Oral Health Group
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Self-Learning, Self Assessment 2006 (May 01, 2006)

May 1, 2006
by Oral Health


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, 2006 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 17

Which of the following influences the success of indirect pulp treatment in primary posterior teeth?

1. Tooth location.

2. Use of a base.

3. Restorative material used.

4. Age of patient.

A. 1, 2, 3D. 4 only

B. 1 and 3E. All of the above

C. 2 and 4

Rationale

Indirect pulp capping (IPC) was advocated more than 200 years ago by Fauchard, who recommended retention of some caries because, if caries were removed completely, a pulp exposure would occur. The term IPC was recently replaced by the term Indirect Pulp Treatment (IPT). One hundred thirty-two patients were selected to test the value of IPT; 187 primary posterior teeth were so treated. The patients were followed clinically and radiographically for a time ranging from two weeks to six years. The overall success rate was 95%. The use of a base over a calcium hydroxide liner significantly increased the success rate. A stainless steel crown as a restoration was significantly better in registering a successful outcome than amalgam. Primary first molars failed more frequently than second molars, but there was no significant difference between maxillary and mandibular teeth. Gender, age of patient, caries risk and operator’s skill and experience had no significant effect on the success rate. Indirect pulp treatment should therefore be considered as an alternative to pulpotomy in the management of deep dental caries in primary molars without signs of pulpal degeneration.

REFERENCE

Al-Zayer, M.A., Straffon, L.H., Feigal, R.J., et al. Indirect pulp treatment of primary posterior teeth: a retrospective study. Pediatric Dentistry. 25:29-36, 2003.

QUESTION 18

Following invasive dental procedures, HIV-positive patients are more prone to develop complications postoperatively than HIV-negative patients.

Following invasive dental procedures, the most common complications seen in HIV-positive patients are alveolitis and delayed wound healing.

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

Human immunodeficiency virus (HIV) infection or acquired immunodeficiency syndrome (AIDS) is now viewed as a chronic disease. Because of deficient oral hygiene practices and reduced salivary flow, HIV-positive patients are likely to require dental treatment for caries and periodontal disease. HIV-positive patients have been viewed as highly prone to complications postoperatively, but studies reveal that rates are similar between HIV-positive and HIV-negative patients. The complications that do develop are readily treated. The most common are alveolitis and delayed wound healing. When universal precautions are followed, routine dental treatment of HIV-infected patients presents little risk to either patient or dentist, but if a cut or puncture wound occurs, the guidelines to follow are:

* Press area to increase bleeding.

* Wash wounds thoroughly with soap and water.

* Disinfect.

* Record date, time, and description of exposure.

* Seek advice from a hospital department of infectious diseases (within 24 to 48 hours) to evaluate the need for postexposure prophylaxis (PEP):

– With appreciable risk, PEP is recommended.

– With low risk, PEP should be considered.

– With minimal risk, PEP is not recommended.

The risks faced by dental staff are extremely low, and refusal of treatment to these patients is not justified.

REFERENCE

Campo-Trapero, J., Cano-Sanchez, J., del Romero-Guerrero, J., et al. Dental management of patients with immunodeficiency virus. Quintessence Int. 34:515-525. 2003.

QUESTION 19

With respect to impacted mandibular third molars, which of the following panoramic radiographic markers is the most reliable in predicting contact between the mandibular canal and the tooth?

A. Increased radiolucency around the tooth apex

B. Interruption of the radiopaque border of the canal

C. Narrowing of the canal

D. Diversion of the canal

Rationale

The panoramic radiograph (PR) allows an initial evaluation of possible problems associated with an impacted tooth. A recent study assessed the accuracy of five radiographic markers on the PR in predicting contact between the mandibular canal and the third molar. These markers were:

* superimposition of the tooth on the canal

* increased radiolucency around the tooth apex

* interruption of the radiopaque border of the canal

* diversion of the canal

* narrowing of the canal.

Three of these had a high predictive value for relationship between the tooth and the canal, viz. narrowing of the canal, increased radiolucency and interruption of the radiopaque border of the canal. Increased radiolucency around the tooth apex was the best predictor and practitioners should be aware of this.

Where two or more markers were identified, contact between the mandibular canal and the tooth was found. Cases that showed a true relationship between the tooth and the canal tended to involve teeth in a horizontal position, but when no increased radiolucency was seen, the risk of a true relationship decreased. The number of cases with diversion of the canal was too small to draw any conclusion. When superimposition is noted on the PR, a periapical film is usually sufficient to determine position, but when markers are found that carry a high predictive value for a true relationship between tooth and canal, consultation is advised and a CT scan may be required as this is the most accurate method.

REFERENCE

Monaco, G., Montevecchi, M., Alessandri, G., et al. Reliability of panoramic radiography in evaluating the topographic relationship between the mandibular canal and third molars. JADA 135:312-318, 2004.

QUESTION 20

Antibiotics may be prescribed to patients with periodontal disease that is not responding to conventional mechanical therapy.

Antibiotics are prescribed for acute necrotizing periodontitis.

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 recent report examined the practice of use of antibiotics in treatment of periodontitis. Although microbial etiology provides a rationale for use of antibiotics, arguments are made against indiscriminate therapy. Prime candidates for such care are those patients who continue to show loss of periodontal attachment despite careful mechanical treatment. Recurrent or refractory periodontitis with resistant subgingival pathogens or impaired host resistance can benefit from systemic antibiotics. Patients with acute periodontal infections, such as periodontal abscess or necrotizing gingivitis/periodontitis, are also candidates for systemic antibiotic therapy.

The report suggests that if using antibiotics, the dentist should try to determine the pathogenic microbia of the subgingival pocket. These samples are to be collected by sterile paper point or curette.

Common antibiotic therapies are shown in the table below and selection should be made according to sensitivity testing:

AntibioticAdult Dosage

Met
ronidazole500 mg/tid/8 days

Clindamycin300 mg/tid/8 days

Doxycycline or minocycline100-200 mg/qd/21 days

Ciprofloxin500 mg/bid/8 days

Azithromycin500 mg/qd/4-7 days

Metronidazole and amoxicillin250 mg/tid/8 days of each drug

Metronidazole and ciprofloxacin500 mg/bid/8 days of each drug

REFERENCE

Position paper. Systemic antibiotics in periodontics. J Periodontol. 75:1553-1565, 2004.

Answers to the April 2006 SLSA Questions

13. A

14. D

15. B

16. E


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