A dental hygienist is asked to visit a long-term care facility to provide periodontal therapy for 92 year old Mr. Whelan, who is confined to a single bed placed against a wall. The dental hygienist cannot provide dental hygiene therapy using her dominant hand. Which one of the following actions would be most appropriate for the dental hygienist to take?

What deciduous tooth is retained in this occlusal radiograph?

Mrs. Knight, 70 years old, has generalized gingival recession of 2 mm and evidence of progressive demineralization on exposed root surfaces. She dislikes “taking pills” and rarely takes her calcium supplement. In addition to a physician referral, which of the following recommendations would be most appropriate for the dental hygienist to make?

The dental hygienist is making a presentation to a local sports team about “chewing tobacco”. During the session, the dental hygienist notices that a group of players at the back of the room are whispering to each other. When questioned, the players state that the presentation is “boring”.

Which one of the following oral health descriptions of a 37 year old male client would suggest the need for referral to a periodontist?

What must the dental hygienist do when experiencing difficulty angulating a curet on the distal surface of tooth 16?

Which one of the following statements is the best recommendation for applying an acid etch when preparing a primary molar for a pit and fissure sealant?

Jared, 19 years old, presents with partially erupted mandibular third molars. Which one of the following radiographic interventions would be most appropriate?

Ms. Lake, 28 years old, presents for her continuing care appointment. Intraoral findings reveal less than 1 mm of keratinized gingival tissue on the buccal surface of teeth 34 and 44. Ms. Lake has a previous history of orthodontic treatment. What should the dental hygienist recommend?

1. Mr. Rawleigh, 71 years old, returns for a 6 week evaluation appointment after completion of periodontal debridement. He states that he has noticed less bleeding when he brushes his teeth. What would be the best method for the dental hygienist to assess the changes in Mr. Rawleigh’s gingival health?

The dental hygienist notes bilateral hypertrophy of the masseter muscles during the head and neck assessment of a client. Based on this finding, what should the dental hygienist investigate further in the client’s mouth?

1. The dental hygienist has been hired to assess the oral health of the residents of a long term care facility. Which one of the following indices would be most appropriate to determine the periodontal status of this population?

What is the correct term to describe the root morphology of tooth 44 as seen on the following periapical radiograph?

1. Ms. Brown, 24 years old, had quadrants 1 and 4 debrided at a previous appointment. She presents today for the periodontal debridement of quadrants 2 and 3. The dental hygienist notices localized moderate inflammation on the lingual aspect of tooth 46. What is the most likely cause of this inflammation?

1. Mr. Menard, 50 years old, has established the following two goals: 1) to be able to explain the relationship between dental biofilm and the gingival disease process; and 2) to master the sulcular brushing technique. At the next appointment, how should the dental hygienist determine if Mr. Menard has met these goals?

What specific oral side effect is associated with most anticonvulsants and most calcium channel blockers?

1. Mrs. Sims, 67 years old, states she brushes with baking soda and hydrogen peroxide instead of a dentifrice. She questions the dental hygienist about the efficacy of this regimen. What information should the dental hygienist provide to Mrs. Sims?

1. The dental hygienist is administering an inferior alveolar injection for an adult client. Which scenario indicates that the tip of the needle has reached the correct area for injecting the anesthetic?

1. The intraoral assessment of a 27 year old female client reveals a raised, white, non-sloughing, painless lesion on the left lateral border of the tongue. The client is on long-term corticosteroid therapy. Which one of the following conditions is most likely to be present?

What must the dental hygienist consider when assessing the client’s ability to make an informed choice for treatment?

A dental hygienist critiques research journal articles on the efficacy of hypnotism as an anxiety management approach. Which population sample is appropriate to ensure the validity of this study?

The dental hygienist is presenting a proposal for an oral health education initiative to a community agency. Which of the following elements of a planning process should be described first?

Mr. Smith, 23 years old, is concerned about the black line stain on his teeth. What is associated with this condition?

What practice would illustrate cross-cultural sensitivity during the dental hygiene assessment and diagnosis?

What instrument should be used to debride a mesiopalatal class II furcation on tooth 26?

Mr. Proulx, 48 years old, has just completed non-surgical periodontal therapy for generalized Stage III Grade B periodontitis. What would be the most appropriate continuing care interval for Mr. Proulx?

1. Mrs. Wylie, 68 years old, presents for periodontal debridement. She informed the dental hygienist for the past 12 months, she has been treated for tuberculosis. Mrs. Wylie says that the tuberculosis is no longer active. What should the dental hygienist do?

During a routine check of the emergency kit, the dental hygienist discovers the nitroglycerin (Nitrostat) has expired. What medical emergency treatment would be adversely affected by this finding?

The dental hygienist is not satisfied with the desensitizing product currently available in the dental office. What is the best strategy for selecting an alternative agent?

What information regarding a hazardous material should be on a Material Safety Data Sheet (MSDS)?

What ergonomic measures should the dental hygienist undertake to help prevent repetitive strain injury?

What would purulent exudate indicate in a periodontal assessment?

1. The normal aging process includes which one of the following conditions

1. Mr. Carter, 86 years old, presents for his 6 month continuing care appointment. His health history indicates diet-controlled diabetes and high blood pressure controlled with MAO inhibitors. The dental hygienist determines that local anesthetic without epinephrine is appropriate for the planned periodontal treatment. In calculating the maximum recommended dose (MRD) of local anesthetic, what should the dental hygienist consider?

1. Dimitri, 8 years old, arrives at the dental office for his first visit. He appears anxious. During the course of the appointment, Dimitri reports, “I’m dizzy and I can’t breathe”. During the appointment, the dental hygienist observes respirations of approximately 30-35 breaths per minute. What emergency strategy should the dental hygienist initiate?

1. The dental hygienist ensures that 84 year old Mrs. Chipman takes prescribed premedication before a periodontal debridement appointment. Which one of the following ethical principles is being addressed?

1. During the initial assessment of Ms. Anders, 69 years old, the dental hygienist notes generalized posterior gingival recession with associated shiny, wedge-shaped areas on a number of root surfaces. Ms. Anders’ general health is good. She takes diazepam (Valium) to treat her anxiety. How should the dental hygienist assist Ms. Anders in controlling these lesions?

1. Charlotte, 16 years old, presents for her continuing care appointment. She completed active fixed orthodontic  treatment 4 months ago and now wears a removable maxillary retainer and a fixed mandibular lingual bar. Clinical assessment reveals mobility of M2 on tooth 22 and radiography findings of resorption of approximately one third of the root length on tooth 22. What is the best explanation for this finding?

Andre, 13 years old, presents for his continuing care appointment with generalized dental biofilm-induced gingivitis. He states that he brushes his teeth 3 times a day, and demonstrates the scrub-brush method. The dental hygienist observes a moderate amount of dental biofilm in the cervical area of the teeth. Which one of the following brushing methods should the dental hygienist suggest?

Mrs. Braun, 72 years old, presents for dental hygiene care accompanied by her daughter. Mrs. Braun is withdrawn and waits for her daughter to respond to the dental hygienist’s questions. The dental hygienist notes abrasions at the left corner of the mouth, a fractured maxillary partial denture and that teeth 33 and 34 are fractured. What should the dental hygienist conclude?

Mrs. Leong, 44 years old, has completed initial dental hygiene therapy. The dental hygienist explains to her the need for a continuing care appointment in 6 months. Mrs. Leong insists the appointment be in 12 months. Which of the following actions would be most appropriate for the dental hygienist to take?

What must the dental hygienist do when removing surgical sutures?

Mr. Franco, 43 years old, is undergoing radiation therapy to the submandibular and sublingual salivary glands. Which one of the following oral hygiene mouthrinses should the dental hygienist recommend to Mr. Franco to help him cleanse his mouth?

For which one of the following conditions is the use of nitrous oxide CONTRAINDICATED?

Mr. Fisher, 23 years old, presents for her continuing care appointment with a Biofilm Control Record of 10%, generalized pink gingiva and no bleeding on probing. Based on the following bitewing radiograph, what should the dental hygienist do next?

Akesha, 8 years old, is a new client that presents for a dental hygiene assessment. Her mother has indicated in her health history that Akesha has epileptic seizures. Which one of the following questions would provide the most critical information regarding Akesha’s condition?

Salah, 13 years old, is undergoing fixed orthodontic treatment and presents for her 9 month continuing care appointment. The gingiva is generally inflamed and moderate dental biofilm is present. The dental biofilm score and gingival bleeding index have increased from Salah’s last visit. In addition to oral self care instruction, what should the dental hygienist recommend?

A client presents for periodontal debridement with a health condition that is a relative contraindication of a commonly used local anesthetic. What must the dental hygienist consider regarding the use of this particular anesthetic?

The dental hygienist is interpreting the panoramic radiograph of 74 years old Mr. Jacob. There is a large radiolucent band superimposed over the apices of the maxillary teeth. What does this indicate about the exposure technique?

Mr. Nelson, 28 years old, presents for his continuing care appointment. His health history indicates that he had a kidney transplant 9 months ago. The client’s intraoral assessment reveals a low dental biofilm score and generalized gingival enlargement. What should the dental hygienist consider with regard to Mr. Nelson’s medication regimen?

To determine why a client is no longer using a recommended perio aid, what must the dental hygienist assess?

In order to avoid a hematoma, what should the dental hygienist consider when delivering local anesthetic using a posterior superior alveolar nerve block technique?

What blade angulation should the dental hygienist use when debriding residual deposits on root surfaces?

1. Based on the following photograph, which medication would most likely address the condition identified at the labial commissures?

1. What should the dental hygienist suggest to a client who has a relapse while trying to quit smoking?

1. Which one of the following techniques for removing soft deposits would result in the least amount of damage to a complete maxillary denture?

Ms. Bryant, 48 years old, presents with generalized Stage III Grade B periodontitis at her initial dental hygiene appointment. She received quadrant periodontal debridement with local anesthesia. At her 6 weeks post-initial therapy evaluation appointment, bleeding is minimal and periodontal probing depth are decreased; however, Ms. Bryant indicates she is surprised by the generalized sensitivity she is now experiencing. What error has been made in providing care for Ms. Bryant?

Mr. Sandowski, 45 years old, has a healthy history that includes recent phlebitis in his right leg. His medications include warfarin sodium (Coumadin) and acetaminophen (Tylenol Extra Strength). What action should the dental hygienist take with Mr. Sandowski for his dental hygiene care?

1. Which one of the following indices should the dental hygienist use to determine caries experience in preschool children?

Which one of the following conditions best identifies the narrow white elevated strip on Mr. Dubois’ buccal mucosa?

Which one of the following conditions is the most probable cause of Mr. Dubois’ radiographic findings?

Which one of the following conclusions should the dental hygienist reach regarding Mr. Dubois’ dry mouth?

Mr. Dubois understands smoking is related to many health problems, but is not prepared to stop smoking at this time. Which one of the following responses would be most appropriate for the dental hygienist to make?

During the appointment, Mr. Dubois indicates he finds it difficult to fill the hours in his days and misses the contact with his co-workers. Which one of the following actions would be most appropriate for the dental hygienist to take?

What is the first step the dental hygienist should take to best facilitate a behavior change for Mark?

What would be the most likely effect of systemic fluoride supplements for Mark?

How would the condition of the gingiva affect the dental hygiene care plan for Mark?

Which dental hygiene intervention would be most effective when teaching Mark about oral self care?

What is the most likely explanation for the gingival hyperplasia in Mrs. Singh?

During the assessment, Mrs. Singh becomes pale, disoriented, and appears ready to faint. What intervention would be most appropriate?

What is the most likely cause of Perminder's cleft lip?

Which of the following developmental processes did not fuse in Perminder's case?

Upon further assessment, the dental hygienist notes a slightly rough surface on teeth 11 and 15. How did the dental hygienist determine the initial findings?

Perminder and her mother want teeth 13 and 23 extracted, thinking this will stop the teasing at school. How should the dental hygienist proceed?