NJXDG EXAM 2023 STUDY GUIDE WITH COMPLETE
SOLUTION
Applying topical fluoride gel or foam (efda)
Selecting the tray
1) Select a disposable tray that is of the appropriate size for the patient's mouth. The
tray must be long and sufficiently deep to cover all erupted teeth completely without
extending beyond the distal surface of the most posterior tooth. Trays are available in
sizes to fit primary, mixed, and adult dentition. If the patient's mouth can accommodate
it, you may use a double-arch tray. This saves time by treating both arches at the same
time. Remember, trays are discarded after a single use & if you try a tray in the mouth
but do not use it that tray must be discarded.
Preparing the teeth
2) Check to see whether calculus is present; if it is not, no preparation is required.
Fluoride diffuses easily through the acquired pellicle and bacterial plaque.
3) If calculus is present, request that the dentist or dental hygienist remove it. The
presence of plaque will not affect the uptake of fluoride.
Applying the topical fluoride
4) Seat the patient in an upright position and explain the procedure. Having the pt
upright prevents gel from going into the throat.
5) Instruct the pt not to swallow the fluoride.
6) Select the appropriate tray, and load it with a minimal amount of fluoride, following
guidelines according to the patient's age.
7) Dry the teeth using air from the air water syringe. For fluoride to be maximally
effective, the teeth must be dry when the fluoride is applied.
8) Insert the tray, and place cotton rolls between the arches. Ask the patient to bite up
and down gently on the cotton rolls, to squeeze the fluoride over all tooth surfaces.
9) promptly place the saliva ejector, and tilt the patient's head forward.
10) Set the timer for the appropriate amount of time in accordance with the
manufacturer's instructions. During this time, do not leave the patient unattended.
11) On completion, remove the tray, but do not allow the pt to rinse or swallow.
Promptly use the saliva ejector or the high-volume oral evaluator tip to close the lips
tightly around the saliva ejector. Removing excess saliva and fluoride solution will make
the pt more comfortable and less likely to rinse with water.
12) Instruct and the pt not to rinse, eat, drink, or brush the teeth for at least 30 minutes.
These activities could disturb the action of the fluoride.
Documentation
- date
- "applied APF fluoride get. Instructed pt not to eat for 30 min.)
- operator
Applying fluoride varnish (EFDA)
,1) Obtain informed consent from the pt, or parent/legal guardian in the case of a minor
patient. Informed consent is a legal requirement for the provision of any dental
treatment.
2) Gather supplies and single-unit dose for application. Once you begin the procedure,
you will not be able to stop in your the middle to get something you forgot.
3) Recline the pt to an ergonomically correct position for better access to the oral cavity
& be in a comfortable position.
4) Wipe the teeth to be varnished with the gauze or cotton roll & insert the saliva ejector.
The varnish is not moisture sensitive and can be applied in the presence of saliva, the
saliva ejector is for pt comfort only.
5) Using a cotton tip applicator, brush or syringe applicator, apply 0.3 to 0.5 ml of
varnish (unit dose) to clinical crown of teeth; application time is 1-3 minutes. Refer to
manufacturer's instructions for specific application time.
6) Dental floss may be used to draw the varnish inter-proximally.
7) allow pt to rinse after the procedure has been completed to remove any residual
taste.
8) Remind the pt to avoid eating hard foods, drinking hot or alcoholic beverages,
brushing, and flossing for at least 4-6 hours, or preferably until the next day after the
application. Drink through a straw for the first few hours after application.
Documentation
- date
- "applied 0.3 ml of 5% sodium fluoride varnish (insert brand name) on facial and lingual
surfaces of teeth #s 6-14, and 19-30.
- operator
Assisting patient with dental floss (EFDA)
Preparing the floss
1) Cut a piece of floss about 18 inches long. Wrap the excess floss around the middle or
index fingers of both of your hands, leaving 2-3 inches of working space exposed.
2) Stretch the floss tightly between your fingers, and use your thumb and index finger to
guide the floss into place.
3) Hold the floss tightly between the thumb and forefinger of each hand. These fingers
control the floss and they should be no farther away than 1/2 inch apart.
Flossing the teeth
4) Pass the floss gently between the patient's teeth, using a sawing motion. Guide the
floss to the gumline. Do not force or snap the floss past the contact area. The floss may
cut or injure the tissue.
5) Curve the floss into a C shape against one tooth. Slide it gently into the space
between the gingiva and the tooth. Use both hands to move the floss up and down on
one side of the tooth.
6) Repeat these steps on each side of all teeth in both arches; including the posterior
surface of the last tooth in each quadrant.
7) As the floss becomes frayed or soiled, move a fresh area into the working position.
Documentation
,- date
- "provided flossing demonstration and instruction. Patient practiced technique and did
well.
- operator
Using an instrument intraorally (EFDA)
1) Seat and place the pt in the supine position.
2) Position yourself as the operator.
3) Adjust the dental light to illuminate the oral cavity.
4) Using a pen grasp, pick up the mirror with your nondominant hand and the explorer
with your dominant hand.
5) Instruct your pt to open his/her mouth and turn toward or away from you, depending
on the location of the mouth.
6) Establish a fulcrum close to the area that you will be exploring with your instrument.
7) Adapt the explorer to the most posterior tooth in the upper right quadrant. A well-
adapted instrument prevents damage to the tooth and surrounding tissue.
8) Follow around the tooth with the mirror and the explorer, and examine all surfaces
through visualization and touch.
Preparing, placing, and removing the dental dam (EFDA)
Patient preparation
1) Check the pt's record for contrainidications, and identify the area to be isolated.
Inform the pt of the need to place a dental dam, and explain the steps involved.
2) Assist the dentist in the administration of local anesthetic. The dentist will determine
which teeth are to be isolated and will note whether any malposed teeth must be
accommodated.
3) Apply lubricating ointment to the pt's lip with a cotton roll or cotton-tipped applicator.
Pt's comfort is a matter of concern throughout placement and removal of the dental
dam.
4) Place yourself in the operator's position, and adjust your pt for easier access.
5) Use the mouth mirror and the explorer to examine the site where the dam is to be
placed. It should be free of plaque and debris. If the dam is placed in an area with
plaque and debris, the dam could push the plaque and debris into the sulcus and irritate
the gingival tissues. If debris and plaque is present, selective coronal polishing is
performed on these teeth before dam is applied.
6) Floss all contacts involved in placement of the dental dam. Any tight contacts may
tear the dam.
Punching the dental dam
7) Use a template or stamp to mark on the dam the teeth to be isolated.
8) Correctly punch the marked dam according to the teeth to be isolated. Be sure to use
the correct size of punch hole for the specific tooth.
9) If teeth have tight contacts, lightly lubricate the holes on the tooth surface
(undersurface) of the dam. This eases placement of dam.
Placing the clamp and the frame
10) Select the correct size of the clamp.
11) Secure the clamp by tying a ligature of dental tape on the bow of the clamp.
, 12) Place the beaks of the dental dam forceps into the holes of the clamp. Grasp the
handles of the dental dam forceps, and squeeze to open the clamp. Turn upward, and
allow the locking bar to slide down to keep the forceps open for placement.
13) Retrieve the dental dam forceps. Position the lingual jaws of the clamp first, then the
facial jaws. During placement, keep an index finger on the clamp to prevent the clamp
from coming off before it has been stabilized on the tooth. Check the clamp for fit.
Lingual jaw placement serves as a fulcrum for placement of the facial jaws.
14) Transfer the dental dam to the site; stretch the punch hole for the anchor tooth over
the clamp.
15) Use cotton pliers to retrieve the ligature and pull it through so that it is exposed and
easy to grasp if necessary.
16) Position the frame over the dam, and slightly pull the dam, allowing it to hook onto
the projections of the frame to ensure a smooth and stable fit.
17) Fit the last hole of the dam over the last tooth to be exposed at the opposite end of
the anchor tooth. This stabilizes the dam and aids in locating the remaining punch holes
for the teeth to be isolated.
18) Using the index fingers of both hands, stretch the dam on the lingual and facial
surfaces of the teeth so that the dam slides through each contact area.
19) With a piece of dental tape or waxed floss, floss through the contacts, pushing the
dam below the proximal contacts of each tooth to be isolated. Slide the floss through the
contact rather than pulling it back through the contact. This will keep the dam in place.
20) If the contacts are extremely tight, use floss or a wooden wedge placed into the
interproximal area to separate the teeth slightly.
21) A ligature is placed to stabilize the dam at the opposite end of the anchor tooth.
Inverting the dam
22) Invert, or reverse, the dam by gently stretching it near the cervix of the tooth.
Inverting the dam creates a seal to prevent the leakage of saliva.
23) Apply air from the air-water syringe to the tooth that is being inverted to help in
turning the dam material under. When the tooth surface is dry, the margin of the
stretched dam usually inverts into the gingival sulcus as the dam is released.
24) A black spoon, FP1, or beavertail burnisher can be used to invert the edges of the
dam.
25) When all punched holes are properly inverted, the dental dam application is
complete.
26) If necessary for pt comfort, a saliva ejector may be placed under the dam. This is
positioned on the floor of the pt's mouth on the side opposite the area being treated.
27) If the pt is uncomfortable and has trouble breathing only through the nose, cut a
small hole in the palatal area of the dam by pinching a piece of dam with cotton pliers
and cutting a small hole near the palatal area.
Removing the dam
28) If a ligature was used to stabilize the dam, remove it first. If a saliva ejector was
used, remove it.
29) Slide your finger under the dam parallel to the arch and pull outward, so you are
stretching the holes away from the isolated teeth.
SOLUTION
Applying topical fluoride gel or foam (efda)
Selecting the tray
1) Select a disposable tray that is of the appropriate size for the patient's mouth. The
tray must be long and sufficiently deep to cover all erupted teeth completely without
extending beyond the distal surface of the most posterior tooth. Trays are available in
sizes to fit primary, mixed, and adult dentition. If the patient's mouth can accommodate
it, you may use a double-arch tray. This saves time by treating both arches at the same
time. Remember, trays are discarded after a single use & if you try a tray in the mouth
but do not use it that tray must be discarded.
Preparing the teeth
2) Check to see whether calculus is present; if it is not, no preparation is required.
Fluoride diffuses easily through the acquired pellicle and bacterial plaque.
3) If calculus is present, request that the dentist or dental hygienist remove it. The
presence of plaque will not affect the uptake of fluoride.
Applying the topical fluoride
4) Seat the patient in an upright position and explain the procedure. Having the pt
upright prevents gel from going into the throat.
5) Instruct the pt not to swallow the fluoride.
6) Select the appropriate tray, and load it with a minimal amount of fluoride, following
guidelines according to the patient's age.
7) Dry the teeth using air from the air water syringe. For fluoride to be maximally
effective, the teeth must be dry when the fluoride is applied.
8) Insert the tray, and place cotton rolls between the arches. Ask the patient to bite up
and down gently on the cotton rolls, to squeeze the fluoride over all tooth surfaces.
9) promptly place the saliva ejector, and tilt the patient's head forward.
10) Set the timer for the appropriate amount of time in accordance with the
manufacturer's instructions. During this time, do not leave the patient unattended.
11) On completion, remove the tray, but do not allow the pt to rinse or swallow.
Promptly use the saliva ejector or the high-volume oral evaluator tip to close the lips
tightly around the saliva ejector. Removing excess saliva and fluoride solution will make
the pt more comfortable and less likely to rinse with water.
12) Instruct and the pt not to rinse, eat, drink, or brush the teeth for at least 30 minutes.
These activities could disturb the action of the fluoride.
Documentation
- date
- "applied APF fluoride get. Instructed pt not to eat for 30 min.)
- operator
Applying fluoride varnish (EFDA)
,1) Obtain informed consent from the pt, or parent/legal guardian in the case of a minor
patient. Informed consent is a legal requirement for the provision of any dental
treatment.
2) Gather supplies and single-unit dose for application. Once you begin the procedure,
you will not be able to stop in your the middle to get something you forgot.
3) Recline the pt to an ergonomically correct position for better access to the oral cavity
& be in a comfortable position.
4) Wipe the teeth to be varnished with the gauze or cotton roll & insert the saliva ejector.
The varnish is not moisture sensitive and can be applied in the presence of saliva, the
saliva ejector is for pt comfort only.
5) Using a cotton tip applicator, brush or syringe applicator, apply 0.3 to 0.5 ml of
varnish (unit dose) to clinical crown of teeth; application time is 1-3 minutes. Refer to
manufacturer's instructions for specific application time.
6) Dental floss may be used to draw the varnish inter-proximally.
7) allow pt to rinse after the procedure has been completed to remove any residual
taste.
8) Remind the pt to avoid eating hard foods, drinking hot or alcoholic beverages,
brushing, and flossing for at least 4-6 hours, or preferably until the next day after the
application. Drink through a straw for the first few hours after application.
Documentation
- date
- "applied 0.3 ml of 5% sodium fluoride varnish (insert brand name) on facial and lingual
surfaces of teeth #s 6-14, and 19-30.
- operator
Assisting patient with dental floss (EFDA)
Preparing the floss
1) Cut a piece of floss about 18 inches long. Wrap the excess floss around the middle or
index fingers of both of your hands, leaving 2-3 inches of working space exposed.
2) Stretch the floss tightly between your fingers, and use your thumb and index finger to
guide the floss into place.
3) Hold the floss tightly between the thumb and forefinger of each hand. These fingers
control the floss and they should be no farther away than 1/2 inch apart.
Flossing the teeth
4) Pass the floss gently between the patient's teeth, using a sawing motion. Guide the
floss to the gumline. Do not force or snap the floss past the contact area. The floss may
cut or injure the tissue.
5) Curve the floss into a C shape against one tooth. Slide it gently into the space
between the gingiva and the tooth. Use both hands to move the floss up and down on
one side of the tooth.
6) Repeat these steps on each side of all teeth in both arches; including the posterior
surface of the last tooth in each quadrant.
7) As the floss becomes frayed or soiled, move a fresh area into the working position.
Documentation
,- date
- "provided flossing demonstration and instruction. Patient practiced technique and did
well.
- operator
Using an instrument intraorally (EFDA)
1) Seat and place the pt in the supine position.
2) Position yourself as the operator.
3) Adjust the dental light to illuminate the oral cavity.
4) Using a pen grasp, pick up the mirror with your nondominant hand and the explorer
with your dominant hand.
5) Instruct your pt to open his/her mouth and turn toward or away from you, depending
on the location of the mouth.
6) Establish a fulcrum close to the area that you will be exploring with your instrument.
7) Adapt the explorer to the most posterior tooth in the upper right quadrant. A well-
adapted instrument prevents damage to the tooth and surrounding tissue.
8) Follow around the tooth with the mirror and the explorer, and examine all surfaces
through visualization and touch.
Preparing, placing, and removing the dental dam (EFDA)
Patient preparation
1) Check the pt's record for contrainidications, and identify the area to be isolated.
Inform the pt of the need to place a dental dam, and explain the steps involved.
2) Assist the dentist in the administration of local anesthetic. The dentist will determine
which teeth are to be isolated and will note whether any malposed teeth must be
accommodated.
3) Apply lubricating ointment to the pt's lip with a cotton roll or cotton-tipped applicator.
Pt's comfort is a matter of concern throughout placement and removal of the dental
dam.
4) Place yourself in the operator's position, and adjust your pt for easier access.
5) Use the mouth mirror and the explorer to examine the site where the dam is to be
placed. It should be free of plaque and debris. If the dam is placed in an area with
plaque and debris, the dam could push the plaque and debris into the sulcus and irritate
the gingival tissues. If debris and plaque is present, selective coronal polishing is
performed on these teeth before dam is applied.
6) Floss all contacts involved in placement of the dental dam. Any tight contacts may
tear the dam.
Punching the dental dam
7) Use a template or stamp to mark on the dam the teeth to be isolated.
8) Correctly punch the marked dam according to the teeth to be isolated. Be sure to use
the correct size of punch hole for the specific tooth.
9) If teeth have tight contacts, lightly lubricate the holes on the tooth surface
(undersurface) of the dam. This eases placement of dam.
Placing the clamp and the frame
10) Select the correct size of the clamp.
11) Secure the clamp by tying a ligature of dental tape on the bow of the clamp.
, 12) Place the beaks of the dental dam forceps into the holes of the clamp. Grasp the
handles of the dental dam forceps, and squeeze to open the clamp. Turn upward, and
allow the locking bar to slide down to keep the forceps open for placement.
13) Retrieve the dental dam forceps. Position the lingual jaws of the clamp first, then the
facial jaws. During placement, keep an index finger on the clamp to prevent the clamp
from coming off before it has been stabilized on the tooth. Check the clamp for fit.
Lingual jaw placement serves as a fulcrum for placement of the facial jaws.
14) Transfer the dental dam to the site; stretch the punch hole for the anchor tooth over
the clamp.
15) Use cotton pliers to retrieve the ligature and pull it through so that it is exposed and
easy to grasp if necessary.
16) Position the frame over the dam, and slightly pull the dam, allowing it to hook onto
the projections of the frame to ensure a smooth and stable fit.
17) Fit the last hole of the dam over the last tooth to be exposed at the opposite end of
the anchor tooth. This stabilizes the dam and aids in locating the remaining punch holes
for the teeth to be isolated.
18) Using the index fingers of both hands, stretch the dam on the lingual and facial
surfaces of the teeth so that the dam slides through each contact area.
19) With a piece of dental tape or waxed floss, floss through the contacts, pushing the
dam below the proximal contacts of each tooth to be isolated. Slide the floss through the
contact rather than pulling it back through the contact. This will keep the dam in place.
20) If the contacts are extremely tight, use floss or a wooden wedge placed into the
interproximal area to separate the teeth slightly.
21) A ligature is placed to stabilize the dam at the opposite end of the anchor tooth.
Inverting the dam
22) Invert, or reverse, the dam by gently stretching it near the cervix of the tooth.
Inverting the dam creates a seal to prevent the leakage of saliva.
23) Apply air from the air-water syringe to the tooth that is being inverted to help in
turning the dam material under. When the tooth surface is dry, the margin of the
stretched dam usually inverts into the gingival sulcus as the dam is released.
24) A black spoon, FP1, or beavertail burnisher can be used to invert the edges of the
dam.
25) When all punched holes are properly inverted, the dental dam application is
complete.
26) If necessary for pt comfort, a saliva ejector may be placed under the dam. This is
positioned on the floor of the pt's mouth on the side opposite the area being treated.
27) If the pt is uncomfortable and has trouble breathing only through the nose, cut a
small hole in the palatal area of the dam by pinching a piece of dam with cotton pliers
and cutting a small hole near the palatal area.
Removing the dam
28) If a ligature was used to stabilize the dam, remove it first. If a saliva ejector was
used, remove it.
29) Slide your finger under the dam parallel to the arch and pull outward, so you are
stretching the holes away from the isolated teeth.
