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LWBK942-FM.qxd 6/25/11 8:45 AM Page x
 Lippincott Williams & Wilkins’
Certification Preparation
for Dental Assisting

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Dental_CertPrep_FM.indd ii 2/12/11 2:09 PM
Dental_CertPrep_FM.indd iii 2/12/11 2:09 PM
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Dental_CertPrep_FM.indd v 2/12/11 2:09 PM
 VI C O N T R I B U TO R S A N D R E V I E W E R S

Jessica L. Fisher, CDA, EFDA, CPT, BLS, AASCJ

Director of Dental Assisting
FORTIS College, Indianapolis, Indiana

Teresa A. Macauley, CDA, EFDA, MS

Associate Professor of Health Sciences
Ivy Tech Community College, Anderson, Indiana

Diana L. Olsen, CDA, CDPMA, RDH, EFDA, MS

Coordinator and Adjunct Instructor, EFDA Program
York County Community College, Wells, Maine

Helene A. Pizzuta, CDA, RDA

Dental Program Director
American Institute, Clifton, New Jersey

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 C O N T R I B U TO R S A N D R E V I E W E R S VII

R EV IE W ER S
Leora Harty
Medical Careers Institute, Newport News, Virginia

Carole Landes
Everest University, Largo, Florida

Mark Matney
Chattanooga State Community College, Chattanooga,Tennessee

Julie Muhle
Truckee Meadows Community College, Reno, Nevada

Carrie Olewinski
Carrington College, Boise, Idaho

Diana Romero
Delta Tech, Lake Charles, Louisiana

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Dental_CertPrep_FM.indd viii 2/12/11 2:10 PM
Dental_CertPrep_FM.indd ix 2/12/11 2:10 PM
 X CONTENTS

p a r t III
Simulated Examination 77
General Chairside (GC) Practice Exam 77
Radiation Health and Safety (RHS) Practice Exam 92
Infection Control (ICE) Practice Exam 105
Answers and Rationales: General Chairside (GC) 117
Answers and Rationales: Radiation Health and Safety (RHS) 131
Answers and Rationales: Infection Control (ICE) 142

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 p a r t I
Preparing for the Dental Assisting
National Certification Exam

Note: This book covers preparation for only the DANB

The Certification Exam CDA exam.

Why get DANB certified? Why go through the hassle, the

Computerized Exam
added time, and the pressure of taking a national board
exam to prove your credentials? The answer is relatively The DANB exam is only administered as a computerized
simple. Dentists generally would like their patients to re- exam. A written version is no longer available. The test is ad-
spect and trust them and possibly even recommend them ministered year-round at over 200 testing centers across the
to other potential patients. If that isn’t the case, those den- country. Applications may be turned in at any time, and can-
tists will soon find their practices dwindling. In order to didates may schedule their exam online at any time after re-
win patients’ trust and respect, it is not enough for only ceiving their test admission notice. The exam must be taken
the dentist display a high degree of knowledge and profes- during a 60-day eligibility window. For further information and
sionalism; the entire dental staff should be held to high test center locations, visit the DANB website (www.danb.org).
expectations as well. A dentist could seek and hire quali-
fied dental assistants based on their word alone (“Sure,
I’m qualified!”), but chances are, most dentists will require The Exam Components
some documentation as proof that the candidate is, indeed, The CDA exam consists of three component exams: General
a qualified professional. To ensure a reputation of excel- Chairside (GC), Radiation Health and Safety (RHS), and Infec-
lence for themselves and for their staff, many dentists may tion Control (ICE). General information about each of these
require the national certification for employment, even exams—such as the allotted testing time, the total number
though it may not be a state requirement. Therefore, even of questions (items) in each component, and the percentage
if your state does not require taking a credentialing exam (%) of exam questions in each topic area—is provided here.
such as the DANB, obtaining and maintaining this national
credential will speak volumes about your qualifications, General Chairside (GC) Exam
professionalism, dedication, and sincerity in being a den-
■ 120 multiple-choice items
tal assistant. Frame your certificate and display it proudly
■ 90 minutes (1.5 hours) testing time
where patients can see it! Showing that you are a highly
■ Topics:
qualified professional will instill patient confidence in
● Collection and recording of clinical data (10%, 12
your abilities.
As you may already know, the Dental Assisting National questions)
● Chairside dental procedures (45%, 54 questions)
Board, Inc. (DANB) is the foremost recognized certification
● Chairside dental materials (preparation, manipula-
and credentialing agency for dental assistants and is a mem-
ber of the Institute for Credentialing Excellence (formerly tion, application) (11%, 13 questions)
● Lab materials and procedures (4%, 5 questions)
NOCA). Certification by a nationally recognized leader in
● Patient education and oral health management (10%,
dental assisting qualifications has many benefits. DANB-
certified assistants usually receive higher salaries than 12 questions)
● Prevention and management of emergencies (14%,
their noncredentialed colleagues, and DANB-certification
is a requirement for dental assistants to provide expanded 17 questions)
● Office management procedures (6%, 7 questions)
functions in many states.
The two areas of certification that are open to eligible
candidates are: Radiation Health and Safety (RHS) Exam
■ Certified Dental Assistant (CDA) ■ 100 multiple-choice items
■ Certified Orthodontic Assistant (COA) ■ 75 minutes (1.25 hours) testing time

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 2 PA R T I P R E PA R I N G F O R T H E D E N TA L A S S I S T I N G N AT I O N A L C E R T I F I C AT I O N E X A M

■ Topics: Matching items, true/false items, and questions that

● Exposing and evaluating radiographs (intraoral, could have more than one possible answer, such as “both A
extraoral) (37%, 37 questions) and B,” “None of the above,” or “All of the above,” are not
● Processing films (16%, 16 questions) used on the DANB exam.
● Mounting/labeling films (11%, 11 questions)
● Radiation safety, patient (24%, 24 questions)
● Radiation safety, operator (12%, 12 questions)
Studying Ahead for the Exam
Infection Control (ICE) Exam
■ 100 multiple-choice items One of the most important aspects of studying for an
■ 75 minutes (1.25 hours) testing time exam is not to “study” for the exam at all.Yes, you read that
■ Topics: right! But isn’t this book designed to help you study for
● Patient and dental health care worker education the test? Yes, of course it is. However, many students con-
(10%, 10 questions) fuse “studying” with “cramming” for an exam. “Cramming”
● Prevention of cross-contamination and transmission as much information into your head in a day or two—or
(20%, 20 questions) even an hour or two—before taking the exam is not re-
● Maintaining aseptic conditions (10%, 10 questions) ally “studying.” To truly study is to come prepared to each
● Performing sterilization procedures (15%, 15 questions) class throughout the academic term, read the material for
● Environmental asepsis (15%, 15 questions) that day, take notes on the material, and gain a deeper-
● Occupational safety (30%, 30 questions) than-surface-level understanding of the topic. Studying is a
wide-ranging commitment. So, to clarify the meaning of the
In total, you will answer 320 multiple-choice items in opening sentence: Don’t study for the exam, study for the
4 hours. For each component exam, there are minimum knowledge. Then review for the exam and pass. Studying
performance standards that you must meet in order to and reviewing go hand in hand.“Reviewing” for an exam is
earn the CDA certification. It is to your advantage to know going back over the material you have already learned and
the percentage of questions that will appear for each topic internalized in order to freshen it in your mind.
on the exam so that you can schedule your study time ac- A great way to begin to truly study is by implementing
cordingly. For example, you should allot more time and some long-term studying strategies and methods into your
energy to studying chairside dental procedures because student life.
these questions make up 45% (54 questions) of the GC
component exam rather than lab materials and procedures
because only 4% (5 questions) of the GC component exam Set Up Your Study Space
address that topic.
The most important thing you need to know before you
get started is what type of environment, or study space,
The Exam Questions is most conducive to your needs. Ask yourself some very
simple questions:
The DANB national exam follows strict guidelines. The ■ Where can I be most organized?
questions are written in a straightforward style with ■ What type of sounds do I like to hear when I’m learning?
simple vocabulary; they are not written to trick you into ■ When during the day am I most alert and most recep-
answering incorrectly. Strategies for answering exam
tive to new information?
questions are provided later in the section, Answering ■ How do I best learn?
Exam Questions.
The exam is written in a simple multiple-choice format, Some people think the dining room table is a great
which asks you to answer in one of two ways: place to study (and for them it might be), because it may
■ Direct-question format: You must answer a direct ques- be large and desklike. However, if that means having to
tion by choosing one BEST or MOST CORRECT answer put away all study materials at every mealtime or trying to
from a choice of possible answers. study in the center of a large and/or loud household, it may
■ Incomplete-statement format: You much complete an actually be the least conducive place. Find a space where
open-ended statement by choosing one BEST or MOST you can be consistently organized and where your high-
CORRECT word or phrase from a choice of four pos- lighters, notebooks, a computer (if necessary), textbooks,
sible answers. and other study materials can stay and be easily and readily
■ Negative format: The DANB exam does not contain accessible. Your study space should also not be cluttered
many of these types of questions, but it does contain with other items that could possibly be a distraction, such
a few. These are questions in which you must find an as phones, pictures, hobbies, magazines, and the like.
EXCEPTION or determine which choice is NOT appro- Many instructors have argued for studying in a noiseless
priate for the question. room.That seems to make a lot of sense—fewer distractions,

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 P R E PA R I N G F O R T H E D E N TA L A S S I S T I N G N AT I O N A L C E R T I F I C AT I O N E X A M 3

comfortable, and quiet. However, this may not work for time of day. What you put into your body and what type
you at all. Utter silence can be deafening and distracting of stress you place on your body directly affect how ef-
in itself to some people. If you know that you concentrate ficiently your mind works, how readily you absorb infor-
better when listening to soft music in the background, by mation, and how accurately you retain and recall material.
all means, do that. (Just be sure that the sound level is truly Eating right, exercising, getting enough sleep, and taking
beneficial to studying, not to dancing and singing along.) frequent relaxation breaks will help the knowledge be
By the same token, if you like the sounds of nature, study absorbed.
outside (weather permitting), but go elsewhere if you be-
come distracted by sounds of lawnmowers and heavy traf-
fic. Maybe an indoor room with the window slightly open The Process of Studying
would serve you better. In the end, you know best what
When you have considered all these options, then you are
works for you.
ready to get down to the business of studying. Obviously,
you should study your dental assisting textbook. Focus
your reading by asking questions and answering those
Set Up a Study Method questions while you read.Think:
It is important to be aware of how you learn best. If you ■ When will I most likely need to use this fact, procedure,
are an auditory learner—you prefer to hear the informa- or idea?
tion spoken—consider reading your information or text ■ How would this be phrased as an exam question?
into a recording device and playing back for yourself. This ■ What is the next step in this procedure? How does it
means you can study while driving, jogging, or even while relate to the step before?
taking the dog for a walk! If you are a visual learner—pre- ■ Does this make sense?
ferring to see a visual representation of the material—then
If it helps you, write down the questions (and answers).
draw some pictures of the material. If you are not an art-
If you come across a question for which you have no an-
ist, take photographs. Need to memorize lab materials and
swer, ask your instructor during the next class. This brings
proper procedures? Take pictures of them and use those as
us to the topic of taking notes.
flashcards. If you learn best by discussing the material to
Whether you are in class or reading alone, there are
be learned, join or create a study group with other vocal
many ways to take effective notes. The method you
learners. You could also explain the material to an inter-
use depends on the purpose for the note taking (build-
ested friend or relative, or even to your pet. (Don’t laugh,
ing vocabulary, memorization of facts, understanding a
it works!) In short, get creative. You know how you learn
concept, etc.) and on your style of learning. A few of the
best. However, if you have any question about it, there are
most popular note-taking styles are:
a number of free online sites (such as www.learning-styles- ■ Cornell method:The notebook page is divided into two
online.com) that will test your learning style and give you
sections, with the left section approximately 2" wide.
results with suggestions for how to make your learning
Notes are recorded on the right side, and correspond-
style work for you.
ing vocabulary, important concepts, and key words are
listed on the left. A brief summary is usually written at
the bottom of the page.
Set Up a Study Schedule ■ Outline: Topics and subtopics are carefully aligned and
Are you most alert in the morning, afternoon, or evening? indented according to how the information relates
This is the time when your mind is most receptive to new to the facts before it. Because of the formal structure
and challenging thoughts, so you should schedule your of an outline, it is not always the most effective note-
study sessions for those times. If this is not a realistic op- taking method for lectures or in-class notes (unless the
tion because of your work schedule, school, or other obli- instructor also uses an outline to teach). While taking
gations, try to get as close as possible to your ideal time or “live” notes in class, it may be best not to use the Roman
work out a study schedule in which you can study at your numeral and letter/number format because that makes
best time at least two to three times a week. it impossible to later add important information to the
Carving out time to study from your other activities is a outline; instead, use bullets, dashes, and indentions to
must, and creating a study schedule will help you stick to mark subtopics.
a routine and build great study habits. As you create your ■ Mapping: A central idea, concept, or piece of informa-
study schedule, don’t forget to include break times of 5 to tion is written in the center of the page and corre-
10 minutes every 45 minutes or so.Your brain needs down- sponding ideas or subtopics are branched out from it
time to absorb new information, and your body needs a via connecting lines. This method is useful when learn-
break to relax and de-stress from studying. ing a complex concept or theory and is great for visual
Make sure that you don’t schedule your study time im- learners because colors, drawings, or small graphics are
mediately after a heavy meal or after a hectic or stressful easily integrated into the notes.

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 4 PA R T I P R E PA R I N G F O R T H E D E N TA L A S S I S T I N G N AT I O N A L C E R T I F I C AT I O N E X A M

No matter which methods you use—or if you create ❍ “First . . . Next . . . Last . . .”
your own—there are some important principles to follow ❍ Raising the voice or emphasizing words
to make any note-taking style more effective. ❍ Pointing out items on a chart, in an outline, or

even in the text

❍ Moving closer to students

General Guidelines for Note Taking ❍ Repeating words or phrases (sometimes several

times)
■ Always: ❍ Writing information on the board, overhead trans-
● Choose a note-taking method that works for your
parency, etc.
learning style and for the topic. ● Ask questions. Some instructors ask you to wait until
● Date and number all your notes.
an appointed time, such as after a demonstration or
● Leave some empty space in case you need to fill in
instructional video or even at the end of class, to ask
more information later.
questions.
■ Before class: ● Use common sense. If you are the only one who does
● Read the material thoroughly before class, highlight-
not fully understand something, perhaps it’s better
ing important information, making notes in the mar-
to wait until after class to ask. Find out what your
gin, and indicating questions for the instructor. The
instructor prefers.
class will make much more sense and you’ll be ready ■ After class:
to ask questions about items that are confusing to you. ● Review your notes as soon as possible after class, fill-
● Write down unfamiliar terms and look them up;
ing in notes, clarifying ideas, and writing down addi-
make sure you understand the appropriate defini-
tional questions to ask the instructor or research on
tion and how it relates to your topic—for example, a
your own.
crown has a much different meaning to you than it ● Use the shorthand you’ve developed to point out
does to a member of royalty.
key terms, important points, confusing concepts, etc.
● As you take notes, write in your own words, not those
● Summarize the notes using just a sentence or two
of the instructor or textbook. Summarizing, para-
and highlight the summary. It will prove useful when
phrasing, and even listing information help make
creating a study plan for your exam.
sure you understand and internalize the information
and make studying and reviewing more user-friendly. Great note taking will only get you so far.To really know
● Develop and use your own shorthand symbols to your subject deeply and be able to pass an exam means
later draw your attention to important points (!), you also need to review your notes on a regular basis. Reg-
questions you have about a point/topic (?), or items ular review helps ensure that you understand the material
that need to be memorized (*). Visual symbols will and cuts down dramatically on the amount of time you’ll
not only help you quickly locate and identify the ma- need to study and review immediately before the exam.
terial in question during class (questions to ask) but After all, you will have been studying all along!
also after class while reviewing and adding to your Lastly, use all available tools to check your understanding.
notes. The symbols used in the parentheses are sim- Part II of this text contains a content review outline inter-
ply examples of shorthand symbols. Feel free to be spersed with review questions. Read through the outline,
creative or use whatever is most effective for you. highlight important information, compare your study notes
● Bring your notes and questions to class and review with the outline, and quiz yourself using the review ques-
them before class begins. tions. If you find that you need more preparation in certain
■ During class: areas or that some concepts are still a little vague, go back
● Sit where there are the fewest distractions, where to your textbook to clarify.After you feel you have mastered
you can hear the instructor clearly, and where you the material, use the simulated exam and scoring guide in
can clearly see any notes or demonstrations the in- Part III of this text and on the accompanying CD to test your
structor provides. exam readiness. If you do well, give yourself a well-deserved
● Listen for content key words that are specific to the pat on the back. If you don’t perform as well as you had
subject.Write down all vocabulary and important facts. expected, don’t despair and don’t give up. These are study
● Pay attention to clue words and the instructor’s physi- tools for you to measure your readiness to take the formal
cal cues that let you know something important is com- exam—they are not end results. Whether you score high,
ing up that you should write down. Some examples of medium, or low on the review questions, use the rationales
instructor’s verbal and nonverbal cues and clues are: as an additional tool to better understand any questions
❍ “Three important safety regulations . . .” (a list is you missed and to verify and solidify the correct answers
coming up) you had. Then make a list and formulate a study plan and
❍ “Most importantly . . .” schedule to help you focus on the areas in which you had
❍ “The advantages and/or disadvantages to this . . .” trouble. Remember, studying is a cycle, not a linear process.

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 P R E PA R I N G F O R T H E D E N TA L A S S I S T I N G N AT I O N A L C E R T I F I C AT I O N E X A M 5

the information you’ve put into it. If you’ve done your

Preparing for the Exam work all along and internalized the information, the
knowledge will be there.Trust in yourself.
■ Eat small, nutritious, well-balanced meals several times
It is very important to prepare yourself physically and psy-
chologically for the exam itself. Arriving at the test center every day. Feed your body and your mind so you can
weak, worn out, tired, frazzled, or otherwise unhealthy is function at optimal level.
not going to help you pass that exam. So what’s the best
way to prepare? By being proactive, of course! The Day Before the Exam
This is not a time for cramming. You may want to take
Avoid Test Anxiety some time to review, but relaxation and positive attitude
Many people experience a snowball effect of fear, stress, building should be your primary concern. If you haven’t
and anxiety by worrying about how their test anxiety will done so already, drive to the test center at about the same
affect their exam score, increasing their anxiety even more. time of day as on the day of the exam in order to judge traf-
If you are one of those people, take a deep breath when fic patterns, time delays, etc.This will help ensure that you
you catch yourself becoming anxious. Remind yourself allow adequate time to arrive on time at the exam center
that you have been studying and preparing for the test all destination. Locate where you will park, identify the cor-
along. Focus on the positive and build up your confidence rect entrance, etc. You should also make sure that there is
instead of tearing it down. Try writing positive messages plenty of gas in your vehicle to get you to the location.You
on sticky notes and posting them around your living space. do not want to be late, hurried, or confused before you
Be your own cheerleader and recruit family, friends, and even step foot in the testing center.
fellow students to be your cheerleaders.
The Night Before the Exam
Several Days Before the Exam ■ Have a light, nutritious dinner. You want to make sure
■ Your knowledge of the material should be very solid at you sleep well before the test. Heavy dinners, alcohol, or
this point. Even though you are past the point of learn- extremely spicy foods can interfere with a good night’s
ing major new concepts, continue to stick to your study sleep. Avoid them.
schedule and focus on strengthening any areas in which ■ Decide what you will wear. Choose light, comfortable
you feel weak and reviewing those areas in which you are clothing that won’t detract your attention. If you get
strong. Don’t try to memorize the information—own it! chilled easily, plan to bring a light jacket or sweater.
■ If you haven’t already done so, make flashcards for the ■ Gather the necessary items you’ll need to bring with
various components on the exam. Use the flashcards you and place them where you will not forget them on
yourself as a quick check throughout the day or ask sup- test day:
portive family members and friends to quiz you periodi- ● Two forms of valid identification

cally as you have dinner, chat on the phone, etc. Make it ● Any additional paperwork you may be required to

a fun game, not a stress-filled obligation. bring

■ Take a practice test—in fact, take more than one. Be- ■ Plan to get the optimum amount of sleep for you. For
come familiar with the layout of the exam, the format most people, that is between 6 and 8 hours. However,
of the questions, and the wording of the directions. But for some, 8 hours can be either too much or not quite
remember that no practice test can include all the ques- enough.
tions on the actual exam or ones similar in phrasing. ■ Check your attitude and build yourself up. This is not a
Study the material, not the specific practice questions. night for cramming or studying. It’s a night for relaxing
■ Consider completing the DANB online tutorial (avail- and boosting your confidence.
able for download at http://www.danb.org/exams/tuto-
rial2.asp) before you get to the test center. It describes
how to mark your answers, skip items, and return to
The Morning of the Exam
questions. You can also take the tutorial at the test site At this point, you should be well prepared for the exam.
immediately before you begin the test—it does not You’ve laid out your clothes, assembled all required ma-
count toward your testing time. Going through the tu- terials, ensured you know how and when to get to the
torial twice will ensure you haven’t missed anything. test center, and gotten a good night’s rest. All that is left
■ Get plenty of sleep (at least 6 to 8 hours a night).A tired to do is get dressed, eat a light and nutritious breakfast,
mind does not function well. including some protein, and build up a positive can-do
■ Try to relax as much as possible and don’t spend every attitude. Leave yourself plenty of time to get to the test
waking hour studying. Allow your mind to process all center, arriving at least 5 minutes early. If you think better

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 6 PA R T I P R E PA R I N G F O R T H E D E N TA L A S S I S T I N G N AT I O N A L C E R T I F I C AT I O N E X A M

after a morning cup of coffee, then by all means, indulge a ■ Eliminate “wrong” answers right away. Just be careful
little, but be careful not to consume too much caffeine— not to do this too quickly; you don’t want to eliminate
you don’t want to be jittery or anxious—or consume too the right answer. Read, evaluate, and think through
many liquids. Testing time does not stop while you use the choices.
the restroom! ■ If you find you really do not know an answer at all, try
to eliminate as many of the wrong choices as possible
to increase your chances of getting the right answer
During the Exam and then take your best educated guess; you will not
be penalized.
As difficult as it may seem, you need to try to relax. Focus
on your breathing; don’t hold your breath. Also, try to sit Practice using these tips as you answer the review ques-
in a comfortable, upright position, leaning slightly forward. tions in this text and on the accompanying CD.
Being hunched over will only serve to give you a backache
and remind you how uncomfortable you are. Don’t sit still Strategies for Taking the Exam
too long. Move your legs and arms from time to time and
■ Take the online tutorial available at the test center be-
rotate your shoulders. Try to keep your blood circulating.
fore you begin your exam, even if you’ve taken it else-
Use the tips and strategies provided in the following sec-
where online already.
tions to improve your test-taking abilities.
■ Budget your time and don’t spend too much time on
any one question.
Tips for Answering Exam Questions ■ Conversely, don’t hurry.Try to use every bit of time you
The exam is written using simple multiple-choice ques- have available for your exam.
tions.This does not mean that the questions themselves are ■ Use the restroom if necessary, but remember that the timer
simple, but that the questions are formatted in a simple, keeps going even when you’re taking a restroom break.
straightforward style that is not meant to trick or confuse ■ Don’t allow yourself to become frustrated. If you feel
you. However, the exam is meant to measure and evalu- anxiety creeping in, take a minute to look away from the
ate your knowledge of the subject. Each question will computer, take a deep breath, clear your mind, then col-
have only one right answer, along with several “distractor” lect yourself and refocus.Tell yourself you can do this.
choices that may look very plausible or even correct at first ■ During the exam, you will be able to access a list of
glance. Distractors are not meant to confuse or trick you, commonly used acronyms used on the DANB exam, so
even though it may appear that way at first. Don’t allow don’t worry that you’ll forget what the letters in OSHA
yourself to become frazzled. Have confidence in your stand for.
knowledge and read each question and answer carefully. ■ Don’t dwell on answers you really don’t know. If you
Familiarize yourself with multiple-choice-style questions truly don’t know the right answer, give it your best edu-
and follow these strategies when answering multiple-choice cated guess and move on. You will not be penalized for
questions: guessing incorrectly (some exams will take off more
■ Read all directions very carefully, even if you think you points for wrong answers than blank ones; the DANB
know what they may say. does not do this).
■ Read the question carefully and look for clues to the ■ If, after eliminating wrong answers and narrowing
right answer: down your answer choices, you are still unsure of the
● Sometimes, the way a question is phrased will offer correct answer, flag the question for review and come
a hint by having only one grammatically correct back to it later. Other questions/answer choices may jog
answer. your memory and give clues to a previous question.
● Dissect the question into smaller parts, if possible, to ■ Only flag for review the questions where you are really
make sure you understand what is being asked. stuck. If you flag too many, you’ll likely end up confus-
■ Look for words that are capitalized or in bold print in ing yourself more.
the question. In negative format questions, the words ■ After you have answered all exam questions within a
“NOT” or “EXCEPT” indicate that the answer will be given component exam, an answer review screen will
negative. The distractors (incorrect answer choices) appear, displaying a comprehensive list of question
will be true. items and indicating which items you’ve left blank (in-
■ Look for absolute words in the answer choices, such as complete) and which items you’ve flagged for review
“always” or “never,” which are rarely the correct answer. or for comment. You may choose to review all items or
■ Have the answer in mind before you begin looking for only review flagged answer choices; however, you must
the correct choice. complete your review in the time you have left.You will
■ Read each answer choice separately and evaluate not receive extra exam time to review the answers.
whether it answers the question completely, is only part ● If you choose to review all questions, only double-

of the right answer, or is completely off topic. check that you’ve marked the answer choices that

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 P R E PA R I N G F O R T H E D E N TA L A S S I S T I N G N AT I O N A L C E R T I F I C AT I O N E X A M 7

you intended. If you find a mismarked item (for ex-

ample, you intended to choose answer “A” but some- After the Exam
how marked “C”), change it.
● If you choose to go back to questions you’ve flagged
You will receive a preliminary score report at the testing
for review, only change the answer if you find a glar- center, and official scores will be mailed to you approxi-
ing error. If you are unsure if the answer is right, do mately 4 weeks after your exam. The scores are “scaled,”
not second-guess yourself. Leave your first answer. meaning that a complex score is translated into a more
Chances are, your first response is right. user-friendly scale. This scale has a numerical range of 100
● After the answer review screen, you will be asked to
(low) to 900 (high). A scaled score of 400 is considered
confirm that you are ending the exam review. After passing for each component. You may retake the compo-
you click “yes,” you will not be able to return to the nent exam(s) that were not passed, but you are required to
exam or change any answers. reapply and pay exam fees for those exams. You must pass
■ You may also flag items for comments. After exit- all component exams within 5 years to receive certification.
ing the answer review screen, the comment review Along with your scaled score, your score report will
screen appears. also show your performance on the subtests or general
● You may choose to comment on all items or only content areas. The performance indicators will show on
those that you have flagged. which sections you scored “high average” (best), “average”
● You are allotted 10 minutes in addition to the exam (medium), and “low average” (weak). If you need to retake
time for posting comments. the test, it is highly recommended that you increase your
● You cannot change answers or return to answer re- knowledge in the “low average” subtest material.
view mode while in comment review mode. For additional information about the DANB exam, such
● After confirming that you are exiting the comment as individualized standards for passing, who else can see
review mode, you cannot return to the exam, to your test scores, how you can request a duplicate score
answer review mode, or to comment review mode. report, etc., visit the DANB website at www.danb.org.

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Dental_CertPrep_Part_I.indd 8 2/12/11 1:39 PM
 p a r t II
Review

GENERAL CHAIRSIDE ASSISTING (GC)

Collecting and Recording Clinical Data

I. Basic Oral and Dental Anatomy and Physiology

A. Bones of the cranium, face, and neck
1. Cranial bones are the single frontal, occipital, sphenoid, and ethmoid bones and also the paired pari-
etal and temporal bones.
2. Facial bones are the lacrimal bones, nasal bones, vomer, nasal conchae, zygomatic bones, maxillae, and
mandible.
3. The hyoid bone is suspended between the mandible and larynx.
B. Muscles of the head and neck
1. Muscles of mastication are: temporal muscles, masseter muscles, internal (or medial) pterygoid mus-
cles, and external (or lateral) pterygoid muscles.
2. Muscles of facial expression are: orbicularis oris muscle, buccinators muscle, mentalis muscle, and
zygomatic major.
3. Muscles of the floor of the mouth are: digastric muscle, mylohyoid muscle, stylohyoid muscle, and
geniohyoid muscle.
4. Muscles of the tongue are classified as intrinsic (within the tongue) or extrinsic (outside the tongue).
Intrinsic muscles shape the tongue during speech, mastication, and swallowing. Extrinsic muscles
move the tongue.
5. Muscles of the soft palate (major) are: palatoglossus and palatopharyngeus.
6. Muscles of the neck are: sternocleidomastoid muscle and trapezius muscle.
C. Glands
1. The most significant glands for dental health professionals are the major and minor salivary glands.
2. The pituitary gland, pineal gland, thyroid gland, and parathyroid glands are found within the head and
neck.
3. The thyroid gland is located within the neck on the front and sides of the trachea just below the larynx.
D. Nerves
1. The trigeminal nerve (cranial nerve V) is the primary source of innervation for the oral cavity.
2. The trigeminal nerve is subdivided into three divisions: maxillary, mandibular, and ophthalmic. Of these
three divisions, the maxillary and mandibular are of particular interest to dental health professionals.
E. Blood vessels
1. Major arteries of the face and mouth are the aorta and the common carotid artery.
2. Blood descends from the face and mouth through this network of veins: maxillary vein, temporal vein,
retromandibular vein, and lingual veins. These veins empty into the jugular veins, which empty into
the superior vena cava to transport blood to the heart and lungs for reoxygenation.

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 10 PA R T I I REVIEW

F. Teeth
1. There are essentially four components of the tooth: enamel, dentin, pulp, and cementum.
2. The tooth consists of a crown and a root.
General Chairside

a. The anatomic crown of the tooth is the part covered by enamel.The clinical crown refers to the
part of the crown visible in the oral cavity.
b. The anatomic root is the part of the tooth covered by cementum.The clinical root refers only to
the part of the root that is not visible.
G. Oral cavity
1. The vestibule is the space between the teeth and the inner lining of the cheeks and lips.
2. The frena (singular: frenum), raised lines of mucosal tissue, are visible when the lips are pulled back
and they support or restrain teeth and other structures.
3. The gingivae—commonly called the gums—are attached to the alveolar ridge and vary in color from
pale pink to brownish pink. Free gingivae or marginal gingivae is where the gingivae meet the
teeth and is the first area to respond to inflammation.
4. The hard palate, a bony plate covered with keratinized tissue, sits toward the front of the mouth and
forms the anterior portion of the palate.
5. The soft palate is composed of muscle tissue rather than bone and sits toward the back of the mouth.
The uvula, the projection visible when the mouth is opened wide, hangs from the back of the soft palate.
II. Clinical Exam
A. While escorting patient to the clinical examination area, observe patient’s overall appearance, gait,
speech, and general behavior and note unusual or concerning characteristics or behavior.
B. Seat patient upright in dental chair, secure paper bib or napkin around patient’s neck, and compile or
update patient’s medical and dental history. Note drug allergies and chronic diseases, such as diabetes;
record the purpose of the patient’s visit.
C. Types and locations of teeth in the primary and permanent dentition
1. Incisors cut food, support lips, and help produce sounds for speech.
2. There are four canine teeth (cuspids), one in each quadrant of the mouth. They have a single cusp
(cingulum), whose primary purpose is to tear food.
3. Premolars are found only in the permanent dentition. They replace the first and second molars of
the primary dentition.
4. First and second molars have four cusps used to chew and grind food.
5. Third molars (“wisdom” teeth) erupt in late adolescence/early adulthood.
D. Surfaces of the tooth are: facial, lingual, incisal/occlusal, mesial, and distal. They are named for their re-
lationship or closeness to other intraoral structures, such as the lips and tongue, or according to which
direction they face within the intraoral cavity.
E. Record abnormal findings in head and neck (TMJ) region
1. As the dentist comments on the patient’s dental conditions and health, note or chart any abnormalities,
such as: soft tissue abnormalities; tooth structure abnormalities, including missing teeth; and restorations.
2. If allowed in your state, examine extraoral soft tissue by palpation. When searching for oral cancer,
examine the head and neck, including inspection and palpation of extraoral tissues, temporoman-
dibular joint, tongue, floor of mouth, palate, uvula, and lymph nodes.
3. Note any other abnormal findings in the head or neck region that may be related to other health
conditions.
III. Patient Charts
A. Identify permanent and primary teeth using numbering systems
1. The universal numbering system is the main numbering system used on dental charts in the United
States.
2. The international tooth numbering system is a two-digit system that uses only numerals 1 through 8
for each digit.
3. The Palmer notation system identifies the teeth by quadrant and number.
B. Chart conditions
1. Use Black’s classification of cavities (describes six classes of cavities and outlines restorative treat-
ments for each) to observe/record suspected cavities.
2. Use abbreviations, symbols, and colors in the patient chart to document decay, restoration, or other
existing conditions.

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 GENERAL CHAIRSIDE ASSISTING (GC) 11

3. Record the results of the periodontal exam, including the dentist’s assessment of mobility, pocket
depth, and furcation involvement.
4. Record existing damage or disease to tooth pulp (endodontics) or periapical tissue.

General Chairside
IV. Diagnostic Testing
A. Assist in collecting diagnostic patient information.
1. Dental radiographs allow the dentist to examine the health of the pulp, the root canal space, and the
bone and to detect possible dental caries.
2. Various pulp tests, such as thermal pulp testing and electric pulp testing, are used to diagnose peri-
odontal disease.
3. Photography can provide a before-and-after record of original conditions and the subsequent effects
of any procedures.
4. Preparing materials for taking an occlusal registration include (1) softening the wax in warm
water and preparing it for placement in the patient’s mouth and (2) mixing other materials on a
paper pad and putting them on a quadrant tray for placement in the patient’s mouth.
B. Diagnostic casts (diagnostic models or study models) are three-dimensional models of the patient’s teeth,
mouth, and arches. They are useful because they show actual distances and proportion of the patient’s
teeth and arches.They are created from alginate impressions and included in the patient’s record.
V. Documenting Treatment
A. Maintain accurate records of drugs prescribed or dispensed to patients. If a drug is discussed in detail
with the patient, record important points of this discussion.
B. Before the patient arrives, familiarize yourself with the patient’s record to alert you to the patient’s pre-
medications (premeds), any medical concerns you and the dental team should be aware of, any change
in dental treatment that should be provided, and any change in the way in which dental treatments
should be performed.
C. Record recommended treatment in patient’s chart and make sure the chart includes signed and dated
consent forms necessary for treatment. If a patient refuses an examination, treatment, or test, document
the refusal in the chart. If possible, ask the patient to sign a statement indicating that they refused treat-
ment and keep that statement in the chart.
D. Record that the patient complied with the treatment provided.
VI. Obtain Vital Signs
A. Take a pulse by gently palpating an artery with fingertips, pressing lightly but firmly enough to feel the
pulse. Count the number of pulse beats for 30 seconds; multiply your count by two and record pulse
rate in patient chart, along with date, time, and your signature.
B. Measure respiration by counting the number of times the patient’s chest rises and falls in 30 seconds.
Each cycle of rise and fall of the chest counts as one. Multiply your count by two and record respiration
rate in patient chart, along with date, time, and your signature.
C. Measure blood pressure using a sphygmomanometer and a stethoscope. Record blood pressure in pa-
tient chart, along with date, time, and your signature. The systolic number is written first, followed by
the diastolic.
D. Temperature is measured with a thermometer at different body sites: under the tongue, inside the arm-
pit, inside the ear, and inside the rectum (for infants). Record temperature in patient chart, along with
date, time, and your signature.

Rev iew Q u esti o n s

1. Using the universal numbering system, the permanent maxillary right second molar is tooth number
A. 2.
B. 7.
C. 15.
D. 18.

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 12 PA R T I I REVIEW

2. A small, rounded extension of bone covered with soft tissue located posterior to the last maxillary molar is the
A. Stensen’s papilla.
B. retromolar pad.
General Chairside

C. maxillary tuberosity.
D. torus palatinus.

3. Which of the following best describes the palantine rugae?

A. The demarcation between the hard and soft palate.
B. Horizontally raised folds of hard tissue behind the incisive papilla on the hard palate.
C. The ridged line that extends from behind the incisive papilla down the midline of the palate.
D. A raised area of tissue just behind the maxillary incisors.

4. To identify Stensen’s papilla, look for a

A. small raised flap of soft tissue on the buccal mucosa opposite the maxillary second molar.
B. triangular area of bone covered with soft tissue behind the last mandibular molar.
C. raised horizontal extension of soft tissue along the occlusal line on the buccal mucosa.
D. raised rounded area of soft tissue directly behind the two maxillary central incisors.

5. Which of the following nerves provides sensory innervation for the teeth and mouth?
A. Trapezius
B. Glossopharyngeal
C. Trigeminal
D. Zygomatic

6. Which of the following major salivary glands is located on the side of the face, behind the ramus, below
and in front of the ear?
A. Buccal
B. Parotid
C. Sublingual
D. Submandibular

See p. 33 for the correct answers and rationales

General Dentistry Chairside Procedures

I. Assisting with the Patient and Equipment

A. Prepare the treatment room by cleaning and disinfecting clinical contact areas; placing infection con-
trol barriers in the area; bringing the patient’s record, radiographs, and lab work to the area; bringing in
a sterile preset tray and other supplies; clearing a pathway for the patient; and positioning the dental
chair.
B. Prepare treatment trays by lining up instruments in the order in which they’ll be used. Place those
instruments to be used first on the left side of the tray and hinged instruments on the right side of the
tray. Also, arrange instruments and material based on their function.
C. Greet the patient in the reception area and invite him or her to the treatment room. Once seated in the
dental chair, position the patient upright, supine, semisupine, or subsupine (Trendelenburg). Position
yourself, the operator, the dental unit, and all instruments and equipment that will be needed during a
procedure so that you and the operator use only class I, II, and III motions.
D. Four-handed dentistry, or team dentistry, is the method of providing dental treatment in which the opera-
tor and assistant work together as a team while both are seated in specific positions near the patient.
1. Maintain the dentist’s fulcrum during instrument transfer. A fulcrum is a hand position in which the
dentist’s fingers are stabilized so the hand can easily pivot and perform work in the oral cavity.
2. Sit across from the dentist and hand instruments across the transfer zone to the dentist as needed.
The transfer zone is the space where instrument transfer occurs during four-handed dentistry, usually
below the patient’s chin and directly over his or her throat and upper chest.

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 GENERAL CHAIRSIDE ASSISTING (GC) 13

3. After the patient has been placed in the proper position, the chair may need to be raised or lowered by
the operator to get a clear vision of the operating field and to allow ergonomic access to the oral cavity.
II. Select and Prepare Trays and Other Dental Equipment

General Chairside
A. Select, prepare, and modify impression trays.
1. Selecting a proper tray from among a supply of stock trays requires that you try several before choos-
ing one that causes the patient as little discomfort as possible.
2. Modify stock trays with utility wax. If a stock tray does not fit a patient’s needs, construct custom
trays, which are specially designed and built to fit a particular patient’s mouth. Several types of materi-
als may be used, which may be self-curing or light-cured acrylic resin, vacuum resin, or a thermoplastic
material.
B. The tray for local anesthetic administration should include aspirating syringe, two carpules of anesthetic,
long and short needles, alcohol sponge, cotton gauze, tongue depressor (optional), needle recapping
device, sharps disposal system, topical anesthetic, and a cotton applicator on a clean cotton gauze.
C. Select and prepare tray setups and equipment.
1. The tray setup for anesthetics varies depending on the type of anesthetic being administered.
a. Topical anesthetics setups require a topical agent, gauze pad, and applicator.
b. Local anesthetics require injection equipment and an anesthetic cartridge.
c. Inhalation anesthesia requires nitrous oxide and oxygen cylinders and related equipment.
d. Intravenous sedation setup requires an antiseptic, small needle, tourniquet, and IV.
2. Permanent restorations require a restorative tray (basic setup, hand-cutting instruments, amalgam
carrier, condensers, burnishers, carvers, composite placement instrument, articulating paper holder),
local anesthetic setup, dental dam setup, high-volume oral evacuator tip, high-speed handpiece, low-
speed handpiece, saliva ejector, burs, cotton pellets and rolls, gauze, dental liners, base, bonding
agents, sealers, permanent restorative material (composite or amalgam), and dental floss.
3. Tray setup for tooth whitening includes basic setup, protective gel or dental dam, tooth whitener
product, resin polishing cup or fluoride prophy paste, and a light or laser source.
4. Crown setups require cotton rolls, bite stick, plastic filling instrument, permanent luting cement,
scaler or explorer, custom fabricated crown, and cementing materials.
5. Bridge setups need cotton rolls, petroleum jelly, alginate impression, self-curing acrylic resin with
spatula and mixing container, finishing diamonds or burs, rubber wheels and cusp for polishing,
polishing paste, and cementing materials.
6. Cotton rolls or gauze, a microbrush, and a desensitizing agent are needed for desensitization.
7. Root canal procedures require a local anesthetic agent setup (optional), dental dam setup, handpiece
(high speed) with burs, handpiece (low speed) with latch attachment, syringe, broaches and Hedstrom/
K-type files of assorted lengths/sizes, rubber instrument stops, lentulo spiral, paper points, gutta-percha
points, spoon excavator, endodontic explorer, endodontic sealer supplies, Glick #1, locking cotton pli-
ers, millimeter ruler, sodium hypochlorite solution, hemostat, and high-volume oral evacuator (HVE) tip.
8. Pupal therapies require local anesthetic agent setup, dental dam setup, low-speed handpiece, round
burs, spoon excavators, sterile cotton pellets, formocresol, zinc oxide eugenol base, final restorative
material, and instruments for placement.
9. The exact composition of the surgical tray setup for extractions, impactions, incisions and drain-
age, prosthetic implants, and suture placement and removal depends on the procedure and opera-
tor, so it’s essential to understand the nature of the surgery and the surgeon’s preferences while
assembling the setup.
10. Partial dentures require a basic tray setup, complete with mouth mirror, explorer, and cotton pliers;
articulating paper and forceps; pressure indicator paste; a low-speed handpiece and acrylic and
finishing burs; three-pronged pliers; and the patient’s partial denture.
11. Full and immediate denture setups require a mouth mirror, explorer, and cotton pliers; HVE and
air-water syringe tips; a hand mirror; articulating forceps and paper; high-speed and low-speed
handpieces and burs and discs; the patient’s dentures from the laboratory; and take-home materials
and hygiene aids.
12. Fluoride treatments require disposable applicator trays, a saliva ejector, air-water syringe, cotton
rolls, and a timer.
13. Initial impressions for partial and full dentures require a basic tray setup and stock trays for alginate
impressions and a wax bite registration.The alginate impressions will be used to make the custom
trays used in the secondary impressions.

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 14 PA R T I I REVIEW

14. Secondary impressions for partial dentures require the basic tray setup, mouth wash, the custom
tray created for the patient or a stock tray, contouring wax and impression materials (spatula and
mixing pad or dispensing gun and tips), a laboratory prescription form, disinfectant, wax or sili-
General Chairside

cone bite registration materials, a container for the impressions and bite registration, and tooth
shade and mold guides.
15. Secondary impression setups for full dentures require a mouth mirror, explorer, and cotton pliers;
HVE and air-water syringe tips; cotton rolls and gauze; mouthwash; the patient’s custom tray; com-
pound wax and a Bunsen burner; laboratory knife; impression materials; laboratory prescription
form; disinfectant; and a container for the impressions and bite registration.
16. Setups for fixed space maintainer appliances require permanent cement, a mouth mirror and
explorer, cotton roll and gauze, HVE and air-water syringe, an appliance from laboratory, and
articulation paper.
17. Occlusal equilibration/adjustment requires a mouth mirror, articulation paper, high-speed and low-
speed handpieces, and burs and discs.
18. Oral examination setups require a mouth mirror, explorer, cotton pliers, periodontal probe, gauze
sponges/squares, dental floss, articulating paper and paper holder, air-water syringe, red and blue
colored pencils, eraser, and a clean, unmarked examination form clipped to the patient chart.
19. Oral prophylaxis tray setup includes a mouth mirror, explorer, cotton gauze and swabs, low-speed
handpiece, rubber cups and brushes, prophy paste, and dental floss.
20. Periodontal procedure setups, such as scaling and polishing, require a mouth mirror, explorer, probe,
scalers and curettes, gauze, dental floss and tape, prophy angle with rubber cups and brushes, and
prophy paste.
21. Surgical periodontal procedure setups, such as gingivectomy, require a mouth mirror, explorer,
cotton pliers, periodontal probe, cotton rolls and gauze sponges, saliva ejector with tips, markers,
periodontal knives, scalpel, blades, burs, scalers and curettes, soft tissue rongeurs, surgical scissors,
hemostat, suture supplies, anesthestic supplies, and periodontal dressing supplies.
22. Surgical dressing placement setups require a mouth mirror, explorer, cotton pliers, gauze sponges,
dressing material, paper pad, tongue depressor, lubricant, and contouring instrument.
23. Surgical dressing removal setups require a mouth mirror, explorer, cotton pliers, spoon excavator,
suture scissors, floss, saliva ejector with various tips, gauze sponges, and tissue.
24. Root planing and curettage setups require the mouth mirror, explorer, probe, scalers, curettes,
gauze, dental floss and tape, prophy angle with rubber cups and brushes, and prophy paste.
25. Dental dams require sheets of pliable, thin latex or latex-free material; frames; napkins; lubricants;
templates and stamps; punch; clamps; forceps; floss; and stabilization cord.
26. Dental sealants require protective eyeware, rubber dam or cotton balls, sealant material, etching
agent gel or liquid, pumice and water, prophy brush, applicator device or syringe, high-volume oral
evacuator, curing light with shield, articulating paper and holder, low-speed dental handpiece with
contra-angle attachment, and round white stone (latch type).
a. Temporary crown setup requires cotton rolls, bite stick, plastic filling instrument, temporary lut-
ing cement, scaler or explorer, and prefabricated crown
b. Temporary restorations require a Tofflemire matrix retainer (for class II), a matrix band system
(for classes II, III, and IV), a wedge (for classes II, III, and IV), intermediate restoration material
setup, condenser, carvers, discoid/cleoid, plastic instrument, carver, Hollenback, cotton pellet,
and articulating paper.
c. The basic setup for dry socket or alveolitis requires a mouth mirror, explorer, cotton pliers, peri-
odontal probe, cotton rolls and gauze sponges, saliva ejector with tips, HVE, scissors, irrigation
solution, warm saline solution, iodoform gauze, and medicated dressing.
d. Rotary instruments
III. Assisting with and Performing Intraoral Procedures
A. Maintain the field of operation.
1. Keep the operating field well lit, free from debris and moisture, and easily accessible. Move obstructing
tissues out of the line of vision with instruments such as tissue retractors.
2. Use an air-water syringe in conjunction with the HVE to remove saliva, blood, and debris from the
oral cavity.
3. Clean the area around the operating field with either limited rinsing or complete oral rinsing.
4. Use cotton rolls, dry angle, or rubber dam to isolate the area.

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 GENERAL CHAIRSIDE ASSISTING (GC) 15

B. Place and remove cotton rolls with gloved fingers or cotton pliers.
C. Assisting with or polishing the teeth.
1. Begin with the surface of the tooth closest to the cheek (the buccal surface) and proceed from the

General Chairside
right side of the mouth to the left, moving across the mandibular arch.
2. After all of the mandibular teeth are polished, work proceeds from left to right, focusing on the side
of the teeth closest to the tongue.
3. Next, the teeth of the maxillary arch are polished in the same order and manner. Utilizing a low-
speed handpiece and a prophy angle, and the finest grit prophylaxis paste possible, the teeth should
be polished using a light, intermittent pressure for 1 to 2 seconds per tooth.
D. Apply topical fluoride, which is available in gels and foams.
1. Remove all plaque and calculus.
2. Seat the patient upright throughout the procedure with a saliva ejector placed between the arches
to prevent ingestion of fluoride.
3. Select a fluoride tray.
4. After loading the fluoride into the tray, dry the teeth and insert the tray into the patient’s mouth.
5. Instruct the patient to bite down to spread the fluoride throughout the teeth.
6. Set the timer and stay with the patient throughout the treatment.
7. After the timer has ended, remove excess saliva and fluoride from the oral cavity.
E. To perform vitality tests, use palpation, percussion, thermal testing, electric testing, radiography, or
transillumination testing.
F. After surgery, control minor bleeding with cotton or gauze pads.
G. Assist with the placement and removal of temporary cement.
H. After a temporary crown is cemented, remove the extra cement from the edge of the tooth with the
dental explorer. Use floss to remove cement from between teeth.
I. Place dental dams after the dentist administers the anesthetic and remove the dental dam after the
procedure.
1. Make sure the site is free from plaque and debris.
2. Mark the dental dam for the appropriate teeth and punch the keyhole and the holes for individual
teeth. Each hole should be separated by a slight septum that will be eased into the interproximal
space.
3. Select a clamp and tie a safety line of dental floss to the clamp bow. Grip the clamp with the forceps,
spread the beaks of the forceps, and use the sliding bar to hold them open. Place the clamp by
sliding it over the anchor tooth. Gently release the forceps and remove the beaks from the anchor
holes.
4. If you haven’t already placed the dental dam, slide the keyhole over the clamp’s bow. Retrieve the
dental floss ligature with cotton pliers or an explorer and slide it through the dental dam. Secure the
dental dam to the opposite tooth.
5. Place the dental napkin around the patient’s oral cavity and slide the frame into position. Hook the
dental dam material on the frame to hold it steady.
6. Work the remaining teeth to be isolated through the punched holes in the dental dam material.
7. Work the dental dam septum in between the tooth contacts, using floss if necessary to ensure that
the dental dam is located below the contacts.
8. Remove the dental dam when indicated. To remove the dental dam, first remove the clamp and any
ligature or stabilization cord used to secure the dental dam. Pull the dental dam away from the teeth.
Clip the interseptal dam bridges.Then remove the dam and frame in one motion. Inspect the dental
dam to make sure no part was left inside the patient’s mouth.
J. Prepare, assist with, and/or apply a matrix band and remove the matrix band after the procedure.
1. Select the band and contour it to make sure it is thinned and slightly concave.
2. Place the band into the retainer handle and insert the retainer into the oral cavity, parallel to the
buccal surface.
3. Slide the open band down over the occlusal surface of the tooth.
4. Adjust the inner knob until the band has tightened around the tooth. Make sure the band is adapted
to the tooth surface and there is no material or tissue between the band and the tooth.
5. Remove the matrix band when indicated.
K. To apply a topical ointment, dry the site with a gauze pad.Then place a small amount of the anesthetic
on the injection site for several minutes.

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 16 PA R T I I REVIEW

L. Assist with and/or monitor the administration of nitrous oxide.

1. Sedation with nitrous oxide begins and ends with giving the patient pure O2.
2. At the start of the process, the clinician establishes the patient’s tidal volume and then slowly titrates
General Chairside

the concentration of N2O until the appropriate level is achieved.

3. At the end of the sedation process, 100% O2 should be given again, for several minutes. Ask the
patient about symptoms such as dizziness, headache, or tiredness. When the patient reports feeling
normal, check vital signs again.
M. Rotary instruments, such as burs and abrasive instruments, can include tips for cutting, grinding,
polishing, and abrading dental surfaces.
1. Burs are available in different shapes (e.g., round, cone, etc.) and in different materials (e.g., diamond,
steel, etc.). Burs are typically identified by their structure and form, as well as their length.
2. Abrasive instruments are most often used to finish restorations, although some can be used for cut-
ting.They lack cutting blades, but instead feature a variety of abrasive materials on a variety of bases
and shapes. Abrasive instruments are classified by their shape (e.g., wheel, disc, etc.) and their mate-
rial (e.g., rubber, stone, etc.).
3. Exchange the rotary instrument in the dental handpiece as needed.
N. Assist with general dentistry and dental emergencies.
1. Anesthesia includes topical and local anesthetics.
a. To apply a topical ointment, dry the site with a gauze pad, place a small amount of the anesthetic
on a cotton-tipped applicator and place it on the injection site, holding it in place for several
minutes before the injection is administered.
b. The dental assistant assembles and passes the syringe to the clinician, receives the syringe after
injection, and recaps using the scoop or one-handed method. The oral cavity is rinsed and the
dental assistant remains with the patient while the local anesthetic takes effect.
2. In cavity preparation and restoration, be familiar with the differences between the various kinds of
restorations, including the instrumentation used in each procedure, the materials required, and the
dentist’s and patient’s needs during the procedure. Your role depends on the specific legal require-
ments and regulations of your state. In states with expanded functions, you may place bases, liners,
and varnishes or create temporary restorations. In states without this function, you will help the
dentist perform these tasks.
3. Assist in crown and bridge restoration preparation, temporization, and cementation.
a. Crowns
1. Before a crown can be placed, the area of the tooth just under the gingival tissue must be ex-
posed with a retraction cord.
2. Prepare the impression material. Load the resin into the prepared impression and transfer the
impression to the dentist, who makes the impression and places the provisional crown.
3. After the provisional crown is removed, assist the dentist in placing the permanent crown by
rinsing and drying the tooth and surrounding it with cotton rolls. Then mix the permanent
cement and transfer it to the dentist, who places the permanent crown.
b. Bridges
1. Place and remove the gingival cord so an accurate impression can be taken, which helps en-
sure the provisional bridge is fabricated to the correct size.
2. To make a provisional bridge, first make an impression of the teeth and arch. Then mix the
resin and place it onto the impression so the dentist can place it in the patient’s oral cavity.
After the resin sets for a few minutes, the dentist removes it from the patient’s mouth. Carefully
remove the provisional coverage from the impression.The dentist then places it back into the
patient’s mouth while it continues to set.
3. The dentist marks and trims off excess material and attaches the provisional bridge with tem-
porary cement.
4. To desensitize teeth, the dental assistant dries the sensitive tooth with a cotton roll or gauze and
hands the desensitizing agent and microbrush to the dentist to apply.
5. The two common endodontic therapies are a root canal and a pulpotomy.
a. For a root canal, aid in preparation by taking a radiograph of the tooth and placing rubber stops
on the endodontic files and reamers for the correct filling of the canal. Isolate the tooth being
treated by assisting with preparation and placement of the dental dam and clean the area to be
treated with disinfectant and a cotton swab.

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 GENERAL CHAIRSIDE ASSISTING (GC) 17

b. For a pulpotomy, prepare and place the dental dam and clean the area to be treated with disinfec-
tant and a cotton swab. After the pulp chamber is exposed by the dentist, transfer a spoon exca-
vator to the dentist for removal of pulp tissue in the coronal chamber.To control hemorrhaging,

General Chairside
transfer to the dentist a sterile cotton pellet moistened with formocresol for placement in the
pulp chamber.
6. Assist with extractions and impactions.
a. For a simple tooth extraction, prepare the patient for surgery and administer a topical anesthetic
and assist in the administration of a local anesthetic. Transfer the elevator and forceps to the
surgeon as he or she performs the extraction. Be ready to remove blood and debris and adjust
the light during the procedure.To assist with tissue retraction, place a pad of gauze in the empty
socket to stop bleeding.
b. In the case of impacted teeth, or complex extractions, first assist the surgeon with anesthesia.
During the operation, transfer instruments to the surgeon and use a special surgical suction tip
to prevent surgical complications. During suturing, place the sutures in the needle holder and
retract the cheeks.
7. Assist with partial and full dentures.
a. In fabricating a partial denture, help with the final impression, wax-denture try-in, and placement
of the denture.
b. In fabricating a full denture, help with the final impression and placement of a full denture.
8. Assist the dentist with occlusal equilibration/adjustment.
9. When assisting with an occlusal registration, have the patient open and close his or her mouth
several times and observe the patient’s normal pattern. Have the patient rinse to remove debris.
Then place the cold wax over the occlusal and incisal surfaces of the teeth. If the wax is long
enough, trim away extra length. Soften the wax and place it against the surfaces of the teeth. Have
the patient bite gently. After the wax hardens, remove it from the patient’s mouth.
10. Carefully observe the oral examination conducted by the dentist. As the dentist comments on the
patient’s dental conditions and health, note or chart the findings on specially designed forms for
the patient’s record.
11. The prophylaxis angle, or prophy angle, is an angled instrument that holds the rubber cup or brush
bristles used for oral prophylaxis. When using the prophy angle and handpiece, the operator alter-
nates between lighter and heavier pressure and applies strokes in a circular motion. Steady pressure
can cause excess heat, which can damage the tooth and cause pain for the patient. The foot pedal
should be released as soon as the prophy angle and handpiece is no longer touching the tooth;
otherwise, it can cause the polishing material to splatter.
12. Periodontal procedures can be either nonsurgical, such as scaling and polishing, or surgical, such
as a gingivectomy.
a. Assist with periodontal procedures by providing retraction of the patient’s lips, tongue, and
cheek and transferring instruments as needed.
b. A dry field is maintained with the high-velocity evacuator to remove excess oral fluids.
c. If periodontal dressing is needed, it is prepared and passed to the dentist.
d. Periodontal dressing removal is accomplished at the postoperative visit.
13. Apply dental sealants.
a. First clean and rinse the teeth.
b. Then isolate the teeth and make sure they are dry. Isolation is usually achieved with a dental dam
or cotton rolls.
c. Apply the etchant to the tooth enamel and remove with suction and rinse the remainder away.
d. Dry the enamel and apply a sealant with a syringe or brush. If necessary, cure the sealant.
e. Check coverage with a mouth mirror.
14. Assist with perioperative treatment and complications.
15. Assist with dental implants and bone grafts.
a. Dental implants may take place in one-stage or two-stage surgeries. Assist with anesthesia,
placement of template over the implants, and transfer the cleaned implant and instruments
to the doctor. Irrigation and evacuation of the surgical field is maintained throughout the
procedure.
b. During a bone graft, help to maintain ease of visibility, rinse the patient’s mouth, transfer instru-
ments as needed for shaping and contouring, and prepare sutures.

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 18 PA R T I I REVIEW

16. Assist with suture placement and removal.

a. To assist in placing sutures, first remove sterile suture material, and using a needle holder, hold
the needle in the upper third, away from the sharp point. Transfer the needle holder to the sur-
General Chairside

geon and provide tissue retraction during placement of the sutures.After the sutures are tied, cut
the sutures with suture scissors.
b. To assist in removing sutures, transfer the cotton pliers to the oral surgeon to lift away the suture
and expose the knot. Transfer suture scissors to surgeon to cut sutures. Retract tissues as neces-
sary. Keep track of the number of sutures removed and compare it to the dental record to make
sure they are all removed.
17. Assist in taking impressions.
a. When assisting with an impression, first prepare the basic tray setup.
b. As the dentist prepares and places the impression material in the tray, prepare materials for tak-
ing the bite registration: softening the wax in warm water and preparing it for placement in the
patient’s mouth.
c. Mix the other materials on a paper pad and put them on a quadrant tray for placement in the
patient’s mouth.
d. After these materials have set, remove them.
e. Disinfect the impressions.
IV. Working with Patients
A. Communicate in a way that conveys professionalism, care, and concern. Focus on office procedures,
policies, and patient care.Try to understand patients’ thoughts and feelings in order to help patients feel
calm and relaxed.
B. Strive to maximize the well-being and health of every patient. This goal can involve extra effort when
patients have special needs, such as physical or intellectual disabilities. Patients who have special needs
may require extra assistance.
C. The best way to prepare for, or prevent, a medical emergency is to be alert and gather as much infor-
mation as possible, including a thorough medical history. Monitor patients who are taking drugs (both
pharmaceutical and illicit drugs) more closely.

Rev iew Q u est i o n s

7. In rubber dam placement, the purpose of inverting the dam is to

A. stabilize the restoration.
B. remove excess material.
C. prevent the clamp from slipping.
D. prevent saliva leakage.

8. Which of the following instruments is likely to be included in a basic tray setup?

A. Chisel
B. Mouth mirror
C. Angle former
D. Amalgam carrier

9. A carious lesion in a pit or a fissure would be classified as:

A. Class I caries: a lesion located in a pit or fissure of a tooth.
B. Class II caries: a lesion located in the interproximal surfaces of a posterior tooth (premolar or molar).
C. Class III caries: a lesion located in the interproximal area of anterior teeth such as canines or
incisors.
D. Class V caries: a lesion located on the cervical area of the tooth.

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 GENERAL CHAIRSIDE ASSISTING (GC) 19

10. Which of the following is an example of biological pulpal stimuli?

A. Changes from hot and cold coming into contact with the tooth
B. Changes in occlusion, resulting in trauma

General Chairside
C. Acidic materials coming into contact with pulpal tissues
D. Bacteria from saliva coming into contact with pulpal tissues

11. What does an etchant remove in preparation for dental bonding?

A. Resin veneer
B. Dentinal tubules
C. Smear layer
D. Pulp

12. Which of the following procedures uses enamel bonding?

A. Sealant
B. Dental varnish
C. Calcium hydroxide
D. Dental base

13. Which instrument is used first during an amalgam restoration?

A. Excavator
B. Cleoid-discoid
C. Burnisher
D. Condenser

14. Which one of the following tests provides a definitive diagnosis of oral cancer?
A. Bleeding upon probing
B. Checking mucosal and gingival pallor
C. Running laboratory blood tests
D. Performing a biopsy

15. Which of the following may help prevent a patient from gagging during an alginate impression?
A. Storing the alginate in a humid environment
B. Using warm water to mix the alginate
C. Mixing the alginate slowly
D. Adding an accelerant to the alginate

16. The curing time of composite restorations depends on the

A. shade of the restorative material.
B. age of the restorative material.
C. etching time.
D. rinsing time.

17. Which of the following must be done first when preparing a tooth for provisional coverage?
A. Placement of gingival retraction cord
B. Preliminary impression
C. Placement of the post and core
D. Removal of tooth structure

18. When assisting during final impressions in a crown and bridge preparation, which elastomeric
impression material is applied first to the teeth?
A. Light-bodied
B. Regular-bodied
C. Heavy-bodied
D. Extra heavy-bodied

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 20 PA R T I I REVIEW

19. What is the operating zone for an assistant who is assisting a right-handed operator?
A. 12 o’clock to 2 o’clock
B. 2 o’clock to 4 o’clock
General Chairside

C. 4 o’clock to 7 o’clock
D. 7 o’clock to 12 o’clock

20. Which part of an anesthetic syringe locks into the rubber stopper so that the stopper can be retracted
by pulling back on the piston rod?
A. Barrel
B. Thumb ring
C. Piston rod
D. Harpoon

21. During a class II amalgam procedure, when is the wedge removed?

A. Before the matrix band and holder are removed
B. After the matrix band and holder are removed
C. Before placement of the amalgam
D. After placement of the amalgam

22. When preparing a Tofflemire matrix band and retainer, the inner nut on the retainer is used to
A. tighten the spindle within the diagonal slot vise.
B. loosen the spindle within the diagonal slot vise.
C. adjust the size of the matrix band loop.
D. hold the wedge in place.

23. Using the clock concept, the zone located between 4 o’clock and 7 o’clock when working with a right-
handed operator is the
A. assistant’s zone.
B. operator’s zone.
C. static zone.
D. transfer zone.

24. When an instrument is held in the palm of the hand with all four fingers surrounding the instrument
and the thumb supporting the instrument, which grasp is being used?
A. Pen
B. Modified pen
C. Palm
D. Palm-thumb

25. When passing an instrument that will be used on tooth number 17, the working end should be in what position?
A. Upward toward the maxillary teeth
B. Downward toward the mandibular teeth
C. Facing to the right
D. Facing to the left

26. Which of the following medications could increase the patient’s blood pressure and heart rate?
A. Aspirin
B. Warfarin
C. Over-the-counter cold medication
D. Nitroglycerin

27. In the United States, nitrous oxide tanks are color-coded

A. green.
B. white.
C. blue.
D. orange.

Dental_CertPrep_Part_IIA_GC.indd 20 2/12/11 1:29 PM

 GENERAL CHAIRSIDE ASSISTING (GC) 21

28. The drug of choice for dental and outpatient inflammatory pain is
A. aspirin.
B. morphine.

General Chairside
C. acetaminophen.
D. ibuprofen.

29. Which drug would be contraindicated in patients with peptic ulcers?

A. Aspirin
B. Acetaminophen
C. Morphine
D. Codeine

30. Nitrous oxide/oxygen inhalation is indicated for which of the following conditions?
A. Adenoid obstruction
B. Dental anxiety
C. Nasal deformity
D. Bronchitis

31. Codeine is classified at what level of abuse and addiction potential?

A. Schedule I
B. Schedule II
C. Schedule III
D. Schedule IV

32. Why would an oral surgeon administer diazepam (Valium) to a patient before extraction of a molar?
A. To reduce postoperative nausea
B. To relieve anxiety
C. To increase metabolism
D. To control muscle movement

33. What is the most commonly used formulation of topical anesthetic?

A. 20% lidocaine
B. 5% lidocaine
C. 5% benzocaine
D. 20% benzocaine

See p. 33 for the correct answers and rationales

Preparing and Working with Chairside Materials

I. Impressions
A. Prepare various materials for impressions.
1. To mix irreversible hydrocolloid (alginate), measure and place water and alginate powder into the
bowl. Mix with the spatula until smooth. After mixing, fill the impression tray. Alginate impressions
should be poured with model material within 1 hour of being taken to prevent distortion.
2. Reversible hydrocolloid is an impression material that changes physical states upon heating and cooling.
a. A stock water-cooled tray is selected to fit the patient’s mouth without impinging on soft tissues or
teeth.
b. To prevent sticking, plastic stops are placed in the tray.
c. Tubing is connected to the tray and the water outlet to drain.
d. Warm water is pumped through the tubing and tray to liquefy and then moved to a second storage
bath.
e. Light-bodied material is placed in a syringe, heavy-bodied material is placed in the tray, and the tray
is moved to the third tempering bath.

Dental_CertPrep_Part_IIA_GC.indd 21 2/12/11 1:29 PM

 22 PA R T I I REVIEW

f. Light-bodied material is placed around the prepared tooth and the dentist seats the tray.
g. The water running through the tray and tubing is cooled to solidify the impression.
3. Elastomeric materials include polysulfide and silicone. To mix these impressions, dispense equal
General Chairside

lengths of the base and catalyst onto the mixing pad and mix with spatula until the color is uniform.
Load material into impression tray and deliver to the dentist.
4. To prepare bitewing wax, place the cold wax over the occlusal and incisal surfaces of the teeth. If
the wax is long enough, trim away extra length. Soften the wax and place it against the surfaces of
the teeth. Have the patient bite gently. After the wax hardens, remove it from the patient’s mouth.
II. Restorative Materials
A. Prepare various materials for restorations.
1. Amalgam
a. To prepare amalgam, place the mercury and alloy capsule in an activator, if needed, to break the
membrane separating the two materials.
b. Then place the capsule in an amalgamator or triturator to mix the mercury and alloy.
c. After it emerges from the amalgamator, the amalgam is ready to be loaded into the amalgam
carrier, according to the dentist’s preference.
d. Store mercury and amalgam scraps according to local ordinances, or submerged in a covered,
unbreakable container filled with used X-ray fixer.
2. Form dental cement by mixing a powder and liquid, which causes a chemical reaction. Mix cements
on either a glass mixing slab or mixing paper with a spatula, following the manufacturer’s instruc-
tions.The assistant should then load the mixed cement into the prepared crown or bridge.
3. The majority of composites today come in individual cartridges used with a syringe. The assistant
assists with shade selection, loads the appropriate shade cartridge into the syringe, and passes it to
the dentist. The assistant then passes shaping and contouring instruments, clear matrices, and the
curing light if needed.
4. Bonding agents can be self-curing, light-cured, or dual-curing. Some are premixed in applicators,
whereas others require mixing together two liquids. Each system typically includes three basic pro-
cesses: etching, priming, and bonding. Follow the manufacturer’s instructions.Assist with mixing and
passing the components of the bonding system, keeping area clean and dry.
5. Glass ionomers are similar to some composites in their preparation and applications. They can be
supplied as a powder and liquid that must be mixed before application or they are supplied in
premixed application tubes or capsules. Follow the manufacturer’s instructions for mixing and
storage.
6. Intermediate restorative material (IRM) is available as premixed capsules that are triturated like
amalgam or as liquid and powders that must be mixed before application. These materials do not
last more than a year, but this is plenty of time for a provisional restoration.
7. Prepare varnishes, bases, and liners.
a. To prepare varnishes for use, open the bottle of varnish, dip the cotton pellet into the varnish, and
transfer it to the dentist. Recap immediately to prevent thickening of varnish.
b. For bases, mix the cement materials until the consistency of putty and roll into two balls. Use a
plastic filling instrument to pick up each ball and transfer it to the dentist.
c. For liners, dispense equal amounts of each paste onto opposite ends of a paper pad. Use a spatula
to mix the pastes together. Transfer the liner to the dentist. Gather mixed pastes together onto
end of spatula and pass to the dentist.
B. To prepare a provisional crown, prepare the liquid monomer and mix according to the manufacturer’s
directions. Load the resin into the prepared impression and transfer to the dentist.
III. Sedative and Palliative Materials
A. Periodontal surgical dressings can be formulated with or without zinc oxide eugenol. To mix, place
equal lengths of the two pastes on a wax paper pad and mix with a wooden tongue depressor until
uniform in color. When the paste loses its stickiness place it in a paper cup filled with room tempera-
ture water. Lubricate glove hands with water and form into strips and hand to the dentist.
B. Postextraction dressings can be periodontal dressings applied to the extraction sites to protect
the sutures and can be either zinc oxide eugenol or eugenol free. They are mixed like periodontal
dressings.
C. Sedative dressings are specifically formulated with zinc oxide eugenol, which has a sedative or pallia-
tive effect on the tissue.They are mixed the same way as other periodontal dressings.

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 GENERAL CHAIRSIDE ASSISTING (GC) 23

IV. Prepare Other Dental Materials

A. Tooth whitener should be prepared and applied according to the manufacturer’s instructions. Some
products can be applied with a special tray that is custom fitted to the patient’s teeth. Others are

General Chairside
brushed onto the tooth surface. Some materials are light-cured with a special light wand, whereas
others must be continuously washed away and reapplied every 10 minutes during the procedure.
B. Dental assistants use different endodontic materials to assist in root canal therapy. The filling material,
called gutta-percha, is a rubber-like substance. Heat the filling material with a solvent before placing
into the canal space. Gutta-percha is used in combination with an endodontic sealer. Sealers are avail-
able in either paste or powder and liquid form, which should be mixed according to manufacturer’s
instructions and transferred to the dentist.
C. Apply etchants according to the manufacturer’s instructions using the applicator or syringe.
D. Apply sealants according to the manufacturer’s directions. Cure the sealant if necessary, according to
the manufacturer’s instructions.

Rev iew Q u esti o n s

34. Which of the following cements have anticariogenic properties?

A. Zinc polycarboxylate
B. Zinc oxide eugenol
C. Glass ionomer
D. Zinc phosphate

35. Some materials give off heat when mixed.This is called a/an
A. chemical reaction.
B. exothermic reaction.
C. thermal conductivity.
D. thermal expansion.

36. A fluid’s resistance to flow is called its

A. flowability.
B. viscosity.
C. solubility.
D. density.

37. A restoration that is created in the mouth is

A. direct.
B. indirect.
C. preventive.
D. chemical.

38. Dental bonding works by which of the following mechanisms?

A. Creation of a smear layer to aid retention.
B. Dissolution of the smear layer to aid retention.
C. Creation of macromechanical retention.
D. Creation of micromechanical retention.

39. Microleakage occurs when

A. restorations are over-cured.
B. the tooth is over-etched.
C. contaminates are not removed.
D. bonding material is excessive.

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 24 PA R T I I REVIEW

40. The organic matrix of composite resins is made up of

A. BIS-GMA.
B. glass.
General Chairside

C. silica.
D. quartz.

See p. 33 for the correct answers and rationales

Dental Materials and Laboratory Procedures

I. Correctly Select Lab Materials and Mix and Handle Correctly

A. Gypsum products are designated types I to V.
1. Type I is an impression plaster and rarely used.
2. Type II is a model plaster for preliminary impressions.
3. Type III is a laboratory stone.
4. Type IV is a die stone for bridges, crowns, and indirect restorations.
5. Type V is a high-strength die stone.
6. Orthodontic stone is used for orthodontic treatment.
7. Measurements of water and powder must be exact. If too much water is used, the mix will be thin
and runny. If too little water is used, the powder and water will not mix sufficiently or properly.
8. Temperature of the water influences the setting time of the gypsum product: cool water—slows
setting, warm water—speeds setting.
B. Select and manipulate dental waxes.
1. Use utility wax to extend the borders of an impression tray or cover metal orthodontic appliances.
2. Use sticky wax to join objects together until they can be repaired or to form wax patterns.
3. Use boxing wax to frame a preliminary impression.
4. Use casting wax to create molds for indirect porcelain or metal restorations and also to fix bridges
and metal portions of a partial denture.
5. Use baseplate wax to create dentures.
6. Use bite registration wax to make an imprint of the teeth.
C. Store acrylic products and substitutes according to manufacturer’s instructions.
D. Correctly store all lab materials.
II. Performing Laboratory Procedures
A. Fabricate, evaluate, trim, and finish diagnostic casts, including face bow mounting.
B. Remove deposits and polish removable and fixed appliances and protheses.
C. Remove deposits and polish complete and partial dentures.
D. Fabricate mouth and athletic guards, custom impression and bleaching trays, and provisional prosthetics.

Rev iew Q u est i o n s

41. When stone is mixed with silica, it is referred to as

A. a die stone.
B. model plaster.
C. porcelain.
D. investment material.

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 GENERAL CHAIRSIDE ASSISTING (GC) 25

42. How will the clinician know that it is safe to remove the poured model from the impression tray?
A. The plaster/stone feels hard to the touch.
B. The plaster/stone is no longer glossy.

General Chairside
C. The plaster/stone is cool to the touch.
D. The plaster/stone is warm to the touch.

43. Which of the following materials is most often used for veneers?
A. Gold alloys
B. Composites
C. Porcelain
D. Amalgams

See p. 33 for the correct answers and rationales

Educating and Assisting Patients with Oral Health

I. Patient Oral Health Education

A. Plan and deliver dental health education information for the patient and community groups.
1. Inform the patient of the importance of primary and permanent teeth in the relationship to
supporting the jaw.
2. Inform the patient of the causes of dental disease.
3. Instruct the patient on the process of eruption and loss of teeth.
4. Inform the patient of occlusal relationships, classifications, and their importance.
5. Tell patients about saliva’s role in oral health.
6. Help patients choose the best restorative materials and procedures for their needs.
7. Educate patients on how systemic health affects healing.
8. Inform patient groups on how to adapt to their special needs
9. Inform patients of the importance of their self-care and how to accomplish optimum oral health.
B. Good communication is necessary for exchanging important information as well as building positive
relationships with patients. Focus conversations on office procedures, policies, and patient care.
C. Educate the patient on the advantages, disadvantages, delivery methods, and safe use of the different
types of fluoride.
II. Instructions Before and After Treatment
A. Deliver written and oral instructions to the patient before and after treatment including medication
instructions.
B. Provide written instructions to take home for patients to maintain and care for their dentures, including
how to store and clean them. Also, advise patients not to attempt to adjust their dentures but, instead,
to see their dentist with any problems.
III. Assisting Patients with Plaque Control
A. Document the dentist’s findings during clinical examinations. Record the findings and plans for treat-
ment and follow-up care on specially designed forms that go in the patient’s record.
B. Educate patients on effective self-care oral health regimen. Especially as the number of dental products
on the consumer market proliferates, make sure that patients are armed with solid information.
C. Toothbrushes are available in many styles and shapes, but most dentists recommend soft bristles.
Instruct patients on proper brushing technique.
1. Tell patients to brush their teeth for 2 to 3 minutes, following the same pattern every time, twice a day.
2. There are several techniques to guide patients in the right motions to both clean teeth and stimu-
late the gingiva, including Bass and modified Bass brushing technique, modified Stillman brushing
technique, and the Charters brushing technique.
D. Explain to patients the function of disclosing agents and how they operate.Then either apply the liquid
disclosing agent or have the patient chew the tablet. Supply the patient with a hand-held mirror so he
or she can inspect the results.

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 26 PA R T I I REVIEW

E. Help patients understand the wide selection of oral hygiene products available and what will work best
for them.
1. Remind patients of the benefits of using floss and dental tape, both in caries prevention and gingival
General Chairside

health.
2. Tell patients that oral irrigation is particularly helpful for them if they cannot or will not floss or if
they have oral appliances that make adequate flossing difficult.
3. Instruct patients on interdental aids, such as interproximal brushes and dental stimulators, used to
complement adequate brushing and flossing.
4. Explain to patients that mouth rinses are used to flush debris from the oral cavity, freshen the breath,
and deliver fluoride.
F. Assess the patient’s oral health regarding their ability to perform homecare procedures.
IV. Nutritional Education
A. Help patients understand how nutrition and lifestyle habits contribute to healthy teeth and gingiva.
Proper nutrition is one of the most important ways to prevent dental caries. When educating patients
about diet, consider several factors before giving recommendations: the patient’s age, geographic back-
ground, medical conditions, and social and financial situation.
B. Sugar increases the risk of tooth decay. Rather than trying to eliminate sugar completely, encourage
patients to decrease consumption of sugary foods and drinks. Patients can defend against the effects
of sugar by brushing their teeth right after eating sweet treats. Although complex carbohydrates are
converted to sugar in the body, they do not promote bacteria growth as quickly as simple carbohy-
drates. Encourage patients to stick to complex carbohydrates as much as possible, which are healthier
in general.

R ev iew Q u esti o n s

44. Which of the following will occur as a result of ingesting too much fluoride?
A. Anodontia
B. Caries
C. Mottled enamel
D. Decalcification

45. Before topical fluoride is applied to a patient’s teeth, the dental assistant should
A. recline the patient to a supine position.
B. have the patient rinse with mouthwash.
C. dry the teeth thoroughly.
D. use disclosing solution to look for plaque.

46. Toothbrushing alone has the ability to clean which of the following tooth surfaces?
A. Buccal
B. Occlusal pits and fissures
C. Lingual pits
D. Interproximal surfaces

47. Although sealants are most commonly placed on permanent molars, they may also be placed on decidu-
ous teeth that
A. have deep pits and fissures.
B. have high caries activity.
C. are ready to exfoliate.
D. have shallow pits and fissures.

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 GENERAL CHAIRSIDE ASSISTING (GC) 27

48. The main role of the dental assistant in preventive dentistry is

A. dispensing fluoride rinses.
B. taking radiographs.

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C. recording data.
D. educating patients.

49. Which of the following microorganisms must be present in order for caries formation to begin?
A. Staphylococci
B. Streptococcus mutans
C. Herpes zoster
D. Candida albicans

See p. 33 for the correct answers and rationales

Medical and Dental Emergencies

I. Medical Emergencies
A. The best way to prepare for, and hopefully prevent, a medical emergency is to be alert and gather as
much information as possible about the patient.
1. Patients who have AIDS should be questioned regarding their CD–4 helper T-cell count. If the count
is below 200, their immune system is too weakened to withstand the stresses of dental treatment.
2. Alcoholics frequently have advanced liver disease, compromising their blood clotting ability. The
dental team should be prepared to deal with excessive bleeding problems.
3. When obtaining a history from a patient, list drug allergies and repeat the information on each page
of the record.
4. Patients who have angina should be questioned about the frequency of their angina attacks, if they
are well controlled, and when the last one occurred. If patients are experiencing frequent uncon-
trolled attacks, they should be referred to their physician. All patients with angina should have their
nitroglycerin tablets with them and readily available during dental treatment.
5. Arthritis symptoms may worsen throughout the day, so patients who have arthritis may prefer
morning appointments. Be aware of the need for assistance getting in and out of the dental chair,
comfort level in the chair, and ability to open the mouth and assume other positions as requested.
6. When treating patients who have asthma, obtain information about triggers, frequency, and last
asthma attack. If the asthma is poorly controlled, or stress induced, physician consultation is recom-
mended. Asthma patients should always bring their inhalers with them to dental treatment and have
them readily available for use.
7. Depending on the type of blood dyscrasia, treatment modifications may be needed to prevent emer-
gencies. Patients with low white blood cell counts are at risk for infection and poor healing, so elective
treatment should be postponed until their white blood cell count improves. Patients with bleeding dis-
orders need to have their clotting times evaluated and a physician’s consult before any treatment that
could cause bleeding. Patients who are anemic are at risk for hypoxia, and supplemental oxygen may be
required
8. The patient who is undergoing cancer treatment should always have a physician consult before dental
treatment to avoid introducing infections due to their immunocompromised status. Cancer survivors
may have residual oral problems such as osteoradionecrosis or salivary dysfunction.The mandible is a
common site for cancer metastasis, so any oral problem should be have careful follow-up.
9. Patients with heart disorders may need special care, including avoiding stress, keeping them in a
semi-upright position, monitoring vital signs before and during treatment, and administering supple-
mental oxygen during treatment.
10. Patients who have diabetes may have gingival irritation, alveolar bone loss, acetone breath, and
delayed healing. Also, be sure to tell patients who have diabetes to eat normally before a dental ap-
pointment to prevent low blood sugar. Always have some sort of sugar source should a diabetic go
into insulin shock (whereby they have insufficient glucose in their system).

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 28 PA R T I I REVIEW

11. Patients with chronic obstructive pulmonary disease may need to have the dental chair positioned
more upright and have frequent drinks of water during treatment. Some patients’ breathing may worsen
throughout the day, so try to schedule morning appointments. Oxygen via cannula should be available,
General Chairside

but dose delivered should never be over 2–3 L/min to avoid shutting down the hypoxic drive.
12. For a patient with epilepsy, ask if the patient is taking his or her medications, is eating regularly, well
rested, or under stress. Also, ask if he or she has an aura that indicates a seizure, so the dental team
can take appropriate measures.
13. Liver disease compromises clotting, so the patient should be carefully monitored for excess bleeding.
14. If a patient’s blood pressure reading is too high, reschedule the patient—or even have them trans-
ported immediately to the hospital.To prevent orthostatic hypotension, raise the patient in the den-
tal chair slowly and encourage them to remain reclined against the chair for a few minutes.
15. Patients with kidney or liver function problems may have problems with swelling, bleeding, or
proper drug metabolism and excretion. Care should be exercised in prescribing medications and
anesthesia administration to avoid toxicity.
16. Patients who have a compromised heart may need to take antibiotics prior to dental procedures
to prevent bacteria from entering their bloodstream. Ensure that patients take medication before
the appointment.
17. Patients with respiratory problems may need to be placed in a more upright position.A preprocedural
rinse is especially important to avoid aspiration of harmful oral microorganisms into the lungs.
18. If there is damage to the heart valves due to rheumatic fever or congenital heart disease, the patient
may need to receive prophylactic antibiotic premedication before dental treatment. A physician’s
consult is advised.
19. Patients with ulcers may experience internal bleeding and become severely anemic. Supplemental
oxygen may be indicated.
20. For patients with venereal disease, if oral lesions exist, care must be taken not to spread them to
other sites.
B. Understand how various classes and types of medications, patients may be taking, can affect bodily func-
tions and how these effects might influence dental care, carefully documenting both prescription drugs
and those purchased over the counter (OTC).
C. Be aware of the potential side effects, synergistic effects, and adverse effects of medications patients
are taking that may interfere with the administration and effectiveness of drugs used during dental care.
Careful monitoring is important. If a narcotic agent is given for sedation or pain relief, a narcotic antago-
nist (reverses the drug effect) should be available to prevent oversedation.
D. During a medical emergency, stay alert; quickly and correctly assess the situation.
1. The symptoms of an airway obstruction are usually immediate and obvious. Conscious patients who
are choking frequently make the universal distress signal. Unconscious patients may quickly experi-
ence cardiac arrest.
2. Cardiovascular and cerebrovascular problems
a. Symptoms of heart attacks vary among different people. Typically, the person experiences crush-
ing or shooting chest pain or pressure, numbness in the left arm, dizziness, fainting (syncope), and
heavy sweating.The person may also experience abdominal pain, back pain, and other non–chest-
oriented symptoms.
b. During a bout of angina, the patient experiences chest pains and may become dizzy or have
trouble breathing.They may become pale and fearful. It is important to administer nitroglycerin
sublingually immediately. If the patient does not respond after three doses, 5 minutes apart,
they are experiencing a heart attack; emergency medical services (EMS) should be activated
immediately.
c. Symptoms of a stroke are an unsteady gait, confusion, a sudden and intense headache, along with
vomiting, fainting and nausea, partial paralysis, vision disturbances, and a sudden loss of the ability
to speak clearly. With a stroke, paralysis is on one side only, so that is an important diagnostic tool.
3. Problems related to diabetes or epilepsy
a. If a diabetic patient is experiencing hyperglycemia, he or she may need to urinate excessively,
become groggy and confused, and experience nausea. If a patient is experiencing hypoglycemia, he
or she might become dizzy, have a pounding heartbeat, double vision, and fatigue, or may become
unconscious.
b. Patients with seizure disorders may experience an aura prior to a seizure.

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 GENERAL CHAIRSIDE ASSISTING (GC) 29

4. Contact dermatitis is extremely rare, as are allergic reactions to local anesthetics. Patients may experi-
ence transient increase in heart rate due to the vasoconstrictor. Local anesthetic toxicity can occur if
too much local anesthetic is administered, but it occurs as seizures, then loss of consciousness.

General Chairside
5. Respiratory problems
a. When a patient hyperventilates, he or she may feel faint, numb, or groggy.
b. Symptoms of an asthma attack range from mild wheezing to severe attacks.
6. Shock is a drastic drop in blood pressure that causes insufficient blood supply to the vital organs.
The patient’s blood pressure drops rapidly, the pulse becomes rapid, and collapse occurs quickly.
E. Respond appropriately to chairside emergencies.
1. Assist the dentist in the treatment of allergy attacks with antihistamines and epinephrine.
2. During a patient hemorrhage, apply local pressure and cold to diminish bleeding, place the patient
in a supine position, and if bleeding does not abate, contact EMS.
3. Cardiovascular and cerebrovascular problems
a. During a heart attack, if the patient is alert and awake, assist the dentist in the administration of
oxygen along with nitroglycerin pills and baby aspirin. An unconscious patient may have gone
into ventricular fibrillation and cardiac arrest, and requires cardiopulmonary resuscitation (CPR)
and defibrillation with an automated external defibrillator (AED).
b. Allow the patient to self-administer prescribed nitroglycerin.
c. For strokes, place the patient in a reclining position on the affected side, contact EMS, and administer
oxygen.
4. Emergencies related to metabolic and neurologic disease
a. Insulin should never be administered by anyone except by physician order, so the dental assistant
should activate EMS for emergency transport after being instructed by the dentist. The dental as-
sistant can offer orange juice or a sugared drink upon instructions from the dentist.
b. For seizures, remove everything from the patient’s mouth, including tools and devices. Do not
restrain the patient, but allow him or her to pass through the seizure episode. Protect the patient
by moving furniture, equipment, etc., away from him or her.
5. Respiratory problems
a. Assist patients who are having an asthma attack in using their inhaled bronchodilators.
b. Treat choking by sitting the patient up and having them attempt to cough or spit the object out. If
this is not successful, attempt the Heimlich maneuver. In unconscious patients, perform a finger-
sweep in the patient’s mouth and provide CPR as needed.
6. A patient in shock should be placed in a supine position. EMS should be activated immediately. Until
the arrival of EMS, monitor vital signs and administer oxygen.
7. With transient unconsciousness, reposition the patient to a supine position and administer oxygen.
F. Every dental office should have an emergency kit stocked with basic medical supplies, as well as drugs
that might be necessary in a medical emergency.
G. Emergency numbers should be posted next to every phone in the office, in an easy-to-locate spot.
II. Dental Emergencies
A. The most common dental emergency is syncope. Hypoglycemic episodes, angina, and asthma may be
brought on by dental anxiety.
B. During a phone call with a distressed patient, only give advice under the direction of the dentist, or get
the dentist on the phone.

Rev iew Q u esti o n s

50. Which of the following is a way to treat a patient having a hypoglycemic attack?
A. Allow the patient to use a bronchodilator.
B. Give the patient carbohydrates.
C. Perform CPR on the patient.
D. Remove everything from the patient’s mouth.

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 30 PA R T I I REVIEW

51. If a patient has a grand mal seizure while in the office, the staff should
A. stand back and let the seizure run its course.
B. place the patient in an upright and seated position.
General Chairside

C. clear away any hazards and call EMS.

D. try to open the patient’s airway.

52. Nitroglycerin is placed under the tongue of a patient who is experiencing

A. heart failure.
B. angina.
C. a cerebrovascular accident.
D. a severe allergic reaction.

53. In case of a medical emergency in the dental office

A. all employees should be trained to render assistance.
B. one person should be assigned to help the victim.
C. the patient should rescheduled and sent home.
D. a staff member should transport the patient to a hospital.

54. Treatment for a choking patient would begin when

A. the patient becomes unconscious.
B. the patient begins coughing vigorously.
C. the patient’s breathing and speech are impaired.
D. the patient asks for assistance.

55. A patient who passes out immediately after dental treatment is most likely suffering from
A. an allergic reaction.
B. anesthetic overdose.
C. syncope.
D. hypoglycemia.

56. Symptoms of a patient suffering from a partially obstructed airway include

A. loss of consciousness.
B. excessive salivation.
C. wheezing.
D. respiratory distress.

57. A blood pressure reading of 140/90 indicates the patient has

A. normal blood pressure.
B. prehypertension.
C. stage 1 hypertension.
D. angina.

See p. 33 for the correct answers and rationales

Assisting in Dental Office Management

I. Maintain Adequate Supplies and Inventory Control

A. Be sure that the cabinets are well stocked with the appropriate supplies needed in each treatment area.
An efficient inventory control system includes a way to recognize when dental supplies are running low,
a way to order them, and subsequently store them when they arrive. Inventory consists of expendable
items that are consumed quickly and frequently reordered and nonexpendable items like machinery and
equipment that is rarely replaced.
B. Maintain accurate records of drugs prescribed or dispensed to patients. Order prescription pads and ensure
that they are kept in a secure place; place controlled substances in locked cabinets to keep them secure.

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 GENERAL CHAIRSIDE ASSISTING (GC) 31

II. Properly Maintain Equipment and Instruments

A. Maintain the supply of instruments by making sure the office is fully equipped with the proper instru-
ments in top working condition. Clean and sterilize dental instruments.

General Chairside
B. Maintain sterility of disposable items and effectiveness of nitrous oxide and oxygen by proper care and
storage.
C. Maintain the cutting edge of the hand instruments by use of mechanical and manual methods.
III. Patient Management
A. Establish good communication for exchanging important information as well as building positive rela-
tionships with patients, coworkers, and supervisors.
B. After entering the reception area and identifying the patient by name, smile, greet the patient courte-
ously while making eye contact, introduce yourself, and politely ask him or her to follow you back to
the treatment area.When dismissing a patient, follow a series of steps that includes removing equipment
from around the patient, updating the patient’s record, and escorting the patient to the reception area.
C. Dental appointments are scheduled in units of time in the appointment book—each procedure should
be allotted enough units of time to enable its completion.
D. On a patient’s first visit to a dental practice, the patient is also entering into a financial arrangement
with the business.With the patient’s financial information in hand, treatment can be given or suggested.
Dentists charge fees for their treatment commensurate with the type of treatment provided. If advised
by the dentist, the dental assistant can provide information about treatment fees.
E. For complicated, more expensive procedures that might require financing, patients may also have to give
permission for the office to access their credit reports. This is an important document for dental offices
that offer financing to patients, essentially loaning their patients money at an agreed-upon interest rate.
F. Facilitate patient referrals under the dentist’s instructions.
G. Make sure you are trained to efficiently and effectively use the computers in the dental office.
IV. Legal Considerations for Dentistry
A. A patient record is both a medical and a legal collection of documents and treatment tools.
1. Legally, patients’ medical histories are protected health information. During the course of taking a medi-
cal history, or using one in the office, the information should always remain confidential and be released
only for purposes of treatment, payment, or oversight (governmental audits, accreditation, etc.).
2. A patient record includes examination progress, test results, diagnoses, treatments, and legal forms, such
as privacy and consent documents and registration forms.
3. Dental practices are required to have a written privacy policy that is in compliance with the Health
Insurance Portability and Accountability Act, or HIPAA. The law stipulates which kinds of informa-
tion are considered privileged medical information and lays out the conditions under which sharing
this information is allowed.
4. Many different types of patient data are kept in the dental office.
a. The dental history form is obtained from patients at the beginning of their treatment.
b. A clinical examination form includes detailed information from the clinical examination, including
charting, the patient’s chief complaint, results from evaluations, and comments from the dentist.
c. The medical history contains a record of the patient’s past and present medical conditions.
d. The consent form is a form given to new patients that obtain patient consent for dental exams
and treatment.
e. The privacy form is a signed acknowledgement that the patient received and understands the
HIPAA privacy policy.
f. Patient correspondence is any letters between the patient and the dental office.
g. Radiographs and photographs
h. Diagnostic or laboratory models
5. File items are retained not only as hard (paper) copies, but also as digital files accessible via computer.
6. Any letters between the patient and the dental office should be included in the patient record.
This includes phone calls, emails, photos, or any other communication that might be pertinent to a
patient’s dental treatment.
B. A dental practice is governed by a combination of federal, state, and local laws.
1. Risk management includes professional and office practices designed to reduce the risk of injury to
patients and employees—and therefore the risk of lawsuit. It starts with personal behavior and respon-
sibility, such as following professional codes and standards, documenting patient treatments and
consent, maintaining professional competence, and following the four Cs of malpractice prevention.

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 32 PA R T I I REVIEW

2. When a dentist explains a procedure to a patient and the patient signs an agreement indicating that
he or she understands the procedure, is aware of possible complications, and agrees that the pro-
cedure should be done, this is a written agreement between the dentist as the service provider and
General Chairside

the patient as the recipient of the service. It is called informed consent.When a patient comes in and
allows the dentist to conduct an examination, this implies treatment is wanted. No written contract
is needed and this is implied consent.
3. As a dental assistant, you owe a duty of care to the dentist to make sure that properly signed and
dated consent forms are in the patient’s chart before the treatment or procedure is performed.
4. HIPAA ensures the privacy and confidentiality of patient healthcare information. HIPAA require-
ments apply to all direct and indirect healthcare providers.
5. Within a dental practice, the dentist is viewed as ultimately responsible for the work of all others in
the practice. It can be an important legal protection for you if you are ever accused of a tort. This
legal principle applies when the actions you take are within your scope of practice, so you should
always be on guard against acting outside your scope of practice.
6. The state dental practice act spells out requirements dental assistants, dentists, and dental hygienists
need to meet in order to obtain and maintain licenses or registration within that state. The act sets
up requirements for state board examinations and for continuing education. Each state’s act also
explains the conditions under which a license can be renewed, suspended, or revoked.
7. If a patient refuses an examination, treatment, or test, document the refusal in the chart. If possible,
ask the patient to sign a statement indicating that he or she is refusing treatment and keep that state-
ment in the chart.
8. All dental assistants must be thoroughly acquainted with the regulatory and professional bodies of the
Centers for Disease Control and Prevention and Occupational Safety and Health Administration. Offices
should have an inspection and enforcement mechanism in place to make sure they are compliant.

R ev iew Q u esti o n s

58. Communication through body language is what kind of communication?

A. Verbal
B. Nonverbal
C. Active listening
D. Passive listening

59. Which of the following is the next logical step after presentation of the patient’s treatment plan?
A. Treatment should start immediately without regard to financial arrangements.
B. Treatment should be delayed until all payments can be made.
C. The dentist or other dental team member discusses estimated fees and makes financial arrangements.
D. The dentist or other dental team member submits estimated fees to the insurance company.

60. The Health Insurance Portability and Accountability Act stipulates that protected health information can
be released to which of the following persons?
A. Patient’s spouse
B. Patient’s brother
C. Patient’s children
D. Patient only

61. A dentist who refuses to treat a patient in need of dental care, without giving adequate notice to the
patient, has committed which of the following?
A. Abandonment
B. A felony
C. Fraud
D. Malpractice

See p. 33 for the correct answers and rationales

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 A N S W E R S A N D R AT I O N A L E S : G E N E R A L C H A I R S I D E 33

ANSWERS AND RATIONALES:

General Chairside
General Chairside

Collecting and Recording Clinical Data

1. Using the universal numbering system, the permanent maxillary right second molar is tooth number

A. 2. In the universal numbering system, the permanent teeth are numbered 1–32, beginning with the
maxillary right third molar (tooth number 1). The permanent maxillary right second molar is tooth
number 2.

2. A small, rounded extension of bone covered with soft tissue located posterior to the last maxillary molar is the

C. maxillary tuberosity. The maxillary tuberosity is located behind the last maxillary molar.

3. Which of the following best describes the palantine rugae?

B. Horizontally raised folds of hard tissue behind the incisive papilla on the hard palate. The
palantine rugae are raised fold-like ridges of keratinized tissue behind the incisive papilla. They are as
distinctive as fingerprints.

4. To identify Stensen’s papilla, look for a

A. small raised flap of soft tissue on the buccal mucosa opposite the maxillary second molar.
Stensen’s papilla, often marked with small red dot, is a small raised flap of soft tissue on the buccal mu-
cosa just opposite the maxillary first molar.

5. Which of the following nerves provides sensory innervation for the teeth and mouth?

C. Trigeminal. In addition to the teeth and mouth, the trigeminal nerve also provides sensory innervation
for the scalp and face.

6. Which of the following major salivary glands is located on the side of the face, behind the ramus, below
and in front of the ear?

B. Parotid. The parotid gland is the largest of the salivary glands.

General Dentistry Chairside Procedures

7. In rubber dam placement, the purpose of inverting the dam is to

D. prevent saliva leakage. Inverting the dam creates a seal, which helps to prevent the leakage of saliva.

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 34 PA R T I I REVIEW

8. Which of the following instruments is likely to be included in a basic tray setup?

B. Mouth mirror. Basic instruments are typically included in every tray setup and include a mouth
General Chairside

mirror, explorer, cotton pliers, and periodontal probe.

9. A carious lesion in a pit or fissure would be classified as:

A. Class I caries: a lesion located in a pit or fissure of a tooth. Class I caries are located on pits
and fissures of the teeth in both anterior and posterior areas.

10. Which of the following is an example of biological pulpal stimuli?

D. Bacteria from saliva coming into contact with pulpal tissues. Biological stimuli occur as a
result of bacteria from saliva coming into contact with pulpal tissues.

11. What does an etchant remove in preparation for dental bonding?

C. Smear layer. Bonding to the dentin first requires removal of the smear layer, which is a thin film of
fluids and particles that forms over the dentin when a cavity is prepared.

12. Which of the following procedures uses enamel bonding?

A. Sealant. Sealants are retained by the micromechanical bonds created after enamel etching.

13. Which instrument is used first during an amalgam restoration?

A. Excavator. During an amalgam procedure, the excavator is used to remove any soft carious tissue
from the tooth.After the amalgam is placed into the prep with the condenser, the cleoid-discoid carves
the anatomy back into the amalgam of the occlusal surface of the tooth. Finally, a burnisher ward com-
pletes the anatomy and smooths it out.

14. Which one of the following tests provides a definitive diagnosis of oral cancer?

D. Performing a biopsy. The only certain method of diagnosis for cancer is histological testing, or biopsy.

15. Which of the following may help prevent a patient from gagging during an alginate impression?

B. Using warm water to mix the alginate. Using warm water to mix the alginate aids in shortening
the length of the procedure for the patient by shortening the time that the impression material and
tray must be in the patient’s mouth.

16. The curing time of composite restorations depends on the

A. shade of the restorative material. The darker the shade of the composite material, the longer the
curing time required.

17. Which of the following must be done first when preparing a tooth for provisional coverage?

C. Placement of the post and core. A preliminary impression must be taken before the tooth is
prepared to obtain a reproduction of the tooth and surrounding tissues in order to fabricate a custom
provisional.

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 A N S W E R S A N D R AT I O N A L E S : G E N E R A L C H A I R S I D E 35

18. When assisting during final impressions in a crown and bridge preparation, which elastomeric
impression material is applied first to the teeth?

General Chairside
A. Light-bodied. The light-bodied material is used first as it has the ability to flow into and around the
details of the prepared teeth.

19. What is the operating zone for an assistant who is assisting a right-handed operator?

B. 2 o’clock to 4 o’clock. If we look at the work area as a clock, the assistant’s zone is from 2 to 4 o’clock.

20. Which part of an anesthetic syringe locks into the rubber stopper so that the stopper can be retracted
by pulling back on the piston rod?

D. Harpoon. This hook is at the end of the piston and locks into the rubber stopper of the cartridge,
enabling the stopper to be retracted when the dentist pulls back on the thumb ring.

21. During a class II amalgam procedure, when is the wedge removed?

A. Before the matrix band and holder are removed. To safeguard the integrity of the newly placed
amalgam restoration, the wedge is removed before removing the matrix band. If the matrix band is
removed before the wedge is removed, the new restoration is more likely to fracture.

22. When preparing a Tofflemire matrix band and retainer, the inner nut on the retainer is used to

C. adjust the size of the matrix band loop. After the band has been bent into shape, it is inserted
into the diagonal slots on the retainer and positioned with the guide channels. Then it is screwed into
place with the spindle pin.The size of the loop can be adjusted using the inner knob on the retainer.

23. Using the clock concept, the zone located between 4 o’clock and 7 o’clock when working with a right-
handed operator is the

D. transfer zone. When working with a right-handed operator, the transfer zone is under patient’s
chin and above the patient’s chest.

24. When an instrument is held in the palm of the hand with all four fingers surrounding the instrument
and the thumb supporting the instrument, which grasp is being used?

D. Palm-thumb. The palm-thumb grasp is used with straight-line instruments where both precision
and strength are necessary, such as chisels and hoes.

25. When passing an instrument that will be used on tooth number 17, the working end should be in what
position?

B. Downward toward the mandibular teeth. When transferring an instrument to be used on tooth num-
ber 17, the working end should be pointing downward for the mandibular area.When working in the maxil-
lary region, the position of use for the instrument being transferred is upward toward the maxillary teeth.

26. Which of the following medications could increase the patient’s blood pressure and heart rate?

C. Over-the-counter cold medication. Although all of the medications can have an effect on dental
treatment, over-the-counter cold medications mimic the sympathetic nervous system, increasing both
heard rate (pulse) and blood pressure. Aspirin and warfarin could cause increased bleeding and nitro-
glycerin is prescribed for patients with angina pectoris, who are at risk for heart attacks.

Dental_CertPrep_Part_IIA_GC.indd 35 2/12/11 1:29 PM

 36 PA R T I I REVIEW

27. In the United States, nitrous oxide tanks are color-coded

C. blue. In the United States, nitrous oxide tanks are color-coded blue and oxygen tanks are color-
General Chairside

coded green to prevent accidental mix-ups.

28. The drug of choice for dental and outpatient inflammatory pain is

D. ibuprofen. Ibuprofen is a member of the nonsteroidal anti-inflammatory drug group and is the drug
of choice because of its effectiveness in reducing pain and inflammation related to dental treatment.

29. Which drug would be contraindicated in patients with peptic ulcers?

A. Aspirin. Aspirin causes gastrointestinal upset and even bleeding in some patients. Patients with
peptic ulcers should never be given aspirin which could make the ulcer worse.

30. Nitrous oxide/oxygen inhalation is indicated for which of the following conditions?

B. Dental anxiety. The anxious patient will benefit from the relaxing and analgesic effects of nitrous
oxide/oxygen inhalation sedation.The other conditions would interfere with adequate respiration and
would not allow the full effect of nitrous oxide.

31. Codeine is classified at what level of abuse and addiction potential?

C. Schedule III. The Drug Enforcement Administration classifies codeine as a schedule III drug, which
means it has a moderate potential for abuse and addiction and is a controlled substance.

32. Why would an oral surgeon administer diazepam (Valium) to a patient before extraction of a molar?

B. To relieve anxiety. Diazepam (Valium) is of the benzodiazepine class of medications that is given
to reduce anxiety. It is often used preoperatively for sedation.

33. What is the most commonly used formulation of topical anesthetic?

D. 20% benzocaine. Twenty percent benzocaine is the most commonly used formulation of topical
anesthetic used in dentistry today.

Preparing and Working with Chairside Materials

34. Which of the following cements have anticariogenic properties?

C. Glass ionomer. Of the cements listed, glass ionomer cement has the unique ability to release fluo-
ride after setting. Because of this, glass ionomer cements are useful in inhibiting decay.

35. Some materials give off heat when mixed.This is called a/an

C. thermal conductivity. An exothermic reaction occurs when heat is given off as the result of a
chemical reaction.

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 A N S W E R S A N D R AT I O N A L E S : G E N E R A L C H A I R S I D E 37

36. A fluid’s resistance to flow is called its

B. viscosity. The way a material flows is its viscosity. An example of a material with a high viscosity is

General Chairside
cold maple syrup, which does not flow very easily. Warm maple syrup, however, has a lower viscosity
and flows more easily.

37. A restoration that is created in the mouth is

A. direct. A direct restoration is applied to the tooth/teeth while the restorative material is still pliable
and can be easily adapted.

38. Dental bonding works by which of the following mechanisms?

D. Creation of micromechanical retention. Bonding systems work by etching surfaces, creating mi-
croscopic areas that the bonding agent can flow into, and improve retention of the restorative material.

39. Microleakage occurs when

C. contaminates are not removed. Contaminants can contribute to microleakage when they are not
properly removed before and during the bonding process.

40. The organic matrix of composite resins is made up of

A. BIS-GMA. The most commonly used resin for the matrix of composites is BIS-GMA, or dimethacrylate

Dental Materials and Laboratory Procedures

41. When stone is mixed with silica, it is referred to as

D. investment material. When stone is mixed with silica, it forms dental investment, a material able
to withstand the high heat and stress produced when molten metal is forced into molds to form
indirect restorations.

42. How will the clinician know that it is safe to remove the poured model from the impression tray?

C. The plaster/stone is cool to the touch. Gypsum products such as plaster and stone are exother-
mic (release heat) while the setting is occurring.The model will lose its glossy appearance at the initial
set, but the reaction is not complete, and removing the model from the tray at this point can result in
breakage. Once heat is no longer produced, and the model feels cool to the touch, it is safe to remove
the model from the impression tray.

43. Which of the following materials is most often used for veneers?

C. Porcelain. Although porcelain is effective in making teeth appear healthier and more natural look-
ing, as a material, it is not very strong and does not resist fracturing as well as other materials. This is
why porcelain is generally used in making veneers, not inlays, onlays, or crowns.

Dental_CertPrep_Part_IIA_GC.indd 37 2/12/11 1:29 PM

 38 PA R T I I REVIEW

Educating and Assisting Patients with Oral Health

General Chairside

44. Which of the following will occur as a result of ingesting too much fluoride?

C. Mottled enamel. Dental fluorosis, also referred to as mottling or mottled enamel, is caused by in-
gesting too much fluoride during the development and mineralization of the teeth.

45. Before topical fluoride is applied to a patient’s teeth, the dental assistant should

C. dry the teeth thoroughly. Teeth should be thoroughly dried using the air-water syringe and/or a gauze
sponge to remove saliva and any remaining toothpaste prior to applying a topical fluoride treatment.

46. Toothbrushing alone has the ability to clean which of the following tooth surfaces?

A. Buccal. Tooth brushing alone cleans the buccal and lingual tooth surfaces. Deep occlusal fissures,
pits, fossa, as well as lingual pits cannot be adequately cleaned by tooth brushing alone.Tooth brushing
also cannot interproximal and subgingival areas.

47. Although sealants are most commonly placed on permanent molars, they may also be placed on
deciduous teeth that

A. have deep pits and fissures. To reduce the risk of decay, pit and fissure sealants are commonly
used on deciduous molars where deep occlusal grooves, pits, and fissures are present.

48. The main role of the dental assistant in preventive dentistry is

D. educating patients. Patients need to be thoroughly educated on how to care for their mouth at
home in order for what is done at the dental office to be successful.

49. Which of the following microorganisms must be present in order for caries formation to begin?

B. Streptococcus mutans. Dental caries is a transmittable bacterial infection that is caused by the
mutans streptococcus or the lactobacilli.

Medical and Dental Emergencies

50. Which of the following is a way to treat a patient having a hypoglycemic attack?

B. Give the patient carbohydrates. Giving the patient a glucose supplement will help to raise the
patient’s blood sugar.

51. If a patient has a grand mal seizure while in the office, the staff should

C. clear away any hazards and call EMS. A patient having a seizure should be allowed to lie on the
floor with hazards moved away to prevent serious injury. As with any emergency, EMS should be acti-
vated so that the patient can receive optimum emergency care.

Dental_CertPrep_Part_IIA_GC.indd 38 2/12/11 1:29 PM

Other documents randomly have
different content
He drew her to him and kissed her forehead gravely. "Good-night,
my love," he said. "You will be my love, whatever happens."
And so he departed to the township, accompanied by his hospitable
host, and she went miserable to bed. And at the first pale streak of
dawn the little steamer sounded her whistle and puffed away from
the little jetty, carrying him back to the world, and she stood on the
cliff, a mile away from Seaview Villa, to watch the last whiff of smoke
from its funnels fade like a breath upon the horizon.

CHAPTER XXXV.

HOW ELIZABETH MADE UP HER MIND.

If we could trace back the wonderful things that happen to us "by

accident," or, as some pious souls believe, by the operation of a
special Providence or in answer to prayer, to their remote origin, how
far should we not have to go? Into the mists of antiquity, and
beyond—even to the primal source whence the world was derived,
and the consideration of the accident of its separation from its
parent globe; nay, of the accident which separated our sun itself
from the countless dust of other suns that strew the illimitable ether
—still leaving the root of the matter in undiscoverable mystery. The
chain of causes has no beginning for us, as the sequence of effects
has no end. These considerations occurred to me just now, when I
sat down, cheerful and confident, to relate how it came to pass (and
what multitudinous trifles could have prevented it from coming to
pass) that an extraordinary accident happened to the three Miss
Kings in the course of the week following Mr. Yelverton's departure.
Thinking it over, I find that I cannot relate it. It would make this
chapter like the first half-dozen in the book of Chronicles, only much
worse. If Mr. King had not inherited a bad temper from his great-
great-grandfathers—I could get as far as that. But the task is beyond
me. I give it up, and content myself with a narration of the little
event (in the immeasurable chain of events) which, at this date of
which I am writing—in the ephemeral summer time of these three
brief little lives—loomed so large, and had such striking
consequences.
It happened—or, as far as my story is concerned, it began to happen
—while the steamer that carried away Mr. Yelverton was still
ploughing the ocean waves, with that interesting passenger on
board. Seaview Villa lay upon the headland, serene and peaceful in
the sunshine of as perfect a morning as visitors to the seaside could
wish to see, all its door-windows open to the south wind, and the
sibilant music of the little wavelets at its feet. The occupants of the
house had risen from their beds, and were pursuing the trivial round
and common task of another day, with placid enjoyment of its
atmospheric charms, and with no presentiment of what was to befall
them. The girls went down to their bath-house before breakfast, and
spent half an hour in the sunny water, diving, and floating, and
playing all the pranks of childhood over again; and then they
attacked a dish of fried flathead with appetites that a schoolboy
might have envied. After breakfast the lawyer had to go to his office,
and his guests accompanied him part of the way. On their return,
Sam Dunn came to see them, with the information that his best
boat, which bore the inappropriate title of "The Rose in June," was
moored on the beach below, and an invitation to his young ladies to
come out for a sail in her while the sea was so calm and the wind so
fair. This invitation Elizabeth declined for herself; she was still
wondering in which direction the right path lay—whether towards
the fruition of her desires or the renunciation of all that now made
life beautiful and valuable to her—and finding no solution to the
problem either in meditation or prayer; and she had little inclination
to waste any of the short time that remained to her for making up
her mind. But to Patty and Eleanor it was irresistible. They
scampered off to their bedrooms to put on their oldest frocks, hats,
and boots, rushed into the kitchen to Mrs. Harris to beg for a bundle
of sandwiches, and set forth on their expedition in the highest spirits
—as if they had never been away from Sam Dunn and the sea, to
learn life, and love, and trouble, and etiquette amongst city folks.
When they were gone, the house was very still for several hours.
Elizabeth sat on the verandah, sewing and thinking, and watching
the white sail of "The Rose in June" through a telescope; then she
had her lunch brought to her on a white-napkined tray; after eating
which in solitude she went back to her sewing, and thinking, and
watching again. So four o'clock—the fateful hour—drew on. At a little
before four, Mr. Brion came home, hot and dusty from his long walk,
had a bath and changed his clothes, and sat down to enjoy himself
in his arm-chair. Mrs. Harris brought in the afternoon tea things, with
some newly-baked cakes; Elizabeth put down her work and seated
herself at the table to brew the refreshing cup. Then home came
Patty and Eleanor, happy and hungry, tanned and draggled, and in
the gayest temper, having been sailing Sam's boat for him all the day
and generally roughing it with great ardour. They were just in time
for the tea and cakes, and sat down as they were, with hats tilted
back on their wind-roughened heads, to regale themselves
therewith.
When Patty was in the middle of her third cake, she suddenly
remembered something. She plunged her hand into her pocket, and
drew forth a small object. It was as if one touched the button of that
wonderful electric apparatus whereby the great ships that are
launched by princesses are sent gliding out of dock into the sea.
"Look," she said, opening her hand carefully, "what he has given me.
It is a Queensland opal. A mate of his, he says, gave it to him, but I
have a terrible suspicion that the dear fellow bought it. Mates don't
give such things for nothing. Is it not a beauty?"—and she held
between her thumb and finger a silky-looking flattened stone, on
which, when it caught the light, a strong blue sheen was visible. "I
shall have it cut and made into something when we go back to town,
and I shall keep it for ever, in memory of Sam Dunn," said Patty with
enthusiasm.
And then, when they had all examined and appraised it thoroughly,
she carried it to the mantelpiece, intending to place it there in safety
until she went to her own room. But she had no sooner laid it down,
pushing it gently up to the wall, than there was a little click and a
faint rattle, and it was gone.
"Oh," she exclaimed, "what shall I do? It has fallen behind the
mantelpiece! I quite forgot that old hole—and it is there still. Surely,"
she continued angrily, stamping her foot, "when Mr. Hawkins took
the trouble to do all this"—and she indicated the surface of the
woodwork, which had been painted in a wild and ghastly imitation of
marble—"he might have taken a little more, and fixed the thing close
up to the wall?"
Mr. Brion examined the mantelpiece, pushed it, shook it, peered
behind it with one eye, and said that he had himself lost a valuable
paper-knife in the same distressing manner, and had long intended
to have the aperture closed up. "And I will get a carpenter to-
morrow morning, my dear," he boldly declared, "and he shall take
the whole thing to pieces and fix it again properly. Yes, I will—as
well now as any other time—and we will find your opal."
Having pledged himself to which tremendous purpose, he and they
finished their tea, and afterwards had their dinner, and afterwards
sat on the verandah and gossiped, and afterwards went to bed—and
in due time got up again—as if nothing out of the common way had
happened!
In the morning Fate sent another of her humble emissaries from the
township to Seaview Villa, with a bag of tools over his shoulder—
tools that were keys to unlock one of her long-kept secrets. And half
an hour after his arrival they found the opal, and several things
besides. When, after Mrs. Harris had carefully removed the furniture
and hearthrug, and spread cornsacks over the carpet, the carpenter
wrenched the mantelpiece from its fastenings, such a treasure-trove
was discovered in the rough hollows of the wall and floor as none of
them had dreamed of. It did not look much at the first glance. There
were the opal and the paper-knife, half a dozen letters (circulars and
household bills of Mrs. King's), several pens and pencils, a pair of
scissors, a silver fruit-knife, a teaspoon, a variety of miscellaneous
trifles, such as bodkins and corks, and a vast quantity of dust. That
seemed all. But, kneeling reverently to grope amongst these humble
relics of the past, Elizabeth found, quite at the bottom of everything,
a little card. It was an old, old card, dingy and fretted with age, and
dried and curled up like a dead leaf, and it had a little picture on it
that had almost faded away. She carefully wiped the dust from it
with her handkerchief, and looked at it as she knelt; it was a crude
and youthful water-colour drawing of an extensive Elizabethan
house, with a great many gables and fluted chimney-stacks, and
much exuberance of architectural fancy generally. It had been
minutely outlined by a hand trained to good draughtsmanship, and
then coloured much as a child would colour a newspaper print from
a sixpenny paint-box, and less effectively, because there was no light
and shade to go upon. It was flat and pale, like a builder's plan, only
that it had some washy grass and trees about it, and a couple of
dogs running a race in the foreground, which showed its more
ambitious pretensions; and the whole thing had evidently been
composed with the greatest care. Elizabeth, studying it attentively,
and thinking that she recognised her father's hand in certain details,
turned the little picture over in search of the artist's signature. And
there, in a corner, written very fine and small, but with elaborate
distinctness, she read these words:—"Elizabeth Leigh, from
Kingscote Yelverton, Yelverton, June, 1847."
She stared at the legend—in which she recognised a peculiar capital
K of his own invention that her father always used—with the utmost
surprise, and with no idea of its tremendous significance. "Why—
why!" she gasped, holding it up, "it belongs to him—it has Mr.
Yelverton's name upon it! How in the world did it come here? What
does it mean? Did he drop it here the other day? But, no, that is
impossible—it was quite at the bottom—it must have been lying here
for ages. Mr. Brion, what does it mean?"
The old man was already stooping over her, trying to take it from her
hand. "Give it to me, my dear, give it to me," he cried eagerly. "Don't
tear it—oh, for God's sake, be careful!—let me see what it is first."
He took it from her, read the inscription over and over and over
again, and then drew a chair to the table and sat down with the card
before him, his face pale, and his hands shaking. The sisters
gathered round him, bewildered; Elizabeth still possessed with her
first impression that the little picture was her lover's property,
Eleanor scarcely aware of what was going on, and Patty—always the
quickest to reach the truth—already beginning dimly to discern the
secret of their discovery. The carpenter and the housekeeper stood
by, open-mouthed and open-eyed; and to them the lawyer
tremulously addressed himself.
"You had better go for a little while," he said; "we will put the
mantelpiece up presently. Yet, stay—we have found a very important
document, as I believe, and you are witnesses that we have done
so. You had better examine it carefully before you go, that you may
know it when you see it again." Whereupon he solemnly proceeded
to print the said document upon their memories, and insisted that
they should each take a copy of the words that made its chief
importance, embodying it in a sort of affidavit, to which they signed
their names. Then he sent them out of the room, and confronted the
three sisters, in a state of great excitement. "I must see Paul," he
said hurriedly. "I must have my son to help me. We must ransack
that old bureau of yours—there must be more in it than we found
that time when we looked for the will. Tell me, my dears, did your
father let you have the run of the bureau, when he was alive?"
No, they told him; Mr. King had been extremely particular in allowing
no one to go to it but himself.
"Ah," said the old man, "we must hunt it from top to bottom—we
must break it into pieces, if necessary. I will telegraph to Paul. We
must go to town at once, my dears, and investigate this matter—
before Mr. Yelverton leaves the country."
"He will not leave the country yet," said Elizabeth. "What is it, Mr.
Brion?"
"I think I see what it is," broke in Patty. "Mr. Brion thinks that father
was Mr. Yelverton's uncle, who was lost so long ago. King—King—Mr.
Yelverton told us the other day that they called him 'King,' for short
—and he was named Kingscote Yelverton, like his uncle. Mother's
name was Elizabeth. I believe Mr. Brion is right And, if so—"

"And, if so," Patty repeated, when that wonderful, bewildering day

was over, and she and her elder sister were packing for their return
to Melbourne in the small hours of the next morning—"if so, we are
the heiresses of all those hundreds of thousands that are supposed
to belong to our cousin Kingscote. Now, Elizabeth, do you feel like
depriving him of everything, and stopping his work, and leaving his
poor starved costermongers to revert to their original condition—or
do you not?"
"I would not take it," said Elizabeth, passionately.
"Pooh!—as if we should be allowed to choose! People can't do as
they like where fortunes and lawyers are concerned. For Nelly's sake
—not to speak of mine—they will insist on our claim, if we have one;
and then do you suppose he would keep your money? Of course not
—it's a most insulting idea. Therefore the case lies in a nutshell. You
will have to make up your mind quickly, Elizabeth."
"I have made up my mind," said Elizabeth, "if it is a question of
which of us is most worthy to have wealth, and knows best how to
use it."

CHAPTER XXXVI.

INVESTIGATION.
They did not wait for the next steamer, but hurried back to
Melbourne by train and coach, and reached Myrtle Street once more
at a little before midnight, the girls dazed with sleep and weariness
and the strain of so much excitement as they had passed through.
They had sent no message to Mrs. Duff-Scott at present, preferring
to make their investigations, in the first place, as privately as
possible; and Mr. Brion had merely telegraphed to his son that they
were returning with him on important business. Paul was at the
house when they arrived, but Mrs. M'Intyre had made hospitable
preparations at No. 6 as well as at No. 7; and the tired sisters found
their rooms aired and their beds arranged, a little fire lit, gas
burning, kettle boiling, and a tempting supper laid out for them
when they dragged their weary limbs upstairs. Mrs. M'Intyre herself
was there to give them welcome, and Dan, who had been reluctantly
left behind when they went into the country, was wild with rapture,
almost tearing them to pieces in the vehemence of his delight at
seeing them again, long past the age of gambols as he was. Mr.
Brion was consoled for the upsetting of his own arrangements,
which had been to take his charges to an hotel for the night, and
there luxuriously entertain them; and he bade them an affectionate
good-night, and went off contentedly to No. 7 under the wing of
Paul's landlady, to doze in Paul's arm-chair until that brilliant
ornament of the press should be released from duty.
Cheered by their little fire—for, summer though it was, their fatigues
had made them chilly—and by Mrs. M'Intyre's ham and chicken and
hot coffee, the girls sat, talking and resting, for a full hour before
they went to bed; still dwelling on the strange discovery of the little
picture behind the mantelpiece, which Mr. Brion had taken
possession of, and wondering if it would really prove them to be the
three Miss Yelvertons instead of the three Miss Kings, and co-
heiresses of one of the largest properties in England.
As they passed the old bureau on their way to their rooms, Elizabeth
paused and laid her hand on it thoughtfully. "It hardly seems to me
possible," she said, "that father should have kept such a secret all
these years, and died without telling us of it. He must have seen the
advertisements—he must have known what difficulties he was
making for everybody. Perhaps he did not write those names on the
picture—handwriting is not much to go by, especially when it is so
old as that; you may see whole schools of boys or girls writing in
one style. Perhaps father was at school with Mr. Yelverton's uncle.
Perhaps mother knew Elizabeth Leigh. Perhaps she gave her the
sketch—or she might have come by it accidentally. One day she
must have found it—slipped in one of her old music-books, maybe—
and taken it out to show father; and she put it up on the
mantelpiece, and it slipped down behind, like Patty's opal. If it had
been of so much consequence as it seems to us—if they had desired
to leave no trace of their connection with the Yelverton family—
surely they would have pulled the house down but what they would
have recovered it. And then we have hunted the bureau over—we
have turned it out again and again—and never found anything."
"Mr. Brion thinks there are secret drawers," said Eleanor, who, of all
the three, was most anxious that their golden expectations should
be realised. "It is just the kind of cabinet work, he says, that is
always full of hidden nooks and corners, and he is blaming himself
that he did not search it more thoroughly in the first instance."
"And he thinks," continued Patty, "that father seemed like a man
with things on his mind, and believes he would have told us had he
had more warning of his death. But you know he was seized so
suddenly, and could not speak afterwards."
"Poor father—poor father!" sighed Elizabeth, pitifully. They thought
of his sad life, in the light of this possible theory, with more tender
compassion than they had ever felt for him before; but the idea that
he might have murdered his brother, accidentally or otherwise—and
for that reason had effaced himself and done bitter penance for the
rest of his days—never for a moment occurred to them. "Well, we
shall know by to-morrow night," said the elder sister, gently. "If the
bureau does not yield fresh evidence, there is none that we can
allow Mr. Brion, or anyone else, to act upon. The more I think it over,
the more I see how easily the whole thing could be explained—to
mean nothing so important as Mr. Brion thinks. And, for myself, I
should not be disappointed if we found ourselves only Miss Kings,
without fortune or pedigree, as we have always been. We are very
happy as we are."
"That is how I felt at first," said Patty. "But I must say I am growing
more and more in love with the idea of being rich. The delightful
things that you can do with plenty of money keep flashing into my
mind, one after the other, till I feel that I never understood what
being poor meant till now, and that I could not content myself with a
hundred a year and Mrs. Duff-Scott's benefactions any more. No; the
wish may be father to the thought, Elizabeth, but I do think it,
honestly, that we shall turn out to be Mr. Yelverton's cousins—
destined to supersede him, to a certain extent."
"I think so, too," said Eleanor, anxiously. "I can't—I won't—believe
that Mr. Brion is mistaken."
So they went, severally affected by their strange circumstances, to
bed. And in the morning they were up early, and made great haste
to get their breakfast over, and their sitting-room in order, in
readiness for the lawyer's visit. They were very much agitated by
their suspense and anxiety, especially Patty, to whom the impending
interview with Paul had become of more pressing consequence,
temporarily, than even the investigations that he was to assist. She
had had no communication with him whatever since she cut him on
the racecourse when he was innocently disporting himself with Mrs.
Aarons; and her nerves were shaken by the prospect of seeing and
speaking to him again, and by the vehemence of her conflicting
hopes and fears. She grew cold and hot at the recollection of one or
two accidental encounters that had taken place since Cup Day, and
at the picture of his contemptuous, unrecognising face that rose up
vividly before her. Elizabeth noticed her unusual pallor and restless
movements, and how she hovered about the window, straining her
ears to catch a chance sound of the men's voices next door, and
made an effort to divert her thoughts. "Come and help me, Patty,"
she said, putting her hand on her sister's shoulder. "We have nothing
more to do now, so we may as well turn out some of the drawers
before they come. We can look over dear mother's clothes, and see
if they have any marks on them that we have overlooked. Mr. Brion
will want to have everything examined."
So they began to work at the bureau with solemn diligence, and a
fresh set of emotions were evolved by that occupation, which
counteracted, without effacing, those others that were in Patty's
mind. She became absorbed and attentive. They took out all Mrs.
King's gowns, and her linen, and her little everyday personal
belongings, searched them carefully for indications of ownership,
and, finding none, laid them aside in the adjoining bedroom. Then
they exhumed all those relics of an olden time which had a new
significance at the present juncture—the fine laces, the faded
brocades, the Indian shawl and Indian muslins, the quaint fans and
little bits of jewellery—and arranged them carefully on the table for
the lawyer's inspection.
"We know now," said Patty, "though we didn't know a few mouths
ago, that these are things that could only belong to a lady who had
been rich once."
"Yes," said Elizabeth. "But there is another point to be considered.
Elizabeth Leigh ran away with her husband secretly and in haste,
and under circumstances that make it seem most unlikely that she
should have hampered herself and him with luggage, or bestowed a
thought on such trifles as fans and finery."
The younger sisters were a little daunted for a moment by this view
of the case. Then Eleanor spoke up. "How you do love to throw cold
water on everything!" she complained, pettishly. "Why shouldn't she
think of her pretty things? I'm sure if I were going to run away—no
matter under what circumstances—I should take all mine, if I had
half an hour to pack them up. So would you. At least, I don't know
about you—but Patty would. Wouldn't you, Patty?"
"Well," said Patty, thoughtfully, sitting back on her heels and folding
her hands in her lap, "I really think I should, Elizabeth. If you come
to think of it, it is the heroines of novels who do those things. They
throw away lovers, and husbands, and fortunes, and everything else,
on the slightest provocation; it is a matter of course—it is the correct
thing in novels. But in real life girls are fond of all nice things—at
least, that is my experience—and they don't feel like throwing them
away. Girls in novels would never let Mrs. Duff-Scott give them
gowns and bonnets, for instance—they would be too proud; and
they would burn a bureau any day rather than rummage in it for a
title to money that a nice man, whom they cared for, was in
possession of. Don't tell me. You are thinking of the heroines of
fiction, Elizabeth, and not of Elizabeth Leigh. She, I agree with Nelly
—however much she might have been troubled and bothered—did
not leave her little treasures for the servants to pawn. Either she
took them with her, or someone able to keep her destination a
secret sent them after her."
"Well, well," said Elizabeth, who had got out her mother's jewellery
and was gazing fondly at the miniature in the pearl-edged locket,
"we shall soon know. Get out the books and music, dear."
They were turning over a vast pile of music, which required at least
half a day to examine properly, when the servant of the house
tapped at the door to ask, with Mr. Brion's compliments, when it
would be convenient to Miss King to receive that gentleman. In a
few minutes father and son were in the room, the former distributing
hasty and paternal greetings all around, and the latter quietly
shaking hands with an air of almost aggressive deliberation. Paul
was quite polite, and to a certain extent friendly, but he was terribly,
uncompromisingly business-like. Not a moment did he waste in mere
social amenities, after shaking hands with Patty—which he did as if
he were a wooden automaton, and without looking at her—but
plunged at once into the matter of the discovered picture, as if time
were money and nothing else of any consequence. Patty's heart
sank, but her spirit rose; she determined not to "let herself down" or
in any way to "make an exhibition of herself," if she could help it.
She drew a little aside from the bureau, and went on turning over
the music—which presently she was able to report valueless as
evidence, except negative evidence, the name, wherever it had been
written at the head of a sheet, having been cut out or erased; while
Elizabeth took the remaining articles from their drawers and pigeon-
holes, and piled them on the table and in Nelly's arms.
For some time they were all intent upon their search, and very
silent; and it still seemed that they were to find nothing in the shape
of that positive proof which Elizabeth, as the head of the family,
demanded before she would give permission for any action to be
taken. There were no names in the old volumes of music, and the
fly-leaves had been torn from the older books. Some pieces of
ancient silver plate—a pair of candlesticks, a pair of salt-cellars, a
teapot and sugar basin (now in daily use), a child's mug, some
Queen Anne spoons and ladles—were all unmarked by crest or
monogram; and two ivory-painted miniatures and three
daguerreotypes, representing respectively one old lady in high-
crowned cap and modest kerchief, one young one with puffs all over
her head, and a classic absence of bodice to her gown, one little
fair-haired child, similarly scanty in attire, and one middle-aged
gentleman with a large shirt frill and a prodigious quantity of neck-
cloth—likewise failed to verify themselves by date or inscription
when carefully prised out of their frames and leather cases with Paul
Brion's pen-knife. These family portraits, understood by the girls to
belong to the maternal side of the house, were laid aside, however,
along with the pearl-rimmed locket and other jewels, and the picture
that was found behind the mantelpiece; and then, nothing else
being left, apparently, the two men began an inspection of the
papers.
While this was going on, Patty, at a sign from Elizabeth, set up the
leaves of a little tea-table by the window, spread it with a white
cloth, and fetched in such a luncheon as the slender larder afforded
—the remains of Mrs. M'Intyre's chicken and ham, some bread and
butter, a plate of biscuits, and a decanter of sherry—for it was past
one o'clock, and Mr. Brion and Paul had evidently no intention of
going away until their investigations were complete. The room was
quite silent. Her soft steps and the brush of her gown as she passed
to and fro were distinctly audible to her lover, who would not so
much as glance at her, but remained sternly intent upon the
manuscripts before him. These were found to be very interesting,
but to have no more bearing upon the matter in hand than the rest
of the relics that had been overhauled; for the most part, they were
studies in various arts and sciences prepared by Mr. and Mrs. King
for their daughters during the process of their education, and such
odds and ends of literature as would be found in a clever woman's
common-place books. They had all been gone over at the time of Mr.
King's death, in a vain hunt for testamentary documents; and
Elizabeth, looking into the now bare shelves and apertures of the
bureau, began to think how she could console her sisters for the
disappointment of their hopes.
"Come and have some lunch," she said to Paul (Mr. Brion was
already at the table, deprecating the trouble that his dear Patty was
taking). "I don't think you will find anything more."
The young man stood up with his brows knitted over his keen eyes,
and glanced askance at the group by the window. "We have not
done yet," he said decisively; "and we have learned quite enough, in
what we haven't found, to justify us in consulting Mr. Yelverton's
solicitors."
"No," she said, "I'll have nothing said to Mr. Yelverton, unless the
whole thing is proved first."
Never thinking that the thing would be proved, first or last, she
advanced to the extemporised lunch table, and dispensed the
modest hospitalities of the establishment with her wonted simple
grace. Mr. Brion was accommodated with an arm-chair and a music-
book to lay across his knees, whereon Patty placed the tit-bits of the
chicken and the knobby top-crust of the loaf, waiting upon him with
that tender solicitude to which he had grown accustomed, but which
was so astonishing, and so interesting also, to his son.
"She has spoiled me altogether," said the old man fondly, laying his
hand on her bright head as she knelt before him to help him to
mustard and salt. "I don't know how I shall ever manage to get
along without her now."
"Has this sad fate overtaken you in one short week?" inquired Paul,
rather grimly. "Your sister should be labelled like an explosive
compound, Miss King—'dangerous,' in capital letters." Paul was
sitting in a low chair by Elizabeth, with his plate on his knee, and he
thawed a good deal, in spite of fierce intentions to the contrary,
under the influence of food and wine and the general conversation.
He looked at Patty now and then, and by-and-bye went so far as to
address a remark to her. "What did she think of the caves?" he
asked, indifferently, offering her at the same moment a glass of
sherry, which, though unaccustomed to fermented liquors, she had
not the presence of mind to refuse—and which she took with such a
shaking hand that she spilled some of it over her apron. And she
plunged at once into rapid and enthusiastic descriptions of the caves
and the delights of their expedition thereto, absurdly uplifted by this
slight token of interest in her proceedings.
When luncheon was over, Elizabeth culled Eleanor—who, too restless
to eat much herself, was hovering about the bureau, tapping it here
and there with a chisel—to take her turn to be useful by clearing the
table; and then, as if business were of no consequence, bade her
guests rest themselves for a little and smoke a cigarette if they felt
inclined.
"Smoke!" exclaimed Paul, with a little sarcastic laugh. "Oh, no, Miss
King, that would never do. What would Mrs. Duff-Scott say if she
were to smell tobacco in your sitting-room?"
"Well, what would she say?" returned Elizabeth, gently—she was
very gentle with Paul to-day. "Mrs. Duff-Scott, I believe, is rather
fond of the smell of tobacco, when it is good."
Mr. Brion having satisfied the demands of politeness with profuse
protestations, suffered himself to indulge in a mild cigarette; but
Paul would not be persuaded. He resumed his study of the
manuscripts with an air of determination, as of a man who had idled
away precious time. He conscientiously endeavoured to fix his
attention on the important business that he had undertaken, and to
forget everything else until he had finished it. For a little while Patty
wandered up and down in an aimless manner, making neat heaps of
the various articles scattered about the room and watching him
furtively; then she softly opened the piano, and began to play, just
above a whisper, the "Sonata Pathetique."

CHAPTER XXXVII.

DISCOVERY.

It was between two and three o'clock; Mr. Brion reposed in his arm-
chair, smoking a little, talking a little to Elizabeth who sat beside him,
listening dreamily to the piano, and feeling himself more and more
inclined to doze and nod his head in the sleepy warmth of the
afternoon, after his glass of sherry and his recent severe fatigues.
Elizabeth, by way of entertaining him, sat at his elbow, thinking,
thinking, with her fingers interlaced in her lap and her gaze fixed
upon the floor. Patty, intensely alert and wakeful, but almost
motionless in her straight back and delicately poised head, drooped
over the keyboard, playing all the "soft things" that she could
remember without notes; and Paul, who had resisted her
enchantments as long as he could, leaned back in his chair, with his
hand over his eyes, having evidently ceased to pay any attention to
his papers. And, suddenly, Eleanor, who was supposed to be washing
plates and dishes in the kitchen, flashed into the room, startling
them all out of their dreams.
"Elizabeth, dear," she exclaimed tremulously, "forgive me for
meddling with your things. But I was thinking and thinking what else
there was that we had not examined, and mother's old Bible came
into my head—the little old Bible that she always used, and that you
kept in your top drawer. I could not help looking at it, and here"—
holding out a small leather-bound volume, frayed at the corners and
fastened with silver clasps—"here is what I have found. The two first
leaves are stuck together—I remembered that—but they are only
stuck round the edges; there is a little piece in the middle that is
loose and rattles, and, see, there is writing on it." The girl was
excited and eager, and almost pushed the Bible into Paul Brion's
hands. "Look at it, look at it," she cried. "Undo the leaves with your
knife and see what the writing is."
Paul examined the joined leaves attentively, saw that Eleanor was
correct in her surmise, and looked at Elizabeth. "May I, Miss King?"
he asked, his tone showing that he understood how sacred this relic
must be, and how much it would go against its present possessor to
see it tampered with.
"I suppose you had better," said Elizabeth.
He therefore sat down, laid the book before him, and opened his
sharp knife. A sense that something was really going to happen now
—that the secret of all this careful effacement of the little chronicles
common and natural to every civilised family would reveal itself in
the long-hidden page which, alone of all the records of the past,
their mother had lacked the heart to destroy—fell upon the three
girls; and they gathered round to watch the operation with pale
faces and beating hearts. Paul was a long time about it, for he tried
to part the leaves without cutting them, and they were too tightly
stuck together. He had at last to make a little hole in which to insert
his knife, and then it was a most difficult matter to cut away the
plain sheet without injuring the written one. Presently, however, he
opened a little door in the middle of the page, held the flap up,
glanced at what was behind it for a moment, looked significantly at
his father, and silently handed the open book to Elizabeth. And
Elizabeth, trembling with excitement and apprehension, lifting up the
little flap in her turn, read this clear inscription—
"To my darling child, ELIZABETH,
From her loving mother,
 ELEANOR D'ARCY LEIGH.
Bradenham Abbey. Christmas, 1839.
Psalm xv., 1, 2."
There was a dead silence while they all looked at the fine brown
writing—that delicate caligraphy which, like fine needlework, went
out of fashion when our grandmothers passed away—of which every
letter, though pale, was perfectly legible. A flood of recollection
poured into the minds of the three girls, especially the elder ones, at
the sight of those two words, "Bradenham Abbey," in the corner of
the uncovered portion of the page. "Leigh" and "D'Arcy" were both
unfamiliar names—or had been until lately—but Bradenham had a
place in the archives of memory, and came forth at this summons
from its dusty and forgotten nook. When they were children their
mother used to tell them stories by the firelight in winter evenings,
and amongst those stories were several whose scenes were laid in
the tapestried chambers and ghostly corridors, and about the parks
and deer-drives and lake-shores of a great "place" in an English
county—a place that had once been a famous monastery, every
feature and aspect of which Mrs. King had at various times described
so minutely that they were almost as familiar with it as if they had
seen it for themselves. These stories generally came to an untimely
end by the narrator falling into an impenetrable brown study or
being overtaken by an unaccountable disposition to cry—which gave
them, of course, a special and mysterious fascination for the
children. While still little things in pinafores, they were quick enough
to perceive that mother had a personal interest in that wonderful
place of which they never tired of hearing, and which evidently did
not belong to the realms of Make-believe, like the palace of the
Sleeping Beauty and Blue-beard's castle; and therefore they were
always, if unconsciously, trying to understand what that interest was.
And when, one day when she was painting a wreath of forget-me-
nots on some little trifle intended for a bazaar, and, her husband
coming to look over her, she said to him impulsively, "Oh, do you
remember how they grew in the sedges round the Swan's Pool at
Bradenham?"—and when he sternly bade her hush, and not speak of
Bradenham unless she wished to drive him mad—then Patty and
Elizabeth, who heard them both, knew that Bradenham was the
name of the great house where monks had lived, in the grounds of
which, as they had had innumerable proofs, pools and swans
abounded. It was the first time they had heard it, but it was too
important a piece of information to be forgotten. On this memorable
day, so many years after, when they read "Bradenham Abbey" in the
well-worn Bible, they looked at each other, immediately recalling that
long-ago incident; but their hearts were too full to speak. It was Mr.
Brion who broke the silence that had fallen upon them all.
"This, added to our other discoveries, is conclusive, I think," said the
old lawyer, standing up in order to deliver his opinion impressively,
and resting his hands on the table. "At any rate, I must insist on
placing the results of our investigation before Mr. Yelverton—yes,
Elizabeth, you must forgive me, my dear, if I take the matter into my
own hands. Paul will agree with me that we have passed the time
for sentiment. We will have another look into the bureau—because it
seems incredible that any man should deliberately rob his children of
their rights, even if he repudiated his own, and therefore I think
there must be legal instruments somewhere; but, supposing none
are with us, it will not be difficult, I imagine, to supply what is
wanting to complete our case from other sources—from other
records of the family, in fact. Mr. Yelverton himself, in five minutes,
would be able to throw a great deal of light upon our discoveries. It
is absolutely necessary to consult him."
"I would not mind so much," said Elizabeth, who was deadly pale, "if
it were to be fought out with strangers. But he would give it all up at
once, without waiting to see—without asking us to prove—that we
had a strictly legal title."
"Don't you believe it," interposed Paul sententiously.
She rose from her chair in majestic silence, and moved towards the
bureau. She would not bandy her lover's name nor discuss his
character with those who did not know him as she did. Paul followed
her, with his chisel in his hand.
"Let us look for that secret drawer, at any rate," he said. "I feel
pretty certain there must be one, now. Mr. King took great pains to
prevent identification during his lifetime, but, as my father says, that
is a very different thing from disinheriting you. If you will allow me,
I'll take every moveable part out first."
He did so, while she watched and assisted him. All the brass-handled
drawers, and sliding shelves, and partitions were withdrawn from
their closely-fitting sockets, leaving a number of holes and spaces
each differing in size and shape from the rest. Then he drew up a
chair in front of the exposed skeleton, and gazed at it thoughtfully;
after which he began to make careful measurements inside and out,
to tap the woodwork in every direction, and to prise some of its
strong joints asunder. This work continued until four o'clock, when,
notwithstanding the highly stimulating excitement of the day's
proceedings, the girls began to feel that craving for a cup of tea
which is as strong upon the average woman at this time as the
craving for a nobbler of whisky is upon the—shall I say average
man?—when the sight of a public-house appeals to his nobler
appetite. Not that they wanted to eat and drink—far from it; the cup
of tea was the symbol of rest and relief for a little while from the
stress and strain of labour and worry, and that was what they were
in need of. Elizabeth looked at her watch and then at Patty, and the
two girls slipped out of the room together, leaving Eleanor to watch
operations at the bureau. Reaching their little kitchen, they
mechanically lit the gas in the stove, and set the kettle on to boil;
and then they went to the open window, which commanded an
unattractive view of the back yard, and stood there side by side,
leaning on each other.
"In 1839," said Patty, "she must have been a girl, a child, and living
at Bradenham at home. Think of it, Elizabeth—with a mother loving
her and petting her as she did us. She was twenty-five when she
married; she must have been about sixteen when that Bible was
given to her—ever so much younger than any of us are now. She
lived in those beautiful rooms with the gold Spanish leather on the
walls—she danced in that long gallery with the painted windows and
the slippery oak floor and the thirty-seven family portraits all in a
row—no doubt she rode about herself with those hunting parties in
the winter, and rowed and skated on the lake—I can imagine it,
what a life it must have been. Can't you see her, before she grew
stout and careworn, and her bright hair got dull, and her pretty
hands rough with hard work—young, and lovely, and happy, and
petted by everybody—wearing beautiful clothes, and never knowing
what it was to have to do anything for herself? I can. And it seems
dreadful to think that she had to remember all that, living as she did
afterwards. If only he had made it up to her!—but I don't think he
did, Elizabeth—I don't think he did. He used to be so cross to her
sometimes. Oh, bless her, bless her! Why didn't she tell us, so that
we could have done more to comfort her?"
"I don't think she ever repented," said Elizabeth, who remembered
more about her mother than Patty could do. "She did it because she
loved him better than Bradenham and wealth and her own personal
comfort; and she loved him like that always, even when he was
cross. Poor father! No wonder he was cross!"
"Why didn't he go back—for her sake, if not for ours—when he saw
the advertisements? Elizabeth, my idea is that the death of his
brother gave a permanent shock to his brain. I think he could never
have been quite himself afterwards. It was a sort of mania with him
to disconnect himself from everything that could suggest the tragedy
—to get as far away as possible from any association with it."
"I think so, too," said Elizabeth.
Thus they talked by the kitchen window until the kettle bubbled on
the stove; and then, recalled to the passing hour and their own
personal affairs, they collected cups and saucers, sugar-basin and
milk-jug, and cut bread and butter for the afternoon repast. Just as
their preparations were completed, Eleanor came flying along the
passage from the sitting-room. "They have found a secret drawer,"
she cried in an excited whisper. "At least not a drawer, but a double
partition that seems to have been glued up; and Mr. Brion is sure, by
the dull sound of the wood, that there are things in it. Come and
see!"
She flew back again, not even waiting to help her sisters with the
tea. Silently Elizabeth took up the tray of cups and saucers, and
Patty the teapot and the plate of bread and butter; and they
followed her with beating hearts. This was the crisis of their long
day's trial. Paul was tearing at the intestines of the bureau like a cat
at the wainscot that has just given sanctuary to a mouse, and his
father was too much absorbed in helping him to notice their return.
"Now, pull, pull!" cried the old man, at the moment when the sisters
closed the door behind them. "Break it, if it won't come. A—a—ah!"
as a sudden crash of splintered wood resounded through the room,
"there they are at last! I thought they must be here somewhere!"
"What is it?" inquired Elizabeth, setting down her tea-tray, and
hastily running to his side. He was stripping a pink tape from a thin
bundle of blue papers in a most unprofessional state of excitement
and agitation.
"What is it?" he echoed triumphantly. "This is what it is, my dear"—
and he began in a loud voice to read from the outside of the blue
packet, to which he pointed with a shaking finger—"The will of
Kingscote Yelverton, formerly of Yelverton, in the county of Kent—
Elizabeth Yelverton, sole executrix."

CHAPTER XXXVIII.

THE TIME FOR ACTION.

Yes, it was their father's will—the will they had vainly hunted for a
year ago, little thinking what manner of will it was; executed when
Eleanor was a baby in long clothes, and providing for their
inheritance of that enormous English fortune. When they were a
little recovered from the shock of this last overwhelming surprise, Mr.
Brion broke the seal of the document, and formally and solemnly
read it to them. It was very short, but perfectly correct in form, and
the testator (after giving to his wife, in the event of her surviving
him, the sole control of the entire property, which was unentailed,
for her lifetime) bequeathed to his younger daughters, and to any
other children who might have followed them, a portion of thirty
thousand pounds apiece, and left the eldest, Elizabeth, heiress of
Yelverton and residuary legatee. Patty and Eleanor were thus to be
made rich beyond their dreams of avarice, but Elizabeth, who had
been her father's favourite, was to inherit a colossal fortune. That
was, of course, supposing such wealth existed in fact as well as in
the imagination of this incredible madman. Paul and his father found
themselves unable to conceive of such a thing as that any one in his
senses should possess these rare and precious privileges, so
passionately desired and so recklessly sought and sinned for by
those who had them not, and should yet abjure, them voluntarily,
and against every natural temptation and moral obligation to do
otherwise. It was something wholly outside the common course of
human affairs, and unintelligible to men of business. Both of them
felt that they must get out of the region of romance and into the
practical domain of other lawyers' offices before they could cope
effectively with the anomalies of the case. As it stood, it was beyond
their grasp. While the girls, sitting together by the table, strove to
digest the meaning of the legal phrases that had fallen so strangely
on their ears, Mr. Brion and Paul exchanged sotto voce suggestions
and opinions over the parchment spread out before them. Then
presently the old man opened a second document, glanced silently
down the first page, cleared his throat, and looking over his
spectacles, said solemnly, "My dears, give me your attention for a
few minutes."
Each changed her position a little, and looked at him steadily. Paul
leaned back in his chair, and put his hand over his eyes.
"What I have just been reading to you," said Mr. Brion, "is your
father's last will and testament, as I believe. It appears that his
surname was Yelverton, and that King was only an abbreviation of
his Christian name—assumed as the surname for the purpose of
eluding the search made for him by his family. Now, certain
circumstances have come to our knowledge lately, referring,
apparently, to this inexplicable conduct on your father's part." He
paused, coughed, and nervously smoothed out the sheets before
him, glancing hither and thither over their contents. "Elizabeth, my
dear," he went on, "I think you heard Mr. Yelverton's account of his
uncle's strange disappearance after—ahem—after a certain
unfortunate catastrophe?"
"Yes," said Elizabeth. "We all know about that."
"Well, it seems—of course we must not jump at conclusions too
hastily, but still it appears to me a reasonable conjecture—that your
father and Mr. Yelverton's lost uncle were one and the same person.
The affair altogether is so extraordinary, so altogether
unaccountable, on the face of it, that we shall require a great deal of
proof—and of course Mr. Yelverton himself will require the very
fullest and most absolute legal proof—before we can accept the
theory as an established fact—"
"Did I not say so?" Elizabeth interrupted eagerly, surprised by the
old man's sudden assumption of scepticism now that all doubt and
uncertainty seemed to be over. "I wish that nothing should be done
—that no steps of any sort should be taken—until it is all proved to
the last letter."
"Well," said Mr. Brion, at once abandoning his cautious attitude, "we
must take steps to obtain proof before we can obtain it. And, as it
providentially happens, we have received the most opportune and,
as I believe, the most unimpeachable testimony from Mr. Yelverton
himself, who is the loser by our gain, and who gave us the
information which is so singularly corroborated in these documents
before the existence of such documents was known to anybody. But
if more were wanted—"
"More is wanted," urged Elizabeth. "We cannot take advantage of his
own admissions to ruin him."
"If more were wanted," Mr. Brion repeated, with growing solemnity
of manner, "we have here a paper under your father's hand, and
duly witnessed by the same persons who witnessed the will—where
are you going, Paul?" For at this point Paul rose and walked quietly
towards the door.
"Go on," said the young man. "I will come back presently."
"But where are you going?" his father repeated with irritation. "Can't
you wait until this business is finished?"
"I think," said Paul, "that the Miss Kings—the Miss Yelvertons, I
suppose I ought to say—would rather be by themselves while you
read that paper. It is not just like the will, you know; it is a private
matter—not for outsiders to listen to."
Elizabeth rose promptly and went towards him, laying her hand on
his arm. "Do you think we consider you an outsider?" she said,
reproachfully. "You are one of us—you are in the place of our brother
—we want you to help us now more than we have ever done. Come
and sit down—that is, of course, if you can spare time for our affairs
when you have so many important ones of your own."
He went and sat down, taking the seat by Patty to which Elizabeth
pointed him. Patty looked up at him wistfully, and then leaned her
elbows on the table and put her face in her hands. Her lover laid his
arm gently on the back of her chair.
"Shall I begin, my dear?" asked the lawyer hesitatingly. "I am afraid
it will be painful to you, Elizabeth. Perhaps, as Paul says, it would be
better for you to read it by yourselves. I will leave it with you for a
little while, if you promise faithfully to be very careful with it."
But Elizabeth wished it to be read as the will was read, and the old
man, vaguely suspecting that she might be illegally generous to the
superseded representative of the Yelverton name and property, was
glad to keep the paper in his own hands, and proceeded to recite its
contents. "I, Kingscote Yelverton, calling myself John King, do
hereby declare," &c.
It was the story of Kingscote Yelverton's unfortunate life, put on
record in the form of an affidavit for the benefit of his children,
apparently with the intention that they should claim their inheritance
when he was gone. The witnesses were an old midwife, long since
dead, and a young Scripture reader, now a middle-aged and
prosperous ecclesiastic in a distant colony; both of whom the lawyer
remembered as features of the "old days" when he himself was a
new-comer to the out-of-the-world place that counted Mr. King as its
oldest inhabitant. It was a touching little document, in the sad story
that it told and the severe formality of the style of telling it.
Kingscote Yelverton, it was stated, was the second of three brothers,
sons of a long line of Yelvertons of Yelverton, of which three,
however, according to hereditary custom, only one was privileged to
inherit the ancestral wealth. This one, Patrick, a bachelor, had
already come into his kingdom; the youngest, a briefless barrister in
comfortable circumstances, had married a farmer's daughter in very
early youth (while reading for university honours during a long
vacation spent in the farmer's house), and was the father of a sturdy
schoolboy while himself not long emancipated from the rule of
pastors and masters; and Kingscote was a flourishing young captain
in the Guards—when the tragedy which shattered the family to
pieces, and threw its vast property into Chancery, took place.
Bradenham Abbey was neighbour to Yelverton, and Cuthbert Leigh
of Bradenham was kin to the Yelvertons of Yelverton. Cuthbert Leigh
had a beautiful daughter by his first wife, Eleanor D'Arcy; when this
daughter was sixteen her mother died, and a stepmother soon after
took Eleanor D'Arcy's place; and not long after the stepmother came
to Bradenham Cuthbert Leigh himself died, leaving an infant son and
heir; and not long after that Mrs. Cuthbert Leigh married again, and
her new husband administered Bradenham—in the interest of the
heir eventually, but of himself and his own children in the meantime.
So it happened that Elizabeth Leigh was rather elbowed out of her
rights and privileges as her father's daughter; which being the case,
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