The business of the practice

Correct answer: C. Subscription

• A. The SUPERSCRIPTION is the patient's identifying information — name, address, age and date — together with the Rx symbol at the head of the prescription.
• B. The TRANSCRIPTION, or SIGNA (Sig.), is the direction to the PATIENT, which the pharmacist transfers onto the label — for example ‘Take 4 tablets (2000 mg) 30 to 60 minutes before the dental appointment’.
• C. CORRECT. The SUBSCRIPTION is the ‘Disp.’ line — the instruction to the pharmacist naming the dosage form and how much to dispense, for example ‘Disp. four (4) tablets’.
• D. The INSCRIPTION is the drug itself and its strength, for example ‘Amoxicillin 500 mg tablets’. It is the core of the prescription.

Note: Two further elements are required for validity: the SIGNATURE of the prescriber, without which the prescription is not valid, and the number of refills. Also indicate whether generic substitution is permissible. A DEA number is required only for CONTROLLED substances and should never be pre-printed on the prescription pad, since a stolen pad then becomes a usable one.

Correct answer: D. Lessor's insurance

• A. Workers' compensation covers employees injured in the course of their work and is legally mandated in almost every jurisdiction once a practice has staff.
• B. Professional liability covers claims of negligence in patient care. It is essential and in most jurisdictions effectively mandatory.
• C. Business interruption insurance replaces lost income when the practice cannot operate after a covered event such as fire or flood, and it typically funds payroll and fixed costs during the closure. It is directly relevant — see the flooding scenario in this same case.
• D. CORRECT as the exception. LESSOR'S insurance is carried by the party who LEASES PROPERTY OUT — the landlord. A dentist renting an office suite is the LESSEE, and the lessor's policy is the landlord's concern, not the practice's. (A dentist who happens to own a building and rent it to someone else would carry it in that capacity as a landlord, which is precisely the distinction the question is testing.)

Note: The rest of the portfolio to recognise: GENERAL liability (a visitor slipping in the reception area), PROPERTY insurance on equipment and leasehold improvements, EMPLOYMENT PRACTICES liability, CYBER liability for protected health information, and DISABILITY plus OVERHEAD EXPENSE insurance for the owner — the last of these being the one most often overlooked and most needed, since the practice's income depends on one person's hands.

Correct answer: A. Ensure personal and staff safety, then shut off electrical power before securing records and equipment

• A. CORRECT. LIFE SAFETY COMES FIRST, always. Water and live electricity together are lethal, so people are evacuated and power is isolated at the main breaker BEFORE anyone wades in or touches equipment. Only then does asset protection begin — and the highest-value asset is the PATIENT RECORDS, which are legally required, irreplaceable and the operational lifeline of the practice. In a modern office that usually means verifying that the offsite or cloud backup is intact rather than physically carrying charts.
• B. Documentation for the claim matters and should be thorough, but it happens once the situation is stable and safe to enter.
• C. Notification of the carrier follows, within whatever time limit the policy specifies. It is not the first action.
• D. Moving equipment is a legitimate asset-protection step, but it comes AFTER the power is isolated and people are clear. Doing it first is how staff are injured.

Note: The general emergency sequence for any practice disaster: PEOPLE, then HAZARDS, then RECORDS and assets, then documentation and notification. Every office should hold a written emergency plan naming who does what, and HIPAA specifically requires a CONTINGENCY PLAN for electronic records covering data backup, disaster recovery and emergency-mode operation — which is why the backup, not the filing cabinet, is the thing to verify.

Correct answer: B. Inform the patient of the change and that there is no additional charge, and document it

• A. Billing an insurer for a material the patient was not charged for, and routinely waiving the patient's co-payment, moves into territory that carriers treat as fraud. Bill what was agreed and what was provided.
• B. CORRECT. Consent is given to a SPECIFIC treatment plan, and any material change to that plan belongs to the patient — including a favourable one. Telling them respects AUTONOMY and VERACITY together, removes any possibility of an unwelcome surprise later, and ensures the record accurately reflects what was actually placed, which matters for any future clinician and for warranty or replacement. Say it plainly: what changed, why, and that there is no extra charge.
• C. Silence assumes the only thing the patient could care about is the bill. They may have their own reasons — a known material sensitivity, a preference, advice from another clinician — and an undisclosed substitution damages trust out of all proportion to the benefit when it comes to light later.
• D. The insurance carrier is not the party whose consent is required for a change in the patient's treatment. The patient is.

Note: The free-upgrade scenario is the addition, and the principles engaged are autonomy and veracity together. The practical rule: no surprises, even pleasant ones.

Correct answer: D. Do not proceed; consult the oncology team about the radiation field and dose, and explain to the patient why imaging is essential before any extraction

• A. Documenting a refusal records a decision; it does not license substandard care. A well-documented negligent extraction is still a negligent extraction.
• B. Imaging a patient who has explicitly refused is a battery. The refusal must be respected even where it is clinically unwise — the remedy is persuasion and, failing that, declining to treat.
• C. Dismissal without addressing an urgent problem abandons the patient. Explain, offer alternatives, and refer appropriately.
• D. CORRECT, and for two independent reasons. First, a patient may refuse a radiograph, but a dentist may NOT provide treatment that falls below the standard of care — and an extraction planned without imaging does. Informed REFUSAL means explaining the specific consequences of declining; if the patient still declines, the correct response is to decline that treatment, not to perform it unsafely. Second, the history transforms the risk: radiation-induced changes in bone are PERMANENT, leaving the mandible hypocellular, hypovascular and hypoxic, so the risk of OSTEORADIONECROSIS after extraction is LIFELONG and does not diminish with time. Whether the mandible lay in the treatment field and what dose it received — above roughly 60 Gy the risk becomes substantial — determines whether this extraction belongs in general practice at all, and that information comes from the oncology team.

Note: If extraction in irradiated bone proves unavoidable it goes to a specialist for atraumatic technique with antibiotic cover; hyperbaric oxygen is considered, though the evidence supporting it is genuinely contested.

Correct answer: C. Beneficence against autonomy

• A. Nonmaleficence would be the operative principle if the central claim were that fluoridation causes harm. At the optimal level — 0.7 ppm under the current US recommendation — the recognised effect is mild dental fluorosis, and harm is not the substance of the mainstream debate.
• B. Veracity is truthfulness in communication and is not what is contested; no serious party alleges that fluoridation is concealed from the public.
• C. CORRECT. Fluoridation is the paradigm case of BENEFICENCE — a population-level intervention that substantially reduces caries at low cost and reaches precisely those least able to obtain dental care, which is also why it is defended on JUSTICE grounds — set against AUTONOMY, because an individual cannot readily opt out of the public water supply and has given no personal consent. That is the axis the debate has always turned on, and it is why the argument is framed as population benefit versus individual choice rather than as a dispute about the evidence.
• D. Same difficulty — veracity is not the axis of the disagreement, and pairing it against beneficence does not describe the conflict.

Note: ⚠️ The recall author answered ‘both’, which is defensible for the beneficence half but does not name the conflict. The ADA's five principles: AUTONOMY (self-governance), NONMALEFICENCE (do no harm), BENEFICENCE (do good), JUSTICE (fairness), and VERACITY (truthfulness). Justice supports the beneficence side of this particular argument rather than opposing it.

Correct answer: B. Exposed participants developed the outcome about 3.1 times as often as unexposed participants, and the result is statistically significant

• A. That describes the ODDS RATIO, which is what a CASE-CONTROL study yields. In a case-control design participants are selected by OUTCOME, so incidence cannot be measured and true relative risk cannot be calculated. The odds ratio approximates the relative risk only when the outcome is rare.
• B. CORRECT, on both halves. RELATIVE RISK is the incidence of the outcome among the EXPOSED divided by the incidence among the UNEXPOSED, so 3.1 means the exposed group developed the outcome 3.1 times as often. Interpretation: RR greater than 1 is INCREASED risk, RR of 1 is NO difference, RR less than 1 is REDUCED risk. And the confidence interval doubles as the significance test — because the interval 2.4 to 4.0 EXCLUDES the null value of 1, the result is statistically significant at the 5% level. A wide interval crossing 1 would not be, however impressive the point estimate looked.
• C. This inverts the rule. EXCLUDING the null value is exactly what makes a ratio measure statistically significant.
• D. 3.1 is a RATIO of incidences, not a percentage of participants, and a ratio on its own does not establish causation.

Note: Know which design yields which measure — COHORT studies, whether prospective or retrospective, give RELATIVE RISK because incidence is measurable; CASE-CONTROL studies give the ODDS RATIO. For RATIO measures the null value is 1; for DIFFERENCE measures such as risk difference or mean difference the null value is 0.