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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.

Dental_CertPrep_Part_IIA_GC.indd 14 2/12/11 1:29 PM

 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.

Dental_CertPrep_Part_IIA_GC.indd 23 2/12/11 1:29 PM

 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.

Dental_CertPrep_Part_IIA_GC.indd 25 2/12/11 1:29 PM

 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.

General Chairside
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).

Dental_CertPrep_Part_IIA_GC.indd 27 2/12/11 1:29 PM

 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.

Dental_CertPrep_Part_IIA_GC.indd 28 2/12/11 1:29 PM

 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.

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

 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.

Dental_CertPrep_Part_IIA_GC.indd 30 2/12/11 1:29 PM

 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

Dental_CertPrep_Part_IIA_GC.indd 32 2/12/11 1:29 PM

 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.

Dental_CertPrep_Part_IIA_GC.indd 33 2/12/11 1:29 PM

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dishevelled and barefoot in shabby stretch /leopard skin leggings,
mesmerised by the outline of his own shadow on the video
projection of an unfinished work in progress: VIDEOVOID. Clutching
a microphone into which he speaks in a low whisper, half to himself,
"What I was going to do here erm, it's funny seeing it projected for
the first time." Shadow artifice. The audience gurgle adoringly.
Osnabriick European Media Festival 1990. David's film EETC, 5
monitors. Various versions brought along, so he talks and drinks with
the five versions running simultaneously. People clamouring to
squeeze into the large room, no standing room, no space on the
stairway... In Germany Larcher is hailed as the phenomenon that he
is. Have you ever heard of him? Jackson's Lane, Archway, London
(before it became a lo-brow chi-chi dance space). David is in a pair
of stripy pyjamas in a makeshift bed with a bedside lamp just like in
Granny's flat. The 'ISH-TANK film is floating on a TV screen at the
foot of the bed. Multi-projections from Monkey's business (excerpts
from the epic double screen MONKEY'S BIRTHDAY. A bottle of
whisky on the small round table echoing Granny's... His amour at the
time, the film-maker young Julie Osborne with dark glasses, a tight
leopard skin cocktail number and a long white stick... Larcher curses
the acolytes, critic O'Pray and Curtis from the Arts Council who show
up nervously and then lurk in the wings. "Get out I don't want you,
what good have you ever done? You never gave me a penny so you
can shove off. Make sure they paid to get in. Playful acrimony. Huh."
Larcher made a film called MARE'S TAIL, 4 hours, 16mm, which
Berio saw at the old Arts Lab and rated as a work of genius, when
David was only a young man. His next epic was MONKEY'S
BIRTHDAY, 6 hours, two screens, colour. An exotic travelogue with
two separate optical sound tracks. They could run completely in
synch but they never do. MONKEY'S BIRTHDAY outstrips Warhol's
CHELSEA GIRLS in assemblage terms with its complex hand matting,
superimposition, colour tinting, solarization and other optical effects
and devices, the kind of which have never been produced or
reproduced on video and which are not the premise of words.
MONKEY'S BIRTHDAY is alchemical. 99 1991. David is lying on his
back with one foot in the air to demonstrate to the appalling Film
Co-op administrators the division between two screens in a twin
screen film, in case they were too blind to notice, adding for which
as an artist he ought to get paid double, even if it's only to pay for
the repair. David Dawson of KD Digital is slewed projecting. The film
shreds. David yells that he wishes the admin' bitch Wieland would
croak. With two films together that makes twelve hours of celluloid...
now someone somewhere must have believed in David otherwise
even then, it really wouldn't have been possible to produce such an
extravaganza. There is a group of overwhelmed Viennese art
students sitting on the bench at the back of the cinema, spell-bound
as whirling dervishes solarise, change colour and swirl against fast
moving clouds. MONKEY'S BIRTHDAY is an epic. It was made 25
years ago and it has been shown about 7 times in Britain. Of those 7
I've seen the full thing twice. The first time there was an audience of
me, a member of the public and the Co-op Cinema projectionist.
Larcher is one of many who fell foul of the mainstream avant-garde
because of his hybridity, his collage, his use of all media, his
tendency to synthesise, to take the medium for what it was, stretch
it to where it would go. There is no-one else - and with this number,
age doesn't enter into the equation - working in Britain who has
taken film printing and video to such limits. Granny's flat in
Gloucester Road. It's the middle of winter. David comes in starkers,
waggling his dick. Cerith Wyn Evans, my daughter Rachel and I are
sprawled on the bed in the back room at Granny's, gawping at yet
another version of EETC. Ra tells him to act his age. The music boys
for CLING FILM have all got a big crush on David's mind and copy as
much of his oeuvre as they're able whilst he's away. They probably
made off with his double dildo too. In excited 'round the fire and I'll
tell you a tale or two' mode, David turns on a tape he can't think
what to do with. Sarah his new found amour (David has an
insatiable penchant for lush ladies), is lying naked on the couch.
David, goat-like and 20 some years her elder /senior cavorts, hairy
and unshaven, like an evil satyr round his prize, brandishing a heavy
leather belt, thwacking her with a nod BRITISH UNDERGROUND
CINEMA
 in the direction of S & M. He's making more noise than
doing harm. He peers disgracefully and myopically into the lens, his
face distorts. He takes the camera, the new video toy, and tunnels
between her legs to arrive at a hairy mound. He's discovered a cave
OK, a crevice. The tape goes frizzy. The camera swoops round and
hones in on her face. She's out for the count. He lifts an eyelid. Her
eyes roll white. David pops into frame and turns to face the lens:
"And what are you doing now Malcolm LeGrice and Peter Gidal and
the little Arts Council, tee hee..." David chips in live, "Can you
imagine, on my great night of passion ? How could they have got so
deep into my subconscious... It's appalling... I'll have to do
something about this tape some time." "The guilt", I thought. Guilt
for not having played their game, joined their club.. Guilt for
showering your seed recklessly across Europe, when they had the
knot tied in the vasectomy vogue, one of them at the age of 23
because he didn't believe in reproduction in any form... Guilt for your
wavering sexual preferences, when they had none. 1994. I take
VIDEOVOID in a programme on tour to East Germany, Leipzig, Halle
and Dresden. I'm worried the work may be too abstract for an
uninitiated audience. East Germans haven't had much exposure to
the avant-garde as you can imagine. In Leipzig after the films the
discussion is thronged. And one after the other people try to explain
to themselves and to others why they sat mesmerised, mouths
open, almost hypnotised for half an hour, when there was no
narrative, no story line, not really any kind of a line, save allusions to
the 18 Buddhist states of the VOID encircling the earth. In fact
they'd spent half an hour mesmerised by travelling images of drop
out, the bits you usually don't want or reject... the holes in the tape.
So this is an electronic manifestation of aspects of the void. But wait,
don't you sit for half an hour listening to Bach, abstract even by
musical standards, does Bach always have a melody (the musical
equivalent of a story line) or does he drop it and pick it up again?
David is a trickster and magician. He works with Anthony who used
to work with Pink Floyd. Seeing the two of them putting the finishing
touches to the tracks on EETC (bravely shown by Rod Stoneman on
Channel 4)... A line of coke. A fat joint. Cans of lager. What a state!
4 a.m. the two stood in front of banks of equipment like two loony
magicians or improvising musicians - their musical tools also
consisting of image tracks, dealt with as tracks... Now! Bring it in
now... One, two, three, four.... Get it! Start! accompanied by
agitated foot tapping and finger clicking etc. There is a difference
between the way a film will perform with an audience when the
artist is adept at manipulating sound levels and tone, at introducing
a sound, an interruptive breath, even spontaneously, playing the
image and sound as two hands on a piano, and when they are not.
By this I don't mean they can't assemble adequate and meaningful
chunks of text on paper, but they can send the audience rushing for
their ear plugs, like if I opened my mouth and tried trilling that aria
from the Magic Flute. The difference is between those who are
musicians (even amateur musicians) and those who are not, those
who can act /use their voices (yes, like in the theatre or at least in
public) with the presence to hold the audience, and those who can
do no such thing; natural born story tellers, singers, charmers - and
those who are not. So the films fall into two categories for me, the
ones where the sound is conscious and real, the second where the
sound is a mess. It may be the tenor of the voice that's wrong, as in
Liz Rhodes's insistent use of the plum alienating variety. Slowing it
fractionally to lower the pitch doesn't take away the sign value, the
meaning of this sound. For miners, workers, thickos from the
regions, this accent and tone is the epitome of the coloniers. Cut.
OK. Redo it out of courtesy for the dead. Change your fucking
accent. Cut the squawky edge from the voice. Think about the
theatre of voices, whispers, shouts. How to captivate, or alienate the
audience on purpose. Larcher the amateur clarinet player. No
coincidence that it is a blowing instrument which requires him to
control his breathing when he is speaking and it is this, above
everything else, which holds and captivates his audience. He would
probably loathe my guts for picking up on this, but you can comb
through his soundtracks and find an abundance of electric sound
moments, but his voice is shifting pitch, faltering, finding its pitch,
musing.. Waffling on the soundtrack is real close up work, but he
chooses to take the philosophy of others, the authority of the
philosophy of others, the scientific handbook or text, backed up with
secondary texture - tap tap tap on the mike, contrasted with a
casual but conscious familiarity, "hello, hello" set against the deep
rasping tobacco cracked old wise philosophers' rhythmic formal
enunciations: " Quand est la trace, quand est le vol, quand est
I'oiseau..." Accentuated by the rhythmic white flash underlining the
image, the single or double line of white subtitles. THE EYEBALL
COMPENDIUM: FEATURES
 GRANNY'S IS (1989, 46 mins) Originated on low-grade
video. Unusually a BF1 NEW DIRECTORS film, and so blown up to
film for distribution by the BFI. A few prints sold at cost price. The
BF1 almost immediately lose theirs and don't bother to replace it.
The Freunde der Deutschen Kinemathek's is either lost or stolen.
There are two versions - the TV one at 58mins and a longer one on
the international circuit at 70-80mins. Wheras 58mins is too
cramped, the longer version has a tedious lOmins. As usual it would
be better somewhere inbetween. In 1988 or was it 1987 Larcher's
Granny died. This was a terrible blow. Granny had painted, was
cultured 1 assume and exceedingly tolerant of David's eccentricity,
perhaps because of her own. She was eccentric herself we soon
gather; quite proper, of her era. David lived in Granny's flat near
Gloucester Road, whenever he was in England and not France. (It's
important not to forget that Larcher is from old colonialist blondie
stock. Mauritian. Bi-lingual. French / English and he could also speak
Mauritian Creole which absolves him from some of the sins of his
Fathers (but not many). Everyone thought this an eccentric
arrangement, for a grown man to live at Granny's flat. The warmest
shot of the intended film was Granny in bed on her birthday in a
pink bolero with one tit exposed, snorting coke with great abandon
and opening presents - Christmas. David's kids were distraught
when Channel 4 insisted this scene be cut since it might shock and
offend the general public: a scene which'd make us all wish we'd had
a real dame, a game Granny like that. GRANNY'S IS is an
affectionate and exacting portrayal of losing some-one who has been
there so long; who is still lingering in film cans and on videos and in
photographs like a ghost, and realising that now that she is dead
how much she meant to him, how much his own life was formulated
by her. David only manages to say this through Proust's words.
Proust gives him the back-up to grieve over a thing a grown man
ain't supposed to sniffle about - an old woman. Proust gives him the
authority, the permission even, to grieve publically through this film.
A clock ticking - a still image of Granny in bed - an image of Granny
on a park bench. The sound of traffic near Gloucester Road, near
Granny's flat. Granny is very old now - in bed - her faint voice - a
video image distorted. Granny's eye beams out lurid video lines.
Granny is no longer - (are we viewing a horror film from the
underworld?). Granny's eye, in close-up: "Could you come and sleep
near me?" "You know, I feel really jumpy...." (we catch the word
“ghosts") - aeroplane sound. Cut to Granny's foot in a dainty brown
leather shoe with a leather bow. She hums and taps her stick. This
stick tapping is repeated like DON'T LOOK NOW. Now over and over.
Granny is only a trace - is distorted. Titles spin like crazy. Granny: "I
used to go to church and my tummy used to rumble - awful
thought". David busy with his camera. SHE WHO SLEEPS - Title over
image. Matting out Granny. David in the photographic studio. The
crystal ball from MONKEY'S BIRTHDAY and EETC. "She married
George Elsworth... At some point he made circular saivs in
Sheffield..." The image rotates, and puns: "Circular saws are quite
interesting." A room. Granny's flat. David twists the lens in front of
the camera. The image changes magically. Granny and her friencds
scoff biscuits. 7 don't drink coffee Granny". A refrain from the
funeral. Voice "she died..." The voices of the old ladies. David
gathering together the photos in the room.... "Logi Baird" David
unscrews the diopter. The image physically rotates, becomes circular,
becomes rectangular. "I know how difficult it is to stay alive... It's
not the weight of years you know", David says to Granny. David
vacuuming the empty flat. Granny's room. Exaggerated clock ticking.
WHAT IS SPOKEN REMAINS IN THE WAITING ROOM FOR THE
FUTURE TO HEAR IT David faffing with leads in his leopard skin
leggings. Scraps of domestic chatter. Meanwhile, an image of David
left alone in the flat. The stuff of diary or autobiography. Within the
frame of an old plate camera - a ship on an ocean wavering - the
edge old Granny's face. Quiet. Peacefully she sleeps. David
whispering sotto voce - words from Proust as Granny slumbers: “I
became conscious that she ivas dead... but behind my thoughts was
a callous and cruel young man ...the memory of ivhat she had been.
( only phrases, isolated words, can be captured). "shocked by the
certainty of that annihilation... a mere strangerbefore and after
those years I ivas and would be nothing" "waiting for the kettle to
boil" "I urns wondering whether DAVID LARCHER
 102 to have coffee or chocolate" Kettle whistles. Clock ticks.
Gloucester Road traffic rumbles. Kitchen sounds. Granny is very old.
"I'll leave you to go to bed" The light goes out. Blackness. Granny: "
What are you thinking?" David: "Nothing special..." TAP TAP THE
BUND NIGHT'S WHITE STICK (appears on the screen). Granny's
having a sherry watching TV. Granny's painting of her room.
Silhouette of Granny as an old woman, like the ageing Adam in Piero
della Francesca's Arezzo fresco. The silhouette appears like a shroud.
The family group photo. David plays with obliterating and re-
appearing members of the family group, so delicately done, and
she’s your daughter" Daughter and child sail into the plate camera
frame. Granny's video image rotates across the image of the room.
In the background like a refrain “Don’t cry Granny.... Don't cry
Granny" whispering gently, voices as texture. "Suddenly called into
being by her voice" "very upset I don't know why, alas , it was this
fact" "I found her there reading. She wasn't aware of my presence.
She was absorbed in thoughts which were never allowed to be
seen... to become the spectator of one's own absence..." Granny by
the sea in Mauritius. "The delicate quality of her mind... smacked of
necromancy... each face that we love... a mirror of the past... seeing
the most trivial aspects of our daily life..." Granny's faint image like a
ghost. She stumbles elderly, clad in a dressing gown, across the
room. Faint voice in the background "beloved person.." Close up of
Granny's ageing watery eye, whitening, pallid, clouding over,
translucent. "A transparency of contiguous and overlapping
memories..." "Since she vanished very quickly" “crazed eyes" "a
dejected old ivoman".... Silence. Dripping sounds. The ticking clock.
Some faint music. A kind of electronic buzz. A disturbance. It falters,
fades like a radio wave. Granny is snoozing. Radio 3. The image is
carefully placed and changed. Abrupt cut. Granny with a neighbour.
"Oh darling!" Granny is now matted electronically into the arm chair
- into the plate camera... David to old lady neighbours "I've got her
picking her nose. Would you like to see that ?" Granny is
everywhere, in the pictures, in the dresser - on the wall. “That’s
fantastic..." "Extra-ordinary" Posho voices pipe in. David stands in
the doorway contemplating the empty grannyless room. Banalities.
The neighbours conversation, “...and she got gastric flu" "I'll murder
him" "He only does it because he loves you" The neighbour cuts in.
The image flips. A Proust text in French appears in granny's
armchair. Granny: " You're interested in the solar system aren't you?"
Granny varnishing her nails. Granny on the phone. The word
UNHINGED appears prominently across the image (this seems to
refer to David's lostness after Granny's death). Parts of Granny's
diaries. The word DAVID in handwriting. Granny as a child. The
image floats in - a hymn is vaguely heard in the background.
Perhaps from a funeral. The image is highly distorted. The return of
the little chant "Don't cry Granny... A subtle mix of rhythm voice -
hymn. David examining photos under the eyeglass, endless albums.
" The invisible shadow" "mirror' "in other words her double" "see no
image" "suffering mourning is preferable..." Granny's room reflected
in a convex mirror or the curve of a lens. A wide angle... fish eye
lens. David puts out the light. Puts out the light and then puts out
the light. Creaks and more creaks. Fab titles to the tap tap tapping
of granny's stick heard like a thousand woodpeckers, like a litany,
like a literal army of Granny's sticks, relinquished to the sound of
creaks as the titles rotate pivoted on an invisible axis, fly into reverse
and swivel back again - forward reverse forward... occasionally wind
shooshing in the trees or simply the hiss of tape noise... The film
ends. Now I would go on to talk about the use of momentum and
speed and rhythm, the choreography of video effects, which begins
quite crudely in EETC but this is definitely the thing to watch for and
wonder about the function of in GRANNY'S IS (as well as in
VIDEOVOID, VOIDTEXT and the upcoming 'ISH TANK, which he is
currently working on). It wasn't until he was allowed to use the
video artists' monastery /play school at Montbeliard in France that
the Nijinsky of celluloid became the Nijinsky of electronic art. There
is not enough space here to give more than a few leads or hints.
What is important to stress is that in the UK we the potential
audience are given restricted access, via the structures that exist, to
see and enjoy the cutting edge of media art, which incidentally has
not issued from the gallery system but from the laboratories and
workshops. Clearly such artists made the big philosophical and
tactical THE EYEBALL COMPENDIUM: FEATURES
 103 art market mistake of calling themselves makers. David
Larcher was last year invited to become Professor at the New Media
Centre in Cologne in Germany. He's never held a job down in his life
before, but he's been lured by the financial and other appreciation
that he is receiving outside this ungrateful, uncultured quick art buck
country. The sad fact is that Larcher is only part of a massive UK
media art drain. We are left wondering not very much about the
outbreak of easy-come easy-go. Emperor's New Clothes, thin-on-
the-intellectual-ground installation work that remains. (PS: Several of
David Larcher 's films and video pieces are available through London
Film-makers' Co-op distribution. Contact them for details. Note to
colleges, film societies etc: arrange screenings wherever possible!
This man is the real deal, a brilliant artist whose work has been
criminally neglected in his own country ignoring him is like ignoring
Brakhage! - Stephen Thrower) DAVID LARCHER
 Monogram madness: THE APE MAN menaces a Rhodes
Boyson lookalike whilst a mortified starlet looks on...
 The Grin Beneath the Flesh by Ramsey Campbell "Many do
not realize that horror has always had an element of the comic in it."
So say Anthony J. Fonseca and June Michele Pulliam in Hooked on
Horror: a Guide to Reading Interests in Horror Fiction (Libraries
Unlimited, Englewood, 1999). Is this something of an exaggeration?
I don't recall many chuckles in Le Fanu or Walter de la Mare, not to
mention The Willows and The White People, for just a few instances.
Still, horror and humour do have crucial elements in common:
timing, for example, and a willingness to confront taboos in a form
that stylises them, which can make them more approachable. Both
genres are also liable to be accused of having gone too far. I would
also suggest that nothing is funnier than a really bad horror film,
though 1 say this in a spirit of celebration: for me the world would
be a poorer place without Edward D. Wood. All of which certainly
suggests some inter-relationship, and I hope the ruminations this
prompts may prove at least amusing. The horror genre has always
been hospitable to parody. The Gothic novel had begun to parody
itself before Jane Austen sniffed at it. Of course this won't do as a
dismissal of Northatjger Abbey, which both pointed to this very
situation and suggested that there could after all be some truth in
the Gothic. Equally, by the time the feature film began to take it on,
the theatrical genre had reached a self-parodic state. Thus Paul Leni
(THE CAT AND THE CANARY) and Roland West (THE BAT, THE
MONSTER) relish parodying the old dark house thriller by treating it
with arguably more style and enthusiasm than it deserves. THE
MONSTER also finds room for outright comedy, with a brilliant wire-
walking sequence that turns into a gag worthy of Keaton. Nor had
verbal humour to await the coming of sound. While Lugosi's delivery
of Dracula's ambiguous lines is unforgettable, and established a
talent for melodramatic comedy on which he was able to draw
during the doldrums of his career (in THE DEVIL BAT, for instance.
where he instructs the chosen victims of his giant bat to dab a
spiked aftershave on their throats and then intones a sepulchral
goodbye), it was Max Schreck's Nosferatu who hailed a photograph
of Mina Harker with the intertitle "Is this your wife? What a lovely
throat." Some have assumed that the sequence in NOSFERATU
where the vampire's coach speeds up to the accompaniment of an
intertitle reading "The dead travel fast" is meant as a joke. I'm
reminded that before a showing of the film at the Philharmonic Hall
in Liverpool, the leader of the musical accompanists told the
audience that they wouldn't mind if we laughed. Guess which
spectator was heard to growl that some of us would mind.
Presumably some people need to be reassured that humour is
intentional, a theme to which I'll return. The first major exponent of
humour in the horror film was James Whale, whose sly gay wit is
seldom fully appreciated. In FRANKENSTEIN this ranges from puns
about birth, both visual (the cord that is the film's first image) and
verbal {"Here he comes" and of course "It's alive"), to outright
comedy (Frankenstein's double-take at learning what kind of brain
he has put in his monster). THE BRIDE OF FRANKENSTEIN hardly
needed Mel Brooks to underline the humour of the meeting of
monster and hermit, and the film is more overt than its predecessor
about the implications of two men “giving birth" to a creature; rather
than object to the title on the grounds that it confuses the creator
with his monster, I'd argue that the bride is the decidedly feminine
Dr Praetorius, who seduces Frankenstein away from his marriage
before that can be consummated. The same actor, Ernest Thesiger,
was also Horace Femm, owner of THE OLD DARK HOUSE. Could the
name be another wink to those in the know? Whale directs some of
the film as a comedy as broad as Charles Laughton's Yorkshire
accent in it, an approach that leaves audiences unprepared THE
GRIN BENEATH THE FLESH
 io6 for Whale's willingness to frighten. If the film parodies
the genre of its title, it is darker than most of the originals. How
intentionally comic is Michael Curtiz's DR X? Excess in our genre can
be fun for those able to take it, and this is among the earliest
examples on film, where one member of staff at Dr Xavier's
Academy of Surgical Research is a cannibal maniac, and all of them
potentially are. More power to Curtiz for never sending it up. A yet
more spectacular thirties instance is Dwain Esper's roadshow movie
MANIAC, now available on British video, in which Poe's The Black Cal
was turned into a deranged exploitation extravaganza. Not only does
the unfortunate cat suffer deoculation, but the perpetrator swallows
the result. Intertitles were brought in to turn the film into a serious
study of psychosis, but only added to the fun, not least by their
arbitrariness. The way Universal horror films often resorted to comic
relief was taken over, along with their monsters, by Hammer (at this
point I abandon from sloth the semblance of chronological order to
which I've kept so far). Perhaps the Hammerheads didn't notice that
their films already gained humour from Peter Cushing's timing and
his relish of his lines, though admittedly the movies would be less
endearing without the pop-eyed cameos by such stalwarts as
Michael Ripper and Miles Malleson. In the previous decade, however,
the Universal influence had gone fascinatingly wrong when taken up
by Monogram and PRC. In THE APE MAN, for instance, one might
have thought the spectacle of Lugosi's titular transformation would
have satisfied the comic appetite at least as much as the tragic
sense of taste poor bugger, he's afflicted with sideboards that would
shame Rhodes Boyson and with a swinging of the arms too - but the
film also offers walk-ons by a grotesque who, in the final shot,
identifies himself as the screenwriter. Does one laugh, or groan, or
merely experience a tightening of the guts? I suggest that the
unique embarrassment of witnessing the death-throe of a joke
shudders very close to a kind of horror, and this seems to be my cue
to talk about discomfort as it relates to our theme. For a start,
imagine that Hell might consist of eternity spent locked up with your
least favourite comedian. What an incitement to lead a better life! A
film that seems to hint at such a situation is THE NUTTY PROFESSOR
II: THE KLUMPS, starring Eddie Murphy and Eddie Murphy, not to
mention Eddie Murphy... Overtly the film may attempt a comic
reworking of Flowers for Algernon, but another similarity is to Philip
K. Dick's Upon the Dull Earth, in which everyone on Earth turns into
the same person. Next time you're drifting off to sleep, try
visualising a world populated by Eddie Murphy in various stages of
grossness. I'm not sure I envy you your dreams. While the
discomfort implicit in all this (or in anything involving, say, Norman
Wisdom) is presumably unintentional, some films seem to aim to
achieve it. That's the area in which the ruthless psychological satire
of Mike Leigh meets the bad dreams of David Lynch. The heightened
realism of Leigh's TV films such as Nuts in May and Grownups (just
as unsettling as the better-known Abigail's Party) challenges the
audience to deny that people - we - are like this (whereas the
documentaryish surface of Ken Loach's films seems to insist on a
single political interpretation of events, an approach that I'm afraid
always sets me echoing Kingsley Amis). Recently television shows
such as Trisha, that mismating of spectacle and would-be social
work, have invaded Leigh's territory, but the power of his
observation seems undiminished, not least because the portrayal of
his grotesques never invites THE EYEBALL COMPENDIUM: FEATURES
 107 anything as comforting as a straightforward laugh. A
similar realism underlies such episodes in David Lynch as Henry's
dinner with his girlfriend's parents in ERASERHEAD, surely the most
disconcerting such episode since George Stevens's ALICE ADAMS, in
which the dinner scene is one long slow burn of embarrassment.
One source of discomfort is truth to experience. More openly popular
comedy can also confront the darkness. My sense is that Kenneth
Williams adopted so many personae partly in order to combat the
depression of being alone with himself. Of course depression is often
the underbelly of creativity, but even in comedy it sometimes seeps
to the surface. Are there many more oppressive halfhours than
Hancock's attempts to while away a Sunday? Perhaps some of those
involving Steptoe and Son, surely the grimmest comic duo outside
Beckett. It's also hardly surprising that One Foot in the Grave ended
with a revenge murder that could have been imagined by Ruth
Rendell or Nicholas Blake - why, one episode of the series was even
called "The Pit and the Pendulum" - and the coda of the last episode
was oddly sobering, a series of quintessential Victor Meldrew gags at
which, because they were posthumous, the audience didn't laugh.
As we get older it becomes more crucial to know how to laugh at
whatever pratfalls mortality has in store for us. Well, this is grim,
isn't it? Perhaps it's time to return to the comforts of horror. In The
American Cinema Andrew Sarris commented that Blake Edwards's A
SHOT IN THE DARK got laughs from gags too gruesome for most
horror movies, but that doesn't hold true any longer. Indeed, in the
EVIL DEAD trilogy gruesomeness famously meets the Three Stooges,
as if they weren't frightful enough in themselves (though in one
short they met a mummy grislier than either Abbott and Costello or
that pair's Egyptian nemesis). This kind of hybrid seems to bother
some mainstream audiences, not to say reviewers. When should
they stop laughing in THE WICKER MAN?, they complain. How to
react to Polanski's peculiar humour, which in DANCE OF THE
VAMPIRES lurched from farce and slapstick into eerier vampire
imagery than anything in Hammer? The worst offender, if one
believed contemporary reviews, was DEATH LINE, widely derided as
inadvertently hilarious (though Robin Wood, Philip Jenkinson and
Tony Bilbow sprang to its defence). 1 can only conclude that the
London press show refused to let the film be itself: certainly in a
packed public screening in Liverpool the audience laughed only at
the film's intentional humour, uncomfortable though some of that is.
I'm also reminded that around the same time Alan Bennett
condemned WITCHFINDER GENERAL for not being unintentionally
funny, which he declared all horror films should be, and drew a
passionate riposte from Michael Reeves. I wonder whether Bennett
would acknowledge verbal wit, one of his own strengths, when it
occurs in horror films. Some lines from PSYCHO are never forgotten
once heard (though let us remember that Robert Bloch invented
them), but the acme of verbal playfulness is surely VIDEODROME, a
feast of puns and ambiguities entirely suited to its theme. It's
generally worth scrutinising the names of Cronenberg's characters as
well as everything they say. Only audiences less than alert to his
methods can have been surprised by the overt if disquieting comedy
of EXISTENZ. And only readers hoping for me to dredge up a
conclusion from my ramblings will be disappointed. Let me rather
end by celebrating the variety of fun to be had in our field. In no
particular order - good Lord, in no order at all - I commend the
irrepressible Antipodean humour of Peter Jackson, the man who
must have made the Muppets ashamed to appear in public... the
spectacle of the entire cast of THE GIANT CLAW performing with a
seriousness that proves they never saw the special effects... the task
Ed Wood set himself in NIGHT OF THE GHOULS of staging a fake
stance that was meant to look inept... for the utterly unsqueamish,
Lucio Fulci sending up his entire horror career as a deranged version
of himself in CAT IN THE BRAIN ("But Lucio, you'd have to be mad
to go and see a psychiatrist")... years before Kevin Williamson
undermined the horror film with hollow post-modernism, the greater
(not to say less obtrusive) wit of HALLOWEEN... the often
unacknowledged and entirely intentional comedy of Lovecraft:
"Damn it, it wasn't quite fresh enough" was a running gag in Herbert
West: Reanimator before it was ever filmed... DEATH TRAP, Tobe
Hooper's reworking of PSYCHO as a nightmare pantomime complete
with Captain Hook's crocodile, a film only the humourless could have
wanted to see prosecuted... But let me end on a serious note after
all. Horror, exactly like humour, can be used for reactionary and
repressive ends. Monsters that utter bad jokes as punch lines to
their atrocities should be viewed with suspicion. Never trust a film
that announces we aren't to take it seriously - never take it at its
own valuation, at any rate. We who know the genre recognise that
nowhere is everyone's last grin closer to the surface. THE GRIN
BENEATH THE FLESH
 TO EXCESS: The grotesque in Juraj Herz's Czech films by
Daniel Bird Since 1966, Juraj Herz has directed over 30 films for film
and television, forming a body of work constituting a dense
exploration of the fantastic. Herz is primarily known in the West for a
brilliant, nauseous black comedy, SPALOVAC MRTVOL (THE
CREMATOR, 1968). However, the director's filmography
encompasses a wide range of genres: MORGIANA (1971) and UPIR
Z FERATU (THE VAMPIRE OF FERAT, 1981) can be classified as
horror; in PANNA A NETVOR (BEAUTY AND THE BEAST, 1978)
FROSCHKONIG (THE FROG KING, 1990) and DIE DUMME
AUGUSTINE (THE DUMB AUGUSTINE, 1992) he adopts the formal
trappings of the fairytale; PASAZ (PASSAGE, 1998) is an exercise in
the absurd; and ZNAMENI RAKA (THE SIGN OF CANCER, 1966) is a
warped detective story. More recently (1994 and 1995), he has
made two French films in the Maigret series about the eponymous
police inspector, and there is even a burlesque musical to his credit,
KULHAVY DABEL (THE LIMPING DEVIL, 1967). Outside the New
Wave Herz's palette is predominantly grotesque, and, as in the films
of Fellini (described by Herz as his "only love") and more recently
Alexei German's KHRUSTALIEV, MASHINU! (KHRUSTALIEV, MY CAR!
1998), visual and narrative excess becomes a formal strategy.
Expressionist madness is played as comedy in SPALOVAC MRTVOL;
in MORGIANA, the doppelganger device is loaded to the point of
absurdity; whilst themes of social decadence and moral decay are
played out of a physically sick body in PETROLEJOVS LAMPY (OIL
LAMPS, 1971). Herz possesses a somewhat precarious place in film
history: he is a Slovak known for his work in Prague, though since
his emigration in the late 1980s the majority of his films have been
made in Germany. However, Herz's 'Czech' films are generally
disassociated from the New Wave, for, on the one the one hand, the
emergence of Herz as a major filmmaker came after the Prague
Spring with the release of SPALOVAC MRTVOL in 1969, and, on the
other hand, his work lacks the political bite of, for example, Jan
Nemec or Vera Chytilova's films, favoring, as the Czech author Josef
Skvoreckv puts it, the 'time machine' or period drama. However,
within those constraints, two of Herz's subsequent films,
PETROLEJOVE LAMPY and MORGIANA, made immediately after the
Soviet-led invasion of Czechoslovakia, are in no sense compromised.
For example, Herz encouraged cinematographer Jaroslav Kucera to
continue the colorful photographic experimentation of Chytilova's
SEDMIKRASKY (DAISIES, 1966) and OVOCE STROMU RAJSKYCH
JIME (THE FRUIT OF PARADISE, 1969) in MORGIANA, resulting in
the film being described as the 'last' film of the New Wave. Herz
himself stated that he feels little sense of belonging to the Wave, but
rather a kinship with Evald Schorm and the late Jarmoil Jires. Like
Schorm and Jires, Herz contributed to, as Josef Skvorecky put it, the
"manifesto of the Czech New Wave": the portmanteau adaptation of
Bohumil Hrabal stories PERLICKY NA DNE (PEARLS OF THE DEEP,
1965). Herz's episode, however, was later excluded, along with Ivan
Passer's, to reduce the running time. Unlike Schorm and Jires, Herz
did not attend FAMU, the film and television faculty at the Academy
of Performing Arts in Prague (Akademie muzickych umeni, Praha;
AMU). Conversely, Herz's formal training began, like that of Jan
Svankmajer (an exact contemporary of Herz, both being born on 4
September 1934) by studying puppetry at the theatre faculty of AMU
between 1954 and 1958. Like two of the most famous New Wave
luminaries, Jin' Menzel and THE EYEBALL COMPENDIUM: FEATURES
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