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Self learning, Self assessment 2010 (April 01, 2010)

April 1, 2010
by Oral Health


The SLSA program is based on current, referenced literature and consists of 40 questions, answers, rationales are 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 tthe quiz will be forwarded to their respective provincial licensing authorities.

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QUESTION 13

When considering the aesthetics of a smile which of the following relate(s) to the maxillary gingiva?

1. Pink stippled tissue.

2. Height and contour.

3. Display.

4. Biotype.

A. 1, 2, 3

B. 1 and 3

C. 2 and 4

D. 4 only

E. All of the above.

Rationale

All the above must be considered for aesthetics. Gingival tissue should be pink, stippled and the papillae pointed and tight to the cervical margin of the teeth. In terms of height a line between the apices of the gingiva of both central incisors should be at the same level. An extension of this line back to the molars should lie in a continuum. The lateral incisor gingival apex is just below the central incisor line. For gingival display, the upper lip lies on the cervical margins of the teeth. Excessive gingival display beyond this causes a non aesthetic “gummy smile”. Two biotypes of the gingivae are recognized – thick and flat, and thin and scalloped. The former resists recession whereas thin biotype tends towards poor aesthetics by recession, particularly after any treatment involving the periodontium.

REFERENCES

1. Leblebicioglu, B., Rawal, S. and Mariotti, A. A review of the functional and esthetic requirements for dental implants. JADA 138 : 321 – 329, 2007.

2. Secrets of cosmetic dentistry (3) Perio aesthetics. Canadian Journal of Cosmetic Dentistry 22 – 24.

QUESTION 14

Which of the following is/are associated with cluster headache?

1. Can give rise to pain in teeth, gingiva and jaw.

2. Is unilateral.

3. Occurs more frequently in men than women.

4. Is associated with autonomic features.

A. 1, 2, 3

B. 1 and 3

C. 2 and 4

D. 4 only

E. All of the above.

Rationale

Cluster headache (CH) is characterized by severe, strictly unilateral pain attacks and occurs more frequently in men than women. Its peak age of onset is between 20 and 30 years. The pain is localized deep in and around the orbit and temporal region and may radiate to the maxilla, nostril, upper teeth, gingiva, palate and jaw. It is accompanied by ipsilateral conjunctival injection, lacrimation, nasal congestion, rhinorrhea, forehead and facial sweating, miosis, ptosis and eyelid oedema. The pain lasts on average from 15 minutes to 3 hours, and the headache occurs at least once every other day for a period of weeks or months, followed by a remission of weeks or years.

Because of the involvement of the midface patients may interpret the pain as originating in the teeth, jaw or temporomandibular joint. It is reported that 45% of patients with CH are seen first by a dentist. In a retrospective study of 33 subjects with CH, it was seen that 42% were seen by a dentist for some form of treatment which was often irreversible. The dental practitioner should be knowledgeable about this type of headache disorder and avoid the pitfall of implementing unnecessary and inappropriate traditional treatments in hopes of alleviating this neurovascular pain.

REFERENCE

1. Balasubramanian, R. and Klasser, G.P. Trigeminal autonomic cephalalgias. Part 1 : cluster headache. 0000E 104 : 345 – 354, 2007.

QUESTION 15

The most important source of oral malodor is related to microbial metabolism producing

1. amines and acids.

2. dimethyl sulfide.

3. methyl mercaptan.

4. hydrogen sulfide.

A. 1, 2, 3

B. 1 and 3

C. 2 and 4

D. 4 only

E. All of the above.

Rationale

The aetiology of oral malodor may be of oral or non-oral sources, but the most important source is microbial metabolism in the formation of volatile sulfur compounds including hydrogen sulfide, methyl mercaptan, dimethyl sulfide and other minor components such as amines and acids. The pathogenesis of oral malodor is associated with the degradation of sulfur-containing bacteria into volatile sulfur compounds. Some of these bacteria are located in plaques, gingival sulcus and dorsum of the tongue.

A double blind clinical study was undertaken to investigate the effectiveness of a dentifrice containing triclosan and a copolymer for controlling breath odor 12 hours after brushing the teeth compared to a placebo dentifrice which did not contain triclosan or a copolymer. The results of the study showed that after 12 hours a mean breath odor score for the test group was within the range of values for pleasant breath. The control group presented a mean breath odor score above the threshold corresponding to unpleasant breath which was statistically significant. A dentifrice containing triclosan with copolymer provides effective control of breath odor 12 hours after brushing the teeth.

REFERENCE

1. Sharma, N.C., Galustians, H.J., Qaqish, J. et al. Clinical effectiveness of a dentifrice containing triclosan and a copolymer for controlling breath odor. American Journal of Dentistry. 20 : 79 – 81, 2007.

QUESTION 16

Which of the following is/are characteristics of glass ionomers?

1. Caries prevention by sealing pits.

2. Caries prevention by sealing fissures.

3. Fluoride release.

4. Hydrophilic.

A. 1, 2, 3

B. 1 and 3

C. 2 and 4

D. 4 only

E. All of the above.

Rationale

Glass ionomers can be used where resin sealants are contraindicated. Clinical situations in which glass ionomers can serve as sealants are:

• primary molars that have deeply pitted or fissured surfaces where isolation may be difficult.

• treatment of permanent first or second molars that have not fully emerged.

• where a “transitional” sealant may be considered before placement of a “permanent” one.

Glass ionomer has many advantages. Of clinical importance is its hydrophilic nature and its ability to set rapidly. Glass ionomers release fluoride which allows remineralization of enamel. Fluoride ions are taken up by the enamel which renders the tooth structure less susceptible to acid challenge. The ability of glass ionomer to release other ions, notably calcium and aluminum, has been studied and there is evidence to show that these ions also promote remineralization.

Sealants should be placed during the most susceptible period to caries (the first year after eruption), when the tooth is emerging and oral hygiene is difficult to maintain. Glass ionomers offer a mechanism for applying sealants to newly erupted teeth when resin-based sealants may be contraindicated.

REFERENCE

1. Lindemeyer, R.G., The use of glass ionomer sealants on newly erupting permanent molars. JCDA 73 : 131 – 134, 2007.

Answers to the March 2010 SLSA questions:

9. E

10. B

11. C

12. A


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