Free ADEX Hygiene Exam Flashcards

Identifies systemic conditions, medications, and allergies that affect treatment planning, drug/anesthetic selection, bleeding risk, and the need for medical consultation or antibiotic prophylaxis before periodontal instrumentation.

ASA I = healthy patient, no systemic disease. ASA II = mild systemic disease or significant risk factor with no functional limitation (e.g., well-controlled diabetes or hypertension, current smoker, obesity 30<BMI<40).

ASA III = severe systemic disease that limits activity (e.g., poorly controlled diabetes/hypertension, COPD, MI/CVA more than 3 months ago). ASA IV = severe systemic disease that is a constant threat to life (e.g., MI/CVA within the last 3 months, unstable angina, severe valve dysfunction); ASA III/IV needs medical consult before elective care.

Normal adult BP is under 120/80 mmHg. Stage 2 hypertension (≥140/90) warrants caution/monitoring; ≥160/100 means defer elective treatment; ≥180/110 is a medical emergency cutoff requiring referral before any treatment. Normal pulse: 60-100 bpm; normal respiration: 12-20 breaths/min.

Warfarin, DOACs, and antiplatelets (aspirin, clopidogrel) raise bleeding risk during SRP and deep probing. Check INR if on warfarin (therapeutic range is about 2-3) or consult the physician; routine discontinuation is not recommended.

Long-term, especially IV, bisphosphonate or other antiresorptive/antiangiogenic therapy raises the risk of osteonecrosis after invasive dental procedures. Document duration/route of therapy and minimize unnecessary bone trauma during periodontal treatment.

Submandibular, submental, cervical (anterior and posterior chains), preauricular, and postauricular nodes are palpated for size, tenderness, mobility, and consistency to screen for infection or malignancy.

Location, size, shape/border, color, surface texture, consistency (soft, firm, fluctuant), whether single or multiple, presence of pain, and duration since the lesion was first noticed.

Clicking or popping, crepitus, deviation on opening, limited range of motion (opening under about 40 mm is restricted), and muscle or joint tenderness on palpation.

1-3 mm in a healthy sulcus with no bleeding on probing. Probing depths of 4 mm or more suggest attachment loss or active periodontal inflammation.

CAL equals the probing depth when the gingival margin is at the CEJ. If the margin is apical to the CEJ (recession present), CAL = probing depth + the amount of gingival recession measured from the CEJ to the free gingival margin.

BOP indicates active gingival inflammation and is one of the most reliable clinical indicators of periodontal disease activity; it is tracked over time to assess healing and treatment response.

Grade I: probe detects the furcation concavity but cannot enter it (early bone loss, no radiographic change). Grade II: probe partially enters the furcation (cul-de-sac) but does not pass through. Grade III: inter-radicular bone is completely lost and the probe passes through, but soft tissue still covers the opening. Grade IV: same bone loss as Grade III but the furcation is clinically visible due to tissue recession.

Grade 0: no detectable mobility beyond normal physiologic movement. Grade I: up to 1 mm horizontal movement. Grade II: more than 1 mm and up to 2 mm horizontal movement. Grade III: more than 2 mm horizontal movement and/or vertical (depressible) mobility.

Apical migration of the gingival margin beyond the CEJ, exposing root surface. Measured from the CEJ to the free gingival margin, then added to probing depth to calculate clinical attachment level.

Teeth are numbered 1-32 starting at the maxillary right third molar (#1), continuing across the maxillary arch to the maxillary left third molar (#16), then down to the mandibular left third molar (#17) and across to the mandibular right third molar (#32).

First digit = quadrant (1-4 for permanent teeth: 1 upper right, 2 upper left, 3 lower left, 4 lower right; 5-8 for primary teeth); second digit = tooth position from the midline (1 = central incisor through 8 = third molar). Example: 11 = permanent maxillary right central incisor.

M = mesial, D = distal, F/B = facial/buccal, L = lingual, O = occlusal (posterior teeth), I = incisal (anterior teeth).

Stage I: 1-2 mm interdental CAL, under 15% bone loss, PD ≤4 mm. Stage II: 3-4 mm CAL, 15-33% bone loss, PD ≤5 mm. Stage III: ≥5 mm CAL, bone loss beyond the coronal third, ≤4 teeth lost to periodontitis, PD ≥6 mm, vertical bone loss ≥3 mm and/or Class II-III furcations. Stage IV: Stage III findings plus need for complex rehabilitation and/or fewer than 20 remaining teeth (10 opposing pairs). Extent is further noted as localized (under 30% of teeth affected) or generalized (30% or more).

Grading estimates the rate of disease progression and future risk: Grade A = slow progression, no risk factors. Grade B = moderate progression. Grade C = rapid progression or documented risk factors present (e.g., smoking ≥10 cigarettes/day, uncontrolled diabetes).

Typically 18-20 intraoral images (commonly 4 bitewings plus 14 periapicals; the FDA defines the range as 14-22 images), providing crown-to-apex and interproximal coverage of the entire dentition.

Detect interproximal caries and evaluate crestal alveolar bone levels and subgingival calculus; the beam is directed perpendicular to the tooth and film/sensor to minimize horizontal overlap.

Horizontal bone loss runs parallel to a line connecting adjacent CEJs (uniform crestal loss). Vertical/angular bone loss creates an oblique defect relative to the CEJ line and is often associated with localized or more aggressive periodontal destruction.

"As Low As Reasonably Achievable" - minimize patient radiation exposure using the fastest image receptor, proper collimation, lead/thyroid shielding, and by prescribing radiographs only when clinically justified.

Radiopaque projections, spurs, or ledges extending from the proximal root surface into the interproximal space, most easily seen on bitewings; thin supragingival calculus is often not radiographically visible.

Widened periodontal ligament (PDL) space, loss of the lamina dura, and periapical radiolucency indicate pulpal necrosis or periapical inflammatory disease requiring dental referral.

A lead (or lead-equivalent) apron with thyroid collar is used for every intraoral radiographic exposure to shield the reproductive organs and thyroid gland from scatter radiation.

Use an FDA-cleared barrier sleeve on the sensor or plate for every exposure; sensors cannot be heat-sterilized, so they must be disinfected between patients per the manufacturer's instructions.

Prophylaxis removes plaque, calculus, and stain in a periodontally healthy or gingivitis patient with no attachment loss. SRP removes subgingival calculus and diseased/contaminated cementum and planes the root surface; it is indicated for periodontitis with attachment loss.

Typically every 3-4 months for patients previously treated for periodontitis, compared with about 6 months for periodontally healthy prophylaxis patients, individualized by ongoing risk assessment.

Typically 4-6 weeks after SRP, allowing tissue healing and reattachment before re-probing to assess response and decide whether further active therapy or periodontal maintenance is indicated.

Groups and prioritizes patients by periodontal status (health, gingivitis, or a specific periodontitis stage/grade) and treatment complexity, which drives care sequencing, recall interval, and documentation for third-party payers.

Address urgent or emergency needs first, then disease control (SRP plus oral hygiene instruction), then re-evaluation, then supportive periodontal maintenance, with preventive/esthetic needs addressed last.

Toothbrushing technique (e.g., the modified Bass method), interdental cleaning (floss or interdental brush), fluoride use, and individualized reinforcement based on the patient's plaque control record.

The blade forms a 90-degree angle to the lower shank and has two parallel cutting edges, allowing use on mesial, distal, facial, and lingual surfaces of any tooth with a single instrument.

The blade is offset 60-70 degrees from the lower shank and has only one cutting edge (the lower, longer edge). Each numbered pair is designed for specific teeth and surfaces, improving adaptation to root curvature versus a universal curette.

Anterior teeth: incisors and canines.

Posterior teeth, facial and lingual surfaces (7/8 premolars and molars; 9/10 a less commonly used posterior facial/lingual variant).

Gracey 11/12 = posterior mesial surfaces. Gracey 13/14 = posterior distal surfaces.

Unshielded cardiac pacemakers/ICDs (per manufacturer guidance), patients with communicable respiratory disease or high aerosol risk, difficulty swallowing/aspiration risk, and demineralized or exposed root/implant surfaces needing plastic or specialty tips instead of metal.

Maximum recommended dose (MRD) is calculated from patient body weight for the specific agent; for lidocaine 2% with epinephrine the classically taught adult MRD is 4.4 mg/kg (2 mg/lb). In practice, the epinephrine content (about 0.2 mg limit for a healthy adult) is often reached first and becomes the true limiting factor.

5% sodium fluoride (22,600 ppm) varnish applied to all tooth surfaces; recommended about every 3-6 months for moderate-to-high caries-risk patients.

A resin-based (or resin-modified glass ionomer) material placed in the pits and fissures of caries-susceptible posterior teeth, typically permanent first and second molars soon after eruption, to block bacterial colonization of the fissure.

Position the patient supine with legs elevated (Trendelenburg), ensure an open airway, administer an aromatic ammonia inhalant and oxygen, and monitor vital signs; most vasovagal episodes resolve within 1-2 minutes.

Amoxicillin 2 g orally, 1 hour before the dental/hygiene procedure, for patients with prosthetic heart valves, a prior episode of infective endocarditis, certain congenital heart disease, or a cardiac transplant with valvulopathy, per 2021 AHA guidance.

NSAIDs (e.g., ibuprofen) are first-line when not contraindicated; combination NSAID/acetaminophen is used for more significant pain before escalating to an opioid, per current dental pain-management guidance.

20 primary teeth erupt between about 6 months and 2.5-3 years of age. Mixed dentition (primary plus permanent teeth present together) begins around age 6, typically starting with the first permanent molars and mandibular central incisors.

Brackets and bands create extra plaque-retentive surfaces, raising caries and gingivitis risk; recommend interdental/orthodontic brushes, fluoride rinses, and shorter recall intervals during active treatment.

Critical instruments (penetrate soft tissue or bone, e.g., scalers, curettes, surgical instruments) require heat sterilization. Semi-critical instruments (contact mucosa, e.g., mirrors, impression trays) require heat sterilization or high-level disinfection. Non-critical instruments (contact intact skin) require intermediate or low-level disinfection.

Hygienists must practice within their state-defined scope (e.g., supervision level, local anesthesia permit status) and obtain informed consent - disclosing diagnosis, proposed treatment, risks/benefits, and alternatives - before performing procedures.