Your FREE NBDHE Flashcards 2026 – 250+ Cards

NBDHE Flashcards

Order of the periodontal disease spectrum?

Health → gingivitis (reversible, no attachment loss) → periodontitis (attachment + bone loss, not reversible) → advanced periodontitis.

Earliest reliable clinical sign of gingival inflammation?

Bleeding on probing (BOP) — inflamed sulcular tissue is vascular and ulcerated, so it bleeds with gentle probing.

Which cranial nerve supplies general sensation to the teeth?

The trigeminal nerve (CN V) — V2 maxillary teeth, V3 mandibular teeth. V3 also carries motor to the muscles of mastication.

Gingivitis vs periodontitis — the dividing line?

Clinical attachment loss. Gingivitis has NONE (reversible); periodontitis has attachment loss + radiographic bone loss (not reversible).

Probing depth vs clinical attachment level (CAL)?

Probing depth = gingival margin → pocket base. CAL = fixed CEJ → pocket base. CAL is the truer measure of support lost.

With recession, how do you calculate CAL?

CAL = probing depth + recession (margin is apical to the CEJ). E.g. 5 mm pocket + 2 mm recession = 7 mm CAL.

STEEP vertical angulation on a radiograph causes?

Foreshortening — the image looks too SHORT. Memory hook: STEEP angle → SHORT image.

FLAT (insufficient) vertical angulation causes?

Elongation — the image looks too LONG. Memory hook: FLAT angle → LONG image.

How does fluoride prevent caries?

Topically: promotes remineralization, forms acid-resistant fluorapatite, and inhibits bacterial metabolism.

Most common medical emergency in the dental office?

Syncope (vasovagal fainting). Management: stop, supine position, ensure airway, give oxygen, monitor.

What is the NBDHE?

The National Board Dental Hygiene Examination — the JCNDE/ADA written board exam required for dental hygiene licensure in the U.S.

Trigeminal nerve (CN V) three branches?

V1 ophthalmic (forehead/eye), V2 maxillary (maxillary teeth/palate/cheek), V3 mandibular (mandibular teeth/lower lip/anterior tongue + motor to mastication).

Cranial nerve for TASTE to the anterior 2/3 of the tongue?

Facial nerve (CN VII), via the chorda tympani. The trigeminal carries general (not taste) sensation there.

Four muscles of mastication?

Masseter, temporalis, medial pterygoid, lateral pterygoid — all innervated by V3 (mandibular division of CN V).

Which muscle protrudes the mandible?

The lateral pterygoid. The posterior fibers of the temporalis retract the mandible.

Hardest, most mineralized tissue of the body?

Enamel — covers the crown; acellular and avascular, so it cannot repair itself once cavitated.

What is dentin?

The mineralized, tubule-containing tissue beneath enamel and cementum; forms the bulk of the tooth and transmits sensitivity.

What is cementum?

The mineralized tissue covering the root that anchors the periodontal ligament fibers to the tooth.

The four parts of the periodontium?

Gingiva, periodontal ligament (PDL), cementum, and alveolar bone — the support apparatus destroyed in periodontitis.

Universal tooth numbering — where does #1 start?

The maxillary right third molar (#1), running across to the maxillary left third molar (#16), then down to the mandibular teeth (17–32).

Salivary glands (major three)?

Parotid (serous, mumps), submandibular (mixed, most resting saliva), and sublingual (mostly mucous).

Role of saliva in oral health?

Buffers acid, remineralizes enamel, lubricates, clears food, and has antimicrobial proteins. Low flow (xerostomia) sharply raises caries risk.

What is dental plaque?

A structured bacterial biofilm in a sticky matrix on the tooth surface — the cause of both caries and gingival inflammation.

Primary cariogenic bacterium?

Streptococcus mutans — it ferments dietary sugars into acid that demineralizes enamel; Lactobacillus advances the lesion.

Caries = a balance between what two processes?

Demineralization (acid removing mineral) vs remineralization (fluoride and saliva returning mineral). Caries occurs when demineralization wins.

What dietary factor most drives caries risk?

The FREQUENCY of fermentable-carbohydrate intake — more important than the total amount, because each exposure causes an acid attack.

Leading modifiable risk factors for oral cancer?

Tobacco and alcohol — synergistic (multiplicative) when used together. HPV is rising for oropharyngeal cancer.

Oral lesion features concerning for malignancy?

Non-healing ulcer >2 weeks, induration (firmness), fixation, irregular red-white (erythroleukoplakia) appearance. Refer for biopsy.

Vitamin deficiency linked to delayed wound healing and bleeding gingiva?

Vitamin C (scurvy) — it is required for collagen synthesis. Vitamin K is required for clotting-factor synthesis.

Predominant antibody in saliva?

Secretory IgA (sIgA) — provides mucosal immune protection at the oral surfaces.

Local anesthetic mechanism of action?

Reversibly blocks sodium channels, stopping nerve conduction and producing a temporary loss of sensation.

Why add a vasoconstrictor (epinephrine) to a local anesthetic?

It slows absorption — prolonging anesthesia, reducing bleeding, lowering systemic toxicity, and raising the allowable dose.

How many mg of lidocaine in a 1.8 mL cartridge of 2% solution?

36 mg. A 2% solution = 20 mg/mL (% × 10); 1.8 mL × 20 mg/mL = 36 mg.

Convert a % anesthetic solution to mg/mL?

Multiply the percentage by 10. 2% = 20 mg/mL; 4% articaine = 40 mg/mL; 3% mepivacaine = 30 mg/mL.

Signs of local-anesthetic systemic toxicity?

CNS first (perioral numbness, tinnitus, tremor, seizures) then cardiovascular depression. Always track total mg vs the maximum dose.

First-line analgesic for dental pain?

NSAIDs such as ibuprofen (anti-inflammatory). Watch GI, renal, and bleeding cautions; acetaminophen when NSAIDs are contraindicated.

Standard antibiotic premedication regimen?

Amoxicillin 2 g (adult), taken one hour before the appointment, per AHA/ADA guidance for at-risk cardiac patients.

Anticoagulant relevant to dental hygiene treatment?

Warfarin and the DOACs — they raise bleeding risk. Review the medical history and INR (warfarin) before instrumentation.

Inferior alveolar nerve block anesthetizes which structures?

The mandibular teeth on that side (via V3), plus the lower lip and chin (mental nerve). It does not anesthetize the maxillary teeth.

Endocrine disease with major oral implications?

Diabetes — poor glycemic control worsens periodontitis (and periodontitis worsens control). It impairs healing and immune response.

The dental hygiene process of care (ADPIE)?

Assessment → Diagnosis → Planning → Implementation → Evaluation — the five-step framework every Component B case asks you to work.

Most important single data source in patient assessment?

The medical/dental history — it drives premedication, drug interactions, and contraindications. Always update it.

What is a dental hygiene diagnosis?

The hygienist's identification of the patient's unmet needs and problems within the dental-hygiene scope of practice, based on assessment data.

Probing force used in periodontal probing?

Light — about 0.25 N (20–25 g) — so bleeding reflects disease, not trauma.

Healthy probing depths?

1–3 mm, with no bleeding on probing and no attachment or bone loss.

2017 periodontitis classification — what determines STAGE?

Severity and complexity — chiefly interdental clinical attachment loss at the site of greatest loss, plus radiographic bone loss and tooth loss.

2017 periodontitis classification — what determines GRADE?

The rate of progression and risk factors (e.g. smoking, diabetes) — Grade A slow, B moderate, C rapid.

Scaling vs root planing?

Scaling removes plaque and calculus from the crown/supragingival surfaces; root planing smooths the root to remove subgingival deposits and biofilm.

What is calculus?

Hardened, mineralized plaque (tartar) firmly attached to the tooth; it must be removed by instrumentation, not brushing.

Why is a stable fulcrum important in instrumentation?

The finger rest stabilizes the hand for controlled strokes, prevents injury, and gives the leverage needed to remove calculus effectively.

Ultrasonic scaler — how it works and a key caution?

High-frequency vibration with a water lavage disrupts biofilm and calculus. Caution with certain pacemakers and some restorations.

Most accurate intraoral radiographic technique?

The paralleling technique — receptor parallel to the tooth, central beam perpendicular — minimizing dimensional distortion.

Incorrect HORIZONTAL angulation causes which error?

Overlapping of the proximal (interproximal) contacts. Direct the central ray perpendicular to the contacts to fix it.

What is a cone cut on a radiograph?

A clear, unexposed area where the beam was not centered on the receptor. Fix by re-centering the PID over the entire receptor.

What does ALARA stand for?

As Low As Reasonably Achievable — minimizing radiation exposure to patient and operator while still getting a diagnostic image.

How should radiographs be prescribed?

Based on the individual patient's clinical needs and risk assessment (selection criteria) — not a fixed routine schedule.

Optimal level for community water fluoridation?

About 0.7 mg/L (ppm) — the current U.S. recommendation.

What is dental fluorosis?

Mottling/discoloration of enamel from excess fluoride ingestion during tooth development (before eruption).

When and where are sealants indicated?

In the deep pits and fissures of newly erupted, caries-free posterior teeth (molars/premolars), especially in children and adolescents at risk.

Main cause of sealant failure?

Saliva (moisture) contamination during placement — isolation/moisture control is critical for retention.

Nitrous oxide–oxygen sedation — key advantage?

Rapid onset and rapid recovery with a wide margin of safety; it is titratable for mild-to-moderate anxiety.

Required final step of nitrous oxide sedation?

Administer 100% oxygen for several minutes to prevent diffusion hypoxia.

A relative contraindication to nitrous oxide?

Severe COPD (the hypoxic drive), nasal obstruction, first-trimester pregnancy, and certain psychiatric conditions.

Why are scavenging systems used with nitrous oxide?

To minimize chronic occupational exposure of dental personnel to waste anesthetic gas.

The four core principles of dental ethics?

Autonomy (patient self-determination), beneficence (do good), non-maleficence (do no harm), and justice (fairness).

What is informed consent?

The patient's voluntary agreement after being told the diagnosis, the proposed treatment, the risks/benefits, and the alternatives, including no treatment.

Patients most likely to need antibiotic premedication?

Highest-risk cardiac patients: prosthetic heart valve, prior infective endocarditis, certain congenital heart disease, or cardiac transplant with valvulopathy.

Management of syncope (fainting)?

Stop treatment, place the patient supine (legs slightly up), open the airway, give oxygen, and monitor vital signs.

First action if a patient shows signs of an allergic/anaphylactic reaction?

Severe (anaphylaxis): epinephrine, activate EMS, support airway/breathing. Mild: diphenhydramine. Recognize urticaria, wheeze, hypotension.

What does the medical history tell you about treatment?

It determines premedication, drug interactions, contraindications, vital-sign limits, and how systemic disease will affect oral findings and healing.

Pregnancy gingivitis — cause?

Elevated progesterone and estrogen exaggerate the gingival inflammatory response to plaque. Meticulous biofilm control is the key.

Drug-influenced gingival enlargement — common causes?

Phenytoin (anti-epileptic), cyclosporine (immunosuppressant), and calcium-channel blockers (e.g. nifedipine).

Necrotizing ulcerative gingivitis (NUG) hallmark?

Punched-out, cratered interdental papillae with a grayish pseudomembrane, pain, and a fetid odor; linked to stress, smoking, poor hygiene.

Microbe strongly associated with localized aggressive periodontitis?

Aggregatibacter actinomycetemcomitans (A. a.).

What is furcation involvement?

Bone loss in the area where the roots of a multi-rooted tooth divide; it signals advanced periodontal destruction.

Gingival recession — definition and consequence?

Apical migration of the gingival margin exposing the root surface; raises root-caries and sensitivity risk and increases CAL.

What is a periodontal pocket?

A pathologically deepened gingival sulcus, formed by inflammation. A 'true' pocket has apical migration of the junctional epithelium (attachment loss).

Pseudo-pocket vs true pocket?

A pseudo-pocket (gingivitis) deepens from swelling with NO attachment loss; a true pocket (periodontitis) has attachment loss.

Purpose of supportive periodontal therapy (maintenance)?

Regular recare to control biofilm, monitor for recurrence, and preserve the results of active therapy; interval set by risk.

What does mobility tell you in a periodontal exam?

Increasing tooth mobility usually reflects loss of bony support (advanced periodontitis) or occlusal trauma; it is a later finding than BOP.

Community Health/Research — share of the discipline-based items?

About 24 of the 200 Component A items — the smallest discipline-based area, but reliably tested.

What does the DMFT index count?

Decayed, Missing (due to caries), and Filled permanent teeth — a measure of a population's caries experience.

DMFT vs dmft?

Uppercase DMFT = permanent teeth; lowercase dmft (or deft) = primary teeth. Different notation for the two dentitions.

DMFT vs DMFS?

DMFT counts whole TEETH; DMFS counts tooth SURFACES affected — DMFS is more sensitive.

A limitation of the DMFT index?

It cannot distinguish current disease from past treatment, and 'Missing' may reflect non-caries tooth loss.

What does the OHI-S measure?

The Simplified Oral Hygiene Index = a Debris Index plus a Calculus Index, scored on six index teeth.

Measures of central tendency?

Mean (average — sensitive to outliers), median (middle value — best for skewed data), and mode (most frequent value).

Validity vs reliability?

Validity = the test measures what it intends to. Reliability = the test gives consistent, reproducible results. They are different.

What is the gold-standard study design for cause and effect?

The randomized controlled trial (RCT) — randomization controls confounding, making it the strongest evidence for an intervention.

Primary vs secondary vs tertiary prevention (dental)?

Primary = prevent disease (fluoride, sealants, education). Secondary = treat early (restorations, SRP). Tertiary = rehabilitate after damage (prostheses).

Steps of a community oral health program?

Assessment of needs → planning → implementation → evaluation (the population-level parallel of the process of care).

Classic population-level preventive program in dentistry?

Community water fluoridation — one of the great public-health achievements for reducing caries across a population.

What is evidence-based dental hygiene practice?

Integrating the best available scientific evidence with clinical expertise and the patient's needs and preferences.

Independent vs dependent variable?

The independent variable is manipulated (the intervention); the dependent variable is the measured outcome (the effect).

What is the standard deviation?

A measure of how spread out (dispersed) data are around the mean — large SD = wide spread.

What does a p-value < 0.05 conventionally indicate?

Statistical significance — a result unlikely (<5%) to be due to chance alone, by convention.

How is a Component B patient case structured?

A patient history, dental and periodontal charting, and radiographs, followed by a cluster of items that apply the disciplines to that one patient.

Best strategy for a case-based item set?

Read the entire case first, anchor on the medical history (it changes everything), interpret charting and radiographs together, then apply the process of care.

Why does the case-based component have no separate facts to memorize?

It reuses every discipline from Component A (anatomy, perio, radiology, pharmacology, prevention) applied to a single patient.

Types of patients featured in the case-based component?

Across the lifespan and special populations: child, adolescent, adult, geriatric, periodontal, medically compromised, and special-needs patients.

Hyperglycemia (high A1c) effect on periodontal tissue?

It impairs immune response and wound healing and amplifies inflammatory destruction — worsening periodontitis. The relationship is bidirectional.

Therapeutic INR range for a warfarin patient before SRP?

Generally 2.0–3.0 — within this range routine scaling/root planing can usually proceed with local hemostasis measures.

Patient with a recent (<6 month) myocardial infarction — action?

Defer elective dental hygiene care and consult the physician; elective care is generally postponed after a recent MI.

Scheduling a hemodialysis patient for dental hygiene care?

Schedule on non-dialysis days (or the day after) — not on a dialysis day, when the patient is heparinized and fatigued.

Prosthetic heart valve in a case history — implication?

Antibiotic prophylaxis may be indicated before procedures that manipulate gingival tissue (highest-risk cardiac category).

Why anchor on the medical history in a patient case?

It determines premedication, drug interactions, contraindications, and how systemic disease modifies the oral and periodontal picture.

Patient on bisphosphonates — oral concern?

Risk of medication-related osteonecrosis of the jaw (MRONJ), especially after invasive/bony procedures; coordinate care and avoid trauma.

Pregnant patient — safest trimester and radiograph stance?

Elective care is best in the second trimester; radiographs are taken only when needed, with shielding (ALARA). Avoid the supine-hypotensive position.

Child patient case — fluoride consideration?

Use age-appropriate fluoride amounts (smear/pea-size), supervise toothpaste use to limit fluorosis risk, and prescribe based on caries risk.

Geriatric patient — common oral findings?

Root caries (recession), xerostomia (polypharmacy), attrition, and existing restorations/prostheses to maintain.

What is the junctional epithelium?

The epithelial attachment at the base of the sulcus that seals the gingiva to the tooth; its apical migration marks attachment loss.

What is the cementoenamel junction (CEJ)?

The line where the enamel of the crown meets the cementum of the root — the fixed reference point for measuring clinical attachment level.

Anterior vs posterior teeth — function?

Anterior (incisors, canines) cut and tear; posterior (premolars, molars) crush and grind.

How many roots does a maxillary first molar usually have?

Three — two buccal (mesiobuccal, distobuccal) and one palatal root.

The five tooth surfaces?

Mesial, distal, facial (buccal/labial), lingual (palatal), and occlusal (posterior) or incisal (anterior).

Primary (deciduous) dentition — how many teeth?

20 primary teeth; the permanent dentition has 32 (including third molars).

Glossopharyngeal nerve (CN IX) oral roles?

Taste and general sensation to the posterior 1/3 of the tongue, the gag reflex, and parasympathetic fibers to the parotid gland.

Hypoglossal nerve (CN XII) function?

Motor to the muscles of the tongue — damage causes tongue deviation toward the affected side.

Bell's palsy affects which cranial nerve?

The facial nerve (CN VII) — causing one-sided facial-muscle weakness (can't wrinkle forehead, close eye, smile evenly).

Embryologic stages of tooth development?

Bud → cap → bell → apposition → maturation. Disturbances during these stages cause developmental enamel defects.

What is fluorapatite?

The acid-resistant crystal formed when fluoride incorporates into enamel hydroxyapatite — more resistant to acid dissolution.

What is xerostomia and why does it matter?

Dry mouth from reduced salivary flow (often medication-induced); it removes saliva's buffering/remineralizing protection, sharply raising caries risk.

Cardiac cycle — systole vs diastole?

Systole = ventricular contraction (the higher BP number); diastole = relaxation/filling (the lower number).

Normal adult blood pressure (current ACC/AHA)?

Less than 120/80 mmHg is normal; 130/80 or higher is hypertension. Defer elective care for very high readings and refer.

Leukoplakia vs erythroplakia — which is more concerning?

Erythroplakia (a red patch) has a higher rate of dysplasia/malignancy than leukoplakia (a white patch). Both warrant evaluation/biopsy.

What is candidiasis (oral thrush)?

A Candida albicans fungal infection — white, wipeable plaques; risk factors include xerostomia, antibiotics, dentures, diabetes, immunosuppression.

Aphthous ulcers vs herpetic lesions?

Aphthous ulcers occur on movable (non-keratinized) mucosa and are not viral; recurrent herpes occurs on keratinized/attached tissue and is HSV.

What is attrition?

Tooth wear from tooth-to-tooth contact (e.g. bruxism). (Abrasion = wear from a foreign object; erosion = chemical/acid wear.)

Articaine vs lidocaine — a key difference?

Articaine is 4% (40 mg/mL) and metabolized partly by plasma esterases; lidocaine is the 2% benchmark amide. Track total mg either way.

Epinephrine caution in cardiovascular disease?

Use the lowest effective dose; high doses can raise heart rate/BP. It is not absolutely contraindicated but is limited in significant CVD.

What is a furcation probe (Nabers) used for?

To detect and grade furcation involvement (bone loss between the roots of multi-rooted teeth).

Correct working stroke direction in scaling?

Strokes are activated coronally (toward the crown), away from the soft-tissue base, with controlled overlapping strokes.

Adaptation in instrumentation?

Keeping the leading 1–2 mm of the working-end's cutting edge against the tooth surface to clean effectively without trauma.

Universal curette vs area-specific (Gracey) curette?

A universal curette adapts to all surfaces (two cutting edges); a Gracey is area-specific (one working cutting edge, offset blade).

What is a bitewing radiograph best for?

Detecting interproximal caries and assessing crestal alveolar bone levels.

What is a periapical radiograph best for?

Imaging the entire tooth from crown to root apex plus the surrounding bone — periapical pathology, root morphology.

What is a panoramic radiograph?

An extraoral image of both arches, the TMJs, sinuses, and impactions — broad survey, lower detail than intraoral films.

Herringbone (tire-track) artifact — cause?

The film was placed backward, so the lead foil faced the beam. Face the tube (smooth/pebbled) side toward the beam.

Image too dark (overexposed film) — causes?

Excessive exposure time, excessive developer time/temperature, or too high mA/kVp.

Where does the operator stand during exposure?

At least 6 feet away, behind a barrier, at a 90–135° angle to the primary beam.

Topical fluoride professional products?

Fluoride varnish (5% NaF), APF gels/foams, and high-concentration prescription toothpastes — applied to high-risk patients.

Sealant material types?

Resin-based sealants (most common, need a dry field) and glass-ionomer sealants (release fluoride, tolerate moisture better).

What is plaque (biofilm) control instruction?

Teaching effective brushing (e.g. modified Bass technique) and interdental cleaning so the patient can disrupt biofilm daily.

Modified Bass brushing technique?

Bristles angled 45° toward the gingival sulcus, gentle vibratory motion, then a roll — to clean the marginal/sulcular area.

Chlorhexidine mouthrinse — use and side effect?

An antimicrobial rinse (e.g. post-SRP, for gingivitis); side effects include extrinsic staining and altered taste with prolonged use.

What is desensitization for dentin hypersensitivity?

Occluding open dentinal tubules (e.g. potassium nitrate, stannous fluoride, varnishes) to reduce fluid movement and pain.

Indication for an alginate impression in hygiene care?

Making study models/casts (e.g. for whitening trays, mouthguards, orthodontic records).

Standard (universal) precautions principle?

Treat all blood and body fluids as potentially infectious for every patient — PPE, hand hygiene, instrument sterilization.

Sterilization vs disinfection?

Sterilization destroys ALL microbial life including spores (autoclave for instruments); disinfection reduces but may not kill all (surfaces).

Biologic indicator (spore test) purpose?

It verifies the autoclave actually achieved sterilization by killing resistant bacterial spores (e.g. Geobacillus stearothermophilus for steam).

First step if you sustain a needlestick?

Wash the site, report it, and follow the post-exposure protocol (source/baseline testing, prophylaxis per guidance).

HIPAA — what does it protect?

Patient health-information privacy and security; share protected health information only as permitted and keep records confidential.

What is supragingival vs subgingival calculus?

Supragingival calculus forms above the gingival margin (often lingual to lower anteriors, buccal to upper molars); subgingival forms in the pocket, darker.

Recare interval — what sets it?

The patient's periodontal risk and disease control — higher risk/active disease = shorter intervals (e.g. 3 months).

What is gingival hyperplasia management?

Improve plaque control, review the causative drug with the physician, and provide scaling; surgery if it persists.

Tobacco cessation in dental hygiene — the 5 A's?

Ask, Advise, Assess, Assist, Arrange — the brief-intervention framework for helping patients quit.

What is a treatment plan sequence?

Address urgent/pain first, then disease control (perio/caries), then definitive care, then maintenance — re-evaluating throughout.

Documentation principle?

Record findings, care provided, patient response, instructions, and consent accurately and contemporaneously — for safety and legal protection.

What is the scope of practice?

The range of services a dental hygienist is legally and professionally permitted to perform, which varies by state.

What is supervised neglect?

Failing to recognize/treat or refer active disease while the patient remains under care — an ethical and legal failing.

Trigeminal — which division anesthetizes maxillary teeth?

V2 (the maxillary division) — supplying the maxillary teeth, palate, and midface.

What is the alveolar bone?

The bone of the jaws that surrounds and supports the tooth roots; its resorption is seen radiographically in periodontitis.

Stippling of the gingiva indicates?

Healthy attached gingiva (an orange-peel texture). Its loss can accompany inflammation/edema.

What is keratinized vs non-keratinized oral mucosa?

Keratinized (attached gingiva, hard palate) resists friction; non-keratinized (movable mucosa, floor of mouth) is thinner — site of aphthous ulcers.

Function of the periodontal ligament (PDL)?

Attaches cementum to alveolar bone, absorbs occlusal forces (shock absorber), and provides proprioception (bite sense).

Most common benign salivary gland tumor?

Pleomorphic adenoma (benign mixed tumor), usually in the parotid gland.

What is a torus?

A benign bony growth — torus palatinus (midline palate) or torus mandibularis (lingual mandible); normal variant, relevant for impressions/dentures.

What is the mental foramen?

The opening on the facial mandible (near the premolars) where the mental nerve exits — a radiographic landmark.

What is the maxillary sinus relevance in dentistry?

It overlies the maxillary posterior root apices; it can appear on periapical/panoramic films and relate to sinus/tooth pain confusion.

What is the temporomandibular joint (TMJ)?

The joint between the mandibular condyle and the temporal bone; assess for clicking, deviation, pain (TMD).

What is gingival index (GI) vs plaque index (PI)?

GI scores gingival inflammation severity; PI scores the amount of plaque present. Both quantify status for monitoring/research.

What is incidence vs prevalence?

Incidence = number of NEW cases over a period; prevalence = total EXISTING cases at a point in time.

What is sensitivity vs specificity of a test?

Sensitivity = correctly identifies those WITH disease (true positives); specificity = correctly identifies those WITHOUT (true negatives).

What is a confounding variable?

An outside factor associated with both the exposure and the outcome that can distort the apparent relationship between them.

Nominal, ordinal, interval, ratio — what are these?

Levels of measurement: nominal (categories), ordinal (ranked), interval (equal gaps, no true zero), ratio (true zero, e.g. DMFT count).

What is the strongest level of research evidence?

A systematic review/meta-analysis of randomized controlled trials sits atop the evidence hierarchy.

What does 'access to care' mean in community health?

Whether populations can obtain dental services — barriers include cost, geography, workforce, and education; a major public-health focus.

What is health literacy?

The patient's ability to understand and use health information to make decisions — low literacy reduces adherence; tailor communication.

Fluoride varnish in a community/school program?

A widely used, evidence-based caries-prevention measure applied in schools and clinics to at-risk children.

What is the bias of using a non-random (convenience) sample?

It may not represent the target population, threatening external validity (generalizability) of the findings.

Case patient on phenytoin with gingival overgrowth — first management?

Intensify plaque control and professional scaling; consult the physician about the medication; surgery only if it persists.

Case patient with asthma — emergency item to have ready?

The patient's short-acting bronchodilator (albuterol inhaler); avoid known triggers and have it accessible during care.

Case patient with epilepsy — chairside concern?

Risk of a seizure; know the trigger history, clear the area, do not restrain, protect the airway, and time the seizure.

Case patient with a latex allergy — action?

Use latex-free gloves, dam, and supplies; schedule as the first appointment of the day to limit ambient latex exposure.

Case patient with a pacemaker — instrumentation caution?

Newer pacemakers are generally shielded, but follow manufacturer/physician guidance regarding ultrasonic/magnetostrictive scalers.

Case patient with rampant root caries and xerostomia — key intervention?

High-concentration fluoride (varnish/prescription paste), saliva substitutes/stimulants, diet counseling, and frequent recare.

Reading a case radiograph — generalized horizontal bone loss suggests?

Generalized periodontitis; correlate with probing depths, CAL, and bleeding to stage and grade the disease.

Case patient with hepatitis/liver disease — drug consideration?

Impaired drug metabolism (e.g. amide anesthetics, acetaminophen) and bleeding risk — adjust dosing and consult the physician.

Case patient who is immunocompromised — infection-control emphasis?

Strict aseptic technique; watch for opportunistic infections (candidiasis); coordinate timing of care with the medical team.

Case-based item logic — what should drive your answer?

The specific data in THAT patient's case (history, charting, radiographs) applied through the process of care — not a generic rule.

What is remineralization?

Redeposition of calcium and phosphate into a demineralized enamel surface, promoted by fluoride and saliva, that can reverse an early lesion.

What is demineralization?

Loss of mineral from the tooth surface caused by acid (from bacterial sugar fermentation) — the start of a caries lesion.

White spot lesion — significance?

An early, non-cavitated caries lesion (demineralization) that can still be remineralized with fluoride and improved hygiene.

Critical pH for enamel demineralization?

About 5.5 — below this pH, hydroxyapatite begins to dissolve. Fluorapatite has a lower critical pH (~4.5), so it resists acid better.

Role of buffering capacity of saliva?

Bicarbonate and phosphate buffers neutralize plaque acids, raising pH after a sugar exposure and protecting against caries.

What are the muscles of facial expression innervated by?

The facial nerve (CN VII) — distinct from the muscles of mastication, which are V3 (trigeminal).

What is the gingival sulcus?

The shallow space between the free gingiva and the tooth; healthy depth is 1–3 mm, measured by probing.

What is gingival crevicular fluid?

Fluid that flows from the sulcus; its volume increases with inflammation, reflecting the host inflammatory response.

Difference between acute and chronic inflammation?

Acute = rapid, neutrophil-driven, short-lived (e.g. abscess); chronic = prolonged, lymphocyte/macrophage-driven with tissue destruction (e.g. periodontitis).

What is hyperkalemia and its dental relevance?

Elevated serum potassium (e.g. in renal failure) — relevant in medically complex case patients; coordinate care, avoid dialysis-day appointments.

What is the function of the dental hygiene diagnosis step?

To interpret assessment data into the patient's actual hygiene needs/problems, guiding a targeted, individualized care plan.

What is the evaluation step of the process of care?

Re-assessing after treatment to judge whether goals were met, then deciding on continued care, maintenance, or referral.

Localized vs generalized in periodontal classification?

Localized = <30% of sites involved; generalized = ≥30% of sites involved.

What is biologic width (supracrestal tissue attachment)?

The connective-tissue + junctional-epithelial attachment above the alveolar crest; violating it (e.g. with a restoration margin) causes inflammation.

What is occlusal trauma?

Injury to the attachment apparatus from excessive occlusal force; it does not cause periodontitis but can worsen mobility when attachment is reduced.

What is a class III furcation?

A through-and-through furcation — the probe passes completely between the roots; the most advanced furcation grade.

Magnetostrictive vs piezoelectric ultrasonic scaler tip motion?

Magnetostrictive tips move in an elliptical pattern (all surfaces active); piezoelectric tips move linearly (lateral surfaces active).

Why is moisture (lavage) used with ultrasonic scaling?

It cools the tip, flushes debris, and produces acoustic streaming/cavitation that disrupts biofilm.

What is air polishing and a caution?

A powder/air/water spray to remove stain and biofilm; use appropriate (glycine/erythritol) powders and avoid on certain restorations/tissues.

What is selective polishing?

Polishing only where stain is present, rather than routinely on every tooth, to avoid unnecessary enamel/cementum abrasion.

Component A vs Component B of the NBDHE?

Component A is the discipline-based component (200 stand-alone items); Component B is the case-based component (150 items across 12–15 cases).

Largest discipline-based area on the NBDHE?

Provision of Clinical Dental Hygiene Services — about 115 of the 200 Component A items. Periodontology and radiology recur throughout.

What is risk assessment in dental hygiene?

Identifying a patient's caries and periodontal risk factors (diet, hygiene, systemic disease, smoking) to individualize prevention and recare.

What is the purpose of community-based prevention?

To reduce disease burden across populations (e.g. water fluoridation, school sealant programs) rather than one patient at a time.

Continuing competence — why required?

Dental hygiene knowledge and standards evolve; continuing education maintains safe, evidence-based, current practice.

What is the difference between a sign and a symptom?

A sign is objective and observed by the clinician (e.g. BOP, bone loss); a symptom is subjective and reported by the patient (e.g. pain).

What is a null hypothesis?

The default assumption of NO difference/association; a study seeks evidence to reject it (a significant result rejects the null).

Quantitative vs qualitative research?

Quantitative measures numerical data (counts, scores) for statistical analysis; qualitative explores experiences/meanings (interviews, themes).

What is informed refusal?

When a patient declines recommended care after understanding the risks; document it to protect both patient and clinician.

What is cultural competence in care?

Delivering care that respects patients' cultural beliefs, language, and practices to improve communication and outcomes.

Case patient with poorly controlled diabetes — recare interval?

Shorten it (e.g. 3 months) — uncontrolled diabetes raises periodontal risk and impairs healing; emphasize biofilm control and physician coordination.

Case patient with a bleeding disorder — pre-treatment step?

Consult the physician, review labs (platelets/INR), plan local hemostatic measures, and stage treatment to limit bleeding.

Case patient on chemotherapy — oral risk?

Mucositis, infection, and bleeding from myelosuppression; time invasive care between cycles and coordinate with the oncology team.

Case patient who had head-and-neck radiation — major risk?

Osteoradionecrosis and rampant radiation caries with xerostomia; avoid extractions in irradiated bone and emphasize fluoride/saliva care.

Case patient with a prosthetic joint — premedication?

Routine antibiotic prophylaxis is generally NO longer recommended; consult the orthopedic surgeon/physician case by case.

Case patient with hypertension reading 180/110 at the visit?

Defer elective care and refer for medical evaluation; severely elevated BP raises cardiovascular risk during treatment.

Case patient pregnant in the first trimester — radiograph stance?

Take radiographs only if essential, with shielding; defer elective imaging/care to the second trimester when possible (ALARA).

Case patient with special needs — care adaptation?

Adapt communication, positioning, and appointment length; involve caregivers; use behavior-guidance and desensitization strategies.

Reading a case with deep pockets + furcation + mobility?

Advanced periodontitis — plan non-surgical therapy, likely referral to a periodontist, and a short maintenance interval.

Case patient with an INR of 4.5 before SRP — action?

Postpone elective scaling and consult the physician — an INR well above the 2.0–3.0 therapeutic range carries high bleeding risk.

What is a recession defect's effect on CAL when margin is below the CEJ?

It adds to attachment loss: CAL = probing depth + the recession amount, since the margin is apical to the CEJ.

When the gingival margin is swollen above the CEJ, CAL = ?

CAL = probing depth − the distance the margin sits coronal to the CEJ (you subtract the overgrowth).

Most common site for supragingival calculus?

Lingual of the mandibular anterior teeth and buccal of the maxillary molars — opposite the major salivary duct openings.

What is the purpose of disclosing solution?

A dye that stains plaque to make it visible — for patient education and to evaluate oral-hygiene effectiveness.

What is a sealant retention check?

Re-evaluating placed sealants at recare for retention/integrity; replace or repair lost or partially lost sealants.

What does a bitewing reveal about bone?

Crestal alveolar bone height/levels — early horizontal bone loss in periodontitis.

What is the difference between F-speed film and digital sensors for dose?

Both lower patient dose vs older D-speed film; digital sensors typically allow the lowest exposure and instant images.

What is rectangular collimation?

Restricting the X-ray beam to the size/shape of the receptor — significantly reducing patient radiation dose.

When is supragingival vs subgingival irrigation used?

As an adjunct to mechanical debridement to deliver antimicrobials and flush debris; it does not replace scaling/root planing.

Why re-evaluate after non-surgical periodontal therapy?

To measure tissue response (reduced probing depths, less BOP), reinforce hygiene, and decide on maintenance vs referral.

What is the most common chronic disease of childhood?

Dental caries — largely preventable, which is why fluoride, sealants, diet counseling, and education are emphasized.

What are pellicle, plaque, and calculus in sequence?

Acquired pellicle (salivary protein film) forms first → bacteria colonize it forming plaque biofilm → mineralization hardens plaque into calculus.

What is early childhood caries (ECC)?

Caries in primary teeth of young children, classically from frequent sugary liquids in a bottle; highly preventable with counseling.

What is the role of vitamin D and calcium in dentistry?

They support mineralization of teeth and bone; deficiency impairs development and bone health relevant to the periodontium.

What is the chorda tympani?

A branch of the facial nerve (CN VII) carrying taste from the anterior 2/3 of the tongue and parasympathetic fibers to salivary glands.

What is the difference between primary and permanent enamel maturation?

Newly erupted enamel is not fully mineralized and continues post-eruptive maturation, making fluoride especially valuable early.

What is the most common location for oral squamous cell carcinoma?

The lateral border of the tongue and the floor of the mouth are high-risk sites; examine them carefully in the oral-cancer screening.

What is a fibroma?

A common benign reactive overgrowth of fibrous connective tissue, often from chronic irritation (e.g. cheek-biting).

What is geographic tongue?

A benign migratory glossitis — map-like depapillated patches; usually asymptomatic and needs reassurance, not treatment.

What is amelogenesis vs dentinogenesis imperfecta?

Hereditary defects: amelogenesis imperfecta affects enamel formation; dentinogenesis imperfecta affects dentin (gray-blue, fragile teeth).

First instrument used to detect calculus and caries?

The explorer (for tactile detection of surface irregularities) alongside the periodontal probe and visual/radiographic exam.

What is the goal of patient-specific oral hygiene instruction?

To enable daily self-care that disrupts biofilm — the single most important factor the patient controls for caries and perio.

Periodontal maintenance vs a prophylaxis (prophy)?

A prophy is preventive for a healthy/gingivitis patient; periodontal maintenance follows active perio therapy in a treated periodontitis patient.

What is the function of a thyroid collar during radiographs?

It shields the thyroid gland from scatter radiation; used along with selection criteria and fast receptors (ALARA).

What is the difference between staging and grading concisely?

Staging = how SEVERE/extensive the disease is now (CAL, bone loss); grading = how FAST it is progressing and the risk factors.

What is desquamative gingivitis?

Red, sloughing gingiva often linked to mucocutaneous diseases (e.g. lichen planus, pemphigoid) rather than plaque alone — needs evaluation.

What is the management priority for an acute periodontal abscess?

Drainage and debridement, manage pain/infection, and re-evaluate; it is an acute infection within the periodontium.

Why review medications before every appointment?

Medications change — they affect bleeding, salivary flow (xerostomia), gingival overgrowth, and anesthetic/premed decisions.

What is the role of the dental hygienist in oral cancer screening?

To perform a thorough extra- and intraoral exam at every visit, document findings, and refer suspicious lesions promptly for biopsy.

What is the most reliable way to prevent cross-contamination at the chair?

Hand hygiene plus standard precautions — barriers, surface disinfection, and sterilized instruments for every patient.

What is the difference between caries risk and caries activity?

Risk = likelihood of FUTURE caries from contributing factors; activity = presence of CURRENT progressing lesions. Both guide prevention.

What is xylitol's role?

A non-fermentable sugar alcohol that reduces S. mutans and stimulates saliva — an adjunct (e.g. gum) in caries prevention.

What is silver diamine fluoride (SDF)?

A topical agent that arrests caries (and reduces sensitivity); it stains the arrested lesion black — useful for high-risk/special populations.

What is the dental hygiene treatment goal for a gingivitis patient?

Reverse the inflammation by removing biofilm/calculus and establishing effective daily self-care — gingivitis is fully reversible.

Final review: what reuses every NBDHE discipline?

The case-based component (Component B) — master anatomy, perio, radiology, pharmacology, and prevention, then apply them through the process of care.