ADC Practical Exam cheat sheet

Spaulding classification: critical items (surgical instruments, extraction forceps) must be sterilised; semi-critical items (mirrors, impression trays) require sterilisation or high-level disinfection; non-critical items (light handles, countertops) require low-level disinfection.

Hand hygiene with soap and water is required when hands are visibly soiled or after exposure to Clostridioides difficile spores or norovirus; alcohol-based rub is acceptable for routine decontamination of non-soiled hands.

Sterilisation validation uses three tiers: physical (autoclave gauge and printout), chemical (autoclave tape or internal indicator strips), and biological (Geobacillus stearothermophilus spores for steam, Bacillus atrophaeus for dry heat and ethylene oxide).

Type B vacuum autoclaves are required for wrapped hollow instruments and porous loads; type N benchtop units are limited to solid unwrapped items.

Sharps injury protocol: encourage bleeding, wash with soap and water, do not scrub or suck, report immediately; HIV PEP should start within hours and no later than 72 hours, and hepatitis B status determines need for immunoglobulin.

Aerosol-generating procedures such as ultrasonic scaling and high-speed drilling require a high-volume evacuator, rubber dam, and appropriate respiratory protection; standard precautions apply to all patients regardless of known status.

Routine spatter control includes flushing waterlines for 20-30 seconds between patients and running the ultrasonic scaler with copious irrigation to reduce biofilm and aerosol load.

Clinical waste segregation: sharps into rigid puncture-resistant containers filled to no more than three-quarters; infectious soft waste into yellow or orange bags per local regulation; amalgam waste into sealed mercury-retaining containers.

Cavity classification (G.V. Black): Class I pits and fissures; Class II proximal surfaces of posteriors; Class III proximal surfaces of anteriors without incisal edge involvement; Class IV includes the incisal edge; Class V cervical third of any tooth.

Enamel bond strength to resin composite relies on acid etching with 30-40% phosphoric acid for 15 seconds on enamel; dentine requires a separate primer or self-etch approach because of its higher water and collagen content.

C-factor equals bonded surface area divided by unbonded surface area; high C-factor cavities, such as Class I, generate more polymerisation shrinkage stress and favour incremental layering.

Resin composite increments should not exceed 2 mm for bulk-fill materials or about 1.5-2 mm for conventional composites to ensure adequate depth of cure with a light unit of at least 1000 mW/cm2.

Glass ionomer releases fluoride and bonds chemically to tooth structure, making it suitable for high caries-risk patients, root caries, and paediatric restorations, but it has lower fracture toughness than composite.

Amalgam has no adhesive bond and requires mechanical retention; it should not be placed in contact with other metals where galvanic current is a concern, and it is contraindicated in visible aesthetic zones.

Rubber dam isolation is essential for adhesive dentistry and endodontics; it protects the airway, maintains a dry field, and improves visibility and moisture control.

Post-operative sensitivity after composite placement is often linked to incomplete dentine sealing, excessive etching time, or inadequate light curing; occlusal adjustment should be checked before dismissal.

Working length is typically estimated 0.5-1.0 mm short of the radiographic apex; electronic apex locators are reliable in the presence of blood or exudate but may be affected by metallic restorations or excessive irrigant.

Irrigation with sodium hypochlorite at 0.5-5.25% dissolves organic tissue and provides antimicrobial action; EDTA at 17% is used as a chelating agent to remove the smear layer.

Sodium hypochlorite must never be extruded beyond the apex; signs of extrusion include sudden severe pain, immediate swelling, and tissue necrosis, requiring immediate irrigation with saline and supportive care.

Canal preparation uses a crown-down or step-back technique; the apical foramen should be enlarged to at least a size 25 file in most cases, with larger sizes for younger or wider canals.

Root canal obturation with gutta-percha and sealer should be verified radiographically; a dense, three-dimensional fill with no voids and no sealer extrusion beyond the apex is the goal.

A flare-up after endodontic treatment is defined as pain or swelling requiring an unscheduled visit; incidence is higher with necrotic pulps, retreatment, and inadequate cleaning.

Pulpal diagnosis categories: reversible pulpitis (sharp, stimulus-provoked, subsides quickly), irreversible pulpitis (spontaneous or lingering pain), and necrotic pulp (no response to thermal or electric pulp testing).

Endodontic treatment of a tooth with an immature apex may require apexification or regenerative endodontics; calcium hydroxide or MTA apexification induces a hard tissue barrier.

Periodontal probing depth of 1-3 mm is generally healthy; 4 mm suggests early attachment loss; 5 mm or greater indicates significant pocketing requiring intervention.

Clinical attachment loss equals probing depth plus recession minus the cementoenamel junction; it is the key measure of true periodontal destruction.

The 2017 classification stages periodontitis by severity: Stage I (CAL 1-2 mm), Stage II (CAL 3-4 mm), Stage III (CAL 5 mm or more with tooth loss of 4 or fewer), and Stage IV (tooth loss of 5 or more with complex rehabilitation needs).

Grading reflects progression rate: Grade A (slow), Grade B (moderate), Grade C (rapid), based on radiographic bone loss divided by age and other risk factors such as smoking and diabetes.

Non-surgical periodontal therapy includes scaling and root planing, oral hygiene instruction, and risk factor modification; re-evaluation is typically performed 6-8 weeks after completion.

Systemic risk factors that modify periodontal management include poorly controlled diabetes (HbA1c above 7%), smoking, and immunosuppression; smoking reduces bleeding on probing and masks inflammation.

Gingival crevicular fluid flow and bleeding on probing are indicators of active inflammation; absence of bleeding on probing has a high negative predictive value for stability.

Antibiotic adjuncts such as amoxicillin with metronidazole are reserved for aggressive or Grade C periodontitis and should not replace mechanical debridement.

Occlusal vertical dimension can be assessed using the rest position minus 2-4 mm freeway space, phonetics (closest speaking space), and facial proportions such as the thirds of the face.

Complete denture retention depends on adhesion, cohesion, surface tension, and atmospheric pressure; maximum extension within functional limits improves the border seal.

The neutral zone is the space where the tongue, lips, and cheeks exert balanced forces; arranging teeth in this zone improves stability of complete dentures.

Conventional complete denture impressions use a stock tray and alginate for the primary impression, followed by a custom tray and elastomeric material for the final impression.

Crown preparation should preserve a minimum of 1.5 mm occlusal reduction for porcelain and 1.0-1.5 mm axial reduction for metal-ceramic restorations, with a chamfer or shoulder margin.

Abutment selection for fixed partial dentures follows Ante's rule: the combined root surface area of the abutments should equal or exceed that of the missing teeth.

Implant osseointegration requires primary stability, adequate bone volume, and a healing period of 3-6 months depending on bone quality and implant surface.

Occlusal splints for bruxism should provide even, simultaneous contacts in centric relation and disclude in excursive movements to reduce muscle activity.

Extraction forceps selection: maxillary central and lateral incisors use upper anterior forceps (No. 1); maxillary molars use upper molar forceps (No. 18R and 18L); mandibular molars use lower molar forceps (No. 23).

The extraction sequence involves anaesthesia, syndesmotomy, luxation with an elevator, application of forceps apically, and controlled buccal and lingual forces, avoiding excessive force on the buccal plate.

Dry socket (alveolar osteitis) presents 2-4 days post-extraction with severe throbbing pain and an empty socket; treatment involves irrigation and a medicated dressing, not antibiotics alone.

Post-extraction bleeding management includes pressure with gauze, local haemostatic agents, and suturing; persistent bleeding requires investigation for coagulopathy or hypertension.

Third molar assessment uses Winter's classification (mesioangular, distoangular, horizontal, vertical) and Pell and Gregory classification for depth and ramus relationship.

Inferior alveolar nerve injury risk is highest with deeply impacted mandibular third molars; radiographic signs include loss of the white line and diversion of the canal.

Surgical extraction indications include severe caries below the gum line, retained roots, ankylosis, and teeth that cannot be removed with forceps alone.

Post-operative instructions after extraction include avoiding rinsing for 24 hours, no smoking, soft diet, and analgesia; sutures are typically removed 5-7 days later.

Maximum safe doses: lidocaine 2% with 1:100,000 epinephrine is 4.4 mg/kg (up to 300 mg); articaine 4% is 7 mg/kg (up to 500 mg); bupivacaine 0.5% is 1.3 mg/kg (up to 90 mg).

One cartridge of 2% lidocaine contains 36 mg; one cartridge of 4% articaine contains 72 mg; one cartridge of 0.5% bupivacaine contains 9 mg.

Inferior alveolar nerve block targets the pterygomandibular space; landmarks include the coronoid notch, the pterygomandibular raphe, and the occlusal plane of the mandibular molars.

The Gow-Gates technique provides a wider area of anaesthesia and a lower rate of positive aspiration than the conventional inferior alveolar block.

Positive aspiration occurs more often with the inferior alveolar block than with infiltration; aspirate in two planes before injecting to reduce intravascular injection risk.

Epinephrine-containing solutions are contraindicated in patients with uncontrolled hyperthyroidism, pheochromocytoma, or severe cardiovascular disease; plain solutions may be preferred.

Complications of local anaesthesia include syncope, haematoma, trismus, nerve paraesthesia, and needle breakage; syncope is the most common adverse reaction.

Topical anaesthetic should be applied to dry mucosa for 1-2 minutes before injection; benzocaine should not be used in children under 2 years due to methaemoglobinaemia risk.

The paralleling technique uses a film or sensor holder to keep the receptor parallel to the tooth and the central ray perpendicular, minimising distortion; the bisecting angle technique is used when paralleling is not possible.

Cone cutting occurs when the central ray is not aligned with the receptor; elongation results from insufficient vertical angulation, and foreshortening results from excessive vertical angulation.

ALARA principles require the lowest radiation dose reasonably achievable; rectangular collimation and lead aprons reduce patient dose, and digital sensors require lower exposure than film.

Panoramic radiography provides a broad overview but has lower resolution than intraoral films; it is useful for assessing third molars, impacted teeth, and bone pathology.

Cone beam computed tomography is indicated for implant planning, complex endodontics, and impacted teeth; it should be justified by clinical need because of higher radiation dose than 2D imaging.

Radiographic interpretation should be systematic: assess image quality, then teeth, bone, periodontium, and surrounding structures; compare with previous images when available.

Digital radiography allows post-processing such as contrast enhancement and measurement tools but does not improve diagnostic accuracy if the original exposure is inadequate.

Pregnancy is not an absolute contraindication to dental radiography; elective imaging should be deferred, but urgent imaging with shielding is acceptable when clinically necessary.

Informed consent requires disclosure of the nature of the procedure, risks, benefits, alternatives, and the consequences of no treatment; it should be documented in the record.

The principles of biomedical ethics are autonomy, beneficence, non-maleficence, and justice; autonomy underpins informed consent and the right to refuse treatment.

Breaking bad news can follow the SPIKES framework: Setting, Perception, Invitation, Knowledge, Empathy, and Strategy or Summary.

Communication barriers include hearing impairment, language differences, and anxiety; use plain language, teach-back, and professional interpreters rather than family members for consent discussions.

Confidentiality is a core professional duty; disclosure without consent is permitted only when required by law, to prevent serious harm, or for public health reporting.

Record keeping should be contemporaneous, legible, and factual; clinical notes are legal documents and may be disclosed in litigation or regulatory proceedings.

Managing an angry patient involves active listening, acknowledging concerns, avoiding defensiveness, and offering a clear plan; escalate to a senior colleague or practice manager if unresolved.

Professional boundaries require avoiding dual relationships and declaring conflicts of interest; social media contact with patients should be avoided.

Syncope management: position the patient supine with legs elevated, ensure airway patency, administer oxygen, monitor vital signs, and allow recovery before discharge.

Anaphylaxis management: administer intramuscular adrenaline 0.5 mg (0.5 mL of 1:1000) into the anterolateral thigh, repeat every 5 minutes if needed, call emergency services, and provide high-flow oxygen.

Angina or myocardial infarction: stop treatment, sit the patient upright, administer sublingual glyceryl trinitrate, give aspirin 300 mg if not contraindicated, and call emergency services for persistent chest pain.

Asthma exacerbation: stop treatment, sit the patient upright, administer a salbutamol inhaler with a spacer, and give oxygen; call emergency services if there is no improvement.

Hypoglycaemia in a conscious patient: give 15-20 g of fast-acting oral carbohydrate; in an unconscious patient, give intramuscular glucagon 1 mg or intravenous glucose and call emergency services.

Basic life support sequence: check responsiveness and breathing, call for help, start chest compressions at 100-120 per minute at a depth of 5-6 cm, and use an AED as soon as available.

Foreign body airway obstruction: encourage coughing if effective; for ineffective cough in a conscious adult, give up to 5 back blows followed by 5 abdominal thrusts, alternating until relief.

Emergency drug kit essentials include adrenaline, glyceryl trinitrate, salbutamol, glucagon, aspirin, chlorphenamine, and oxygen, with regular checks for expiry dates.