INBDE cheat sheets · Updated October 2026
INBDE Cheat Sheets: Local Anesthetics, Anticoagulants, Steroids, Infection Control and Ethics
Five one-screen reference sheets for the topics INBDE candidates ask about most, plus quick tabs for analgesics and antibiotics. Every number comes from an FDA label, a US guideline or the ADA Code, and each sheet lists its sources.
7 mg/kglidocaine with epinephrine, US label cap 500 mg
0.04 mgconservative epinephrine limit, cardiac patients
Weeklyspore test, at minimum
500 CFU/mLmaximum for dental unit water
How to use these sheets
Short answers to the questions the exam keeps asking
A cheat sheet does not replace learning the topic. It is the page you open the night before a test to check that the numbers in your head are the right ones. At The Study Boards we see the same small facts cost marks again and again: the maximum dose of a local anesthetic, whether to stop a blood thinner before an extraction, how often to spore-test an autoclave. These sheets put those facts in one place.
PrintingTap a tab to read one sheet on your phone. When you print the page, all six sheets print together, one after another.
How The Study Boards helps you
How The Study Boards helps you with these facts
- No need to build your own sheets: our faculty-created Modules and Master Files already hold these doses, rules and principles, subject by subject.
- Recall built in: our daily tasks, nightly live tests at 9 PM New York time and test series are built on active recall, and red lines and assignments come back to you on the go until the numbers stick.
- Used in cases: 35,000+ focused questions put each number into a patient case, the way the INBDE asks.
- Extremely personalised: the course learns from the way you are studying, and US-licensed dentists answer your questions, not AI.
See the full structure in the INBDE course blueprint.
Six sheets
The cheat sheets
Pick a topic. Each sheet ends with the sources it was built from.
Sheet 1 · Local anesthetics
Dental local anesthetics: dose per cartridge and US maximums
| Agent | mg per cartridge | US label maximum (healthy adult) | Onset and duration (label) |
|---|---|---|---|
| Lidocaine 2% with epinephrine 1:100,000 | 36 mg per 1.8 mL (34 mg per 1.7 mL) | 7 mg/kg (3.2 mg/lb); keep below 500 mg1 | The standard agent others are compared with |
| Articaine 4% with epinephrine 1:100,000 | 68 mg per 1.7 mL | 7 mg/kg; same limit for children 4 to 16 years2 | Onset 1 to 9 minutes; about 1 hour after infiltration, up to about 2 hours after a block2 |
| Mepivacaine 3% plain | 51 mg per 1.7 mL (54 mg per 1.8 mL) | 6.6 mg/kg (3 mg/lb); total 400 mg3 | Short: operating anesthesia about 20 minutes upper jaw, 40 minutes lower jaw3 |
| Prilocaine 4% plain or with epinephrine 1:200,000 | 72 mg per 1.8 mL | 8 mg/kg under 70 kg; 600 mg at 70 kg or more, within 2 hours4 | Plain: short maxillary procedures. With epinephrine: soft tissue about 2.25 to 3 hours4 |
| Bupivacaine 0.5% with epinephrine 1:200,000 | 9 mg per 1.8 mL | 90 mg per dental sitting5 | Long: onset 2 to 10 minutes; numbness often about 7 hours, 2 to 3 times longer than lidocaine or mepivacaine5 |
mg per cartridge = concentration (%) x 10 x volume (mL). US cartridges are labelled 1.7 or 1.8 mL; check the one in your hand. Children: the labels give no fixed maximum; dose by weight and use the least amount that works.1
Epinephrine limits
0.018 mgepinephrine in one 1.8 mL cartridge of 1:100,000
0.2 mgmaximum per appointment, healthy adult (about 11 cartridges of 1:100,000)7
How to work out the real maximumFor a healthy 70 kg adult on 2% lidocaine with 1:100,000: 7 x 70 = 490 mg, which is about 13 cartridges. Epinephrine stops you sooner: 0.2 mg is about 11 cartridges. Always take the lower of the two numbers.8
Cardiac patients: what the evidence saysThe 0.04 mg figure is the most conservative and most quoted limit, and it applies to roughly a 30-minute period, not a whole day. Take vital signs before you start and after each 1 to 2 cartridges.6 The AHA and ADA hold that a vasoconstrictor is not contraindicated when given carefully, and a systematic review found up to 4 cartridges of lidocaine 1:100,000 relatively safe in cardiovascular patients.7
Sources: FDA dental cartridge labels for lidocaine, articaine, mepivacaine, prilocaine and bupivacaine; Becker and Reed, Anesth Prog 2012; Godzieba et al., Med Sci Monit 2014; DiMarco and Bassett, Dimensions of Dental Hygiene 2013. Full links in References 1 to 8.
Sheet 2 · Anticoagulants and antiplatelets
Blood thinners and extractions
The rule that runs through all of this: stopping a blood thinner raises the risk of clot, stroke and heart attack, so the default is to keep the drug and control bleeding locally. Any change to the regimen is made only with the patient’s physician.9
| Drug group | What to do for a simple extraction |
|---|---|
| Warfarin | INR in the therapeutic range (3.0 or less): continue the usual dose. An uncomplicated extraction is considered safe with an INR up to 3.5 (AAOM 2016); some experts accept up to 4.0.9 |
| DOACs: apixaban, rivaroxaban, dabigatran, edoxaban | For most patients no change is needed. For higher bleeding risk, and only with the physician: delay the daily dose, book the procedure as late as possible after the last dose, or pause for 24 to 48 hours.9 |
| Aspirin, clopidogrel and other antiplatelets | No need to stop; use local measures.9 |
| Dual antiplatelet therapy, coronary stent | Never stop early: stent thrombosis risk. Talk to the cardiologist before any change. A 2020 meta-analysis advised against stopping dual therapy before minor oral surgery.9 |
Local measures to stop bleeding
1
PressureFirm gauze pressure over the socket.
2
Hemostatic agentsAbsorbable hemostatic material packed into the socket.
3
SuturesClose the socket to hold the clot and the agent in place.
4
Tranexamic acidAn antifibrinolytic, used locally to protect the clot.9
Sources: ADA Oral Health Topics, Oral Anticoagulant and Antiplatelet Medications and Dental Procedures (updated 28 September 2022). Reference 9.
Sheet 3 · Corticosteroids
Patients on steroids and adrenal insufficiency
The current viewAdrenal crisis is a rare event in dentistry, and most routine dental procedures can be done without extra (supplemental) steroid. The large “cover” doses used since the 1950s are no longer the default.10
| Situation | What to do |
|---|---|
| Secondary adrenal insufficiency (suppression from long-term steroid medicine), routine care | Usually no supplement. Risk rises with bigger surgery, general anesthesia, an unwell or unstable patient and poor pain control.10 |
| Primary adrenal insufficiency (Addison disease), minor treatment such as scaling or a filling | Higher risk group. UK guidance: an extra oral dose of the usual steroid 1 hour before the visit.11 |
| Primary adrenal insufficiency, minor oral surgery under local anesthesia | Supplement before the procedure and for a full 24 hours afterwards. Ask the patient to bring their emergency hydrocortisone kit. Plan with the endocrinologist.11 |
| Minor to moderate surgical stress, endocrine guideline dosing | Hydrocortisone 25 to 75 mg per 24 hours, usually for 1 to 2 days.12 |
Suspected adrenal crisis in the chair
100 mghydrocortisone by injection (IM or IV), straight away12
1,000 mLisotonic saline in the first hour12
200 mghydrocortisone over the next 24 hours12
In the chair: stop treatment, call emergency services and use the patient’s emergency hydrocortisone kit if they brought it.
Sources: Miller, Little and Falace, JADA 2001; NHS Specialist Pharmacy Service 2019; Endocrine Society clinical practice guideline on primary adrenal insufficiency, 2016. References 10 to 12.
Sheet 4 · Infection control
Sterilization methods and parameters
| Method | Parameters |
|---|---|
| Steam autoclave, gravity displacement, wrapped instruments | 121°C (250°F) for 30 minutes, or 132°C (270°F) for 15 minutes; dry 15 to 30 minutes14 |
| Steam autoclave, prevacuum, wrapped instruments | 132°C (270°F) for 4 minutes; dry 20 to 30 minutes14 |
| Dry heat | 170°C for 60 minutes, 160°C for 120 minutes, or 150°C for 150 minutes15 |
| Unsaturated chemical vapor | Mainly alcohol with 0.23% formaldehyde, heated in a closed pressurised chamber13 |
Which items need what (Spaulding categories)
| Category | Touches | Processing |
|---|---|---|
| Critical | Penetrates soft tissue or bone (surgical instruments) | Heat sterilize |
| Semicritical | Mucous membranes or non-intact skin (handpieces, prophy angles) | Heat sterilize; heat-sensitive items need at least high-level disinfection |
| Noncritical | Intact skin only | Clean, or clean and disinfect with an EPA-registered hospital disinfectant13 |
Monitoring the sterilizer
| Check | How often |
|---|---|
| Mechanical: time, temperature, pressure readouts | Every load |
| Chemical indicator | Inside every package; add an outside indicator if the inside one cannot be seen |
| Biological indicator (spore test) | At least weekly, with a control from the same lot, and every load that contains an implant16 |
| Positive spore test | Take the sterilizer out of service, review the steps, retest at once. A second positive: repair, then three negative fully loaded cycles before use; recall items back to the last negative test.16 |
Water, vaccination and exposures
500 CFU/mLmaximum heterotrophic bacteria in treatment water (EPA drinking water standard)17
20 to 30 sflush devices that enter the mouth after each patient13
Sterilesterile saline or water as coolant or irrigant for surgery17
| Topic | The rule |
|---|---|
| Hepatitis B vaccine | Every team member who may touch blood or sharps should be vaccinated; test anti-HBs 1 to 2 months after the 3-dose series.13 |
| HIV post-exposure prophylaxis (2025 USPHS) | Report the injury at once. Start PEP as soon as possible, up to 72 hours after exposure; course lasts 28 days; final HIV test at week 12.18 |
| Patient exposed in your office | Tell the patient immediately and refer for post-exposure evaluation (ADA Code 2.E).19 |
| Prion precautions | Steam autoclave at 134°C for 18 minutes.13 |
Sources: CDC Guidelines for Infection Control in Dental Health-Care Settings 2003; CDC Summary of Infection Prevention Practices in Dental Settings 2016; CDC Guideline for Disinfection and Sterilization 2008; CDC sterilization monitoring FAQ; 2025 USPHS occupational HIV PEP guideline. References 13 to 18.
Sheet 5 · Ethics
The five principles of the ADA Code, with an example of each
| Principle | Meaning | One-line example from the Code |
|---|---|---|
| 1. Patient autonomy | Self-governance: respect self-determination and confidentiality | Explain the proposed treatment and reasonable alternatives so the patient can take part in the decision (1.A). |
| 2. Nonmaleficence | Do no harm | Do not stop a course of treatment without adequate notice and a chance to find another dentist (2.F, patient abandonment). |
| 3. Beneficence | Do good: promote the patient’s welfare | Learn the signs of abuse, neglect and human trafficking and report suspected cases as state law requires (3.E). |
| 4. Justice | Fairness | Do not refuse a patient because of race, creed, colour, gender, sexual orientation, gender identity, national origin or disability (4.A). |
| 5. Veracity | Truthfulness | Recommending or performing unnecessary treatment is unethical (5.B.6).19 |
Rules that often appear in questions
| Topic | What the Code says |
|---|---|
| Informed consent | The dentist informs the patient of the proposed treatment and any reasonable alternatives, in a way that lets the patient become involved in the decision (1.A). |
| Records | Keep them confidential. On request from the patient or their new dentist, provide copies or summaries, including radiographs, whether or not the account is paid (1.B, 1.B.1). |
| Reporting abuse | Report suspected cases to the proper authorities, consistent with state law. For an adult who asks you not to report, respect that wish where the law does not require a report (3.E, 3.E.1). |
| Emergencies | Arrange emergency care for patients of record. After treating someone else’s patient in an emergency, return them to their regular dentist unless they say otherwise (4.B). |
| Faulty work by another dentist | Tell the patient their current oral health status without disparaging the earlier dentist. Report gross or continual faulty treatment to the appropriate reviewing agency (4.C).19 |
Sources: ADA Principles of Ethics and Code of Professional Conduct, with advisory opinions revised to October 2025. Reference 19.
Sheet 6 · Prescribing quick tabs
Pain (ADA guideline, 2024)
| Point | Guideline |
|---|---|
| First line, age 12 and over | NSAIDs such as ibuprofen or naproxen, alone or combined with acetaminophen, after an extraction or for toothache when care is not available at once. |
| Opioids | Limited situations only. No “just in case” prescriptions. Extreme caution in adolescents and young adults; explain safe storage and disposal.20 |
Doses, combinations and the opioid steps: analgesics in dentistry for the INBDE.
Antibiotics for pulpal and periapical pain or swelling (ADA guideline, 2019)
| Situation | Regimen |
|---|---|
| Irreversible pulpitis, or necrosis with symptomatic apical periodontitis | No antibiotic when definitive treatment is available. Definitive treatment fixes the problem.21 |
| When an antibiotic is indicated | Amoxicillin 500 mg three times a day, or penicillin V potassium 500 mg four times a day, for 3 to 7 days. Review at 3 days; stop 24 hours after systemic signs fully resolve.21 |
| Penicillin allergy, no anaphylaxis, angioedema or hives | Cephalexin 500 mg four times a day, 3 to 7 days |
| Penicillin allergy with anaphylaxis, angioedema or hives | Azithromycin 500 mg on day 1, then 250 mg for 4 more days; or clindamycin 300 mg four times a day, 3 to 7 days22 |
Endocarditis prophylaxis (AHA, 2021): single dose 30 to 60 minutes before
| Situation | Adult dose |
|---|---|
| Standard, oral | Amoxicillin 2 g |
| Penicillin allergy, oral | Cephalexin 2 g; or azithromycin or clarithromycin 500 mg; or doxycycline 100 mg. No cephalosporin after anaphylaxis, angioedema or hives with a penicillin. |
| Clindamycin | No longer recommended for dental prophylaxis23 |
Full tables, high-risk heart conditions and trauma rules: high-yield antibiotics for the INBDE, antibiotic prophylaxis and dental trauma guidelines and high-yield microbiology for the INBDE.
Sources: ADA acute dental pain guideline announcement, February 2024; ADA 2019 antibiotic guideline and chairside guide; AHA 2021 scientific statement on viridans group streptococcal endocarditis. References 20 to 23.
From cheat sheet to exam-ready
Use these numbers in patient cases
Knowing a number is one step; using it in a patient case is what the INBDE tests. Our nightly live tests put these sheets to work.
Check yourself
Three quick questions
Answer in your head first, then open the answer.
1. A healthy 70 kg adult needs extensive work with 2% lidocaine and 1:100,000 epinephrine. What is the most cartridges you can give?
Show answer
About 11The lidocaine limit (490 mg) allows about 13 cartridges, but the 0.2 mg epinephrine limit is reached at about 11. The lower number wins.
2. A patient on apixaban for atrial fibrillation needs one simple extraction. Should the drug be stopped?
Show answer
NoFor most patients on a DOAC no change is needed; control bleeding with pressure, a hemostatic agent, sutures or tranexamic acid. Any change is the physician’s decision.
3. This week’s spore test is positive. What do you do first?
Show answer
Take it out of serviceStop using the sterilizer, review how it was loaded and run, and retest at once. Only a negative repeat test with correct procedures returns it to service.
We teach the INBDE
How to prepare: our full plan
Cheat sheets cover the facts. A plan covers the whole exam.
INBDE
The Study Boards INBDE course
- 12 course sections, Master Files and 35,000+ questions
- Two full 2-day simulation exams
- Nightly live tests at 9 PM New York time
- 99% first-attempt pass rate for students who complete the course, with a Pass Guarantee
Next
Keep studying
- The INBDE study guide: every step from registration to results
- What is tested on the INBDE
- 10 free INBDE practice questions
- The month-by-month INBDE study plan
- Taking the DLOSCE as well? Prescriptions and infection control appear there too: The Study Boards DLOSCE course
Quick answers
Frequently asked questions
Is there an official INBDE cheat sheet?
No. These sheets are our own summaries of US labels, guidelines and the ADA Code. Use them to check facts quickly, then practise applying them to patient cases, because that is how the exam asks.
What is the maximum dose of lidocaine with epinephrine in dentistry?
The US label for 2% lidocaine with epinephrine says to keep the dose below 500 mg and never above 7 mg/kg in a healthy adult. The epinephrine limit (0.2 mg in a healthy adult, 0.04 mg in significant heart disease) often caps the number of cartridges first.
Should a patient stop warfarin before an extraction?
Usually not. With an INR in range, the ADA notes that patients can stay on their regular dose, and an uncomplicated extraction is considered safe with an INR up to 3.5. Control bleeding locally and involve the physician before any change.
Is clindamycin still used for endocarditis prophylaxis?
No. The AHA 2021 statement says clindamycin is no longer recommended for dental prophylaxis. Penicillin-allergic patients can take cephalexin, azithromycin, clarithromycin or doxycycline instead.
How does The Study Boards help you prepare for pharmacology on the INBDE?
Our INBDE course teaches pharmacology through clinical cases, timed tests and simulation exams, and our faculty answer every question you send. See the INBDE course blueprint for the full structure.
Can I print these cheat sheets?
Yes. Use your browser’s print option and all six sheets print together, with their tables and sources.
Stuck on a dose or a guideline?
Send us your question. Our Admin Team with Dr. T and Dr. Kaur will contact you over WhatsApp.
References
- Lidocaine HCl 2% and epinephrine dental cartridge, US prescribing information: maximum dose and pediatric guidance. prescriberpoint.com
- Septocaine (articaine HCl 4% and epinephrine 1:100,000), US prescribing information. rxlist.com
- Carbocaine (mepivacaine HCl) dental, US prescribing information. rxlist.com
- Citanest Plain and Citanest Forte Dental (prilocaine HCl), US prescribing information. rxlist.com
- Marcaine (bupivacaine HCl) with epinephrine, US prescribing information, dental use. rxlist.com
- Becker DE, Reed KL. Local anesthetics: review of pharmacological considerations. Anesth Prog. 2012;59(2):90-102. PMC3403589
- Godzieba A, et al. Clinical assessment of the safe use of local anaesthesia with vasoconstrictor agents in cardiovascular compromised patients: a systematic review. Med Sci Monit. 2014;20:393-398. PMC3958566
- DiMarco AC, Bassett K. Update on maximum dosages of local anesthesia. Dimensions of Dental Hygiene. 2013;11(10). dimensionsofdentalhygiene.com
- American Dental Association. Oral Anticoagulant and Antiplatelet Medications and Dental Procedures. Oral Health Topics, updated 28 September 2022. ada.org
- Miller CS, Little JW, Falace DA. Supplemental corticosteroids for dental patients with adrenal insufficiency: reconsideration of the problem. JADA. 2001;132(11):1570-1579. doi.org/10.14219/jada.archive.2001.0092
- NHS Specialist Pharmacy Service. What steroid supplementation is required for a patient with primary adrenal insufficiency undergoing a dental procedure? 5 December 2019. sps.nhs.uk
- Bornstein SR, et al. Diagnosis and treatment of primary adrenal insufficiency: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2016;101(2):364-389. PMC4880116
- CDC. Guidelines for Infection Control in Dental Health-Care Settings, 2003. MMWR 2003;52(RR-17). cdc.gov
- CDC. Guideline for Disinfection and Sterilization in Healthcare Facilities (2008), Table 7: minimum cycle times for steam sterilization. cdc.gov
- CDC. Guideline for Disinfection and Sterilization: other sterilization methods (dry heat). cdc.gov
- CDC. Best practices for sterilization monitoring in dental settings. cdc.gov
- CDC. Summary of Infection Prevention Practices in Dental Settings: Basic Expectations for Safe Care (October 2016), dental unit water quality. cdc.gov
- Kofman AD, et al. 2025 US Public Health Service guidelines for the management of occupational exposures to HIV and recommendations for post-exposure prophylaxis in healthcare settings. Infect Control Hosp Epidemiol. 2025. PMC12616222
- American Dental Association. Principles of Ethics and Code of Professional Conduct, with advisory opinions revised to October 2025. ada.org
- American Dental Association. New guideline details acute pain management strategies for adolescent and adult dental patients. Press release, 5 February 2024. ada.org
- Lockhart PB, et al. Evidence-based clinical practice guideline on antibiotic use for the urgent management of pulpal- and periapical-related dental pain and intraoral swelling. JADA. 2019;150(11):906-921; summarised in CDC “Dentists: Be Antibiotics Aware”. cdc.gov
- ADA. Antibiotics for dental pain and swelling: chairside guide (2019 guideline). ada.org
- Wilson WR, et al. Prevention of viridans group streptococcal infective endocarditis: a scientific statement from the American Heart Association. Circulation. 2021;143:e963-e978, Table 5. doi.org/10.1161/CIR.0000000000000969
Current as of October 2026. This page is a study aid for exam preparation, not a substitute for the full guidelines or for clinical judgment.