Public Health

OSHA/BEHAVIORAL SCIENCE/PUBLIC HEALTH
LEGEND
Major Topic Abbreviation
Behavioral Science BS
OSHA OSHA
Public Health PH
Sterilization/Disinfection SID
Copyright 2001 - DENTAL DECKS
SID
Quaternary ammonium compounds are classified as which type of surface-acting
substance?
Nonionic
Anionic
Cationic
r
Cationic
Quaternary ammonium compounds have antimicrobial activities that are used as
disinfectants and antiseptics. The most probable site of their antimicrobial action
is the cell membrane. Gram-positive bacteria are the most susceptible to destruction.
These compounds are not sporicidal, tuberculocidal, or viricidal and are inactivated by
anionic detergents (soaps and the iron in hard water).
Anionic surface-acting substances include synthetic anionic detergents and soaps.
These substances alter the nature of interfaces to lower surface tension and increase
cleaning. Their primary value appears to be their ability to remove microorgan-
isms mechanically from the skin surface.
Note: Nonionic chemicals do not possess any antimicrobial properties.
SID
How long does it take to kill bacterial spores when a dental instrument is placed in a
2% solution of glutaraldehyde?
15 minutes
2 hours
10 hours
36 hours
10 hours
Advantages of glutaraldehydes:
Most potent category of chemical germicide
Capable of killing spores (after 10 hours)
EPA registered as chemical sterilant
Can be used onheat sensitive materials
Disadvantages of glutaraldehydes:
Long period required for steril ization
Allergenic
Not an environmental disinfectant
Extremely toxic to tissues
SID
Which of the following is the proper time and temperatures for unsaturated chemical
vapor sterilization?
250
0
F (121
0
C) for 15-20 minutes
350
0
F (17r C) for 2 hours
270
0
F (132
0
375
0
F (191 C) for 12 minutes
Copyright ce 2001 - DENTAL DECKS
270 F (132 C) for 20-40 minutes (these conditions will yield 20 Ibs. pressure of
sterilizing vapor)
The principal operation of this system is similar to that of steam sterilizers but
instead of distilled water, a solution of alcohol, formaldehyde, ketone, acetone and
water is used to produce the sterilizing vapor.
The temperature and pressure required for chemical vapor sterilizers are greater
than those for the autoclave.
The major advantage of this system is that it does not rust or corrode metal instru-
ments, including carbon steel. Disadvantages include instruments must be dried com-
pletely before processing, a special chemical solution must be used and it will destroy
heat-sensitive plastics.
Note: Rapid heat transfer sterilization requires the following, 375
0
F (191
0
C) with a
cycle time of 12 minutes for wrapped instruments and 6 minutes for unwrapped instru-
ments.
Which of the following are advantages of the ethylene oxide sterilization?
Highly penetrative
Does not damage heat-sensitive materials (rubber, colton, plastic, etc.)
Evaporates without leaving toxic residue
Works well for materials that cannot be exposed to moisture
All of the above
Copyright (l;) 2001 - DENTAL DECKS
SID
All of the above
Ethylene oxide gas has been widely used as a sterilization agent, particularly for
prepackaged, disposable plastic ware in hospitals. This gas is fairly toxic to humans
and is also flammable, so that its general use is limited. Exposure of materials to eth-
ylene gas must be performed in special sealed chambers. Note: Sterilization with
ethylene oxide is a slow process ( 10-16 hQurs] - depending on material to be ster-
ilized. Items must be cleaned and dried thoroughly before the sterilization process.
Important: Ethylene oxide functions as an alkylating agent by irreversibly inactivating
,fg! lular nucleic acids_rONA) and proteins,
SID
All of the following are advantages of using alcohols (70% isopropyl and 70% ethyl
etconoti as surface disinfectants except:
They are bactericidal
They are sporicidal
They are tuberculocidal
They are economical
Copyright ~ 2001 - DENTAL DECKS
r
They are sporicidal
'This is false; they are not sporicidal
Alcohol is probably the most widely used antiseptic and is used to reduce the number
of microorganisms on the skin surface in the area of a wound. Alcohol denatures pro-
teins, extracts membrane lipids and acts as a dehydrating agent, all of which
contribute to its effectiveness as an antiseptic. Even some viruses (lipophilic virus-
es only) are inactivated by alcohol. The drawbacks of alcohol are that it evaporates too
quickly and has diminished activity against viruses in dried blood, saliva and other
secretions on surfaces (this is due to the presence of tissue proteins and glycoproteins
which render alcohol ineffective) .
For the above reason, alcohols are not regarded as effective surface cleansing
agents (i.e., cleaning a dental operatory following patient treatment) .
SID
Which of the following is the proper time and temperature for dry heat sterilization?
320
0
F (160C) for 2 hours
250
0
F (121C) for 20-30 minutes
450
0
F (232C) for 5 minutes
89F (31C) for 30 minutes
320
0
F (160
0
C) for 2 hours
k )
Note: 340
0
F ( 170
0
C) for 1 hour is also effective.
d '
Items which are usually sterilized by dry heat can be autoclaved. They should be
removed immediately after cycle to diminish the possibility of corrosion of the instru-
ments and dulling of sharp points or edges (carbon steel instruments) . Dry heat
destroys microorganisms by causing coagulation of proteins.
Advantages of dry heat:
Effective and safe for sterilization of metal instruments.
Does not dull or corrode instruments.
Disadvantages of dry heat:
Long cycle.
Poor penetration.
Will ruin heat-sensitive materials.
Note: instruments must be dry before both dry heat sterilization and ethylene oxide
sterilization. Water will interfere with the sterilization process.
SID
Which type of pathogens listed below provide the ultimate test for efficacy of sterili-
zation?
Bacteria
Spore-forming
Virus
Fungi
Spore-forming
Saturated steam (autoclave) has proven to be the most practical , the most economi-
cal, and the most currently effective sporicide. It is also the most efficient method for
destruction of viral and fungal microorganisms.
The steam autoclaves are made to operate in the following ranges:
121
0
C (2SIEE) at a pressure of 15 pounds per square inch (psi) for 15-20 minutes.
134
0
C (270
0
EI at a pressure of 30 psi for a minjmum of 3 minutes ("flash ess:
To positively destroy all living organisms, the minimum, required temperature is
121
0
C (250F).
Note: The autoclaving time will vary directly with the type of the load placed into the
chamber. The 3-minute "flash cycle" is best indicated for unwrapped instruments. When
instruments are wrapped, a longer sterilization cycle is required to permit adequate
penetration of steam for proper disinfection.
Which of the following is the proper time and temperature for autoclaving?
350
0
F (17r C) for 1 hour
250
0
F (121C) for 15-20 minutes
450
0
89
0
SID
250
0
F (121C) for 15-20 minutes (these conditions will yield 151bs. pressure of
steam)
Moist heat destroys bacteria by denaturation of the high protein-containing bacteria.
The autoclave provides sterilization when used at 250
0
F (121
0
because it applies the heat under pressure, which greatly speeds up the denatura-
tion process when compared with boiling water. Usually only ten minutes is required to
destroy all of the bacteria , but the increased time is allowed for penetration when the
instruments are wrapped in thick towels.
The effectiveness of autoclaving is best determined by culturing bacterial
spores. OSHA and the CDC recommend steril izer monitoring weekly (spore testing
is best).
Note: Precleaning is the most important step in instrument sterilization. Debris
acts as a barrier to the sterilant and sterilization process. Ultrasonic instrument
cleaning is the safest and most efficacious method of precleaning.
SID
Which of the following is the process by which all forms of microorganisms are
destroyed, including viruses, bacteria, fungi and spores?
Disinfection
Sterilization
Cleaning
Wiping
Sterilization (refers to the absence of aI/living forms)
Disinfection fers to the destruction of disease-causing microorganisms. It does not
Inctude-t e destruction of s p o r e s . ~ h e term disinfectant is reserved for chemicals
applied to mammate surfaces (lab tops, counter tops, headrests, light handles, etc.).
They are not considered safe for use on living tissue.
Antiseptics are chemical agents similar to disinfectants, but they may be applied
safely to living tissue. Note: Soap only removes microorganisms.
Note: Remember the doctrine of sterilization. Do not disinfect what you can steril-
ize.
Remember:
1. The immersion of dental instruments in cold disinfectants will not destroy spores or
the hepatitis viruses (they are resistant to physical and chemical agents).
2. Liquids are generally sterilized by filtration. This is accomplished by pouring the
liquid through a filter with pores small enough to trap the microbes.
SID
All of the following statements concerning sodium hypochlorite are true except:
It is EPA registered
It is effective in dilute solution
It is economical
It is a chemically stable solution
It has rapid antimicrobial action
It is bactericidal , tuberculocidal and viricidal
It is a chemically stable solution
***This is false; it is a chemically unstable solution
Disinfectants are antimicrobial agents that kill (germicide) or prevent the growth (microbiostat-
icyof pathogenic microorganisms. Qj.i.l1fectapts are ncLcoDsidered safe for lise on living tis-
....awu'as opposed to antiseptics which are) and are applied only to inanimate objects (counter
tops, light handles, headrests, etc.)
Note: Sodium hypochlorite, a 1:10 solution (household bleach) to 1: 100 with water, is a very
effective germicide following initial cleanup of the surface.
Remember for disinfectants:
1. Water-based is better than alcohol-based.
2. Pump spray is better than aerosol spray.
Also:
1. To be acceptable in the dental office, a chemical disinfection agent must be registered by the
EPAas a hospital disinfectant and must display an EPA number on its label.
2. The product must be used in strict compliance with the printed instructions on the labels.
3. The product should state on the label that it kills Mycobacterium Tuberculosis.
PH
If the major purpose of an epidemiologist's research is to determine caries SlJscp.ntl.
DMFT
The DMFT is an irreversible index and is applied only to permanent teeth. The
results of the DMFT index yield a group's caries susceptibility. It has received prac-
tically universal acceptance and is probably the best known of all dental i n d i c ~ ~ - - - -
PH
The ethical rules and principles of professional conduct for the pract ice of dentistry are
set forth in the ADA's publication entitled, Principles of Ethics and Code of Professional
Conduct. Which of the following are ethical principles found in the code?
Justice
Autonomy
Beneficence
All of the above
r All of the above
Three ethical principles in the code:
1. Justice - the quality of being impartial and fair.
2. Autonomy - to inform patients about treatment, to be truthful and also protect their
confidentiality.
3. Beneficence - to be kind and to give the highest quality of care that one is capable
of.
Remember: The dentist is responsible for providing information and dental care, how-
ever, ultimately the patient is responsible for maintaining his/her own oral health
(brushing, flossing, etc.).
Note: The Good Samaritan law, enacted in all states, provides immunity from suit for
specified health practitioners who render emergency aid to victims of accidents, pro-
vided there is no evidence of gross negligence. Important: Not all states include
dentists in the Good Samaritan law.
Which of the following are fundamental principles of public health?
Prevention
Cost efficiency
Teamwork
All of the above
PH
All of the above
Prevention is the major objective of publ ic health programs because it entails ethics, teamwork
and cost efficiency.
It is more ethical to prevent disease than to cure it
Teamwork is necessary to handle large groups efficiently
Cost efficiency plays a major role because prevention is cheaper than a cure
Education plays an important role in publ ic health because it decreases the need for govern-
ment intervention. In other words, when people learn why requtanons are of value they will com-
J:lly. For example, when people ... .. I ;.. .. .. h ..
PH
A system where a provider of coverage contracts to pay for some of the patient's
dental treatment is known as?
First-party dentistry
Second-party dentistry
Third-party dentistry
Fourth-party dentistry
_.
r Third-party dentistry
The major forms of third-party reimbursement currently in use are:
Usual, customary, and reasonable (VCR) fee
Table of allowance
Fee schedules
Capitation
All of the above
Dentists are morally, ethically and legally obligated to report a suspected case of
child abuse.
Once an injury of a suspicious nature is observed, the dentist's first and immediate
responsibility is the protection of the child.
Reports should be made to the designated state agency (social services or police).
Dentists must familiarize themselves with the exact procedures to be followed in their
own states.
Notes:
Child abuse most commonly involves newborns and children up to the age of
three years.
Dentists are also ethically obligated to identify and refer cases of domestic vio-
lence. Practitioners should become familiar with the physical signs of domestic vio-
lence, especially because 68% of battered WOn:leR'S injuFi es ilwolve the face, 4!o
the eyes, and 12% the neck.
PH
Which of the following are true concerning the Americans with Disabilities Act?
Dentists cannot deny anyone care due to a disability
Dental offices must undergo structural changes to allow access for the disabled
Dentists cannot dismiss employees due to a disability
All of the above
All of the above
Both state and federal statutes define disability as having the following:
1. A physical or mental impairment that substantially limits one or more of the major
life activities of such individual.
2. A record of such impairment.
3. Being regarded as having such impairment.
Note: Patients with HIV are protected under the Americans with Disabilities Act.
I
PH
The measure of the quality of care provided in a particular setting is called?
Quality assurance
Qual ity evaluation
Quality assessment
Quality inspection
r
Quality assessment
Quality assurance is the measurement of the quality of care and the implementation
of any necessary changes to either maintain or improve the quality of care rendered.
The differences in these definitions are important: quality assessment is limited
to the appraisal of whether or not standards of quality have been met, whereas quali-
ty assurance includes the additional dimension of action to take the necessary cor-
rective steps to improve the situation in the future.
The following concepts relate to quality assurance:
1. Structure - refers to the layout and equipment of a facility.
2. Process - involves the actual services that the dentist and assistant perform for the
patients and how well they perform.
3. Outcome - is the change in health status that occurs as a result of the care deliv-
ered.
PH
Which of the following are vital statistics routinely collected by epidemiologists and
public health professionals?
Mortal ity
Morbidity
Natality
Birth-death ratios
Crude death ratios
All of the above
All of the above
Vital statistics are quantitative methods used to monitor and evaluate the life histo-
ryof a specific population.
Mortality (also called death rate) reflects the number of deaths caused by a specific
disease. It is the ratio of the number of deaths caused by the disease to the total num-
ber of cases of the disease at a specific time.
Morbidity is the incidence of a specific disease within a given population.
Natality is the birth rate (ratio of births to the general population).
Birth-death ratio (also called the vital index) is the number of births in a given year
divided by the number of deaths in a given year. It is an indication of the population
growth, stability or reduction.
Crude death rate is the ratio of the number of deaths occurring within a given time peri-
od and population to the total population during that time.
Note: These statistics are used to identify community health needs, to estimate
health care costs and to evaluate health program effectiveness.
PH
Which agency listed below is a branch of the United States Department of Health and
Human Services?
The Food and Drug Administration (FDA)
The Drug Enforcement Administration (DEA)
The Food and Drug Administration (FDA)
The FDA determines which drugs and medical devi ces can be marketed in the United
States; requires proof of both safety and efficacy.
The Drug Enforcement Administration (DEA) is a branch of the Department of
Justice; this agency determines degree of control for substances with abuse potential
(Schedules I through V).
PH
Which of the following indices would most likely be used in assessing the prevalence
of periodontal disease in populations of people?
PMA index
Plaque index
Periodontal index
Gingival index
Periodontal index
In this index, the CQ!)dition of E.. 0th the gingiva and thE;l .wme. is estimated individually for each
tooth in the mouth. A progressive scal e thar glves relai lvely little weight to gingival inflammat ion
and relatively more weight to alveolar bone resorption is used for scoring. The scores from
each tooth are added together, and the total is divided by the number of teeth present in the
mouth. The result gives the periodontal disease index of the patient, which reflects the average
status of periodontal disease in a given mouth without reference to the type or causes of the dis-
ease. The community's score is the average of individual scores of persons examined.
Remember: Gingivitis is most commonly scored with the gingival index (GI) of Loe and
Silness. This index grades the gingiva on the four surfaces of each tooth. It is based on inflam-
mation and bleeding.
Notes:
1. The Gingival Index (GI) and Papillary, Marginal, and Attached Gingival Index (PMA index)
are confined to measurements within the gingiva.
2. The Plaque Index (PI) is used to determine accumulation of plaque
3. The Sulcus Bleeding Index (S81) is used to determine the bleeding and gingival health
4. The best time 10perform an index (perio. or plaque) is at the beginning of the appointment.
PH
A test result which erroneously excludes an individual from a specific diagnostic or
reference group, due particularly to insufficiency exact methods of testing is known as:
A false negative test
A true negative test
A false positive test
A true positive test
A false negative test
Simply stated, if a diagnostic test fails to identify a case of true disease, it is a false
negative result.
A false positive test result erroneously assigns an individual to a specific diagnos-
tic or reference group, due particularly to insufficiently exact methods of testing.
PH
Which of the following is an arrangement wharahv ::I third-nSlrtv nSlVAr It=! (J i n C: /l r:: :mr t=!
Managed care
Examples of managed-care practices:
HMO
PPO
IPA
Note: PPOs typically involve contracts between insurers and a number of dentists.
Patients are allowed to choose from whom they will receive dental treatment from
depending upon whether or not the dentists participates in the PPO arrangement.
Participants of HMOs are much more limited in the selection of dentists from whom
they can receive treatment.
eavment to the dentist for these managed-care programs is usually made on aJWH-
itation basis. A capitation fee is usually a Ixe monthly payment aid by a carrier 0 a
' dentist based on the number of patients assigne to the dentist for treatment. This fee
is the same regardless of how much or how little care is delivered.
PH
A public health problem must meet which of the following two criteria?
A condition or situation that is a widespread actual or potential cause of morbidity
and/or mortality
Results in public demand for immediate intervention by the government
In "- - - -
A condition or situation that is a widespread actual or potential cause of mor-
bidity and/or mortality
Involves a perception on the part of the public, public health authorities, and
the government that a public health problem is occurring
Pub!i<!._healt h is defined as "the science and art of pr eventing dlsease,..prolonging life and
promoti ng physical health and efficiency through organized community efforts._" _
Which index listed below is used to measure oral debris?
Decayed, Missing, and Filled Teeth (DMFT)
Plaque Index (PI)
Sulcus Bleeding Index (S81)
Decayed, Missing , and Filled Surfaces of Teeth (DMFS)
PH
The periodontal index is a (an):
Reversible index
Irreversible index
PH
Reversible index
Important: An irreversible index is one that measures conditions which cannot be reversed (dental
caries). A reversible index measures conditions that can be changed (plaque and bleeding).
A dental index is a data collection instrument used to numerically express the oral health status of a
population,
Common indices include:
Periodontal index - a reversible index used to measure the periodontal condition of a population
Decayed-missing-filled teeth index (DMFT) - an irreversible index used to determine total den-
tal caries experience, past and present. II is used only on permanent teeth. It has received practi-
cally universal acceptance and is probably the best known 01 all dental indexes. The primary den-
tition uses the DEFT index (decayed, extracted, filled teeth). Note: The DMFS index is the same
as the DMFT index except it records tooth surfaces involved instead of teeth.
Gingival index - a reversible index used to assess the severity of gingivitis based on color, con-
sistency, and bleeding on probing.
Simplified oral hygiene index - a reversible index used to measure oral hygiene status (by esti-
mating the tooth surface covered with material alba and/or calculus) .
Plaque index - a reversible Index used to assess the thickness 01 plaque at the gingival margin.
Note: An irreversible index is one that measures conditions which cannot be reversed (dental caries).
A reversible Index measures conditions that can be changed (plaque and bleeding) .
PH
The proportion of persons within a population suffering from a part icular disease at a
given point in time is known as:
Incidence
Prevalence
Epidemiology
Frequency
Prevalence
***Prevalence is expressed as a percentage of the population
Incidence refers to the number of new cases of a specific disease occurring within a
population over a certain amount of time. It is expressed as a rate (cases) J (popula-
tion) J (time)
Remember: Incidence is a rate and requires a unit of time, whereas prevalence is a
proportion and is expressed as a percentage of the population.
Epidemiology is the study of the incidence, prevalence, mode of transmission and
control of diseases in a defined human population for the purpose of establishing pro-
grams to prevent and control their development and spread .
Note: Frequency is simply a count
PH
Which characterist ic of a diagnostic test listed below measures the proportion of peo-
ple with a disease who are correctly identified by a positive test?
Specificity
Sensitivity
Sensitivity
the proportion of those
tified'DYa egative tes
Note: Sensitivity and specificity arelnversely proportionaLAs the specificity of a test
increases. the sensitivity decreases.
Specificity is defined by the number of true negative (TN) results divided by the total
number of false positive (FP) plus true negative (TN) results in the sample. Summary:
Specificity = TN I FP + TN.
Sensitivity is defined as the number of true positives (TP) divided by the total number
of potential positive findings (true positives and false negatives) in the sample.
Summary: Sensitivity = TP I TP + FN.
A study in which all subjects have an equal change of being assigned to either
the study or control group
Statistical probability is such that the assumption can then be made that the groups differ from
each other only in terms of the agent under study. Any uncontrolled variables influencing the out-
come are likely to affect subjects in both groups equally. For this reason, researchers prefer the
random assignment method for placing subjects into either the study or control group.
and blinding are two methods of reducing bias in research studies.
When subjects are unaware of whether they are in a test or control group, this is said to be a
blind study. When neither participants nor examiners know the group allocations (test or con-
trol groups) it is called a double-blind study. Note: One means of achieving a blinded study
is with the use of placebos.
Two variables used in research studies:
1. Dependent variable is the variable whose value depends on those of others; e.g., in the for-
mula x = 3y + Z, x is the dependent variable.
2. Independent variable is the variable whose value determines that of others; e.g., in the same
formulas as above, y and z are the independent variables.
What does OSHA stand for?
Occasional Safety and Habits Administration
Occupational Safety and Health Administration
Occupational Services and Hygiene Administration
Optional Standards and Health Administration
OSHA
Occupational Safety and Health Administration
OSHA is a federal agency, created by Congress in 1970, to protect workers from haz-
ards in the work place.
Remember:
1. OSHA is concerned with regulated waste within the dental office.
2. The EPA(Environmental Protection Agency) regulates the transportation of waste
from the dental office.
OSHA
Which of the following is waste that causes harm or injury to the environment?
Toxic waste
Infectious waste
Hazardous waste
None of the above
Hazardous waste
Toxic waste is waste that is capable of causing
I.!Ifectious waste is waste that contains strong enough pathogens in sufficient quanti-

Notes:
1. All infectious waste is contaminated, however, not all contaminated waste is
infectious (may not be able to cause disease).
2. all hazardous waste is toxic (mav not be
OSHA
Which of the following statements are true concerning "antiretraction valves"?
These valves are used on handpiece and air-water syringe hoses to prevent the
retraction of fluid back into the tubing
These valves prevent patient material (fluids) from getting into the water lines
These valves reduce the risk of cross-contamination to another patient
All of the above statements concerning "antiretraction valves" are true
All of the above statements concerning "antiretraction valves" are true
Important: The Center for Disease Control and Prevention recommends a mini-
mum of 20 to 30 seconds of flushin of the water lines between patients, and sev-
eral minutes of flushing of the water lines if the system has been i e or a period of
time, such as over the weekend.
Remember:
1. Handpieces should be autoclaved between patients.
2. Disposable saliva ejectors cannot be reused.
3. Reusable air-water syringe tips must be autoclaved (disposable air-water syringe
tips are available).
Note: The FDA (Food and Drug Administration) is responsible for regulating hand-
pieces and making recommendations for sterilizat ion procedures for them.
Universal precautions for bloodborne pathogens requires changing gloves:
Only if they have contacted blood
Between every other patient
Only when they become worn out
Between all patients
OSHA
Between all patients
Gloves and gowns are required when you reasonably anticipate skin contact with
blood or other potentially infectious materials, including saliva. This means that if you
reasonably anticipate the forearms will be spattered with saliva or blood, then forearms
must be covered.
Any gown or clinic jacket that prevents blood or other potentially infectious materi-
als, including saliva from reaching work clothes, street clothes or skin is considered
adequate. Fluid-resistant gowns are not required unless it is anticipated that large
amounts of blood, saliva or other body fluids will soak through the gown to the employ-
ee's clothing. OSHA appears to consider colton or cotton/polyester clinic jackets or lab
coats as satisfactory barriers for most routine dental procedures . When surgical proce-
dures are performed involving large quantities of blood (e.g., trauma surgery), addi-
tional personal protective equipment , such as long-sleeved gowns, are required.
According to OSHA, the selection is to be based on the quantity and type of
exposure expected.
Note: When handling chemical agents or cleaning a dental office, you should wear pro-
tective eye wear, a mask, and heavy-duty utility or nitrile gloves.
Wearing gloves, protective eyewear and a face mask is recommended:
Only when treating patients that are known to have AIDS
Only when treating patients that have ANUG
When treating all patients
Only when you want to
OSHA
When treating all patients
Masks and protective eyewear are required when splashes, spray, splatter or
droplets of blood or other potentially infectious materials, including saliva, may be gen-
erated and eye, nose or mouth contamination can be reasonably anticipated. A
OSHA
OSHA
What employee records must be maintained other than the infection control training
records?
Insurance records
Attendance records
Medical records if employee is involved in an occupational exposure
None of the above
Medical records if employee is involved in an occupational exposure
The employer must maintain a medical record for each employee whose job involves occu-
pational exposure to blood and other potentially infectious materials. The record must include:
- The employee's name and Social Security number
- Acopy of the employee 's hepatitis B vaccination status (dates and medical records regard-
ing the employee's ability to receive the vaccination)
- Medical opinions and evaluations
- Test results
- Details about ex osure incidents routes of ex
Which of the following sharps does OSHA regulate?
Non-contaminated sharps
Contaminated sharps
All sharps
Copvrlght 2001 - DENTAL DECKS
OSHA
Contaminated sharps
The rule defines "contaminated sharps" as any contaminated object that can pene-
trate the skin, including, but not limited to, needles, scalpels, broken glass, broken
capillary tubes and exposed ends of dental wires. There may be other objects used in
your office that are sharps, and if they become contaminated with blood or other
potentially infectious materials, including saliva, then they are regulated.
Information about recapping: The rule generally prohibits bending, recapping,
breaking, shearing, or removing sharps. However, recapping with a one-handed
method or using a mechanical device is permitted if the employer can demonstrate that
no alternative is feasible or that such action is required by specific medical procedure.
The rule's introduction lists the administration of an anesthetic as a medical procedure
that may require recapping (e.g., reinjection of the same patient to enhance the local
anesthetic).
OSHA
Dental health care workers are at greatest risk for contracting which of the following?
Hepatitis
Tuberculosis
AIDS
Herpes
- DENTAL DECKS
Hepatitis
Remember: As a dentist (employer) you must offer to provide vaccination to all
employees who have occupational exposure. Any FDA-approved hepatitis vaccine is
acceptable. Currently, these are Recombivax HB and Enger lx-B.
The Hepatitis B Virus is usually transmitted by one of the following methods:
1. percutaneous inoculation
2. sexual intercourse
3. prenatal transfer
The center for disease control has identified the following groups as being high risk:
IV drug users
Homosexual/bisexual males
Persons receiving transfusions or blood products
Health care workers who may come into contact with body fluids
Note: Treat each patient and instrument as potentially infectious ("universal precau-
tions").
OSHA
OSHA defines which of the following as' any reasonably anticipated skin, mucosal,
eye or parenteral contact with blood or other potentially infectious fluids during
the course of one's duties while at work?
Accidental exposure
Incidental exposure
Occupational exposure
All of the above
Occupational exposure
OSHA includes saliva in dental procedures in the definition of "other potentially
infectious materials" because saliva may be mixed with blood in some dental proce-
dures. OSHA concluded, therefore, that saliva should be treated as potentially infec-
tious even though scientists believe that bloodborne diseases are not transmitted via
saliva.
The following should be included in the procedures for evaluating an exposure inci-
dent:
State the policies that were in place at the office at the time of the incident.
State the engineering controls (i.e., needle recapping device, sharps container,
rubber dam) and work practices that were in place at the office at the time of the
incident.
State the personal protective equipment (gloves, lab coats, etc.) that were in use
at the office at the time of the incident.
OSHA
Which of the following prompted OSHA to adopt the Bloodborne Pathogens
Standard for dentistry?
Tuberculosis
AIDS
Hepatitis B
All of the above
AIDS
OSHA also is concerned about Hepatitis B and other bloodborne diseases, but AIDS is the
disease that prompted regulatory action. In 1986, unions representing health care workers peti-
tioned OSHA for an emergency rule to protect their members from work place exposure to the
human immunodeficiency virus (HIV) and the hepatitis B virus (HBV). OSHA denied the petition
but agreed to adopt a permanent rule on exposure to bloodborne pathogens through the regular
rule making process. It took five years to develop the rule. It applies to hospitals, physicians'
offices, nursing homes, other health care sellings, emergency response personnel and funeral
homes, as well as dental offices.
Notes:
Bloodborne pathogens are pathogenic microorganisms that are present in human blood and
can cause disease in humans.
Other potential infectious materials (OPIMs) are the following:
- Human body fluids such as semen, vaginal secret ions, cerebrospinal fluid, synovial fluid,
pleural fluid, pericardial fluid, peritoneal fluid, amniotic fluid and saliva in dental proce-
dures; only in dental procedures is saliva considered a potentially infectious material
- Any unfixed tissue or organ
OSHA
The OSHA bloodborne pathogens standard is:
A comprehensive rule that sets forth the specific requirements OSHA believes will
prevent the transmission of bloodborne diseases to patients
prevent the transmiss ion of bloodborne diseases to employers
prevent the transmission of bloodborne diseases to employees
All of the above
A comprehensive rule that sets forth the specific requirements OSHA believes
will prevent the transmission of bloodborne diseases to employees
It imposes a number of requirements:
Employers covered by the standard must make exposure determinations and
develop an exposure control plan
They must also use engineering and work practice controls to prevent employee
exposure and develop a system to evaluate exposure incidents
It requires training all employees who provide or assist in providing patient care, as
well as those who clean operatories, instruments, and gowns.
Remember: Through this standard, OSHA directs that:
1. Uniform clothing worn in the dental office should be laundered at the dental office
or an outside service, not at an employee's home.
2. Offices are using barrier techniques, communicating hazards to employees (train-
ing), performing proper cleaning of office and offering hepatitis B vaccinations.
OSHA
Which of the following are considered to be "regulated waste" by OSHA?
Blood or other potentially infectious materials, including saliva in dental proce-
dures
Items that would release blood and other potentially infectious materials, includ-
ing saliva, if compressed
Items that are caked with dried blood or other potentially infectious materials
and are capable of releasing these materials during handling
Contaminated sharps
Pathological and microbiological waste containing blood or other potentially
infectious materials, including saliva
All of the above
All of the above
Regulated waste must be placed in containers that are closable, constructed to con-
tain all contents and prevent leakage, and labeled appropriately. The container must
be closed prior to removal to prevent spillage or protrusion of contents. The rule also
requires that if the outside of the container becomes contaminated, it must be placed
in a second container that has the same characteristics. The need for a second con-
tainer is extremely unlikely in a dental office.
OSHA
Which of the following are considered to be "regulated waste" by OSHA?
Blood or other potentially infectious materials, including saliva in dental proce-
dures
Items that would release blood and other potentially infectious materials, includ-
ing saliva, if compressed
Items that are caked with dried blood or other potentially infectious materials
and are capable of releasing these materials during handling
Contaminated sharps
Pathological and microbiological waste containing blood or other potentially
infectious materials, including saliva
All of the above
All of the above
Regulated waste must be placed in containers that are closable, constructed to con-
tain all contents and prevent leakage, and labeled appropriately. The container must
be closed prior to removal to prevent spillage or protrusion of contents . The rule also
requires that if the outside of the container becomes contaminated, it must be placed
in a second container that has the same characteristics. The need for a second con-
tainer is extremely unlikely in a dental office.
OSHA
True or False
Employers must ensure that all employees with occupational exposure participate in
a training program, at no cost, during working hours, with material appropriate to
the education, literacy and language of the employee.
True
Training is the key to OSHA compliance. The training must include:
A copy of the standard and an explanation of its contents
A general explanation of the epidemiology, symptoms and modes of transmission of blood-
borne diseases
An explanation of the office's exposure control plan and how the employee can obtain a
copy of it
Information about the office's protocol for gloves, gowns, masks and eyewear (or
faceshields), including the type of equipment available, where it is located, when it is to be
used and how it is to be removed, handled, decontaminated and disposed of
An explanation of how to recognize tasks that may involve occupat ional exposure and how
to prevent or minimize such exposure (e.g" how to use a sharps container properly)
Information on the hepatitis 8 vaccine, including efficacy, safety, how administered, bene-
fits of being vaccinated, and that it will be offered free of charge
Information on how to handle emergencies involving occupational exposure (what actions
to take and whom to contact)
An explanation of the office protocol for handling exposure incidents, such as injuries from
contaminated sharps (how to report the incident , follow-up medical care, and evaluation)
An explanation of the biohazard labels used in the office
An opportunity for interactive questions and answers with the trainer
OSHA
What term refers to a method of infection control in which all human blood and cer-
tain body fluids (saliva in dentistry) are treated as if known to be infectious for HIV,
HBV and other bloodborne pathogens?
Universal precautions
Universal precautions means that the same infection control procedures are
used for all patients.
A thorough medical history should be obtained for all patients at the first visit and
updated and reviewed at subsequent visits. However, since not all patients with infec-
tious diseases can be identified by medical history, physical examination or readily
available laboratory tests, the CDC has introduced the concept of universal pre-
cautions.
What is an "exposure incident"?
OSHA
OSHA
Which of the following are the most commonly used dental materials that are
What is an "exposure control plan"?
OSHA
The standard requires that every employer have a written exposure control plan
designed to eliminate or minimize employee exposure to bloodborne diseases.
Basically, the plan must set forth your office policies and protocols to protect
MSDS's
WMSDS stands for Material Safet y Data Sheets
Chemical manufacturers and importers are required to obtain a material safety data sheet for each
hazardous chemical they produce or import. Distributors are responsible for ensuring that their cus-
tomers are provided with a copy of these MSDS's. Employers must have an MSDS for each hazardous
chemical which they use. Employers may rely on the information received from their suppliers.
The role of MSDS's under the rule is to provide detailed information on each hazardous chemical ,
including its potential hazardous effects, its physical and chemical characteristi cs and recommenda-
tions for appropriate protective measures. This information should be useful to you as the employer
responsible for designing protective programs, as well as to the workers. If you are not familiar with
material safety data sheets and with chemi cal terminology, you may need to learn to use them your-
self. A glossary of MSDS terms may be helpful in this regard. Generally speaking, most employers
using hazardous chemicals wi ll primarily be concerned with MSDS information regarding hazardous
effects and recommended protective measures.
MSDS's must be readily accessible to employees when they are in their work areas during their
work shifts. This may be accomplished in many different ways. You must decide what is appropriate
for your particular work place. Some employers keep the MSDS's in a binder in a central location. As
longas employees can get the information when they need it, any approach may be used. The employ-
ees must have access to the MSDS's themselves.
BS
Behavioral development is defined as any observable response which is mediated
through the neuromotor system. What are the four major fields of behavior?
1. Personal social - this is usually a function of environment , work, play and society.
2. Motqr - .starting point to access maturity
3. Language - vocalization , words, sentences, facial and manual movements
4. Adaptive - use of motor capacity and solutions to practical behavior
Note: To understand the development of human behavior you need to understand
the basic concepts of maturation and learning.
BS
Which type of parents listed below have excessively demanding attitudes?
Neglectful
Overprotective
Manipulat ive
Hostile
Manipulative parents
"'These demanding attitudes usually start with appointment times and can extend to
directing the course of diagnosis or treatment.
Overprotective parents - they insist on remaining with the child in the dental operatory,
regardless of the situation or age of the child. Note: Pointing to the lack of apprehension
of a young child and the importance of establishing one-to-one relationship between
the child and dentist usually satisfies most overprotective parents.
Hostile parents - they question the necessity for treatment (this is usually not due to
curiosity, but distrust).
Neglectful parents - they fail to maintain appointments, miss recall visits or do not over-
see oral hygiene of child.
Note:
1. Overprotective parents usually have children who are shy, docile and manageable.
2. Children with defiant behavior are usually said to be stubborn or spoiled.
3. For children who are hostile or angry, try to Identify the underlying source of these
emotions (this holds true for adult patients as well).
BS
Which of the following refers to a state or feeling of apprehension , uneasiness, agita-
tion or uncertainty resulting from the anticipation of some threat or danger, usually of
intrapsychic rather than external origin, whose source is generally unknown or unrec-
ognized?
Fear
Anxiety
Stress
None of the above
Anxiety
Fear generally refers to the anticipation of threat elicited by an external object that is
generally agreed to be harmful. Note: In evaluating a patient's dental fears, take note of
what he/she says, how he/she behaves, and also how he/she appears while in the dental
office.
Note: Fear is distinguished from anxiety on the basis of the person's ability to locate the
threatening agent "out there" and to recognize the clear presence of a behavior that will
reduce perceived danger. Patients who are fearful or anxious will do anything to put off
making dental appointments.
Stress - is a term used to describe a general disturbance in psycho-physiolog ical adapta-
tion. II implies a person who is being maladaptively influenced by more than one negative
or aversive factor.
Note: Of the three terms, stress is most associated with response aspects.
Stress, anxiety and fear are simultaneously negative or aversive emotional states, full of
symptoms that can motivate through a process of threat appraisal. The interaction of the
intensity of emotional response with threat appraisal determines the content of the behav-
ior that will follow - whether or not to show up at the dentist's office, to submit to an
injection, to accept the need for an extraction or filling, etc.
BS
Which kind of aggress ion listed below is an act of self-assertiveness in response to a
threatening action for purpose of self-protection and preservation?
Destructive aggression
Inward aggression
Constructive aggression
None of the above
Constructive aggression
Destructive aggression is an act of hostility unnecessary for self-protection or preser-
vation that is directed toward an external object or person.
Inward aggression is destructive behavior that is directed against oneself.
Note: An aggressive personality is a personality with behavior patterns characterized
by irritability, tantrums, destructiveness or violence in response to frustration.
All of the above
Behavior can be defined as a determined, purposeful unit of activity.
Each term can be further examined:
Determined - the assumption that behavior is lawful and has determinants.
Purposeful - the assumption that behavior is goal-oriented, that it seeks to
achieve positive and reduce negative need or motivated states.
Unit of activity - what a person does that can be reported or described as discrete
elements.
Example: Teeth do not behave, individuals do. Observing that a pulpal or periodontal
problem exists is a common behavior for the dentist. Avoiding the dentist, even
though an objective need exists and the patient requires treatment , is a common
behavior for patients. Both meet the criterion of being determined, purposeful units of
human activity.
Behavior management is the means by which the dental health team effectively and
efficiently performs treatment for the patient and, at the same time, instills a positive
attitude.
Note: Most researchers believe that ~ s . . . . l n behaylor are a prerequisite to
changes in attitude_
as
Mary, a 32-year-old woman, comes in for her routine cleaning appointment. Sue, the
hygienist , finds that Mary has not been following the home care program that was rec-
ommended six months ago. Sue believes that Mary's problem is a management defi-
ciency and not a skills deficiency. Which of the following is the best course of action for
Sue?
Accept that Mary might never change her habits
Provide Mary with a pamphlet on periodontal disease
Meet with her supervising dentist to determine the future course of action
Look into factors that affect patient motivation
Go over brushing and flossing techniques
Meet with her supervising dentist to determine the future course of action
Since this is not a skills deficiency problem, reviewing home care techniques is not
going to solve the problem. Mary knows what to do. Now Sue and Mary's supervising
. .. . .,.
as
How are you doing with your brushing and flossing, is considered to be which type
of question?
Direct question
Probing question
Laundry list quest ion
Open-ended question
Leading quest ion
Facilitating quest ion
Open-ended question
These types of questions request information in the patient's own words and speci-
fy a general content area.
Direct questions - are questions that ask the patient for a specific bit of information.
Example: "Is it easier to hold the brush this way?"
Probing questions - are questions that ask for more specific information that the
patient offers spontaneously. Example: "What else did you notice about your gums?"
Laundry list questions - are questions that ask the patient to respond from among
a list of alternative adjectives or descriptions provided. Example: "Is the pain throbbing,
aching, dull or sharp?"
Leading questions - are questions that entice a patient to answer a specific way.
Example: "You are not afraid of needles, are you?"
Facilitating questions - are questions that encourage the patient to say more, with-
out specifying an area or topic. Example: "How are you?"
Note: These are all verbal communication behaviors.
BS
Which of the following is the principal nonverbal cue that two or more people can u
to regulate verbal communication?
Posture
Facial expression
Eye contact
Body position (physical proximity to another)
Gesticulations
Eye contact
Eyes should be directed toward the patient and engage the patient's eyes as frequent-
ly as is comfortable for the talker and the listener.
Communication is basic to all aspects of the dentist-patient relationship. Without
proper communication, whether it be verbal or nonverbal, the dentist-patient relation-
ships will fail.
Remember: "Acceptable" nonverbal behavior varies with age, sex, ethnic back-
ground, geographical region, culture and situation.
When presenting treatment plans always use open-ended questions (those that
cannot be answered with a simple "yes" or "no"). These types of questions are the
most effective in helping patients to express their understanding of the proposed treat-
ment plan. When reviewing oral hygiene, have the patient repeat what you have gone
over with him or her.
When communicating with children, try to reinforce positive behavior by telling the
child exactly or specifically what he is doing well.
BS
All of the following are specific ways in communicating effectively with patients except:
Describe
Be specific
Be evasive
Be responsive
Pay attention
Be evasive
SOME SPECIFIC DO'S AND DON'TS
IN COMMUNICATING EFFECTIVELY WITH PATIENTS
Do Don't
Describe Evaluate
Step 1: recognizing needs - the dentist recognizes educational needs as he
checks for treatment needs. Then the dentist helps the patient to recognize his
own needs.
Step 2: expressing needs - the dentist records educational needs and helps the
patient to state his own needs.
Step 3: stimulating motivation - motivation arouses and maintains interest. The
dentist may appeal to inner needs or use artificial stimuli.
Step 4: setting goals - these may be short-range or long-range guides to activity.
They must be meaningful, attractive and attainable.
BS
Which of the following statements are true concerning needs and learning?
Needs are driving forces that prompt a person to act
The process of learning is continual and multiple
Learning occurs as a person attempts to satisfy his needs
Telling a person what he needs may convince him that a behavior change is desir-
able
Expressing needs helps to pinpoint them for the dentist and patient
Recording educational needs can be as important as recording treatment needs
All of the above statements are true
All of the above statements are true
Remember:
Motivation stimulates a person to act on his needs.
Motivation is a fundamental part of every learning situation.
Motivation may be artificial or built-in.
Needs and goals may provide motivation.
Patients rarely learn without some kind of motivation.
Motivation arouses and maintains interests.
Short-range goals are less remote and more easily attained.
Goals should be attractive and attainable in order to be meaningful.
Goal-directed activity is necessary for learning.
Behavior shaping is also called:
Aversive conditioning
Successive approximation
Restraining
Hypnodontics
as
Successive approximation
Behavior shaping is an operant conditioning technique used in behavior therapy in
which new behavior is produced by providing reinforcement for progressively clos-
ft. r. ....
Behavior modif ication is also known as:
as
BS
Which mechanism listed below by which behavioral responses are learned oper-
Classical conditioning (also called pavlovian or respondent conditioning)
A stimulus leads to a response. If individuals in white coats are the ones who give painful injec-
tions that cause crying, the sight of an individual in a white coat soon may provoke an outburst
of crying. If this is not reinforced, the conditioned response will no longer occur. This is referred
to as extinction of the conditioned behavior.
Operant conditionina has as the basic principle that the consequence of a behavior is in
itself a stimulus that can affect future behavior. In other words thA " o n !':An IlAn " A th"t follow!': "
as
All of the following are considered to be aversive conditions of interaction between the
dentist and patient except
Psychophys iological reactions
Stress. anxiety and fear
Preventive oral health behavior
Pain
Preventive oral health behavior
Aversive conditions:
- Psychophysiolog ical reactions
- Stress, anxiety and fear
- Pain
Note: These conditions are perceived as aversive and the dentist-patient interaction
seeks to minimize them.
Nonaversive conditions:
- Communication-gathering information, identifying problems, giving information
(as in case presentations)
- Preventive oral health behavior
- Management of except ional patients such as the physically or emotionally dis-
abled (for these patients, gradually expose them to the dental office)
Note: These conditions are perceived as nonaversive and the dentist-patient inter-
actions seeks to maximize them.
BS
What type of patient listed below is usually considered to be the most "difficult"
patient?
The "know-it-all" patient
The anxious patient
The shy patient
The talkative patient
The stubborn patient
The anxious patient
Most dentists say that they themselves become anxious with an anxious patient.
Most patients are anxious have had traumatic experience in a dental or medical set-
ting.
Some things to do to reduce patient anxiety:
Explain procedures before doing them.
Forewarn about the possibility of pain.
o Give patient some control over the procedures and pain (ex., raise your hand if
you feel anything).
o Build trust between you and the patient.
Note: Watching a patient's eyes or eyebrows will give a good indication whether a
patient is feeling pain during dental treatment.

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