Dependent older adult with a full-time caregiver

Correct answer: B. Glass ionomer cement

• A. Amalgam has no fluoride release, requires retentive preparation that sacrifices sound cervical tooth structure, and offers nothing that glass ionomer does not offer better in this specific situation.
• B. CORRECT. Glass ionomer bonds chemically to dentine without a demanding bonding protocol, tolerates moisture, and releases fluoride continuously into a high-caries-risk, xerostomic mouth. It can be placed with atraumatic restorative technique in a patient who tires quickly and cannot be isolated well. This is the material of choice for cervical lesions in a dependent older adult.
• C. A saliva substitute treats the xerostomia that is driving the caries, and it belongs in the overall plan — but it is a preventive adjunct, not a restoration. The cavitated lesions still need restoring.
• D. Composite gives a better long-term margin and better aesthetics, but it demands excellent moisture control and a meticulous bonding sequence. In a patient with heavy plaque, xerostomia and limited chair tolerance, those conditions cannot be met reliably at the cervical margin.

Note: Build the whole plan around the caries risk, not just the fillings: caregiver-delivered brushing with 5000 ppm fluoride paste, in-office fluoride varnish at short recall, silver diamine fluoride for lesions that are hard to access, saliva substitutes, and a medication review with the physician for xerostomic agents.

Correct answer: C. A decline in glomerular filtration rate

• A. Total body water DECREASES with age while the proportion of body fat rises. This raises plasma levels of water-soluble drugs and prolongs the effect of fat-soluble ones.
• B. Serum albumin tends to FALL with age, which raises the free fraction of highly protein-bound drugs — again the opposite direction to what is stated here.
• C. CORRECT. Glomerular filtration falls steadily with age, so renally cleared drugs accumulate. That means longer half-lives, higher plasma concentrations and greater toxicity risk at standard adult doses. Renal function — not chronological age alone — governs dose adjustment.
• D. Gastric acid production tends to DECREASE with age, which can alter absorption of some drugs, but it is not the governing consideration for antibiotic dosing.

Correct answer: A. Report suspected neglect to the appropriate protective services agency

• A. CORRECT. Dentists are mandated reporters in every US jurisdiction. Gross, sustained neglect of a dependent adult's basic health needs is reportable to Adult Protective Services or the equivalent state agency. The threshold is REASONABLE SUSPICION, not proof — investigating and substantiating is the agency's job, not the dentist's.
• B. Raising it with the facility is reasonable in addition to reporting, but it cannot substitute for it — particularly when the facility is the likely source of the neglect.
• C. Treating the disease without reporting leaves the patient to return to the same conditions. The dental treatment addresses the consequence; the report addresses the cause.
• D. Dependent adults frequently cannot advocate for themselves, which is exactly why mandated reporting exists.

Correct answer: D. The ADA (American Dental Association)

• A. OSHA regulates workplace safety for dental EMPLOYEES — bloodborne pathogens, hazard communication, PPE.
• B. The FDA regulates devices, drugs and materials, not the delivery model of care.
• C. The CDC issues infection prevention and public health guidance for dental settings — not standards for remote care delivery.
• D. The ADA has issued teledentistry policy and guidance defining the modalities (synchronous, asynchronous, remote monitoring, mobile health) and the standard that the same duty of care applies as for in-person treatment.

Note: ⚑ Worth knowing both halves: the ADA writes the PROFESSIONAL guidance, but LEGAL authority over teledentistry — licensure, what may be delegated, what counts as an examination of record — sits with each STATE DENTAL BOARD. If a stem asks who REGULATES rather than who sets standards, the state board is the better answer.