# INBDE practice questions: FK9 — Behavioral science, ethics and law Ten original INBDE practice questions on FK9 — Behavioral science, ethics and law, each answered on this page with a rationale and a source. Last updated: 2026-08-10. ## Question 1 Before a surgical extraction on a 64-year-old man with several medical conditions, the dentist sends a consultation request to his physician. The reply arrives in full: "Patient is cleared for all dental treatment." No values, dates, or medication comments are included. What should the dentist do? - A. Accept it as authorisation, since the physician has now assumed the treatment decision - B. Re-ask a specific question, naming the procedure, expected bleeding, and planned prescriptions - C. Cancel the extraction, since a reply without numbers means treatment is contraindicated - D. Proceed and document that the patient was medically cleared before the appointment **Answer B:** Re-ask a specific question, naming the procedure, expected bleeding, and planned prescriptions A consultation asks a physician a specific clinical question, and "please clear the patient for dental treatment" is not a question — a reply saying "cleared for all dental treatment" with no number has answered nothing. A useful request states who you are and what you propose, the specific answerable question, what you already know including today's vital signs and the medication list, what you plan to prescribe, and how and by when to reply. A and D both read the reply as permission: the physician supplies facts, but only the dentist knows the procedure, so the dental decision stays with the dentist regardless of what the consultation says. C treats an unhelpful reply as a contraindication rather than as a request that needs rewriting, cancelling care nothing has ruled out. **Common trap:** Reading "cleared" as cover for the decision instead of information you still have to weigh. Source: Little & Falace's Dental Management of the Medically Compromised Patient ## Question 2 After explaining post-extraction instructions to a 35-year-old man, a dentist asks, "Does that make sense?" He says yes. At home he rinses vigorously and loses the clot. Which question during the visit would most likely have exposed his misunderstanding? - A. "So I know I explained it well, what will you do tonight at home?" - B. "Do you understand each of the written instructions I have just handed you?" - C. "Would you like me to repeat any part of the instructions again slowly?" - D. "Do you have any questions for me before you head home today?" **Answer A:** "So I know I explained it well, what will you do tonight at home?" AHRQ's teach-back method asks the patient to state, in his own words, what he needs to know or do, framed as a check on the clinician's explanation rather than a test of the patient. The toolkit explicitly identifies "Do you understand?" and "Does that make sense?" as not teach-back questions, because patients answer yes whether they understood or not — which is exactly what happened here. B is another yes/no comprehension question, and handing over written instructions checks nothing about what he actually absorbed. C offers repetition without ever revealing what he took away; re-explaining is the response to a failed teach-back, not the probe that finds the failure. D invites questions, but a patient who does not know he misunderstood has no question to ask. **Common trap:** Accepting a yes to a yes/no question as evidence of comprehension. Source: [AHRQ Health Literacy Universal Precautions Toolkit, 3rd Edition](https://www.ahrq.gov/health-literacy/improve/precautions/tool5.html) ## Question 3 A dentist gives a 70-year-old woman one long consent discussion covering diagnosis, options, risks, and home care, then asks her at the end to summarize. She repeats his phrases nearly word for word but cannot say what she will actually do. What should he change? - A. Have her sign now, since a verbatim repetition documents adequate understanding - B. Repeat the identical explanation once more and ask the same closing question - C. Break the information into chunks, check after each, and re-explain a different way - D. Switch to written instructions at a professional reading level for her home reference **Answer C:** Break the information into chunks, check after each, and re-explain a different way AHRQ's guidance is explicit on both failures here. First, do not save teach-back for the end of the visit: chunk and check — break information into small segments and check comprehension after each one. Second, a patient who parrots your words may not have understood, and when teach-back fails you re-explain a different way and ask again; you do not move on. A treats a verbatim echo as comprehension and the signature as the consent, but a signature does not necessarily constitute informed consent. B repeats the identical failed explanation, violating the rule that re-teaching must take a different form. D points the wrong direction: with 36 percent of US adults at or below Basic health literacy, materials must get simpler and be paired with a verbal check, not more professional. **Common trap:** Mistaking a parroted summary for understanding and re-teaching in the same failed way. Source: [AHRQ Health Literacy Universal Precautions Toolkit, 3rd Edition](https://www.ahrq.gov/health-literacy/improve/precautions/tool5.html) ## Question 4 A 44-year-old man signs a consent form for extraction of tooth #19 after the dentist explains the diagnosis, the procedure, and its risks and benefits. No alternatives are mentioned. The extraction goes well, but he later complains he was never told the tooth could have been saved. What is the status of his consent? - A. Valid, because the signed procedure-specific form documents the disclosure that occurred - B. Invalid, because alternatives, including no treatment, were never disclosed to him - C. Valid, because the uneventful outcome shows the disclosed risks were the material ones - D. Invalid, because written consent must always list all eight recommended form items **Answer B:** Invalid, because alternatives, including no treatment, were never disclosed to him The ADA describes informed consent as the conversation covering the dental problems observed, the nature of the proposed treatment, its benefits and risks, the alternatives, and the risks and benefits of those alternatives including not treating the condition, with the opportunity to ask questions. The omitted element here is the one candidates drop most: no treatment is always an alternative that must be disclosed. Consent is a process and discussion, not a document, so the missing conversation element defeats it regardless of the signature. A treats the form as the consent, when a signature does not necessarily constitute informed consent. C reasons backward from a good outcome, but adequacy of disclosure is judged at the conversation, not by results. D confuses the recommended contents of a written form with the disclosure duty itself. **Common trap:** Letting a signed form and a good outcome stand in for a complete disclosure conversation. Source: [ADA — Types of Consent](https://www.ada.org/resources/practice/practice-management/types-of-consent) ## Question 5 A 31-year-old woman is under nitrous oxide for a planned restoration on tooth #30 when the dentist finds caries extending into #31. He explains the added filling while she is still breathing nitrous, she nods, and staff bring a form to sign. What is wrong with obtaining consent this way? - A. Nothing, because a nod plus a signed form documents her agreement adequately - B. The form should have been signed by an accompanying adult on her behalf - C. Only the added cost, not the added procedure, required any new discussion - D. Consent from a patient under nitrous oxide may be invalid; discuss it unsedated **Answer D:** Consent from a patient under nitrous oxide may be invalid; discuss it unsedated ADA guidance states that consent obtained from a patient who is already under nitrous oxide, or on high doses of benzodiazepines or opioids, may be invalid: consent is taken before sedation, not after. When the plan changes, the consent must be updated, but the update must itself be a valid process — a discussion held once she is no longer sedated, since complex-treatment consent should be obtained in advance. A mistakes documentation for decision-making capacity; a nod under sedation plus a signature records nothing she could validly weigh. B misuses surrogates: she is a competent adult whose judgment is transiently clouded by sedation the practice administered, not a patient who needs a substitute decision maker. C shrinks the disclosure duty to fees, when it must cover the added procedure's nature, risks, benefits, and alternatives. **Common trap:** Updating the plan mid-visit without noticing the patient can no longer validly consent to it. Source: [ADA — Types of Consent](https://www.ada.org/resources/practice/practice-management/types-of-consent) ## Question 6 A practice's intake packet has every new patient sign a form authorizing "any and all treatment deemed necessary" for the coming year. A 58-year-old man signs it, and the dentist later relies on it for a crown. How would US courts view this consent? - A. As too broad and unspecific to satisfy the duty of informed consent - B. As valid general consent that covers restorative work but not surgical care - C. As enforceable if the patient initialed each page of the intake packet - D. As adequate because annual renewal keeps the authorization reasonably current **Answer A:** As too broad and unspecific to satisfy the duty of informed consent US courts have held that blanket wording such as "any and all treatment deemed necessary" is so broad and unspecific that it does not satisfy the duty of informed consent. Forms must be procedure-specific and in simple terms, and the consent itself is the conversation covering the specific diagnosis, proposed treatment, benefits, risks, and alternatives including no treatment — none of which a packet signed before any finding exists can contain. B invents a restorative-versus-surgical boundary; the defect is unspecificity, which invalidates the wording for a crown as surely as for surgery. C treats more signatures as more consent, but a signature does not necessarily constitute informed consent. D misapplies a real rule — some consents are valid only for a defined period and must be renewed — but renewal cannot cure wording that described no specific procedure. **Common trap:** Treating a broad standing authorization as a substitute for procedure-specific consent. Source: [AAPD — Informed Consent](https://www.aapd.org/globalassets/media/policies_guidelines/bp_informedconsent.pdf) ## Question 7 A 63-year-old woman declines the periodontal treatment her dentist recommends, after a full discussion of the consequences of refusing. She signs an informed-refusal form. Six months later her disease has progressed. What did her documented refusal do to the dentist's obligations? - A. It transferred responsibility for monitoring the progressing disease entirely onto the patient - B. It ended the treatment relationship and required dismissing her from the practice - C. It recorded her decision but did not release him from the standard of care - D. It limited him to supportive care and barred him from re-raising treatment **Answer C:** It recorded her decision but did not release him from the standard of care When a patient declines treatment, the dentist explains the consequences of not accepting it, documents the refusal, and obtains a signed informed refusal for the record where possible — all of which happened. But the AAPD is explicit that an informed refusal does not release the dentist from the standard of care; if he believes the refusal violates proper standards, his options are to recommend a second opinion and/or dismiss the patient from the practice. A shifts the ongoing duty wholesale onto the patient, which is exactly what the no-release rule forbids. B converts an option that exists only where the refusal violates proper standards into an automatic consequence of any refusal. D invents a limitation found nowhere in the guidance; nothing bars continuing to monitor, inform, and re-recommend the indicated treatment. **Common trap:** Reading a signed refusal as a discharge of the dentist's continuing duty of care. Source: [AAPD — Informed Consent](https://www.aapd.org/globalassets/media/policies_guidelines/bp_informedconsent.pdf) ## Question 8 A 27-year-old man arrives obtunded after facial trauma, with a bleeding oral wound that needs immediate surgical control. No family member or other surrogate can be reached, and the decision cannot wait. May the dentist proceed without informed consent? - A. Yes; treatment may begin now, with the patient informed at the earliest opportunity - B. Yes, but only the hospital's ethics committee can authorize starting the treatment - C. No; two licensed clinicians must first document agreement that treatment is required - D. No; treatment must wait until a court appoints a surrogate decision maker **Answer A:** Yes; treatment may begin now, with the patient informed at the earliest opportunity The AMA Code recognizes one narrow exception to prior informed consent: when a decision must be made urgently, the patient cannot participate, and no surrogate is available, treatment may begin without it, with the patient or surrogate informed at the earliest opportunity and consent obtained for ongoing care. All three conditions are met — the decision cannot wait, he is obtunded, and no surrogate is reachable. B misstates the ethics committee's role: its triggers are the absence of a surrogate for decisions that can wait, unresolvable disagreement, or a surrogate decision plainly contrary to the patient — not authorization of emergency care. C invents a two-clinician attestation the exception does not contain. D imposes the very delay the exception exists to prevent; no court appointment is required before emergency treatment. **Common trap:** Demanding a consent formality in the one situation the consent rules themselves exempt. Source: [AMA Code of Medical Ethics — Opinions 2.1.1, 2.1.2, and 5.3](https://code-medical-ethics.ama-assn.org/ethics-opinions/informed-consent) ## Question 9 A 52-year-old man with a fractured premolar hears the options — crown, extraction with implant, extraction alone — with the trade-offs of each. He says, "You're the expert; just tell me what you'd do." Under shared decision-making as taught in US practice, what should the dentist do? - A. Refuse to give a recommendation, since choosing for him would override his autonomy - B. Give a clear recommendation, matching the level of involvement he asked for - C. Have him complete a validated decision aid before any recommendation is offered - D. Defer the decision to a second clinician so the choice stays neutral **Answer B:** Give a clear recommendation, matching the level of involvement he asked for AHRQ's SHARE Approach is a clinician-led shared-decision-making model built on dialogue exploring the benefits, harms, and risks of the options and what matters most to the patient — which this dentist has done. Healthy People 2030 frames the national objective as providers involving patients in decisions as much as they wanted, and that qualifier carries the answer: shared decision-making is not forcing choice on a patient who wants a recommendation; it is matching the level of involvement the patient asks for. Delegating the choice after honest disclosure is itself an autonomous decision. A mistakes autonomy for abandonment and refuses the involvement level he chose. C erects a mandatory instrument no element of the model requires, delaying the answer he asked for. D outsources a conversation the model makes the treating clinician's to lead. **Common trap:** Confusing respect for autonomy with refusing to recommend when the patient requests a recommendation. Source: [AHRQ — The SHARE Approach](https://www.ahrq.gov/sdm/share-approach/index.html) ## Question 10 A 49-year-old woman with several intact amalgam restorations and no allergy history sees a dentist who, on his own initiative, recommends replacing them all to "remove toxic substances from her body." Under the ADA Code, how is this recommendation characterized? - A. Acceptable if she consents after a full discussion of costs and risks - B. Acceptable because the choice of restorative material lies within clinical judgment - C. Improper only if he charges more than his usual restorative fee - D. Improper and unethical, since the dentist initiated the recommendation himself **Answer D:** Improper and unethical, since the dentist initiated the recommendation himself Under veracity — truthfulness — dentists shall not represent the care being rendered in a false or misleading manner, and the ADA Code's advisory opinion is directly on point: recommending removal of amalgam restorations from the non-allergic patient for the alleged purpose of removing toxic substances, when recommended solely by the dentist, is improper and unethical, and the same principle applies to recommending removal of any restorative material. A fails because consent cannot launder the recommendation; the ethical defect is the unsupported representation that precedes and corrupts the consent conversation. B stretches clinical judgment past its warrant — representing that a treatment can cure or alleviate conditions is unethical when the representation is not based on accepted scientific knowledge or research. C relocates the wrong to the fee, but the opinion condemns the recommendation itself. **Common trap:** Believing that a willing, consented patient makes an unscientific recommendation ethical. Source: [ADA Principles of Ethics and Code of Professional Conduct](https://www.ada.org/-/media/project/ada-organization/ada/ada-org/files/about/ada_code_of_ethics.pdf) ## Next step [Take the free INBDE practice test](https://dentovio.com/inbde/free-practice-test) Official reference: [JCNDE — Integrated National Board Dental Examination](https://jcnde.ada.org/inbde). Original exam-style questions written for study, never recalled exam content. Independent educational preparation, not clinical advice, and not affiliated with or endorsed by the Joint Commission on National Dental Examinations.