General Medicine questions for the ADC written exam.

Answer: C. Written refusal of night guard

Documentation of patient refusal after advice demonstrates that risks were communicated and declined knowingly. This is particularly important when foreseeable complications occur. Shade selection and lab prescriptions are clinically relevant but less legally protective. Occlusal notes alone do not address consent.

Answer: C. Autonomy

Respect for patient autonomy requires providing sufficient information for informed decision-making. Patients must understand risks to make voluntary choices. Beneficence and non-maleficence guide care but do not replace disclosure. Justice relates to fairness, not consent.

Answer: B. Buffering capacity

Saliva’s buffering capacity neutralizes acids and restores oral pH. This reduces the duration enamel is exposed to demineralizing conditions. Low buffering capacity increases erosion risk. Viscosity and enzymes play minor roles in erosion control.

Answer: C. Actively listen and validate concerns

Active listening and validation help establish trust and reduce patient anxiety. Many patients with chronic pain feel unheard, which worsens their distress. Addressing emotional concerns can improve cooperation and symptom perception. This approach allows time to gather information before committing to irreversible treatment. It also aligns with patient-centered care principles.

Answer: C. Worsening pain and dissatisfaction

Irreversible treatment without a clear diagnosis often fails to relieve symptoms. This can increase patient frustration and reinforce distrust toward dental professionals. Additional procedures may create new sources of pain or complications. Careful diagnosis and conservative management help avoid harm. Ethical practice requires avoiding unnecessary interventions.

Answer: B. Documented informed consent

Medico-legal liability primarily depends on whether risks, alternatives, and limitations were properly explained and documented. Even if a complication occurs, well-kept records demonstrating informed consent significantly reduce practitioner liability. Material choice and laboratory work may contribute clinically but are secondary legally. Patient satisfaction alone does not define negligence.

Answer: B. Beneficence

Beneficence requires acting in the patient’s best interest by preserving natural dentition when possible. Conservative trauma management maximizes long-term oral health. Extraction would be unnecessarily aggressive. Ethical care prioritizes tooth preservation in children.

Answer: B. Limit adrenaline to 1:100,000

For patients with hypertension and renal issues, limiting the dose of vasoconstrictors is advisable to prevent blood pressure spikes. Using a standard concentration like 1:100,000 or 1:200,000 is generally safe but should be kept to a minimum (usually 2-3 cartridges). Felypressin (found in Prilocaine) should be used with caution in some medical contexts, but Lidocaine with limited adrenaline is the gold standard. Intravascular injection must be strictly avoided.

Answer: C. Case dismissal or defense success

Complete documentation significantly strengthens the dentist’s defense. Many cases are dismissed or resolved in favor of the practitioner when consent and records are clear. Compensation is not automatic following complications. Disciplinary action requires evidence of negligence.

Answer: C. Clear documentation

Clear, contemporaneous documentation is the strongest defense against disputes. It demonstrates professional reasoning and patient involvement. Fee reduction and free repairs may appease temporarily but do not address liability. Longer appointments alone do not prevent misunderstandings.