Gateway Exam 2023 Questions and Answers with complete
solution
How do you calculate a pack year?
(# of years smoked) X (average # of packs smoked per day) = pack years
Once a patient quits smoking, how long before their overall disease risk is the same as
a never-smoker?
If the pt. smoked less than a pack a day (20 cigarettes), then it is 13 years. If 20 or more
cigarettes a day then they retain a small risk for life.
Describe type 1 diabetes
The body attacks the beta cells of the pancreas which produce insulin. The decreased
insulin the body can't store blood glucose and there are increased levels of blood
glucose.
Describe type 2 diabetes
In Type 2 diabetes the body cells no longer respond to insulin produced by the
pancreas usually due to constantly high glucose levels in the blood.
Name some type 1 diabetes meds
Humalog, Apidra, Humulin, Novolin, Levemir, Lantus, Toujeo
Name some type 2 diabetes meds
metformin (biguanide), Sulfonylureas (glipizide and glimepiride), precose, glyset
What is considered a "normal" HbA1c?
5.7% and lower
What HbA1c value when a patient is considered diabetic?
6.5% or higher
What HbA1c value indicates poor control of blood glucose?
7% or higher
What are the systolic/diastolic BP categories?
What are some common HTN meds?
HCTZ, Drugs ending in -tan, furosemide, lisinopril (meds ending in -pril), Calcium
channel blockers (ending in -pine but not always)
What are oral manifestations for calcium channel blockers, ACE inhibitors, diuretics,
(thiazides, methyldopa, propranolol and labetalol), and mercurial diuretics?
Calcium channel blockers - gingival overgrowth
ACEIs - neutropenia, delayed healing, gingival bleeding, oral burning, angioedema and
persistent cough.
Diuretics - dry mouth
Thiazides, methyldopa, propranolol and labetalol - Lichenoid reactions
Mercurial diuretics - oral lesion associated with an allergic or toxic base
Does a patient with a joint replacement need pre-med (prophylactic antibiotics) for
dental treatment?
,In general, they do NOT but if they have a history of complications with their joint a
consult with their surgeon is best. If the surgeon wants to pre-med, it's best if they
recommend the regimen and prescribe it.
What are some examples of anticoagulants?
Heparin, warfarin (Coumadin)
What precautions should a dentist take for a patient on warfarin? Why?
Need INR, Avoid block anesthesia because if done incorrectly it can cause vessel
damage and hematoma formation
Which drugs do NOT need INR testing? Why?
antiplatelets and novel oral anticoagulants because NOAC's use PT or PTT because
these affect coagulation factors themselves as opposed to vitamin K. Platelets use BT
because these do not affect coagulation cascade they affect platelet aggregation only
What INR do you want for dental treatment?
<3.5
Should you do treatment on the day of a patient's dialysis?
No, avoid that day because patients are anticoagulated on the day of dialysis. However
they should have more frequent dental visits in general due to decreased ability to fight
off infections.
What conditions require antibiotic prophylaxis prior to dental treatment?
Any artificial valve, shunt, or prothesis material or device.
History of infective endocarditis.
For cardiac patients what is the maximum dose of epi?
0.04 mg
What are signs/symptoms of Cardiovascular disease?
Extreme fatigue, fast HR (100bpm or more), pain/numbness in limbs, pain/aching in
head and neck area or back, chest pain, difficulty breathing, swelling of arms or legs,
periodontal complications, excessive caries spread, etc.
Define floccular
a term that describes a radiopacity with separate or confluent internal precipitates or
calcifications.
Vertical angulation errors on radiographs cause:
foreshortening or elongation
Horizontal angulation errors on radiographs cause:
overlapped contacts
If the patient was too far forward when exposing a Pan, how will the image look?
excess cervical spine, bunching/overlapping of teeth, inadequate magnification of target
structures
,If the patient was too far back when exposing a Pan, how will the image look?
inability to servisualize airway/condyles, adequate spacing of teeth, but anterior blurred
due to being behind the image layer, more midline projection of cervical spine
If the patient's chin was too high when exposing a Pan, how will the image look?
flattening/reverse arch
curvature, increased overlap
of structures such as
occipital bone and cervical
spine, root distortion
If the patient's chin was too low when exposing a Pan, how will the image look?
What is more likely to be malignant single or multiple lesions?
single lesion
What is more likely to be malignant red (erythroplakia) or white (leukoplakia) lesions?
erythroplakia and erythroleukoplakia (red and white mixed lesion) is also more likely to
be malignant
What is more likely to be malignant single or multiple lesions?
single
What are the most common sites for oral mucosal malignancy?
floor of the mouth & lateral border of the tongue
When disinfecting an impression when are your gloves on/off?
Gloves on for running it under water to remove saliva, blood, debris.
Hold with a gloved hand and spray disinfectant with a non-gloved hand. Allow to sit for 1
minute and rinse with water. Once disinfected, impressions are handled with bare
hands.
What do we disinfect impressions with and what is the active ingredient?
, OptimTM, .5% hydrogen peroxide
What is exposure control and who regulates it?
Written out plan and precautions that need to be taken to both prevent and protect
employees from exposure to bloodborne pathogens and other harmful bodily fluids at
the workplace. OSHA and local/state boards regulate this.
What is infection control and who regulates it?
Infection control goes hand in hand with exposure control and are standards of care that
has an emphasis on stopping the spread on infections via cross-contamination, often
times involving the patient, but also healthcare workers. It is regulated by the CDC, and
local/state boards.
What is an engineering control?
Engineering controls protect workers from hazardous conditions by either eliminating
the hazard or reducing it. This removes the hazard at the source, before it even has the
opportunity to come into contact with the worker.
What are some examples of engineering controls?
-Air ventilation
-Isolation or enclosing hazards
-Wet methods to reduce generation of dusts or particulates
-Fume hoods
What are work practice controls?
Controls which reduce the likelihood of exposure by altering the manner in which the
task is performed.
What are examples of work practice controls?
One handed scoop method for recapping, not bending or breaking needles, using an
instrument for retraction instead of fingers, placing sharps in sharp containers ASAP
How do dental unit waterlines become contaminated? What type of bacteria is it?
A biofilm can develop in the tubing that serves as a reservoir for heterotrophic bacteria.
Under what CFU (colony forming unit) does the dental unit water need to be?
<500 CFU/mL (the same as drinking water)
Who regulates the standards for dental unit water lines?
The CDC
How are DUWs maintained at DCG?
We have a pretreated plumbing system and our own. water reservoir. We test the water
to monitor CFU levels.
What does PPE stand for and who regulates it?
personal protective equipment, OSHA (occupational safety and health administration)
What are universal precautions?
Treating each patient the same with standard infection control practices as if they were
known to have HIV, HBV and other blood borne diseases.
Describe DCG protocol for a needle stick injury.
-Stop procedure, notify attending faculty immediately
-Disinfect area
-Notify business office
-Business office notifies OMS to prepare nurse to draw source pt blood (if after 4 pm
Employee health is notified instead)
-Both source and recipient fill out blood borne exposure packet at business office
solution
How do you calculate a pack year?
(# of years smoked) X (average # of packs smoked per day) = pack years
Once a patient quits smoking, how long before their overall disease risk is the same as
a never-smoker?
If the pt. smoked less than a pack a day (20 cigarettes), then it is 13 years. If 20 or more
cigarettes a day then they retain a small risk for life.
Describe type 1 diabetes
The body attacks the beta cells of the pancreas which produce insulin. The decreased
insulin the body can't store blood glucose and there are increased levels of blood
glucose.
Describe type 2 diabetes
In Type 2 diabetes the body cells no longer respond to insulin produced by the
pancreas usually due to constantly high glucose levels in the blood.
Name some type 1 diabetes meds
Humalog, Apidra, Humulin, Novolin, Levemir, Lantus, Toujeo
Name some type 2 diabetes meds
metformin (biguanide), Sulfonylureas (glipizide and glimepiride), precose, glyset
What is considered a "normal" HbA1c?
5.7% and lower
What HbA1c value when a patient is considered diabetic?
6.5% or higher
What HbA1c value indicates poor control of blood glucose?
7% or higher
What are the systolic/diastolic BP categories?
What are some common HTN meds?
HCTZ, Drugs ending in -tan, furosemide, lisinopril (meds ending in -pril), Calcium
channel blockers (ending in -pine but not always)
What are oral manifestations for calcium channel blockers, ACE inhibitors, diuretics,
(thiazides, methyldopa, propranolol and labetalol), and mercurial diuretics?
Calcium channel blockers - gingival overgrowth
ACEIs - neutropenia, delayed healing, gingival bleeding, oral burning, angioedema and
persistent cough.
Diuretics - dry mouth
Thiazides, methyldopa, propranolol and labetalol - Lichenoid reactions
Mercurial diuretics - oral lesion associated with an allergic or toxic base
Does a patient with a joint replacement need pre-med (prophylactic antibiotics) for
dental treatment?
,In general, they do NOT but if they have a history of complications with their joint a
consult with their surgeon is best. If the surgeon wants to pre-med, it's best if they
recommend the regimen and prescribe it.
What are some examples of anticoagulants?
Heparin, warfarin (Coumadin)
What precautions should a dentist take for a patient on warfarin? Why?
Need INR, Avoid block anesthesia because if done incorrectly it can cause vessel
damage and hematoma formation
Which drugs do NOT need INR testing? Why?
antiplatelets and novel oral anticoagulants because NOAC's use PT or PTT because
these affect coagulation factors themselves as opposed to vitamin K. Platelets use BT
because these do not affect coagulation cascade they affect platelet aggregation only
What INR do you want for dental treatment?
<3.5
Should you do treatment on the day of a patient's dialysis?
No, avoid that day because patients are anticoagulated on the day of dialysis. However
they should have more frequent dental visits in general due to decreased ability to fight
off infections.
What conditions require antibiotic prophylaxis prior to dental treatment?
Any artificial valve, shunt, or prothesis material or device.
History of infective endocarditis.
For cardiac patients what is the maximum dose of epi?
0.04 mg
What are signs/symptoms of Cardiovascular disease?
Extreme fatigue, fast HR (100bpm or more), pain/numbness in limbs, pain/aching in
head and neck area or back, chest pain, difficulty breathing, swelling of arms or legs,
periodontal complications, excessive caries spread, etc.
Define floccular
a term that describes a radiopacity with separate or confluent internal precipitates or
calcifications.
Vertical angulation errors on radiographs cause:
foreshortening or elongation
Horizontal angulation errors on radiographs cause:
overlapped contacts
If the patient was too far forward when exposing a Pan, how will the image look?
excess cervical spine, bunching/overlapping of teeth, inadequate magnification of target
structures
,If the patient was too far back when exposing a Pan, how will the image look?
inability to servisualize airway/condyles, adequate spacing of teeth, but anterior blurred
due to being behind the image layer, more midline projection of cervical spine
If the patient's chin was too high when exposing a Pan, how will the image look?
flattening/reverse arch
curvature, increased overlap
of structures such as
occipital bone and cervical
spine, root distortion
If the patient's chin was too low when exposing a Pan, how will the image look?
What is more likely to be malignant single or multiple lesions?
single lesion
What is more likely to be malignant red (erythroplakia) or white (leukoplakia) lesions?
erythroplakia and erythroleukoplakia (red and white mixed lesion) is also more likely to
be malignant
What is more likely to be malignant single or multiple lesions?
single
What are the most common sites for oral mucosal malignancy?
floor of the mouth & lateral border of the tongue
When disinfecting an impression when are your gloves on/off?
Gloves on for running it under water to remove saliva, blood, debris.
Hold with a gloved hand and spray disinfectant with a non-gloved hand. Allow to sit for 1
minute and rinse with water. Once disinfected, impressions are handled with bare
hands.
What do we disinfect impressions with and what is the active ingredient?
, OptimTM, .5% hydrogen peroxide
What is exposure control and who regulates it?
Written out plan and precautions that need to be taken to both prevent and protect
employees from exposure to bloodborne pathogens and other harmful bodily fluids at
the workplace. OSHA and local/state boards regulate this.
What is infection control and who regulates it?
Infection control goes hand in hand with exposure control and are standards of care that
has an emphasis on stopping the spread on infections via cross-contamination, often
times involving the patient, but also healthcare workers. It is regulated by the CDC, and
local/state boards.
What is an engineering control?
Engineering controls protect workers from hazardous conditions by either eliminating
the hazard or reducing it. This removes the hazard at the source, before it even has the
opportunity to come into contact with the worker.
What are some examples of engineering controls?
-Air ventilation
-Isolation or enclosing hazards
-Wet methods to reduce generation of dusts or particulates
-Fume hoods
What are work practice controls?
Controls which reduce the likelihood of exposure by altering the manner in which the
task is performed.
What are examples of work practice controls?
One handed scoop method for recapping, not bending or breaking needles, using an
instrument for retraction instead of fingers, placing sharps in sharp containers ASAP
How do dental unit waterlines become contaminated? What type of bacteria is it?
A biofilm can develop in the tubing that serves as a reservoir for heterotrophic bacteria.
Under what CFU (colony forming unit) does the dental unit water need to be?
<500 CFU/mL (the same as drinking water)
Who regulates the standards for dental unit water lines?
The CDC
How are DUWs maintained at DCG?
We have a pretreated plumbing system and our own. water reservoir. We test the water
to monitor CFU levels.
What does PPE stand for and who regulates it?
personal protective equipment, OSHA (occupational safety and health administration)
What are universal precautions?
Treating each patient the same with standard infection control practices as if they were
known to have HIV, HBV and other blood borne diseases.
Describe DCG protocol for a needle stick injury.
-Stop procedure, notify attending faculty immediately
-Disinfect area
-Notify business office
-Business office notifies OMS to prepare nurse to draw source pt blood (if after 4 pm
Employee health is notified instead)
-Both source and recipient fill out blood borne exposure packet at business office
