QUESTION 21
Periodontal disease in the elderly can lead to the development of
1. acute pneumonia.
2. chronic respiratory disease.
3. obstructive pulmonary disease.
4. tooth loss.
A. 1, 2, 3
B. 1 and 3
C. 2 and 4
D. 4 only
E. All of the above.
Rationale
There is a high prevalence of periodontal disease in older adults which increases the risk for both root caries and tooth loss. This in turn leads to difficulties in mastication, nutrition and speech. There are medical consequences of periodontal disease which can set the stage for diabetes mellitus, respiratory disease, stroke and myocardial infarct. Type 2 diabetes is common in adults and periodontal disease can influence the course of the diabetes. Evidence suggests that periodontal disease is associated with poor glycemic control.
Respiratory disease, especially pneumonia, is a common cause of mortality in the elderly. The oral cavity and particularly teeth harbor pathogenic bacteria in biofilms which are readily shed and inhaled to develop pneumonia and other chronic respiratory diseases. A recent study further suggests an association between periodontal disease and chronic obstructive pulmonary disease.
Epidemiological data have shown association between periodontal disease and cardiovascular disease (CVD) and stroke especially in younger male subjects. Co-relation between alveolar bone loss and increased risk to CVD have also been demonstrated.
REFERENCE
1. Boehm, T.K. and Scannapiece, F.A. The epidemiology, consequences and management of periodontal disease in older adults. JADA 138 : 26S – 33S, 2007.
QUESTION 22
In pulpless teeth bonding to coronal dentin is better than to radicular dentin.
In pulpless teeth radicular dentin remains hydrated.
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 review of prefabricated fibre posts for crowns has shown a trend towards their increased use in clinical practice.
Retention of fibre posts and composite resins is dependent on the quality of bond at the various interfaces and it is of interest to note that bonding to radicular dentine is less favourable than that to coronal dentine. It is thought to be due to retained water still present in radicular dentin of pulpless teeth.
REFERENCE
1. Monticelli, F., Osorio, R., Sadek, F.T. et al. Surface treatments for improving bond strength to prefabricated fibre posts: A literature review. Op. Dent. 33. 346 – 355, 2008.
QUESTION 23
Porcelain veneer restorations (PVR) used for closure of interproximal spaces
1. create long contacts.
2. tend to have a square appearance.
3. look unnatural.
4. mainly fail through fracture.
A. 1, 2, 3
B. 1 and 3
C. 2 and 4
D. 4 only
E. All of the above.
Rationale
The result of closing of interproximal spaces with PVRs is the creation of long contacts which square the teeth causing them to look unnatural. Long term success rates of PVRs are similar to full crowns. There are three forms of failure – fracture (67%), microleakage (22%) and debonding (11%).
REFERENCE
1. Jacobson, N. and Frank, C.A. The myth of instant orthodontics: An ethical quandry. JADA 139 : 424 – 433, 2008.
QUESTION 24
The eating of cheese
1. prevents demineralization of teeth.
2. increases salivary flow rate.
3. raises calcium concentrations of plaque.
4. raises salivary pH.
A. 1, 2, 3
B. 1 and 3
C. 2 and 4
D. 4 only
E. All of the above.
Rationale
Dietary advice for dental health often focuses on negative messages, such as avoidance of high sugar and acidic soft drink consumption. However, positive dietary messages are more likely to be adhered to. There are a number of foods that can be recommended to patients because of their beneficial effects on dental health. These include milk, cheese, peanuts and interestingly, also raw cranberries, tea and high-fiber foods. Although cow’s milk contains up to 5% sugar (predominantly lactose, the least cariogenic sugar) it also contains calcium, phosphate, casein and other protein components that are cariostatic. Studies have shown that cheese prevents demineralization, increases salivary flow rate and pH, and raises the calcium concentrations of dental plaque, hence favouring remineralization.
REFERENCE
1. Moynihan, P. Foods and dietary factors that prevent dental caries. Quintessence International 38 : 320 – 324, 2007.
Answers to the May 2010 SLSA questions:
17. E
18. D
19. D
20. E
