ADC Written (Dental Therapy) cheat sheet

Scope of practice: dental therapists provide preventive and restorative care to children, adolescents, and in some jurisdictions adults, under supervision or collaborative agreement; exact scope is defined by jurisdiction.

Assessment sequence: medical/dental history, vital signs if indicated, extraoral/intraoral examination, periodontal charting, caries risk assessment, then treatment planning within scope.

Caries risk assessment tools (e.g., CAMBRA, Cariogram) categorize risk as low/moderate/high/extreme and guide recall interval and preventive therapies.

Restorative procedures within scope often include amalgam and composite for primary and permanent teeth, stainless steel crowns, and pulpotomies in some jurisdictions.

Local anesthesia and nitrous oxide administration may be permitted for dental therapists depending on jurisdiction and certification.

Recall interval is risk-based: low risk 12–24 months, moderate 6–12 months, high 3–6 months, with radiographs according to ALARA and guidelines.

Referral triggers: lesions beyond scope, uncontrolled medical conditions, suspected pathology, trauma requiring specialist care, or patient behavior requiring advanced management.

Documentation must include informed consent, findings, treatment provided, materials used, and any referrals; record is a legal document.

Infection control follows standard precautions: hand hygiene, PPE, sterilization of critical instruments, and surface disinfection between patients.

Primary caries prevention: twice-daily brushing with fluoride toothpaste (1000–1500 ppm for most), interdental cleaning daily, and limiting free sugars to <10% of energy intake (WHO).

Fluoride varnish (5% NaF) applied 2–4 times/year reduces caries incidence by ~30–40% in children; indicated for high-risk patients.

Silver diamine fluoride (38%) arrests active dentinal caries and is a non-invasive option for high-risk or uncooperative patients; causes black staining.

Periodontal disease prevention: daily plaque removal, professional mechanical plaque removal at risk-based intervals, and tobacco cessation advice.

Oral health promotion uses the Common Risk Factor Approach: diet, tobacco, alcohol, hygiene, and injuries shared with other NCDs.

Motivational interviewing is an evidence-based counselling method for behavior change (e.g., smoking cessation, diet, oral hygiene).

Pit and fissure sealants are indicated for deep caries-susceptible pits/fissures, especially in children; retention should be checked at recall.

Oral health education should be culturally appropriate, use plain language, and involve caregivers for children.

Recall and screening: visual-tactile caries detection (ICDAS) and periodontal screening (PSR/BPE) guide preventive and referral decisions.

Tooth anatomy: enamel (96% hydroxyapatite), dentin (70% mineral, 20% organic, 10% water), pulp (connective tissue, nerves, vessels), cementum, periodontal ligament, alveolar bone.

Dental caries is a biofilm-mediated, sugar-driven, multifactorial disease; demineralization occurs when pH <5.5 (critical pH for enamel).

Periodontal disease: gingivitis is reversible inflammation limited to gingiva; periodontitis involves attachment loss, pocket formation, and alveolar bone loss.

Pulpitis: reversible (provoked pain, no spontaneous pain) vs irreversible (spontaneous, lingering pain); irreversible requires pulpectomy or extraction.

Local anesthesia: lidocaine 2% with 1:100,000 epinephrine provides ~60 min pulpal anesthesia; max dose 4.4 mg/kg (7 mg/kg with epi).

Antibiotic prophylaxis is indicated for patients with certain cardiac conditions (e.g., prosthetic valve, history of endocarditis) before invasive dental procedures.

Microbiology: Streptococcus mutans and lactobacilli are key cariogenic bacteria; Porphyromonas gingivalis, Treponema denticola, Tannerella forsythia are periodontal pathogens.

Saliva buffers acids (bicarbonate) and contains antimicrobial proteins (lysozyme, lactoferrin, IgA); hyposalivation increases caries risk.

Wound healing: primary intention (clean wound), secondary intention (infected/gaping), and factors impairing healing (diabetes, smoking, steroids).

Informed consent requires capacity, disclosure of material risks/benefits/alternatives, and voluntary decision; documented in the record.

Confidentiality: patient information may only be disclosed with consent or as required by law (e.g., suspected abuse, court order, public health reporting).

Scope of practice: practitioners must only perform procedures for which they are trained, competent, and authorized; referral is required when beyond scope.

Mandatory reporting: suspected child abuse/neglect, elder abuse, and certain communicable diseases must be reported to authorities per jurisdiction.

Cultural safety: recognize power imbalances, historical trauma (e.g., colonization), and provide care that respects the patient's cultural values and identity.

Health equity: use interpreters, culturally appropriate resources, and trauma-informed communication to reduce barriers.

Professional boundaries: avoid dual relationships, maintain appropriate physical and emotional boundaries, and manage conflicts of interest.

Record keeping: accurate, contemporaneous, legible, and secure; retain per legal requirements; patients have right to access their records.

Ethical principles: autonomy, beneficence, non-maleficence, justice, veracity, and fidelity guide decision-making.