Oral Health Group
Feature

2003 Self Learning Assessment (June 01, 2003)

June 1, 2003
by Oral Health


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.

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QUESTION 21

When comparing self-threaded pin-retained amalgams with bonded amalgams

A. pin-retained restorations will have better marginal adaptation.

B. bonded amalgam restorations will demonstrate less tooth sensitivity than pin-retained.

C. secondary caries will be more prevalent in bonded amalgams.

D. pin-retained restorations will result in more non-vital teeth.

E. None of the above

Rationale

A recent study examined the restoration of functional but badly broken down posterior teeth in which cusp and proximal replacements were part of the selection criteria. Sixty teeth were selected and randomly allocated for either treatment. One half of the study teeth was restored with a self-threaded pin-retained amalgam and the other half with bonded amalgam.

At the time of five-year recall, statistical analysis failed to show any significant difference between the two treatment methods for marginal adaptation, marginal discolouration, secondary caries, sensitivity or tooth vitality. In a functional sense too, bonded restorations performed as well as pin-retained amalgams.

REFERENCE

1.Summitt, J.B., Burgess, J.O., Berry, T.G. et al. The performance of bonded vs. pin-retained complex amalgam restorations-a five-year clinical evaluation. JADA 132:923-931. 2001.

QUESTION 22

In periodontal probing, a major predictor of bacteraemia is the presence of interproximal bone loss as seen on radiographs.

Smokers exhibit less gingival bleeding on probing than non-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

In a recent study, a major predictor of bacteraemia due to probing was the presence of interproximal bone loss as seen from radiographs. The study also reported that neither age nor the number of teeth probed were contributors to bacteraemia. However, the extent of bleeding on probing and the probing depth per tooth were associated with positive bacteraemias. Patients with untreated adult periodontitis were at greater risk to bacteraemia due to periodontal probing than those with chronic gingivitis.

Although studies have shown that smokers exhibit less gingival bleeding on probing than non-smokers, there was no evidence that smokers would experience less of a bacteraemia than non-smokers.

As a means of preventing bacteraemia, especially in patients at risk for infective endocarditis and other heart ailments, an important finding of the study points to the use of a radiographic assessment of patients to detect the presence of active bone loss and periodontitis before periodontal probing. In such patients, appropriate antibiotic coverage is essential before probing, as detailed in the rationale of question 23.

REFERENCE

1.Daly, C.G., Mitchell, D.H., Highfield, J.E. et al. Bacteraemia due to periodontal probing: a clinical and microbiological investigation. J Periodontol 72:210-214. 2001.

QUESTION 23

A patient with an allergy to penicillin requires prophylactic antibiotic coverage because of a heart murmur. Which of the following regimens is/are recommended?

1. Clindamycin 300 mg po one hour before.

2. Azithromycin 500 mg po one hour before.

3. Clarithromycin 1 g po one hour before.

4. Clindamycin 600 mg po one hour before.

A. 1, 2, 3D. 4 only

B. 1 and 3E. All of the above

C. 2 and 4

Rationale

The table below lists antibiotic prophylactic regimens for various situations in adults (including those with an allergy to penicillin), as recommended by the American Heart Association (2000), but practitioners should be aware that guidelines change periodically.

REFERENCE

1.Tong, D.C., Rothwell, B.R. Antibiotic prophylaxis in dentistry: a review and practice recommendations. JADA 131:366-374. 2000.

QUESTION 24

A patient presents with gingival recession to the mucogingival junction with no periodontal tissue loss in the interdental area. After a subepithelial connective tissue graft, full root coverage can be expected.

A patient presents with gingival recession beyond the mucogingival junction and soft tissue loss in the interdental area. Following a subepithelial connective tissue graft, full root coverage can be expected.

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

The most widely used surgical procedure for management of gingival recession is the subepithelial connective tissue graft because of its high predictability in achieving root coverage. The surgery is less traumatic than the free gingival graft and has fewer and less severe postoperative complications. It results in a better aesthetic outcome, allowing superior tissue colour match.

Miller introduced the following classification of gingival recession:

Class 1–Marginal tissue recession with no extension to the mucogingival junction. No periodontal loss in the interdental area.

Class 2–Marginal tissue recession with extension to or beyond the mucogingival junction. No periodontal loss in the interdental area.

Class 3–Marginal tissue recession with extension to or beyond the mucogingival junction. Bone or soft tissue loss in the interdental area is present or there is malposition of teeth.

Class 4–Marginal tissue recession with extension to or beyond the mucogingival junction. Severe bone or soft tissue loss in the interdental area or severe malposition of teeth.

The clinician can anticipate full root coverage in Class 1 and Class 2 cases, partial coverage in Class 3 cases, and very little or no coverage in Class 4 cases.

REFERENCE

1.Leve, R. The subepithelial connective tissue graft. Oral Health 54-60. May 2001.

Answers to May 2003 SLSA Quiz

17. D

18. B

19. C

20. A