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Chapter 5 Case C 63
CASE STUDY QUESTIONS
ASSESSING PATIENT CHARACTERISTICS
Basic Level Questions
1. Which of the following is the most likely assessment of the bilateral white lines (arrows) observed on the right and left facial side of the arches?
A. Linea alba B. Mucogingival line C. Free gingival margin D. Exotosis
E. Scarring
2. The yellow spots observed on the occlusal surfaces of the primary maxillary right canine, first molar, and left canine are most likely
A. Dentin B. Caries
C. Stained enamel D. Food debris
E. Cementum
3. Which of the following accurately describes the defect observed on the incisal edge of the maxillary left central incisor?
A. Abfraction B. Abrasion C. Attrition D. Erosion
E. Fracture
Competency Level Questions
4. Which of the following terms best describes this patient’s caries? A. Hidden or backward
B. Early childhood C. Chronic D. Arrested E. Recurrent
5. Which of the following terms best describes the stains observed on the facial surfaces of the mandibular anterior teeth?
A. Intrinsic and endogenous B. Intrinsic and exogenous C. Extrinsic and endogenous D. Extrinsic and exogenous
6. Which of the following is an oral adverse effect of this patient’s medication? A. Xerostomia
B. Early tooth loss
C. Increased risk for congenitally missing teeth D. Intrinsic tooth staining
OBTAINING AND INTERPRETING RADIOGRAPHS
Basic Level Questions
7. The brown stains on the maxillary right molar periapical radiograph and the left bite- wing radiograph indicate that
A. These two films became overlapped in the automatic processor and stuck together while processing.
B. These film packets were opened before turning off the white light in the darkroom. C. Saliva penetrated the outer protective paper wrapping of these film packets to con-
taminate the films.
D. These two films were rubbed together during transport to the darkroom and static electricity created artifacts.
8. The radiographic appearance of the primary mandibular canines indicates A. Incomplete developing root structure
B. Congenitally missing root structure C. External resorption
D. Internal resorption
9. The radiolucency surrounding the permanent mandibular left second molar is most likely A. A dentigerous cyst
B. The dental sac C. An abscess D. The dental papilla
E. Sharpey’s fibers
Competency Level Questions
10. Which of the following is the most likely reason for the wide appearance of the pulp chambers of the permanent maxillary central incisors?
A. Hypercementosis
B. Lack of formation of secondary dentin C. Internal resorption
D. Sclerosis E. Pulpal infection
11. The radiographs reveal an abscess on which of the following teeth? A. Primary maxillary left first molar
B. Primary mandibular right canine C. Permanent maxillary right canine D. Permanent mandibular left second molar
E. Permanent mandibular right first molar
12. Which of the following primary teeth will most likely be exfoliated next? A. Maxillary right first molar
B. Maxillary right canine C. Mandibular left second molar D. Mandibular left canine
E. Mandibular right first molar
PLANNING AND MANAGING DENTAL HYGIENE CARE
Basic Level Questions
13. Which of the following will most likely play a role in influencing this patient’s gag reflex? A. Shiny, edematous facial gingival tissue
B. Color and consistency of hard palate rugae C. White coating on dorsal surface of tongue D. Size and shape of uvula and tonsils
Chapter 5 Case C 65 14. Each of the following is recommended for this patient EXCEPT one. Which one is the
EXCEPTION?
A. Short appointments
B. Professional fluoride treatment C. Full-mouth disinfection D. Nutritional counseling
E. Monitoring of vital signs
Competency Level Questions
15. Following examination of the oral pharyngeal area, which of these would be contrain- dicated for this patient?
A. Foam dispensed fluoride tray application B. Conscious sedation with nitrous oxide C. Use of compressed air for examining tissues D. Cotton roll isolation of teeth for sealant placement
E. Placement of the patient in a supine position during treatment
16. Which of these actions is least likely to motivate this patient to better oral self-care? A. Comprehensively explain the causes of caries and what the patient can do to help
prevent his adult teeth from ending up in the same conditon as his decayed pri- mary teeth.
B. Using disclosing solution, demonstrate brushing technique in the patient’s mouth and then have him practice while you observe his ability to use the technique.
C. Use a lot of positive feedback and compliment the patient on his desire to want to learn better self-care for healthier teeth.
D. Provide a reward system such as placing a star sticker on the indices you use to score the patient’s biofilm accumulation at each appointment.
E. Repeat the oral hygiene instructions multiple times and use several ways to explain the same message.
PERFORMING PERIODONTAL PROCEDURES
Basic Level Question
17. Order the stages leading to the formation of the soft deposit noted on the facial sur- faces of the mandibular left and right central incisors. Match each letter with its proper sequence number.
Beginning within minutes after an abrasive has removed all material from the teeth surfaces.
1. ___ A. Filamentous bacteria and slender gram-positive rods grow.
2. ___ B. Glycoproteins are absorbed into the enamel from the saliva.
3. ___ C. Gram-positive cocci and rods (Streptococcus mutans and Streptococcus sanguis) accumulate.
4. ___ D. Microorganisms arrange themselves perpendicular to the tooth to coalesce into a continuous mass.
5. ___ E. Fusobacteria and gram-negative spirochetes and vibrios accumulate near the gingival margin.
USING PREVENTIVE AGENTS
Basic Level Question
18. Which of the following permanent first molars should be recommended for sealant placement?
A. Maxillary right B. Maxillary left C. Mandibular right D. Mandibular left
Competency Level Question
19. Which of the following home-use fluorides should be recommended for this patient? A. Brush-on gel of 0.4% SnF2 once daily
B. Oral rinse with 0.05% NaF once daily C. Tray application of 0.5% APF once daily D. Oral rinse with 0.2% NaF once weekly
E. Brush-on dentifrice containing Na2PO3F two to three times daily
PROVIDING SUPPORTIVE TREATMENT SERVICES
Basic Level Questions
20. In addition to scaling, which of the following would be recommended for professional stain removal for this patient?
A. Air-power polishing with sodium bicarbonate B. Porte polisher with sodium fluoride
C. Oral irrigation with chlorhexidine gluconate D. Power-driven prophylaxis with pumice
E. Toothbrushing with tartar control toothpaste
21. Each of the following must be assessed to assist this patient with caries control EXCEPT one. Which one is the EXCEPTION?
A. Frequency of intake of cariogenic foods B. Types of foods selected for snacks
C. Identification of food consistency (soft, sticky, etc.) D. When fermentable carbohydrates are consumed
E. Number of calories consumed per day
Competency Level Question
22. Which one of these snacks reported as his favorites by the patient’s mother would be least likely to produce acidic plaque precipitating demineralization of enamel?
A. Cookies B. Pretzels C. Ice cream D. Coke™
E. Gummy bears
DEMONSTRATING PROFESSIONAL RESPONSIBILITY
Basic Level Question
23. Which of the following is the ALARA exposure setting for this patient’s radiographs? A. Equivalent to the exposure setting used for adult radiographs
B. A reduction by one-fourth of the exposure setting used for adult radiographs C. A reduction by one-third of the exposure setting used for adult radiographs D. A reduction by one-half of the exposure setting used for adult radiographs
Chapter 5 Case C 67
Competency Level Questions
24. Neglect of oral health needs can be considered child abuse. This patient’s oral condition is most likely the result of child abuse.
A. The first statement is true, the second statement is false. B. The first statement is false, the second statement is true. C. Both statements are true.
D. Both statements are false.
25. Which of the following responses to this patient’s mother’s concerns regarding the value of professional preventive oral health care treatment is most helpful?
A. “Not accepting the care plan for restoring Andrew’s oral health could be consid- ered child neglect.”
B. “We can see that you want the best for Andrew, and now that you understand the value of professional preventive dental and dental hygiene care, we want to assist you with meeting his oral health needs.”
C. “A responsible parent would accept the recommended treatment plan for getting Andrew’s mouth back in shape.”
D. “If you do not agree to the comprehensive treatment plan for improving Andrew’s oral health, then he is likely to encounter worse problems down the road.” E. “We can’t believe that you let Andrew’s teeth get this bad.”
SETTING PATIENT GOALS
ESTABLISHING A DENTAL HYGIENE CARE PLAN
To assist this patient in meeting his needs, develop a dental hygiene care plan that estab- lishes a framework within which to help him and his caregiver identify goals for obtaining oral health. In addition to the clinical assessment, a well-prepared dental hygiene care plan should take into account the patient’s age, gender, lifestyle, culture, attitudes, health beliefs, and knowledge level. To help link this patient’s needs for overall well-being with his oral conditions, and to provide motivation for achieving better health, the following is a partial list of possible deficits based on the Human Needs Conceptual Model to Dental Hygiene Practice (see Chapter 1). Use this partial list of unmet needs or deficits as a guide in prepar- ing a dental hygiene care plan for this patient. One set of goals and dental hygiene actions/ interventions has been completed as an example.
Deficit identified in protection from health risks Due to: adverse side effects of medication Evidenced by: elevated readings for vital signs
Goals: ______________________________________________________________ Dental hygiene actions/interventions: ____________________________________ Deficit identified in biologically sound and functional dentition
Due to: future caries risk; premature loss of primary teeth Evidenced by: multiple, large caries present
Goals: ______________________________________________________________ Dental hygiene actions/interventions: ____________________________________
Deficit identified in conceptualization and problem solving
Due to: mother’s lack of preventive actions; lack of knowledge of preventive measures
for oral health
Evidenced by: no history of preventive professional dental or dental hygiene care Goals:
schedule and keep appointments to restore oral health; maintain regular preventive
dental hygiene appointments; monitor patient’s oral self-care for effectiveness; assist patient
with developing lifelong sound nutritional habits
Dental hygiene actions/interventions: