. age and hormonal changes. D. unknown etiology.

A. a local irritant. RATIONALE: It is most highly likely that the redness (erythema) is due to acute inflammation caused by retained plaque biofilm - a local irritant. The canine is in the corner of the mouth; often brushing is traumatic or ineffective in this area. Self-care in this area is complicated by a subgingival crown margin. The hygienist should specifically identify the challenges of maintaining tissue health in this area when addressing safety and adequacy of self-care, including floss technique. Also note that similar inflammatory signs are present on the mesial marginal and papillary tissue of tooth #10. She does not wear a denture. Age and hormonal changes may certainly be contributory, but this condition not generalized; retained plaque biofilm is the most likely cause.

The interdental col area is particularly susceptible to destruction because of A. absence of keratinization and interproximal location. B. keratinization and a rough surface. C. facial location, where toothbrushing could easily destroy it. D. posterior location, where patient access for self-care is limited.

A. absence of keratinization and interproximal location. RATIONALE: Given the unkeratinized epithelium of the interdental col and its interproximal location, it is highly susceptible to inflammation and breakdown. The col is smooth in texture and is located between the facial and lingual aspects of interdental papilla of teeth that are in contact. The col is absent when teeth are not in contact. Note that while posterior teeth pose more of a challenge for self-care access, location alone is not a factor.

For a topical antimicrobial mouthrinse to claim that it has "substantivity," the product must be able to A. adhere to soft and hard tissue for a long duration while releasing active ingredient(s). B. be swallowed. C. be bound to the pellicle and tooth surface. D. have added binders and fillers.

A. adhere to soft and hard tissue for a long duration while releasing active ingredient(s). RATIONALE: A product with substantivity remains effective for an extended period because its ability to adhere to soft and hard tissues. This property promotes healing by enabling a slow release of active ingredients over an extended period of time. Topical antimicrobials are not intended to be swallowed and need not be bound to the pellicle and tooth surface. Note that binders and fillers typically are added to dentifrices and dental materials.

Agents such as sodium bicarbonate and chlorine dioxide are added to oral self-care products to A. alleviate oral malodor. B. reduce dentinal hypersensitivity. C. prevent xerostomia. D. reduce dental caries.

A. alleviate oral malodor. RATIONALE: A major cause of oral malodor is from production of volatile sulphur compounds (VSCs) such as sulfides and methyl mercaptan). Malodor from VSCs can best neutralized/eliminated by deodorizing (sodium bicarbonate) and oxidizing (chlorine dioxide) agents. These VSC-reducing agents do not directly contribute to reduction or prevention of dentinal hypersensitivity, xerostomia, or dental caries.

During an oral assessment, both the appearance and the ability of Stensen's ducts to function adequately are examined while palpating the A. buccal mucosa. B. floor of the mouth. C. mucobuccal fold. D. palate.

A. buccal mucosa. RATIONALE: The Stenson's duct, which transports saliva from the parotid gland, is located in the buccal mucosa opposite the maxillary molar area. The submandibular and submental salivary glands are located within the floor of the mouth. Minor salivary glands and their ducts are present throughout the oral cavity, including the mucobuccal fold and palate.

Cell junctions that are attached by cell-to-cell mechanisms are called A. desmosomes. B. tight junctions. C. gap junctions. D. hemidesmosomes.

A. desmosomes. RATIONALE: Desmosomes attach the body's building blocks to each other by cell-to-cell attachments. Desmosomes are found between ameloblasts and cells of the stratified squamous epithelium that lines the oral cavity. In tight junctions cells attach to each other by fusion of their cell membranes. Gap junctions contain a channel that runs between cells for communication of cell electrical impulses and passage of molecules. Hemidesmosomes form attachments by a cell to a noncellular surface.

After periodontal surgery, the embedding of new periodontal ligament fibers into new cementum and formation of a new gingival attachment in an area previously degenerated by disease is referred to as A. healing by new attachment. B. epithelial adaptation. C. healing by repair. D. healing by regeneration.

A. healing by new attachment. RATIONALE: Healing by new attachment is a term that defines embedding of new periodontal ligament fibers into new cementum and formation of a new gingival attachment in an area previously degenerated by disease rather than repair of the periodontal attachment apparatus after an injury (reattachment). Epithelial adaptation refers to close adaptation of the marginal gingival epithelium without complete pocket elimination; this occurs with shrinkage of the gingiva after therapy and involves formation of a longer junctional epithelium. Healing by repair, also called healing by scar tissue or fibrosis, does not necessarily restore the original architecture of function of the tissue or part. In contrast, healing by regeneration is the biologic process by which the architecture and function of lost tissue is completely restored. This is the primary means of healing after NSPT, creating a longer junctional epithelium.

A university dental hygiene school received a state-funded grant to improve the oral health status of senior citizens in a rural area of the United States. The funding was for $50,000 over a 1-year period and covered expenses for salaries, equipment, supplies, and education. It was determined that high rates of root caries, root sensitivity, and gum disease were present in this population. The dental hygiene school decided to address these needs by implementing an oral health program in its clinic and to determine the effectiveness of two different types of desensitizing agents on treating root sensitivity. The local dental hygienists' association offered its services to provide educational sessions to the senior citizens. During these educational sessions, toothbrushes, dental floss, floss threaders, and denture brushes were made available for distribution. The distribution of dental products as part of a dental health program for senior citizens is indicative of A. health promotion. B. disease prevention. C. health prevention. D. disease promotion.

A. health promotion. RATIONALE: Health promotion is defined as the promotion of healthy ideas and concepts to motivate individuals to adopt healthy behaviors. Distributing dental products is an example of promoting the concept utilizing these products - promotion of a positive behavior to support oral health. Whereas disease prevention is defined as the act of preventing a disease, health promotion goes further than encouraging healthy; it promotes a positive concept. Note that neither health prevention nor disease promotion is a concept of dental public health.

combination of antibody and antigen is a(n) A. immune complex. B. humoral immunity. C. cellular immunity. D. autoimmune disease.

A. immune complex. RATIONALE: An immune complex develops when an antibody encounters an antigen and destroys it. Humoral immunity is an antibody mediated immune response. (Another type of immune response is cellular immunity which is mediated by cells. An autoimmune disease, also called autoallergic, occurs when "self" antigens stimulate the production of antibodies or sensitized lymphocytes. Note that this involves an antigen-antibody complex.

If a child accidentally ingests a toxic quantity of fluoride, the hygienist should FIRST A. induce vomiting by administration of ipecac syrup. B. force fluids to dilute the fluoride concentration. C. have the child eat high-fiber foods to speed the elimination of the fluoride. D. have the child drink a sodium bicarbonate solution to neutralize the toxicity of the fluoride.

A. induce vomiting by administration of ipecac syrup. RATIONALE: The dental hygienist should administer ipecac syrup to induce vomiting (only if a patient has a gag reflex, and is conscious, and is not convulsing). Forcing fluids is not recommended in acute fluoride poisoning nor is having the child ingest high fiber foods or sodium bicarbonate. These actions will not reduce fluoride concentration, eliminate fluoride, or neutralize toxicity.

A structure in the cell that contains a single, circular DNA, and synthesizes adenosine triphosphate (ATP) is the A. mitochondria. B. lysosome. C. endoplasmic reticulum. D. Golgi apparatus.

A. mitochondria RATIONALE: Mitochondria are powerful cellular organelles that contain a single circular DNA, and synthesize the body's primary source of energy, adenosine triphosphate (ATP). Lysosomes contain digestive enzymes and lead the breakdown of foreign substances by the process of phagocytosis. The endoplasmic reticulum is involved in protein synthesis and the transport of nutrients to the nucleus. The Golgi apparatus stores, packs, and transfers proteins and other cellular components to the exterior of a secretory cell.

Microscopic functional units that make up the bulk of the kidney are called A. nephrons. B. cortical nephrons. C. juxtamedullary nephrons. D. Bowman's capsule.

A. nephrons. RATIONALE: Microscopic functional units that make up the bulk of the kidney are called nephrons. Those nephrons located in the renal cortex are called cortical nephrons. Those nephrons near the junction of the cortical and medullary layers are called juxtamedullary nephrons. Each nephron is made up of various structures such as Bowman's capsule which is the cup-shaped mouth of the nephron.

A Mission of Mercy (M.O.M.) event was planned for an urban city in a southern state of the United States. This 2-day event was designed to meet the critical needs of underserved people of all ages by providing free dental care to as many adults and children as time, volunteers, and supplies would allow. Local dentists, dental hygienists, dental assistants, dental students, dental hygiene students, and dental assisting students volunteered for the event. Local politicians and two state representatives were also in attendance. Before receiving dental treatment, informed consent was required of all patients. A 10-question patient survey was distributed, and volunteers reviewed each question with patients while the patients were completing the questionnaire. Confidential questions included information on age, gender, education, family income, address, and past dental experiences. At the end of each patient's treatment and before each volunteer completed his or her shift, the patient was asked to complete an evaluation survey. There was an 88% response rate, and 79% answered that their experience was positive. What type of data is information such as gender and address? A. Nominal B. Ordinal C. Demographic D. Knowledge

A. nominal RATIONALE: While data such as gender and address is demographic in a general sense, in research terms it is considered nominal data. Scales of measurement of data fall into one of four scales: nominal, ordinal, interval, and ratio. Nominal scale observations belong to mutually exclusive classes or categories (political party, gender, place of residence, address). Note that nominal data can be "named". Data such as age, education, and family income are ordinal scaled. This applies to classes or categories that have a ranking of characteristic in some empirical order. Note that ordinal data can be "ordered". On a wider basis, please note that such demographic data, regardless of its scale of measurement, is descriptive of population-based characteristics and offers insight into the need, access, or knowledge an individual or a group.

Blood type is determined by the assortment of glycolipids and glycoproteins, called isoantigens, present on the surfaces of red blood cells (RBCs). Surfaces of type A red blood cells display A. only antigen A. B. only antigen B. C. Type AB red cells display both antigens A and B. D. Type O red cells display neither antigen A nor antigen B.

A. only antigen A. RATIONALE: The ABO blood group system is based on isoantigens A and B. Type A red cells display only antigen A. Type B red cells display only antigen B. Type AB red cells display both antigens A and B. Type O red cells display neither antigen A nor antigen B.

Each of the following is a step indicated when a curette tip breaks during periodontal debridement EXCEPT one. Which one is this EXCEPTION? A. Placing the patient in a supine position B. Examining the mucobuccal fold and floor of the mouth C. Taking a radiograph to locate the tip D. Gently instrumenting the sulcus/pocket to locate the tip

A. placing the patient in a supine position RATIONALE: The patient should not be placed in a supine position. An upright position will help prevent aspiration of the broken tip. Appropriate actions include careful examination of the mucobuccal fold and floor of the mouth; exposure of a periapical radiograph to view the radiopaque instrument end; and cautiously using another instrument to examine the sulcus and/or pocket.

A Mission of Mercy (M.O.M.) event was planned for an urban city in a southern state of the United States. This 2-day event was designed to meet the critical needs of underserved people of all ages by providing free dental care to as many adults and children as time, volunteers, and supplies would allow. Local dentists, dental hygienists, dental assistants, dental students, dental hygiene students, and dental assisting students volunteered for the event. Local politicians and two state representatives were also in attendance. Before receiving dental treatment, informed consent was required of all patients. A 10-question patient survey was distributed, and volunteers reviewed each question with patients while the patients were completing the questionnaire. Confidential questions included information on age, gender, education, family income, address, and past dental experiences. At the end of each patient's treatment and before each volunteer completed his or her shift, the patient was asked to complete an evaluation survey. There was an 88% response rate, and 79% answered that their experience was positive. The PRIMARY goal of this dental event was to A. provide free dental services to children and adults. B. reduce the prevalence of dental disease. C. educate the public on the prevention of dental disease. D. promote the need to seek future dental care.

A. provide free dental services to children and adults. RATIONALE: Based on the information provided, the primary goal of this program is to provide free dental care to as many adults and children as time, volunteers, and supplies would allow during this two day event. Although this endeavor will reduce the prevalence of dental disease, the effect from a two day event will be minimal. From a community health perspective, utilizing results of this program to institute future programs with long range impact would be the long term goal. While providing education about disease prevention and promoting the need to seek future dental care can and should occur, the program description names neither of these as the primary goal.

Agreement between states for recognition of dental hygiene licensure to practice in those respective states is referred to as A. reciprocity. B. endorsement. C. licensure by examination. D. licensure by waiver.

A. reciprocity RATIONALE: Reciprocity is an agreement between states for recognition of dental hygiene licensure from another state. Slightly different, endorsement grants licensure if the applicant is licensed in another state and can present specific documents or credentials, and the state's requirements are the same or similar. Licensure by examination is required for those seeking their first dental hygiene license or when neither reciprocity nor endorsement is an option. Licensure by waiver omits, or waives, a step toward licensure (e.g. waiver of the clinical examination requirement).

When mixing alginate material, addition of warm water will A. shorten the gelation (setting) time. B. make the mix unusable. C. lengthen the gelation time. D. increase the voids in the impression.

A. shorten the gelation (setting time) RATIONALE: Alginate, which is 85% water, absorbs moisture through the process of imbibition. Heat, an accelerator for many materials including alginate, decreases the setting/gelation time. Warm water does not directly increase the likelihood of voids within an impression or make the mix unstable. In contrast to warm water, use of cold water lengthens the gelation time.

CASE A Age: 72 Sex: F Height: 5'5" Weight: 135 lbs/60 kg BP: 130/85 mmHg Pulse: 72 bpm Respiration: 18 rpm Medical hx: Presents with hypertension, open heart surgery within the past 5 years (aorta valve replaced and mitral valve repaired), osteoporosis, and high cholesterol. Dental Hx: Hx of perio-flap surgery. Smoked for 50 years but quit 2 years ago. Brushes 3x daily and flosses 2-3x per week. Clinical Eval: minimal plaque biofilm, limited BOP, recession, sensitivity, perio surgry, maxillary anterior bridge and mandibular posterior bridge. Overbite by ~4 mm. Meds: Metropolol, Crestor, Fosamax, Aspirin Social Hx: Retired and widowed. Has 2 children and one grandchild. During patient preparation for the panoramic radiograph, the thyroid collar A. should be removed because it can block part of the beam. B. should be removed so that it does not interfere with rotation of the machine. C. should be raised to prevent a ghost image on anterior teeth. D. should be placed low enough that it does not block the x-ray beam.

A. should be removed because it can block part of the beam. RATIONALE: If the lead apron is placed too high on the patient's neck, it will block the x-ray beam from reaching the receptor, and a radiopaque, cone-shaped artifact will obscure the mandible. This is prevented by appropriate adjustment of the collar. Ghost images are caused by metallic objects that remain in the head and neck region during panoramic radiography. Good info to know: Ghost images are seen on the opposite side of the original item and located higher than the original item. They often appear indistinct or distorted.

The term for verbal defamation of character is A. slander. B. libel. C. intrusion on seclusion. D. battery.

A. slander. RATIONALE: Verbal defamation of character is referred to as slander whereas libel refers to written defamation. Note that libel and slander are two types of defamation, which is an intentional tort. Intrusion on seclusion is invasion of a private place or upon the affairs of another. To qualify for intrusion on seclusion, the act must be highly offensive to a reasonable person. Battery is intentional inflection of offensive or harmful bodily contact; unwanted touching is an act of battery.

The self-applied 1.1% (5000 parts per million) fluoride gel that can be applied as a brush-on or tray application contains A. sodium fluoride (NaF). B. acidulated phosphate fluoride (APF). C. stannous fluoride (SnF2). D. monofluorophosphate.

A. sodium fluoride (NaF). RATIONALE: The active ingredient in the self-applied fluoride available as a 1.1% (5000 ppm) preparation is sodium fluoride (NaF). Acidulated phosphate fluoride (APF) formulated for self-application is available in as 0.05% gel and a 0.044% rinse. A 0.4% stannous fluoride (SnF2) is available for self-care as is monofluorophosphate which is incorporated in some over-the-counter dentifrices.

A state-hired full-time public health dentist and dental hygienist are responsible for collecting data on the dental plaque rates of elementary school-aged children. Correlational studies are planned to determine strength of data between genders and among geographical locations of the elementary schools. It was decided to screen children in grades K, 2, 4, and 6 within 25 schools throughout the state. The 25 schools were chosen on the basis of geographic locations and number of students enrolled. All students within each of the chosen grades would be part of the study. Three other public health dental hygienists were hired part time to help in the data collection process. When data collection was completed, analyzed, and interpreted, the public health dentist and the dental hygienist would decide on an oral health program to best meet the needs of the elementary school-aged children of the state. After calculating the results of the correlation test between geographic location and plaque scores, the correlation coefficient (r-value) was 0.26. This relationship between these two variables is A. weak. B. moderate. C. strong. D. very strong.

A. weak. RATIONALE: In this study, an r-value of 0.26 quantifies the correlation between two or more variables as weakly positive (also stated as having a positive, but low correlation). The following ranges are assigned to quantify degree of correlation: ● R = 0.0 to 0.2 Little if any correlation (+ or -) ● R = 0.2 to 0.4 Weak, low correlation (+ or -) ● R = 0.4 to 0.7 Moderate correlation (+ or -) ● R = 0.7 to 0.9 Strong, high correlation (+ or -) ● R = 0.9 to 1.0 Very strong correlation (+ or -) Further, a correlation coefficient is a statistical measure of the degree to which changes to the value of one variable predict change to the value of another. Expressed as an r-value, correlation coefficient values range between +1 and -1. A coefficient of +1 indicates a perfect positive correlation: A change in the value of one variable will predict a change in the same direction in the second variable. A coefficient of -1 indicates a perfect negative correlation: A change in the value of one variable predicts a change in the opposite direction in the second variable. Lesser degrees of correlation are expressed as non-zero decimals. A coefficient of zero indicates there is no discernable relationship between fluctuations of the variables.

Bruxism is associated with which of the following defects that form within tooth structure? A. Erosion B. Attrition C. Abrasion. D. Abfraction

Attrition RATIONALE: Bruxism and other parafunctional habits such as clenching are habits that contribute to attrition. Note that attrition is the wearing-away of tooth surface by active physiologic forces ("tooth to tooth" contact). Erosion is the chemical wearing of tooth structure. Abrasion is the wearing-away of tooth structure by external forces such as improper toothbrushing, use of a hard toothbrush, or occupational exposure to grit or dust. Abfraction is related to microfracture of tooth structure in areas of focused stress. The microfractures create notched lesions at cervical areas of teeth.

During treatment of a patient with compromised pulmonary function, all of the following must be done EXCEPT one. Which one is the EXCEPTION? A. Avoid using motor-driven polishing devices B. Assure that the patient has been pre-medicated C. Avoid aerosol producing mechanized scalers D. Ask the patient if they would like to be in a more upright position

B. Assure that the patient has been pre-medicated RATIONALE: Unless otherwise indicated by their physician, patients with compromised pulmonary function do not need to be pre-medicated. Due to aerosol production and aspiration risk, motor driven publishing devices and mechanized scalers should be avoided. Many patients with compromised pulmonary function can breathe more comfortably in a semi-reclined or upright position.

A disadvantage of acidulated phosphate fluoride (APF) for professional use is that it is unstable when stored in a plastic container. Fluoride varnish contains a 2% sodium fluoride solution (NaF). A. Both statements are TRUE. B. Both statements are FALSE. C. The first statement is TRUE, the second is FALSE. D. The first statement is FALSE, the second is TRUE.

B. Both statements are FALSE. RATIONALE: Acidulated phosphate fluoride has the advantage of stability when stored in a plastic container. Available as foam, gels, and thixotropic gels, APF does not color teeth and is non-irritating to soft tissues. Fluoride varnish contains a 5% NaF concentration. Note that a 2% NaF solution is designed for professional administration in a series of four applications at 1-week intervals that coinciding with the eruption of primary and permanent teeth.

The introduction of solid foods too early is the MOST likely cause of early childhood caries. Early tooth eruption is strongly correlated with early childhood caries (ECC). A. Both statements are TRUE. B. Both statements are FALSE. C. The first statement is TRUE, the second is FALSE. D. The first statement is FALSE, the second is TRUE.

B. Both statements are FALSE. RATIONALE: The most likely cause of early childhood caries is frequent intake of bottles containing milk or juice or prolonged breast feeding which feeds the growth of S. mutans in the child's mouth. Early tooth eruption is not a likely cause of early childhood caries.

In assessing the molar relationship of a patient's occlusion you determine that there is a distal relationship of the mesiobuccal groove of the mandibular first molar to the mesiobuccal cusp of the maxillary first permanent molar. This assessment represents which classification of malocclusion accompanied by which facial profile? A. Class II malocclusion with likelihood of a prognathic profile B. Class II malocclusion with likelihood of a retrognathic profile C. Class III malocclusion with likelihood of a prognathic profile D. Class III malocclusion with likelihood of a retrognathic profile

B. Class II malocclusion with likelihood of a retrognathic profile RATIONALE: In Class II malocclusion (retrognathic profile), there is a distal relationship of the mesiobuccal groove of the mandibular first molar to the mesiobuccal cusp of the maxillary first permanent molar. In Class III malocclusion (prognathic profile) there is a mesial relationship of the mesiobuccal groove of the mandibular first permanent molar to the mesiobuccal cusp of the maxillary first permanent molar.

Functions of the adult liver include all of the following EXCEPT one. Which one is the EXCEPTION? A. Bile formation B. Concentration of bile C. Glycogenolysis D. Detoxification of chemicals

B. Concentration of bile RATIONALE: The gallbladder, a sac located in a depression under the liver, stores and concentrates bile. The liver produces bile and detoxifies chemicals. Through the process of glycogenolysis, the liver converts stored liver glycogen into blood glucose, essential for energy production. The liver also stores lipid soluble vitamins (A,D,E,K) and metabolizes products of digestion and drugs.

What type of breach occurs if the dental hygienist discusses a patient's dental condition with a friend and the identity of the patient is inadvertently revealed? A. Informed consent B. Confidentiality C. Defamation D. Statute of limitations

B. Confidentiality RATIONALE: Discussing a patient's history with a non-dental or non-medical professional, considered a tort, is a violation of confidentiality. An aspect of professional risk management addresses maintaining confidentiality. Ethical behavior requires that a professional obtain proper written authorization from the patient before release of any patient information. Informed consent is a person's agreement to allow something to happen based on full disclosure of facts required to make an intelligent decision. Defamation whether in writing (libel) or spoken (slander), is communication to a third person of an untrue statement about another person. The length of time an aggrieved person has to enter a suit against another for an alleged injury is called a statute of limitations.

Infectious mononucleosis is caused by A. gram-negative bacteria. B. Epstein-Barr virus. C. thermophilic fungus. D. gram-positive bacteria.

B. Epstein-Barr virus. RATIONALE: Infectious mononucleosis is caused by the Epstein-Barr virus. Hence, it is not caused by any type of bacteria or any type of fungus.

Criteria for successful treatment outcomes of dental implants include each of the following aspects of the implant-tissue interface EXCEPT one. Which one is the EXCEPTION? A. Formation of the perimucosal seal B. Formation and attachment of the periodontal ligament C. Establishment of the implant-tissue interface D. Osseointegration occurs

B. Formation and attachment of the periodontal ligament RATIONALE: After tooth replacement by a dental implant the periodontal ligament is no longer present. Ideally present upon successful implant therapy is a perimucosal seal which may be similar to the attachment to a natural tooth. Also called the biologic seal, the perimucosal seal is defined as the adaption of keratinized or nonkeratinized epithelium to the abutment. This implant-tissue interface is the basis of implant success; osseointegration must occur. Contact must be established between the normal and remodeled bone as it contacts the implant surface without the interposition of connective tissue.

The administration of oxygen is indicated in most medical emergencies. In which of the following is oxygen NOT indicated? A. Hyperglycemia B. Hyperventilation C. Syncope D. Asthma

B. Hyperventilation RATIONALE: Oxygen is not indicated during hyperventilation because the excess air inhaled by the patient is saturated with oxygen. Instead, the patient is in need of carbon dioxide. The administration of oxygen is indicated in emergencies related to hyperglycemia, syncope, and asthma.

Functions of saliva that affect the carious process include all of the following EXCEPT one. Which one is the EXCEPTION? A. Clearance of food B. Increase in acidogenic factors C. Buffer activity D. Antibacterial function

B. Increase in acidogenic factors RATIONALE: The role of saliva in the carious process is to provide functions beneficial to the host. In health, these functions affect the carious process in healthy ways such as helping to clear food, providing a buffering activity (which increases pH / decreases acidity), and provides antibacterial functions. Antibacterial functions include immunoglobulin A, lysozymes, and salivary peroxidase - each of which is detrimental to microorganisms.

During which stage does a periapical cemento-osseous dysplasia (cementoma) radiographically appear as a mixed radiolucent/radiopaque lesion? A. Early stage (osteolytic stage) B. Middle stage (osteoblastic stage) C. End stage D. Mature stage

B. Middle stage (osteoblastic stage) RATIONALE: The middle stage (osteoblastic stage) of a periapical cemento-osseous dysplasia (cementoma) appears radiographically as a mixed radiolucent/radiopaque lesion; indicative of calcification of connective tissue. The early stage (osteolytic stage) this lesion appears as a radiolucent and cannot be differentiated from other apical pathology. The end-stage, also known as the mature stage, of a periapical cemento-osseous dysplasia (cementoma) radiographically appears uniformly radiopaque throughout with a radiolucent rim; the periodontal ligament remains intact.

Standard radiographic film size for intraoral dental radiography is A. No. 1 size film - 24x40 mm. B. No 2 size film - 31x41 mm. C. No 3 size film - 27x54 mm. D. No 34 size film - 57x76 mm.

B. No 2 size film - 31x41 mm. RATIONALE: Standard radiographic film size is No 2 size which is 24x41 mm. No 1 size film is 24x40 mm. No 3 size film is 27x54 mm. No 4 size film is 57x76 mm. Also available, No 0 size film is 22x35 mm.

The area-specific advanced periodontal instruments that feature a working end shaped like a tiny circular disc and designed for easy adaptation to furcations and grooves are the A. DeMarco furcation curettss B. O'Hehir debridement curettes C. Quentin furcation curettes D. Langer curettes

B. O'Hehir debridement curettes RATIONALE: O'Hehir area-specific debridement curettes are designed to remove light residual calculus and bacterial contaminants from root surfaces. They feature a working end shaped like a tiny circular disc and are designed for easy adaptation to furcations and grooves. These curettes have extended lower shanks; the entire working end is a cutting edge. DeMarco furcation curettes, designed to debride furcation areas and root concavities, have discoid-shaped working ends that allow all sides of the blade to debride. Quentin furcation curettes have miniature working ends featuring a single, straight cutting edge with rounded corners. Langer curettes have a 90-degree angle from the terminal shank to the blade for use on both mesial and distal surfaces.

The American Dental Hygienists' Association (ADHA) and the Canadian Dental Hygienists' Association (CDHA) have established codes of ethics. These codes encourage all of the following EXCEPT one. Which one is the EXCEPTION? A. Ethical expectations of the dental hygienist by the public B. Overseeing the responsibilities of the dentist C. Professional and ethical consciousness D. Professional judgment and conduct

B. Overseeing the responsibilities of the dentist RATIONALE: Overseeing the responsibilities of the dentist is not part of the ADHA or the CDHA Code of Ethics. However, both codes address: ● Ethical expectations of the dental hygienist by the public ● Professional and ethical consciousness ● Professional judgment and conduct Common to professional codes is The Patient's Bill of Rights. Note that ethical codes for health care professionals continue to be evaluated and revised to reflect current practices and professional responsibilities.

The periodontal surgery that may be used as a method of surgical curettage is the A. Gingivectomy B. Periodontal flap surgery C. Gingivoplasty D. Periodontal plastic and reconstructive surgery

B. Periodontal flap surgery RATIONALE: Periodontal flap surgery may be used as a method of surgical curettage such as when the Modified Widman flap procedure is performed. Gingivectomy is a surgical procedure for pocket reduction by excision of the soft tissue pocket wall. Gingivectomy is indicated for pockets composed of fibrotic enlargement or to correct gingival form and only involves the gingiva. Gingivoplasty reshapes the gingiva to obtain a physiologic form similar to that characteristic of healthy tissue. Periodontal plastic and reconstructive surgery includes muco-gingival surgery to correct defects or deficiencies in the shape, position, or amount of keratinized, attached gingiva surrounding the teeth.

A university dental hygiene school received a state-funded grant to improve the oral health status of senior citizens in a rural area of the United States. The funding was for $50,000 over a 1-year period and covered expenses for salaries, equipment, supplies, and education. It was determined that high rates of root caries, root sensitivity, and gum disease were present in this population. The dental hygiene school decided to address these needs by implementing an oral health program in its clinic and to determine the effectiveness of two different types of desensitizing agents on treating root sensitivity. During which of the following public health process stages is the final development of program goals and objectives accomplished? A. Assessment B. Planning C. Implementation D. Evaluation

B. Planning RATIONALE: Program goals and objectives are completed in the planning stage. For each prioritized need, a goal with related objectives must be determined. This includes identification of expected outcomes and evaluation measures to determine whether goals are being met during or after completion of program. During the assessment stage, identification of the target group and the extent and severity of oral health needs are defined whereas planned activities are activated during the implementation stage. Evaluation that is ongoing from the beginning to the end of the program is called formative evaluation; summative evaluation occurs after analysis of outcomes.

A state-hired full-time public health dentist and dental hygienist are responsible for collecting data on the dental plaque rates of elementary school-aged children. Correlational studies are planned to determine strength of data between genders and among geographical locations of the elementary schools. It was decided to screen children in grades K, 2, 4, and 6 within 25 schools throughout the state. The 25 schools were chosen on the basis of geographic locations and number of students enrolled. All students within each of the chosen grades would be part of the study. Three other public health dental hygienists were hired part time to help in the data collection process. When data collection was completed, analyzed, and interpreted, the public health dentist and the dental hygienist would decide on an oral health program to best meet the needs of the elementary school-aged children of the state. Which of the following is characteristic of the type of sampling used to collect these data? A. Simple random B. Stratified C. Systematic D. Convenience

B. Stratified RATIONALE: Stratified sampling first organizes the intended population into subdivided categories (e.g., by gender, age, income level, etc.) and then selects a sample from each category or strata. In this study researchers first selected the grades to study, then the schools were selected, lastly the subjects were divided by gender. Simple random implies that each member of the population has an equal chance of being selected for the study sample whereas in systematic sampling every "nth" subject from a given population is selected for inclusion in the study. In convenience sampling, subject selection is based on researcher convenience rather than any subject characteristic.

What type of lymphocyte is thymus-derived and participates in a variety of cell-mediated immune reactions? A. B lymphocyte B. T lymphocyte C. Plasma cell D. Macrophage

B. T lymphocyte RATIONALE: T lymphocytes, also called T cells, are thymus-derived; they participate in a variety of cell-mediated immune reactions. Examples of the many roles of T cells include their ability to activate macrophages, cytotoxic cells, and other T cells. One type of T cell, TS (suppressor) or CD8 cell regulates the immune response. Macrophages are phagocytic mononuclear cells derived from bone marrow monocytes. Found in tissues at the site of inflammation, macrophages serve accessory roles in cellular immunity. Note that T helper cells activate macrophages when presented with an antigen. B lymphocytes (B cell) are the precursors of plasma cells that produce antibodies. Involved in humoral immunity, B lymphocytes produce and release specific antibodies into the circulating blood or body fluids. Plasma cells, a type of white blood cell, secrete large quantities of proteins called antibodies in response to antigens. Plasma cells develop from B lymphocytes.

All of the following are contraindications for dental sealant application EXCEPT one. Which one is the EXCEPTION? A. Presence of proximal decay B. Teeth with noncavitated lesions C. Previously restored tooth D. Primary tooth near exfoliation

B. Teeth with noncavitated lesions RATIONALE: Teeth with noncavitated lesions should be sealed. Moisture contamination is the leading cause of sealant failure. The presence of proximal decay, previously restored teeth, and primary teeth that will soon be exfoliated are generally contraindications for placement of dental sealants.

All of the following are appropriate treatment modifications for an individual with chronic obstructive pulmonary disease (COPD) EXCEPT one. Which one is the EXCEPTION? A. Placing chair in an upright position B. Use of ultrasonic scaling device to decrease appointment length C. Administering oxygen D. Avoiding the use of nitrous oxide-oxygen conscious sedation in severe cases

B. Use of ultrasonic scaling device to decrease appointment length RATIONALE: Use of ultrasonic scaling devices and air polishers should be avoided in patients with COPD due to the likelihood of aspiration. Patients with respiratory conditions are generally more comfortable in an upright position. Many patients with COPD carry a portable oxygen device with them. Dental personnel may determine that oxygen is indicated to avoid hypoxia. While nitrous oxide-oxygen conscious sedation is contraindicated in severe cases of COPD, it may help patients with more mild conditions relax. Caution is advised due to potential drug interactions.

The muscles of facial expression and taste within the tongue are controlled by cranial nerve A. V. B. VII. C. X. D. XII.

B. VII RATIONALE: Cranial nerve VII (facial) has efferent (motor) and afferent (sensory) components. There are two branches: greater petrosal nerve (efferent) and chorda tympani nerve (parasympathetic efferent and afferent components). ● An afferent component of the chorda tympani nerve of VII carries taste sensation for the body of the tongue. Afferent nerve fibers from the greater petrosal nerve component of VII carry taste sensations for the palate. ● Efferent branches supply the muscles of facial expression. A complex nerve with great significance to the dental hygienist. See Table 4.15 for details. Cranial nerve V (trigeminal nerve) is the largest cranial nerve; both efferent and afferent components. ● Efferent (motor) component supplies muscles of mastication and some cranial muscles. ● Afferent (sensory) component supplies sensation to the teeth, tongue, oral cavity, and most of the skin of the face and head. A complex nerve with great significance to the dental hygienist. See Table 4.3 and 4.4 for details. Cranial nerve X (vagus nerve) is a mix of afferent and efferent nerves. ● Larger efferent (motor) component supplies muscles of the soft palate, pharynx, larynx, and parasympathetic fibers to the organs in thoracic and abdominal cavities. ● Smaller afferent (sensory) component conveys innervation to the skin around the ear and taste sensation of the epiglottis. Cranial nerve XII (hypoglossal nerve) is efferent (motor) only. It innervates all muscles of the tongue.

The MOST common cause of tooth mobility is A. trauma from occlusion. B. destruction of the periodontium. C. aggressive periodontal instrumentation. D. generalized slight gingival recession.

B. destruction of the periodontium. RATIONALE: The most common cause of the tooth mobility is the destruction of the periodontium and bone support. While trauma from occlusion contributes to tooth mobility, it is not the most common cause. Neither aggressive periodontal instrumentation nor generalized slight gingival recession is a cause of tooth mobility.

A type of electrochemical corrosion that occurs to due contact of dissimilar metals is known as A. crevice corrosion. B. galvanic corrosion. C. Van der Waals corrosion. D. Munsell corrosion.

B. galvanic corrosion RATIONALE: Galvanic corrosion, a form of electrochemical corrosion, occurs when dissimilar metals contact. The electrochemical current created when a cast gold crown (cathode) contacts a dental amalgam (anode) is an example of galvanic corrosion. Another form of electrochemical corrosion occurs in the crevice immediately under plaque biofilm, between a restoration and the tooth structure, or in a scratch on the surface of a restoration. Note that in crevice corrosion the metals may be the same but the electrolytes differ. There is not a form of Van der Waals or Munsell corrosion. Van der Waals dispersion forces are fluctuating dipoles found in dental composites and acrylics whereas the Munsell Color System defines color properties such as hue, value, and chroma.

A patient who tolerates pain well and shows little reaction to pain is said to have a A. low pain threshold. B. high pain threshold C. physiologic response to pain. D. minimal threshold stimulus impulse.

B. high pain threshold RATIONALE: A patient with a high pain threshold is considered hyporeactive; tolerates pain well; and shows little reaction to pain. A patient with a low pain threshold is considered hyperreactive; does not tolerate pain well; and shows more reaction to pain than a patient with an average threshold. A physiologic response to pain that all people have is an increased respiratory rate, increased heart rate (HR), and increased blood pressure (BP). The minimal threshold stimulus for pain is the magnitude of stimulus required to initiate a nerve impulse.

A university dental hygiene school received a state-funded grant to improve the oral health status of senior citizens in a rural area of the United States. The funding was for $50,000 over a 1-year period and covered expenses for salaries, equipment, supplies, and education. It was determined that high rates of root caries, root sensitivity, and gum disease were present in this population. The dental hygiene school decided to address these needs by implementing an oral health program in its clinic and to determine the effectiveness of two different types of desensitizing agents on treating root sensitivity. Four dental hygiene clinical instructors will document the patient's response to each desensitizing agent. To ensure consistency of documentation among the four instructors, a calibration session is scheduled. This is an example of A. intra-rater. B. inter-rater reliability. C. data consistency. D. interpreter reliability.

B. inter-rater reliability. RATIONALE: Inter-rater (inter-examiner) reliability is achieved when consistency exists between or among examiners. This is a statement about the degree to which different raters obtain the same results when using the same data collection instrument. Intra-rater reliability is established when each examiner repeats the scoring process using the same data collection instrument. Intra-rater reliability measures the extent to which a rater remains consistent within himself or herself. The term data consistency can be used to describe methods of data collection that will yield consistent research data. Interpreters may be utilized to interpret foreign languages spoken by respondents; they also may be utilized to interpret aspects of data. Methods of ensuring reliability among interpreters would follow the same logic as that of intra-rater and inter-rater reliability.

The term for written defamation of character is A. slander. B. libel. C. breach of contract. D. assault.

B. libel. RATIONALE: Libel is the term for written defamation of character (which is an intentional tort). Slander is defined as oral defamation of character. Breach of contract occurs one or more of the parties does not honor a binding agreement. Assault is any action that places a person in fear of bodily harm.

The byproducts from smoking are eliminated from the body by A. exhaling. B. liver metabolism. C. lung absorption. D. blood dissemination.

B. liver metabolism. RATIONALE: The byproducts from smoking are primarily eliminated by the liver. While exhaling helps eliminate smoke, the by-products are absorbed by the lungs and are not eliminated through the dissemination/circulation of smoke.

Cardiac output is determined by the A. number of heart beats per minute and peripheral resistance. B. number of heart beats per minute and stroke volume (SV). C. number of heart beats per minute and strength of contraction. D. number of heart beats per minute and vascular dilation.

B. number of heart beats per minute and stroke volume (SV). RATIONALE: Cardiac output, a function of both number of heart beats per minute and stroke volume, is the volume of blood ejected per minute from the left ventricle into the aorta. Although related physiologically, cardiac output is not directly determined by peripheral resistance, strength of contraction, or vascular dilation.

The junction of three surfaces on the crown of a tooth is referred to as a(n) A. line angle. B. point angle. C. occlusal surface. D. incisal edge.

B. point angle. RATIONALE: A point angle is formed by the junction of three surfaces. The point angle also derives its name from the combination of the names of the surfaces forming it. For example, the junction of the mesial, buccal, and occlusal surfaces of a molar is called the mesiobucco-occlusal point angle. Each tooth has 4 point angles. By contrast, a line angle is formed by the junction of two surfaces and derives its name from the combination of the two surfaces that join. For instance, on an anterior tooth, the junction of the mesial and labial surfaces is called the mesiolabial line angle. Each tooth has 8 line angles. The occlusal surface is toward the opposite arch on a posterior tooth whereas the incisal surface is the surface of an incisor that is toward the opposite arch.

People with anorexia nervosa are commonly deficient in A. iron. B. protein. C. chromium. D. magnesium.

B. protein RATIONALE: Anorexia nervosa is described as a state of protein-energy malnutrition brought on by voluntary starvation. While individuals suffering from anorexia nervosa have a variety of nutrient deficiencies, a direct association between anorexia nervosa and deficiency in iron, chromium, or magnesium is not described.

A university dental hygiene school received a state-funded grant to improve the oral health status of senior citizens in a rural area of the United States. The funding was for $50,000 over a 1-year period and covered expenses for salaries, equipment, supplies, and education. It was determined that high rates of root caries, root sensitivity, and gum disease were present in this population. The dental hygiene school decided to address these needs by implementing an oral health program in its clinic and to determine the effectiveness of two different types of desensitizing agents on treating root sensitivity. The data collection instrument selected to measure the effect of the desensitizing agent on root sensitivity has been used successfully in numerous studies with published results appearing in the Journal of Dental Hygiene. This indicates that the instrument is A. reliable. B. valid. C. systematic. D. correctional.

B. valid. RATIONALE: Validity is the accuracy of measuring what is intended to be measured. Because this instrument has successfully been utilized in the same manner as proposed for this study, it seems an appropriate selection with promise for producing valid results. If after evaluating the published studies researchers conclude that the data are valid, (studies measured what they intended to measure), then this instrument would be likely to produce valid results. A study is considered reliable if other researchers are able to consistently achieve the same results using the same research design. Systematic describes procedures conducted in a planned and orderly manner. To produce valid and reliable data, all aspects of the research design must utilize a systematic approach. Correctional is a term that describes "undoing", or correcting, mistakes.

The attached gingiva is generally A. widest in the maxillary facial anterior areas and narrowest in the mandibular lingual anterior areas B. widest in the maxillary facial anterior areas and narrowest in the mandibular facial premolar areas C. widest in the maxillary facial anterior areas and narrowest in the mandibular facial molar areas D. widest in the maxillary facial anterior areas and narrowest in the maxillary facial premolar areas

B. widest in the maxillary facial anterior areas and narrowest in the mandibular facial premolar areas RATIONALE: Width of the attached gingiva varies from 1.8 to 4.5 mm. The attached gingiva is generally widest in the maxillary facial anterior areas and narrowest in the mandibular facial premolar areas.

Sweetened and acidic beverages should be consumed A. early in the day. B. with meals. C. between meals. D. in the evening

B. with meals RATIONALE: It is recommended that sweetened and acidic beverages be consumed with meals to allow for a buffering action, rather than consuming soft drinks between meals. Regardless of what time of day such beverages are consumed, the recommendation to "drink water often" is applicable.

If a negligent act presents a scope-of-practice issue, a dental hygienist's actions should be A. within the scope of practice of the state in which the hygienist was originally licensed. B. within the scope of practice for the particular jurisdiction. C. within the scope of practice of the supervising dentist. D. within the scope of practice of the state the business entity is registered in.

B. within the scope of practice for the particular jurisdiction. RATIONALE: If a negligent act presents a scope-of-practice issue, a dental hygienist's actions should be within the scope of practice for the particular jurisdiction that the hygienist is currently practicing. Note that while the hygienist is supervised by dentists in various capacities in various states, the dental hygienist's license must have legal jurisdiction in the state or province of practice.

Which fibers of the principal fiber group extend from the cervical cementum and insert themselves into the alveolar crest? A. Horizontal B. Oblique C. Alveolar crest D. Interradicular

C. Alveolar crest RATIONALE: The alveolar crest fibers extend from the cervical cementum and insert themselves into the alveolar crest. Horizontal fibers extend at right angles to the long axis of the root of the tooth in a horizontal plane from alveolar bone to cementum. Horizontal fibers are found in the cervical third of the root. The oblique fibers slant occlusally from cementum to alveolar bone. The oblique are the most abundant of the fiber bundles; they start at the apical two thirds of the root. Interradicular fibers, seen only in multiple-rooted teeth) extend from the cementum in the furcation area of the tooth to the inter-radicular septum of the alveolar bone

All of the following are adverse reactions associated with oral contraceptives EXCEPT one. Which one is the EXCEPTION? A. Headache B. Weight gain C. Anorexia D. Nausea

C. Anorexia RATIONALE: Anorexia is not an adverse reaction of oral contraceptives. Adverse reactions of oral contraceptives include headaches, weight gain, and nausea. Other adverse reactions include dizziness, breast tenderness, hypertension, liver damage, thrombophlebitis, and thromboembolism.

In a panoramic radiograph which of the following is the result a focal trough positioning error? A. An exaggerated smile line appears on the image B. Mandibular incisor region appears blurred C. Anterior teeth appear blurred and magnified in size ANS D. Condyles may not be visible

C. Anterior teeth appear blurred and magnified in size ANS RATIONALE: While exposing a panoramic radiograph, a focal trough positioning error will result in blurring and magnification in size of anterior teeth. This occurs because the dental arches are positioned too far back (posterior). A Frankfort plane positioning error produces numerous areas of distortion including: an exaggerated smile line, mandibular incisor region appears blurred, and condyles may not be visible.

Which of the following is NOT recommended for a patient with asthma? A. Bronchodilator B. Prednisone C. Aspirin D. Cromolyn sodium

C. Aspirin RATIONALE: Aspirin is contraindicated in patients who have experienced asthma or allergic reaction to aspirin therapy. Aspirin may cause bronchospasm. Inhalers and prednisone are used in the management of asthma. Cromolyn sodium (Intal, Nasalcrom) is used for asthma prophylaxis by inhalation and for maintenance therapy for asthma.

All of the following are recommended as successful individual-provider interactions to address tobacco cessation with patients EXCEPT one. Which one is the EXCEPTION? A. Ask B. Advise C. Assist D. Arrange

C. Assist RATIONALE: When discussing tobacco cessation intervention with a patient, numerous organizations advise that health care practitioners engage in the following forms of interactions: Ask, Assess, Assist, and Arrange. Note that the tendency to advise is not included. Also relevant, the American Dental Hygienists' Association's tobacco cessation initiative includes only ASK, ADVISE, and REFER.

Common themes to a code of ethics include each of the following EXCEPT one. Which one is the exception? A. Respecting autonomy B. Preventing harm C. Assuring fairness in financial arrangements D. Protecting confidentiality

C. Assuring fairness in financial arrangements RATIONALE: Codes of ethics rarely, if ever, directly address financial arrangements between a provider and a patient. Inherent to ethics is fairness, full disclosure, ethical treatment in all aspects, including financial considerations. Respecting autonomy, preventing harm, and protecting confidentiality are common concepts of all professional codes.

A state-hired full-time public health dentist and dental hygienist are responsible for collecting data on the dental plaque rates of elementary school-aged children. Correlational studies are planned to determine the strength of data between genders and among geographical locations of the elementary schools. It was decided to screen children in grades K, 2, 4, and 6 within 25 schools throughout the state. The 25 schools were chosen on the basis of geographic locations and the number of students enrolled. All students within each of the chosen grades would be part of the study. Three other public health dental hygienists were hired part-time to help in the data collection process. When data collection was completed, analyzed, and interpreted, the public health dentist and the dental hygienist would decide on an oral health program to best meet the needs of the elementary school-aged children of the state. To gain the support of the principals of all these elementary schools, the dentist and dental hygienist decided to meet with each of the 25 school boards. Who should be invited to attend this board meeting? A. Board of education members only B. Board of education members and the school principals C. Board of education members, the school principals, and the parents D. Board of education members, the school principals, the parents, and the elementary school children

C. Board of education members, the school principals, and the parents RATIONALE: The board of education, school principal, and parents would benefit from hearing the information and becoming stakeholders in the decision-making process. This will increase the success/support of the planned school-based program. The children do not need to be included in this meeting. However, upon implementation of the program, an orientation session for the children would be beneficial.

Each of the following statements accurately describes aspects of the mineralization of plaque biofilm as it transitions to calculus EXCEPT one. Which one is the EXCEPTION? A. Earliest mineralization occurs along the inner surface of plaque or in attached subgingival plaque B. Calcium and phosphorus come from the saliva for mineralization of supragingival calculus C. Calcium and phosphorus come from the blood for mineralization of subgingival calculus D. The porosity of calculus serves as a reservoir for bacteria and endotoxins

C. Calcium and phosphorous come from the blood for mineralization of subgingival calculus RATIONALE: Calcium and phosphorus come from the gingival crevicular fluid (GCF) for mineralization of subgingival calculus. The earliest mineralization occurs along the inner surface of plaque or in attached subgingival plaque. Calcium and phosphorus come from the saliva for the mineralization of supragingival calculus. The porosity of calculus serves as a reservoir for bacteria and endotoxins that are destructive to the periodontium and impossible for the patient to remove.

Direct injury to periodontal tissue is caused by each of the following EXCEPT one. Which one is the EXCEPTION? A. Exotoxins B. Endotoxins C. Calculus D. Enzymes

C. Calculus RATIONALE: Calculus plays a secondary role in the etiology of periodontal diseases by serving as a plaque-retentive factor. Note that while not all plaque necessarily calcifies, all calculus in humans is covered by bacterial plaque. Pathogenic effects on the periodontium are directly caused by injury from various toxins and enzymes. Examples include exotoxins that originate from proteins and other metabolic byproducts as well as endotoxins such as lipopolysaccharides and other cytotoxic agents. Also injurious are enzymes such as proteases, collagenase, hyaluronidase, and chondroitin sulfatase that directly degrade surrounding tissue and structural barriers.

During intraoral examination of the occlusal surface of the mandibular right first premolar, a carious lesion with a mass of reddish tissue protruding from the large cavity is observed. The patient is a 35 year old female and has no symptoms. The mass of tissue is called A. a cementoma. B. periapical abscess pulpitis. C. chronic hyperplastic pulpitis. D. a periapical granuloma.

C. Chronic hyperplastic pulpitis. RATIONALE: Chronic hyperplastic pulpitis, also called pulp polyp, manifests intraorally as a benign red to pink outgrowth of pulp tissue protruding from the occlusal surface. It occurs most commonly in females (15:1) and in African Americans (70%). Cementoma is a benign fibro-osseous lesion adjacent to or surrounding the apices of teeth. Cementoma mainly occurs in the anterior mandible; it is rare in the maxilla, and is of unknown etiology. Neither periapical abscess pulpitis nor periapical granuloma exhibit a mass of tissue protruding from the crown of a tooth.

During the patient's periodontal evaluation, the hygienist detects a furcation on tooth #30. She notes that while there is through-and-through involvement with complete loss of bone between roots, the opening is covered by gingiva. This type of furcation involvement is classified as A. Class I. B. Class II. C. Class III. D. Class IV.

C. Class III. RATIONALE: This statement describes a class III furcation involvement. Note that the distinguishing feature between class III and class IV furcations is the presence or absence (respectively) of tissue covering the opening of the furcation. Note also that gingival recession is more likely to be present in a class IV than in a class III furcation. Indicative of early disease, in a class I involvement the furcation is exposed, but bone remains between the roots.

Advantages of silver diamine fluoride (SDF) include each of the following EXCEPT one. Which one is the EXCEPTION? A. SDF is indicated for individuals unable to access or tolerate dental care B. Approved by FDA in 2014 as a desensitizing agent C. Clear opaque final color is aesthetically pleasing D. Beneficial for early childhood caries and challenging carious lesions

C. Clear opaque final color is aesthetically pleasing. RATIONALE: A disadvantage of silver diamine fluoride is the aesthetic concern because treated caries turn dark/black in color. SDF is indicated for individuals unable to access or tolerate dental care. SDF was approved by the FDA in 2014 as a desensitizing agent; the FDA is conducting ongoing trials for use in arresting caries. Silver diamine fluoride is beneficial for treating early childhood caries (ECC) challenging carious lesions. SDF is also beneficial in treating special needs patients including children, those with disability, and elderly/frail populations.

Through which of the following routes/mechanisms is tuberculosis not transmitted? A. Direct inoculation B. Ingestion C. Congenital D. Inhalation of droplets

C. Congenital RATIONALE: The tuberculosis bacterium (Mycobacterium tuberculosis) can be spread by multiple modes including: inhalation of droplets, ingestion, or direct inoculation. Tuberculosis is disseminated by coughing, sneezing, or contaminated dust. Diseases passed from mother to child in the womb are considered congenitally transmitted.

All of the following are types of subgingival plaque EXCEPT one. Which one is the EXCEPTION? A. Attached B. Tooth-associated plaque C. Connective tissue-attached plaque D. Epithelium-associated

C. Connective tissue-attached plaque RATIONALE: There is NOT a substance called connective tissue-attached plaque. Subgingival plaque may be attached (also called tooth-associated) or loosely adherent which is also referred to as epithelium-associated or unattached plaque.

A university dental hygiene school received a state-funded grant to improve the oral health status of senior citizens in a rural area of the United States. The funding was for $50,000 over a 1-year period and covered expenses for salaries, equipment, supplies, and education. It was determined that high rates of root caries, root sensitivity, and gum disease were present in this population. The dental hygiene school decided to address these needs by implementing an oral health program in its clinic and to determine the effectiveness of two different types of desensitizing agents on treating root sensitivity. What is the independent variable in the study on the effectiveness of two different types of desensitizing agents on root sensitivity? A. Senior citizen population B. Root sensitivity C. Desensitizing agents D. Plaque scores

C. Desensitizing agents RATIONALE: The independent variables (also called the treatment or research variables) are the two desensitizing agents selected by the researcher to be studied for their ability to decrease root surface sensitivity. Definitions for independent variables include: the treatment or intervention under study; the condition that is manipulated or controlled by the investigator; and/or a preventive intervention. Note that the values/changes in the measurement of root sensitivity "depend" upon the independent variables the researcher selects. Hence, root sensitivity is the dependent variable - its measurement is "dependent" upon the treatment (independent variable) the researcher selects and manipulates. Note that if this study were measuring plaque accumulation, plaque scores would be the dependent variable. Dependent variables are also called measurement variables and/or outcome variables.

During radiographic exposure, if the vertical angulation of the PID is too little or insufficient, the image on the film becomes distorted. Which of the following terms BEST describes the appearance of the tooth? A. Foreshortened B. Overlapped C. Elongated D. Open contacts

C. Elongated RATIONALE: Insufficient vertical angulation causes the tooth to appear elongated while excessive vertical angulation causes foreshortening. Correct horizontal angulation results in open contacts whereas overlapped contacts are the result of incorrect horizontal angulation.

The abuse of alcohol by a pregnant woman can cause all of the following to the fetus EXCEPT one. Which one is the EXCEPTION? A. Low birth weight B. Developmental/cognitive challenges C. Flat palate D. Fetal alcohol syndrome

C. Flat palate RATIONALE: The abuse of alcohol by a pregnant woman can cause oral manifestations that may include a V-shaped or cleft palate. Fetal alcohol syndrome can result from maternal alcohol consumption during pregnancy. Signs, symptoms, and clinical manifestations include growth retardation resulting in short stature, slight build, low body weight, and small head. Also possible is a wide range of developmental and cognitive challenges.

Each of the following are effects of dehydration EXCEPT one. Which one is the EXCEPTION? A. Fragility of epithelial tissues B. Decreased muscle strength for chewing C. Geographic tongue D. Xerostomia

C. Geographic tongue RATIONALE: Fissured tongue is an effect of dehydration; geographic tongue is not. Fragility of epithelial tissues, decreased muscle strength for chewing, and xerostomia are effects of dehydration.

Which type of surgical intervention uses semi-permeable membranes to prevent rapid down growth of tissue from interfering with connective tissue regrowth? A. Respective periodontal surgical procedures B. Gingivoplasty C. Guided tissue regeneration (GTR) D. Bone grafting procedures

C. Guided tissue regeneration (GTR) RATIONALE: Guided tissue regeneration (GTR) uses semi-permeable membranes to prevent rapid downgrowth of epithelium or connective tissue from interfering with connective tissue regrowth. Respective periodontal surgical procedures involve excision of the soft tissue pocket wall; indicated for gingival pockets composed of fibrotic enlargement or to correct gingival form. Gingivoplasty reshapes the gingiva to obtain a physiologic form similar to that characteristic of healthy tissue. Bone grafting procedures involve placing bone-grafting material into a debrided defect to the level of the uninvolved crest to promote healing and regeneration.

Adverse reactions to calcium channel blocking agents include all of the following EXCEPT one. Which one is the EXCEPTION? A. Gingival enlargement B. Hyperkalemia C. Increased bleeding D. Renal failure

C. Increased bleeding RATIONALE: Increased bleeding is not an adverse reaction to of calcium channel blocking agents. Adverse reactions to calcium channel blocking agents include gingival enlargement, hyperkalemia, renal failure, and dysgeusia (altered sense of taste).

What type of supervision requires that a licensed dentist authorize dental hygiene procedures and remain in the dental facility while those procedures are being performed? A. Direct B. General C. Indirect D. Personal

C. Indirect RATIONALE: Indirect supervision of a licensed dental hygienist requires that a licensed dentist authorize treatment for a patient of record and remain on the premises while treatment is performed. Note that indirect supervision does not require that the dentist approve the work performed prior to the dismissal of the patient. This differs from direct supervision during which the dentist must authorize treatment, must remain on the premises while the procedure is being performed; in many states must approve the work prior to patient dismissal. General supervision means that while a licensed dentist must authorize a procedure for a patient of record, he or she need not be present during the performance of the procedure. However, some states require that under general supervision the dentist or a designated dentist be available for consultation if needed. Personal supervision means that during the time the dentist is personally treating a patient, a dental auxiliary may aid in treatment by concurrently performing a supportive procedure.

Which of the following permanent teeth occlude with only one tooth in the opposite arch, assuming ideal relations exist? A. Maxillary canine B. Maxillary first molar C. Mandibular central incisor D. Mandibular first premolar

C. Mandibular central incisor RATIONALE: Assuming ideal occlusal relations, the mandibular central incisor occludes with only the maxillary central incisor. The maxillary canine occludes with the mandibular canine and 1st premolar whereas the maxillary first molar occludes with both the mandibular first and second molars. Also occluding with more than one tooth is the mandibular 1st premolar which occludes with the maxillary canine and first premolar.

CASE A Age: 72 Sex: F Height: 5'5" Weight: 135 lbs/60 kg BP: 130/85 mmHg Pulse: 72 bpm Respiration: 18 rpm Medical hx: Presents with hypertension, open heart surgery within the past 5 years (aorta valve replaced and mitral valve repaired), osteoporosis, and high cholesterol. Dental Hx: Hx of perio-flap surgery. Smoked for 50 years but quit 2 years ago. Brushes 3x daily and flosses 2-3x per week. Clinical Eval: minimal plaque biofilm, limited BOP, recession, sensitivity, perio surgry, maxillary anterior bridge and mandibular posterior bridge. Overbite by ~4 mm. Meds: Metropolol, Crestor, Fosamax, Aspirin Social Hx: Retired and widowed. Has 2 children and one grandchild. Which of the following is the small, round radiolucent area viewed on the apical area of tooth #20? (located inferior to root, not adjacent). A. Mandibular fossa B. Periapical abscess C. Mental foramen D. Apical granuloma

C. Mental foramen RATIONALE: The radiolucency apical to tooth #20 is an anatomical landmark characteristic of the mental foramen. Note that the mandibular fossa, the depression in the temporal bone that articulates with the mandibular condyle, is not located in this area. There is no evidence of pathology apical to tooth #20, thus the area in question is neither a periapical abscess nor is it an apical granuloma.

CASE A Age: 72 Sex: F Height: 5'5" Weight: 135 lbs/60 kg BP: 130/85 mmHg Pulse: 72 bpm Respiration: 18 rpm Medical hx: Presents with hypertension, open heart surgery within the past 5 years (aorta valve replaced and mitral valve repaired), osteoporosis, and high cholesterol. Dental Hx: Hx of perio-flap surgery. Smoked for 50 years but quit 2 years ago. Brushes 3x daily and flosses 2-3x per week. Clinical Eval: minimal plaque biofilm, limited BOP, recession, sensitivity, perio surgry, maxillary anterior bridge and mandibular posterior bridge. Overbite by ~4 mm. Meds: Metropolol, Crestor, Fosamax, Aspirin Social Hx: Retired and widowed. Has 2 children and one grandchild. Which of the following medications is prescribed for a patient's treatment of high blood pressure? A. Fosamax B. Crestor C. Metoprolol D. Aspirin

C. Metroprolol RATIONALE: Metoprolol is indicated for the treatment of hypertension. Commonly called Lopressor, metoprolol is a selective β1blocker used to treat hypertension, angina, and arrhythmias. Fosamax is indicated for the treatment of osteoporosis whereas Crestor is utilized in the treatment of high cholesterol. Aspirin, also known as acetylsalicylic acid (ASA), contains an analgesic that relieves minor aches and pains, an antipyretic to reduce fever, and an anti-inflammatory component.

A dental hygienist whose ethical principles include taking only necessary radiographs and maintaining equipment to prevent patient injury, such as replacing worn instruments, is demonstrating what type of ethical principle? A. Autonomy B. Beneficence C. Nonmaleficence D. Justice

C. Nonmaleficence RATIONALE: Beneficence is the provision of a benefit, preventing evil or harm, or promoting good. This question depicts a dental hygienist who feels responsible for contributing to the health and welfare of others. Autonomy is the belief that independent actions and choices of an individual should not be constrained by others whereas nonmaleficence is summarized by "above all, do no harm." Justice relies on fairness and equality; veracity involves truth-telling or integrity and is critical to meaningful communication.

A state-hired full-time public health dentist and dental hygienist are responsible for collecting data on the dental plaque rates of elementary school-aged children. Correlational studies are planned to determine strength of data between genders and among geographical locations of the elementary schools. It was decided to screen children in grades K, 2, 4, and 6 within 25 schools throughout the state. The 25 schools were chosen on the basis of geographic locations and number of students enrolled. All students within each of the chosen grades would be part of the study. Three other public health dental hygienists were hired part time to help in the data collection process. When data collection was completed, analyzed, and interpreted, the public health dentist and the dental hygienist would decide on an oral health program to best meet the needs of the elementary school-aged children of the state. The MOST appropriate index to use to measure the plaque rate of these children is A. PHP. B. DMTF/DEFT. C. OHI-S. D. CPITN.

C. OHI-S RATIONALE: The Simplified Oral Hygiene Index (OHI-S) assesses oral cleanliness by estimating the extent tooth surfaces covered with debris and/or calculus. This index is ideal for studying plaque rates in a population because it scores six teeth that represent the whole mouth regardless of stage of dentition (primary/mixed/permanent). The Patient Hygiene Performance Index (PHP) assesses the extent of biofilm and debris over specific tooth surfaces. Although very accurate for assessment of individual patients, this specificity makes the PHP less practical for studying populations. Neither the DMFT (Decayed, Missing, Filled Permanent Teeth Index) nor deft (decayed, indicated for extraction, filled primary teeth) are appropriate for this study because they both determine total caries experience, past and present. The Community Periodontal Index of Treatment Needs (CPITN) assesses priorities for periodontal treatment so it is also inappropriate for this study.

All of the following can decrease the effectiveness of a topical anesthetic agent EXCEPT one. Which one is the EXCEPTION? A. Degree of tissue keratinization B. Thickness of epithelium C. Patient nervousness D. Presence of saliva

C. Patient nervousness RATIONALE: Topical anesthetics are directly absorbed into the mucosa and effective to a depth of 2-3 mm. Their efficacy is not reduced by patient stress of nervousness. Factors that reduce effectiveness include degree of keratinization, thickness of epithelium, and presence of saliva.

Which of the following oral tissues receives stimuli from nociceptors, mechanoreceptors, and proprioceptors? A. Pulp B. Dentin C. Periodontium D. Oral mucosa

C. Periodontium RATIONALE: The nerve supply for the periodontium receives stimuli from nociceptors (pain), mechanoreceptors (position), and proprioceptors (pressure). Nerve supply is derived from branches of the trigeminal nerve (sensory in nature); nerve branches terminate in the periodontal ligament, on the surface of the alveolar bone, and within gingival connective tissue. These physiological features enable individuals to detect forces associated with pain, position, and pressure in periodontal tissues. The pulp, dentin, and oral mucosa have differing pathways of innervation.

A university dental hygiene school received a state-funded grant to improve the oral health status of senior citizens in a rural area of the United States. The funding was for $50,000 over a 1-year period and covered expenses for salaries, equipment, supplies, and education. It was determined that high rates of root caries, root sensitivity, and gum disease were present in this population. The dental hygiene school decided to address these needs by implementing an oral health program in its clinic and to determine the effectiveness of two different types of desensitizing agents on treating root sensitivity. The local dental hygienists' association is planning to provide educational services for the senior citizens about the prevention and treatment of root caries. Which of the following presentation strategies would MOST effectively foster retention of the information? A. Review of topics presented in pamphlet. B. Discussion of oral conditions and therapeutic strategies. C. Presentation of PowerPoint slides. D. Having the seniors look at one another's mouth and describe what they see.

C. Presentation of PowerPoint slides. RATIONALE: With limited time and new information to convey, a presentation that includes pleasing media can integrate diverse materials and highlight various concepts in an orderly way. A review of a pamphlet or discussion of oral conditions could engage the audience and encourage interaction among participants. However, time may be limited and strong personalities often influence the group. Many issues come to mind, but a major detriment to having participants examine each other's mouths is maintaining infection control and preventing disease transmission.

Absolute contraindications for conscious sedation with nitrous oxide-oxygen include all of the following EXCEPT one. Which one is the EXCEPTION? Which one of the following is MOST characteristic of nitrous oxide abuse? A. Recent ophthalmic surgery during which gas was administered to protect eyes after surgery for up to 3 months B. Middle ear infection or recent ear surgeries C. Respiratory infection such as with sinus or tonsils; cold; active allergies; active tuberculosis (TB) D. Bleomycin sulfate treatment for cancer patients

C. Respiratory infection such as with sinus or tonsils; cold; active allergies; active tuberculosis (TB) RATIONALE: Respiratory infection such as with sinus or tonsils; cold; active allergies; active tuberculosis (TB) is a relative contraindication (versus absolute) for conscious sedation with nitrous oxide-oxygen. With TB, it is difficult to sterilize contaminated items, so treatment should be postponed until the infection is resolved. Recent ophthalmic surgery during which gas was administered to protect eyes after surgery for up to 3 months. Nitrous oxide-oxygen can disrupt bubbles and cause blindness. Middle ear infection or recent ear surgeries (can experience ear pain because of increased pressure in the tympanic cavity). Bleomycin sulfate treatment for cancer patients; such patients cannot receive hyperoxygenation (100%).

When taken with antacids, which one of the following can result in a decrease in intestinal absorption of the medication? A. Meperidine (Demerol) B. Penicillin V C. Tetracycline D. Acetaminophen (Tylenol)

C. Tetracycline RATIONALE: The absorption of tetracycline is inhibited by the magnesium and aluminum within antacids. Antacid use in conjunction with meperidine (Demerol), penicillin V, or acetaminophen (Tylenol) does not directly cause decreased drug absorption.

A face shield does not replace the need for other forms of protective eyewear. Face shields do not provide the same respiratory protection as provided by facemasks. A. Both statements are TRUE. B. Both statements are FALSE. C. The first statement is TRUE, the second is FALSE. D. The first statement is FALSE, the second is TRUE.

C. The first statement is FALSE, the second is TRUE. RATIONALE: A face shield may be worn as an alternative to safety glasses. However, face shields do not provide the same respiratory protection as facemasks.

Minimizing the recurrence and progression of periodontal disease is an objective of periodontal maintenance. The recommended frequency of periodontal maintenance care visits decrease when the self-care practices of patients are less than optimal. A. Both statements are TRUE. B. Both statements are FALSE. C. The first statement is TRUE, the second is FALSE. D. The first statement is FALSE, the second is TRUE.

C. The first statement is TRUE, the second is FALSE. RATIONALE: A major objective of periodontal maintenance is minimizing the recurrence and progression of periodontal disease. Other objectives include reduction of tooth loss, re-evaluation of results after active periodontal therapy, reinforcement of self-care instructions, and determination of need for additional treatment in a timely manner. Note that the recommended frequency of maintenance care (also called continued

Tachycardia is characterized by an increase in pulse rate. Bradycardia is characterized by premature impulses resulting in premature atrial beats. A. Both statements are TRUE. B. Both statements are FALSE. C. The first statement is TRUE, the second is FALSE. D. The first statement is FALSE, the second is TRUE.

C. The first statement is TRUE, the second is FALSE. RATIONALE: Tachycardia, caused by disruption of normal electrical impulses that control the pumping action of the heart, is characterized by an increased pulse rate (more than 100 beats per minute). Bradycardia is characterized by a slowed heart rate (less than 60 beats per minute). Premature impulses resulting in premature atrial beats is referred to as isolated ectopic beats.

A Mission of Mercy (M.O.M.) event was planned for an urban city in a southern state of the United States. This 2-day event was designed to meet the critical needs of underserved people of all ages by providing free dental care to as many adults and children as time, volunteers, and supplies would allow. Local dentists, dental hygienists, dental assistants, dental students, dental hygiene students, and dental assisting students volunteered for the event. Local politicians and two state representatives were also in attendance. Before receiving dental treatment, informed consent was required of all patients. A 10-question patient survey was distributed, and volunteers reviewed each question with patients while the patients were completing the questionnaire. Confidential questions included information on age, gender, education, family income, address, and past dental experiences. At the end of each patient's treatment and before each volunteer completed his or her shift, the patient was asked to complete an evaluation survey. There was an 88% response rate, and 79% answered that their experience was positive. Two types of program evaluation are formative and performance. Formative, or ongoing, evaluation is a continual process throughout the program that can lead to revisions that improve program success. A. Both statements are TRUE. B. Both statements are FALSE. C. The first statement is TRUE, the second is FALSE. D. The first statement is FALSE, the second is TRUE.

C. The first statement is TRUE, the second is FALSE. RATIONALE: The two basic types of program evaluation are formative and summative. The basic difference is that formative evaluation is ongoing throughout the program with the goal of incorporating revisions while summative evaluation occurs exclusively at completion. Note that while performance is a criteria for evaluation, there is not a type of program evaluation called performance.