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LWBK942-FM.qxd 6/25/11 8:45 AM Page xLippincott Williams & Wilkins’ Certifi cation Preparation for Dental Assisting Dental_CertPrep_FM.indd i Dental_CertPrep_FM.indd i 2/12/11 2:09 PM 2/12/11 2:09 PMDental_CertPrep_FM.indd ii Dental_CertPrep_FM.indd ii 2/12/11 2:09 PM 2/12/11 2:09 PMDental_CertPrep_FM.indd iii Dental_CertPrep_FM.indd iii 2/12/11 2:09 PM 2/12/11 2:09 PMSenior Publisher: Julie K. Stegman Acquisitions Editor: Peter Sabatini Product Director: Eric Branger Senior Product Manager: Heather A. Rybacki Product Manager: Michael Marino Marketing Manager: Shauna Kelley Development Editor: Tom Lochhaas Manufacturing Coordinator: Margie Orzech-Zeranko Design Coordinator: Steve Druding Compositor: Absolute Service, Inc. First Edition Copyright © 2012 Lippincott Williams & Wilkins, a Wolters Kluwer business 351 West Camden Street Two Commerce Square Baltimore, MD 21201 2001 Market Street Philadelphia, PA 19103 Printed in China All rights reserved. This book is protected by copyright. No part of this book may be repro- duced or transmitted in any form or by any means, including as photocopies or scanned-in or other electronic copies, or utilized by any information storage and retrieval system without written permission from the copyright owner, except for brief quotations embodied in critical articles and reviews. Materials appearing in this book prepared by individuals as part of their of- fi cial duties as U.S. government employees are not covered by the above-mentioned copyright. To request permission, please contact Lippincott Williams & Wilkins at Two Commerce Square, 2001 Market Street, Philadelphia, PA 19103, via email at permissions@lww.com, or via website at lww.com (products and services). 9 8 7 6 5 4 3 2 1 Library of Congress Cataloging-in-Publication Data Cataloging-in-Publication data is available on request. DISCLAIMER Care has been taken to confi rm the accuracy of the information present and to describe generally accepted practices. However, the authors, editors, and publisher are not responsible for errors or omissions or for any consequences from application of the information in this book and make no warranty, expressed or implied, with respect to the currency, completeness, or accuracy of the contents of the publication. Application of this information in a particular situation remains the professional responsibility of the practitioner; the clinical treatments de- scribed and recommended may not be considered absolute and universal recommendations. The authors, editors, and publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accordance with the current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant fl ow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any change in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new or infrequently employed drug. Some drugs and medical devices presented in this publication have Food and Drug Adminis- tration (FDA) clearance for limited use in restricted research settings. It is the responsibility of the health care provider to ascertain the FDA status of each drug or device planned for use in their clinical practice. To purchase additional copies of this book, call our customer service department at (800) 638- 3030 or fax orders to (301) 223-2320 . International customers should call (301) 223-2300 . Visit Lippincott Williams & Wilkins on the Internet : http://www.lww.com. Lippincott Williams & Wilkins customer service representatives are available from 8:30 am to 6:00 pm, EST. Dental_CertPrep_FM.indd iv Dental_CertPrep_FM.indd iv 2/12/11 2:09 PM 2/12/11 2:09 PMDental_CertPrep_FM.indd v Dental_CertPrep_FM.indd v 2/12/11 2:09 PM 2/12/11 2:09 PMVI CONTRIBUTORS AND REVIEWERS Jessica L. Fisher , CDA, EFDA, CPT , BLS, AASCJ Director of Dental Assisting FORTIS College, Indianapolis, Indiana T eresa A. Macauley , CDA, EFDA, MS Associate Professor of Health Sciences Ivy Tech Community College, Anderson, Indiana Diana L. Olsen , CDA, CDPMA, RDH, EFDA, MS Coordinator and Adjunct Instructor, EFDA Program York County Community College, Wells, Maine Helene A. Pizzuta , CDA, RDA Dental Program Director American Institute, Clifton, New Jersey Dental_CertPrep_FM.indd vi Dental_CertPrep_FM.indd vi 2/12/11 2:10 PM 2/12/11 2:10 PM CONTRIBUTORS AND REVIEWERS VII REVIEWERS Leora Harty Medical Careers Institute, Newport News, Virginia Carole Landes Everest University, Largo, Florida Mark Matney Chattanooga State Community College, Chattanooga, Tennessee Julie Muhle Truckee Meadows Community College, Reno, Nevada Carrie Olewinski Carrington College, Boise, Idaho Diana Romero Delta Tech, Lake Charles, Louisiana Dental_CertPrep_FM.indd vii Dental_CertPrep_FM.indd vii 2/12/11 2:10 PM 2/12/11 2:10 PMDental_CertPrep_FM.indd viii Dental_CertPrep_FM.indd viii 2/12/11 2:10 PM 2/12/11 2:10 PMDental_CertPrep_FM.indd ix Dental_CertPrep_FM.indd ix 2/12/11 2:10 PM 2/12/11 2:10 PMX CONTENTS part III Simulated Examination 77 General Chairside (GC) Practice Exam 77 Radiation Health and Safety (RHS) Practice Exam 92 Infection Control (ICE) Practice Exam 105 Answers and Rationales: General Chairside (GC) 117 Answers and Rationales: Radiation Health and Safety (RHS) 131 Answers and Rationales: Infection Control (ICE) 142 Dental_CertPrep_FM.indd x Dental_CertPrep_FM.indd x 2/12/11 2:10 PM 2/12/11 2:10 PMpart I Preparing for the Dental Assisting National Certifi cation Exam The Certifi cation Exam Why get DANB certifi ed? Why go through the hassle, the added time, and the pressure of taking a national board exam to prove your credentials? The answer is relatively simple. Dentists generally would like their patients to re- spect and trust them and possibly even recommend them to other potential patients. If that isn’t the case, those den- tists will soon fi nd their practices dwindling. In order to win patients’ trust and respect, it is not enough for only the dentist display a high degree of knowledge and profes- sionalism; the entire dental staff should be held to high expectations as well. A dentist could seek and hire quali- fi ed dental assistants based on their word alone (“Sure, I’m qualifi ed!”), but chances are, most dentists will require some documentation as proof that the candidate is, indeed, a qualifi ed professional. To ensure a reputation of excel- lence for themselves and for their staff, many dentists may require the national certifi cation for employment, even though it may not be a state requirement. Therefore, even if your state does not require taking a credentialing exam such as the DANB, obtaining and maintaining this national credential will speak volumes about your qualifi cations, professionalism, dedication, and sincerity in being a den- tal assistant. Frame your certifi cate and display it proudly where patients can see it! Showing that you are a highly qualifi ed professional will instill patient confi dence in your abilities. As you may already know, the Dental Assisting National Board, Inc. (DANB) is the foremost recognized certifi cation and credentialing agency for dental assistants and is a mem- ber of the Institute for Credentialing Excellence (formerly NOCA). Certifi cation by a nationally recognized leader in dental assisting qualifi cations has many benefi ts. DANB- certifi ed assistants usually receive higher salaries than their noncredentialed colleagues, and DANB- certifi cation is a requirement for dental assistants to provide expanded functions in many states. The two areas of certifi cation that are open to eligible candidates are: ■ Certifi ed Dental Assistant (CDA) ■ Certifi ed Orthodontic Assistant (COA) Note: This book covers preparation for only the DANB CDA exam. Computerized Exam The DANB exam is only administered as a computerized exam. A written version is no longer available. The test is ad- ministered year-round at over 200 testing centers across the country. Applications may be turned in at any time, and can- didates may schedule their exam online at any time after re- ceiving their test admission notice. The exam must be taken during a 60-day eligibility window. For further information and test center locations, visit the DANB website (www.danb.org). The Exam Components The CDA exam consists of three component exams: General Chairside (GC), Radiation Health and Safety (RHS), and Infec- tion Control (ICE). General information about each of these exams—such as the allotted testing time, the total number of questions (items) in each component, and the percentage (%) of exam questions in each topic area—is provided here. General Chairside (GC) Exam ■ 120 multiple-choice items ■ 90 minutes (1.5 hours) testing time ■ Topics: ● Collection and recording of clinical data (10%, 12 questions) ● Chairside dental procedures (45%, 54 questions) ● Chairside dental materials (preparation, manipula- tion, application) (11%, 13 questions) ● Lab materials and procedures (4%, 5 questions) ● Patient education and oral health management (10%, 12 questions) ● Prevention and management of emergencies (14%, 17 questions) ● Offi ce management procedures (6%, 7 questions) Radiation Health and Safety (RHS) Exam ■ 100 multiple-choice items ■ 75 minutes (1.25 hours) testing time Dental_CertPrep_Part_I.indd 1 Dental_CertPrep_Part_I.indd 1 2/12/11 1:39 PM 2/12/11 1:39 PM2 PART I PREPARING FOR THE DENTAL ASSISTING NATIONAL CERTIFICATION EXAM Matching items, true/false items, and questions that could have more than one possible answer, such as “both A and B, ” “None of the above, ” or “All of the above, ” are not used on the DANB exam. Studying Ahead for the Exam One of the most important aspects of studying for an exam is not to “study” for the exam at all. Yes, you read that right! But isn’t this book designed to help you study for the test? Yes, of course it is. However, many students con- fuse “studying” with “cramming” for an exam. “Cramming” as much information into your head in a day or two—or even an hour or two—before taking the exam is not re- ally “studying. ” To truly study is to come prepared to each class throughout the academic term, read the material for that day, take notes on the material, and gain a deeper- than-surface-level understanding of the topic. Studying is a wide-ranging commitment. So, to clarify the meaning of the opening sentence: Don’t study for the exam, study for the knowledge. Then review for the exam and pass. Studying and reviewing go hand in hand. “Reviewing” for an exam is going back over the material you have already learned and internalized in order to freshen it in your mind. A great way to begin to truly study is by implementing some long-term studying strategies and methods into your student life. Set Up Y our Study Space The most important thing you need to know before you get started is what type of environment, or study space, is most conducive to your needs. Ask yourself some very simple questions: ■ Where can I be most organized? ■ What type of sounds do I like to hear when I’m learning? ■ When during the day am I most alert and most recep- tive to new information? ■ How do I best learn? Some people think the dining room table is a great place to study (and for them it might be), because it may be large and desklike. However, if that means having to put away all study materials at every mealtime or trying to study in the center of a large and/or loud household, it may actually be the least conducive place. Find a space where you can be consistently organized and where your high- lighters, notebooks, a computer (if necessary), textbooks, and other study materials can stay and be easily and readily accessible. Your study space should also not be cluttered with other items that could possibly be a distraction, such as phones, pictures, hobbies, magazines, and the like. Many instructors have argued for studying in a noiseless room. That seems to make a lot of sense—fewer distractions, ■ Topics: ● Exposing and evaluating radiographs (intraoral, extraoral) (37%, 37 questions) ● Processing fi lms (16%, 16 questions) ● Mounting/labeling fi lms (11%, 11 questions) ● Radiation safety, patient (24%, 24 questions) ● Radiation safety, operator (12%, 12 questions) Infection Control (ICE) Exam ■ 100 multiple-choice items ■ 75 minutes (1.25 hours) testing time ■ Topics: ● Patient and dental health care worker education (10%, 10 questions) ● Prevention of cross-contamination and transmission (20%, 20 questions) ● Maintaining aseptic conditions (10%, 10 questions) ● Performing sterilization procedures (15%, 15 questions) ● Environmental asepsis (15%, 15 questions) ● Occupational safety (30%, 30 questions) In total, you will answer 320 multiple-choice items in 4 hours. For each component exam, there are minimum performance standards that you must meet in order to earn the CDA certifi cation. It is to your advantage to know the percentage of questions that will appear for each topic on the exam so that you can schedule your study time ac- cordingly. For example, you should allot more time and energy to studying chairside dental procedures because these questions make up 45% (54 questions) of the GC component exam rather than lab materials and procedures because only 4% (5 questions) of the GC component exam address that topic. The Exam Questions The DANB national exam follows strict guidelines. The questions are written in a straightforward style with simple vocabulary; they are not written to trick you into answering incorrectly. Strategies for answering exam questions are provided later in the section, Answering Exam Questions. The exam is written in a simple multiple-choice format, which asks you to answer in one of two ways: ■ Direct-question format: You must answer a direct ques- tion by choosing one BEST or MOST CORRECT answer from a choice of possible answers. ■ Incomplete-statement format: You much complete an open-ended statement by choosing one BEST or MOST CORRECT word or phrase from a choice of four pos- sible answers. ■ Negative format: The DANB exam does not contain many of these types of questions, but it does contain a few. These are questions in which you must fi nd an EXCEPTION or determine which choice is NOT appro- priate for the question. Dental_CertPrep_Part_I.indd 2 Dental_CertPrep_Part_I.indd 2 2/12/11 1:39 PM 2/12/11 1:39 PM PREPARING FOR THE DENTAL ASSISTING NATIONAL CERTIFICATION EXAM 3 time of day. What you put into your body and what type of stress you place on your body directly affect how ef- fi ciently your mind works, how readily you absorb infor- mation, and how accurately you retain and recall material. Eating right, exercising, getting enough sleep, and taking frequent relaxation breaks will help the knowledge be absorbed. The Process of Studying When you have considered all these options, then you are ready to get down to the business of studying. Obviously, you should study your dental assisting textbook. Focus your reading by asking questions and answering those questions while you read. Think: ■ When will I most likely need to use this fact, procedure, or idea? ■ How would this be phrased as an exam question? ■ What is the next step in this procedure? How does it relate to the step before? ■ Does this make sense? If it helps you, write down the questions (and answers). If you come across a question for which you have no an- swer, ask your instructor during the next class. This brings us to the topic of taking notes. Whether you are in class or reading alone, there are many ways to take effective notes. The method you use depends on the purpose for the note taking (build- ing vocabulary, memorization of facts, understanding a concept, etc.) and on your style of learning. A few of the most popular note-taking styles are: ■ Cornell method: The notebook page is divided into two sections, with the left section approximately 2" wide. Notes are recorded on the right side, and correspond- ing vocabulary, important concepts, and key words are listed on the left. A brief summary is usually written at the bottom of the page. ■ Outline: Topics and subtopics are carefully aligned and indented according to how the information relates to the facts before it. Because of the formal structure of an outline, it is not always the most effective note- taking method for lectures or in-class notes (unless the instructor also uses an outline to teach). While taking “live” notes in class, it may be best not to use the Roman numeral and letter/number format because that makes it impossible to later add important information to the outline; instead, use bullets, dashes, and indentions to mark subtopics. ■ Mapping: A central idea, concept, or piece of informa- tion is written in the center of the page and corre- sponding ideas or subtopics are branched out from it via connecting lines. This method is useful when learn- ing a complex concept or theory and is great for visual learners because colors, drawings, or small graphics are easily integrated into the notes. comfortable, and quiet. However, this may not work for you at all. Utter silence can be deafening and distracting in itself to some people. If you know that you concentrate better when listening to soft music in the background, by all means, do that. (Just be sure that the sound level is truly benefi cial to studying, not to dancing and singing along.) By the same token, if you like the sounds of nature, study outside (weather permitting), but go elsewhere if you be- come distracted by sounds of lawnmowers and heavy traf- fi c. Maybe an indoor room with the window slightly open would serve you better. In the end, you know best what works for you. Set Up a Study Method It is important to be aware of how you learn best. If you are an auditory learner—you prefer to hear the informa- tion spoken—consider reading your information or text into a recording device and playing back for yourself. This means you can study while driving, jogging, or even while taking the dog for a walk! If you are a visual learner—pre- ferring to see a visual representation of the material—then draw some pictures of the material. If you are not an art- ist, take photographs. Need to memorize lab materials and proper procedures? Take pictures of them and use those as fl ashcards. If you learn best by discussing the material to be learned, join or create a study group with other vocal learners. You could also explain the material to an inter- ested friend or relative, or even to your pet. (Don’t laugh, it works!) In short, get creative. You know how you learn best. However, if you have any question about it, there are a number of free online sites (such as www.learning-styles- online.com) that will test your learning style and give you results with suggestions for how to make your learning style work for you. Set Up a Study Schedule Are you most alert in the morning, afternoon, or evening? This is the time when your mind is most receptive to new and challenging thoughts, so you should schedule your study sessions for those times. If this is not a realistic op- tion because of your work schedule, school, or other obli- gations, try to get as close as possible to your ideal time or work out a study schedule in which you can study at your best time at least two to three times a week. Carving out time to study from your other activities is a must, and creating a study schedule will help you stick to a routine and build great study habits. As you create your study schedule, don’t forget to include break times of 5 to 10 minutes every 45 minutes or so. Your brain needs down- time to absorb new information, and your body needs a break to relax and de-stress from studying. Make sure that you don’t schedule your study time im- mediately after a heavy meal or after a hectic or stressful Dental_CertPrep_Part_I.indd 3 Dental_CertPrep_Part_I.indd 3 2/12/11 1:39 PM 2/12/11 1:39 PM4 PART I PREPARING FOR THE DENTAL ASSISTING NATIONAL CERTIFICATION EXAM ❍ “First . . . Next . . . Last . . . ” ❍ Raising the voice or emphasizing words ❍ Pointing out items on a chart, in an outline, or even in the text ❍ Moving closer to students ❍ Repeating words or phrases (sometimes several times) ❍ Writing information on the board, overhead trans- parency, etc. ● Ask questions. Some instructors ask you to wait until an appointed time, such as after a demonstration or instructional video or even at the end of class, to ask questions. ● Use common sense. If you are the only one who does not fully understand something, perhaps it’s better to wait until after class to ask. Find out what your instructor prefers. ■ After class: ● Review your notes as soon as possible after class, fi ll- ing in notes, clarifying ideas, and writing down addi- tional questions to ask the instructor or research on your own. ● Use the shorthand you’ve developed to point out key terms, important points, confusing concepts, etc. ● Summarize the notes using just a sentence or two and highlight the summary. It will prove useful when creating a study plan for your exam. Great note taking will only get you so far. To really know your subject deeply and be able to pass an exam means you also need to review your notes on a regular basis. Reg- ular review helps ensure that you understand the material and cuts down dramatically on the amount of time you’ll need to study and review immediately before the exam. After all, you will have been studying all along! Lastly, use all available tools to check your understanding. Part II of this text contains a content review outline inter- spersed with review questions. Read through the outline, highlight important information, compare your study notes with the outline, and quiz yourself using the review ques- tions. If you fi nd that you need more preparation in certain areas or that some concepts are still a little vague, go back to your textbook to clarify. After you feel you have mastered the material, use the simulated exam and scoring guide in Part III of this text and on the accompanying CD to test your exam readiness. If you do well, give yourself a well-deserved pat on the back. If you don’t perform as well as you had expected, don’t despair and don’t give up. These are study tools for you to measure your readiness to take the formal exam—they are not end results. Whether you score high, medium, or low on the review questions, use the rationales as an additional tool to better understand any questions you missed and to verify and solidify the correct answers you had. Then make a list and formulate a study plan and schedule to help you focus on the areas in which you had trouble. Remember, studying is a cycle, not a linear process. No matter which methods you use—or if you create your own—there are some important principles to follow to make any note-taking style more effective. General Guidelines for Note T aking ■ Always: ● Choose a note-taking method that works for your learning style and for the topic. ● Date and number all your notes. ● Leave some empty space in case you need to fi ll in more information later. ■ Before class: ● Read the material thoroughly before class, highlight- ing important information, making notes in the mar- gin, and indicating questions for the instructor. The class will make much more sense and you’ll be ready to ask questions about items that are confusing to you. ● Write down unfamiliar terms and look them up; make sure you understand the appropriate defi ni- tion and how it relates to your topic—for example, a crown has a much different meaning to you than it does to a member of royalty. ● As you take notes, write in your own words, not those of the instructor or textbook. Summarizing, para- phrasing, and even listing information help make sure you understand and internalize the information and make studying and reviewing more user-friendly. ● Develop and use your own shorthand symbols to later draw your attention to important points (!), questions you have about a point/topic (?), or items that need to be memorized (*). Visual symbols will not only help you quickly locate and identify the ma- terial in question during class (questions to ask) but also after class while reviewing and adding to your notes. The symbols used in the parentheses are sim- ply examples of shorthand symbols. Feel free to be creative or use whatever is most effective for you. ● Bring your notes and questions to class and review them before class begins. ■ During class: ● Sit where there are the fewest distractions, where you can hear the instructor clearly, and where you can clearly see any notes or demonstrations the in- structor provides. ● Listen for content key words that are specifi c to the subject. Write down all vocabulary and important facts. ● Pay attention to clue words and the instructor’s physi- cal cues that let you know something important is com- ing up that you should write down. Some examples of instructor’s verbal and nonverbal cues and clues are: ❍ “Three important safety regulations . . . ” (a list is coming up) ❍ “Most importantly . . . ” ❍ “The advantages and/or disadvantages to this . . . ” Dental_CertPrep_Part_I.indd 4 Dental_CertPrep_Part_I.indd 4 2/12/11 1:39 PM 2/12/11 1:39 PM PREPARING FOR THE DENTAL ASSISTING NATIONAL CERTIFICATION EXAM 5 the information you’ve put into it. If you’ve done your work all along and internalized the information, the knowledge will be there. Trust in yourself. ■ Eat small, nutritious, well-balanced meals several times every day. Feed your body and your mind so you can function at optimal level. The Day Before the Exam This is not a time for cramming. You may want to take some time to review, but relaxation and positive attitude building should be your primary concern. If you haven’t done so already, drive to the test center at about the same time of day as on the day of the exam in order to judge traf- fi c patterns, time delays, etc. This will help ensure that you allow adequate time to arrive on time at the exam center destination. Locate where you will park, identify the cor- rect entrance, etc. You should also make sure that there is plenty of gas in your vehicle to get you to the location. You do not want to be late, hurried, or confused before you even step foot in the testing center. The Night Before the Exam ■ Have a light, nutritious dinner. You want to make sure you sleep well before the test. Heavy dinners, alcohol, or extremely spicy foods can interfere with a good night’s sleep. Avoid them. ■ Decide what you will wear. Choose light, comfortable clothing that won’t detract your attention. If you get chilled easily, plan to bring a light jacket or sweater. ■ Gather the necessary items you’ll need to bring with you and place them where you will not forget them on test day: ● Two forms of valid identifi cation ● Any additional paperwork you may be required to bring ■ Plan to get the optimum amount of sleep for you. For most people, that is between 6 and 8 hours. However, for some, 8 hours can be either too much or not quite enough. ■ Check your attitude and build yourself up. This is not a night for cramming or studying. It’s a night for relaxing and boosting your confi dence. The Morning of the Exam At this point, you should be well prepared for the exam. You’ve laid out your clothes, assembled all required ma- terials, ensured you know how and when to get to the test center, and gotten a good night’s rest. All that is left to do is get dressed, eat a light and nutritious breakfast, including some protein, and build up a positive can-do attitude. Leave yourself plenty of time to get to the test center, arriving at least 5 minutes early. If you think better Preparing for the Exam It is very important to prepare yourself physically and psy- chologically for the exam itself. Arriving at the test center weak, worn out, tired, frazzled, or otherwise unhealthy is not going to help you pass that exam. So what’s the best way to prepare? By being proactive, of course! Avoid T est Anxiety Many people experience a snowball effect of fear, stress, and anxiety by worrying about how their test anxiety will affect their exam score, increasing their anxiety even more. If you are one of those people, take a deep breath when you catch yourself becoming anxious. Remind yourself that you have been studying and preparing for the test all along. Focus on the positive and build up your confi dence instead of tearing it down. Try writing positive messages on sticky notes and posting them around your living space. Be your own cheerleader and recruit family, friends, and fellow students to be your cheerleaders. Several Days Before the Exam ■ Your knowledge of the material should be very solid at this point. Even though you are past the point of learn- ing major new concepts, continue to stick to your study schedule and focus on strengthening any areas in which you feel weak and reviewing those areas in which you are strong. Don’t try to memorize the information—own it! ■ If you haven’t already done so, make fl ashcards for the various components on the exam. Use the fl ashcards yourself as a quick check throughout the day or ask sup- portive family members and friends to quiz you periodi- cally as you have dinner, chat on the phone, etc. Make it a fun game, not a stress-fi lled obligation. ■ Take a practice test—in fact, take more than one. Be- come familiar with the layout of the exam, the format of the questions, and the wording of the directions. But remember that no practice test can include all the ques- tions on the actual exam or ones similar in phrasing. Study the material, not the specifi c practice questions. ■ Consider completing the DANB online tutorial (avail- able for download at http://www.danb.org/exams/tuto- rial2.asp) before you get to the test center. It describes how to mark your answers, skip items, and return to questions. You can also take the tutorial at the test site immediately before you begin the test—it does not count toward your testing time. Going through the tu- torial twice will ensure you haven’t missed anything. ■ Get plenty of sleep (at least 6 to 8 hours a night). A tired mind does not function well. ■ Try to relax as much as possible and don’t spend every waking hour studying. Allow your mind to process all Dental_CertPrep_Part_I.indd 5 Dental_CertPrep_Part_I.indd 5 2/12/11 1:39 PM 2/12/11 1:39 PM6 PART I PREPARING FOR THE DENTAL ASSISTING NATIONAL CERTIFICATION EXAM ■ Eliminate “wrong” answers right away. Just be careful not to do this too quickly; you don’t want to eliminate the right answer. Read, evaluate, and think through the choices. ■ If you fi nd you really do not know an answer at all, try to eliminate as many of the wrong choices as possible to increase your chances of getting the right answer and then take your best educated guess; you will not be penalized. Practice using these tips as you answer the review ques- tions in this text and on the accompanying CD. Strategies for T aking the Exam ■ Take the online tutorial available at the test center be- fore you begin your exam, even if you’ve taken it else- where online already. ■ Budget your time and don’t spend too much time on any one question. ■ Conversely, don’t hurry. Try to use every bit of time you have available for your exam. ■ Use the restroom if necessary, but remember that the timer keeps going even when you’re taking a restroom break. ■ Don’t allow yourself to become frustrated. If you feel anxiety creeping in, take a minute to look away from the computer, take a deep breath, clear your mind, then col- lect yourself and refocus. Tell yourself you can do this. ■ During the exam, you will be able to access a list of commonly used acronyms used on the DANB exam, so don’t worry that you’ll forget what the letters in OSHA stand for. ■ Don’t dwell on answers you really don’t know. If you truly don’t know the right answer, give it your best edu- cated guess and move on. You will not be penalized for guessing incorrectly (some exams will take off more points for wrong answers than blank ones; the DANB does not do this). ■ If, after eliminating wrong answers and narrowing down your answer choices, you are still unsure of the correct answer, fl ag the question for review and come back to it later. Other questions/answer choices may jog your memory and give clues to a previous question. ■ Only fl ag for review the questions where you are really stuck. If you fl ag too many, you’ll likely end up confus- ing yourself more. ■ After you have answered all exam questions within a given component exam, an answer review screen will appear, displaying a comprehensive list of question items and indicating which items you’ve left blank (in- complete) and which items you’ve fl agged for review or for comment. You may choose to review all items or only review fl agged answer choices; however, you must complete your review in the time you have left. You will not receive extra exam time to review the answers. ● If you choose to review all questions, only double- check that you’ve marked the answer choices that after a morning cup of coffee, then by all means, indulge a little, but be careful not to consume too much caffeine— you don’t want to be jittery or anxious—or consume too many liquids. Testing time does not stop while you use the restroom! During the Exam As diffi cult as it may seem, you need to try to relax. Focus on your breathing; don’t hold your breath. Also, try to sit in a comfortable, upright position, leaning slightly forward. Being hunched over will only serve to give you a backache and remind you how uncomfortable you are. Don’t sit still too long. Move your legs and arms from time to time and rotate your shoulders. Try to keep your blood circulating. Use the tips and strategies provided in the following sec- tions to improve your test-taking abilities. Tips for Answering Exam Questions The exam is written using simple multiple-choice ques- tions. This does not mean that the questions themselves are simple, but that the questions are formatted in a simple, straightforward style that is not meant to trick or confuse you. However, the exam is meant to measure and evalu- ate your knowledge of the subject. Each question will have only one right answer, along with several “distractor” choices that may look very plausible or even correct at fi rst glance. Distractors are not meant to confuse or trick you, even though it may appear that way at fi rst. Don’t allow yourself to become frazzled. Have confi dence in your knowledge and read each question and answer carefully. Familiarize yourself with multiple-choice-style questions and follow these strategies when answering multiple-choice questions: ■ Read all directions very carefully, even if you think you know what they may say. ■ Read the question carefully and look for clues to the right answer: ● Sometimes, the way a question is phrased will offer a hint by having only one grammatically correct answer. ● Dissect the question into smaller parts, if possible, to make sure you understand what is being asked. ■ Look for words that are capitalized or in bold print in the question. In negative format questions, the words “NOT” or “EXCEPT” indicate that the answer will be negative. The distractors (incorrect answer choices) will be true. ■ Look for absolute words in the answer choices, such as “always” or “never, ” which are rarely the correct answer. ■ Have the answer in mind before you begin looking for the correct choice. ■ Read each answer choice separately and evaluate whether it answers the question completely, is only part of the right answer, or is completely off topic. Dental_CertPrep_Part_I.indd 6 Dental_CertPrep_Part_I.indd 6 2/12/11 1:39 PM 2/12/11 1:39 PM PREPARING FOR THE DENTAL ASSISTING NATIONAL CERTIFICATION EXAM 7 After the Exam You will receive a preliminary score report at the testing center, and offi cial scores will be mailed to you approxi- mately 4 weeks after your exam. The scores are “scaled, ” meaning that a complex score is translated into a more user-friendly scale. This scale has a numerical range of 100 (low) to 900 (high). A scaled score of 400 is considered passing for each component. You may retake the compo- nent exam(s) that were not passed, but you are required to reapply and pay exam fees for those exams. You must pass all component exams within 5 years to receive certifi cation. Along with your scaled score, your score report will also show your performance on the subtests or general content areas. The performance indicators will show on which sections you scored “high average” (best), “average” (medium), and “low average” (weak). If you need to retake the test, it is highly recommended that you increase your knowledge in the “low average” subtest material. For additional information about the DANB exam, such as individualized standards for passing, who else can see your test scores, how you can request a duplicate score report, etc., visit the DANB website at www.danb.org. you intended . If you fi nd a mismarked item (for ex- ample, you intended to choose answer “A” but some- how marked “C”), change it. ● If you choose to go back to questions you’ve fl agged for review, only change the answer if you fi nd a glar- ing error. If you are unsure if the answer is right, do not second-guess yourself. Leave your fi rst answer. Chances are, your fi rst response is right. ● After the answer review screen, you will be asked to confi rm that you are ending the exam review. After you click “yes, ” you will not be able to return to the exam or change any answers. ■ You may also fl ag items for comments. After exit- ing the answer review screen, the comment review screen appears. ● You may choose to comment on all items or only those that you have fl agged. ● You are allotted 10 minutes in addition to the exam time for posting comments. ● You cannot change answers or return to answer re- view mode while in comment review mode. ● After confi rming that you are exiting the comment review mode, you cannot return to the exam, to answer review mode, or to comment review mode. Dental_CertPrep_Part_I.indd 7 Dental_CertPrep_Part_I.indd 7 2/12/11 1:39 PM 2/12/11 1:39 PMDental_CertPrep_Part_I.indd 8 Dental_CertPrep_Part_I.indd 8 2/12/11 1:39 PM 2/12/11 1:39 PMpart ReviewII GENERAL CHAIRSIDE ASSISTING (GC) Collecting and Recording Clinical Data I. Basic Oral and Dental Anatomy and Physiology A. Bones of the cranium, face, and neck 1. Cranial bones are the single frontal, occipital, sphenoid, and ethmoid bones and also the paired pari- etal and temporal bones. 2. Facial bones are the lacrimal bones, nasal bones, vomer, nasal conchae, zygomatic bones, maxillae, and mandible. 3. The hyoid bone is suspended between the mandible and larynx. B. Muscles of the head and neck 1. Muscles of mastication are: temporal muscles, masseter muscles, internal (or medial) pterygoid mus- cles, and external (or lateral) pterygoid muscles. 2. Muscles of facial expression are: orbicularis oris muscle, buccinators muscle, mentalis muscle, and zygomatic major. 3. Muscles of the fl oor of the mouth are: digastric muscle, mylohyoid muscle, stylohyoid muscle, and geniohyoid muscle. 4. Muscles of the tongue are classifi ed as intrinsic (within the tongue) or extrinsic (outside the tongue). Intrinsic muscles shape the tongue during speech, mastication, and swallowing. Extrinsic muscles move the tongue. 5. Muscles of the soft palate (major) are: palatoglossus and palatopharyngeus. 6. Muscles of the neck are: sternocleidomastoid muscle and trapezius muscle. C. Glands 1. The most signifi cant glands for dental health professionals are the major and minor salivary glands. 2. The pituitary gland, pineal gland, thyroid gland, and parathyroid glands are found within the head and neck. 3. The thyroid gland is located within the neck on the front and sides of the trachea just below the larynx. D. Nerves 1. The trigeminal nerve (cranial nerve V) is the primary source of innervation for the oral cavity. 2. The trigeminal nerve is subdivided into three divisions: maxillary, mandibular, and ophthalmic. Of these three divisions, the maxillary and mandibular are of particular interest to dental health professionals. E. Blood vessels 1. Major arteries of the face and mouth are the aorta and the common carotid artery. 2. Blood descends from the face and mouth through this network of veins: maxillary vein, temporal vein, retromandibular vein, and lingual veins. These veins empty into the jugular veins, which empty into the superior vena cava to transport blood to the heart and lungs for reoxygenation. Dental_CertPrep_Part_IIA_GC.indd 9 Dental_CertPrep_Part_IIA_GC.indd 9 2/12/11 1:29 PM 2/12/11 1:29 PM10 PART II REVIEW F . Teeth 1. There are essentially four components of the tooth: enamel, dentin, pulp, and cementum. 2. The tooth consists of a crown and a root. a. The anatomic crown of the tooth is the part covered by enamel. The clinical crown refers to the part of the crown visible in the oral cavity. b. The anatomic root is the part of the tooth covered by cementum. The clinical root refers only to the part of the root that is not visible. G. Oral cavity 1. The vestibule is the space between the teeth and the inner lining of the cheeks and lips. 2. The frena (singular: frenum), raised lines of mucosal tissue, are visible when the lips are pulled back and they support or restrain teeth and other structures. 3. The gingivae—commonly called the gums—are attached to the alveolar ridge and vary in color from pale pink to brownish pink. Free gingivae or marginal gingivae is where the gingivae meet the teeth and is the fi rst area to respond to infl ammation. 4. The hard palate, a bony plate covered with keratinized tissue, sits toward the front of the mouth and forms the anterior portion of the palate. 5. The soft palate is composed of muscle tissue rather than bone and sits toward the back of the mouth. The uvula, the projection visible when the mouth is opened wide, hangs from the back of the soft palate. II. Clinical Exam A. While escorting patient to the clinical examination area, observe patient’s overall appearance, gait, speech, and general behavior and note unusual or concerning characteristics or behavior. B. Seat patient upright in dental chair, secure paper bib or napkin around patient’s neck, and compile or update patient’s medical and dental history. Note drug allergies and chronic diseases, such as diabetes; record the purpose of the patient’s visit. C. Types and locations of teeth in the primary and permanent dentition 1. Incisors cut food, support lips, and help produce sounds for speech. 2. There are four canine teeth (cuspids), one in each quadrant of the mouth. They have a single cusp (cingulum), whose primary purpose is to tear food. 3. Premolars are found only in the permanent dentition. They replace the fi rst and second molars of the primary dentition. 4. First and second molars have four cusps used to chew and grind food. 5. Third molars (“wisdom” teeth) erupt in late adolescence/early adulthood. D. Surfaces of the tooth are: facial, lingual, incisal/occlusal, mesial, and distal. They are named for their re- lationship or closeness to other intraoral structures, such as the lips and tongue, or according to which direction they face within the intraoral cavity. E. Record abnormal fi ndings in head and neck (TMJ) region 1. As the dentist comments on the patient’s dental conditions and health, note or chart any abnormalities, such as: soft tissue abnormalities; tooth structure abnormalities, including missing teeth; and restorations. 2. If allowed in your state, examine extraoral soft tissue by palpation. When searching for oral cancer, examine the head and neck, including inspection and palpation of extraoral tissues, temporoman- dibular joint, tongue, fl oor of mouth, palate, uvula, and lymph nodes. 3. Note any other abnormal fi ndings in the head or neck region that may be related to other health conditions. III. Patient Charts A. Identify permanent and primary teeth using numbering systems 1. The universal numbering system is the main numbering system used on dental charts in the United States. 2. The international tooth numbering system is a two-digit system that uses only numerals 1 through 8 for each digit. 3. The Palmer notation system identifi es the teeth by quadrant and number. B. Chart conditions 1. Use Black’s classifi cation of cavities (describes six classes of cavities and outlines restorative treat- ments for each) to observe/record suspected cavities. 2. Use abbreviations, symbols, and colors in the patient chart to document decay, restoration, or other existing conditions. Dental_CertPrep_Part_IIA_GC.indd 10 Dental_CertPrep_Part_IIA_GC.indd 10 2/12/11 1:29 PM 2/12/11 1:29 PM GENERAL CHAIRSIDE ASSISTING (GC) 11 3. Record the results of the periodontal exam, including the dentist’s assessment of mobility, pocket depth, and furcation involvement. 4. Record existing damage or disease to tooth pulp (endodontics) or periapical tissue. IV. Diagnostic Testing A. Assist in collecting diagnostic patient information. 1. Dental radiographs allow the dentist to examine the health of the pulp, the root canal space, and the bone and to detect possible dental caries. 2. Various pulp tests, such as thermal pulp testing and electric pulp testing, are used to diagnose peri- odontal disease. 3. Photography can provide a before-and-after record of original conditions and the subsequent effects of any procedures. 4. Preparing materials for taking an occlusal registration include (1) softening the wax in warm water and preparing it for placement in the patient’s mouth and (2) mixing other materials on a paper pad and putting them on a quadrant tray for placement in the patient’s mouth. B. Diagnostic casts (diagnostic models or study models) are three-dimensional models of the patient’s teeth, mouth, and arches. They are useful because they show actual distances and proportion of the patient’s teeth and arches. They are created from alginate impressions and included in the patient’s record. V . Documenting Treatment A. Maintain accurate records of drugs prescribed or dispensed to patients. If a drug is discussed in detail with the patient, record important points of this discussion. B. Before the patient arrives, familiarize yourself with the patient’s record to alert you to the patient’s pre- medications (premeds), any medical concerns you and the dental team should be aware of, any change in dental treatment that should be provided, and any change in the way in which dental treatments should be performed. C. Record recommended treatment in patient’s chart and make sure the chart includes signed and dated consent forms necessary for treatment. If a patient refuses an examination, treatment, or test, document the refusal in the chart. If possible, ask the patient to sign a statement indicating that they refused treat- ment and keep that statement in the chart. D. Record that the patient complied with the treatment provided. VI. Obtain Vital Signs A. Take a pulse by gently palpating an artery with fi ngertips, pressing lightly but fi rmly enough to feel the pulse. Count the number of pulse beats for 30 seconds; multiply your count by two and record pulse rate in patient chart, along with date, time, and your signature. B. Measure respiration by counting the number of times the patient’s chest rises and falls in 30 seconds. Each cycle of rise and fall of the chest counts as one. Multiply your count by two and record respiration rate in patient chart, along with date, time, and your signature. C. Measure blood pressure using a sphygmomanometer and a stethoscope. Record blood pressure in pa- tient chart, along with date, time, and your signature. The systolic number is written fi rst, followed by the diastolic. D. Temperature is measured with a thermometer at different body sites: under the tongue, inside the arm- pit, inside the ear, and inside the rectum (for infants). Record temperature in patient chart, along with date, time, and your signature. Review Questions 1. Using the universal numbering system, the permanent maxillary right second molar is tooth number A. 2. B. 7. C. 15. D. 18. Dental_CertPrep_Part_IIA_GC.indd 11 Dental_CertPrep_Part_IIA_GC.indd 11 2/12/11 1:29 PM 2/12/11 1:29 PM12 PART II REVIEW 2. A small, rounded extension of bone covered with soft tissue located posterior to the last maxillary molar is the A. Stensen’s papilla. B. retromolar pad. C. maxillary tuberosity. D. torus palatinus. 3. Which of the following best describes the palantine rugae? A. The demarcation between the hard and soft palate. B. Horizontally raised folds of hard tissue behind the incisive papilla on the hard palate. C. The ridged line that extends from behind the incisive papilla down the midline of the palate. D. A raised area of tissue just behind the maxillary incisors. 4. To identify Stensen’s papilla, look for a A. small raised fl ap of soft tissue on the buccal mucosa opposite the maxillary second molar. B. triangular area of bone covered with soft tissue behind the last mandibular molar. C. raised horizontal extension of soft tissue along the occlusal line on the buccal mucosa. D. raised rounded area of soft tissue directly behind the two maxillary central incisors. 5. Which of the following nerves provides sensory innervation for the teeth and mouth? A. Trapezius B. Glossopharyngeal C. Trigeminal D. Zygomatic 6. Which of the following major salivary glands is located on the side of the face, behind the ramus, below and in front of the ear? A. Buccal B. Parotid C. Sublingual D. Submandibular See p. 33 for the correct answers and rationales General Dentistry Chairside Procedures I. Assisting with the Patient and Equipment A. Prepare the treatment room by cleaning and disinfecting clinical contact areas; placing infection con- trol barriers in the area; bringing the patient’s record, radiographs, and lab work to the area; bringing in a sterile preset tray and other supplies; clearing a pathway for the patient; and positioning the dental chair. B. Prepare treatment trays by lining up instruments in the order in which they’ll be used. Place those instruments to be used fi rst on the left side of the tray and hinged instruments on the right side of the tray. Also, arrange instruments and material based on their function. C. Greet the patient in the reception area and invite him or her to the treatment room. Once seated in the dental chair, position the patient upright, supine, semisupine, or subsupine (Trendelenburg). Position yourself, the operator, the dental unit, and all instruments and equipment that will be needed during a procedure so that you and the operator use only class I, II, and III motions. D. Four-handed dentistry, or team dentistry, is the method of providing dental treatment in which the opera- tor and assistant work together as a team while both are seated in specifi c positions near the patient. 1. Maintain the dentist’s fulcrum during instrument transfer. A fulcrum is a hand position in which the dentist’s fi ngers are stabilized so the hand can easily pivot and perform work in the oral cavity. 2. Sit across from the dentist and hand instruments across the transfer zone to the dentist as needed. The transfer zone is the space where instrument transfer occurs during four-handed dentistry, usually below the patient’s chin and directly over his or her throat and upper chest. Dental_CertPrep_Part_IIA_GC.indd 12 Dental_CertPrep_Part_IIA_GC.indd 12 2/12/11 1:29 PM 2/12/11 1:29 PM GENERAL CHAIRSIDE ASSISTING (GC) 13 3. After the patient has been placed in the proper position, the chair may need to be raised or lowered by the operator to get a clear vision of the operating fi eld and to allow ergonomic access to the oral cavity. II. Select and Prepare Trays and Other Dental Equipment A. Select, prepare, and modify impression trays . 1. Selecting a proper tray from among a supply of stock trays requires that you try several before choos- ing one that causes the patient as little discomfort as possible. 2. Modify stock trays with utility wax. If a stock tray does not fi t a patient’s needs, construct custom trays, which are specially designed and built to fi t a particular patient’s mouth. Several types of materi- als may be used, which may be self-curing or light-cured acrylic resin, vacuum resin, or a thermoplastic material. B. The tray for local anesthetic administration should include aspirating syringe, two carpules of anesthetic, long and short needles, alcohol sponge, cotton gauze, tongue depressor (optional), needle recapping device, sharps disposal system, topical anesthetic, and a cotton applicator on a clean cotton gauze. C. Select and prepare tray setups and equipment . 1. The tray setup for anesthetics varies depending on the type of anesthetic being administered. a. Topical anesthetics setups require a topical agent, gauze pad, and applicator. b. Local anesthetics require injection equipment and an anesthetic cartridge. c. Inhalation anesthesia requires nitrous oxide and oxygen cylinders and related equipment. d. Intravenous sedation setup requires an antiseptic, small needle, tourniquet, and IV . 2. Permanent restorations require a restorative tray (basic setup, hand-cutting instruments, amalgam carrier, condensers, burnishers, carvers, composite placement instrument, articulating paper holder), local anesthetic setup, dental dam setup, high-volume oral evacuator tip, high-speed handpiece, low- speed handpiece, saliva ejector, burs, cotton pellets and rolls, gauze, dental liners, base, bonding agents, sealers, permanent restorative material (composite or amalgam), and dental fl oss. 3. Tray setup for tooth whitening includes basic setup, protective gel or dental dam, tooth whitener product, resin polishing cup or fl uoride prophy paste, and a light or laser source. 4. Crown setups require cotton rolls, bite stick, plastic fi lling instrument, permanent luting cement, scaler or explorer, custom fabricated crown, and cementing materials. 5. Bridge setups need cotton rolls, petroleum jelly, alginate impression, self-curing acrylic resin with spatula and mixing container, fi nishing diamonds or burs, rubber wheels and cusp for polishing, polishing paste, and cementing materials. 6. Cotton rolls or gauze, a microbrush, and a desensitizing agent are needed for desensitization. 7. Root canal procedures require a local anesthetic agent setup (optional), dental dam setup, handpiece (high speed) with burs, handpiece (low speed) with latch attachment, syringe, broaches and Hedstrom/ K-type fi les of assorted lengths/sizes, rubber instrument stops, lentulo spiral, paper points, gutta-percha points, spoon excavator, endodontic explorer, endodontic sealer supplies, Glick #1, locking cotton pli- ers, millimeter ruler, sodium hypochlorite solution, hemostat, and high-volume oral evacuator (HVE) tip. 8. Pupal therapies require local anesthetic agent setup, dental dam setup, low-speed handpiece, round burs, spoon excavators, sterile cotton pellets, formocresol, zinc oxide eugenol base, fi nal restorative material, and instruments for placement. 9. The exact composition of the surgical tray setup for extractions, impactions, incisions and drain- age, prosthetic implants, and suture placement and removal depends on the procedure and opera- tor, so it’s essential to understand the nature of the surgery and the surgeon’s preferences while assembling the setup. 10. Partial dentures require a basic tray setup, complete with mouth mirror, explorer, and cotton pliers; articulating paper and forceps; pressure indicator paste; a low-speed handpiece and acrylic and fi nishing burs; three-pronged pliers; and the patient’s partial denture. 11. Full and immediate denture setups require a mouth mirror, explorer, and cotton pliers; HVE and air-water syringe tips; a hand mirror; articulating forceps and paper; high-speed and low-speed handpieces and burs and discs; the patient’s dentures from the laboratory; and take-home materials and hygiene aids. 12. Fluoride treatments require disposable applicator trays, a saliva ejector, air-water syringe, cotton rolls, and a timer. 13. Initial impressions for partial and full dentures require a basic tray setup and stock trays for alginate impressions and a wax bite registration. The alginate impressions will be used to make the custom trays used in the secondary impressions. Dental_CertPrep_Part_IIA_GC.indd 13 Dental_CertPrep_Part_IIA_GC.indd 13 2/12/11 1:29 PM 2/12/11 1:29 PM