Dental Assisting: Roles, Procedures, and Infection Control, Exams of Media Laws and Ethics

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RDA Law and Ethics Exam 94 Questions and

Answers.

Conditional duties of an RDA - Correct answer a- remove excess cement with an ultrasonic scalar from supragivgival surfaces of teeth undergoing Roth treatment b- Allowable duties of a Roth assistant permit holder c- Allowable duties of a dental sedation assistant permit holder d- Application of pit and fissure sealants When can an RDA perform conditional duties? - Correct answer only when they have completed a board-approved educational program or when they can provide evidence on completing a board-approved course in the specific subject What evidence does an RDA need to provide to accompany their first license renewal (regarding conditional duties)? - Correct answer evidence of completion of a board- approved pit and fissure sealants course; if not, license will be suspended What duties may a DA/RDA/RDAEF perform while working for/at a primary care clinic or specialty clinic? - Correct answer any extra oral duty, coronal polish, topical fluoride application, pit and fissure sealants (if course completed) when under Direct Supervision of RDH/RDHAP Dental auxiliary - Correct answer a person who may perform dental supportive procedures under specified supervision of a licensed DDS Dental assistant - Correct answer unlicensed person who may perform basic supportive procedures under the supervision of a DDS Registered dental assistant - Correct answer a licensed person who may perform all authorized procedures in addition to all basic supportive procedures a DA may perform Direct supervision - Correct answer supervision of dental procedures based of DDS instruction and the DDS being physically present in treatment facility during the specified procedure General supervision - Correct answer supervision of dental procedures based on DDS instruction but where DDS must not be physically present during time of specified procedure Basic supportive dental procedures - Correct answer dental procedures categorized by their technically elementary characteristics, complete reversibility and inability to create potentially hazardous conditions for the PT

continuing education - Correct answer a condition of license renewal, the submission if evidence of an RDA/RDH/DDS continuing to stay educated on new and improving developments in the practice of dentistry, as well as reviewing infection control procedures, dental law, and BLS How much of a RDAs continuing education can the Board dictate? - Correct answer 7. hrs. in the general areas of PT care, health and safety, and law and ethics (For DDS, 15 hrs.) How many hours of continuing education does an RDA need to complete for each renewal? - Correct answer 25 hours, with 2hrs Infection Control, 2 hrs. Dental Practice Act, a BLS course (no more than 4 hours) Standard precautions - Correct answer a group of infection control and prevention practices that apply to all PTs equally, including the use of PPE, safe handling of sharps Critical vs. semi-critical vs. non-critical items - Correct answer critical - penetrates bone and soft tissue, highest potential for disease transmission Semi-critical - touches oral mucosa or non-intact skin but not penetrating soft tissue or bone Non-critical - items used in PT care but not oral mucosa membranes, much lower risk of transmission Levels of disinfection - Correct answer low - kills some bacteria, microorganisms, viruses but not Tb or spores Intermediate - kills Tb, but not necessarily spores High - kills Tb and some spores, but not guaranteed to kill all spores Germicide - Correct answer chemical agent used to disinfect items/surfaces based on level of contamination Sterilization - Correct answer validated process of rendering ALL viable forms of microorganisms inactive (kills all spores) PPE - Correct answer specialized clothing or equipment used to protect against a hazard (general work attire NOT included) OPIM - Correct answer other potentially infectious materials (bodily fluids form humans, testing animals, and fluid/tissue/organ potentially infected with a BBP) DHCP - Correct answer dental healthcare professional - all paid or non-paid personnel in dental healthcare setting who may be occupationally exposed to infectious materials Regulations regarding Infection Control Procedures - Correct answer a- standard precautions practiced with all PTs

b- Written protocol shall be developed and made available to all employees regarding instrument processing, operatory cleanliness, and management of injuries c- A copy shall be posted in a visible spot in office d- PPE worn during all procedures involving hazardous chemicals or handling contaminated items Hand washing - Correct answer a- with soap and water and start and end of day and when visibly soiled between PTs b- When not visibly soiled, an alcohol-based hand rub may be used C-hands must be thoroughly dried before putting on gloves d- DHCP with open/weeping wounds on hands will refrain from PT care, even with gloves, until it is resolved E-gloves are single use, not to be washed before or after use, discarded only Needles/Sharps Safety - Correct answer a- recapped only using scoop-technique or needle recapping device b- Do not bend disposable needles/scalpels\blades for disposal c- Sharps container will be kept as close as possible to point of use Sterilization/Disinfection - Correct answer a- all germicides must be used how and for the reason they were intended B-cleaning must precede all disinfection/sterilization c- Critical and semi-critical instruments will be disinfected and sterilized, then wrapped until used, stored in a manner that will not allow contamination d- Non-critical instruments must be cleaned with a low-level disinfectant, unless visibly contaminated with blood or OPIM c- Single use items will be disposed of, never reused d- All hand pieces and dental unit attachments will be packaged, labeled and heat sterilized Barriers - Correct answer if something cannot be adequately cleaned, it must be covered with a barrier; if bartered, and the surface below can be considered clean and uncontaminated Flushing Water Lines - Correct answer all lines will be flushed with air or water for 2 mines at start and end of each day, and for at least 20 sacs between PTs Lab Areas - Correct answer sterilization applies in the lab as well: new rag-wheels, pumice, etc. should be used for each PT, and all intraoral items coming out of the lab should be rinsed before being placed in the PTs mouth How soon must a DDS inform the Board of practice address changes? - Correct answer within 1 month - if not, license is suspended until changes have been made and fee paid

For how long may an expired license be renewed? - Correct answer within 5 years of expiration date - must submit renewal form, pay all accrued renewal fees and delinquency fees When will delinquency fees for late license renewal apply? - Correct answer 30 days after license expiration date What does "course of study" include (regarding CE courses)? - Correct answer area of study pertaining to medical or dental health, preventive dental services, diagnosis, treatment planning, clinical procedures, basic health science, dental practice management, or Dental Practice Act, PT management What are the mandatory courses for RDA license renewal? - Correct answer (Board approved) -Infection Control (at minimum, info on Section 1005 and rigs. in dental environment) ( units) -CA Dental Practice Act (2 units) -Basic Life Support (American Heart Asoka, American Red Cross, or course taught by provider approved by ADA) (4 units max) What does a course in Dental Practice Act cover? - Correct answer -acts in violation of DPA -utilization and scope of practice for auxiliaries and DDS -laws about prescribing of meds -citations, fines, revocation and suspension of a license -license renewal -obligations of mandatory reporting and clinical signs of abuse What will a BLS course include? - Correct answer -adult and pediatric CPR, including 2- person scenarios -Foreign-body airway obstruction -relief of choking for adult/child/infant -use of automated defibrillator with CPR -a live, in-person skills practice session, test and written exam CE courses of actual delivery of dental services may include what? - Correct answer - preventive services, diagnostic protocols, TX planning -charting of oral conditions -Record-keeping and informed consent protocols -nutrition and nutrition counseling of PT -esthetic, restorative and corrective dentistry -role of dentistry in community -legal ramifications of HIPPA, and of actual dental practice -admin of general anesthesia, conscious sedation, oral sedation, general medical emergencies -PPE, sterilization techniques

-substance abuse as it relates to medical/dental care -PT management (behavioral science and guidance) -selection, incorporation and use of emerging technologies -legal/ethical aspects of insurance industry -cultural competencies (bilingual dental terminology, cross-culture communication, etc.) What % of CE courses may be related to Practice Management? - Correct answer 20%, as these are considered to primarily benefit the licensee, not the PT Are courses that benefit the licensee directly allowed for CE credit? - Correct answer No

• courses such as money management, general physical fitness, those political in nature, etc. are not considered beneficial to work, only the individual and cannot be used for CE Does completion of a CE course authorize the attendee to use what they have learned in practice? - Correct answer NO! Unless covered under scope of practice, or class results in a permit What must registered providers of CE courses maintain and present in order for the course to be valid? - Correct answer -Speaker's CV -course content outline -eddo objectives and outcomes -teaching methods utilized -attendee records and rosters -record of registration #s and units issued for each course Board may audit at any time, and if this is not available the registered provider status may be revoked/suspended How long must one retain provider records? - Correct answer minimum of 3 renewal periods What should you get at the end of a CE course - Correct answer written certification of course completion, which includes? -licensee's name and license #, provider name, 11-dgit course reg. #, date attended, # of units earned, place for signature of verification of attendance How often are CE credits collected? - Correct answer Every 2 years (2 year renewal period) How many CE credits do dental professionals need? - Correct answer DDS = 50 units RDHAP = 35 units RDH/RDA/Sedation Asset/RDHEF/RDAEF/Ortho Asset = 25 units DDS w/ sedation permit requirements: - Correct answer -general anesthesia: 1 advanced cardiac life support course approved by AHA

-conscious sedation: min. of 15 units related to administration of conscious sedation, medical emergencies -oral conscious sedation: min. of 7 units related to admin. And medical emergencies Reasons for License Revocation or Suspension - Correct answer -unprofessional conduct -incompetence -Gross negligence -repeated acts of negligence in the profession -license issued by mistake

• convicted of crime substantially related to qualifications, functions or duties of RDA (only with certified record of conviction) Who revokes/suspends license - Correct answer Dental Board What is the statute of limitations for the Board to begin proceedings for license suspension/revocation? - Correct answer w/in 3 years of the Board discovering act or omission, or w/in 7 years of the act or omission actually occurring - whichever occurs first If placed on probation by the Board, what must the licensee do to get reinstated? - Correct answer - additional training -pass an exam -submit to a complete diagnostic exam by 1 or more physicians appointed by board (if medical or mental state is in question) -restrict/limit scope of practice -pay restitution of fees to Board or patients, or provide option of alternative community service -Pay ANY/ALL fees assigned by the Board prior to reinstatement (Not limited to these) Does a license suspension get noted on your record? - Correct answer YES - any/all actions that result in suspension or revocation are noted, as well as reinstatement date What construes "unprofessional conduct"? - Correct answer - getting $ for fraud/misrepresentation -employment of any unlicensed/student DA or DDS to practice dentistry -aiding any unlicensed person to practice -committing any acts of abuse, misconduct, relations with a PT that are related to the practice of dentistry -use of false or assumed name when practicing or advertising -obtain or possess any controlled substance (unless licensed to do so) -using any controlled substance or alcoholic beverage to the extent that it would impair one's ability to practice -having any convictions relating to controlled substances

Record-keeping - Correct answer must sign with name as listed on license, or with initials and an identifying number, and date next to the record of the service performed How soon must an office comply with a request for dental records from the Board? - Correct answer - w/in 15 days, or must pay a penalty of $250 per day for each late day, max. Of $5K -a health care institution (hospital, etc.) has 30 days PT's express written authorization must be included What is the penalty for not complying with a subpoena to provide PT records to the Board? - Correct answer - $1000 per day, unless it is deemed that the request is unlawful -not to exceed $5000, and the fees will be tacked onto the renewal fees at next renewal period -limit for a healthcare facility is $10K, plus a report to State Dept. of Health Services for disciplinary action Can a DDS perform services on anyone? - Correct answer only on Patients of Record -this does not include any initial diagnostic procedures What duties can a DDS ask an auxiliary to perform before they see the PT? - Correct answer -take x-rays -any extra-oral duties -Mouth-mirror inspection of oral cavity Patient of Record - Correct answer any person has been examined, has a medical and dental health history on file, and has had oral conditions diagnosed and a written treatment plan developed by the DDS (Does NOT include exams at health fairs, schools, or other community events, not the application of fluoride at such events) Mandated Reporting - Correct answer must report when has knowledge of or observes child abuse, sexual abuse, elder abuse, How much time do you have to report an incident of abuse? - Correct answer 36 hours from time of observation, or risk $1000 fine or up to 6 months jail time What about regarding photos/film of sexual nature? - Correct answer if the child depicted in under 16 years of age and depicted in any kind of sexual manner, this must be reported Do you need to report evidence of abuse to your employer? - Correct answer NO - the law only requires that you report to the correct agency; must not discuss with employer, colleges, or the caregiver or parent - mandated reporters are protected by law from being sued as long as the claim was made in good faith

Can licensees under current investigation request placement in diversion programs? - Correct answer Yes, but this does not mean that any investigation or disciplinary action would halt - unless it is a controlled substances offense: in that case, all disciplinary action is stopped and sealed as long as the program is successfully completed 6 ethical principles - Correct answer autonomy Non-maleficence Beneficence, Justice Veracity Confidentiality PT autonomy - Correct answer "self-governance" -PT has a right to actively participate in their treatment, and make their own decisions regarding treatment -PT have a right to have all records kept confidential unless they give written consent What practices does the principle of autonomy lay the groundwork for? - Correct answer -informed consent -confidentiality Upholding veracity (truth) Is patient autonomy absolute? - Correct answer No - a PT's right to self-determination does not mean that the DDS must perform whatever the PT says; DDS must still uphold all laws and ethics, and has the right to refuse service if PT is asking for something he does not feel he can morally/ethically do, or should refer to a specialist Informed Consent - Correct answer full explanation of treatment, bra’s, alternatives, -this also includes when documenting abuse: if DDS wants photos, impressions or x- rays to help document, he must explain to the PT what they will be used for Obligation to Inform - Correct answer DDS has an obligation to tell PT their exact oral health status, so that the best and most informed course of action can be decided upon RDAs and PT Autonomy - Correct answer - respect PT's right to decide own TX -respect legal, personal rights, human dignity, privacy of all PTs -maintain professional boundaries -maintain confidentiality -DOCUMENT ALL CONVERSATIONS to have record that PT was informed and made whatever decision after knowing all options/recommendations Non-maleficence - Correct answer "do no harm" -DDS has duty to keep from hurting a PT -DDS primary obligation is to keep skills and knowledge current, know one's limitations, and know when to delegation to an auxiliary

What practices does the principle of non-maleficence lay the groundwork for? - Correct answer -CE courses -referring cases to a specialist -unethical to practice when under the influence of a controlled substance, alcohol, or in an impaired mental or physical state Non-maleficence and BBPs - Correct answer -if a DDS gets a BBP he has an ethical duty to inform any PT or staff member who may have been exposed, and refer them to a qualified healthcare provider who may provide post exposure services -DDS should encourage the source individual to cooperate in an evil, or to expose their status, but may NOT tell anyone himself RDAs and Non-maleficence - Correct answer -act in best interest of PT -put PT health/safety first, as well as self and colleges -undertake assignments only when qualified to do so

• use PPE, other protective procedures -CE courses -refuse to conceal any incompetent acts of others Beneficence - Correct answer "do good" -duty to promote PT welfare, act to benefit of others
• DDS owes PT competent and timely dental care, w/in the bounds of the clinical circumstances presented by the PT What practices does the principle of beneficence lay the groundwork for? - Correct answer - very connected to PT autonomy, veracity and justice
• mandated reporting of suspected abuse
• referring cases to specialists when DDS's own skills do not allow them to provide to the standard of care What are the conflicts surrounding Mandated Reporting? - Correct answer DHCP have ethical/legal obligation to report suspected abuse, but adults have the right to confidentiality and self-determination. VERY IMPORTANT to know the law in your area of practice, to know at what point you must bypass PT rights and make a report, or vice versa Health Education to the Community - Correct answer -DCHP may participate, as long as they uphold the dignity of the profession (Advertising for your own practice at these functions is NOT looked upon favorably) -when making public statements, DDS must have a reasonable basis for believing what they say is true and promotes the profession Justice - Correct answer "fairness" -duty to treat people fairly -primarily deals with delivering dental care without prejudice

How does the principle of justice affect dental practice? - Correct answer -may not refuse PTs based on race/color/gender/etc. -may not treat PTs with illness, BBPs any differently OR refuse to treat them (standard precautions for all); may only refer them when a specialist's skills are necessary or if they think the PTs health will be compromised by TX Justice and "2nd Opinions" - Correct answer PTs are dependent on their DDS for true, complete info about their oral health status, so DHCP have obligation to be truthful, well-informed and reliable -when giving a 2nd opinion, be VERY careful not to openly disagree with the other DDS, just present your own opinion and course of TX you would take -do not want to imply that the PT was mistreated by anther DDS Ethics vs. Law - Correct answer nothing can be ethical but illegal, however some things are legal but unethical

• DHCP are held to the standard of legality and ethical TX RDAs and Justice - Correct answer -behave in a manner free from bias or judgment -behave ethically, and without conflict of interest -report unethical acts of others Veracity - Correct answer "truthfulness"
• Duty to communicate truthfully, to be honest and trustworthy What practices does the principle of veracity lay the groundwork for? - Correct answer - truthful representation of care being performed -Truthful representation of fees - for PT and insurance companies -the basis for open doctor-patient relationships Waiver of Co-payment, overbilling, fee differential - Correct answer - illegal to charge an ins. co. for services rendered and then waive the co-payment portion for the PT
• Unethical to increase a fee based on the type of ins. a PT has
• The fee that you would charge a PT without dental benefits is the fee that must be charged for all PTs -may not change dates of treatment on ins. claims to maximize PT benefits -may not incorrectly describe the TX performed on an ins. form to receive payment for otherwise uncovered services -unethical to recommend unnecessary services in order to maximize benefits Unearned or non-health degrees - Correct answer DDS or DHCP may list their academic degrees after their name, but may not list any non-health related, or non- academic degrees: this contributes to confusion on part of PTs, who may attribute certain skills to you that you do not have, and is a misrepresentation RDAs and Veracity - Correct answer -conduct oneself with honesty and integrity -provide PTs with truthful assessments of problems and potential TX, including RBAs

Compassion - Correct answer caring and the ability to identify with the PT's over-all well-being Competence - Correct answer -ability to diagnose and treat the PT's oral health care issues, or to refer when it is in the PT's best interest -a commitment to life-long learning (CE courses) Integrity - Correct answer - behave with honor and decency What practices does the principle of integrity lay the groundwork for? - Correct answer - PT confidentiality

• Not making false statements in any documents filed with ADA, CDA -no false advertising
• Not issuing public statements that would change the public's view of the profession, or that may be questionable in fact -not misrepresenting oneself by listing non-academic or non-health degrees after one's name, and may also not list licenses or certificates Not to involve oneself in situations where a conflict of interest may arise Professionalism - Correct answer -should actively support and promote the profession and its services to the public RDAs and professionalism - Correct answer -obtain/maintain knowledge of laws, rules, regulations that govern dental assisting -comply with CA Dental Practice Act -report illegal acts of others, or violations of DPA Tolerance - Correct answer addresses the continually changing cultural mix in CA/USA -must treat all PTs fairly and equally, but also take into account the differences in culture and what that means with regard to differences in dental care