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TIENT M N GEMENT LEGEND
opic
ards opic
ards
behavioral sciences
1 19
OSHA 51 76
infection control
20 50
public he lth 77 99
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Arrange the following steps of the educational process in correct order.
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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3 1 2 6 7 5 4
Step 4
setting goals
short-range or long-range guides to ac-
tivity
must be meaningful, attractive & at-
tainable
Step 5
acting to achieve goals
activity is needed for learning
must be directed at spec ific goals
Step 6
reinforcing learning
review repetition aid in learning re-
tention
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
Although each learning situation will not fol-
low these steps in exact sequence, most situa-
tions 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
Step 1
recognizing needs
dentist recognizes educational needs as treat-
ment 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 arti-
ficial stimuli
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Identify each of the following statements that are true concerning needs and
learning.
needs are driving forces that prompt a person to act
the process of learning is continuous
learning occurs as a person attempts to satisfy needs
expressing needs helps to pinpoint them for the patient and dentist
recording educational needs can be as important as recording treatment needs
all of the above statements are true
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all of the above statements are true
Needs &
Learning
needs & goals may provide motiva-
tion
motivation arouses & maintains in-
terest
motivation may be artificial or built-
in
patients rarely learn without motiva-
tion
learning is continuous and occurs
when a person attempts to satisfy
needs
motivation stimulates a person to act
on needs
motivation is a fundamental part of
every learning situation
short-range goals are less remote &
more easily attained
goals should be attractive & attain-
able in order to be meaningful
goal-directed activity is necessary
for learning
Assessment of behavior
in order to change behavior, assess-
ment 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 imple-
memtation
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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.
both statements are true
both statements are false
the first statement is true, the second is false
the first statement is false, the second is true
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both statements are true
Behavior
changes in behavior are a prerequisite
to changes in attitude
behavior is defined as a determined,
purposefu l unit of activity
-
determined
the assumption that the behavior
is lawful & has determinants
-
purposeful
the assumption that the
behavior is goal-oriented, that it
seeks to achieve positive and re-
duce negative need or motivated
states
-
unit of activity
what a person does that can be re-
ported or described as discrete
elements
Behavior examples
a common 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 mee t the
criteria of being determined, pur-
poseful units of human activity
Behavior management
as described by the ADA, tech-
niques or therapies used to alter or
control the actions of a patient who
is receiving dental treatment; exam-
ples include education or anxiety
relief techniques
the means by w hich the dental
health team effectively and effici-
ently performs treatment for the
patient, and, at the same time, instills
a positive attitude
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The principal nonverbal cue that two or more persons can use to regulate ver-
bal communication is:
posture
facial expression
eye contact
gestures
proximity
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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 the age, 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
rapport
is 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)
- interpretation
(identify ing the
underlying reason)
-
preparation
(allowing time for dis-
cussion & eliminating distractions)
Eye contact
is the
principle non-verbal cue used to
regulate verbal comm unication
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 comm unication
easier and help to develop trust
include encouraging patient questions,
answering questions, responding to re-
quests & communicating with warmth
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Which term describes a behavioral response that operates by the simple
process of association of one stimulus w ith another?
operant conditioning
classical conditioning
observational learning
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Classical conditioning
a
stimulus
leads to a response
a.k.a. pavlovian or respondent condi-
tioning
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 pre-
sented along with an unconditioned
stimulus that elicits the desired response
Operant conditioning
process of behavior modification in
which the likelihood of a specific be-
havior is increased or decreased through
positive or negative reinforcement each
time the behavior is exhibited, so that
the subject comes to associate the pleas-
ure or displeasure of the reinforcement
with the behavior
four types:
positive reinforcement,
negative reinforcement, punishment
&
extinction
classical conditioning
Observational learning
or modeling, is a type of learning that
occurs as a function of observing, re-
taining and replicating behavior exe-
cuted 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 en-
courage a fear reaction
(conditioned
response)
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Which type of aggression is an act of hostility unnecessary for self-protection
or preservation that is d irected toward an external object or person?
destructive aggression
inward aggression
constructive aggression
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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
destructive aggression
Aggressive personality
personality with behavior patterns
characterized by irritability,
tantrums, destructiveness or vio-
lence in response to frustration
aggressive personalities are individ-
uals whose overall style of inter-
acting involves
considerable, per-
sistent, maladaptive aggression
expressed in a variety of ways and
in a w ide range of circumstances
characteristics include the
following:
-
seek a superior position in any
relationship or encounter
-
abhor subm ission
- self-advancing at expense of
others
-
have d isdain for truth
-
lack internal brakes
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Match the type of question on the left to the correct example on the right.
direct
1
ou're not afraid of needles, are you?
probing
.
ow are you doing with brushing flossing?
laundry list
.
ow are you?
open-ended
.
s it easier to hold the brush this way?
leading
.
hat else did you notice about your gums?
facilitating
.
s the pain sharp, dull, or throbbing?
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4,5,6,2,1,3
#
Type
Example
4 direct
question
Is it easier to hold the brush this way?
direct questions asked for a specific bit of information
C
probing
question
What else did you notice about your gums?
probing questions ask for more specific information that the
Patient offers spontaneously
6
laundry list
question
Is the
pain sharp, dull, or throbbing?
laundry list questions give the patient a list of choices
2
open-ended
question
How are you doing with brushing &
flossing?
open-ended questions request information in the patient's
own words and specify a content area
leading
question
You're not
afraid of needles, are you?
leading questions
entice a patient to answer in a
specific way;
leading questions should not he used with patients
3
facilitating
question
How are
you?
facilitating questions encourage the patient to say
more
without specifying an area or topic
Comm unication 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
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Which one of the following types of patients is usually considered to be the
most difficult?
the know-it-all patient
the anxious patient
the shy patient
the talkative patient
the stubborn patient
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Anxious patient
is the
most difficult patient to manage
in dentistry
anxiety is defined as unpleasant nega-
tive emotional state
without identifi-
able cause
anxiety is the feeling of apprehension,
uneasiness, agitation or uncertainty re-
sulting from the anticipation of a threat
of danger whose source is unknown
most anxious patients have had a trau-
matic experience in a healthcare setting
anxiety causes patients to avoid dental
treatment & interferes with treatment
anxiety may cause problems with pain
Indicators of anxiety
affective patient is emotional, talks a
lot, talks fast
cognitive
patient is not listening &
does not follow instructions
motor
increase in body movement
& muscle tension
psychological increase in heart rate,
respiration, sweating & dry mouth
the anxious patient
Management of the
anxious patient
be friendly
be calm
& patient
build trust; use
empathy & respect
create a relaxing environment
make the patient feel welcome
convey a sincere concern for patient's
well-being
explain procedures before doing them
encourage the patient
to ask questions
use understandable words
pay attention to what the patient is
saying
and
how it is said
forewarn patient about possible pain
watch a patient's eyes eyebrows to
see if the patient is feeling pain
give patient control by giving option
to raise your hand if you feel any-
thing
provide
moral support
during proce-
dure
use headphones or TV as a
distraction
use SUDS (the subjective unit of dis-
tress scale) to assess the level of pat-
ient anxiety
throughout treatment; ask
the patient to rate their level of anxiety
from 0 none) to 10 (highest level)
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Which type of parent has an excessively demanding attitude?
neglectful parent
overprotective parent
manipulative parent
hostile parent
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Manipulative parent
is demanding
demands usually start with appoint-
ment times
may try to provide diagnosis and di-
rect the course of treatment
Overprotective parent
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 appre-
hension of the child and the impor-
tance of establishing a one-on-one
relationship between the dentist and
child, this will usually satisfy most
overprotective parents
manipulative parent
Hostile parent
questions the necessity of treatment
questions stem from d istrust and not
curiosity
Neglectful parent
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 iden-
tify the underlying source of these
emotions
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Dental fear is an unpleasant m ental, emotional or physiologic sensation de-
rived from a specific dental related stimulus.
Someone who experiences fear w ill not necessarily be anticipating a negative
event, their response will occur at the moment the unpleasant event e.g.,
pain
occurs.
both statements are true
both statements are false
the first statement is true, the second is false
the first statement is false, the second is true
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both statements are true
Dental fear
refers to the fear of den tistry and
receiving dental care
is defined as an
unpleasant
mental,
emotional or physiologic sensation
derived from a specific dental-re-
lated stimulus
elements common to all fears
- fear of unknown
- fear of pain/bod ily injury
- fear of loss of control
-
fear of helplessness dependency
understanding the above elements of
fear allows for effective planning for
the treatment of fearful anxious
patients
when evaluating a patient's dental
fear, take note of
what the patient
says
and how
the patient behaves
appears
while in
the dental office
Dental anxiety
is defined as a non-specific uneasiness,
apprehension or negative thoughts about
what may happen during a dental
appointment
patients who are fearful or anxious
avoid dental appointments
Stress
is defined as the
body's reaction to a
change that requires a physical, men-
tal or emotional adjustment or
response
stress can be caused by physical, emo-
tional or psychological influences
Stress, anxiety,
&
fear
of stress, fear & anxiety ---
stress is
associated w ith a response
stress
is the body's response to danger
fear
is a feeling of uneasiness in
response to imminent danger
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 w ill follow
--- whether to show up to a dental
appointment, submit to an injection,
accept the need for extraction etc.
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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 hom e
care program that was recomm ended six months ago. The hygienist believes
that the problem is not a skills deficiency but a management deficiency in-
stead. What is the best course of action for the hygienist?
accept that the patient might never change her habits
provide the patient with a pamphlet on periodontal disease
collaborate w ith the dentist to determine the course of action
go over brushing & flossing techniques
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collaborate with the dentist to determine course of action
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Motivating the patient
reviewing home care instructions will
not solve the problem, since this is
not
a skills
deficiency;
a plan must be
determined to motivate this patient
if the patient knows what to do, and
how to do it, members of the dental
team must collaborate and find a way to
motivate the patient
to embrace the
recommended home care regimen
Stages of change model (SCM)
1 pre-contemplation
(no admission of
problem )
2 contemplation (considering problem
& change)
3 preparation
(getting ready to change)
4
action / willpower
(changing
behavior)
5
maintenance
(maintain behavior
change)
6 relapse
(abandon change)
M otivating pat ients
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-eff icacy;
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 partic-
ular course of action is theirs
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Behavior shaping is also called:
aversive conditioning
successive approximation
restraining
hypnodontics
BS
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successive approximation
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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 reinforce-
ment 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 reinforc-
ement
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 board
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BS
Which one of the following is a conceptual framework that describes a per-
son s health behavior as an expression of his or her health beliefs?
health maintenance model
health role model
health belief model
leading circle model
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he lth belief m odel
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MODIFYING
Age, sex, ethnicity
Personality
So do economics
Knowledge
Health belief model
(HBM)
is a psychological model that a
attempts to explain and predict
health behaviors
by
focusing on
the attitudes beliefs of indivi-
duals
developed in the 1950s by social
psychologists working in the U.S.
Public Health Services
INDIVIDUAL PERCEPTIONS
Perceived susceptibilty/
seriousness of disease
developed in response to the failure
of a free tuberculosis
(TB) health
screening program
has been adapted to explore a
variety of long- and short-term
health behaviors, including sexua l
risk behaviors and the transmission
of HIV/AIDS
suggests that individuals act to
prevent disease only when they are
susceptible to it
FACTORS
IKELIHOOD OF ACTION
Perceived bene Its
versus
barriers to behavioural
change
Likelihood of be
change
erceived threat of
disease
Cues to action
education
s yrrpto rrts
media into ration
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Behavior modification is also known as:
behavior evaluation
behavior therapy
behavior shaping
behavior training
BS
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behavior therapy
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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
operant conditioning
aversive conditioning
modeling
systemic desensitization
classical conditioning
a.k.a. pavlovian or respondent condition-
ing
a naturally occurring
stimulus is paired
with a
response
-
next, a previously neutral stimulus is
paired with the naturally occurring
stimulus
- eventually, the previously neutral stim-
ulus comes to evoke the response with
out the presence of the naturally occur-
ring stimulus
the two elements are known as condi-
tioned stimulus & conditioned response
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 HO ME 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
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BS
Five techniques are used to facilitate patient dialogue: em pathy, respect, re-
flection, interpretation and silence.
Reflection is the explanation and understanding of the patient s com ments.
both statements are true
both statements are false
the first statement is true, the second is false
the first statement is false, the second is true
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the first statement is true, the second is false
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Facilitation
Five techniques are used to facilitate patient
dialogue: empathy,
respect, reflection, in-
terpretation
and silence.
empathy
is the ability to accurately understand
the patient s feelings
empathy also involves being able to
communicate this understanding
when properly done, empathy increases
rapport, encourages expression and
promotes trust
the dentist must actively listen and con-
centrate on what the patient is trying to
say both verbally and nonverbal ly
when communicating empathically, it
is helpful to respond with the same
feeling as the patient's statement
respect
respect promotes rapport, open
expression trust
respect is communicated via the way
the dentist works with the patient
communicate respect by regarding each
patient as an individual
reflection
is a
response that restates or
repeats a segment of the patient s
statement
reflection encourages the patient to
continue comm unicating
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 used
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
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BS
Each of the following are ways to communicate effectively with patients
EXCEPT
one. Which one is the
EXCEPTION?
describe
evaluate
be specific
be responsive
pay attention
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evaluate
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Do
Don't
Describe
Evaluate
Be specific
Be general
Be responsive
Be evasive
Pat attention Be distracted
Listen carefully Interrupt
Make eye contact
Let eyes wander
Use lay terms
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
Be reassuring
Have a calm demeanor
Provide moral support
Work efficiently
Be friendly
Communications Effectively
with Patients
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BS
Each o f the following are considered to be aversive conditions of interaction
between the dentist arid patient
EXCEPT
one. Which one is the
EXCEPTION?
psychophysiological reactions
stress, anxiety & fear
preventive oral health behavior
pain
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preventive oral health behavior
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Aversive conditions
any negative condition to which a per-
son 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
- com munication
- gathering information
- identifying problem s
- giving information
the dentist-patient interaction
seeks to
maximize the conditions that arc
perceived as non-aversive
Dental fear, anxiety &
pain
dental fear
is an unpleasant emotional
or physiologic sensation derived from a
specific dental-related stimulus
dental anxiety
is a non-specific uneasi-
ness, apprehension or negative thoughts
about what may happen during dental
treatment
dental phobia
is when dental treatment
is avoided or endured with intense
anxiety
dental fear anxiety
can come from
different sources
dental fear anxiety are often from a
previous bad experience, or, from
hearing of a bad experience , or a gen-
eral fear of needles
dental fear happens during childhood
or adolescence in approximately 50-
85% of cases
dental fear, anxiety
&
pain
are all
interrelated
fear
may cause a person to endure pain
and not seek treatment
pain & anxiety
-
as pain increases, anxiety increases
-
as anxiety increases, pain is enhanced
& is less tolerable
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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.
ABC m odel behavior theory model)
stages of change model
SCM)
social cognitive theory
contemporary public health model
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stages of change model (SCM)
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Stages of change model
SCM)
behavior change does not happen in
one step
a person will progress through dif-
ferent stages
on the way to successful
change
each person will progress at their own
rate
Stages of change
1 pre-contemplation
not acknowledging there is a prob-
lem that needs to be changed
2
contemplation
acknowledging problem but not
ready or sure of wanting to make a
change
3 preparation
getting ready to change
4
action/willpower
changing behavior
5
maintenance
maintaining behavior change
6 relapse
abandoning change, returning to old
behavior
Social cognitive theory
behaviors are learned through obser-
vation, modeling & motivation such
as positive reinforcement
learning is strengthened if the observer
identifies with their mod el
learning is strengthened if someone
models a behavior he or she has seen
rewarded; this motivates the person
to model the behavior to get a reward
ABC model
behavior theory)
behavior has 3 components :
A= antecedents trigger)
B = behaviors
C = consequences
B comes between A and C
rather than occurring in isolation,
behavior is preceded by an antecedent
that sets off the behavior and is
followed by
a consequence
Contemporary community
public)
health model
a prevention model that
considers so-
cial, cultural, economical
&
enviro-
nmental factors as having significant
influence
on a person's health behaviors
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BS
Which of the following is an essential part of risk management?
veracity
documentation
autonomy
negligence
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document tion
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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, confiden-
tiality and
documentation
Informed consent
informed consent
(written or oral)
must he obtained by the dentist from
adult patients prior to treatment
informed consent components
-
WHO
will render treatment
-
WHA T are the treatment options
-
WH AT 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, con-
sistent & complete
must include ac tual visits, missed visits
& evidence of noncompliance
Documentation tips
inform the insurance carrier if an
incident with a patient occurs
remem ber 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 charac-
terizations, 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
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IC
Identify which one of the following is a false statement concerning personal
protective equipment
PPE):
1. protective clothing must be worn by dental professionals when contact with
blood or other bodily fluids is anticipated
2. gloves must be worn to prevent contact with blood, saliva or mucous membranes
3.
wearing gloves replaces the need for handwashing
4.
protective clothing must be removed before leaving the dental office
5.
masks must be changed between patients
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wearing gloves replaces the need for hand washing
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Protective clothing
protective clothing includes
gowns,
lab coats
& jackets
may be
disposable
is worn over ex isting clothing
street
clothes or scrubs)
is
used to prevent skin & mucous
membrane exposure
when contact
with blood or other body fluids is
anticipated
must be changed daily or more often
if visibly soiled
protective clothing must be removed
before leaving the dental office
Masks protective eyewear
if spatter
& aerosolized sprays are
likely, surgical masks & protective
eyewear, or chin-length plastic face
shields must be used
a mask must be changed between
patients
or more often if it becomes
wet or moist
face shields & protective eyewear
must be washed/disinfected with
appropriate cleaning agents
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
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IC
Identify each of the following that is a true statement regarding the launder
ing of contaminated laundry in the dental setting:
1.
contaminated laundry must be handled as little as possible
2. the dentist may choose to use an outside laundry service
3.
the dentist or assigned office personnel may launder the clothes on-site
4. contaminated laundry should be bagged at the location of use
5. contaminated laundry should be handled with appropriate PPE
6.
if contaminated laundry is transported to a laundromat, the employee must be
trained in the handling of contaminated laundry
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all statements are true
Protective clothing
Laundry choices
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for optimal protection gowns, jackets
or coats are required to be long
sleeved
and high necked
such clothin
g
,
minimizes the potential
for exposed skin
to contact blood,
saliva or other potentially infectious
material
Disposable gowns
if used,
eliminates the need to launder
contaminated protective clothing
Contaminated laundry
defined as laundry
that has been
soiled with blood or OPIM other
potentially infectious material)
handling of contaminated laundry
includes the following:
-
handle as little as possible
- handle with appropriate PPE
-
bag at location of use
- do not sort or rinse at location of use
- label transport bags with a biohazard
sign
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 out-
side laundry service
the dentist or assigned office personnel
may launder the clothes in a washer
and dryer on-site
if contaminated laundry is trans-
ported 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
IC
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Match each term with the correct definition:
clinical contact surface
disinfectant
disinfection
hospital disinfectant
intermediate level disinfectant
low level disinfectant
tuberculocidal
1.
a disinfectant that makes the label claim
tuberculocidal
2.
a germicide effective against HIV and HBV
3. an agent capable of inactivating Mycobac-
terium tuberculosis
4.
any surface directly contaminated from
patient materials,
gloved hands, blood, or OPIM
5.
a process which destroys a majority of, but
not all, microorganisms
6.
a chemical agent used to destroy recognized
pathogens; kills some but not all microorgan-
isms
7.
a germicide effective against
Salmonella
choleraesuis, Staphylococcal aureus and
Pseudomonas aeruginosa
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4 6 5 7 1 2 3
Clinical contact surface
Intermediate level disinfectant
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any surface directly contaminated from
patient materials, gloved hands, blood
or OPIM
other potentially infectious
material)
these surfaces can then cross contam-
inate other instruments, devices, hands,
gloves & other items
Disinfectant
chemical agent used to destroy recog-
nized pathogens; kills some but not all
microorganisms
Disinfection
a process which destroys a majority of,
but not all, 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 non-
living objects
disinfectant that makes the label claim
`tuberculocidaP
Low level disinfectant
germicide effective against HIV &
HBV
Tuberculocidal
agent capable of inactivating Mycobac-
terium tuberculosis
Disinfectant selection
factors to consider
ability to inactivate TB, HIV and Hepa-
titis B
suitability for use as a cleaner and disin-
fectant
health hazards and precautions
contact time requirements
compatibility with equipment, devices
and ma terials
shelf life and storage
sensitivity to temperature
IC
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Match each term with the correct definition:
antiseptic
asepsis
bloodborne pathogens
exposure incident
infectious waste
personal protective equipment
standard precautions
1.
pathogens present in blood that cause disease
in humans
2.
includes protective attire, gloves, mask and
eyewear
3.
involves contact with blood or other poten-
tially infectious materials and that results from
dental procedures
4.
the absence of disease-causing microorgan-
isms
5.
measures designed to protect operators pa-
tients from pathogens spread by blood or any
other body fluid, excretion, or secretion
6.
a substance that inhibits the growth of bacte-
ria
7.
waste that consists of blood, blood products,
contaminated sharps or other microbiologic
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6, 4, 1, 3, 7, 2, 5
Basic terminology
infectious waste
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an understanding of the terminology related
to infection control is important for the den-
tal professional
antiseptic
a substance that inhibits the growth of
bacteria
asepsis
the absence of pathogens, or disease-
causing microorganisms
bloodborne pathogens
pathogens present in blood that cause
disease in humans
disinfect
the use of a chemical or physical proce-
dure 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 infec-
tious materials that results from proce-
dures performed by the dental profes-
sional
waste that consists of blood, blood
products, contaminated 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 den-
tal 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, in-
cluding, but not limited to, needles and
scalpels
standard precautions
measures designed to protect health care
IC
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The interpretation of the Centers for Disease C ontrol
& Prevention (CDC) rec-
ommended 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 set
tings are stand-alone guidelines and are not required to be used in conjunc-
tion with OSHA practices procedures.
both statements are true
both statements are false
the first statement is true, the second is false
the first statement is false, the second is true
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both statements are false
CDC recommended infection control
Recommendations
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practices in dental health care set-
tings
primary purpose of infection control
procedures is to
prevent the trans-
mission of infectious diseases
infectious diseases may be trans-
mitted
-
from patient to dental professional
-
from dental professional to patient
-
from one patient to another patient
use of recommended infection con-
trol guidelines greatly reduces the
transmission of infectious diseases
recommended infection control
practices are applicable to all set-
tings in which dental treatment is
provided and must be observed
in conjunction with required
OSHA Occupational S afety and
Health Administration)
practices
and procedures for worker protec-
tion
vaccination
of dental professionals
use of
protective attire and barrier
techniques
hand washing and care of hands
proper
use and care of sharps
instrum ents 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, anti-
retraction 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
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Instruments in the dental practice can all be classified as e ither critical or non-
critical.
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 m ay enter
the host.
both statements are true
both statements are false
the first statement is true, the second is false
the first statement is false, the second is true
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the first statement is false the second is true
Disease transmission
critical instruments
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for an infection to occur by one of
these routes of transmission,
the fol-
lowing three conditions must be
present:
- a
susceptible host
-
a pathogen
with sufficient infecti-
vity and numbers to cause infection
-
a portal of entry through which the
pathogen may enter the host
effective infection control practices
are intended to alter one of these
three conditions and prevent disease
transmission
Classification
all instruments in the dental practice
can be classified as
critical, semi-
critical or noncritical
instruments are classified depend-
ing on the risk of transmitting infec-
tion the need to sterilize between
uses
penetrate soft tissue or bone
must be sterilized after each use
examples
include forceps, scalpels,
bone ch isels, 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 damag ed by
heat and sterilization is not feasible,
a disposable one-use item is
required
examples
include x-ray beam align-
ment d evices, mirrors, amalgam
condensers and burs
noncritical instruments
do not come in contact with mu-
cous membranes
because there is little risk of trans-
mitting infection, an
intermediate
level or low-level disinfectant is
required
between uses in different
patients
IC
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Match each term with the correct definition:
pasteurization
sanitization
antiseptic
disinfectant
bacteriostatic
bactericidal
1.
pathogens present in blood that cause disease
in humans
2. an agent that prevents further growth of bac-
teria
3.
an agent capable of killing bacteria
4.
to expose food to an elevated temperature for
a period of time sufficient to destroy certain dis-
ease-causing microorganisms
5.
a chemical agent used on inanimate objects to
destroy or inhibit the growth of harmful organ-
isms
6. treatment of water to reduce microbial counts
to safe levels
7. an antimicrobial agent that can be safely
applied to living tissues
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4, 6, 7, 5, 2, 3
Definitions disinfectant
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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
a chem ical agent used on inanimate
objects to destroy or inhibit the
growth of harm ful organisms; not
considered safe for use on hu man
tissues (e.g.,
bleach); a disinfec-
tant kills some, but not all microor-
ganisms
pasteurization
to expose food to an elevated tem-
perature for a period of time suffi-
cient to destroy certain disease-
causing microorganisms; the target
of pasteurization is the destruction
of M ycobacterium tuberculosis
sanitization
treatment of water supplies to
reduce microbial counts to safe
public health levels
IC
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Identify each of the following that is a true statement regarding the pur-
pose of cleaning prior to disinfection:
1.
cleaning destroys all pathogens
2.
cleaning reduces the concentration of pathogens
3.
cleaning removes blood and debris which can interfere with disinfection
4.
cleaning is optional prior to disinfection
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2, 3
Cleaning
Cleaning
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is defined as the
physical removal
of debris
with aseptic technique,
you must
clean before you d isinfect
the cleaning step is
not optional, it
is required
all disinfectant products include
specific instructions for cleaning
prior to disinfection
Results in
a reduction in the number of
microorganisms present
the removal of blood, tissue biobur-
den and other debris that can
interfere with disinfection
IC
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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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sterilization
Sterilization
destruction of all forms
Biological mon itoring
sterilizers must be monitored for
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defined as the
of microbial life
limiting
requirement is the inactiva-
tion of b acterial 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 sterili-
zation, a disposable
one-tim e 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
proper functioning.
his 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 tempera-
ture for a period of time sufficient to
destroy certain disease-causing
microorganisms; the target of pasteur-
ization is the destruction of
M ycob acterium tuberculosis
sanitization
treatment of water supplies to reduce
microbial counts to safe public health
levels
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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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bacterial spores
Biological monitoring
involves the processing of highly
Spore testing
after a spore strip is processed in a
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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
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 cloudi-
ness
if spores are
viable have
not been
killed, the culture m edia appears
cloudy
if no cloudiness is noted in the culture
media, then sterilization is confirmed
cloudiness in the culture media indi-
cates
a
failed test
spores were not
killed),
also known as a positive biolog-
ical spore test
to rule out contamination during testing,
a
Gram stain
is prepared to identify the
bacteria in the failed test
when
the gram-positive Bacillus
organism is observed on the test slide,
sterilization failure is confirmed
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For a steam autoclave, identify each of the following that lists the correct tem-
perature, pressure and time that must be used for sterilization.
250 F, 15 psi, 20 minutes
270 F, 30 psi, 08 minutes
270 F, 20 psi, 20 minutes
320 F, 20 psi, 20 minutes
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250 F, 15 psi, 20
minutes or
270
F, 30
psi
8 minutes
Autoclave
the use of
steam heat under pre
Advantages
Disadvantages
advantages
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sure remains the oldest, most com-
mon and most acceptable method
for instrument sterilization
the typical autoclave uses
- a temperature of
121 C (250 F)
-
a pressure of
15 psi
- cycle time of
20 minutes
r
-
a temperature of 132 C (270 F)
- a pressure of
30 psi
- cycle time of
8 minutes
- a short
efficient cycle time
-
good penetration
- a wide range of
materials can he
processed without destruction
disadvantages
- corrosion
of unprotected carbon
steel instruments
-
dulling
of unprotected cutting edges
-
packages
may remain wet at the
end of a cycle
- use of
hard water may leave
deposits
- possible destruction
of heat-
sensitive materials
Autoclave problems
that may result in a failed spore test
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
IC
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For a dry heat oven, identify the correct temperature and time that must be
used for sterilization.
375 F, 60 minutes
375 F, 120 minutes
320 F, 60 minutes
320 F, 120 minutes
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320 F 120
minut s
Dry heat oven
in the absence of moisture,
destruction
Advantages & Disadvantages
advantages
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of all forms of microbial life requires
conditions very different from the auto-
clave
dry heat sterilizes much less
efficiently than moist heat
a HIGHER TEMPERATURE &
LONG ER CY CLE TIME is required
for sterilization to occur
the typical dry heat oven uses
- a temperature of
160 C (320 F)
-
cycle time of 120 minutes
r
- a temperature of
170 C (340 F)
-
cycle time of
60 minutes
the use of a commercial cooking oven
is not a substitute for an FDA -app-
proved sterilizer
- no dulling
of cutting edges
- no corrosion
of metal instruments
disadvantages
-
the long cycle time
-
poor penetration
- may
discolor or char items
- destroys heat-labile items
- cannot sterilize liquids
- not suitable for hand pieces
Forced air convection ovens
a.k.a.
rapid heat transfer ovens
another option for dry heat sterilization
use a HIGHER TEM PERATURE \
and a CONTROLLED INTERNAL
AIRFLOW
uses a temperature of 190 C (375F)
and a cycle time of
12 minutes for
wrapped items and 6 minutes for
unwrapped items
Dry heat oven problems
that may result in a failed spore test
faulty temperature gauge
faulty timer
IC
For a chem ical vapor sterilizer, identify the correct temperature, pressure and
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time that must be used for s terilization.
250 F, 20 psi, 20-40 minutes
250 F, 30 psi, 40-60 minutes
270 F, 15 psi, 40-60 minutes
270 F 20
psi, 20-40
minutes
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Chemical vapor sterilizer
requires the use of
organic solvents
270 F, 20
psi, 20-40
minutes
Advantages
Disadvantages
advantages
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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
alcohol, formaldehyde, ketone,
acetone and water is used to produce
the sterilizing vapor
- no corrosion of metal instruments
including carbon steel
- no dulling of cutting edges
- suitable for orthodontic stainless
wires
disadvantages
- instruments must be completely
dried
before processing
- special chemical solutions must be
used
- destroys heat sensitive plastics
-
produces a
strong chemical odor in
poorly ventilated areas
-
cannot sterilize liquids
Chemical vapor sterilizer problems
that may result in a failed spore test
faulty temperature gauge
faulty timer
faulty or dirty gasket/seal
faulty or clogged metering valve
IC
How many hours are required to kill bacterial spores when a dental instru-
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ment is placed in a 2
solution of glutaraldehyde?
8 hours
10 hours
12 hours
24 hours
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10 hours
Glutaraldehyde 2
is a liquid chemical sterilant
Advantages
Disadvantages
advantages
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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 w ith sterile water,
dried and placed in a sterile
container (if
not used im m ediately)
Important note
use of a chemical sterilant in
dentistry is no longer considered
appropriate
for sterilizing heat-
stable instruments
- most potent
category of chemical
germicide
- EPA registered as
chemical
sterilant
disadvantages
- long time
period required for
sterilization
-
allergenic
-
highly toxic to tissues
-
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 heat-
based, biologically m onitored
process
if heat sensitive, a heat-stable
alternative or disposable item
must be used
IC
Identify which one of the following is the m ost efficient way to kill microbes:
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cold sterilization
heat sterilization
glutaraldehyde
all of the above
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heat sterilization
Heat sterilization
use of heat has long been recog-
heat sterilization as the method of
choice
when sterilizing instruments
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nized 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
dry heat
destroys m icroorganisms
by causing
coagulation
of proteins
and devices
dental instruments must be appro-
priately cleaned, packaged steril-
ized between uses with a heat-
based, biologically monitored
process
if heat sensitive, it is preferable to
use a heat-stable alternative or
disposable item
IC
Identify which one of the following is a false statement concerning infection
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control in the dental setting:
exposure is not synonymous with infection
do not disinfect what you can sterilize
environmental surfaces must be sterilized between patients
all dental patients can be treated using standard bloodborne precautions
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environmental surfaces must be sterilized
it is
not possible to sterilize the
environmental surfaces
that
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become con taminated during
patient care
thorough cleaning of the
surfaces is sufficient to break the
cycles of cross-contamination and
cross-infection
chemical disinfectants used on sur-
faces should:
- kill as many microbes as possible
in the shortest time possible
- not damage the surface being
decontaminated
-
not be harmful to humans or
animals
- not be affected by presence of
organic material
- be compatible with soap,
detergents and other chem icals
- be inexpensive
- be stable during storage
is
Identify which one of the following is a false statement regarding potential
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operator errors that may cause the failure of a spore test:
the sterilizer was overloaded
the sterilizer cycle was interrupted
improper packaging was used
inadequate time, temperature and/or pressure was used
inadequate warm up time was completed
mineral deposit build up
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mineral deposit build up
Operator errors
overloading
interrupting sterilization cycle
Errors
Problems
A number of conditions may cause a
spore test to fa il - overloading the steril-
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using inadequate time
using inadequate wane up time
using inadequate temperature
using inadequate pressure
using improper packaging
using expired chemical solution
Equipment problems
faulty temperature gauge
faulty pressure gauge
faulty timer
faulty or dirty gasket/seal
faulty heating co il, exhaust line
faulty or clogged bleeder valve
mineral deposit build-up
faulty or clogged metering valve
izer, inadequate temperature and/or pres-
sure, inadequate time or improper
packaging of instruments.
In the majority of cases, OPERATOR
ERRO R is responsible for the failure.
Of all the errors listed in the question,
only one is not an operator error it
is an
EQUIPMENT PROBLEM
mineral deposit build up .
IC
Identify which one of the following is a true statement concerning chemical
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monitoring:
chemical monitoring is a definitive means of determining sterilization
chemical monitoring determines if critical pressure has been reached
chemical monitoring uses heat sensitive chemicals
when a chemical indicator changes color, sterilization is complete
a chemical indicator is part of the spore strip glassine envelope
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chemical monitoring uses heat sensitive chemicals
Chemical monitoring
uses
heat sensitive chemicals
not
weekly testing of the sterilizer
via
biological indicators is the ONL Y
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spores)
to assess the physical condi-
tions during the sterilization process
involves the use of
indicators that
change color when exposed to
certain temperatures
examples include
autoclave tape,
special markings on bags and
pouches, chemical indicator
strips, tabs or packets
a color change only indicates that
the sterilizer reached the proper
temperature
but does not indicate
how long the temperature was
maintained or what pressure was
reached and maintained
confusion often exists between
biological monitoring
spore test-
ing) chemical monitoring
definitive way to verify steriliza-
tion success
a chemical indicator can serve as a
routine check
for all item proce-
ssed in the sterilizer
provides immediate feedback
concerning the critical steriliza-
tion temperature;
identifies if the
sterilizer does not reach critical
temperature
chem ical indicators should be
placed
inside each sterilizer pouch
or wrapped cassette
to verify the
sterilizing parameter for that indica-
tor has been satisfied internally
these indicators should also be
placed on the outside of the
package
IC
Identify which one of the following is a false statement concerning the use
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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
there is a
misguided belief that
alcohol-based hand gels will dry
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use helps to increase compliance
with hand washing guidelines
increasing popularity of hand gels is
due to flexibility convenience
hand washing w ith 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 alco-
hol hand gels kill more germs; hand
gels with 60 - 70 alcohol
reduce
microorganisms including bacteria,
fungi and viruses
significantly better
than soap and water
out the skin,
particularly with
frequent use
alcohol hand gels on the market
today
contain moisturizers specifi-
cally to prevent such dryness
studies have shown that this new
generation of gels
cause less dryness
and irritation than the traditional
soap and water method of hand
washing
IC
Identify which one of the following is a false statement concerning when to
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use hand hygiene techniques in the dental setting:
before touching a patient
before aseptic procedures
after donning gloves
after touching a patient
after touching patient surroundings
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after donning gloves
Hand hygiene recommendations
soap
water hand washing
Techniques
soap
water hand w ashing
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should be used when hands are
dirty or visibly soiled with blood or
other bodily fluids, before eating,
after using a restroom, and, if hands
come in contact with spores
in all other cases, alcohol based
hand gel
can be used for routine
decontamination of hands
once gloves are placed on the
hands,
hand gel or soap
water
should not be used on the gloves
When to clean hands...
before touching a patient
before aseptic procedures
after body fluid exposure or risk
after touching a patient
after touching patient surroundings
-
wet hands
- apply amount of soap recom-
mended by the m anufacturer
-
rub hands togethe r for at least 15
seconds
- rinse with water and dry thoro-
ughly with a disposable towel
-
use towel to turn off faucet
- avoid use of HOT water
alcohol based hand gel
-
apply the amount of gel recom-
mended by the m anufacturer to
one palm
- rub hands togethe r, 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 prod-
uct has been used
IC
Identify which one of the following is a false statement concerning the use of
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disinfectants in the dental setting:
the disinfectant used must be registered by the EPA
each practice must maintain a written schedule for surface disinfection
PPE must be used when using disinfectants
when using a disinfectant, the use of vinyl exam gloves is recommended
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when using a disinfectant the use of vinyl exam gloves is recommended
Surface disinfection
surfaces without barriers must be
cleaned and disinfected with an
Housekeeping surface
reusable pails, bins and containers
must be regularly inspected,
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intermediate-level disinfectant
Manufacturer instructions
disinfecting solutions must be
prepared following manufacturer
guidelines
disinfecting solutions must be EPA
registered
manufacturer instructions for
pre-cleaning surfaces must be
followed before disinfection
the disinfectant must be applied to
the surface for the contact time
designated on the product label
Personal protection equipment
puncture and chemical resistant
utility gloves must be used when
cleanin gand disinfecting surfaces
in addition to gloves, protective
clothing, eye protection mask
must be worn when cleaning and
disinfecting surfaces
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
IC
Between patients, all surfaces without protective coverings m ust be cleaned
and disinfected with an intermediate level disinfectant.
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Between patients, all protective coverings used in p lace of surface disinfec-
tion must be changed/replaced.
both statements are true
both statements are false
the first statement is true, the second is false
the first statement is false, the second is true
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both statements are true
Protective coverings
the use of protective covers on
disinfected surfaces and non-critical
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equipment is acceptable
covers
(barriers)
must be resistant
to fluids and puncture in order to
protect surfaces from contamination
these coverings
may
be used instead
of surface disinfection
between patients
coverings must be replaced/
changed between patients
protective covers eliminate the
need to disinfect the covered
areas between patients
areas covered with barriers during
the treatment day should be
disinfected at the end of the day
s
The Occupational Safety and Health Administration s OSHA)
Bloodborne
Pathogens Standard mandates that all dental healthcare professionals re-
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ceive, at a minimum, the Hepatitis B vaccination series.
The Centers for Disease Control and Prevention (CDC) mandates all other vac-
cinations.
both statements are true
both statements are false
the first statement is true, the second is false
the first statement is false, the second is true
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IC
All employees with potential exposure to bloodborne pathogens are required
to have the Hepatitis B vaccination.
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The vaccination record of each employee must be kept for 30 years beyond
the employee's last day of employment in the practice.
both statements are true
both statements are false
the first statement is true, the second is false
the first statement is false, the second is true
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both statements are true
In the dental setting, who needs the
Hepatitis B vaccination?
all employees with potential exposure
to bloodborne pathogens
What Hepatitis B vaccination documenta-
tion is required?
according to OSHA, a vaccination
record is part of the employee's
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front office and housekeeping staff
should be assessed as to their exposure
level; if the answer to the following
questions is yes , the vaccination
is needed
- do they handle contaminated laundry?
- do they enter patient treatment areas
where there is potential for exposure?
- are they designated to perform first
aid or CPR?
When should the dentist employer offer
Hepatitis B vaccinations to employees?
employers are required to provide
Hep B vaccinations to all new
employees free of charge after train-
ing and within 10 days of working in
a position where there is potential
exposure to bloodborne pathogens
the only exception is if the employee
has previously received the vaccine
series, and, antibody testing has
revealed the worker is immune
medical record, and
is
required
t
e
kept for 30 years
beyond the employ-
ees last date of employment
all part-
time and temporary employ-
ees are required to provide documenta-
tion of Hep B vaccination which must
be
kept for the same amount of time,
30 years
according to the CDC and OSHA 29
CFR 1910.1030 (h) (1) (ii) (B), employ-
ers are required to keep accurate
copies of each employees Hep B
vaccination status, including the date
of each dose
Is a post vaccination titer required?
post vaccination
titer testing m ust be
done 1 -
2 months after the original
vaccine series is completed
documentation is treated like an
employee medical record
and kept for
30 years from last date of employment
IC
A booster dose of the Hepatitis B vaccine is required.
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The Hepatitis B vaccine series requires that at least 16 weeks elapse between
dose 1 and dose 3.
both statements are true
both statements are false
the first statement is true, the second is false
the first statement is false, the second is true
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the first statement is false, the second is true
What if a new employee
has
been previously
vaccinated but has no documentation?
check with em ployee's previous
employers per OSH A requirements, a
What if a titer, administered within
the
proper amount of time, showed the
employee status to be negative?
repeat the three dose series and test for
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copy of the vaccination records should be
part of the m edical record and retained
if all attempts are unsuccessful, OSHA
requires documentation verifying the
employers attempt to obtain the record
and should include a written statement
from the em ployee about vaccination
status and approximate dates of the
vaccinations
if original documents cannot be obtained
then the Hep B vaccination must be made
available unless the employee has titer
documentation
What if an employee started, but did not
complete the three
doses of the vaccine?
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