Patient Management

1: Ethics & Professional Liability

 Dentists are given a position of authority granted to us by the public because of a commitment we made as professionals
 We are self-regulated, so we adhere to the principles of ethics
 The code of conduct is written expression of how we are to behave between implied contract of profession and community
 Principles of Ethics
o Autonomy = self-governance
o Non-maleficence = do no harm
o Beneficence = do good
o Justice = fairness
o Veracity = truthfulness
 Patient Autonomy
o Respect patient’s right to self-determination and privacy
o Treat the patient according to the patient’s desires but within bounds of acceptable treatment
o Safeguard the confidentiality of patient records (HIPAA Privacy Rule)
 Establishes national standards to protect personal health information
 Informed Consent
o Dentist must share information with and obtain consent from patient
o Based on ethical principle of autonomy
o Must inform patient about nature of procedure, benefits, risks, and alternative treatment options including no treatment—not cost of treatment
 Patient has to choose to sign the consent
 Include prognosis of all options
o Otherwise held accountable for assault and battery
 Minors
o Age 1-7 = infant, not responsible for actions
o Ages 8-14 = competent
o Ages 15-17 = responsible
o Minors younger than 18 can give implied consent or assent but not actual consent
o Exception, if they are emancipated (freed from care and control of parents) or in an emergency situation
 Married
 Pregnant
 Parent
 Military
 Patient Records
o Original charts and x-rays must be kept by you
o Copies of charts and x-rays may be provided to patient or attorney with signed authorization by patient
o Keep all documents for as long as possible
 Risk Management
o Constantly weigh risks and benefits of your practice
o Documentation is most essential component
 Be specific
 Be objective
 Be complete
 Be timely
 Never make or sign an entry for someone else
 Never delete or change anything you wrote—instead provide addendum
 All writings are discoverable, so do not write anything you do not want read aloud in court
 Non-Maleficence
o Primum non nocere = first do no harm
o Keep skills and knowledge up-to-date through CEs
o Know your limitations and refer difficult cases to a specialist
 Beneficence
o Professionals have a duty to act for the benefit of others
o Provide service to the patient and public at large
o Promote patient’s welfare
o The same ethical standard exists no matter the financial arrangement
 Justice
o Be fair in dealings with patients, colleagues, and society
o Deal with people justly and deliver dental care without prejudice
o Never slander another dental professional
 Veracity
o Be honest and trustworthy in dealings with the public
o Respect the position and trust inherent in the dentist/patient relationship
o Must not represent care being rendered, fees being charged, or any form of advertising in a false or misleading manner
 Statute of Limitations
o Laws that set the maximum time after an event within which legal proceedings may be initiated
o Occurrence rule = statute of limitations starts to run after the injury or malpractice occurred
o Discovery rule = statute of limitations starts to run after the injury or malpractice is discovered
 Witnesses
o Expert testimony = an expert who has expertise in dentistry and can testify to the existing standard of care and how it was breached by
defendant
 Standard of care = the lowest acceptable care of the members of dentistry
o Fact witness = someone who was there
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 Good Samaritan Act
o Offers legal protection to health professionals and others who “provide reasonable assistance” to individuals who are
 Injured
 Ill
 In peril
 Incapacitated

2: Communication & Interpersonal Skills

 Active Listening
o Prepare to listen by setting time aside free from distraction
o Repeat back what you hear (paraphrase)
o Lean forward
o Maintain good eye contact
o Face the patient
o Ask questions
o Nod
o Smile
o Maintain close proximity
 Rapport
o Mutual sense of trust and openness
o If neglected, can compromise communication
o Ask about patient’s interests (school, work, family)
o Disclose some personal information as appropriate
 Empathy
o The ability to understand and share the feelings of another
o Reflection and showing understanding
o Acknowledge their concerns
o Open-mindedness
o NOT sharing personal experiences
 Nonverbal Communication
o Continuous, automatic, and informative
o First and most common reaction of discomfort is with eye and eyebrow movement
 Verbal communication
o Be simple, specific, and direct
o Do not just give advice—rather help them reach an informed decision
o Do not falsely reassure and say “everything will be fine” or “don’t worry”
o Make expectations clear
 Clinical interviewing (Verbal Communication)
o Open ended questions = allow patient to explain what is important to them
o Closed questions = elicit more specific information
o Leading questions = direct the patient to respond a certain way (DO NOT USE)
o Probing = gather additional information
 “Tell me more”
o Laundry list = ask patient to respond from a list of choices
 Several options to pick from
 Treatment Planning
o Present tx alternatives to patient in descending order of desirability
o Only present options that are consistent with your standard of care
o Ask patient what his or her understanding is of treatment options to verify their understanding (teach-back method)
 Are they listening to you? Do they understand what you’re saying?

3: Health Behavior Change

 Behavior Change (ABC)
o Health behavior involves complex interplay of person’s thoughts, feelings, and behaviors
o Antecedent = factor that facilitates behavior
o Behavior = behavior itself
o Consequences = consequences of the behavior
 The Stages of Change
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o Precontemplation = not considering behavior change
o Contemplation = begins to consider behavior change
o Preparation = preparing to take steps to change, often expresses a desire to change
o Action = engaged in taking action towards behavior change, often requires support
o Maintenance = attempts to maintain a changed behavior
 Social Cognitive Theory
o Motivation to change behavior is influenced by several factors
o 1: Self-Efficacy = cognitive perception that you can execute behaviors necessary for a given situation
o 2: Behavioral modeling = learn proper behavior from models around you
o 3: Social Reinforcement = positive social consequences
 Health Belief Model
o Motivation to change behavior is influenced by several factors
o 1: Perceived susceptibility = to given disease or problem
o 2: Perceived costs/benefits = severity of consequences
o 3: Cues to action = prompts to engage or not engage in certain behavior
 Behavioral Learning

 Classical Condition
o All about stimuli
o Pavlov’s Dogs

 Start with unstimulated stimulus that triggers unstimulated response

 Add in neutral stimulus (bell) and there is no response
 Add in neutral stimulus with unconditioned stimulus and after pairings, this leads to unstimulated response
 The conditioned stimulus elicits conditioned response
o Classical extinction can occur if link between stimulus and reaction is eliminated
 Operant Conditioning (reinforcement preferred over punishment)
o Positive reinforcement = do a good thing  get rewarded
o Negative reinforcement = do a good thing  remove bad stimulus
o Positive punishment = do a bad thing  get punished
o Negative punishment = do a bad thing  remove a good stimulus
 Observational Learning
o Acquisition of a skill by observing someone else
o Asking an anxious or uncooperative child to observe his/her cooperative sibling
 Behavioral Strategies
o Altering antecedents
o Altering consequences
o Shaping = setting small attainable goals and rewarding yourself after each step
o Premack principle = making a behavior that has a higher probability of being performed contingent on a behavior that has a lower probability of
being performed
 Read bedtime story but ONLY if you floss
o Ability to change depends on locus of control
 Internal motivation
 External motivation
 Motivational Interviewing
o Person-centered counseling style to assist in the resolution from ambivalence to change
o OARS
 Open questions
 Affirmations
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 Reflective listening
 Summarizing
o Steps:
 Engaging = form a relationship
 Focusing = exploring motivation, goals, and values
 Evoking = eliciting their own motivations
 Planning = exploring how one might move toward change
 Sustain talk = not ready to change
 Change talk = favors change
 Commitment talk = ready to change

4: Anxiety and Pain Control

 Dental Anxiety
o Stress = perceived threat to one’s well-being
o Anxiety = subjective experience involving cognitive, emotional, behavioral, and psychological factors
o Anxious patients are more likely to sit still and not say much
o Anxious patients typically require more interpersonal distance to stay comfortable
 Stress Management #1 = TRUST
o Provide patients with a sense of control
o Provide information = let the patient know what to expect beforehand
o Hand signals = patient can raise hand to break
o Time structuring = using an egg time or clock
 Stress Management #2 = COMFORT
o Acknowledge the patient’s experience
o Be empathetic and tactful in your initial response
 “I can see that…”
 “It seems like…”
 “It sounds like…”
 Stress Management #3 = COPING
o Use cognitive-behavioral interventions
o Diaphragmatic breathing = deep breathing, triggers physiologic relaxation response
o Progressive muscle relaxation = tensing and relaxing certain muscle groups focusing on the difference between tension/relaxation
o Guided imagery = imagine pleasant scenes
o Hypnosis = attentional focus
o Rehearsals = allow patient to practice using a coping strategy like deep breathing in simulated procedure
o Systematic Desensitization/Graded Exposure = exposing patient to items from an agreed upon hierarchy of slowly increasing feared stimuli
allowing them to pair a relaxation response with a feared stimuli
o Distraction = music, TV, video games, least effective for a hypervigilant anxious patient
o Tell/Show/Do = instructional method (good for peds)
o Habituation = decrease in response that occurs as a result of repeated or prolonged exposure to a conditioned stimulus
o Rational response/reframing/cognitive coping = developing a more adaptive thought or statement as a means of coping
 “I can’t do this  I did fine last time”
 Cognitive Appraisal of a Threat
o Controllability = how controllable the situation seems to be
o Familiarity = how familiar the situation is
o Predictability = how predictable the situation is
o Imminence = if the situation seems to be approaching near
o **the less controllable, familiar, predictable, more imminent = more stressful
 Child Behavior Management
o Create a child-oriented environment
 Toys/books in waiting area
 Hanging posters in operatory
 Ask about their interests
 Consider parent with them
o Ask them to be a helper
o Tell/show/do
o Ask about their fears
o COUNT!
 Dental Pain
o Complex phenomenon involving cognition and emotion
o Anxious patients are more likely to report pain and discomfort
o Wong-Baker Faces Pain Rating Scale is useful for ongoing assessment of pain experience in children
 Behavioral Pain Management
o Start with simplest and least invasive procedure first
o Give patients choices when possible and appropriate
o Use hand signals and respond immediately to signs of discomfort
 Pharmacologic Pain Management
o Rx
 Mild = ibuprofen or acetaminophen
 Moderate = ibuprofen and acetaminophen
 Severe = ibuprofen and/or acetaminophen and opioid
o Nitrous Oxide
 Sensation before onset = tingling
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 Side effect = nausea
o IV Sedation
 Allows doctor to titrate doses

5: Epidemiology
 Public Health
o Public health = Science and art of preventing disease, prolonging life, and promoting physical health and efficiency through organized
community efforts
o Epidemiology = the study of the distribution and determinants of disease
 Epidemiologic Measures
o DMFT (irreversible)
 Conventional method of defining dental caries in a population
 DFMT = decayed, missing, and filled permanent teeth as a result of caries
 DMFS = decayed, missing, and filled surfaces on permanent teeth due to caries
 DEFT = decayed, extracted, and filled permanent teeth due to caries
 dmft = decayed, missing, or filled primary teeth as a result of caries
o Gingival Index (reversible)
 Uses four surfaces on six indicator teeth (one in every sextant of the mouth with the surfaces facial, mesial, lingual, distal)
 0 = normal gingiva
 1 = mild inflammation
 2 = moderate inflammation
 3 = severe inflammation, ulcerated tissue with tendency toward spontaneous bleeding
o Periodontal Index (reversible)
 Many different indices have been developed
 CPITN = community periodontal index of treatment needs
 0 = healthy
 1 = bleeding
 2 = calculus
 3 = shallow pockets
 4 = deep pockets
 ***AAP doesn’t like this because it doesn’t account for recession, so CAL is inaccurate
o Simplified Oral Hygiene Index (reversible)
 Quantifies the amount of debris (DI) and calculus (CI)
 Oral hygiene
 Good
 Fair
 Poor
 Disease Processes
o Caries = tooth decay
o Periodontal disease = gum disease
o Oral cancer
 Early Childhood Caries
o Previous called baby bottle tooth decay
o Defined as 1 or more dmfs between birth and 71 months of age
 Occurs ages 3-5
 Mostly involves maxillary incisors and molars
o 5% of US infant and toddler population
 Oral Cancer
o The tongue is most common site of cancers in oral cavity
o Cancer screening done at every dental exam

6: Prevention of Oral Diseases

 Prevention
o Primary = prevents disease before it occurs; sealants and water fluoridation
o Secondary = eliminates or reduces disease after it occurs; restorations
o Tertiary = rehabilitates a patient after a disease has taken place; prosthodontics (dentures)
 Fluoride
o Topical (strengthen teeth already present; resistance)
o Systemic (incorporated into teeth as they’re forming)
 Can be incorporated with topical as well
 Community Water Fluoridation
o Most cost effective and most practical preventive measure to prevent tooth decay
o Prevalence of caries in the US significantly declined from early 1970s to mid 1990s
o 1ppm (1mg fluoride per liter of water) is optimal amount
o Odorless, colorless, and tasteless when in the proper range of 0.7 to 1.2ppm
o 210 million people of US population live in fluoridated communities
 School Water Fluoridation
o 4.5x concentration of community water since students are only at school for part of the day
o Fluoride mouth rinses are another excellent program to institute at school
 Salt Fluoridation
o For developing countries that don’t have safe public water supply
o 200-350mg fluoride per kg of salt
o Combination of both water and salt fluoridation is not recommended
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 Fluoride Supplements
o Prescription only
o For children at risk of caries who live in non-fluoridated areas
o 3 years old = fluoride drops, because children this young have difficulty chewing and swallowing tablets
o >3 years old = fluoride tablets and lozenges
o >6 years old = fluride mouth rinse
 0.2% NaF solution weekly
 0.05% NaF solution daily
 Fluoride Supplement Dosage Schedule

 Topical Fluoride
o Best for smooth surfaces
o Can also help with root caries and ECC
o Varnish is adhesive and maximizes fluoride-tooth contact with 5% fluoride
o Acidulated phosphate fluoride (APF) gel has pH 3.0 and 1.23% fluoride
 Stannous Fluoride
o Benefit of antimicrobial as well
o Astringent taste (bad taste) and extrinsic tooth staining
 Fluoride Toxicity
o Toxic dose is 5mg/kg
o Lethal dose is 5g for an adult
o Acute toxicity = n/v, vomiting, loss of consciousness, cramping, damage to stomach lining
o chronic toxicity = fluorosis
 Sealants
o best for occlusal surfaces
o recommended for 1st and 2nd permanent molars for children at risk for caries
 Mouth Guards
o Made for athletes to prevent tooth trauma
o Protruding upper incisors are especially vulnerable to trauma
 Health Education
o Health literacy = capacity at which individuals obtain, process, and understand basic health information and services
o Education alone cannot function as a method to prevent disease
 **behavioral modification is more beneficial than education to increase compliance with dental care
 Toothbrushing
o Dental plaque is main cause of both caries and perio disease
o Children <6 years should be supervised when brushing with fluoride toothpaste
 Flossing
o Flossing does not prevent tooth decay but may be helpful for gingival health
 Diet
o Frequency of sugar consumption is more important than amount
o Other important factors
 During day or immediately before bedtime
 Length of time that sticky residual food material remains in the mouth

7: Evidence-Based Dentistry
 Hierarchy of Evidence
o Meta analysis
o Systematic review
o Randomized clinical trial
o Cohort study
o Case-control study
o Cross-sectional study
o Case report
o Expert opinion
o Animal studies
o In vitro studies
 Descriptive/Epidemiological Studies
o To quantify disease status in a community
o Prevalence = proportion of a given population that is affected by a condition at a given time
 Analytical/Observational Studies (longitudinal is case, prospective, retrospective)
o To determine the etiology of a disease
o Cross-sectional = survey or measurement taken to represent a snapshot in time, prevalence
o Case-control = people with a condition (cases) are compared to people without it (controls) in the past, odds ratio
o Prospective cohort study = cohort followed through time to see who develops a disease, incidence and relative risk
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o Retrospective cohort study = look back after following the cohort and decide what disease you want to look for, incidence and relative risk
 Experimental Studies
o To determine the effectiveness of a therapy
o Clinical trial = aim to isolate one factor and examine its contribution to a patient’s health by holding all other factors as constant as possible
 Random sampling
 Random allocation
 Blinding (single vs. double)
 Frequency Distributions
o Normal distribution = bell-shaped
 68% within 1 std deviation
 95% within 2 std deviation
 99.7% within 3 std deviation
o Skewed distribution = tail to the right/left
o Bimodal distribution = two peaks
 Measures of Central Tendency
o Mean = average value
o Median = middle value
o Mode = most frequent measurement in a set of data
 Measures of Dispersion
o Range = max – min
o Variance = how spread out individual values are from the mean
o Standard deviation = square root of the variance
 Outliers

o Outliers have more of an impact on dispersion MORE than anything else

 Quality of Diagnostic Test

o Reliability = precision
o Validity = accuracy
o Specificity = health (# of negative)
o Sensitivity = disease (# of positive)
 Inferential statistics
o Statistical significance (p-value) = probability that two variables are un-related
 If p<0.05 = reject null hypothesis (statistically significant)
 If p>0.05 = accept null hypothesis (not significant)
 Null Hypothesis

o The null hypothesis (H0) is a hypothesis which the researcher tries to disprove, reject, or nullify
 Correlation Analysis
o Correlation coefficient (r) = statistical measure that represents the strength of relationship between two quantitative variables
 Always between -1 and +1
 0 means no linear relationship
 Inferential Statistics
o Chi-squared test = measures the association between two categorical values
o T-test = measures the statistical difference between two means, small sample size
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o Z-test = measures the statistical difference between two means, large sample size, variance is known
o ANOVA (analysis of variance) = used to test differences between two or more means
 Operational Variables
o Qualitative = descriptive (Chi-square)
 Nominal = names or labels
 Ordinal = ranking
o Quantitative = numbers (t-test, z-test, ANOVA)
 Ordinal = ranking
 Interval = range of values
 Ratio = range of values with clear definition of 0
 Operational Variables
o Independent variable (x) = explanatory, predictor
o Dependent variable (y) = outcome, predicted
o Confounding variable = covariate
 Minimize this by randomizing
 Components of a Scientific Paper
o Title
o Abstract
 Quick summary (sparks notes)
o Introduction
 Background on topic, states purpose and hypothesis
o Methods
o Results
o Discussion
o Conclusion
o References

8: Infection Control
 Important Times
o Hand washing = 15 seconds minimum
o Flush ultrasonic = 20-30 seconds minimum
 Routes of Transmission
o Direct contact = via person
o Indirect contact = via fomite (instrument, clothing, furniture)
o Droplets or aerosols = via air
o Parenteral contact = via needle stick (IV, IM subcutaneous)
 Hepatitis
o Hep A and E = fecal/oral
o Hep B, C = contaminated blood
o Hep D = direct contact, prior infection with HepB
 Hep B
o 30% risk of transmission after percutaneous injury
o DNA virus (Dane particle)
o Vaccine is available
o Postexposure prophylaxis includes vaccine and possibly immunoglobulin
 Hep C
o 1.8% risk of transmission after percutaneous injury
o RNA virus
o No vaccine available
o Postexposure prophylaxis is now available
o **acute hepC can go away, not with chronic hepC
 HIV
o 0.3% risk of transmission after percutaneous injury
o RNA virus
o Diagnosed with antibodies to HIV are detected in blood via ELISA test
o No vaccine is available
o Postexposure prophylaxis is with antivirals
 TB
o Inhalation of infected droplet nuclei
o Diagnosed by symptoms, sputum culture, chest x-ray, or a positive TB skin test
o Patient with active TB should not be seen for elective dental care
o Healthcare workers should have a tuberculin skin test at least once a year
 PPE
o Gloves = whenever touching something that is contaminated with body fluids
o Utility gloves = not used during surgical procedures because they are used to wash and rinse dirty instruments prior to sterilization
o Masks = per patient
o Protective glasses = protect from splatter, splash, and projectiles dentist is most at risk for eye injury
o Gowns = per day
 OSHA
o Protects healthcare professionals from occupational hazards
o All dental workers must be offered free HBV vaccines
o Any dental worker who experiences needlestick must get report, eval, and followup
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o Clothing worn at work cannot be washed at home
o Hazard communication standard (HCS) = HazCom
 Created by OSHA so that they know about potentially hazardous materials
 EPA
o Established maximum exposure levels for Hg vapor at 0.1 g/kg body weight
o Regulates transportation of dental waste from dental offices
 Sterilization
o Destruction of all life forms including bacteria, viruses, and spores
o Glutaraldehyde
 Cold solution used for heat-sensitive items
 Requires a long time
o Pressure sterilization/autoclave
 121C at 15psi for 20 minutes
 Moist heat destroys bacteria by denaturation of proteins
 Biologic monitors (done weekly)
 Process indicators (change color with reaching physical conditions)
o Dry heat sterilization
 160C for 60 minutes
 Only glass or metal objects can be used due to high temperatures
 Dry heat destroys bacteria by coagulation of proteins
 Best preservation of cutting edges
o Ethylene oxide
 ETO gas uses relatively low temperatures and can penetrate materials to sterilize pre-packaged items like PSP plates
 Requires lengthy aeration
 Disinfection
o Used on inanimate objects
o Spores are not destroyed in this process, but mycobacterium TB is
o Let it sit for 10 minutes and then wipe
 Antisepsis
o Used on living tissue to reduce bacterial load
o Alcohol = most commonly used antiseptic, denaturation of proteins
o CHX = substantivity (continuous long lasting effect)
o Detergents = help loosen and remove microbes from surface with rinsing
o Quaternary ammonium compounds = disrupt cell membrane and lethal to a wide variety of organisms except endospores, TB, and non-enveloped
viruses
 Disposal of Wastes
o Sharps = sharp bins
o Infectious waste = separate waste bin
 Anything with blood
o Non-infectious waste = normal trash
 Spaulding Classification System
o Critical
 Contacts sterile tissue or vascular system
 Requires sterilization
 Needles
o Semi-Critical
 Contacts mucosa
 Minimum of high-level disinfection but sterilization if material is heat stable
 Mouth mirror
o Non-Critical
 Contacts skin
 Requires disinfection
 Blood pressure cuffs

9: Materials and Equipment Safety

 Mercury
o Inhalation is biggest risk
o If spill occurs, use a special vacuum system and then apply sulfur powder on the floor (absorbs elemental mercury)
o Acute mercury toxicity
 Muscle weakness
 Loss of hair
 Weight loss
 GI disorders
 Exhaustion
 Airborne Particles
o Splatter = visible 50m, fall within 3 feet of patient’s mouth, can carry blood-borne pathogens
o Aerosols = invisible <50m, remain floating in air for hours, can only carry respiratory infections
 Noise Control
o Hearing loss develops slowly over time and can be caused by 90dB
 Water Lines
o EPA requires 500CFU of heterotrophic bacteria per mL of water
 Viable bacteria in sample of liquid (lower number = safer)
o Not recommended to flush lines at beginning of clinic because makes no difference
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o Anti-retraction valves prevent retraction of fluid from a patient into the handpiece and water spray hose which could be passed on to the next
patient
 Material Safety Data Sheet (MSDS)
o Manual made by the manufacturer (not OSHA) that details the hazards of particular chemicals, how to deal with spills, etc.
o National Fire Protection Association Color and Number
 Blue = health
 Red = fire
 Yellow = reactivity of chemical
 White = required PPE
 0-4 least to most dangerous

10: Insurance Terms and Healthcare Systems

 Insurance Terms
o Beneficiary = person with the insurance plan
o Benefactor = the insurance company
o Benefits = what insurance pays for dental services covered under contract
o Premium = monthly amount you pay to have insurance
o Copayment = predetermined rate you pay at time of care
o Deductible = what you need to pay before insurance starts kicking in
o Coinsurance = percentage of charge that you pay
o Out of pocket maximum = the most you have to pay before insurance covers 100% of the bill
 Third Party Payers
o When a third party negotiates payments between providers and patients for services
 Usual, customary, and reasonable (UCR) = reasonable fee based on geographic location
 Table of allowances = lists maximum amount a plan will pay for each procedure but allows dentists to charge more if they want
 Fee schedule = list of fees the dentist has agreed upon for dental services and the insurance will cover in full
 Payment Plans
o Fee for service
 Dentist is paid per procedure
 Leading payer for dental treatment
o Capitation plan (HMO)
 Per capita = dentist is paid flat fee for each patient seen
 Cap on how dentist is paid
 Value of service > payment = dentist’s loss
 Payment > value of service = dentist’s gain
o Sliding scale fee
 Cost of treatment is adjusted based on patient income and ability to pay
o Balance billing
 Dentist charges the remaining balance between the total fee and what the insurance company covered
o Prospective reimbursement (FQHC)
 Dentist is paid pre-determined fixed amount before treatment is provided
 Fraud Terms
o Unbundling = the separating of a dental procedure into component parts
 **dentist commits fraud
o Bundling = the combining of distinct dental procedures
 **insurance commits fraud
o Upcoding = reporting a more complex or higher cost procedure than was actually performed
 **dentist commits fraud
o Downcoding = code change to a less complex or lower cost procedure than was reported
 **insurance commits fraud
o Overbilling = charging more than legally or ethically acceptable
 **dentist commits fraud
 US Health Care
o Private Insurance
 Consumer-driven
 Private fee for service
 Flexible spending account (FSA)
 Health savings account (HAS)
 Managed care
 HMO
o Insurance option that limits coverage to medical care
provided through specific providers who are under
contract
o Doctors paid on capitation plan
 PPO
o Panel of providers agree to accept less than usual
fees in exchange for higher volume of patients, since
subscribers to this plan have a financial incentive to
use providers from this panel
 Dental Managed Care
o Open panel = participating dentist can see any
patient
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o Closed panel = participating dentist is contracted and can only see patients who are members of the managed
care organization
o Department of Health and Human Services (HHS)
 Overview
 Principal agency of US government for protecting health of all Americans
 Suspected elder abuse must be reported to this agency
 All of the remaining agencies are operating divisions of HHS
 Administration for Children and Families (ACF)
 Head start = provides comprehensive early childhood education, health, nutrition, and parent involvement services to low-
income children and their families
 Centers for Medicare and Medicaid Services (CMS)
 Medicare is for elderly
o Does not cover dental care
o Exception is if dental need is related to medical condition like extractions before radiation therapy for cancer
 Medicaid is for destitute
o Early periodic screening diagnostic and treatment (EPSDT) requires states to take action to ensure children
under 21 can access care
o Affordable care act (ACA) expanded Medicaid coverage
 CHIP is for children
o Children whose family’s income is too high to quality for medicaid but too low to afford private insurance
 Health Resources and Services Administration (HRSA)
 National health service corps (NHSC) = provides loan repayment for health professionals who work in underserviced
communities (FQHC)
 Ryan White CARE act = funds medical and dental care for people with HIV/AIDS
 CDC
 Provides oral health surveillance, dental infection control, community water fluoridation, cancer/tobacco related issues and
support for state oral health programs
 FDA
 Evaluates food, drugs, and medical devices based on efficacy and safety
 IHS
 Improves health status of American Indians and Alaskan Indians
 National Institute of Health (NIH)
 Biomedical and public health research
 Agency for Healthcare Research and Quality (AHRQ)
 Quality and access to care research
 Quality assessment = measures quality of care at a location
 Quality assurance = not only measures quality of care but also implements necessary changes to improve the situation
 Government health programs
 Medicare
 Medicaid
 Children’s health insurance program (CHIP)
 Indian health service (IHS)
 Veterans health administration (VHA)

11: Practice Questions

1. Which of the following ADA Principles of Ethics states that a dentist has a duty to respect the patient’s right to self-determination and confidentiality?
a. Patient autonomy
b. Nonmaleficence
c. Privacy
d. Justice
e. Veracity
2. During an informal session of motivational interviewing, your patient says “I don’t have time to quit smoking.” What stage of behavior change is he/she in?
a. Precontemplation
b. Contemplation
c. Preparation
d. Action
e. Maintenance
3. The ______ section of a scientific article provides the reader with detailed information regarding the study design.
a. Abstract
b. Background
c. Introduction
d. Methods
e. Discussion
4. Which of the following is an effective community prevention program?
a. Brushing 2x a day
b. Flossing 1x a day
c. Regular dental checkups
d. School sealant program
e. Low-sugar diet
5. Which method of sterilization is least likely to dull and corrode carbide instruments?
a. Glutaraldehyde
b. Steam heat
c. Dry heat
d. Ethylene oxide
6. What is an example of a conditioned stimulus for a dental patient that had a previous bad experience?
 Patient Management
a. Dental chair
b. High blood pressure
c. Intrinsic fear
d. Anxiety of parent
7. Which of the following is not included in the ADA Code of Conduct?
a. Licensure by credentials
b. Advertising
c. Slander
d. Fees
e. Patient care
8. Which technique is typically not useful in treating an anxious patient?
a. Using less structure in establishing rapport
b. Reassuring the patient by telling the patient not to worry
c. Providing reasons before asking for sensitive information
d. Using empathy
e. Making expectations clear
9. The variance for data set A is 21 and for data set B is 7. We can conclude that
a. There are more items in data set A than B
b. The mean of data set B is smaller than B
c. The items in data set A is more widely spread about the mean value than that in B
d. The standard deviation for data set B is larger than A
e. None of the above
10. Which of the following is an arrangement between a plan and a group of dentists whereby the providers agree to accept certain payments (usually less than
their usual fees) in anticipation of a higher volume of patients?
a. PPO
b. Capitation
c. HMO
d. Medicare
e. None of the above
11. Which of the following is a component of the OARS model?
a. Assertions
b. Appraisals
c. Affirmations
d. Absolutes
12. Fluoride supplementation of a 2-year old child who lives in a non-fluoridated community can best be accomplished by initially prescribing ______
a. Fluoride tablets
b. Fluoride lozenges
c. Fluoride drops
d. Fluoride mouth rinses
e. Fluoride toothpaste
13. An amalgam restoration is considered _____
a. Primary prevention
b. Secondary prevention
c. Tertiary prevention
d. Unsafe
14. Ryan is a young child who consistently presents as an anxious, hypervigilant, and upset during dental visits. Ryan is often accompanied by his parents, who
appears to be very concerned about the child and wants to be involved at all times in her evaluation and treatment. During this visit, Ryan’s treatment
requires an injection and rubber dam application, which you anticipate may lead to increased anxiety. Which strategy would be least effective in completing
the rubber dam application?
a. Tell/show/do
b. Distraction
c. Ask child to be a helper
d. Structure time
e. Rehearsals
15. Ryan has a strong gag reflex during x-ray procedures. You suggest he take several x-ray packets home and practice holding the packets in his mouth for
increasingly longer periods of time. Which of the following techniques does this best exemplify?
a. Social reinforcement
b. Systematic desensitization
c. Modeling
d. Guided imagery
e. Behavioral learning