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, 2009 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 21
Which of the following non-invasive diagnostic techniques has/have been proven clinically effective in early detection of occlusal caries?
1. Caries detection dye (CDD).
2. Fibre optic transillumination (FOTI).
3. Digital imaging fibre optic transillumination (DFOTI).
4. Laser fluorescence.
A. 1, 2, 3
B. 1 and 3
C. 2 and 4
D. 4 only
E. All of the above.
Rationale
Laser fluorescence is an excellent diagnostic method with a high degree of sensitivity. It has been proven clinically effective and recent developments have led to the introduction of a hand held laser caries detection aid (DIAGNO dent). Other non invasive diagnostic techniques include use of caries detection dye (CDD), magnification, fibre optic transillumination (FOTI) and digital imaging fibre optic transillumination (DFOTI), but no published clinical studies can support these yet.
REFERENCE
1. Zandona, A. F. and Zero, D. T. Diagnostic tools for early caries detection. JADA 137 : 1675 -1684, 2006.
QUESTION 22
After placement of a restoration, post-operative pain is caused by bacterial proliferation in the space between the dentine and the restoration base.
Chlorhexidine solution applied to the dentine before placement of the restoration will reduce post operative pain.
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
After placement of a restoration, Brnnstrm suggests that the cause of post-operative pain is the proliferation of bacteria in spaces left between the liner and the dentine. With nutrients derived from dentinal fluid, bacteria grow in the tubules and produce toxins which irritate the pulp and result in post operative pain.
In chlorhexidine pre-treatment two coats are applied and each air dried for forty seconds before restoration. Chlorhexidine reduces the bacterial load and therefore the sensitivity is decreased. Pre-treatment with chlorhexidine before use of any liners is therefore advocated in the management of all restorations.
REFERENCE
1. Al-Omari, W. M., Al-Omari, Q. D. and Omar, R. Effects of cavity disinfection on postoperative sensitivity associated with amalgam restorations. Op Dent 31: 165 -170, 2006.
QUESTION 23
Triclosan
1. is a broad spectrum antibacterial.
2. is effective against oral microorganisms.
3. reduces supragingival plaque.
4. can decrease gingival inflammation.
A. 1, 2, 3
B. 1 and 3
C. 2 and 4
D. 4 only
E. All of the above.
Rationale
Triclosan is a broad spectrum antibacterial agent and the studies referenced here give results of both long and short term use. The triclosan/copolymer dentifrice was compared to a non-antimicrobial dentifrice. Antimicrobial effects were evaluated six and 12 hours after brushing.
Oral microorganisms from the sites of plaque, saliva and tongue were depleted ten fold for the triclosan group at both six and 12 hour collection periods. Quantitative reductions of supragingival plaque wererecorded, gingivitis was controlled and since hydrogen sulfide producing organisms were also suppressed, oral halitosis was kept in abeyance.
In a more recent review, triclosan with 2 percent cyantrex copolymer was credited with a reduction of plaque and plaque prevention with regular brushing. A decrease in gingival inflammation was also observed.
REFERENCES
1. Fine, D. H., Furgang, D., Markowitz, K., et al. The antimicrobial effect of a triclosan/copolymer dentifrice on oral microorganisms in vivo. JADA 137 : 1406 -1413, 2006.
2. Gunsolley, J. C. A meta analysis of six month studies of anti-plaque and anti-gingivitis agents. JADA 137 : 1649 -1656, 2006.
QUESTION 24
With respect to implant placement, an extraction defect sounding (EDS) classification of 4 denotes a compromised socket with
1. 3mm vertical bone loss.
2. more than 5mm of transverse bone loss.
3. a soft tissue loss of 4mm.
4. more than 5mm vertical bone loss.
A. 1, 2, 3
B. 1 and 3
C. 2 and 4
C. 4 only
D. All of the above.
Rationale
In implantology, prior to tooth removal, an evaluation is made of the dento-gingival line for future reference. It is important also to assess the likely extraction defect since this is vital for a satisfactory esthetic outcome. This is done with or without flap reflection. With a periodontal probe, the position of the crest of the bone is noted as well as its relationship to the gingival margin. Using the data on the hard and soft tissue architecture around the tooth socket, an extraction defect sounding (EDS) classification has been developed. This can provide practitioners guidelines of approaches to follow for successful outcomes. An EDS 4 classified defect will have a compromised socket with more than 5mm vertical or transverse loss of hard and/or soft tissue. This will require three stages of treatment: site preservation, site development and implant placement.
REFERENCE
1. Caplanis, N., Lazada, J. L., Kan, J. Y. K. The EDS classification: Extraction defect assessment, classification and management. Oral Health 63 -86, 2006.
Answers to the May 2009 SLSA questions:
17. a
18. a
19. c
20. e
