NDAEB Patient Records and Charting 2 — Questions and Answers

Question 1: When charting a tooth that has been extracted and is no longer present in the patient's mouth, what symbol is typically used in the geometric charting system?

A red circle around the tooth
An X drawn through the tooth symbol (Correct answer)
A blue outline on the tooth
A diagonal line through one root only

Correct answer: An X drawn through the tooth symbol

In the geometric charting system commonly used in Canadian dental offices, a large X drawn through the tooth symbol indicates that the tooth has been extracted or is missing.

Dental charting uses standardized symbols to create a visual record of a patient's oral condition. In the geometric charting system used in most Canadian dental practices, an X through the entire tooth symbol indicates the tooth is missing (extracted or congenitally absent). Other common symbols include: outlined areas in blue/red for existing restorations, filled areas for treatment needed, a circle around a tooth number for a crown, parallel lines across the root for root canal treatment, and arrows for drifted teeth. Accurate charting is a legal document and must be completed carefully. The dental assistant often performs initial charting as the dentist calls out findings during the clinical examination. Both the Universal numbering system (1-32) and the FDI two-digit system (11-48) may be used in Canadian practices, though the FDI system is standard for NDAEB.

Question 2: According to Canadian dental record-keeping standards, how long must patient dental records be retained after the patient's last visit?

5 years
10 years from the date of last entry, or until the patient reaches the age of majority plus 10 years for minors (Correct answer)
1 year
Records may be destroyed immediately after the patient transfers

Correct answer: 10 years from the date of last entry, or until the patient reaches the age of majority plus 10 years for minors

Most Canadian provincial dental regulations require records to be retained for 10 years from the date of the last entry, with additional requirements for minor patients whose records must be kept until 10 years after they reach the age of majority.

Record retention requirements vary slightly by province but generally require a minimum of 10 years from the date of the last entry in the patient's chart. For minor patients, records must be retained for 10 years after the patient reaches the age of majority (18 or 19 depending on the province). Some provinces may require longer retention periods. Records must be stored securely (physical records in locked cabinets, electronic records with appropriate access controls and backup systems) and in compliance with PIPEDA and provincial privacy legislation. When records reach their retention expiry, they must be destroyed securely (shredding for paper, secure deletion for electronic records). Dental assistants should understand these requirements as they often manage records storage and may be responsible for maintaining the records retention schedule.

Question 3: In the FDI (Fédération Dentaire Internationale) tooth numbering system used in Canadian dental practice, what number designates the permanent maxillary right canine?

6
13 (Correct answer)
23
11

Correct answer: 13

In the FDI system, the first digit represents the quadrant (1 = permanent upper right) and the second digit represents the tooth position (3 = canine). Therefore, the permanent maxillary right canine is tooth 13.

The FDI two-digit notation system is the international standard and is used in Canadian dental education and NDAEB examinations. The system divides the dentition into four quadrants numbered clockwise from the patient's upper right: Quadrant 1 = permanent upper right, Quadrant 2 = permanent upper left, Quadrant 3 = permanent lower left, Quadrant 4 = permanent lower right. For primary teeth: 5 = upper right, 6 = upper left, 7 = lower left, 8 = lower right. The second digit identifies the tooth position counting from the midline: 1 = central incisor through 8 = third molar. So tooth 13 = permanent upper right canine, tooth 36 = permanent lower left first molar, tooth 55 = primary upper right second molar. This contrasts with the Universal system (used primarily in the US) where the maxillary right canine is tooth #6.

Question 4: What information must be recorded in the patient's chart immediately following the administration of local anaesthesia?

Only the type of anaesthetic used
The type of anaesthetic, amount administered, lot number, expiration date, injection site, and any adverse reactions (Correct answer)
Just the time of injection
Only a note stating 'local anaesthesia given'

Correct answer: The type of anaesthetic, amount administered, lot number, expiration date, injection site, and any adverse reactions

Complete anaesthesia documentation includes the specific agent, vasoconstrictor type and concentration, number of cartridges, lot number, expiration date, injection technique/site, and any adverse reactions. This is both a legal requirement and essential for patient safety.

Comprehensive anaesthesia documentation is a legal and clinical necessity. The record must include: the specific anaesthetic agent (e.g., lidocaine 2%), vasoconstrictor type and concentration (e.g., epinephrine 1:100,000), number of cartridges used, lot number and expiration date (for traceability in case of adverse reactions or recalls), injection technique (e.g., inferior alveolar nerve block, infiltration), specific anatomical site, needle gauge and length, aspiration results (positive or negative), patient response, and any adverse reactions. The time of administration should also be noted. In Canadian dental practice, this documentation is considered a legal document and may be required in malpractice claims, regulatory investigations, or coroner's inquiries. Incomplete anaesthesia records are one of the most common documentation deficiencies identified during dental practice audits.

Question 5: When updating a patient's medical history form, the patient reports they have started taking warfarin (Coumadin). Why is this medication particularly significant for dental charting and treatment planning?

It causes dry mouth that increases caries risk
It is an anticoagulant that significantly increases bleeding risk during dental procedures (Correct answer)
It causes gingival hyperplasia
It interacts with fluoride treatments

Correct answer: It is an anticoagulant that significantly increases bleeding risk during dental procedures

Warfarin is an anticoagulant (blood thinner) that significantly increases the risk of prolonged bleeding during invasive dental procedures. This must be prominently flagged in the chart and communicated to the dentist before any treatment.

Warfarin (Coumadin) is an oral anticoagulant prescribed for conditions such as atrial fibrillation, deep vein thrombosis, and mechanical heart valves. It inhibits vitamin K-dependent clotting factors, significantly prolonging bleeding time. For dental treatment, the patient's INR (International Normalized Ratio) must be checked - typically within 24-72 hours before invasive procedures. Most dental procedures can be safely performed if the INR is below 3.5, using local hemostatic measures (pressure, absorbable gelatin sponge, tranexamic acid rinse). The dental assistant must flag this medication prominently in the medical alert section of the chart, use a medical alert sticker on the file, and verbally alert the dentist. The patient's physician should be consulted before any extractions or surgical procedures. Never advise a patient to stop warfarin without physician consultation, as the risk of stroke or thromboembolism may outweigh the bleeding risk.

Question 6: What is the primary purpose of obtaining a baseline set of dental radiographs for a new patient?

To satisfy insurance requirements only
To establish a diagnostic baseline for comparison with future radiographs and to detect existing pathology not visible clinically (Correct answer)
To practice radiographic technique
To determine the patient's age

Correct answer: To establish a diagnostic baseline for comparison with future radiographs and to detect existing pathology not visible clinically

Baseline radiographs provide essential diagnostic information about existing conditions (caries, bone loss, periapical pathology, impacted teeth) and serve as a reference point for monitoring changes over time in subsequent visits.

Baseline radiographs for new patients typically include a panoramic radiograph and/or a full-mouth series (FMX) of periapical and bitewing radiographs. These images reveal interproximal caries not visible clinically, periapical pathology (infections, cysts), bone levels for periodontal assessment, impacted or supernumerary teeth, root morphology, existing restoration integrity, and developmental anomalies. The baseline set serves as a comparison standard for future radiographs - changes in bone levels, new carious lesions, or developing pathology can only be detected by comparing to the baseline. The ALARA (As Low As Reasonably Achievable) principle governs radiographic prescription in Canada, meaning radiographs should only be taken when clinically indicated, not on a routine time-based schedule. The dental assistant is responsible for producing diagnostic-quality images and properly mounting/filing them in the patient's record.

NDAEB Patient Records and Charting 2

When charting a tooth that has been extracted and is no longer present in the patient's mouth, what symbol is typically used in the geometric charting system?