ADEX Patient Assessment and Diagnosis 5 — Questions and Answers
Question 1: During a comprehensive health history review, a patient discloses a history of rheumatic heart disease. What is the primary concern when planning dental hygiene treatment?
- Excessive bleeding due to concurrent anticoagulant use
- Risk of infective endocarditis requiring antibiotic prophylaxis evaluation (Correct answer)
- Contraindication to local anesthesia with vasoconstrictor
- Hypersensitivity to fluoride products
Correct answer: Risk of infective endocarditis requiring antibiotic prophylaxis evaluation
Rheumatic heart disease can cause valvular damage, which may require antibiotic prophylaxis evaluation per AHA guidelines before invasive dental procedures.
Question 2: A patient's periodontal chart shows probing depths of 2-3 mm with bleeding on probing at 45% of sites and no bone loss on radiographs. According to the 2017 classification, this is best described as:
- Healthy periodontium
- Gingivitis associated with dental biofilm (Correct answer)
- Stage I periodontitis
- Gingival health on a reduced periodontium
Correct answer: Gingivitis associated with dental biofilm
Bleeding on probing with shallow pockets and no radiographic bone loss in an intact periodontium is classified as gingivitis associated with dental biofilm.
Question 3: Which assessment finding would most strongly indicate the need to defer non-emergency dental hygiene treatment?
- Probing depth of 6 mm on a single posterior tooth
- Blood pressure of 182/112 mmHg (Correct answer)
- HbA1c of 7.2% in a controlled diabetic patient
- Medication list including aspirin 81 mg daily
Correct answer: Blood pressure of 182/112 mmHg
A blood pressure of ≥180/110 mmHg represents a hypertensive crisis, and elective dental treatment should be deferred until BP is controlled.
Question 4: When screening for oral cancer, the dental hygienist should pay particular attention to which anatomical sites as the highest-risk locations for squamous cell carcinoma?
- Hard palate and dorsal tongue
- Lateral and ventral tongue and floor of mouth (Correct answer)
- Attached gingiva and buccal frenum
- Labial mucosa and buccal vestibule
Correct answer: Lateral and ventral tongue and floor of mouth
The lateral/ventral tongue and floor of the mouth account for the majority of oral squamous cell carcinoma cases and require thorough inspection.
Question 5: A dental hygienist notes a 3 mm zone of attached gingiva on the facial of tooth #25. Which of the following best describes this finding?
- Inadequate attached gingiva requiring immediate surgical referral
- Within the range of normal and requires monitoring (Correct answer)
- Pathological recession requiring grafting
- Evidence of Stage III periodontitis
Correct answer: Within the range of normal and requires monitoring
A minimum of 1-2 mm of attached gingiva is generally considered adequate; 3 mm is within normal range and requires monitoring rather than intervention.
Question 6: A patient presents with generalized gingival redness, spontaneous bleeding, and painful ulcerations with a punched-out papillary appearance and a pseudomembrane. The most likely diagnosis is:
- Desquamative gingivitis from pemphigoid
- Necrotizing ulcerative gingivitis (NUG) (Correct answer)
- Acute herpetic gingivostomatitis
- Plasma cell gingivitis
Correct answer: Necrotizing ulcerative gingivitis (NUG)
NUG is characterized by punched-out necrotic interdental papillae, pseudomembrane formation, spontaneous bleeding, and pain.
Question 7: Which of the following best describes the purpose of using a periodontal risk assessment tool during a patient assessment?
- To determine the exact number of appointments needed for debridement
- To identify factors that influence disease susceptibility and guide recall frequency (Correct answer)
- To calculate the patient's plaque index score for documentation
- To select the appropriate ultrasonic tip for subgingival debridement
Correct answer: To identify factors that influence disease susceptibility and guide recall frequency
Periodontal risk assessment evaluates factors such as BOP, pocket depth, bone loss, smoking, and systemic disease to tailor prevention and recall intervals.
ADEX Patient Assessment and Diagnosis 5
During a comprehensive health history review, a patient discloses a history of rheumatic heart disease.
What is the primary concern when planning dental hygiene treatment?