Professional Documents
Culture Documents
1. expressing needs
2. stimulating motivation
3. recognizing needs
4. evaluating results
5. reinforcing learning
6. setting goals
7. acting to achieve goals
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PATIENT MANAGEMENT
BS
Identify each of the following statements that are true concerning needs and
learning.
expressing needs helps to pinpoint them for the patient and dentist
w*
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PATIENT MANAGEMENT
3,1,2,6,7,5,4
Although each learning situation will not follow these steps in exact sequence, most situations will include all of these seven steps in
some form:
recognizing needs
expressing needs
stimulating motivation
setting goals
acting to achieve goals
reinforcing learning
evaluating results
Stepl
recognizing needs
dentist recognizes educational needs as treatment needs are determined
dentist helps patient recognize needs
Step 2
expressing needs
dentist records educational needs
dentist helps patient state needs
Step 3
stimulating motivation
motivation arouses & maintains interest
dentist may appeal to inner needs or use artificial stimuli
Step 4
setting goals
short-range or long-range guides to activity
must be meaningful, attractive & attainable
Step 5
acting to achieve goals
activity is needed for learning
must be directed at specific goals
Step 6
reinforcing learning
review & repetition aid in learning retention
Step 7
evaluating results
aid in judging what patient has learned
aid in determining how effective
dentist's teaching has been
can help clarify or redefine goals
Assessment of behavior
in order to change behavior, assessment of the behavior is needed
how to assess behavior
- identify problem
- consider motivation
- consider readiness
- consider willingness to change
- consider ability to change
- collect baseline data
- reassess behavior after implememtation
BS
Most researchers believe that changes in behavior are a prerequisite to
changes in attitude.
Behavior can be defined as a determined, purposeful unit of activity.
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PATIENT MANAGEMENT
BS
The principal nonverbal cue that two or more persons can use to regulate verbal communication is:
posture
facial expression
eye contact
gestures
proximity
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PATIENT MANAGEMENT
Behavior examples
a c o m m o n behavior for a dentist is
to observe that a problem exists
(e.g., tooth decay)
a common behavior for a patient
is to avoid the dentist even though a
need exists & treatment is required
both of the above examples meet the
criteria of being "determined, purposeful units of human activity "
Behavior management
as described by the ADA, techniques or therapies used to alter or
control the actions of a patient who
is receiving dental treatment; examples include.gducation or anxiety
relief techniques
the means by which the dental
health team effectively and efficiently performs treatment for the
patient, and, at the same time, instills
a rjositive attitude
eye contact
Communication
the process by which information is
exchanged between 2 or more persons
communication is essential in the
dentist-patient relationship
acceptable verbal & non-verbal
communication varies with fhfiage, sex,
ethnicity and culture of the patient
communication is both verbal &
non-verbal; also includes listening
Verbal communication
involves use of language
choice of words is important
delivery of speech is important
(fast vs. slow, loud vs. soft)
Non-verbal communication
involves use of body language
conveyed by eye contact, posture, body
movement, hand gestures & expressions
Empathy & Rapport
empathy (is the ability to experience the
feelings of another person
jj^yjportfis a mutual sense of trust and
openness between individuals
Listening
receiving & understanding messages
a good listener shows attention &
interest
listening techniques include
paraphrasing (repeating in own
words)'"
intCTjrjretation (identifying the
underlying reason)
preparation (allowing time for discussion & eliminating distractions)
Eye contact
is the principle non-verbal cue used to
regulate verbal communication
when listening to a patient, a dentist
should maintain eye contact
a dentist should engage the patient's
eyes as often as is comfortable for both
parties
Facilitative skills
facilitative skills make communication
easier and help to develop trust
include encouraging patient questions,
answering questions, respondz'rcp; to requests & communicating with warmth
BS
Which term describes a behavioral response that operates by the simple
process of association of one stimulus with another?
operant conditioning
classical conditioning
observational learning
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PATIENT MANAGEMENT
BS
Which type of aggression is an act of hostility unnecessary for self-protection
or preservation that is directed toward an external object or person?
destructive aggression
inward aggression
constructive aggression
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classical conditioning
Classical conditioning
a stimulus leads to a response
a.k.a. pavlovian or respondent conditioning
a process of behavior modification by
which a subject comes to respond in a
desired manner to a previously neutral
stimulus that has been repeatedly presented along with an unconditioned
stimulus that elicits the desired response
Operant conditioning
process of behavior modification in
which the likelihood of a specific behavior is increased or decreased through
positive or negative reinforcement each
time the behavior is exhibited, so that
the subject comes to associate the pleasure or displeasure of the reinforcement
with the behavior
four types: positive reinforcement,
negative reinforcement, punishment
& extinction
Observational learning
or modeling, is a type of learning that
occurs as a function of observing, retaining and replicating behavior executed by others in a social context
two phases: acquisition of the behavior
& performance of the behavior
Example
Classical conditioning
before conditioning, a painful injection
(unconditioned stimulus) would elicit a
fear reaction (unconditioned response)
during conditioning, the dentist with
syringe (neutral stimulus) is linked
with the painful injection and elicits a
fear reaction
after conditioning, the dentist with a
syringe (conditioned stimulus) will encourage a fear reaction (conditioned
response)
destructive a g g r e s s i o n
Destructive aggression
act of hostility
unnecessary for self-protection or
preservation
directed toward external object or
person
Constructive aggression
act of self-assertiveness
in response to a threatening action
for purpose of self-protection and
preservation
Inward aggression
destructive behavior directed
against oneself
Aggressive personality
personality with behavior patterns
characterized by irritability,
tantrums, destructiveness or violence in response to frustration
aggressive personalities are individuals whose overall "style" of interacting involves considerable, persistent, maladaptive aggression
expressed in a variety of ways and
in a wide range of circumstances
characteristics include the
following:
- seek a superior position in any
relationship or encounter
- abhor submission
- self-advancing at expense of
others
- have disdain for truth
- lack internal "brakes"
BS
Match the type of question on the left to the correct example on the r ight.
direct
probing
laundry list
open-ended
leading
facilitating
i.
2.
3.
4.
5.
6.
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PATIENT MANAGEMENT
BS
Which one of the following types of patients is usually considered to be the
most difficult?
PATIENT MANAGEMENT
4,5,6,2,1,3
#
Type
Example
4 direct
question
5 probing
question
1 leading
question
3 facilitating
question
C o m m u n i c a t i o n hints
ask questions/never presume
carefully inquire/never interrogate
be specific/avoid being vague or abstract
provide information & educate/instead of giving advice
provide accurate information/fully discuss concerns & offer support
exhibit professionalism/it is an essential component of dentist-patient relationships
exhibit confidence, care & warmth
BS
Which type of parent has an excessively demanding attitude?
neglectful parent
overprotective parent
manipulative parent
hostile parent
PATIENT MANAGEMENT
=SSSSS2X=SSSSS2~
pain) occurs.
p^ENTMANAGEMENf
manipulative parent
Manipulative p a r e n t
is demanding
demands usually start with appointment times
may try to provide diagnosis and direct the course of treatment
Overprotective p a r e n t
insists on remaining with child in
operatory regardless of situation or
age of child
usually has a child who is shy,
docile and manageable
by pointing out the lack of apprehension of the child and the importance of establishing a one-on-one
relationship between the dentist and
child, this will usually satisfy most
overprotective parents
Hostile p a r e n t
questions the necessity of treatment
questions stem from distrust and not
curiosity
Neglectful p a r e n t
fails to keep appointments
misses recall visits
does not oversee oral hygiene of
child
the uncooperative child
may be described as stubborn or
spoiled & is usually a child with
defiant behavior
may be hostile or angry; with this
child, the dentist must try to identify the underlying source of these
emotions
Stress
is defined as the body's reaction to a
change that requires a physical, mental or emotional adjustment or
response
stress can be caused by physical, emotional or psychological influences
Stress, anxiety, & fear
of stress, fear & anxiety stress is
associated with a response
"^-stress is the body's response to danger
v "fear is a feeling of uneasiness in
response to imminent danger
**V**anxiety is a feeling of uneasiness when
no danger is present
the interaction of the intensity of an
emotional response with threat appraisal
determines the behavior that will follow
whether to show up to a dental
appointment, submit to an injection,
accept the need for extraction etc.
BS
A 32-year-old woman visits the dental office for a routine dental cleaning. The
dental hygienist discovers that the patient has not been following the home
care program that was recommended six months ago. The hygienist believes
that the problem is not a skills deficiency but a management deficiency instead. What is the best course of action for the hygienist?
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BS
Behavior shaping is also called:
aversive conditioning
successive approximation
restraining
hypnodontics
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Motivating patients
use good communication techniques
express empathy and engage the
patient
identify the patient's current oral
hygiene status and the agree on
achievable goals for improvement
avoid arguing; gently challenge the
thought that underlies the behavior
support self-efficacy; encourage the
patient to believe that they can change
the behavior and they will achieve their
desired goals
develop a partnership with the patient
consult your patient & elicit their
views , the patient will feel that their
voice is heard & their needs are
considered
ultimately, the patient must believe
that the decision to follow a particular course of action is theirs
successive approximation
Behavior shaping
a.k.a. successive approximation
shaping is used when an existing
behavior needs to be changed into a
more appropriate or new behavior
the strategy involves use of reinforcement of successive approximations of
a desired behavior
immediate positive reinforcement
includes verbal praise and nonverbal
indications of approval
each approximate desired behavior that
is demonstrated is reinforced, while
behaviors that are not approximations of
the desired behavior are not reinforced
examples of behavior shaping methods
include tell-show-do and modeling
Aversive conditioning
using a punishment or something u
pleasant to stop an unwanted behavior
like all forms of punishment, it may
work but is less effective than reinforcement
an example is the HOME technique
(Hand-Over-Mouth)
Hypnodontics
the application of hypnosis and
controlled suggestion in dentistry
Restraining
a dental restraint is defined as any
form of restriction of movement by a
patient in the dental environment
a dental restraint includes the following
characteristics :
- short duration
- limits movement of head & body
- prevents injury to the patient and/or
dental staff during the procedure
- provides physical control to allow
dental staff to complete treatment
- is usually well tolerated by patient
an example is papoose boardj
BS
Which one of the following is a conceptual framework that describes a person's health behavior as an expression of his or her health beliefs?
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PATIENT MANAGEMENT
BS
Behavior modification is also known as:
behavior evaluation
behavior therapy
behavior shaping
behavior training
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INDIVIDUAL PERCEPTIONS
MODIFYING FACTORS
LIKELIHOOD OF ACTION
Personality
versus
So do-economics
barriers to behavioural
Knowledge
change
Pereeiired susceptibility'
Perceived threat of
sericiusness ofdiseas*
disease
Likelihood of behavioural
change
Cues to action
education
symptoms
media information
behavior therapy
Behavior modification
a.k.a. behavior therapy
type of psychotherapy that attempts to
modify observable, maladjusted patterns
of behavior by the substitution of a new
response to a given stimulus
mostly used in pediatric dentistry
Techniques
for modifying behavior
/ classical conditioning
Q operant conditioning
- 3 aversive conditioning
<$ modeling
,3 systemic desensitization
classical conditioning
a.k.a. pavlovian or respondent condition-
SS.
operant conditioning
a.k.a. instrumental conditioning
a method of learning that occurs
through rewards & punishments for
behavior
positive & negative reinforcement
strengthen behavior
punishment & extinction weaken
behavior
aversive conditioning
using a punishment or something
unpleasant to stop unwanted behavior
is less effective than reinforcement
an example is the HOME technique
(Hand-Over-Mouth)
modeling
form of learning where individuals
ascertain how to act by observing
another individual
systemic desensitization
therapy for phobias, fears & aversions
premise is to reduce a person's anxiety
responses through counter conditioning
teaches a person to replace the feelings
of anxiety with feelings of relaxation
when the object or behavior is present
BS
Five techniques are used to facilitate patient dialogue: empathy, respect, reflection, interpretation and silence.
Reflection is the explanation and understanding of the patient's comments.
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BS
Each of the following are ways to communicate effectivel y with patients
EXCEPT one. Which one is the EXCEPTION?
describe
evaluate
be specific
be responsive
pay attention
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r
' the first statement is true, the second is false
Facilitation j
Five techniques are used to facilitate patient
dialogue: empathy, respect, reflection, interpretation and silence.
empathy
~>.:\.>>
Tsltne ability to accurately understand
reflection
is~a response that restates or
repeats a segment of the patient's
statement
reflection encourages the patient to
continue communicating
reflection is a subtle way of asking a
question and is less intimidating than
asking a direct question
interpretation
is the dentist's explanation and
understanding of the patient's
comments
an interpretation may stimulate dialogue
by requiring the patient to agree or to
disagree with the statement
an interpretation does not need to be
correct in order to stimulate dialogue
silence
is iised to facilitate dialogue by
stimulating the patient to comment
and therefore break the silence
when using silence, it is very important
to communicate interest by nodding the
head "yes", leaning toward the patient,
and/or maintaining eye contact
evaluate
Communications Effectively
with Patients
Do
Don't
Describe
Evaluate
Be specific
Be general
Be responsive
Be evasive
Pat attention
Be distracted
Listen carefully
Interrupt
Use jargon
Lean forward
Lean back
Use gestures
Fold arms
Use expression
Show disinterest :
Ask questions
Presume
Suggestions
from Patients
How to Reduce Anxiety
Prevent pain
5e reassuring
Have a calm demeanor
Provide moral support
Work efficiently
Be friendly
BS
Each of the following are considered to be aversive conditions of interaction
between the dentist and patient EXCEPT one. Which one is the EXCEPTION?
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PATIENT MANAGEMENT
BS
Which of the following suggests that change does not happen in one step and
people tend to progress through different stages on their way to successful
change.
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r
preventive oral health behavior
Aversive conditions
any negative condition to which a person will learn to make a response to
avoid it
the dentist-patient interaction seeks to
minimize conditions that are perceived
as aversive
aversive conditions
- psychophysiological reactions
- stress, anxiety & fear
-pain
Non-aversive conditions
non-aversive conditions
- preventive oral health behavior
- communication
- gathering information
- identifying problems
- giving information
the dentist-patient interaction seeks to
maximize the conditions that are
perceived as non-aversive
BS
Which of the following is an essential part of risk management?
veracity
documentation
autonomy
negligence
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ic
Identify which one of the following is a false statement concerning personal
protective equipment (PPE):
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PATIENT MANAGEMENT
documentation
Risk management
refers to the policies and procedures the
dentist should follow in order to reduce
the chance that a patient will file legal
action against him or her
includes issues of legal competence,
informed consent, liability, confidentiality and documentation
Informed consent
informed consent (written or oral)
must be obtained by the dentist from
adult patients prior to treatment
informed consent components
- WHO will render treatment
- WHAT are the treatment options
- WHAT treatment will be done
- WHEN will the treatment occur
- WHERE (if referring the patient)
- WHY purpose of the procedure and
risks versus benefits
- QUESTIONS the opportunity for the
patient to ask questions & obtain info
Patient record
the patient record is the property of the
dentist and must be retained by the dentist
Documentation
is essential to risk management
dental records must be thorough, consistent & complete
must include actual visits, missed visits
& evidence of noncompliance
Documentation tips
inform the insurance carrier if an
incident with a patient occurs
remember that everything written in
the record can be used in court
always document informed consent
never change any written entry - add
an addendum / separate entry instead
if a mistake is made - draw a single
line through the error, mark it "error"
and initial & date it
be specific - write facts only, not opinions
be objective - avoid personal characterizations, state behaviors
be complete
be timely
write legibly
maintain integrity of the patient record
never sign a patient record entry for
someone else, or vice versa
countersign carefully - you are as
responsible as original person who signed
Gloves
wearing gloves does not replace the
need for handwashing
dental professionals must wear gloves
to prevent skin contact with blood,
saliva or mucous membranes
new gloves must be worn for each
patient
gloves must be worn when touching
contaminated items or surfaces
non-sterile gloves are recommended
for examinations & nonsurgical
procedures
sterile gloves are recommended for
all surgical procedures
utility gloves are recommended for
cleaning and instrument processing
gloves must be changed whenever
they are torn, cut or punctured during
treatment
gloves should never be washed
before use, or, disinfected for reuse
IC
Identify each of the following that is a true statement regarding the laundering of contaminated laundry in the dental setting:
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PATIENT MANAGEMENT
IC
Match each term with the correct definition:
disinfectant
disinfection
hospital disinfectant
PATIENT MANAGEMENT
Laundry choices
in the dental office contaminated
laundry includes protective clothing
that is used to cover street clothes or
scrubs
the dentist may choose to use an outside laundry service
the dentist or assigned office personnel
may launder the clothes in a washer
and dryer on-site
if contaminated laundry is transported to a laundromat the
employee or dentist must use PPE, be
trained in handling of contaminated
laundry and transport the laundry in a
red/orange bag that is labelled with a
biohazard symbol
a dentist who is unincorporated and is
the owner may take laundry home; if
the owner is unincorporated, the owner
is not subject to OSHA regulations
4, 6, 5, 7, 1, 2, 3
Clinical contact surface
any surface directly contaminated from
patient materials, gloved hands, blood
or OPIM (otherpotentially infectious
material)
these surfaces can then cross contaminate other instruments, devices, hands,
gloves & other items
Disinfectant
chemical agent used to destroy recognized pathogens; kills some but not all
microorganisms
Disinfection
a process which destroys a majority of,
but notall, microorganisms
while disinfection is lethal to some
organisms, only sterilization kills all
organisms
Hospital disinfectant
germicide effective against Salmonella
choleraesuis, Staphylococcal aureus
and Pseudomonas aeruginosa on nonliving objects
6,4,1,3,7,2,5
Basic terminology
an understanding of the terminology related
to infection control is important for the dental professional
antisegtic
"Vi^ a substance that inhibits the growth of
bacteria
asepsis
the absence of pathogens, or diseasecausing microorganisms
bloodborne pathogens
pathogens present in blood that cause
disease in humans
disinfect
the use of a chemical or physical procedure to inhibit or destroy pathogens;
highly resistant bacterial and mycotic
spores are not killed during disinfection
disinfection
the act of disinfecting
exposure incident &^
a specific incident that involves contact
with blood or other potentially infectious materials that results from procedures performed by the dental professional
infectious waste
waste that consists ofolood, blood
productscontaminated sharps, or other
^nierobiologic products
occupational exposure
contact with blood or other infectious
materials that involves the skin, eye, or
mucous membranes and that results""
from procedures performed by the dental professional
parenteral exposure
exposure to blood or other infectious
materials that results from piercing or
puncturing the skin barrier
personal protective equipment (PPE)
protective attire, gloves, mask and eye
wear
1
sharp
any object that can penetrate skin, including, but not limited to, needles and
scalpels
1
standard precautions
measures designed to protect health care
Recommendations
vaccination of dental professionals
use of protective attire and barrier
techniques
hand washing and care of hands
proper use and care of sharps
(instruments and needles)
sterilization of instruments
cleaning & disinfection of the
dental unit and environmental
surfaces
disinfection of the dental laboratory
use and care of hand pieces, antiretraction valves, and other devices
attached to air & water lines of dental
units
single use of disposable instruments
proper handling of biopsy specimens
proper use of extracted teeth in
dental educational settings
proper disposal of waste materials
implementation of recommendations
6,4,1,3,7,2,5
Basic terminology
an understanding of the terminology related
to infection control is important for the dental professional
antiseptic
\5^*a*"substance that inhibits the growth of
bacteria
asepsis
the absence of pathogens, or diseasecausing microorganisms
bloodborne pathogens
pathogens present in blood that cause
disease in humans
disinfect
the use of a chemical or physical procedure to inhibit or destroy pathogens;
highly resistant bacterial and mycotic
spores are not killed during disinfection
disinfection
the act of disinfecting
exposure incident <S^
a specific incident that involves contact
with blood or other potentially infectious materials that results from procedures performed by the dental professional
infectious waste
waste that consists oFblood, blood
productscontaminated sharps, or other
microbiologic products
occupational exposure
contact with blood or other infectious
materials that involves the skin, eye, or
mucous membranes and that results
from procedures performed by the dental professional
parenteral exposure
exposure to blood or other infectious
materials that results from piercing or
puncturing the skin barrier
personal protective equipment (PPE)
protective attire, gloves, mask and eye
wear
sharp
any object that can penetrate skin, including, but not limited to, needles and
scalpels
standard precautions
measures designed to protect health care
Recommendations
vaccination of dental professionals
use of protective attire and barrier
techniques
hand washing and care of hands
proper use and care of sharps
(instruments and needles)
sterilization of instruments
cleaning & disinfection of the
dental unit and environmental
surfaces
disinfection of the dental laboratory
use and care of hand pieces, antiretraction valves, and other devices
attached to air & water lines of dental
units
single use of disposable instruments
proper handling of biopsy specimens
proper use of extracted teeth in
dental educational settings
proper disposal of waste materials
implementation of recommendations
IC
Instruments in the dental practice can all be classified as either critical or noncritical.
For infection to occur, these three conditions must be present:
a susceptible host, a pathogen with sufficient infectivity and numbers to
cause infection, and, a portal of entry through which the pathogen may enter
the host.
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IC
Match each term with the correct definition:
pasteurization
sanitization
antiseptic
disinfectant
bacteriostatic
bactericidal
PATIENT MANAGEMENT
critical instruments
penetrate soft tissue or bone
must be sterilized after each use
examples include forceps, scalpels,
bone chisels, scalers and surgical
burs
semicritical instruments
contact but do not penetrate soft
tissue or bone
must be sterilized after each use
if the instrument can be damaged by
heat and sterilization is not feasible,
a disposable one-use item is
required
examples include x-ray beam alignment devices, mirrors, amalgam
condensers and burs
noncritical instruments
"" do riot come in contact with mucous membranes
because there is little risk of transmitting infection, an intermediate
level or low-level disinfectant is
required between uses in different
patients
4,6,7,5,2,3
Definitions
antiseptic
an antimicrobial agent that can
be safely applied to living tissues
(e.g., alcohol); inhibits but does not
necessarily destroy microorganisms
bactericidal
an agent that is capable of killing
bacteria; bactericidal agents are
preferable over those which are
bacteriostatic
bacteriostatic
an agent that prevents the further
growth of bacteria
disinfectant
a chemical agent used on inanimate
objects to destroy or inhibit the
growth of harmful organisms; not
considered safe for use on human
tissues (e.g., bleach); a disinfectant kills some, but not all microorganisms
pasteurization
to expose food to an elevated temperature for a period of time sufficient to destroy certain diseasecausing microorganisms; the target
of pasteurization is the destruction
of Mycobacterium tuberculosis
sanitization
treatment of water supplies to
reduce microbial counts to safe
public health levels
IC
Match each term with the correct definition:
antiseptic
M
asepsis
_ bloodborne pathogens
d e n t a , p r o c e dures
infectious waste
5.
standard precautions
measures designed to protect operators & patients from pathogens spread by blood or any
other body fluid, excretion, or secretion
6. a substance that inhibits the growth of bacteria
7. waste that consists of blood, blood products,
contaminated sharps or other microbiologic 23
prodUCtS
PATIENT MANAGEMENT
ic
The interpretation of the Centers for Disease Control & Prevention (CDC) reco m m e n d e d infection control practices in dental healthcare settings varies
from state to state; not all guidelines apply in all states.
The CDC recommended infection control practices in dental healthcare settings are stand-alone guidelines and are not required to be used in conjunction with OSHA practices & procedures.
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IC
Identify each of the following that is a true statement regarding the purpose of cleaning prior to disinfection:
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PATIENT MANAGEMENT
ic
Identify the term that BEST describes the complete destruction of all forms
of microbial life, including heat-resistant bacterial spores:
pasteurization
sanitization
sterilization
disinfection
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2,3
Cleaning
is defined as the physical removal
of debris
with aseptic technique, you must
clean before you disinfect
the cleaning step is not optional, it
is required
all disinfectant products include
specific instructions for cleaning
prior to disinfection
Cleaning
Results in
a reduction in the number of
microorganisms present
the removal of blood, tissue bioburden and other debris that can
interfere with disinfection
sterilization
Sterilization
defined as the destruction of all forms
of microbial life
limiting requirement is the inactivation of bacterial spores
proof of such destruction is the ultimate
criteria for sterilization because spores
are the most heat-resistant microbial
forms
per the Centers for Disease Control and
Prevention (CDC), sterilization is
required for all instruments and
items that are placed in the patient's
mouth
if an item cannot withstand heat sterilization, a disposable (one-time use)
item should be used instead
heat is the most efficient and depend
able physical mode of achieving
sterilization of dental instruments;
the heat may be moist or dry
three equipment options for heat
sterilization include the autoclave, the
chemical vapor sterilizer and the dry
heat oven
Biological monitoring
sterilizers must be monitored for
proper functioning. this is done via
the use of biological indicators (BI) or
spore tests
both the CDC and ADA recommend
weekly spore testing of all sterilizers
Other definitions
disinfection
the inhibition or killing of pathogens;
spores are not killed during disinfection
pasteurization
to expose food to an elevated temperature for a period of time sufficient to
destroy certain disease-causing
microorganisms; the target of pasteurization is the destruction of
Mycobacterium tuberculosis
sanitization
treatment of water supplies to reduce
rHicrobial counts to safe public health
^--'levels
X
IC
Identify the type of pathogen that provides the ultimate test for efficacy of
sterilization:
fungal organisms
HIV
hepatitis B virus
bacterial spores
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PATIENT MANAGEMENT
ic
For a steam autoclave, identify each of the following that lists the correct temperature, pressure and time that must be used for sterilization.
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bacterial spores
Biological monitoring
involves the processing of highly
resistant bacterial spores to determine
if they have been killed
a biological indicator (BI) or spore
strip contains the spores used in
biological monitoring
a spore strip is a small piece of paper
that contains one or more types of
spores - Bacillus atrophaes spores are
used for testing dry heat oven units and
Geobacillus stearothermophilus
spores are used for testing steam and
chemical vapor units
the spore strip is enclosed in a
protective glassine envelope
Spore testing
after a spore strip is processed in a
sterilizer, it is mailed to a monitoring
service
in a laboratory setting, the spore strip
is aseptically placed in a test tube of
culture media for 7 days
for each of the 7 days, the tube of
culture media is inspected for cloudiness
if spores are viable & have not been
killed, the culture media appears
cloudy
if no cloudiness is noted in the culture
media, then sterilization is confirmed
cloudiness in the culture media indicates a failed test (spores were not
killed), also known as a positive biolog-
.--- 7
.-..S
IC
For a dry heat oven, identify the correct temperature and time that must be
used for sterilization.
375F,
60 minutes
60 minutes
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ic
For a chemical vapor sterilizer, identify the correct temperature, pressure and
time that must be used for sterilization.
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1
270 F, 20 psi, 20-40 minutes
Chemical vapor sterilizer
requires the use of organic solvents
(chemicals) instead of water to
produce the sterilizing vapor
the typical chemical vapor sterilizer
uses
- a temperature of 132 C (270 F)
- a pressure of 20 psi
- cycle time of 20-40 minutes
instead of distilled water (used in
steam autoclaves), a solution of
>
tTKohol,,formaldehyde,'tolcetone,
\aeetone and Water is used to produce
the sterilizing vapor
IC
How many hours are required to kill bacterial spores when a dental instrument is placed in a 2% solution of glutaraldehyde?
8 hours
10 hours
12 hours
24 hours
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IC
Identify which one of the following is the most efficient way to kill microbes:
cold sterilization
heat sterilization
glutaraldehyde
all of the above
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10 hours
Glutaraldehyde 2%
is a liquid chemical sterilant
capable of killing spores if
sufficient contact time is provided
and there is absence of extraneous
organic material required contact
time is 10 hours
a.k.a. "cold sterilization"
if this method is used to sterilized
an instrument, after 10 hours, it
must be rinsed with sterile water,
dried and placed in a sterile
container (if not used immediately)
Important note
use of a chemical sterilant in
dentistry is no longer considered
appropriate for sterilizing heatstable instruments
- WgWjaaxkJtoJ^gues
- no way to monitor efficacy
Reminders
CDC refers to heat sterilization as
the method of choice when
sterilizing instruments and devices
dental instruments must be
appropriately cleaned, packaged &
sterilized between uses with a heatbased, biologically monitored
process
if heat sensitive, a heat-stable
alternative or disposable item
must be used
heat sterilization
Heat sterilization
use of heat has long been recognized as the most efficient and
reliable method of sterilization
using a steam autoclave, chemical
vapor sterilizer or dry heat oven
cell death is accomplished via
heat inactivation of critical
enzymes and other proteins
within cells
moist heat destroys bacteria by
denaturation; the denaturation
process is quickened by the use of
pressure
_dryheat destroys microorganisms
by causing coagulation of proteins
\
\ ^
IC
Identify which one of the following is a false statement concerning infection
control in the dental setting:
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PATIENT MANAGEMENT
IC
Identify which one of the following is a false statement regarding potential
operator errors that may cause the failure of a spore test:
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Equipment problems
faulty temperature gauge
faulty pressure gauge
faulty timer
faulty or dirty gasket/seal
faulty heating coil, exhaust line
faulty or clogged bleeder valve
mineral deposit build-up
faulty or clogged metering valve
IC
Identify which one of the following is a true statement concerning chemical
monitoring:
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PATIENT MANAGEMENT
ic
Identify which one of the following is a false statement concerning the use
of alcohol hand gels in the dental setting:
the convenience of alcohol hand gel use helps to increase compliance with hand
washing guidelines
hand washing with an alcohol product takes less time than using soap & water
alcohol hand gels can save busy practitioners valuable time between patients
studies have shown that alcohol hand gels reduce microorganisms significantly
better than soap & water
alcohol hand gels cause more dryness than soap & water hand washing
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hand gels cause more dryness than soap & water washing
Hand gels
the convenience of alcohol hand gel
use helps to increase compliance
with hand washing guidelines
increasing popularity of hand gels is
due to flexibility & convenience
hand washing with an alcohol
product takes less time than water
washing and does not require a sink,
water or paper towels for drying
for the busy practitioner who has to
clean their hands often, the quickness
of hand sanitizers can save valuable
time between patients
studies have also confirmed that alcohol hand gels kill more germs; hand
gels with 60% - 70% alcohol reduce
microorganisms including bacteria,
fungi and viruses significantly better
than soap and water
IC
Identify which one of the following is a false statement concerning when to
use hand hygiene techniques in the dental setting:
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PATIENT MANAGEMENT
ic
Identify which one of the following is a false statement concerning the use of
disinfectants in the dental setting:
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Techniques
soap & water hand washing
- wet hands
- apply amount of soap recommended by the manufacturer
- rub hands together for at least 15
seconds
rmse with water and dry thoroughly with a disposable towel
- use towel to turn off faucet
- avoid use of HOT water
alcohol based hand gel
- apply the amount of gel recommended by the manufacturer to
one palm
- rub hands together, covering all
surfaces
- continue rubbing hands together
until all surfaces are dry
- if hands feel dry after 10 seconds
or less of rubbing, too little product has been used
MiuiMuu nammmaKw.
Housekeeping surface
reusable pails, bins and containers
must be regularly inspected,
cleaned and disinfected
housekeeping surfaces contaminated
with body fluids must be cleaned and
disinfected with an EPA-registered
intermediate level disinfectant
Cleaning schedule
the office must have a cleaning
schedule based on the type and
degree of contamination and location
Surface disinfection & OSHA
,the office must have a written
* schedule for disinfection of surfaces
as required by OSHA
9
IC
Between patients, all surfaces without protective coverings must be cleaned
and disinfected with an intermediate-level disinfectant.
Between patients, all protective coverings used in place of surface disinfection must be changed/replaced.
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ic
The Occupational Safety and Health Administration's (OSHA) Bloodborne
Pathogens Standard mandates that all dental healthcare professionals receive, at a minimum, the Hepatitis B vaccination series.
The Centers for Disease Control and Prevention (CDC) mandates all other vaccinations.
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IC
All employees with potential exposure to bloodborne pathogens are required
to have the Hepatitis B vaccination.
The vaccination record of each employee must be kept for 30 years beyond
the employee's last day of employment in the practice.
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ic
A booster dose of the Hepatitis B vaccine is required.
The Hepatitis B vaccine series requires that at least 16 weeks elapse between
dose 1 and dose 3.
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PATIENT MANAGEMENT
IC
Identify which one of the following is the most common form of a glove-associated reaction seen on the hands of health care professionals:
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IC
Identify each of following that is a true statement concerning providing safe
treatment for patients w i t h possible or documented latex allergy:
PATIENT MANAGEMENT
Latex allergy
type I hypersensitivity to latex
proteins
a more serious systemic allergic
reaction
begins within minutes of exposure
but can sometimes occur hours
later
produces varied symptoms, which
include runny nose, sneezing, itchy
eyes, scratchy throat, hives & itchy
burning sensations
may involve more severe symptoms
including difficult breathing, coughing spells, and wheezing; cardiovascular and gastrointestinal ailments
in rare cases, anaphylaxis & death
may occur
IC
Identify each of following that is a true statement concerning hepatitis C virus
(HCV) infection:
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ic
Identify which one of the following is an option for treating a patient with a
confirmed latex allergy:
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PAHENT MANAGEMENT
At Risk
for HCV Infection
current injection drug users
past injection drug users
blood, blood products & organ
recipients
hemodialysis patients
persons who received body
piercing or tattoos done with
non-sterile instruments
persons with known exposures to
the HCV
- health care workers injured by
needle sticks
- recipients of blood or organs from
a donor who tested positive for
HCV
HIV-infected persons
children born to mothers with HCV
Glove types
the type of glove used should be
based upon the type of procedure to
be performed (non-sterile vs.
sterile vs. utility)
both non-sterile examination gloves
and sterile surgical gloves are
medical devices regulated by FDA
sterile surgical gloves are used for
all surgical procedures & must meet
FDA standards for sterility
assurance
utility gloves are used for house
keeping procedures (cleaning &
disinfecting) and are not FDA
regulated because they are not
promoted for medical use
IC
An infection caused by normally non-pathogenic microorganisms in a host
whose resistance has been decreased or compromised is known as:
a nosocomial infection
a secondary infection
an opportunistic infection
a recurrent infection
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ic
Identify which one of the following that is not a vaccine preventable disease:
hepatitis A infection
hepatitis B infection
hepatitis C infection
VZV (varicella zoster virus) infection
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an opportunistic infection
Infection
invasion by and multiplication of
pathogenic microorganisms in a
bodily part or tissue, which may
produce subsequent tissue injury
and progress to overt disease
through a variety of cellular or toxic
mechanisms
instance of being infected
an agent or a contaminated
substance responsible for one's
becoming infected
the pathological state resulting
from having been infected
Nosocomial infection
a hospital acquired infection
nosocomial means originating or
taking place in a hospital,
especially in reference to an
infection
the term "nosocomial" comes from
two Greek words "nosus" meaning
"disease" + "komeion" meaning
"to take care of;" "nosocomial"
refers to any disease contracted by a
patient while under medical care
Opportunistic
an infection by a microorganism
that normally does not cause
disease but becomes pathogenic
when the body's immune system is
impaired and unable to fight off
infection
hepatitis C infection
List of
Vaccine preventable diseases
Anthrax
Cervical Cancer
Diphtheria*
Hepatitis A
Hepatitis B*
Haemophilus influenzae type b (Hib)
Human Papillomavirus (HPV)
H1N1 Flu (Swine Flu)
Influenza (Seasonal Flu)*
Japanese Encephalitis (JE) Lyme Disease
Measles*
Meningococcal
Monkeypox
* recommended vaccines
for all health care professionals
Mumps*
Pertussis (Whooping Cough)*
Pneumococcal
Poliomyelitis (Polio)
Rabies Rotavirus
Rubella (German Measles)*
Shingles (Herpes Zoster)
Smallpox
Tetanus*
Tuberculosis
Typhoid Fever
Varicella (Chickenpox)*
Yellow Fever
OSHA
What does OSHA stand for?
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OSHA
The Occupational Safety & Health Administration (OSHA) is a federal agency
that develops and enforces regulations designed to protect the:
patient
employer
employee
all of the above
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r
Occupational Safety & Health Administration (OSHA)
Occupational Safety &
Health Administration
OSHA is a federal agency
created in 1970
workplace
under the Occupational Safety &
Health Act of 1970 (OSH Act),
employers are responsible for
providing a safe and healthful work
place for their workers
employee
Occupational Safety &
Health Administration
is a federal agency
a division of the U.S. Department of
Labor
protects employees from hazards in
the work place through standards or
regulations
employers must provide their
workers with a workplace that does
not have serious hazards and must
follow all OSHA safety and health
standards
OSHA
Identify which one of the following is considered to be "infectious" and "regulated" medical waste:
gowns
plastic barriers
extracted teeth
cotton rolls
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PATIENT MANAGEMENT
OSHA
Each one of the following is considered regulated waste EXCEPT one. Which
oneistheEXCEP770/V?
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extracted teeth
Regulated medical waste
comprises l%-2% of waste in dental setting
requires special handling, storage & disposal
in the dental setting, defined as
- liquid or semi-liquid blood or OPIM
- contaminated items that would release
blood or OPIM in a liquid or semi-liquid state if compressed
- items that are caked with dried blood or
OPIM and are capable of releasing these
materials during handling
- contaminated sharps
Types of regulated medical waste
bulk (in liquid or semi-liquid form) blood
or OPIM, including saliva
items that would release blood or OPIM
in a liquid or semi-liquid state if compressed
items that are caked with dried blood or
OPIM and are capable of releasing these materials during handling
contaminated sharps
pathological including extracted teeth
^r
gloves
Non-regulated vs. Regulated medical
waste
studies have compared microorganisms
in residential waste with waste from
multiple health-care settings general
waste from hospitals or dental practices is no more infective than residential waste
the majority of soiled items in dental
offices are general medical waste and
thus can be disposed of with ordinary
waste
although any item that has had contact
with blood, exudates, or secretions might
be infective, treating all as infective is
neither necessary nor practical
waste that carries a substantial risk
of causing infection during handling
and disposal is regulated medical
waste
OSHA
Identify which one of the following is a true^statement from the American
Dental Association's Best Management Practices for Amalgam Waste?
use bleach to flush waste water lines in order to minimize the dissolution of amalgam
dispose of teeth with amalgam restorations ih biohazard or sharps containers
salvage amalgam pieces from restoration removal and recycle with amalgam waste
stock bulk elemental mercury in addition to precapsulated alloys
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OSHA
Identify each one of the following that is a true statement regarding wha t
must be included in the training of employees as detailed by the OSHA Bloodborne Pathogens Standard:
OtfrvW'i
pOfcM^CHJW-M
PATIENT MANAGEMENT
OSHA
Identify which one of the following is a false statement regarding the OSHA
Bloodborne Pathogens Standard training of employees:
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OSHA
The OSHA Bloodborne Pathogens Standard requires that a written exposure
control plan (ECP) be reviewed:
biannually
. annually
. quarterly
none of the above
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annually
Exposure Control Plan (ECP)
the employer shall ensure that a
written copy of the ECP is accessible
to all employees
the ECP shall be reviewed & updated
at least annually and whenever necessary to reflect new or modified
tasks and procedures which affect occupational exposure, and, to reflect
new or revised employee positions
with occupational exposure
the ECP shall reflect changes in
technology that eliminate or reduce
exposure to bloodborne pathogens
ECP Elements
exposure determinations
schedule & method of implementation which includes:
- methods of compliance
- hepatitis b vaccination
- post exposure evaluation/follow up
- communication of hazards
- recordkeeping
OSHA
Which of the following diseases prompted OSHA to adopt the Bloodborne
Pathogens Standard for dentistry:
tuberculosis
HIV disease
HBV/hepatitis B
HCV/hepatitis C
all of the above
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OSHA
The OSHA Bloodborne Pathogens Standard is a comprehensive set of rules
and regulations that have been created to prevent the transmission of bloodborne diseases:
to patients
to employers
to employees
to all of the above
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HIV disease
OSHA Bloodborne Pathogens Standard
HIV disease prompted the OSHA regulatory action
- in 1986, unions representing health
care workers (HCW) petitioned
OSHA for an emergency rule to protect workers from work place exposure to HIV and HBV
- the petition was denied but OSHA
created a permanent rule on exposure
to bloodborne pathogens; it took 5
years to develop this rule
bloodborne pathogens are infectious
microorganisms present in blood that
can cause disease in humans
pathogens include, but are not limited
to, HBV, HCV and HIV
workers exposed to bloodborne
pathogens are at risk for serious or
life-threatening illnesses
> to employees
Bloodborne Pathogens Standard
Overview
bloodborne pathogens are infectious
microorganisms present in blood that
can cause disease in humans
workers exposed to bloodborne
pathogens are at risk for serious or
life-threatening illnesses
the standard's requirements state what
employers must do to PROTECT
EMPLOYEES who are occupationally exposed to blood or OPIM (other
potentially infectious materials)
all of the requirements of OSHA's
Bloodborne Pathogens Standard can be
found in Title 29 of the Code of Fed-_
eral Regulations a(2^FR19Tfj!l030
OSHA
As denned by OSHA, an exposure incident is a specific eye, mouth, other mucous membrane, non-intact skin or parenteral contact with blood or other potentially infectious materials (OPIM) which results from the performance of a
worker's duties.
An example of an exposure incident is a needle stick.
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OSHA
Unless the employer can establish that identification of the source individual
is infeasible or prohibited by state or local law, following an exposure incident the source individual must be identified and the HBV and HIV status
must be determined.
If the source individual does not consent, the employer must establish that
legally required consent cannot be obtained.
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OSHA
In 1996, Universal Precautions were revised and r<snamed:
mandatory precautions
hazard precautions
standard precautions
OSHA precautions
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OSHA
According to the CDC, which of the following are common infection control
violations observed in the dental office:
PATIENT MANAGEMENT
standard precautions
Standard Precautions
the practice of considering that all
blood & body fluids might be contaminated with blood and should be
treated as infectious
all patients must be treated with the
same infection control procedures
because patients with bloodborne infections can be asymptomatic or unaware they are infected
standard precautions must be used
for all patient encounters
standard precautions apply to contact with 1) blood; 2) all body fluids,
secretions, and excretions (except
sweat), regardless of whether they contain blood; 3) non-intact skin; and 4)
mucous membranes
OSHA
Identify each one of the following that is a true statement concerning the use
of a face mask in the dental setting:
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OSHA
OPIM stands for.
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a
a
a
a
Surgical mask
the function is to protect the wearer from
large droplets or spatter that may contact mucous membranes of nose, lip & mouth
face masks also protect the patient from
health-care worker oral or nasal respiratory
secretions
masks should fit the face well, creating a light
seal over the nose and mouth
because they only cover the nose and mouth,
face masks should always be worn with protective eyewear
change the face mask between patients, and
sooner if it becomes moist
Wet masks
condensation from the wearer's breath adds
moisture to the mask material
when wet, resistance to the airflow through
the mask increases which causes more air to
pass through & around the edges of the mask,
weakening the seal between mask & face
wet masks also may collapse against the
skin; direct contamination quickly results,
making the mask an ineffective protective bar-
OSHA
Documents that contain information concerning hazardous chemicals are
called
MDDS
MSSD
'MSDS
'MDSD
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OSHA
Material Safety Data Sheets (MSDS) must be readily available to employees
for all potentially hazardous chemicals used in the dental practice.
Identify each one of the following that is found on the MSDS:
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MSDS
Material Safety Data Sheets-^**
are an important component of product & workplace safety
intended to provide employees &
emergency personnel with procedures
for handling a substance in a safe
manner
includes information such as^jShysical
data (melting-point, boiling point, flash
pointyetc.), toxicity,Walth effects, Yfrst
aid, reactivitystorage, disposal, protective equipment &spill-handling
procedures
MSDS formats can vary from source to
source within a country depending on
national requirements
OSHA requires that MSDS be readily available to employees for all potentially harmful substances handled
in the workplace under the Hazard
Communication Standard
OSHA
Which one of the following is regulated by OSHA?
all sharps
contaminated sharps
non-contaminated sharps
none of the above
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OSHA
Identify each one of the following that is a true statement concerning sharps
containers.
must be puncture-resistant
must have sides & bottom that are leak proof
must be labeled or color-coded as hazardous
must be a reusable containers
must beclosable
must be kept upright
must be replaced routinely and not be overfilled
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contaminated sharps
Sharps
objects that can penetrate a worker's
skin
includes, but not limited to needles,
scalpels, broken glass, capillary tubes
& the exposed ends of dental wires
if blood or OPIM are present or may
be present on the sharp, it is a contaminated sharp & PPE must be worn
a contaminated sharp can result in an
employee being infected with HIV, HBV,
HCV or other bloodborne pathogens
careful handling of contaminated sharps
can prevent injury & reduce risk of infection
employers must ensure that contaminated sharps are disposed of in sharps
disposal containers immediately or as
soon as feasible after use
sharps disposal containers must be
readily accessible & located as close as
feasible to the area where sharps are used
contaminated sharps must never be
sheared or broken
must be puncture-resistant
must have sides & bottom that are leak proof
must be labeled or color-coded as hazardous
must be closable
must be kept upright
must be replaced routinely and not be overfilled
Sharps containers
must be puncture-resistant
sides and the bottom must be leakproof
must be labeled or color-coded red to
warn that the contents are hazardous
must be closable
must be kept upright to keep the
sharps & any liquids from spilling out
must be replaced routinely & not
overfilled
disposal containers that are reusable
must not be opened, emptied, or
cleaned manually or in any other manner that would expose workers to the risk
of injury
Handling containers
employers must ensure that reusable
sharps that are contaminated are not
stored in a manner that requires workers
to reach by hand into the containers where
these sharps have been placed
before sharps disposal containers are removed or replaced, they must be closed
to prevent spilling the contents
if there is a chance of leakage from the
disposal container, the employer must ensure that it is placed in a secondary container that is closable, appropriately
labeled or color-coded red, and constructed to contain all contents and prevent leakage during handling, storage,
transport or shipping
OSHA
Engineering controls are controls that are intended to isolate or remove hazards in the workplace.
Work place controls are controls that are intended to reduce the likelihood of
exposure by altering the manner in which a task is performed.
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OSHA
For each employee whose job involves occupational exposure to blood and
OPIM, what must be maintained in the employee medical record by the dentist employer?
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safety rules implemented by the employer to help assure a safe work environment
examples include written programs,
exposure control plan, education and
training, as well as task-specific Standard Operating Procedures designed to
minimize exposure
ngineering Controlsf/jC
technology-based
^
used to remove or isolate hazards in
the workplace
examples include rubber dams (minimize exposure to oral fluids by creating a
dry field), needle recappers (place contaminated ends of the needles away from
DHCW hands) and sharps containers
(isolate & contain contaminated sharps
in a puncture-resistant receptacle)
\ Work Practice Controls"!
behavior-based
subject to human error & non-compliance
used to change or alter a task or procedure in order to reduce the likelihood of an exposure
greatly influences the success of other
control measures
example is using the one-handed
scoop technique to recap dental needles
& prohibiting the recapping of needles
by a two-handed technique
OSHA
Per the current CDC guidelines, dental unit water lines should be flushed at
the beginning of the day for how long?
30 seconds
45 seconds
60 seconds
none of the above
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PATIENT MANAGEMENT
OSHA
Per OSHA guidelines, what is the minimum amount of time required for employers to keep employee training records?
2 years
3 years
5 years
7 years
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PATIENT MANAGEMENT
30 seconds
Flushing of Dental Unit Water Lines
flush water lines at the beginning of
the day for 30 seconds (may temporarily reduce the level of microbes
in the water)
flush air/water through handpieces
for 20-30 seconds after each patient
(helps reduce any patient-borne microbes that may have entered the
handpiece and were "sucked back"
down the dental unit line)
3 years
Employee Training Records
training records are completed for each employee upon completion of training
documents must be kept for at least three years
training records include:
- the dates of the training sessions
- the contents or a summary of the training sessions
- the names and qualifications of persons conducting the training
- the names and job titles of all persons attending the training sessions
employee training records are provided upon request to the employee or the employee's authorized representative
OSHA
Per OSHA guidelines, what is the minimum amount of time required for employers to keep a sharps injury log?
2 years
3 years
5 years
7 years
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PATIENT MANAGEMENT
OSHA
Per OSHA guidelines, no employee in the dental practice may decline the hepatitis B vaccination.
The hepatitis B vaccination is non-infectious and there is no risk of developing HBV from the vaccine.
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5 years
Sharps Injury Log
all percutaneous injuries resulting from contaminated sharps must be recorded in a
Sharps Injury Log
all incidences must include at least:
- date of the injury
- type and brand of the device involved (syringe, suture needle)
- department or work area where the incident occurred
- explanation of how the incident occurred
this log must be reviewed as part of the annual program evaluation
must be maintained for at least five years following the end of the calendar year
covered
if a copy is requested by anyone, any personal identifiers must be removed from
the report
employee signature
date
PH
Identify which one of the following is the organization that maintains records
on all diseases that occur in the United States.
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PH
Identify which one of the following is the test result that erroneously assigns
ndividual to a specific diagnostic or reference group, due to insufficient
an
exact methods of testing
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EcFl
Administration for Children & Families
responsible for federal programs that promote
the economic & social well-being of families,
children, individuals & communities
responsible for the Head Start program
CMS,
-enters for Medicare & Medicaid Services
administers Medicare & Medicaid programs
that provide health services to roughly 25% of
Americans
,HRSA i
""Health Resources & Services Administration
provides access to essential health care services for people who are low-income, uninsured
or who live in rural or urban areas where health
care is limited
IHS
T h d i a n Health Service
focuses on raising the health status of Native
Americans & Native Alaskans
ml
National Institutes of Health
premier medical r^sjjarch organization
NIDCR (National Institute of Dental &
Craniofacial Research) is part of NIH
^ M M M M I ...
IAHRQ
AHRQJ
Agency for Healthcare Research & Quality
supports research on health care systems,
health care quality and cost issues
supports research on access to health care, &
effectiveness of medical treatments
Types of errors
a false positive result
means that the test indicates presence
of the disease when it is absenT"*
false positives
those who test positive for a condition
but are negative (do not have condition)
true negatives
those who test negative and are negative
false negatives
those who test negative but are positive
PH
Identify which one of the following is defined as the percent of persons without the disease who are correctly classified as not having the disease:
specificity
sensitivity
reliability
validity
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PH
Identify which one of the following is defined as the measure of quality of
care provided in a particular setting:
quality assurance
quality control
quality assessment
quality inspection
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' specificity
Definitions
Validity
refers to whether questions asked by the
study are answered by the method
a valid test is sensitive, specific & unbiased
Reliability
is the repeatability & reproducibility of test
produces very similar results when used to
measure a variable at different times
Sensitivity
percent of persons with the disease who are
correctly classified asliaving the disease
- true positive (IP) those who have the disease
- false negative (FN) those who incorrectly
are classified as not having the disease
Specificity
percent of persons without the disease who
are correctly classified as not having disease
- true negative (TN) those who do not have
the disease
- false positive (FP) those who have the disease but not identified by the test
Inferential statistics
used to make claims about the populations
that give rise to the data collected
allow generalizations to be made from sample
data to a larger group
p value
is a probability
answer calculated by a statistical test of a hypothesis (HQ or null hypothesis)
its magnitude informs the researcher as to the
validity of the hypothesis
< .05 (5%), reject the H 0
results are statistically significant
> .05 (5%), accept the HQ
results are not statistically significant
Correlation/correlation coefficient (r)
quantifies relationship between variables
(x andy)
Multiple regression
"""provides a mathematical model of linear relationship between a dependent & two or more
independent or predictor variables
Chi-square
a test commonly used to compare observed
data with data we would expect to obtain according to a specific hypothesis
T-test
"^"used to analyze the statistical difference between two means
quality assessment
Quality assessment
is limited to the appraisal of whether or
not standards of quality have been met
Quality assurance
includes the action to take the necessary
corrective steps to improve the situation in
the future
is the measurement of the quality of care
PLUS the implementation of any necessary changes to either maintain or improve
the quality of care rendered
Quality assurance concepts
structure
refers to the layout and equipment of a
facility
process
involves the actual services that the dentist
and assistant perform for the patients &
how well they perform
outcome
is the change in health status that occurs as
a result of the care delivered
Informed consent
in the informed consent process for dental treatment, legally there are three components that must be addressed:
%^-explanation of a procedure
so that a competent adult understands
^explanation & assessment
of risks & benefits of the procedure, or
the consequences if no procedure is performed
Vc discussion of alternative choices
the interaction between dentist and patient is the foundation of informed consent,
not the written word
obtaining informed consent should be
viewed as good dental practice
there is a moral duty not to act against
a patient's will; a patient should not be coerced into, unduly influenced to, receive inducements to or be intimidated into having
a procedure
PH
Identify which TWO of the following indices were developed in an attempt to
provide a standardized method of measuring periodontal disease, and, are
criticized because they combine gingivitis and periodontitis measures into a
common score?
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PH
If the major purpose of an epidemiologist's study is to determine caries susceptibility instead of immediate treatment needs, the best caries index to use
is:
TSIF
PSR
. DMFT
. CPITN
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r
PDI (periodontal disease index)
PI (periodontal index)
s=&iH-:,fo;SBi.^&e,-'.,-jH;0L^,
PI & PDI
neither is considered the best method to
measure periodontal disease
both developed in an attempt to provide a
standardized method of measuring periodontal disease among groups of people in epidemiologic studies
both combine gingivitis & periodontitis into
a single tooth score or average score for the
individual or group
El
fPDlf
a modification of PI
distinguishes three levels of gingivitis based
on the extent of the inflammation & severity of the inflammation
quantitatively measures periodontitis by
loss of attachment with a periodontal probe
& defines degrees of periodontitis severity
based on the amount of attachment lost
total score is achieved by averaging the individual tooth scores
DMFT
DMFT
way to define dental caries in a population
measures either the number of teeth (DMFT)
or the number of tooth surfaces (DMFS)
that are decayed, missing or filled due to
caries
with the permanent dentition, acronyms
DMFT and DMFS are used
with the primary dentition, acronyms deft
and defs are used, with e referring to a tooth
that is indicated for extraction
is an irreversible index
results of this index indicate a group's caries
susceptibility
widely accepted & best known dental index
DMFT Limitations
values are not related to the number of
teeth at risk
index can be invalid in older adults because teeth can become lost for reasons other
than caries
index can be misleading in children whose
teeth have been extracted for orthodontic reasons
cannot be used for root caries
cannot account for sealed teeth
Dental Caries
caries prevalence in U.S. declined substantially in the 1970s & 1980s due to fluoridation, the use of fluorides and other preventive
measures
in the 1970's, the mean DMFS for U.S. children ages 5 to 17 was 7.1; in the latel980's
the value dropped to 2.5 (a 65% reduction)
the proportion of DMFS that is either untreated caries or missing surfaces also dramatically decreased during this period
baby bottle tooth decay affects approximately 5% of U.S. infants; ethnic minority &
low socioeconomic children are at the greatest risk
coronal caries prevalence has declined
among U.S. adults under age 45
nearly all dentate U.S. adults have at least
one decayed or filled tooth
PH
According to the plaque index (PI) of Sillness & Loe, tooth #14 would have what
PI score?
1.0
1.5
2.0
2.5
Tooth #14
surface
scores
buccal
lingual
mesial
distal
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PH
Identify which one of the following describes the gingival index (Gl):
reversible index
irreversible index
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2.0
Scores
no plaque
Periodontal Disease
some studies suggest 80-90% of children have inflammatory periodontal
disease (gingivitis or periodontitis) by
age of 15
localized acute gingivitis is the most
common form
studies show the strongest relationship between prevalence & severity of
periodontal disease is with oral hysiene & age
.. ,
...-a.,V'^'-i'";^':";'
reversible index
Dental Index
a data collection instrument
numerically expresses the oral health status of
a population
may be reversible or irreversible
- irreversible index measures conditions that
cannot be reversed; example is dental caries
- reversible index measures conditions that
can be changed; examples are plaque & bleeding
Common Indices
DMFT
- decayed-missing-filled teeth index
- irreversible index
- determines total dental caries experience, past
and present
- only used on permanent teeth
- almost universally accepted
- best known of all dental indices
GI
- gingival index
- reversible index
- measures inflammation of the gingiva
- distinguishes between location/quantity of
gingivitis and the seventy/quality of the gingivitis
P-M-A
- papillary-marginal-attached
- oldest reversible index
- precursor to the GI
- reversible index
- provides conclusions about the incidence of
periodontitis in a population, as well as
treatment needs
OHI-S
- simplified oral hygiene index
- reversible index
- used to measure OH status by using a debris
index & calculus index; both are combined
for a single score
Pi/plaque index
- reversible index
- used to assess thickness of plaque at the
gingival margin
PH
Identify which one of the following is a system where a provider of coverage
contracts to pay for some of the patient's dental treatment:
first-party dentistry
second-party dentistry
third-party dentistry
fourth-party dentistry
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PH
The major objective of public health programs is:
prevention
cost efficiency
teamwork
all of the above
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Capitation
- dentist is paid a fixed amount, usually on
a monthly basis, directly by the capitation
plan
- for this fixed payment, the dentist agrees to
provide specified dental services for patients
who present and who are assigned to the
practice by the capitation plan
Panel of providers
closed panel - dental services provided by
salaried dentists at specified locations only
open panel - dental services provided by
any dentist willing to accept third party payment
Fee-for-service
dentistry is financed mainly through feefor-service self-pay
56% of all dental expenses are paid outof- pocket by the patient
third-party payers represented by private
insurance pay approximately 33% of total
dental expenses, followed by governmentfinanced or public programs (Medicaid,
Veterans Affairs)
prevention
Prevention
is major objective of PH programs
more ethical to prevent disease than cure it
teamwork is necessary to handle large
groups efficiently
cost efficiency plays a major role because
prevention is cheaper than a cure
may be primary, secondary or tertiary
- primary prevention is preventing disease
before it occurs; is the most effective way
to improve health & control costs; examples
include water fluoridation & sealants
- secondary prevention is controlling the
disease after it occurs; example is placing an
amalgam restoration
- tertiary prevention is limiting a disability
from disease, or rehabilitating an individual
with disability; example is providing dentures
Education
plays an important role in public health
it decreases need for government intervention; when people learn why regulations are
of value they comply
PH
Fluoride supplements are available by prescription only.
Fluoride mouth rinses are the most popular school-based fluoride regimen in
the United States.
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PH
In regards to reporting child abuse, a dentist is:
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r
both statements are true
Topical Fluoride
the application of topical fluoride to teeth increases tooth resistance to caries
fluoride can be delivered either brushed on as a
varnish or in a tray as a gel
fluoride varnish
- a vehicle for holding fluoride in close contact
with tooth for a period of time
- way to use high fluoride concentrations in
small amounts of material
- useful to prevent root surface caries in older
adults with gingival recession
- useful in patients with disabilities
Fluoride Supplements
available by prescription only
intended for use by children living in non-fluoridated areas; daily supplements should be used
from 6 months to 16 years
tablets
- chew for 30 seconds, swish for 30 seconds,
then swallow
- provides systemic & topical benefits
- studies show a 30% reduction in caries with
daily use of fluoride tablets on school days
mouth rinse
- most popular school-based regimen
- studies show 25%-28% reduction in caries by
rinsing daily or weekly in school with dilute solutions of fluoride
, -rinsing weekly with 0.2% neutral sodium flu^-y/oride-fjVaF) is more" common than using a
0.05% NaF solution
Office-Based Methods
sealants
- most decay in children occurs on the chewing
surfaces
- use of fluorides & pit and fissure sealants is
needed to prevent caries
- effectiveness of dental sealants has been reported as 51% to 67%
fluoride gels
- most common fluoride used is acidulated
phosphate fluoride (APF)
-APF has apH of about 3.0
- most common concentration is 1.23%, usually
as
,Msl in orthophosphoric acid
Home-Based Methods
brushing
- use a fluoride toothpaste
- use a pea-sized amount of toothpaste
- brush 2 times per day
fluoride gels
- contain stannous fluoride (0.4%) or sodium
fluoride (1.0%)
- formulated in a nonaqueous gel base without
abrasives
- gel should remain in the mouth for 4 minutes
and then spit out
Mandatory Reporting
dentists are obligated to be well versed
in the mandatory reporting procedures in
the state in which they practice
each state has its own guidelines that
must be followed when reporting cases of
suspected abuse
in all states, however, it is standard that
once abuse is suspected against a child,
elderly or disabled patient, it m u s t be reported to the appropriate agency
dentists must identify the appropriate
agencies within their state in which they
practice and ensure that this information
is readily available should the need arise
physical i n d i c a t o rs
- fractured teeth
- oral lacerations
- fractures of the j a w
- braising of the face
b e h a v i o r a l indicator s
- watchfulness and tearfulness
- sullen and withdrawn demeanor
- cowering at adult displeasure
- extreme anxiousness or nervousness
- excessive need to please
- aggressive or out of control behavior
r
PH
Identify which one of the following describes the proportion of existing cases
of disease in a population at one point in time, or, during a specified time:
incidence
prevalence
epidemiology
frequency
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PH
Random assignment and blinding are methods used in clinical trials to enhance study validity and
increase bias
decrease bias
have no change on bias
none of the above
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prevalence
Prevalence V ^
is the proportion of a population with
a problem at a desigriafed'time **' *
it depends on both the incidence and the
duration of the problem
prevalence is more relevant than incidence
when assessing the impact of a problem within
a community & to assess the needs
expressed as percentage of the population
Incidence
""^ferCumulative incidence
is the number of new cases of a disease that
occurs in a population at risk of the disease
during a specific time period
expressed as a rate
Frequency
is a count
Epidemiology
study of the distribution & cause of disease
groups are studied to answer questions about
etiology of diseases, prevention, disease patterns & allocation of resources
communicable disease is one that is transmitted from one to another
non-communicable disease is one that is
not transmitted from one to another; usually
caused by one's own normal flora or an environmental reservoir
Oral Cancer
most oral & pharyngeal cancers are squamous cell carcinoma (SCC)
SCC is twice as common in males as in females
^/fr
SCC causes nearly twice as many deaths in
males as in females
SCC is closely related to advancecrage, alcohol consumption and'smoking
SCC of the lip and oral cavity account for
2/3 of all new oral & pharyngeal cancers
the tongue is the most common site of cancers of the oral cavity
survival rates vary depending on the cancer
site, gender and race
. (l>*-year survival rate for oral & pharyngeal
cancers is about 50%
5-year survival rates for cancer of the lip are
about 90%; of the tongue it is about half that
erythroplakia, rather than leukoplakia, may
be the first sign of cancerous change in a lesion
decrease bias
Definitions
Randomized study
all subjects have an equal chance of
being assigned to either study or control group
researchers prefer the random assignment method for placing subjects
into either the study or control group
because, any uncontrolled variables influencing the outcome are likely to affect subjects in both groups equally
: . .'
Blind study
subjects are unaware of whether
they are in a test or control group; one
way to achieve a blinded study is with
the use of placebos
^0i^m^&tis^^^^i^^<
Double blind study
neither participants nor examiners
know the group allocations (test or
control groups)
PH
The most important concept of public health as defined by C.E.A. Winslow is:
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PH
As used in epidemiology, the term MORTALITY refers to:
disease
lifespan
death
birth
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definition
- as defined by the American Board
of Dental Public Health
- the science and art of preventing
and controlling dental diseases and
promoting dental health through
organized community efforts
form of dental practice which serves
the community as a patient rather
than the individual
is concerned with the dental health
education of the public, with applied
dental research, with administration of group dental care programs
as well as the prevention and control
of dental disease on a community
basis
death
Definitions
mortality (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
number of cases of the disease at a specific time
morbidity (illness) 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 (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 period and population to the
total population during that time
PH
A method of payment for dental services in which the provider is paid a fixed
amount without regard to the actual number or nature of services provided
to each patient is called a:
capitation fee
fixed fee
contractual fee
managed fee
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PH
Identify which one of the following is NOT a fundamental principle defined in
the American Dental Association Code of Professional Conduct:
justice
autonomy
beneficence
maleficence
veracity
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capitation fee
Dental Managed Care
an arrangement whereby a third-party payer
(insurance company, federal government or corporation) mediates between doctors & patients, negotiating fees for services & oversees
the types of treatment given
examples include D-HMO, D-PPO & D-IPA
D-HMO
Dental Health Maintenance Organization
plan most commonly associated with dental
managed care
usually a self-contained staff model practice
where no distinction is made between providers
of insurance and providers of care
also called a capitation dental plan
participants are limited in dentist selection
-%-"'!.e-.,-?
,'. ,!*., .
Capitation Fee
payment to the dentist for these managedcare programs (D-HMO, D-PPO, D-IPA) is
usually made on a capitation basis
capitation fee is usually a fixed monthly
payment paid by a carrier to a dentist based
on the number of patients assigned to the
dentist for treatment
fee is the same regardless of how much or
how little care is delivered
Delivery Model
staff model usually has one or more dental offices that use salaried staff dentists
network model uses multiple dental offices in various locations and is the most
common method of delivering dental benefits in managed dental care
closed model (a.k.a. Exclusive Provider
Organization) is where the patients have a
limited choice of offices where they can go
to obtain dental care
maleficence
ADA Code
includes three main components
The Principles of Ethics
The Code of Professional Conduct
The Advisory Opinions
ADA Code
includes five fundamental principles
1. justice or "fairness" - the dentist has
a duty to treat people fairly
2. autonomy or "self-governance" - the
dentist has a duty to respect a patient's
rights to self-determination and confidentiality
3. beneficeucj|,or^'do good" - the dentist has the duty to be kind and to give the
highest quality of care that one is capable of
4. nonmaleficence or "do no harm" the dentist has a duty to refrain from
harming the patient
5. veracity or "truthfulness" - the dentisTlaTa'au^o'communicate truthfully
PH
All of the following are true concerning the ADA (Americans with Disabilities
Act) EXCEPT one. Which one is the EXCEPTION?
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PH
A descriptive epidemiological study helps to define the
in a population.
of disease
cause
cure
extent
mortality
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Definition
a person with a disability is legally defined as anyone who:
has a physical or mental impairment
that substantially limits one or more
major life activities
has a record of such an impairment is
regarded as having such an impairment
ADA and HIV
persons with HIV disease, both symptomatic & asymptomatic, have physical
impairments that substantially limit one
or more major life activities and are protected by the ADA
persons who are discriminated against
because they are regarded as having HIV
disease are also protected by the ADA
persons who are discriminated against
because they have a known association
or relationship with an individual who
has HIV are also protected by the ADA
extent
Epidemiological Studies can be organized into
three categories
descriptive epidemiology - used to quantify
disease status in the community; major parameters of interest are prevalence and incidence
- prevalence is the proportion of existing cases
of a disease in a population at one point in time
or during a specified period of time; expressed
as percentage from 0 % -100%
Prevalence = # of people with disease
total # of people at risk
- incidence is the number of new cases of a disease that occur in a population at risk of the
disease during a specified time period
Incidence = # of new cases of disease
total # of people at risk
analytical epidemiology - also called "observational epidemiology", is used to assess the relationship between exposures and disease by
observing exposure-disease associations as they
naturally occur in the population under study;
the three main types are as follows: cross-sectional study, case-control study and cohort
study
- cross-sectional study - looks at both the exposure of interest & disease outcome at the
same point in time
- case-control study - identifies subjects on
the basis of whether disease of interest is present and then, by a history, looks for association
between the disease and one or more past exposures
- cohort study - identifies subjects according
to if they have a particular exposure of interest
& then follows them over time to see if an association exists between exposure & development of disease
experimental epidemiology - used in intervention studies'; once etiology is established, researchers determine effectiveness of a program
of prevention; may be clinical or community trials
- clinical trials - conducted to test new preventive or therapeutic agents, with subjects assigned by the investigator to different treatment
groups, usually by random assignment; welldesigned clinical trials use a double-blind design
- community trials - in situations in which an
intervention can be practically evaluated only
at the community level, a community trial can
be conducted; group as a whole is studied
rather than the individuals in it
PH
Identify which one of the following is the part of a published research study
that includes the statement of intent, theory and hypothesis:
abstract
introduction & literature review
methods
results
discussion
summary & conclusion
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PH
Identify which one of the following is described as the presentation, organization and summarization of data:
inferential statistics
descriptive statistics
informative statistics
reliability statistics
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PH
The portion of covered dental care costs for which the covered person has a
financial responsibility, usually a fixed percentage is called:
copayment
coinsurance
deductible
balance billing
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coinsurance
Definitions
deductible is the amount of eligible expenses a
covered person or family must pay each year from
his/her own pocket before the plan will make payment for eligible expenses; on family policies, deductibles are typically per person and usually have
a maximum of 2 or 3 family members that will need
to meet the deductible
copayment is a cost-sharing arrangement in
which an insured pays a specified charge for a specified service, such as $25 for an office visit; the insured is usually responsible for payment at the time
the service is rendered; if a plan has copayments on
dental office visits, this charge typically does not
count toward coinsurance and deductible payments
because the service is covered before the deductible
and coinsurance
coordination of benefits (COB) is a provision in
ffie contract that applies when a person is covered
under more than one dental plan; it requires that
payment of benefits be coordinated by all plans to
eliminate over-insurance or duplication of benefits
coinsurance is the portion of covered dental care
costs for which the covered person has a financial
responsibility, usually a fixed percentage; coinsurance usually applies after the insured meets his/her
deductible
balance billing is the (usually) illegal practice of
dental offices and other medical facilities billing patients for the balance between what they want to
charge their patients for services and what the insurance company has already reimbursed them