Start practicing

Ethics & Law · patient case with 4 questions

Behavior Management and Infection Control

demo: 11-year-old male with autism spectrum disorder

chief: Restorative appointment; parent is present in the operatory.

history: Autism spectrum disorder with repetitive echolalic speech. Plays competitive basketball. Class II Division 1 malocclusion with an overjet of 8 mm.

meds: None

findings: Frankl behavior rating 2 (negative). Parent and child are both to be gowned and masked during an aerosol-generating procedure.

Question 1

The child repeats phrases he hears without apparent communicative intent. This is:

  1. Evidence of an anxiety disorder
  2. A normal developmental stage for an 11-year-old
  3. Echolalia — a classic feature of autism spectrum disorder
  4. A sign of hearing impairment
Show answer and explanation

Correct answer: C. Echolalia — a classic feature of autism spectrum disorder

  • A. Anxiety may accompany autism but does not itself produce echolalia.
  • B. Echolalia is developmentally normal in toddlers around age 2, not at 11.
  • C. Correct. Repetitive or echolalic language is one of the recognized features of autism spectrum disorder, alongside restricted interests, sensory sensitivities, and difficulties with social reciprocity.
  • D. Hearing impairment tends to reduce speech output and distort articulation rather than produce faithful repetition.

Permanent page for this question

Question 2

Given the 8 mm overjet and competitive basketball participation, what should be recommended?

  1. A nightguard worn only during sleep
  2. A custom-fitted mouthguard to protect against traumatic dental injury
  3. Withdrawal from contact sport until the malocclusion is corrected
  4. Immediate comprehensive orthodontic treatment before any sport participation
Show answer and explanation

Correct answer: B. A custom-fitted mouthguard to protect against traumatic dental injury

  • A. A nightguard addresses parafunction during sleep, not impact protection during play.
  • B. Correct. Increased overjet is one of the strongest predictors of anterior traumatic dental injury, and basketball has a high rate of orofacial trauma. A custom mouthguard is the immediate protective measure.
  • C. Withdrawing a child from sport is disproportionate and not a dental recommendation.
  • D. Orthodontics will reduce long-term risk but does not protect him this season; it is not the immediate answer.

Permanent page for this question

Question 3

Which organization provides the guidelines governing the PPE worn by the parent and child during this aerosol-generating procedure?

  1. OSAP, with OSHA setting the enforceable workplace requirements
  2. HIPAA
  3. FERPA
  4. The Joint Commission
Show answer and explanation

Correct answer: A. OSAP, with OSHA setting the enforceable workplace requirements

  • A. Correct. OSAP — the Organization for Safety, Asepsis and Prevention — issues comprehensive dental infection control guidance including PPE recommendations extending to patients and accompanying persons; OSHA sets the legally enforceable occupational requirements.
  • B. HIPAA governs the privacy and security of protected health information, not physical protective equipment.
  • C. FERPA governs the privacy of student education records and has no clinical application here.
  • D. The Joint Commission accredits hospitals and health systems, not routine private dental PPE practice.

Permanent page for this question

Question 4

A parent asks that her child participate in choosing among treatment options and asks who controls access to the child's records. Which framework governs that access?

  1. The ADA Code of Ethics
  2. OSHA
  3. OSAP
  4. HIPAA, which establishes the patient's right of access to their health records
Show answer and explanation

Correct answer: D. HIPAA, which establishes the patient's right of access to their health records

  • A. The ADA Code is professional ethics guidance; it is not the legal framework governing records access.
  • B. OSHA regulates workplace safety for employees.
  • C. OSAP issues infection control guidance.
  • D. Correct. HIPAA sets the rules for privacy, security, and patient access to protected health information, including a parent's access to a minor's records.

Note: Involving a child in decisions appropriate to their maturity is assent, which complements — but does not replace — the legally required informed consent of the parent or guardian.

Permanent page for this question

Practice patient cases Ethics & Law study notes