Special care dentistry

In the dental office, which of the following are reasons for fear in the child patient?

1. The child is too young to understand the procedure as explained.
2. The child has experienced other emotional upsets in his/her life.
3. The child has had previous painful experiences in other health care settings.
4. The child is emotionally ill.

(2) only
(1) and (3)
(2) and (4)
(1), (3) and (4)
All of the above
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In the dental office, which of the following are reasons for fear in the child patient?

1. The child is too young to understand the procedure as explained.
2. The child has experienced other emotional upsets in his/her life.
3. The child has had previous painful experiences in other health care settings.
4. The child is emotionally ill.

(2) only
(1) and (3)
(2) and (4)
(1), (3) and (4)
All of the above
Correct Answer: (E)

The child patient who is frightened, represents a formidable challenge to the dentist. The patient can be managed in most instances if the reason is identified. When a child is unable to understand the explanation of a procedure the fear may persist. At ages 36 to 40 months, a normal child can understand the procedure when appropriately explained. Emotional upsets in life, such as the death of grandparents, divorce, or experiencing child abuse, reduce the child's ability to cope. Previous painful experiences in any health care setting are transferred to the dental office. A mentally ill patient is the most difficult patient to manage and usually requires a referral to a psychiatrist.
The MOST common mental disorder of the elderly is:

AAlzheimer's disease
B Depression
C Memory loss
D Paranoia
E Schizophrenia
Correct Answer: (A)
Cognitive disorders affecting the elderly can be divided into two categories: functional and organic disorders. Examples of functional disturbances are depression, paranoia, and schizophrenia. Depression is the most common of these in the elderly, manifesting itself in a variety of psychological and physical symptoms. The dentist may suspect depression in elderly patients that appear indecisive, sad, pessimistic, or lack self-esteem. While less common, organic disorders such as Alzheimer's disease are more debilitating and irreversible. Loss of memory is a sign in patients with organic brain disorders, but is not itself considered a disease state.
In order to avoid a claim of abandonment, the dentist who unilaterally decides to terminate care must:

A Complete all remaining procedures in the treatment plan
B Directly assist the patient in finding a substitute practitioner
C Provide copies of the patient's dental record to the patient
D Continue to render emergency care for a reasonable time while a substitute dentist is located.
Correct Answer: (D)

The best way to avoid a lawsuit for breach of contract is not to guarantee anything. It has been said that the practice of dentistry is not a science, but an art. So the total fulfillment of a guarantee is often beyond your control. Very few lawsuits are filed against dentists for breach of contract. Unless a dentist actually guarantees his/her services and the patient guaranteed the work, it is difficult to prove breach of contract.
The dentist's obligation to the patient is to:

1. Respect and protect the patient's privacy
2. Complete care within a reasonable amount of time
3. Arrange for patient care during periods of temporary absence
4. Provide duplicate records, at no charge, upon patient's request.

(1), (2) and (3)
(1), (2) and (4)
(1), (3) and (4)
(2), (3) and (4)
All of the above
Correct Answer: (A)

The relationship between the dentist and the patient is governed by contract law. The terms of the contract may be expressed or implied. The courts have identified certain duties owed to the patient simply as a result of the patient-dentist relationship being established. In addition to many other implied duties, upon accepting patient for care, the dentist is obliged to maintain confidentiality of treatment, complete care in a timely manner and ensure that care is available in emergency situations of in the absence of the dentist. In regard to providing access to or duplicate records at the request of the patient, it is generally accepted that the dentist is required to do this. Several states have promulgated regulations concerning this issue. However, the dentist is entitled to compensation to cover duplication and clerical costs.
If a patient is on anticoagulant therapy and is to undergo a dental procedure in which some bleeding can be expected, the dentist should do all of the following EXCEPT:

A Contact the patient's physician regarding the therapy
B Avoid the use of aspirin
C Avoid the use of ibuprofen
D Avoid the use of local anesthetic
Correct Answer: (D)

No surgical procedures should be performed on a patient suspected of having a bleeding problem based on history and examination findings. Such a patient should be screened with the appropriate clinical laboratory tests and, if indicated, referred to a hematologist for diagnosis and treatment. Patients under medical management who may have a bleeding problem should receive no dental treatment until consultation with the patient's physician has taken place and appropriate preparations have been made to avoid excessive bleeding following dental procedures. Aspirin inhibits platelet thromboxane production and platelet aggregation These are nonreversible effects and new platelets will have to be generated for the bleeding time to return to normal. Ibuprofen, a non-steroidal anti-inflammatory, can produce a systemic bleeding tendency by impairing thromboxane-dependent platelet aggregation and thus prolonging the bleeding time. However, this drug's effect is reversible and the duration of it depends on the specific drug dose, serum level, and half-life. Local anesthetics are not contraindicated in the treatment of patients with bleeding diathesis.
A patient with a history of ischemic heart disease (stable angina) suddenly experiences chest pains. How should this be handled?

A Administer 50mg Demerol I.M. until the pain dissipates, then reappoint
B Administer an aspirin tablet and continue the appointment
C Set the patient upright, check the blood pressure and wait 10 minutes before continuing
D Administer sublingual nitroglycerin and oxygen and if the pain is alleviated, the appointment can be resumed or the patient can be reappointed.
Correct Answer: (D)

If the patient with ischemic heart disease experiences chest pain, the dental procedure is halted and a sublingual nitroglycerin tablet and oxygen are administered. If the pain subsides, work may be resumed or the patient may be reappointed. If the pain does not subside within 5 minutes, another nitroglycerin tablet can be given. If the pain persists after three tablets within a 15-minute period, the emergency cardiovascular care system should be activated by calling 911 and ensuring that the patient is immediately transported to an emergency care facility.
Patients experiencing a panic attack may exhibit all of the following EXCEPT:

A Palpitations
B Sleepiness
C Diaphoresis
D Chills
Correct Answer: (B)

A person experiencing a panic attack activates the "fight or flight" response triggering a cascade of sympathetic responses resulting in visible signs to the attending dentist. The dentist needs to be cognizant of "panic attacks" in his differential diagnosis.
All of the following are true about firewalls EXCEPT:

A Firewalls will protect your office computer network from viruses.
B Firewalls can exist as software which allows or blocks internet and network access to and from a computer.
C Firewalls can exist on routers—hardware which controls local network access to the internet.
D Firewalls make your computer "invisible" on the internet making it difficult for hackers to find your computers.
Correct Answer: (A)
As computer hardware and software become more complex so does the sophistication of computer viruses. Much brain power is wasted creating these destructive entities which may breach firewalls. Although there is no perfect fix, antiviral software programs can add a measure of safety to aggressive viral intrusions of your computer network.
Patient information can be released without a HIPPA signature:

A With the permission of the patient's doctor
B With the permission of the patient
C To the subsequent dentist
D To the patient's spouse
Correct Answer: (B)

A request from a patient may be the first indication that the patient is unhappy with treatment and an attempt should be made to address any concerns that may be highlighted in discussions with the patient.
You have been asked to see patients of a local dentist who is gone for the weekend. One of the patients complains of severe pain in the socket of the maxillary right lateral incisor, which was recently extracted. Examination reveals a retained 7 mm root fragment. The appropriate course of action is to:

A. Inform the patient of the cause of the pain and with his/her consent remove the root fragment.
B. Remove the root fragment and make no comment concerning the cause of the pain.
C .Prescribe analgesics and contact the patient's dentist upon return.
D .Prescribe analgesics and advise the patient to contact his/her dentist upon return.
Correct Answer: (D)

Each time dentists speak disparagingly of other dentists to patients of the lay public, they undermine their profession, put other clinicians at risk of complaints and increase their risk of slander litigation. The best way to resolve it is to telephone the dentist.