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 25
Minimal intervention dentistry
1. emphasizes the need for disease detection.
2. emphasizes the need for disease prevention.
3. is valuable in treatment of the elderly.
4. takes account of caries risk and individual need.
A. 1, 2, 3
B. 1 and 3
C. 2 and 4
D. 4 only
E. All of the above.
Rationale
Minimal intervention dentistry (MID) has gained in both status and application through the increased numbers of the elderly who with retention of their natural teeth present a new caries challenge as well as chronic and other forms of periodontal disease. The approaches to care simulate those of a medical model in which the dentist assumes the role of an “oral physician.” Thus emphasis is placed on detection of disease and prevention as well as the overall risk to caries and periodontal disease. MID restorative dentistry uses tunnel and slot type preparations preserving as much of the tooth tissue as possible with no extension for prevention. Cervical lesions are common in the elderly. Many can be treated by re-mineralisation techniques, whilst others can be treated by use of resin modified glass ionomers. Another approach advocated is the “sandwich” technique where two restorative materials are used to gain the biological, physical and aesthetic benefits of each, e. g. glass ionomer, as base material releasing fluoride, with amalgam or composite resin on top for strength.
As indicated, before any restorative care is given, learning, MID requires assessment of the patient for caries risk. Quality and quantity of saliva and the patient’s diet must also be considered. Preventive strategies with chlorhexidine mouth washes to decrease the bacterial load as well as the introduction of fluoride rinses and high fluoride content dentifrices for remineralisation are integral parts of MID. Oral health education with adjustments of oral hygiene techniques must be introduced to comply with each individual patient’s needs.
REFERENCES
1. Chalmers, J. M. Minimal intervention dentistry: Part 1 — Strategies for addressing the new caries challenge in older patients. J Can Dent Assoc 72 : 427 -433, 2006.
2. Chalmers, J. M. Minimal intervention dentistry: Part 2 — Strategies for addressing restorative challenges in older patients. J Can Dent Assoc 72 : 435 -440, 2006.
3. Minimally invasive dentistry. Oral Care Report Vo. 14 No. 4 Ed. C. Douglass, 2004
QUESTION 26
Which of the following is necessary for successful indirect pulp treatment of a primary molar with deep caries?
1. Absence of signs and symptoms of irreversible pulpitis.
2. Completion of treatment in one appointment.
3. Use of calcium hydroxide liner with full marginal seal.
4. Use of gutta percha with an amalgam restoration.
A. 1, 2, 3
B. 1 and 3
C. 2 and 4
D. 4 only
E. All of the above.
Rationale
The aim of indirect pulp treatment is maintenance of pulp vitality. The residual layer of dentine is contaminated by bacteria before treatment, but becomes sterile or there is significant reduction of organisms when treated with calcium hydroxide, zinc oxide, or even gutta percha provided an adhesive resin restoration with a marginal seal is placed over these base materials. The diagnostic criteria for such treatment suggest that primary molars with deep caries but without signs and symptoms of irreversible pulpitis would give successful results. Further, it is claimed that if the pulp treatment and the final restoration can be completed in one appointment, there is increased success. This leads to the conclusion that selection criteria, use of a restoration with full marginal seal with work completed in one appointment are most important for successful outcome.
REFERENCE
1. Franzon, R., Casagrande, L., Pinto, A. S. et al. Clinical and radiographic evaluation of indirect pulp treatment in primary molars: 36 months follow-up. Am J Dent 20 : 189 -192, 2007.
QUESTION 27
Antibiotic prophylaxis prior to an invasive dental procedure is required for a patient with
1. ventricular septal defect.
2. history of previous endocarditis.
3. atrial septal defect.
4. prosthetic heart valve.
A. 1, 2, 3
B. 1 and 3
C. 2 and 4
D. 4 only
E. All of the above.
Rationale
The American Heart Association guidelines for 2007 state that antibiotic prophylaxis is no longer necessary prior to an invasive dental procedure except for patients at highest risk of developing endocarditis. These patients include those with: a prosthetic heart valve, previous endocarditis, certain congenital heart diseases, a cardiac transplant that develops a problem in a heart valve.
The following patients no longer require prophylaxis: mitral valve prolapse, rheumatic heart disease, bicuspid valve disease, calcified aortic stenosis, ventricular and atrial septal defects.
The following are reasons for the revision. Infective endocarditis (IE) is more likely to occur from frequent exposure to random bacteraemias associated with brushing and chewing than from bacteraemia caused by a dental procedure. Prophylaxis may prevent an exceedingly small number of cases of IE.
The risk of antibiotic-associated adverse events exceeds the benefit, if any, from antibiotic therapy. Maintenance of optimal oral health and hygiene may reduce the incidence of bacteraemias from daily activities and is more important than prophylactic antibiotics.
REFERENCE
1. Wilson, W., Taubert, K. A., Gewitz, M. et al. Prevention of infective endocarditis: Guidelines from the American Heart Association. JADA 138 : 739 -760, 2007.
QUESTION 28
For a tooth with irreversible pulpitis, depth of local anaesthesia can be increased by use of premedication therapy.
For a tooth with irreversible pulpitis, ibuprofen, when given as a premedication, is more effective than acetaminophen-codeine in achieving deep local anaesthesia.
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
The difficulty of achieving adequate anaesthesia in teeth with an acutely inflamed pulp (irreversible pulpitis) is a well known clinical finding. A study was conducted to determine whether premedication therapy with acetaminophen-codeine or ibuprofen was able to increase the depth of anaesthesia in inflamed teeth. Ibuprofen, acetaminophen-codeine and a placebo were administered one hour before local anaesthesia. Assessment of preoperative sensitivity and degree of anaesthesia was carried out with the electric pulp tester. Lower tooth sensitivity levels were observed in the ibuprofen and acetaminophen-codeine groups as compared with the placebo group. The ibuprofen group showed significantly lower sensitivity than the acetaminophen-codeine group.
This study showed that ibuprofen, if not contraindicated, administered one hour before local anaesthesia injection, is an effective way of achieving deep anaesthesia during root canal treatment of teeth with irreversible pulpitis.
REFERENCE
1. Modaresi, J., Dianat, O, Mozayeni, M. A. The efficacy comparison of ibuprofen, acetaminophen-codeine, and placebo premedication therapy on the depth of anesthesia during treatment of inflamed teeth. Oral Surg Oral Med Ora
l Pathol Oral Radiol Endod 102 : 399 -403, 2006.
Answers to the June 2009 SLSA questions: 21. D 22.C 23.E 24.C
