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 33
In a patient with Type II diabetes mellitus, periodontal disease is associated with
1. altered collagen metabolism.
2. impaired fibroblast proliferation.
3. altered neutrophil function.
4. altered periodontal pathogens.
A. 1, 2, 3
B. 1 and 3
C. 2 and 4
D. 4 only
E. All of the above
Rationale
Type II diabetes mellitus (non-insulin dependent) results from defects of the insulin molecule or when there are abnormalities on the cell membrane receptors for insulin. This type of diabetes is 3.5 times more prevalent among people 65 years and over. Although a patient may complain of a dry mouth and altered taste, it is the periodontal clinical picture that may be most helpful in identification of the problem. The periodontal disease is apparently not related to increased plaque levels, calculus, or alteration of the periodontal pathogens. Instead it would appear to be related to altered host defences. These include an altered neutrophil function, monocyte and macrophage function, as well as collagen metabolism. Diabetes mellitus patients may produce large amounts of collagenase which can destroy collagen learning, in the periodontium. There is impaired fibroblast proliferation which changes the normal tissue turnover and repair. Large data sets suggest that control of periodontitis can improve glycemic status and thereby metabolic functions. Routine periodontal examination and screening for blood sugar levels can aid diagnosis.
REFERENCES
1. Persson, G. R. What has ageing to do with periodontal health and disease? Int. Dent.
J. 56 : 240 -249, 2006.
2. Oral Care Report 15, No. 1, 2005 Ed. Douglass C.
QUESTION 34
In the management of non vital teeth with incomplete apices, mineral trioxide aggregate (MTA) in comparison with calcium hydroxide
1. has better healing properties.
2. reduces the time for biological barrier formation as assessed radiographically.
3. results in a faster healing time for radiolucencies.
4. reduces the time from start of treatment to final root canal filling.
A. 1, 2, 3
B. 1 and 3
C. 2 and 4
D. 4 only
E. All of the above
Rationale
A study was designed to compare MTA with calcium hydroxide in the formation of an apical biological calcific barrier as well as the healing of periapical radiolucencies in teeth with unformed apices. The study recorded the time taken for barrier formation and, if present, time for any periapical lesion to heal. Out of 20 teeth allocated for apexification, 11 had associated radiolucencies, six in the MTA group and five in the Ca(OH)2 group. Both materials, with a similar pH, recorded comparable healing qualities. However, the total time taken from start of treatment to final root canal filling was much less with MTA. Furthermore, the mean time for biological barrier formation as assessed radiographically was significantly less with MTA. Healing time for radiolucencies was similar.
REFERENCE
1. Pradhan, D. P., Chawla, H. S., Gauba, K. et al. Comparative evaluation of endodontic management of teeth with unformed apices with mineral trioxide aggregate and calciumhydroxide. J. Dent. ForChildren 73:79-84,2006.
QUESTION 35
In posterior primary teeth, the risk of failure by secondary caries is higher for amalgam restorations than it is for compomer/composite resins.
In posterior primary teeth, failure due to fracture is the same for amalgam and resin restorations irrespective of size.
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
Over a five-year period, a randomized clinical trial showed that in posterior primary teeth, resin based restorations had greater replacement rates than amalgam due to recurrent caries. Thus pediatric patients will require more procedures to maintain the resin restorations than if amalgam were used. In another study, the risk of failure by secondary caries was 3.5 times higher for resins than amalgams. Failure due to fracture was equal. Irrespective of the arch, type of tooth or number of restored surfaces, the size of the restoration was not a factor in contributing to fracture.
REFERENCES
1. Soncini, J. A., Maserejian, N. N., Trachtenberg, F. et al. The longevity of amalgam versus compomer/composite restorations in posterior primary and permanent teeth. JADA 138 : 763 -772, 2007.
2. Bernardo, M., Luis, H., Martin, M. D. et al. Survival and reasons for failure of amalgam versus composite posterior restorations placed in a randomized clinical trial. JADA 138 : 775 -783, 2007.
QUESTION 36
Which of the following results in the greatest postoperative dentin sensitivity?
A. Scaling and root planing.
B. Full flap and osseous resection.
C. Gingivectomy.
D. Modified Widman procedure.
Rationale
A study was conducted on 56 patients with chronic periodontitis. With a split mouth design one quadrant in each patient was treated with scaling and root planing. Other quadrants received either Widman flap, gingivectomy, or full flap and osseous resection. Discomfort during the procedure, postoperative pain and postoperative dentine sensitivity were recorded and analyzed along with age and sex. No difference between sexes was shown with either surgical or non-surgical procedures. All surgical procedures caused more dentine sensitivity than scaling and root planing. Postoperative pain was much higher with full flap and osseous resection than with scaling and root planing and modified Widman procedure. Postoperative pain and discomfort was less of a problem with the elderly. This higher pain threshold may be the consequence of tissue changes such as reduced vascularity, fatty degeneration of bone tissue and secondary dentine formation.
REFERENCE
1. Canaki, C. F., Canaki, V. Pain experienced by patients undergoing different periodontal therapies. JADA 138 : 1563 -1573, 2007.
Answers to the August 2009 SLSA questions:
29. E
30. C
31. A
F2. C
