NDHCE cheat sheet

Core ethical principles: autonomy (patient self-determination), beneficence (do good), nonmaleficence (do no harm), justice (fairness), veracity (truthfulness), and confidentiality.

Informed consent requires disclosure of diagnosis, proposed treatment, alternatives, risks, benefits, and the right to refuse; it must be voluntary and documented.

Scope of practice is defined by state statute and the state dental board; expanded functions (local anesthesia, nitrous oxide, restorative) require specific additional licensure.

Mandatory reporting duties typically include child abuse/neglect, elder and dependent-adult abuse, and in many states specific communicable diseases; reporting is a legal obligation, not discretionary.

Supervision categories: direct (supervisor on premises and evaluates), indirect (supervisor on premises but does not evaluate), general (supervisor available by phone), and unsupervised/public health settings.

Breach of duty, duty owed, causation, and damages are the four elements a plaintiff must prove in a dental hygiene negligence claim.

Statute of limitations for malpractice varies by state (commonly 1-3 years from discovery); records are retained per state rule, often 7-10 years, and longer for minors.

A HIPAA breach involves unsecured PHI; notification to affected individuals is generally required within 60 days of discovery.

Documentation standards: objective, chronological, dated, signed entries with corrections made by single line-out, initial, and date; never alter or backdate a record.

Caries balance: demineralization is driven by fermentable carbohydrate frequency and acidogenic bacteria; remineralization is driven by calcium, phosphate, fluoride, and salivary flow.

Fluoride varnish 5% NaF (22,600 ppm) is applied 2-4 times yearly for moderate-to-high caries risk; it is not a substitute for daily home fluoride.

Community water fluoridation is adjusted to 0.7 mg/L; it reduces caries by roughly 25% across the lifespan and is cost-saving at community scale.

Caries risk assessment tools (e.g., CAMBRA, Cariogram) stratify patients by disease indicators, protective factors, and risk factors to set recall and intervention intensity.

Primary prevention (before disease) includes sealants, fluoride, plaque control, and diet counseling; secondary prevention is early detection; tertiary is rehabilitation.

Tobacco cessation follows the 5 A's: Ask, Advise, Assess, Assist, Arrange; brief counseling plus pharmacotherapy improves quit rates.

Pregnancy: elective dental treatment is safest in the second trimester; supine positioning after mid-pregnancy risks supine hypotensive syndrome.

Diabetes and periodontal disease have a bidirectional relationship; glycemic control (HbA1c) influences periodontal status and vice versa.

Vital sign reference: adult BP <120/<80 normal, 120-129/<80 elevated, 130-139 or 80-89 stage 1 hypertension; pulse 60-100 bpm; respirations 12-20/min; temperature 36.1-37.2 C oral.

ASA classification: I healthy, II mild systemic disease, III severe systemic disease not incapacitating, IV incapacitating/threat to life; ASA III-IV often requires medical consultation.

Periodontal charting records probing depth, clinical attachment level, bleeding on probing, mobility, furcation involvement, and recession; CAL = probing depth + recession.

Gingival description uses color, contour, consistency, and texture; healthy tissue is coral pink, stippled, firm, and knife-edged.

Extraoral/intraoral exam screens TMJ, lymph nodes, salivary glands, mucosa, tongue, palate, and oropharynx; any lesion persisting beyond 2 weeks warrants referral.

Radiographic selection follows the ALARA principle and selection criteria (e.g., ADA/FDA guidelines) rather than routine fixed intervals.

Medical history must capture medications, allergies, bleeding disorders, cardiac conditions requiring antibiotic prophylaxis, and bisphosphonate/antiresorptive use.

Indexes: DMFT/dmft for caries, Löe-Silness for gingival inflammation, and periodontal screening tools guide diagnosis and documentation.

The dental hygiene diagnosis identifies human needs (e.g., from the Human Needs Conceptual Model) that the hygienist is licensed to treat; it differs from the dentist's dental diagnosis.

Care plan components: assessment data, dental hygiene diagnosis, goals/outcomes, interventions, evaluation, and documentation with target dates.

Goals must be patient-centered, measurable, time-bound, and realistic; they are written as outcomes, not as clinician tasks.

Recall intervals are risk-based: high-risk patients may need 3-month intervals; low-risk may extend to 6-12 months.

Interventions are sequenced to address urgent needs (pain, infection, bleeding) before elective or preventive care.

Informed refusal must be documented when a patient declines recommended care, including the discussion of risks and alternatives.

Evaluation compares outcomes against baseline data (e.g., reduced bleeding on probing, improved plaque control) and triggers plan revision if unmet.

Collaboration and referral to specialists (periodontist, physician, dietitian) are part of comprehensive planning.

Scaling and root planing removes supra- and subgingival deposits and contaminated cementum; it is definitive nonsurgical therapy for periodontitis and is often done by quadrant with anesthesia.

Instrument selection: sickle scalers for supragingival calculus; universal and area-specific curettes for subgingival; ultrasonic/sonic scalers for heavy deposits and lavage.

Sharpening maintains a sharp cutting edge; a dull instrument requires more lateral pressure, causing burnished calculus and tissue trauma.

Fluoride modalities: 5% NaF varnish, 1.23% APF gel/foam (4-minute tray), 2% NaF solution, and 0.05% NaF daily rinse; APF is contraindicated on porcelain/composite.

Chlorhexidine 0.12% rinse is the antiplaque gold standard but causes staining and taste alteration; it is used short-term as an adjunct.

Local anesthesia: 2% lidocaine with 1:100,000 epinephrine gives approximately 60 minutes pulpal anesthesia; maximum dose considerations apply.

Sealant placement requires isolation and etched enamel; sealants are indicated on pits/fissures of caries-prone teeth, especially permanent molars.

Powered toothbrushes and interdental aids (floss, interdental brushes, water flosser) are selected based on interproximal space and patient dexterity.

Postoperative instructions after SRP include expected sensitivity, bleeding, and avoidance of hard/hot foods until anesthesia resolves.

Tooth eruption and exfoliation schedules: primary dentition completes by ~2.5-3 years; permanent first molars erupt ~6 years; third molars ~17-21 years.

Periodontal disease pathogenesis: plaque biofilm triggers host inflammatory response; tissue destruction is largely host-mediated (MMPs, cytokines), not solely bacterial.

Enamel is 96% mineral (hydroxyapatite); dentin is ~70% mineral with tubules; pulp contains nerves and vessels and responds to thermal/chemical stimuli.

Bone remodeling: osteoblasts form bone, osteoclasts resorb; bisphosphonates and denosumab inhibit osteoclasts, raising MRONJ risk with invasive dental care.

Systemic links: diabetes, cardiovascular disease, and adverse pregnancy outcomes are associated with periodontal inflammation.

Saliva buffers acids and provides calcium/phosphate; xerostomia (from medications, Sjögren, radiation) raises caries and candidiasis risk.

Pharmacology: epinephrine in local anesthetics provides vasoconstriction and hemostasis; avoid in uncontrolled hyperthyroidism and severe cardiovascular disease.

Dental caries is a multifactorial, biofilm-mediated, diet-modulated disease; Streptococcus mutans and Lactobacillus are key acidogenic organisms.

Standard precautions apply to all patients regardless of diagnosis; treat all blood and body fluids as potentially infectious.

Hand hygiene: routine handwashing with soap and water for 15-20 seconds; alcohol-based hand rub is acceptable when hands are not visibly soiled.

PPE: gloves, mask, protective eyewear, and gown; change gloves between patients and after contact with contaminated surfaces.

Sterilization: autoclave (steam under pressure) at 121 C/15 psi for 15-20 minutes or 132 C for 4 minutes; monitor with biological indicators (spore tests) at least weekly.

High-level disinfection for semicritical items (e.g., some items not heat-stable); low-level disinfection for housekeeping surfaces.

Sharps safety: never recap by hand; use the one-handed scoop method or a recapping device; dispose in puncture-resistant sharps containers.

Hepatitis B, HIV, and tuberculosis are key occupational exposures; post-exposure protocols include immediate washing, reporting, and PEP evaluation.

Surface barriers and disinfection of operatory surfaces between patients reduce cross-contamination; waterlines require flushing and periodic testing.

Public health core functions: assessment, policy development, and assurance; dental public health applies these to population oral health.

Epidemiology measures: incidence (new cases/time), prevalence (existing cases), and DMFT/dmft index for caries burden.

Community water fluoridation is a population-level, cost-effective primary prevention strategy; it reduces caries disparities.

School-based sealant programs target high-risk children and are cost-effective when delivered to populations with elevated caries risk.

Health promotion models include the Health Belief Model, Transtheoretical Model (stages of change), and PRECEDE-PROCEED for program planning.

Cultural competence and health literacy affect access and adherence; interpreters and plain-language materials improve outcomes.

Program evaluation uses process, impact, and outcome measures; SMART objectives guide planning and measurement.

Access barriers include cost, transportation, workforce shortages, and insurance; teledentistry and mobile clinics expand reach.