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 13
For a patient who undergoes the removal of a semi-osseous impacted mandibular third molar, which of the following would provide the best post-operative pain relief when used orally?
A. Ibuprofen 400mg q4h beginning 24 hours before surgery and q4h PRN pain post-operatively
B. Ibuprofen 400mg immediately prior to surgery and q4h PRN pain post-operatively
C. Ibuprofen 400mg immediately post-surgery and then q4h PRN pain
D. Ibuprofen 400mg q4h PRN pain post-operatively
Rationale
Pain following surgery is a predictable event and taking steps to minimize the patient’s pain experience is appropriate. Non-steroidal anti-inflammatory drugs (NSAIDs) have both a direct analgesic effect as well as the ability to inhibit prostaglandin formation. This latter property can reduce post-operative swelling, which in itself reduces post-operative discomfort. Various NSAIDs have been investigated. Aspirin, when given pre-operatively, resulted in increased operative bleeding, ecchymosis, and haematoma formation and, when compared with placebo, did not alter post-operative pain. When ibuprofen, another NSAID, was given 24 hours pre-operatively, and compared with placebo, there was a significant decrease in the patient’s pain experience on the day of the procedure as compared with ibuprofen when given at the time of surgery or post-operatively.
Most of the serious side effects associated with NSAIDs come with Iong-term use rather than short-term application. NSAIDs do interact with beta-blockers and diuretics as well as with angiotensin converting enzyme inhibitors, which make concomitant use inadvisable. Gastric mucosa and platelet aggregation are adversely affected by NSAIDs and the combined use of such drugs with anticoagulants can produce a significantly increased potential for bleeding. They should not be used for patients taking digoxin, methotrexate or lithium, or with a history of gastrointestinal ulcer.
REFERENCE
1.Savage, M.G., Henny, M.A. Pre-operative non-steroidal anti-inflammatory agents: Review of the literature. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 98: 146-152, 2004.
QUESTION 14
Aerosols produced during dental treatment become contaminated from
1. nasopharyngeal matter .
2. subgingival fluid.
3. blood.
4. saliva.
A. 1, 2, 3
B. 1 and 3
C. 2 and 4
D. 4 only
E. All of the above
Rationale
Aerosols and splatter are produced routinely during dental treatment and are highly contaminated with bacteria, viruses and blood components. Procedures that cause the most airborne contaminations involve power driven equipment, sprays or compressed air. The patient’s saliva, blood, subgingival fluids and nasopharyngeal matter form the most significant reservoir for potentially harmful micro-organisms.
The use of a rubber dam prevents contamination from sources other than the tooth, which should be minimal. When a rubber dam cannot be used, the high volume evacuator (HVE) can reduce airborne contamination by about 90%, but to be effective it requires a relatively large inside tip diameter of at least 6-8 mm. The HVE is generally not used during dental hygiene procedures. Yet, the ultrasonic scaler is the greatest cause of aerosol contamination. Therefore the HVE should always be used with the ultrasonic scaler. The recent SARS outbreaks have focused attention on airborne contaminants for which dental offices are a rich source.
The following are suggested ways of controlling aerosol contamination:
* pre-procedural antiseptic rinses
* use of a rubber dam
* use of a large bore HVE
Additional devices are:
* high efficiency air filter
* ultraviolet (UV) “upper room” air sanitizer
The air sanitizer is placed in the ventilation system and exposes circulated air to a germicidal UV light. Neither of these last options should be considered a first line of protection for dental personnel as these devices only remove contamination already in the air.
REFERENCE
1.Harrel, S.K.: Airborne spread of disease -the implications for dentistry. Calif Dent Assoc J 32:901-906, 2004.
QUESTION 15
In the orthodontic bonding process, more enamel is lost with the use of a conventional acid etching technique than with the use of a self-etching primer.
At debonding the conventional acid etching technique leaves more adhesive on the enamel surface than does the self-etching primer .
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 study was designed to determine the effects on tooth enamel of removal of orthodontic brackets. Assessment of the enamel surface was made at each step of the process of bonding, debonding, and enamel cleanup after the use of a self-etching primer and compared with the values obtained with conventional etching and priming. The amount of enamel lost after conventional etching was significantly greater than that lost with the self-etching primer. It was also found that more bracket-adhesive failure occurred with the conventional technique as compared with the self-etching primer. At debonding the conventional acid etching technique left more adhesive on the enamel surface. In both groups, the high-speed tungsten carbide bur and the ultrasonic scaler caused the highest loss of enamel. Slow-speed tungsten carbide burs and debanding pliers resulted in the least enamel loss. However, more residual adhesive was present when the debanding pliers were used. The least enamel loss occurred with the use of a self-etching primer and after enamel cleanup with the slow-speed carbide burs.
REFERENCE
1.Hosein, I., Sherriff, M., Ireland, A.J.: Enamel loss during bonding, debonding and cleanup with the use of self-etching primer. Am J Orthod Dentofacial Orthop 126:717-724, 2004.
QUESTION 16
Dentin hypersensitivity, after subgingival scaling and root planing, is a common problem. The discomfort
1. is localized.
2. occurs rapidly.
3. resolves quickly.
4. is chronic.
A. 1, 2, 3
B. 1 and 3
C. 2 and 4
D. 4 only
E. All of the above
Rationale
In dentinal hypersensitivity (DH), the dentin is exposed resulting in a painful sensation after thermal, chemical, mechanical or osmotic stimulation. The pain is described as acute, localized, developing rapidly, and resolving quickly. The usual treatment for DH is desensitizing toothpastes. Recently, the effect of a single topical application of a 3% potassium oxalate gel on teeth was investigated. Patients first underwent non-surgical scaling and root planing (SRP) under local anaesthesia. Using a split mouth design, 3% potassium oxalate gel or a placebo was applied to the cemento-enamel junction after SRP. A visual analog scale at baseline, 7, 14 and 21 days post SRP was used to measure DH reduction. Seven days after treatment the percentage reduction in sensitivity for the potassium oxalate gel group was not statistically significant. Assessment at 14 and 21 days showed a progressive improvement in favour of the potassium oxalate gel group, which was statistically significant. Of the many ways of managing DH, it would seem that 3% potassium oxalate gel when applied topically after SRP, could provide beneficial results.
REFERENCE
1.Pillon, F. L., Romani, I.G., Schmidt, E.R. Effect of a 3%
potassium oxalate topical application on dentinal hypersensitivity after subgingival scaling and root planing. J Periodontol 75: 1461-1464, 2004.
Answers to the March 2007 SLSA questions:
9. A
10. C
11. B
12. C
