Self-Learning Assessment 2007

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.


The posterior surface of the tongue has higher numbers of anaerobic and aerobic organisms than the anterior surface.

Cleaning of the tongue improves taste quality.

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.


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 as 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.


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.


Which of the following is/are a proven risk for oral and pharyngeal cancer?

1. Poor oral hygiene;

2. Excessive alcohol consumption;

3. Use of mouthwashes;

4. Use of tobacco.

A. 1, 2, 3

B. 1 and 3

C. 2 and 4

D. 4 only

E. All of the above


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. 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.


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.


A panoramic radiograph can be a useful screening tool for

1. chronic periodontitis.

2. carotid artery calcification.

3. early atherosclerosis.

4. determining risk for stroke.

A. 1, 2, 3

B. 1 and 3

C. 2 and 4

D. 4 only

E. All of the above


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 CP 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 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.

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.


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.


Oral Lichen Planus is most often found on the

A. floor of the mouth.

B. tongue.

C. cheeks.

D. palate.


Oral Lichen Planus 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.


1.Huber,M.A. Oral lichen planus. Quintessence Int 35: 731-752, 2004.

Answers to the September 2007 SLSA questions:

33. E

34. C

35. A

36. A