NBDHE Dental Hygiene Care 2 — Questions and Answers

Question 1: The dental hygiene process of care follows which systematic sequence?

Assessment → Dental hygiene diagnosis → Planning → Implementation → Evaluation (Correct answer)
Treatment → Assessment → Diagnosis → Planning
Planning → Assessment → Treatment → Evaluation
Implementation → Planning → Assessment → Evaluation

Correct answer: Assessment → Dental hygiene diagnosis → Planning → Implementation → Evaluation

The dental hygiene process of care follows five sequential steps: Assessment, Dental Hygiene Diagnosis, Planning, Implementation, and Evaluation — forming a systematic patient-centered approach.

The dental hygiene process of care is a systematic, problem-solving approach adapted from the nursing process: (1) Assessment — comprehensive data collection (health history, vital signs, intraoral/extraoral exam, periodontal charting, radiographic evaluation); (2) Dental hygiene diagnosis — analyzing assessment data to identify oral health problems/needs within the DH scope; (3) Planning — establishing goals and selecting evidence-based interventions; (4) Implementation — executing the plan (SRP, fluoride, patient education, referral); (5) Evaluation — assessing effectiveness of treatment, modifying the plan as needed. This process distinguishes professional DH practice from routine cleaning and supports critical thinking in complex patient management.

Question 2: Which vital sign measurement is considered hypertensive stage 2 (severe) per the American Heart Association's 2017 guidelines?

Systolic ≥140 mmHg or diastolic ≥90 mmHg (Correct answer)
Systolic 130–139 mmHg or diastolic 80–89 mmHg
Systolic 120–129 mmHg with diastolic <80 mmHg
Systolic <120 mmHg and diastolic <80 mmHg

Correct answer: Systolic ≥140 mmHg or diastolic ≥90 mmHg

The 2017 AHA/ACC guidelines define Hypertension Stage 2 as systolic ≥140 mmHg or diastolic ≥90 mmHg, requiring drug therapy and lifestyle intervention.

2017 AHA/ACC blood pressure classification: Normal — <120/<80; Elevated — 120–129/<80; Hypertension Stage 1 — 130–139/80–89; Hypertension Stage 2 — ≥140/≥90; Hypertensive Crisis — >180/>120. In dental hygiene: (1) Blood pressure should be measured at every appointment; (2) Routine treatment can proceed with Stage 1 with blood pressure recheck and lifestyle counseling; (3) For Stage 2, inform the dentist and consult the patient's physician before any elective procedure; (4) Hypertensive Crisis (>180/120) — do not treat, refer immediately to emergency care. Epinephrine in local anesthetic is generally safe in controlled hypertensives (max 2 carpules of 1:100,000 epi); avoid retraction cord with epinephrine.

Question 3: When applying fluoride varnish in a clinical setting, the clinician should instruct the patient to:

Avoid eating hard foods, hot beverages, and brushing for at least 4–6 hours after application (Correct answer)
Rinse vigorously with water immediately after application
Apply fluoride at home the same evening for enhanced effect
Refrain from all eating and drinking for 24 hours

Correct answer: Avoid eating hard foods, hot beverages, and brushing for at least 4–6 hours after application

After fluoride varnish application, patients should avoid hard/crunchy foods, hot drinks, and brushing for 4–6 hours to maximize fluoride uptake into enamel while the varnish remains on tooth surfaces.

Fluoride varnish (22,600 ppm — 5% NaF or Duraphat) remains on tooth surfaces for several hours, slowly releasing fluoride that diffuses into enamel to form fluorapatite and fluoride reservoirs in the surface layer. Post-application instructions: (1) Avoid brushing, flossing, or using mouthwash for at least 4–6 hours (some protocols say until bedtime/next morning); (2) Consume only soft foods and cool liquids for 4 hours; (3) No hot beverages that could dissolve the varnish coating; (4) The varnish can be gently removed at bedtime with regular brushing. Varnish is applied in-office with cotton roll isolation, dried tooth surface, and thin coat using applicator brush. It is the preferred professional fluoride delivery for high-caries-risk patients and young children.

Question 4: Which type of stroke is used during the assessment phase of ultrasonic debridement to detect calculus?

Light, overlapping exploratory strokes with the tip parallel to the tooth surface (Correct answer)
Heavy lateral pressure strokes perpendicular to the root
Rapid circular strokes in the base of the pocket
Vertical strokes with the tip directed apically at 45°

Correct answer: Light, overlapping exploratory strokes with the tip parallel to the tooth surface

Ultrasonic assessment uses light, overlapping strokes with the side/tip of the instrument kept nearly parallel to the tooth to detect calculus by tactile feedback without excessive thermal/mechanical trauma.

Ultrasonic instrumentation technique: (1) Assessment/detection — light lateral pressure (1–2 g), overlapping strokes at multiple angles, tip adapted to tooth surface to detect calculus via stick/catch feedback; (2) Active debridement — overlapping feather-light strokes in multiple directions (vertical, horizontal, oblique, circular) at appropriate power setting; tip keeps moving to prevent heat buildup; (3) Power setting — fine deposits/maintenance: low; moderate deposits: medium; heavy calculus: medium-high; (4) Water lavage is integral — rinse debris, cool tip, antimicrobial effect. Heavy lateral pressure should be avoided as it increases heat generation, causes root surface damage, and reduces acoustic energy effectiveness. The non-working tip portions should not be adapted apically against the root.

Question 5: A patient with xerostomia secondary to Sjögren's syndrome should receive which dental hygiene intervention to prevent root caries?

Prescription-strength 1.1% sodium fluoride (5,000 ppm) toothpaste applied daily and fluoride varnish every 3 months (Correct answer)
Regular fluoride rinsing with OTC fluoride only
Only nutritional counseling without topical fluoride
Increased sugar-free candy consumption to stimulate saliva

Correct answer: Prescription-strength 1.1% sodium fluoride (5,000 ppm) toothpaste applied daily and fluoride varnish every 3 months

Sjögren's syndrome causes severe xerostomia with dramatically elevated caries risk; prescription 5,000 ppm fluoride toothpaste (daily) combined with quarterly in-office fluoride varnish provides maximum caries protection.

Sjögren's syndrome is a systemic autoimmune disease characterized by lymphocytic infiltration and destruction of salivary and lacrimal glands (sicca syndrome). Consequences for oral health: extremely low salivary flow (near zero in severe cases), loss of salivary buffering and antimicrobial proteins, rampant root caries, candidiasis, dysphagia, and dysgeusia. Dental hygiene management: (1) Prescription 1.1% NaF (5,000 ppm) toothpaste or gel — apply daily with custom trays; (2) In-office fluoride varnish (5% NaF) every 3 months; (3) Chlorhexidine varnish or gel as antimicrobial adjunct; (4) Saliva substitutes (Biotene, ACT Dry Mouth) and sugar-free lozenges/gum (xylitol); (5) Pilocarpine (cholinergic agonist) prescription by physician to stimulate residual gland function; (6) Strict low-sugar diet; (7) 3-month recall intervals.

Question 6: Which instrument is specifically designed for use in the furcation areas of multi-rooted teeth?

Nabers probe (furcation probe) for assessment and curved furcation curettes (e.g., Hirschfeld files) for debridement (Correct answer)
Gracey 11/12 curette exclusively
Explorer only
Periodontal probe for debridement

Correct answer: Nabers probe (furcation probe) for assessment and curved furcation curettes (e.g., Hirschfeld files) for debridement

The Nabers probe has a curved tip calibrated to assess furcation depth, while curved furcation curettes and Hirschfeld files are designed for effective calculus removal in the restricted anatomy of furcation areas.

Furcation areas present unique challenges due to their curved, concave, and restricted anatomy. Assessment: Nabers probe (UNC-furcation probe, Pi probes) has a curved, calibrated tip designed to enter and measure furcation depth and width. It is inserted parallel to the furcation roof. Debridement: Standard straight or slightly curved curettes cannot adapt effectively to concave root surfaces and furcation entrance. Specialized instruments include: (1) Curved furcation curettes — paired working ends designed for buccal and lingual furcation entry; (2) Hirschfeld files — small, double-ended files for working in tight furcations; (3) Mini-bladed curettes (Mini Gracey, After-Five) — access deep narrow pockets; (4) Ultrasonic inserts — slimline/furcation tips provide irrigation advantage in furcation areas.

NBDHE Dental Hygiene Care 2

The dental hygiene process of care follows which systematic sequence?