The SLSA program is based on current, referenced literature and consists of 40 questions, answers, rationales and references. Answers appear in the following issue at the end of each quiz.
Dentists who complete the 15 question quiz in the November, 2007 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
For a patient with a coated tongue, cleaning with a plastic scraper or a toothbrush will, over time,
1. reduce bacterial load.
2. improve taste recognition.
3. reduce the degree of coating.
4. reduce oral malodor.
A. 1, 2, 3
B. 1 and 3
C. 2 and 4
D. 4 only
E. All of the above
Rationale
Most problems with breath odor arise from the oral cavity, but may also arise from the expired air. Gingivitis and periodontitis may be associated with malodor, but not all cases of malodor are linked to these infections. Tongue coating has also been found in some patients with malodor, prompting the suggestion that tongue cleaning may be helpful.
After a 14-day study of cleaning the tongue twice daily with the use of either a plastic scraper or a toothbrush, tongue coating was found to be significantly reduced, the anterior part showing the greatest reduction. Microbial analysis indicated no significant change in the microbial population, with the posterior tongue tending to have higher numbers of aerobic and anaerobic organisms than the anterior region. Using salt, quinine and sugar to test for taste, an improvement after 14 days was statistically significant for the recognition of salt and quinine, and borderline for sugar.
Although tongue cleaning has been advocated as a hygiene measure to reduce bacterial numbers, thereby reducing putrefaction and malodor from volatile sulphur compounds, the results of this study showed only minimal reduction in bacterial load and no effect on malodor.
Less gagging and greater comfort and cleaning capacity were associated with the scraper, but there was no difference in efficacy between it and the toothbrush.
REFERENCE
1.Quirynen, M., Avontroodt, P., Soers, C., et al. Impact of tongue cleansers on microbial load and taste. J Clin Periodontol 31: 506-510, 2004
QUESTION 18
Which of the following is the most common site for the development of a malignant lesion?
A. Floor of the mouth.
B. Buccal mucosa.
C. Tongue.
D. Oropharynx.
Rationale
Oral and pharyngeal cancers refer to the malignancies of the lip, salivary glands, tongue, oral cavity, oropharynx, nasopharynx and hypopharynx. They occur twice as commonly in men as in women. A recent Canadian survey showed that for all cancers, oral and pharyngeal are the seventh most common in men and the sixteenth most common in women. In men, the most common sites are the tongue 19.3%, lip 16.6%, oropharynx 13.5%, hypopharynx 10.8%, floor of mouth 9.4%. In women, the tongue accounts for 21.1%, lip 7.6%, oropharynx 12.5%, hypopharynx 5.8%, and floor of mouth 8.4%. Etiological factors definitely placing an individual at risk are tobacco and excessive alcohol consumption. Possible etiological factors are a diet poor in fresh fruits and vegetables and infection with human papilloma virus. Other factors with even more equivocal evidence supporting their association with cancers are mouthwashes, poor oral hygiene and marijuana.
REFERENCE
1.Allison, P. The epidemiology and etiology of oral and pharyngeal cancers in Canada and Quebec. Journal dentaire du Quebec, supplement. pp. 6-11. February 2004.
QUESTION 19
There is a link between chronic periodontitis and which of the following?
1. Subclinical atherosclerosis
2. Stroke
3. Carotid artery plaque
4. Coronary heart disease
A. 1, 2, 3
B. 1 and 3
C. 2 and 4
D. 4 only
E. All of the above
Rationale
Chronic infection has been implicated as a contributory factor to atherosclerosis. The presence of chronic periodontitis (CP), caused largely by gram-negative bacteria, shows a link to coronary heart disease and stroke. A recent study has shown a link with subclinical atherosclerosis and carotid artery plaque.
Oral panoramic radiographs were used in a study to determine their reliability for diagnosing chronic periodontitis and to determine if there was a relationship with carotid artery plaque, and hence subclinical atherosclerosis. Subjects were between the ages of 54 and 94, and stroke-free. Panoramic radiographs were obtained at baseline as well as a high-resolution carotid ultrasound to document carotid plaque thickness, if present. Subjects who were dentate were categorized as having severe periodontal disease if bone loss was greater than 50%. The covariates evaluated included age, gender, smoking, diabetes, hypertension, low-density lipoprotein cholesterol and high-density lipoprotein cholesterol.
Carotid artery plaque was found in 57% of the patients. Among the dentate group with severe bone loss, the mean carotid plaque thickness was found to be significantly higher than the other group with moderate or no bone loss. A patient with severe periodontal bone loss was found to have four times greater risk of carotid artery plaque. This relationship held even for adjustments for age, current smoking status and high-density lipoprotein levels.
In addition to imaging calcified plaque in carotid arteries, panoramic radiographs can be used as a simple screening test for periodontal disease and thus can be useful in detecting early atherosclerosis.
REFERENCE
1.Engebretson, S.P., Lamster, I.B.,Elkind, M.S.V., et al. Radiographic measures of chronic periodontitis and carotid artery plaque. Stroke 36: 561-566, 2005.
QUESTION 20
A 45-year-old woman presents with bilateral symmetrical, lacelike lesions of the buccal mucosa in the third molar region. Which of the following would you consider in your diagnosis?
1. Lichenoid reaction to a contactant
2. Lichenoid drug reaction
3. Chronic cheek chewing
4. Lichen planus
A. 1, 2, 3
B. 1 and 3
C. 2 and 4
D. 4 only
E. All of the above
Rationale
Oral Lichen Planus (OLP) is one of the most common mucosal conditions a dentist is likely to encounter. It is seen most commonly in women in the fourth through sixth decades of life. The reticular form is the most common and manifests as mucosal keratotic lines arranged in a characteristic lacy pattern, plaques or papules. In most cases the buccal mucosa is involved, but the tongue, lips, floor of mouth, palate and gingiva can also be affected.
The clinical appearance of lichenoid drug reaction is indistinguishable from OLP, and is also bilateral, but the diagnosis can be validated by resolution of the lesion after discontinuation of a suspected agent and reappearance upon re exposure.
Lichenoid reaction to a contactant is also indistinguishable clinically, except that it is typically asymmetrical and in contact with the suspected allergen e.g. amalgam or gold crown.
Chronic cheek chewing is not Iace-Iike. Observation of the habit may be helpful in establishing the diagnosis.
REFERENCE
1.Huber,M.A. Oral lichen planus. Quintessence Int 35: 731-752, 2004.
Answers to the April 2007 SLSA questions:
13. A
14. E
15. C
16. A
