The SLSA Program is based on a series of questions, answers, rationales and references followed by an annual 15-question quiz. All material is from current referenced literature. Completion of the quiz leads to CE points. Names and license numbers of dentists are forwarded to the appropriate licensing authorities.
QUESTION 21
For a patient with asthma, which of the following analgesics could you prescribe?
1. Acetylsalicylic acid
2. Ibuprofen
3. Naproxen
4. Acetaminophen
A. 1, 2, 3
B. 1 and 3
C. 2 and 4
D. 4 only
E. All of the above
Rationale
In the control of pain, it should be noted that up to 20% of asthma patients react with severe bronchoconstriction after ingesting aspirin and other nonsteroidal anti-inflammatory drugs (NSAIDs). Ketorolac, ibuprofen and naproxen sodium are all offenders, along with aspirin, and must be avoided because of possible allergic reaction. The analgesic of choice for a patient with asthma is acetaminophen.
REFERENCE
Steinbacher, D.M., Glick, M. The dental patient with asthma. An update and oral health considerations. JADA 132:1229-1239. 2001.
QUESTION 22
Compared to glass ionomer cements, resin-modified glass ionomer cements are more wear resistant and have a higher compressive strength.
Resin-modified glass ionomer cements should not be used in primary teeth.
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
All glass ionomer systems have a coefficient of expansion similar to that of natural tooth structure and have a physicochemical bond to enamel and dentine. The original glass ionomer cements had poor properties of compressive strength and wear resistance. The newer resin-modified glass ionomer cements show improved wear resistance and compressive strength.
A recent study examined resin-modified glass ionomer cements as restorations for primary teeth in a retrospective manner over at least a three-year period. Restorations were assessed in Classes I, II, III, and V preparations in which evaluation was based on wear, marginal integrity, axial contour and secondary caries and the success rates were as follows:
Class IIIrestorations15out of 15(100.0%)
Class Vrestorations 49out of 50(98.0%)
Class IIrestorations 379out of406(93.3%)
Class I restorations 364out of 393(92.6%)
Most of the failures of Class I and Class II restorations were due to wear. Only 0.1% (1 out of 864) failed as a result of secondary caries. The findings in this retrospective study indicate that resin-modified glass ionomer cement is an effective restorative material for Classes I, II, III and V restorations in primary teeth.
REFERENCE
Croll, T.P., Bar-Zion, Y., Segura, A. et al. Clinical performance of resin-modified glass ionomer cement restorations in primary teeth. A retrospective evaluation. JADA 132:1110-1116. 2001.
QUESTION 23
Evidence exists that the presence of biofilms in dental unit waterlines has resulted in widespread cross-infection of patients.
Biofilms form when planktonic bacteria settle on solid surfaces
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 term biofilm was introduced in 1978 to describe a complex community of bacteria. Rather than a random collection, biofilms exhibit a complex level of organization which is more in keeping with the structure of multi-cellular organisms. Biofilms form when planktonic (free floating) bacteria settle on solid surfaces as a result of gravity, electrostatic attraction or movement of motile organisms to adsorbed nutrients. Some bacteria act as primary colonizers and, by producing long chain exopolysaccharides, form a slime matrix. The change from planktonic to sessile existence marks dramatic phenotype changes in the bacteria, with growth of some types and suppression of others. Although bacteria are primary colonizers, over time fungi, algae, protozoa and others are recruited to the matrix.
Modern dental units provide an environment suitable for the growth of aquatic biofilm. This can contribute to the contamination of the water lines with microorganisms and endotoxins. Untreated dental units will fail to meet national water standards. Little epidemiological evidence exists that biofilm in dental units has resulted in widespread illness. The problem clinically is realized when treating the immunocompromised. For such patients, any work involved in cutting of bone should utilize sterile water systems for the equipment involved.
REFERENCES
1.Mills, S.E., and Karpay, R.I. Dental waterlines and biofilm. Searching for solutions. Compendium 23:237-256. 2002.
2.Linger, J., Molinari, J.A., Forbes, W.C., et al. Evaluation of a hydrogen peroxide disinfectant for dental unit waterlines. JADA 132:1287-1291. 2001.
QUESTION 24
Osteoporosis is characterized by high bone mass and deterioration of the bone architecture.
Oral bone loss can accompany osteoporosis to cause alveolar ridge resorption.
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
Osteoporosis is characterized by low bone mass and deterioration of the bone architecture leading to increased bone fragility and fracture. It is referred to as the “silent disease”-symptomless early and occurring most frequently but not exclusively in post-menopausal women. Improved diagnostic methods have shown that oral bone loss accompanies osteoporosis to cause ridge resorption and alveolar bone height reduction with subsequent tooth loss.
Efforts to prevent oral bone loss are directed at plaque control and, where suspected, referral of patients for appropriate systemic management with estrogen replacement therapy and calcium supplementation if indicated. A patient with osteoporosis who is edentulous requires careful and frequent scrutiny by the dentist to check that dentures fit and occlusion is satisfactory to prevent accelerated ridge resorption.
REFERENCES
1.Krejci, C.B., and Bissada, N.F. Women’s health issues and their relationship to periodontitis. JADA 133:323-328. 2002.
2.Jeffcoat, M.K., Lewis, C.E., Reddy, M.S., et al. Postmenopausal bone loss and its relationship to oral bone loss. Periodontol 2000. 23:94-102. 2000.
Answers to May 2004 SLSA Quiz
17. E
18. C
19. A
20. E
