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 17
Which of the following antimicrobial agents is/are used in the management of periodontal pockets by subgingival irrigation?
A. Povidone-iodineC. Cetylpyridine
B. ChlorhexidineD. 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 povidone-iodine, 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. Other antimicrobials such as chlorhexidine or cetylpyridine are equally effective.
To test this therapy further, a recent study assessed the value of povidone-iodine (PVP) in surgical treatment of chronic destructive periodontitis in 223 patients. However, in addition to ultrasonic instrumentation with 0.1% iodofor (water solution of povidone-iodine), the whole mouth was flushed with the solution. Results demonstrated that such therapy improved the gingival condition, reduced pocket depth and the attachment levels showed gain.
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 18
When used for tooth preparation, air abrasion…
1. can remove areas of decayed tooth structure.
2. initiates cracks in enamel microstructure.
3. preserves healthy tooth structure.
4. requires tactile feedback to determine the extent of cavity preparation.
A. 1, 2, 3D. 4 only
B. 1 and 3E. All of the above
C. 2 and 4
Rationale
Air abrasion is a fine spray of compressed air containing as an abrasive a finely graded aluminum oxide powder. The volume of the abrasive material is controlled by the aperture size of the spray tip. The spray is directed less than 2 mm from the target surface. The spray can remove areas of decayed tooth structure, but healthy tooth structure is preserved.
Unlike rotary drills, air abrasion neither initiates nor propagates cracks in the enamel microstructure. Because there is no tactile feedback with air abrasion, the extent of the tooth preparation must be confirmed visually. 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. When the appropriate case selection is made, the procedure can be efficient and relatively pain free.
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 19
Smoking adversely affects the periodontium.
Alcohol consumption places the periodontium at risk to disease.
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.
Alcohol affects both soft and hard tissues of the periodontium differently. The major effect would appear to be on the gingiva, followed by the periodontal ligament, then alveolar bone. Alcohol’s effect on periodontal disease or indeed other diseases is dose dependent and related to regular or periodic intake. It may be that there is a direct toxic effect on the periodontal tissues with the first effect being felt on the gingiva. The conclusion is that alcohol intake is a risk factor for periodontal disease.
REFERENCES
1.Haffajee, A.D. and Socransky, S.S. Relationship of cigarette smoking to attachment level profiles. J Clin Periodontol 28:283-295. 2001 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 20
Both Type 1 and Type 2 diabetes mellitus place an individual at risk to periodontal disease.
Susceptibility to severe periodontal disease in a diabetic is related to alterations in the periodontal pathogens.
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
Type 1 diabetes mellitus is caused by destruction of the b-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.
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.
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.
Answers to April 2003 SLSA Quiz
13. B
14. A
15. A
16. A
