Deck 17: Instrumentation for Client Assessment and Care

Question 1

The clinician is having difficulty accessing the lingual aspect of a maxillary posterior sextant. For right-handed clinicians, this is the maxillary right posterior sextant, lingual aspect. For left-handed clinicians, this is the maxillary left posterior sextant, lingual aspect. The client and clinician chairs are correctly positioned for the treatment area. Which of the following might allow better access?

A)Ask the client to turn her head away from you
B)Ask the client to turn her head toward you
C)Ask the client to lower her chin (chin down position)
D)Lower the seat of the clinician chair

Answer 1

Ask the client to turn her head toward you

Question 2

A clinician is having difficulty keeping the lower shank parallel to the long axis of tooth #3. The clinician is using a Gracey 13/14 curet with a miniature working end and an extended lower shank. Which of the following would MOST LIKELY improve access in this distolingual surface?

A)Switch to an advanced fulcrum
B)Use a straight, slim-diameter ultrasonic tip
C)Use a universal curet with an extended shank
D)Use a rigid Gracey curet instead

Answer 2

Switch to an advanced fulcrum

Question 3

A large piece of burnished calculus is present on the distal aspect of tooth #2. Which instrument would be MOST effective in preparing the burnished deposit for eventual removal with another periodontal instrument?

A)A beavertail ultrasonic tip
B)A rigid Gracey 13/14
C)A periodontal file
D)A miniature Gracey 13/14 curet with an extended shank

Answer 3

A periodontal file

Question 4

While exploring the mandibular anterior sextant with the ODU 11/12 periodontal explorer, it is difficult to insert the explorer without unduly distending the tissue. Which of the following techniques might cause less tissue distension?

A)Switch to an Orban explorer
B)Aim the point the tip of the ODU 11/12 explorer toward the base of the sulcus so less of the working end is inserted in the sulcus
C)Switch to a cowhorn explorer
D)Use a calibrated periodontal probe to explore for deposits

Question 5

The client has chronic periodontal disease with fibrotic tissue. Tenacious moderate black subgingival calculus is present on most tooth surfaces. Which of the instrument(s) listed below would be the BEST choice to initiate removal of the moderate calculus deposits?

A)Ultrasonic beavertail tip
B)Ultrasonic slim-diameter tip with a straight working end
C)Set of rigid Gracey curets 1/2, 11/12, and 13/14
D)Quetin (kee-tan) furcation curet

Question 6

Access to subgingival calculus deposits on the proximal surfaces of the mandibular anterior teeth is difficult because of papillary enlargement of the gingival tissue. Which of the following statements provides the BEST advice for thorough subgingival calculus removal?

A)Use a curet with a small, thin working end, and approach the deposit from both facial and lingual aspects
B)Try to remove the deposit with an explorer using an assessment stroke
C)Apply a topical anesthetic; then use a calculus removal stroke subgingivally with an anterior sickle scaler
D)Use the ultrasonic with a universal insert applying heavy lateral pressure and working as quickly as possible

Question 7

The clinician is using hand instruments to remove moderate calculus deposits. After 30 minutes, the clinician's hand muscles become noticeably fatigued. Potentially, all of the following can cause hand fatigue EXCEPT one. Which one is the EXCEPTION?

A)Gloves that fit too tightly
B)Using instruments with large-diameter, hollow handles
C)Using an instrument that is not balanced
D)Using finger motion instead of wrist motion activation

Question 8

Which of the following instruments would be the MOST effective in removing a small subgingival calculus deposit on the lingual aspect of tooth #24?

A)A Gracey 1/2 curet with a miniature working end and an extended lower shank
B)An anterior sickle scaler
C)An periodontal file designed for use on the lingual aspect
D)A standard Gracey 1/2 curet

Question 9

Which one of the instruments listed below is the BEST choice for efficient removal of light subgingival calculus from the proximal surfaces of the client's posterior teeth?

A)A posterior sickle scaler
B)A universal curet
C)A set of standard Gracey curets
D)An O'Hehir curet

Question 10

The client has several areas of existing root caries and xerostomia. This combination places him at extreme risk for caries. All of the following are recommended management strategies for caries prevention EXCEPT one. Which one is the EXCEPTION?

A)Professional application of fluoride varnish every 3 months
B)Daily use of an antiseptic mouthrinse
C)Twice daily brushing with a prescription sodium fluoride (NaF) toothpaste
D)Twice daily topical application of calcium or phosphate paste

Question 11

A full mouth radiographic survey indicates the presence of subgingival calculus in the mandibular right posterior sextant, but the clinician is unable to detect it with an ODU 11/12 explorer. All of the following may contribute to an inability to detect calculus EXCEPT one. Which one is the EXCEPTION?

A)Not resting the middle finger lightly on the side of the instrument shank
B)Grasping the instrument handle too tightly
C)Keeping the anterior-third of the working end adapted to the root surface
D)Not inserting the explorer to the base of the periodontal pocket

Question 12

Tooth #3 has a class II furcation involvement on the facial aspect. Of the instruments listed below, which would be the BEST choice for smoothing the roof of the furcation area?

A)Slim-diameter ultrasonic tip with a straight working end
B)Nabers diamond-coated file
C)Standard Gracey curet 11/12
D)Universal curet with an extended lower shank

Question 13

The best way to remove the black line stain on the lingual aspects of both arches is to:

A)Polish with coarse grit pumice using a motor-driven handpiece
B)Use a slim-diameter ultrasonic tip with a straight working end to remove the stain
C)Use a Nabers diamond-coated file (This instrument has a similar design as a Nabers furcation probe and is diamond coated.)
D)Use a universal curet to remove the stain

Question 14

Blowing a stream of compressed air on mandibular anteriors reveals a sheet of light calculus covering the lingual aspect of tooth #22 to #27. Which of the following techniques would be BEST for calculus removal?

A)Use the pointed tip of an anterior sickle scaler
B)Use the side of a Nabers diamond-coated file
C)Use the toe-third of the lateral surface of a universal curet
D)Use a rubber cup on a motor-driven handpiece

Question 15

Because of her pregnancy, it is uncomfortable for the client to lie in the supine position with the back of the chair raised slightly. To ensure client comfort and facilitate the clinician's access to the maxillary arch, which of the following strategies would be helpful?

A)Ask the client to position her head in a manner that facilitates visualization of and access to the treatment area
B)Ask the client to lie on her left side while she receives dental treatment
C)Lower the back of the client's chair to enhance comfort
D)All of the strategies listed above would improve client comfort and facilitate access to the maxillary arch

Question 16

If the clinician decides to use ultrasonic equipment instead of hand instruments, she needs to keep contraindications for ultrasonic use in mind. Which of the following is NOT a contraindication for use of ultrasonic equipment?

A)Client with a communicable disease
B)Client with difficulty swallowing or who is prone to gagging
C)Client with primary or newly erupted teeth
D)Client with multiple amalgam restorations

Question 17

Which instrument would be BEST to detect furcation involvement on multiple-rooted teeth?

A)ODU 11/12 explorer
B)A periodontal file, such as an Orban file
C)Nabers probe
D)A calibrated periodontal probe, such as a UNC 15 probe

Question 18

One of the client's chief complaints is dry mouth. All of the following are useful suggestions for the client to minimize the effects of xerostomia EXCEPT one. Which one is the EXCEPTION?

A)Increase the intake of caffeine-containing drinks to stimulate saliva production
B)Take frequent sips of water throughout the day
C)Use a humidifier in the bedroom at night
D)Chew food slowly and thoroughly, and sip water with it before swallowing

Question 19

While removing calculus deposits from mandibular anterior teeth, the presence of heavy bleeding makes the tooth surfaces slippery. Which of the following fulcrums would give the clinician the GREATEST stability and less chance for an occupational exposure while removing calculus deposits from the mandibular anterior sextant?

A)Basic intraoral fulcrum
B)Opposite arch fulcrum
C)Finger-on-finger fulcrum
D)Stabilized extraoral fulcrum

Question 20

To determine if the client has calculus deposits on the proximal surfaces of the posterior teeth, the instrument of choice would be_______________ and the instrumentation stroke used would be____________________.

A)Orban explorer; a short, firm stroke
B)Orban explorer; a light, flowing stroke
C)ODU 11/12 explorer; a light, flowing stroke
D)ODU 11/12 explorer; a short, firm stroke

Question 21

When performing a coronal polish, all of the following areas should be avoided EXCEPT one. Which one is the EXCEPTION?

A)Areas of demineralization
B)Extrinsic stain on maxillary anterior facials
C)Gold crowns
D)Areas with gingival enlargement and inflammation

Question 22

The straight calibrated periodontal probe can be used for all of the following assessment procedures EXCEPT one. Which one is the EXCEPTION?

A)Measuring the width of attached gingiva
B)Assessment of dental restorations
C)Measuring the extent of recession of the gingival margin
D)Measuring the size of oral lesions

Question 23

A periodontal instrument has the following design features: The face is perpendicular to the lower shank, the cutting edges are level with each other, and the working end has a rounded toe. Which of the following instruments also exhibits these design criteria?

A)A standard anterior Gracey curet
B)An O'Hehir curet
C)A posterior sickle scaler
D)A universal curet

Question 24

During periodontal instrumentation for calculus removal, the clinician's hand becomes fatigued. Self-assessment indicates he has been using finger motion with a hand instrument for calculus removal. Digital activation is acceptable for all of the following situations EXCEPT one. Which one is this EXCEPTION?

A)Using an ultrasonic tip for calculus removal
B)Using a calibrated probe to measure pocket depth
C)Using an explorer to detect calculus
D)Using a universal curet to remove calculus deposits

Question 25

When the clinician puts a new mouth mirror in the client's mouth, she notices the image is distorted. What is the most reasonable explanation for this?

A)The client is breathing through his mouth, causing fog to form on mirror's reflecting surface
B)The mirror has a concave reflecting surface
C)The mirror has a plane reflecting surface
D)The magnification of the reflecting surface is too extreme

Question 26

An intraoral fulcrum is accomplished by establishing a finger rest near the tooth to be instrumented. Establishing a finger rest as close as possible to the working end of the instrument is preferable so the fingers in the grasp will remain touching.

A)Both statements are TRUE
B)The first statement is TRUE; the second FALSE
C)The first statement is FALSE; the second TRUE
D)Both statements are FALSE

Question 27

Tooth #8 is restored with a porcelain-fused-to-metal crown. Which of the following instruments is contraindicated for use around tooth #8?

A)A standard-diameter ultrasonic tip
B)A universal curet
C)An anterior Gracey curet
D)An ODU 11/12 explorer

Question 28

The client started gagging on the ultrasonic's water spray, so the clinician decides to use a hand instrument to remove a tenacious, moderate calculus deposit on the facial surface of tooth #31. The calculus deposit is located supragingivally on the crown of the tooth. Which of the following instruments would you choose?

A)Universal curet with a short lower shank length
B)Standard Gracey 13/14 curet
C)A rigid Gracey curet
D)A posterior sickle scaler

Question 29

A suspected carious lesion on the occlusal surface of tooth #19 is BEST detected by applying firm pressure with the sharp tip of an explorer to the occlusal grooves. Catching the tip of the explorer in the grooves of a tooth is a recommended method of caries detection.

A)Both statements are TRUE
B)The first statement is TRUE; the second FALSE
C)The first statement is FALSE; the second TRUE
D)Both statements are FALSE

Question 30

To remove light subgingival calculus from the furcation area of a mandibular molar, which of the following instruments would be MOST efficient?

A)Standard anterior Gracey curet
B)Universal curet with an extended shank length
C)A Gracey curet with an extended shank and miniature working end
D)Posterior sickle with a complex shank

Question 31

The clinician determines that many of the client's multiple-rooted teeth have loss of clinical attachment. This information should prompt the clinician to use the following instrument to assess for possible furcation involvement.

A)An ODU 11/12 explorer
B)Calibrated Nabers probes with curved working ends
C)Calibrated periodontal probe with a straight working end
D)Slim-diameter curved right and left paired ultrasonic tips with extended shanks

Question 32

The client's mandibular anterior teeth are in linguoversion and are crowded. The clinician is having difficulty accessing the lingual surfaces of these mandibular anterior teeth. Which of the following patient positioning suggestions is BEST to ensure an ergonomic instrumentation technique?

A)Ask the client to lower his chin (chin-down position)
B)Lower the back of the client's chair until it is parallel to the floor
C)Ask the client to keep his chin in an upward position (chin-up position)
D)Stand up and work, with the client in an upright seated position

Question 33

Which of the following ultrasonic tips would be MOST efficient for removing the heavy ledge of supragingival calculus on the client's mandibular anterior sextant, lingual aspect?

A)A bulky ultrasonic tip with a short shank, commonly called a beavertail tip
B)A slim-diameter, straight ultrasonic tip with extended shank
C)Paired right and left slim-diameter curved ultrasonic tips with extended shanks
D)Ultrasonic tip with a rounded ball-end

Question 34

To minimize client discomfort during root surface debridement in periodontal pockets, the clinician should use caution when inserting a universal curet beneath the gingival margin. The face-to-tooth surface angulation during insertion of the working end beneath the gingival margin is between:

A)0 and 40 degrees
B)10 and 50 degrees
C)40 and 80 degrees
D)70 and 90 degrees

Question 35

A posterior sickle is effective in removing moderate calculus deposits from the coronal surfaces of premolars and molars. A posterior sickle is a double-ended instrument that can be used on the facial, lingual, mesial, and distal surfaces of the crowns of posterior teeth.

A)Both statements are TRUE
B)The first statement is TRUE; the second FALSE
C)The first statement is FALSE; the second TRUE
D)Both statements are FALSE

Question 36

While removing calculus from the maxillary anterior tooth surfaces toward the clinician, good adaptation of the toe-third of the working end is facilitated by:

A)Rolling the instrument handle
B)Pivoting the hand
C)Sitting to the side and front of the client
D)All of the above contribute to proper adaptation

Question 37

Before beginning calculus removal, the clinician uses an explorer to determine the type, amount, and location of calculus deposits. Which of the following explorers is NOT recommended for calculus detection?

A)ODU 11/12 explorer
B)Shepherd's hook explorer
C)Orban-type explorer
D)Pigtail explorer

Question 38

The posterior sextants exhibit moderate sub?gingival calculus deposits. The clinician plans to complete subgingival calculus removal on the mandibular left posterior sextant. Clinical attachment loss is present with periodontal pockets greater than 4 mm in depth. A class III furcation involvement is present on teeth #18 and #19. Which sequence of periodontal instruments would be MOST effective for subgingival calculus removal in this sextant?

A)Posterior sickle scaler, Gracey curets with miniature working ends and extended shanks, periodontal files
B)Posterior sickle scaler, standard Gracey curets
C)Universal curet with an extended shank, Gracey curets with extended shank lengths, Gracey curets with miniature working ends and extended shanks, Nabers diamond-coated file
D)Universal curet with a short lower shank, standard Gracey curets, Gracey curets with extended shank lengths

Question 39

The posterior sextants exhibit moderate supragingival and subgingival calculus deposits. Clinical attachment loss is present with periodontal pockets greater than 4 mm in depth. The clinician plans to complete calculus removal on the maxillary right posterior sextant. He plans to use a series of ultrasonic tips followed by hand instruments. Which sequence of ultrasonic tips would be MOST effective for calculus removal in this sextant?

A)Beavertail tip, followed by a slim-diameter straight tip with extended shank length
B)Standard-diameter universal tip with a curved shank, followed by paired right and left slim-diameter curved tips with extended shank length
C)A slim-diameter straight tip, followed by paired right and left slim-diameter curved tips with extended shank length
D)A standard-diameter universal tip with a curved shank, followed by a slim-diameter straight tip

Question 40

A right-handed clinician is working on the buccal aspect of tooth #2. (For a left-handed clinician, this area would be equivalent to the buccal aspect of tooth #15.) The clinician is using a Gracey 13/14 curet and retracting the client's cheek with a mouth mirror. The clinician's neck is bent excessively as she works. What correction should the clinician make for more ergonomic positioning?

A)Ask the client to turn her head slightly away from the clinician
B)Turn the mirror head so that the reflecting surface can be used to view the distal surface
C)Ask the client to turn toward the clinician and lower her chin down toward her chest (chin-down position)
D)Raise the client's chair up to bring the working area level with the clinician's eye level

Question 41

What type of stroke pressure usually is required to remove a calculus deposit from the prosthetic crown of a dental implant?

A)Firm, scraping pressure
B)Moderate, scraping pressure
C)Light lateral pressure
D)No pressure at all, use an assessment stroke

Question 42

Which of the following instruments would be the BEST choice for removing the light subgingival calculus deposits on the proximal surfaces of the posterior teeth?

A)A set of standard Gracey curets
B)A universal curet
C)A posterior sickle scaler
D)A set of Gracey curets with extended shank lengths

Question 43

The working stroke used with an ultrasonic tip is in a coronal to apical direction (starting beneath the gingival margin and moving toward the junctional epithelium). The working stroke with a hand instrument moves in an apical to coronal direction (starting at the junctional epithelium and moving toward the gingival margin).

A)Both statements are TRUE
B)The first statement is TRUE; the second FALSE
C)The first statement is FALSE; the second TRUE
D)Both statements are FALSE

Question 44

The client has porcelain veneers on the facial aspect of her maxillary anterior teeth. Which of the following polishing techniques for the removal of extrinsic stain would be considered the standard of care for a client with porcelain veneers and dental implants?

A)Use of fine grit pumice with rubber cup on all teeth, including the porcelain veneers and dental implants
B)Use of fine grit pumice on porcelain veneers only on maxillary anterior teeth and mandibular anterior teeth
C)Use of an ultrasonic universal tip on all teeth with extrinsic stain, including the porcelain veneers and dental implants
D)Selective polishing of only natural teeth with stain that is visible when the patient smiles or speaks

Question 45

Teeth #19 and #20 have been replaced with dental implants. Which of the following instruments would be the BEST choice to remove light calculus from the prosthetic crowns of these dental implants?

A)Plastic implant instrument with a curet-shaped working end
B)Plastic implant instrument with a wrench-shaped working end
C)Universal curet with a short lower shank length
D)Standard-diameter ultrasonic universal tip with a curved working end

Question 46

The suggested place to begin probing by quadrants is the distal line angle of the posterior-most tooth in the quadrant. The working end of the probe is removed from the sulcus or the pocket after each bobbing stroke.

A)Both statements are TRUE
B)The first statement is TRUE; the second FALSE
C)The first statement is FALSE; the second TRUE
D)Both statements are FALSE

Question 47

A clinician is removing calculus from the lingual aspect of the client's maxillary anterior tooth surfaces away from the 12 o'clock position. The clinician's head is bent forward, and the clinician is leaning toward the client. What correction should the clinician make for an ergonomic body position?

A)Move around to the side of the client
B)Raise the client's chair back to a 45-degree angle
C)Ask the client to change from the chin-down to the chin-up position
D)Raise the entire client chair so that the client's mouth is closer to the clinician

Question 48

Periodontal probing of a dental implant may be invasive because the probe may penetrate the weakly adherent biologic seal and could introduce bacteria into peri-implant tissues. Accurate probing depths may be difficult to obtain because of the constricted "cervical" area of some dental implants.

A)Both statements are TRUE
B)The first statement is TRUE; the second FALSE
C)The first statement is FALSE; the second TRUE
D)Both statements are FALSE

Question 49

What type of instrumentation stroke uses a face-to-tooth angulation of 50 to 70 degrees, light lateral pressure, fluid, flowing strokes, and strokes of moderate length?

A)Placement stroke
B)Assessment stroke
C)Root debridement stroke
D)Calculus removal stroke