The SLSA program is based on current, referenced literature and consists of 40 questions, answers, rationales and references. Answers appear at the end of each quiz.
Dentists who complete the 15 question quiz in the November, 2003 issue of Oral Health may be eligible to receive continuing education points. The names and license numbers of all who complete the quiz will be forwarded to their respective provincial licensing authorities.
QUESTION 37
In the management of periodontal disease, the use of ultrasonic debridement with chlorhexidine, when compared to treatment by debridement alone, can
1. result in gain of clinical periodontal attachment.
2. prevent loss of clinical periodontal attachment.
3. suppress pathogenic microorganisms.
4. improve postoperative healing.
A. 1, 2, 3
B. 1 and 3
C. 2 and 4
D. 4 only
E. All of the above
Rationale
Traditional periodontal therapy aims at resolution of the inflammatory lesion in the periodontal tissues. Such treatment involves the elimination of soft and mineralized microbial deposits on the tooth surfaces by scaling and root planing. The ideal result of periodontal treatment would be regeneration of lost attachment apparatus by the formation of new cementum, periodontal ligament, and alveolar bone.
The technique of ultrasonic bacteriocidal debridement introduces surgical curettage in combination with irrigation of the pockets with antimicrobial agents. The benefit of subgingival irrigation for advanced cases of periodontal disease is that the subgingival periodontal pathogenic organisms are suppressed to the advantage of postoperative healing.
It has been reported that use of this technique, along with chlorhexidine, povidone-iodine or cetylpyridine, resulted in either gain of clinical periodontal attachment or prevention of loss when compared to treatment by surgical access or debridement without use of the antimicrobial agent.
REFERENCES
1.Genco, R.J. Using antimicrobial agents to manage periodontal disease. J Am Dent Assoc. 122:122-131. 1991.
2.Rosling, B., Hellstrm, M.K., Socransky, S.S., et al. The use of PVP-iodine as an adjunct to non-surgical treatment of chronic periodontitis. J Clin Periodontol 28:1028-1031. 2001.
QUESTION 38
Air abrasion
1. provides no tactile feedback.
2. is recommended for early carious lesions.
3. is used for pit and fissure caries.
4. requires anaesthesia.
A. 1, 2, 3
B. 1 and 3
C. 2 and 4
D. 4 only
E. All of the above
Rationale
Air abrasion is appropriate for treating small areas of decay such as pit and fissure caries in the early stages. Larger lesions require use of a rotary drill. In most cases, air abrasion can be performed without anaesthesia. Air abrasion is also well suited for the repair of lesions at incisal edges and cusp tips. Preparation can be minimal, removing only enough structure to provide a clean and sound foundation for bonding.
The disadvantages of air abrasion are that it is useful only for small restorations and there is a lack of tactile feedback. It cannot be used for deep decay on symptomatic teeth and it is only compatible with composite restorations since resistance and retention form cannot be developed.
REFERENCES
1.Freedman, G., Goldstep, F., Seif, T., et al. Ultra-conservative resin restorations. J Can Dent Assoc; 65:579-581. 1999.
2.Oral Care Report, Vol. 11, Number 1. Chester Douglass, Editor. 2001.
QUESTION 39
In smokers, the greatest attachment loss is found on the maxillary labial area.
Periodontal pathogenic microbia are more prevalent in smokers.
A. The first statement is true, the second is false.
B. The first statement is false, the second is true.
C. Both statements are true.
D. Both statements are false.
Rationale
A recent study comparing smokers and non-smokers indicated that smokers had more attachment loss, deeper pockets, more missing teeth, less bleeding sites on probing, yet similar gingival inflammation and levels of plaque as non-smokers. In smokers, the greatest attachment loss was seen on the maxillary lingual area. In a study examining the microbia of the groups, it was found that periodontal pathogenic microbia were more prevalent in smokers. This increased colonization seemed to occur primarily in shallow rather than in deeper pockets.
REFERENCES
1.Haffajee, A.D. and Socransky, S.S. Relationship of cigarette smoking to attachment level profiles. J Clin Periodontol 28:283-295 and 337-388. 2001.
2.Tezal, M., Grossi, S.G., Ho, A.W., et al. The effect of alcohol consumption on periodontal disease. J Periodontol 72:183-189. 2001.
QUESTION 40
Patients with diabetes mellitus have an increased susceptibility to severe periodontal disease because of
1. increased collagenase production.
2. impaired fibroblast proliferation.
3. altered neutrophil function.
4. alteration of periodontal pathogens.
A. 1, 2, 3
B. 1 and 3
C. 2 and 4
D. 4 only
E. All of the above
Rationale
Increased susceptibility for severe periodontal disease is not apparently related to increased plaque levels, calculus, nor alteration of the periodontal pathogens. Instead, it would appear related to altered host defences. These include an altered neutrophil function, monocyte and macrophage function, as well as collagen metabolism. Diabetes mellitus patients may produce large amounts of collagenase which can destroy collagen in the periodontium. There is impaired fibroblast proliferation which changes the normal tissue turnover and repair.
Type 1 diabetes mellitus is caused by destruction of the -cells of the pancreas which produce insulin needed to prevent hyperglycemia. Type 2 diabetes mellitus (non-insulin dependent) results from defects of the insulin molecule or when there are abnormalities on the cell membrane receptors for insulin.
Diabetes mellitus has a significant impact on the periodontal health of an individual as well as on general health. The dental practitioner should monitor the periodontal health of a diabetic patient, since dramatic changes in status are signs of concern and should be a basis for referral to the patient’s physician.
It must be noted that Type 2 diabetes mellitus is associated with the older age groups. This type of diabetes is 3.5 times more prevalent among people 65 years or older. The dental practitioner may be the first to diagnose the problem in the elderly.
REFERENCES
1.Mattson, J.S. and Cerutis, D.R. Diabetes mellitus: A review of the literature and dental implications: Compendium 22:757-772. 2001.
2.Taylor, G.W., Loesche, W.J., Terpenning, M.S. Impact of oral diseases on the systemic health in the elderly: Diabetes mellitus and aspiration pneumonia. J Public Health Dent 60:313-320. 2000.
THE 2003 SLSA QUIZ APPEARS IN THE NOVEMBER ISSUE ALONG WITH INSTRUCTIONS AND REPLY CARD. TO BE ELIGIBLE FOR CE POINTS, RESPONSES MUST BE RECEIVED BY DECEMBER 31ST, 2003.
Answers to September 2003 SLSA Quiz
33. A
34. C
35. E
36. E
