DANB CPFDA cheat sheet

Sealants are indicated for pit-and-fissure caries prevention on permanent molars and premolars, most often newly erupted teeth with deep, retentive, non-carious fissures.

Candidacy rule: a fissure that a #23 explorer cannot penetrate is shallow and typically does not need sealing; a fissure that catches or holds the explorer tip is deep and benefits from sealant.

Sealant placement is contraindicated over active dentinal caries, on partially erupted teeth with operculum or gingival tissue covering the field, and where moisture cannot be controlled.

Isolation is the single largest determinant of retention: cotton rolls plus a dry-angle, or a rubber dam for multi-quadrant placement, must keep enamel dry before and during etching.

Etch enamel with 30-40% phosphoric acid for roughly 15-20 seconds on primary teeth and 20-30 seconds on permanent teeth, then rinse and dry to a frosty white appearance.

Contaminated etched enamel (saliva, water, air line oil) must be re-etched for the full time; do not place sealant over a surface that has lost the frosty appearance.

Light-cured unfilled or filled sealant is cured per manufacturer wavelength and time; the tip must be held close to the surface, and oxygen-inhibited layer is removed or left per product instructions.

Check retention with an explorer after curing; reapply or repair partial loss, and re-evaluate sealed teeth at each recall because sealants can chip or wear.

Coronal polishing removes plaque and extrinsic stain from the clinical crown only; it is not a substitute for scaling and does not remove calculus.

Polishing is contraindicated before sealant or composite bonding unless the surface is thoroughly rinsed, because prophy paste residue and glycerin can interfere with etching and bonding.

Selective polishing is the preferred approach: polish only teeth with visible extrinsic stain or before fluoride varnish, adhesive procedures, or cementation.

Rubber cup and bristle brush are the standard tools; the cup is filled about one-third to one-half full and run at low speed to limit splatter and frictional heat.

Prophy paste grit is chosen by need: coarse for heavy stain, medium for routine, fine for maintenance or before restorative work; fluoridated pastes are common.

Sequence rule for a full-mouth polish: start with the least-stained quadrant and finish with the heaviest stain, changing or replenishing paste between quadrants.

Do not polish exposed root surfaces, demineralized white-spot lesions, active carious lesions, or newly erupted teeth with immature enamel, to avoid removing tooth structure.

Suction and a covered cup or brush limit aerosol; polishing generates splatter, so eyewear, mask, and gloves are required, and the cup should stay in contact with the tooth.

Topical anesthetics act on mucosa and gingiva to a depth of about 2-3 mm; they do not anesthetize teeth or bone and never replace local anesthetic injection.

Common agents are benzocaine 20% (often with 6% or 20% benzocaine gels), lidocaine 2-5%, and lidocaine/prilocaine eutectic mixtures; onset is typically 1-5 minutes depending on agent and site.

Apply to dried mucosa with a cotton swab or applicator, using pressure or a small amount of friction, and allow the full onset time before needle insertion.

Maximum benzocaine dose in adults is generally limited by methemoglobinemia risk; keep application to the smallest effective amount and avoid repeated reapplication.

Benzocaine is contraindicated in children under 2 years and should be used cautiously in young children because of methemoglobinemia reports; many products carry this warning.

Document allergy history before application; ester anesthetics (benzocaine) are more likely to cause true allergy than amides, and a documented ester allergy requires an alternative agent.

Topical anesthetic is not a substitute for aspiration and slow injection technique; it reduces needle pain but does not eliminate intravascular or nerve injury risk.

Adverse effects to monitor include blanching, burning, sloughing of mucosa, and systemic signs such as cyanosis or dyspnea, which suggest methemoglobinemia and require stopping use.

Professionally applied 5% sodium fluoride varnish (22,600 ppm F) is the standard for caries prevention in children and adults; 1.23% acidulated phosphate fluoride (12,300 ppm F) is an alternative.

Varnish application: dry the teeth, apply a thin layer to all erupted surfaces, avoid suctioning the material away, and instruct the patient to avoid brushing and hard food for at least 4-6 hours.

APF is contraindicated on porcelain, composite, and glass ionomer restorations and on sealants because the acidulated pH can etch or degrade them; varnish is compatible with all restorations.

Fluoride varnish is not a substitute for a dentifrice; home use of fluoridated toothpaste with an appropriate amount for age remains the daily preventive baseline.

Application frequency is risk-based: every 3-6 months for high caries risk, and at least every 6 months for moderate risk; low-risk patients may need less frequent application.

Do not apply varnish immediately before or after sealant or bonding procedures unless the product is compatible, because some varnishes interfere with adhesion; sequence per manufacturer.

Fluoride toxicity risk is dose-related; know the probable toxic dose (5 mg F/kg) and that varnish tubes are unit-dose, reducing accidental ingestion risk compared with gels in trays.

Document the agent, concentration, and teeth treated; note any allergy or adverse reaction, and avoid varnish on ulcerated or bleeding mucosa where absorption increases.

Standard precautions apply to all patients regardless of diagnosis: gloves, mask, protective eyewear, and gown as indicated by anticipated exposure to blood or saliva.

Hand hygiene is the single most effective control: wash with soap and water when hands are visibly soiled or after glove removal, and use alcohol-based rub otherwise.

Single-use items (needles, cotton rolls, prophy cups, varnish applicators, gloves) are never reused; sharps go directly into a puncture-resistant container at the point of use.

Critical items (instruments that penetrate tissue) require sterilization, usually steam autoclave; semicritical items (mirrors, explorers) require sterilization or high-level disinfection.

Sterilization monitoring uses biological indicators (spore tests) at least weekly, plus chemical indicators and physical parameters on every load; positive spore tests require load recall.

Surface barriers are preferred for frequently touched surfaces; if not barrier-protected, disinfect with an EPA-registered hospital disinfectant labeled for the appropriate contact time.

Dental unit waterlines must meet drinking-water standards (no more than 500 CFU/mL of heterotrophic bacteria); flush lines and follow the manufacturer's waterline treatment protocol.

Immunization, exposure control plans, and post-exposure protocols (wash, report, evaluate for HIV/HBV/HCV) are required elements of the office safety program.

Sealant material types: unfilled resin (low viscosity, flows into fissures), filled resin (more wear-resistant, needs occlusal adjustment less often), and glass ionomer (moisture-tolerant, fluoride-releasing, lower retention).

Bonding agent or adhesive layer may be used with some filled sealants per manufacturer instructions; do not add steps not specified by the product's instructions for use.

Primary teeth can be sealed when caries risk is high and the tooth is expected to be retained for years; primary molars with deep fissures benefit when risk justifies it.

Sealant over incipient (non-cavitated) caries can arrest the lesion if the surface is clean and dry; sealant is contraindicated over cavitated or radiographically evident dentinal caries.

Retention rates are highest in the first year and decline over time; recall evaluation with an explorer and visual inspection determines need for repair or replacement.

Moisture control sequence: isolate, clean the fissure with a brush or pumice, rinse, etch, rinse, dry, place sealant, cure, and check occlusion and retention.

Informed consent and documentation should record tooth number, material, isolation method, and any caries found; a sealant placed on a questionable surface is noted for follow-up.

Prophy paste contains abrasive (pumice or silica), binder, humectant, and often fluoride; the abrasive grit determines how much enamel and stain are removed.

Rubber cup speed is kept low (slow-speed handpiece) and applied with light intermittent pressure; sustained high pressure generates heat and can gouge enamel or gingiva.

Polishing is deferred for at least 30 minutes after professional fluoride varnish in some protocols, or the varnish is reapplied; check the product's instructions for the sequence.

Air polishing and ultrasonic scalers are not the same as coronal polishing; they are not permitted as coronal polishing substitutes where scope of practice restricts polishing to the crown.

Stain from tobacco, coffee, tea, and chlorhexidine is extrinsic and responds to polishing; intrinsic stain (tetracycline, fluorosis) does not and requires bleaching or restoration.

Assess before polishing: note restorations, orthodontic appliances, exposed cementum, and areas of demineralization; avoid those areas or use a soft cup and fine paste.

After polishing, rinse and suction all paste residue, inspect margins of restorations, and floss interproximally to remove trapped abrasive.

Onset and depth vary by site: thin, non-keratinized mucosa (labial, buccal, palatal anterior) responds faster than thick keratinized tissue such as the hard palate.

Drying the site with gauze before application improves uptake; saliva dilutes and washes away the agent, so isolation with cotton rolls helps.

Topical anesthetic is applied before the needle, not after; the injection site should still be tested and the injection delivered slowly to limit pain.

Benzocaine 20% is the most common OTC and professional topical; lidocaine 2% gel and 5% ointment are alternatives, and eutectic mixture (lidocaine/prilocaine) is used in some settings.

Systemic absorption from intact mucosa is low but increases with broken mucosa, large surface area, and prolonged contact; keep application time to the labeled duration.

Do not use topical anesthetic as a substitute for assessing a patient's medical history; cardiovascular disease, methemoglobinemia history, and pregnancy alter agent choice.

Store topical anesthetics per label, check expiration dates, and avoid cross-contamination by dispensing onto a clean surface rather than dipping a used applicator into the container.

Fluoride mechanisms: topical fluoride promotes remineralization, forms fluorapatite, and inhibits demineralization; systemic fluoride acts mainly during tooth development.

Concentrations: 5% NaF varnish 22,600 ppm; 1.23% APF 12,300 ppm; 2% NaF 9,040 ppm; 0.2% NaF rinse 900 ppm; 0.05% NaF daily rinse 225 ppm; 1,000-1,500 ppm dentifrice.

Varnish is preferred for children under 6 and for patients with many restorations because it adheres to wet surfaces and minimizes ingestion risk.

Fluoride varnish can be applied to white-spot lesions and around orthodontic brackets to reduce demineralization; apply to all surfaces including interproximal areas.

Fluoride gel in trays (APF) is applied for about 4 minutes; varnish is left in place and not rinsed. Follow each product's specific instructions.

Advise patients that varnish may temporarily change tooth color or feel sticky; this resolves and is not a sign of a problem.

High-risk patients may receive varnish every 3 months; document risk level and interval, and coordinate with home fluoride use to avoid exceeding safe total exposure.

Gloves are changed between patients and when torn or heavily contaminated; hand hygiene precedes glove placement and follows removal.

Masks should be fluid-resistant and fit closely; change when wet or soiled. Eyewear with side shields protects against splatter and should be disinfected between patients.

Instrument processing sequence: transport in a closed container, clean (ultrasonic or washer-disinfector), inspect, package, sterilize, store; hand scrubbing is minimized.

Autoclave parameters vary by type: gravity displacement typically 121°C (250°F) at 15 psi for 15-30 minutes; pre-vacuum cycles are shorter. Follow the sterilizer manufacturer's validated cycle.

Sterilization failures require quarantine and reprocessing of the load, investigation of the cause, and documentation; biological indicator results are logged and retained.

Hepatitis B vaccination is recommended for dental personnel; post-exposure management follows current public health guidance and includes source evaluation and prophylaxis as indicated.

Waste segregation: sharps in rigid containers, regulated medical waste in labeled red bags, and general waste separately; never recap needles by hand unless a safety device is used.

Sealant failure modes: loss of retention from moisture contamination, incomplete etching, or occlusal trauma; and marginal leakage that allows caries under an intact sealant.

If a sealant is partially lost, the remaining material is often removed and the tooth re-etched and resealed rather than patched over a contaminated margin.

Sealants are not a substitute for fluoride, diet counseling, or interproximal cleaning; they protect occlusal pits and fissures only, not smooth or interproximal surfaces.

Fluoride varnish and sealants can be combined; sequence per manufacturer, and avoid varnish contamination of the etch field if both are done in the same visit.

Documentation should include tooth number, material type, isolation used, and caries assessment; note any sealant placed over a questionable fissure for recall monitoring.

Recall inspection includes visual and explorer evaluation; radiographs are indicated when caries is suspected beneath or adjacent to a sealant.

Coronal polishing does not remove calculus; if calculus is present, scaling is required first, and polishing follows to smooth the surface and remove stain.

Prophy paste should be dispensed onto a clean surface or into a cup, not taken from a shared container with a used brush, to prevent cross-contamination.

Rubber cup and brush are single-patient use; change cups between patients and when heavily loaded with debris.

Polishing around orthodontic brackets and bands requires care; a small cup or brush and fine paste reduce damage to the bonding adhesive.

Patients with respiratory or swallowing difficulty should be positioned to allow suction and expectoration; polishing paste is not intended to be swallowed.

Fluoride varnish after polishing is applied to clean, dried teeth; some protocols skip polishing before varnish to preserve fluoride-rich surface, so follow the office protocol.

Topical anesthetic does not eliminate the need for aspiration; negative aspiration before injection remains required to reduce intravascular injection risk.

Benzocaine-induced methemoglobinemia presents with cyanosis unresponsive to oxygen, chocolate-brown blood, and dyspnea; stop the agent and seek emergency care.

Patients with a history of methemoglobinemia, G6PD deficiency, or concurrent oxidizing drugs (nitrates, some antimalarials) should avoid benzocaine.

Pediatric dosing: use the smallest amount, avoid application to large areas, and never leave a child unattended with a topical anesthetic product.

Topical anesthetics should be labeled and stored away from other products; mixing up varnish and anesthetic tubes is a recognized error, so check labels before application.

Record the agent, site, and time applied; if the patient reports burning or unusual taste, remove the agent and rinse.

Fluoride varnish is applied with a disposable applicator in a thin layer; a single-dose unit reduces waste and cross-contamination compared with multi-dose containers.

Avoid eating hard or hot foods and brushing for the period specified by the manufacturer, commonly 4-6 hours, to maximize uptake.

Fluoride varnish is generally well tolerated; reported adverse effects include nausea, vomiting, and rare allergic reactions, so keep the patient upright and avoid excess material.

APF gel is acidic (pH about 3.5) and can etch porcelain and composite; use varnish instead for patients with esthetic restorations or sealants.

Fluoride supplements are a systemic, prescription decision based on water fluoride concentration and age; they are not a substitute for topical professional applications.

Document water fluoridation status if known, because it affects supplement decisions and total fluoride exposure counseling.

Dental unit waterline testing is done at least quarterly or per manufacturer; results above 500 CFU/mL require shock treatment and retesting.

Sterilizer monitoring includes a biological indicator at least weekly, a chemical indicator in each package, and a physical readout on each cycle.

Barrier protection covers light handles, chair controls, air/water syringes, and radiographic equipment; barriers are removed with gloves on and followed by disinfection.

Spatter and aerosol control includes high-volume evacuation, rubber dam when feasible, and pre-procedural rinse; these measures reduce exposure during polishing and sealant placement.

Personal protective equipment is removed in the correct order (gloves last among hand-contacting items) and hands are washed after removal.

Regulated medical waste and sharps containers are closed when three-quarters full, labeled, and stored securely before pickup.

Glass ionomer sealants are moisture-friendly and release fluoride, making them useful in partially erupted teeth or when isolation is difficult, but retention is generally lower than resin.

Resin-based sealants require a dry field; if isolation fails, consider a glass ionomer or defer placement rather than sealing a wet surface.

Sealant placement on permanent molars is typically done soon after eruption, when the tooth is fully erupted enough for isolation but before fissures become retentive and caries-prone.

Assess caries risk with a structured tool or clinical judgment; sealants are most cost-effective in moderate- and high-risk patients.

Patient education should describe that sealants are not permanent and require recall checks; explain the procedure, the taste, and the need to avoid chewing on the tooth until the material is fully set.

Prophy paste residue can interfere with bonding and sealant etching, so rinse thoroughly and, where indicated, re-etch the surface before adhesive procedures.

Polishing is limited to the crown; do not extend the cup onto the gingival margin, which can cause trauma and bleeding.

Heavy extrinsic stain may require more than one polishing pass; use a fresh cup and paste and avoid excessive pressure that removes enamel.

Some polishing pastes contain fluoride or calcium; check compatibility with subsequent varnish or sealant steps per the product's instructions.

Document polishing in the treatment record, including areas treated and any restorations or lesions noted.

Topical anesthetic application time should follow the product label; longer is not better and increases systemic absorption and mucosal irritation.

For palatal injections, topical anesthetic is less effective because of keratinized tissue; a small amount of pressure or a brief topical application may still help.

Eutectic lidocaine/prilocaine provides dermal and mucosal anesthesia and is used in some pediatric and periodontal settings; follow the labeled maximum dose and application time.

Topical anesthetics are drugs; record them in the patient's medication history and check for interactions, including with other local anesthetics.

If a patient reports numbness beyond the intended site or prolonged numbness, document and evaluate for inadvertent deep application or allergy.

Fluoride varnish is the preferred professional topical fluoride for children under 6 because it minimizes ingestion compared with gel in trays.

For patients with xerostomia, root exposure, or orthodontic appliances, varnish can be applied more frequently at the clinician's discretion based on risk.

Fluoride varnish should not be applied to bleeding or ulcerated mucosa; treat the tissue first and reschedule if needed.

Instruct patients not to floss or use mouthrinse immediately after varnish; follow the product's post-application instructions.

Record the fluoride agent, concentration, and teeth treated, and note any post-application instructions given.

Handpieces and attachments that contact mucosa must be sterilized between patients; they cannot be merely disinfected.

Use only EPA-registered disinfectants with the label's contact time; wiping and immediately drying does not achieve disinfection.

Needle recapping is avoided; if necessary, use a one-handed scoop technique or a recapping device.

Immunocompromised patients and staff should be identified and managed according to office policy; standard precautions apply regardless.

Documentation of sterilization and waterline monitoring is retained and available for inspection.

Sealant application on a tooth with a recently placed restoration requires the restoration to be fully set and isolated; avoid contaminating the sealant field with restorative material.

Use a sharp explorer or a fine probe to evaluate fissure depth; do not force the explorer into the fissure, which can damage enamel.

Sealant material should not extend beyond the fissure onto smooth surfaces excessively; excess material can create a ledge that traps plaque.

Check occlusion after sealant placement; a high spot can cause discomfort and should be adjusted with a fine bur per scope of practice.

Recall intervals for sealed teeth should match caries risk; high-risk patients benefit from shorter intervals.

Coronal polishing is a reversible, non-invasive procedure but still requires informed consent and a review of the patient's medical history.

Patients with a history of rheumatic fever or infective endocarditis risk should be assessed for antibiotic prophylaxis per current guidelines before procedures that cause bleeding.

Polishing should not be performed on teeth with active herpes lesions or other contagious mucosal infections; defer until resolved.

Use a tongue retractor or gauze to protect the airway and soft tissues during polishing.

Clean and disinfect the handpiece and attachments between patients, and dispose of cups and paste according to infection control policy.

Topical anesthetic is applied to the site of needle penetration, not to the entire quadrant, to limit total dose and mucosal exposure.

For children, use a flavored or unflavored topical agent as appropriate and apply with a cotton swab; avoid gel in a syringe that can be dispensed in excess.

A patient who reports no numbness after topical application may need a longer onset time or a different agent; do not assume the agent is ineffective without checking technique.

Store topical anesthetics at room temperature and protect from light per the label.

Document any adverse reaction and report it according to office policy.

Fluoride varnish can be applied after scaling and polishing; if polishing paste contains fluoride, check compatibility with the varnish.

For patients with a history of fluoride allergy (rare), document and avoid all fluoride products; use alternative preventive measures.

Fluoride varnish is not intended for at-home use; it is a professional product applied in the office.

Advise patients that varnish may leave a yellow or brown tint temporarily; this is normal and resolves.

Keep varnish out of reach of children and store per the label.

Sterile instruments must be stored in a clean, dry area and protected from contamination; packages with compromised wraps are reprocessed.

Ultrasonic cleaners require a lid and a solution change per manufacturer; they reduce hand scrubbing but do not sterilize.

Use a rubber dam or high-volume evacuation during procedures that generate aerosol, such as polishing and sealant placement.

Staff should be trained in exposure control and receive the hepatitis B vaccine series; records are kept confidential.

Report needlesticks and other exposures immediately and follow the post-exposure protocol.

Sealant material should be applied in a thin, even layer; excessive material can cause occlusal interference and pooling.

Cure the sealant according to the manufacturer's wavelength and time; underexposure leaves an uncured, oxygen-inhibited layer that wears quickly.

After curing, remove any excess material and check the margins with an explorer.

If the patient cannot tolerate isolation, consider deferring the sealant or using a moisture-tolerant material.

Recall evaluation should include visual inspection and explorer probing of sealant margins.

Coronal polishing is not indicated for every patient at every visit; it is selected based on stain and plaque presence.

Over-polishing with coarse paste can remove enamel and expose dentin, especially at the cervical area.

Use a soft cup for patients with exposed root surfaces or demineralized enamel.

Rinse and suction thoroughly after polishing to remove abrasive and debris.

Document the type of paste and areas polished.

Topical anesthetic should be applied with a clean applicator for each patient; do not reuse cotton swabs.

Avoid touching the container tip to the mucosa; dispense onto a clean surface first.

Check the expiration date before use; expired agents may be less effective.

If the patient has a known allergy to an ester or amide anesthetic, choose an agent from a different class.

Document the agent and site in the patient record.

Fluoride varnish can be applied to exposed root surfaces to reduce root caries risk.

For patients with dry mouth, recommend fluoride toothpaste and consider additional topical fluoride per risk.

Do not apply varnish to areas with active infection or ulceration.

Record the varnish brand and lot number if required by office policy.

Provide written post-application instructions to the patient or caregiver.

Surface barriers should be changed between patients; if a surface cannot be barrier-protected, disinfect it after each patient.

Use PPE appropriate to the task; gloves are not a substitute for hand hygiene.

Sharps containers should be placed close to the point of use to avoid carrying uncapped needles across the room.

Follow the office's exposure control plan and review it annually.

Keep a log of sterilization and waterline monitoring results.

Sealants are most effective when placed before caries develops; once caries is cavitated, restorative treatment is required.

Use magnification and good lighting to inspect fissures before sealing.

If caries is found during sealant placement, restore the tooth rather than sealing over it.

Recall sealed teeth at every visit and repair or replace as needed.

Document sealant placement and any findings.

Polishing paste should be freshly dispensed for each patient; do not use a communal container with a used brush.

Use a slow-speed handpiece with a disposable cup or brush.

Avoid polishing over areas of active caries or demineralization.

Rinse and suction after polishing.

Document polishing in the treatment record.

Topical anesthetic is applied before injection to reduce needle pain.

Use the smallest effective amount and follow the label's application time.

Avoid benzocaine in children under 2 and use caution in young children.

Check for allergy history before application.

Document the agent and site.

Fluoride varnish is applied in a thin layer to all teeth.

Instruct the patient to avoid brushing and hard food for 4-6 hours.

Do not suction away the varnish.

Use varnish instead of APF gel for patients with esthetic restorations.

Document the agent and teeth treated.

Wash hands before and after glove use.

Change gloves between patients.

Sterilize critical instruments.

Disinfect surfaces with an EPA-registered product.

Monitor sterilizer with biological indicators weekly.

Sealants protect pits and fissures from caries.

They are indicated for deep, non-carious fissures.

Isolation is critical for retention.

Re-etch if contaminated.

Check retention at recall.

Polishing removes plaque and extrinsic stain.

It does not remove calculus.

Use selective polishing.

Avoid exposed root surfaces.

Rinse and suction after polishing.

Topical anesthetics numb mucosa to 2-3 mm.

They do not anesthetize teeth.

Apply to dried mucosa.

Follow the label's application time.

Avoid benzocaine in young children.

Varnish is 5% NaF, 22,600 ppm.

APF is 1.23%, 12,300 ppm.

Varnish is compatible with restorations.

Apply every 3-6 months for high risk.

Document the agent and teeth.

Standard precautions apply to all patients.

Hand hygiene is the most effective control.

Sharps go in puncture-resistant containers.

Sterilize critical items.

Monitor waterlines for CFU limits.