INBDE cheat sheet

Reversible pulpitis: provoked pain that stops when the stimulus is removed, no spontaneous pain, normal periapical tissues; vital pulp therapy or restoration is indicated.

Irreversible pulpitis: spontaneous or lingering pain; a cold response outlasting the stimulus by more than 30 seconds indicates irreversible change and requires pulpectomy.

Pulp tests: cold refrigerant and electric pulp testing assess nerve vitality; a necrotic pulp gives no response to either, so adjacent and contralateral teeth must be tested for comparison.

PSR codes: 0 = healthy, 1 = bleeding on probing, 2 = calculus or defective margins, 3 = probing depth 3.5-5.5 mm, 4 = depth 5.5 mm or more; code 3 or 4 mandates full periodontal charting.

ASA classification: I healthy, II mild systemic disease, III severe disease limiting activity, IV incapacitating disease that is a constant threat to life, V moribund.

Odontogenic pain is usually well localized, provoked by stimuli, and reproduced by percussion; non-odontogenic pain often crosses the midline and is not relieved by local anesthesia.

Sensitivity = TP/(TP+FN); specificity = TN/(TN+FP); positive and negative predictive values shift with disease prevalence, so a positive test in a low-prevalence group is more often false.

CAMBRA caries risk assessment assigns low, moderate, high or extreme risk from disease indicators, protective factors and risk factors; recall interval and treatment intensity follow that category.

Bitewing images are the choice for interproximal caries; panoramic imaging is indicated for third molars, widespread bone loss and trauma, not for detecting individual carious lesions.

Maximum local anesthetic doses: lidocaine 2% with epinephrine 7 mg/kg (500 mg cap); articaine 4% 7 mg/kg (500 mg); mepivacaine 3% 6.6 mg/kg (400 mg); bupivacaine 0.5% 1.3 mg/kg (90 mg).

One 1.8 mL cartridge of 2% lidocaine contains 36 mg of anesthetic; the same volume of 4% articaine contains 72 mg; 1:100,000 epinephrine equals 0.018 mg per cartridge.

Alveolar osteitis (dry socket) appears 2-4 days after extraction with severe pain and an empty socket; irrigate, place a eugenol dressing and give analgesia, since antibiotics are not first-line.

Fluoride varnish is 5% sodium fluoride (about 22,600 ppm); apply every 3-6 months and instruct the patient not to brush or rinse for at least 4-6 hours.

Root canal irrigation: 0.5-5.25% sodium hypochlorite is the primary tissue-dissolving irrigant, 17% EDTA removes the smear layer, and chlorhexidine must never be mixed with hypochlorite.

Space maintenance: a band-and-loop appliance holds space after premature primary molar loss; a distal shoe is used when a first primary molar is lost before the permanent first molar erupts.

Implant spacing: keep at least 1.5-2 mm between an implant and an adjacent tooth and about 3 mm between adjacent implants, with about 2 mm of buccal bone for soft tissue stability.

Early childhood caries prevention: first dental visit by 12 months, fluoride varnish every 3-6 months, and no ad libitum bottle feeding of juice or milk, especially at bedtime.

A fluctuant odontogenic swelling requires incision and drainage; amoxicillin 500 mg three times daily is an adjunct, not a substitute for removal of the source of infection.

Collagen types: I in bone, dentin, cementum, periodontal ligament and skin; II in cartilage; III in granulation tissue and healing wounds; IV in basement membranes.

Eruption timing: mandibular primary central incisor 6-10 months, primary first molar 12-16 months, permanent first molar 6-7 years, permanent canine 11-12 years.

Salivary flow: unstimulated whole saliva 0.3-0.4 mL/min, stimulated 1-2 mL/min, pH 6.7-7.4; critical pH is about 5.5 for enamel and about 6.2 for root dentin.

Caries microbiology: Streptococcus mutans initiates the lesion, Lactobacillus and Bifidobacterium dominate advanced lesions, and Actinomyces species are associated with root caries.

Periodontal pathogens: the red complex (Porphyromonas gingivalis, Tannerella forsythia, Treponema denticola) plus Aggregatibacter actinomycetemcomitans in localized aggressive periodontitis.

Health belief model: behavior is predicted by perceived susceptibility, severity, benefits and barriers plus cues to action; motivational interviewing uses open questions, affirmations, reflections and summaries.

Transtheoretical model stages are precontemplation, contemplation, preparation, action and maintenance; stage-matched counseling outperforms generic advice for tobacco and oral hygiene change.

Supplemental fluoride dosing is about 0.05 mg/kg/day for children in non-fluoridated areas; the window of highest fluorosis risk for anterior teeth is roughly 15-30 months of age.

Antiresorptive therapy: MRONJ risk rises with intravenous agents and longer duration; elective extractions and periodontal surgery should be completed before therapy begins when possible.

ADA principles of ethics: patient autonomy, nonmaleficence, beneficence, justice and veracity; autonomy (self-determination) is ranked first in the Code.

Informed consent must address diagnosis, nature and purpose of treatment, risks and benefits, alternatives including no treatment, prognosis and cost, and must be documented.

Malpractice requires four elements proven together: duty owed, breach of the standard of care, causation, and compensable damages.

HIPAA Privacy Rule: use or disclose only the minimum necessary protected health information, honor patient access requests within 30 days, and notify of breaches within 60 days.

OSHA Bloodborne Pathogens Standard: written exposure control plan, hepatitis B vaccination offered free, gloves and other PPE, annual training, and sharps in rigid labeled containers.

Abandonment occurs when the dentist unilaterally ends the relationship without notice, referral or time to obtain care; a dismissal letter with reasonable notice and records transfer is standard.

Emancipated minors (married, in military service, self-supporting or court-decreed) may consent to their own dental care; otherwise a parent or legal guardian must consent.

Hygienist supervision: general supervision means the dentist authorized care but is not on site; direct supervision means the dentist is physically present and evaluates the patient.

Record retention follows state law, commonly 7-10 years after the last visit and longer for minors (until age of majority plus the statute of limitations).