The splint for a repositioned subluxed permanent maxillary incisor should
1. be applied immediately.
2. allow for a degree of tooth mobility.
3. not interfere with full jaw movement.
4. encourage regeneration of new periodontal fibres.
A. 1, 2, 3
B. 1 and 3
C. 2 and 4
D. 4 only
E. All of the above.
The primary objective of splinting of injured teeth is protection and healing of the injured tissues. This includes alveolar bone and soft tissues and especially the periodontal ligament. If treatment is not rapid the periodontal ligament will fail to heal because of poor regenerative capacity. Therefore, a splint is called for immediately, but it should allow for a degree of tooth movement and not interfere with full excursion of the jaw. In this way, regeneration of the periodontal ligament fibres is encouraged. Many splints are available but the two most easily applied are a wire composite splint and a self etching and bonding material splint. Both use a soft wire support with composite resin or bonding material for attachment to the injured and adjacent teeth, the splint to be in place for 10 days to 3-4 weeks. A splint retention for over 4 weeks is contraindicated.
1. Kenny, D.J., Barrett, E.J. Emergency trauma: Treating the unexpected. Oral Health 97 – 116, 2006.
2. vonArx, T. Splinting of traumatized teeth with focus on adhesive techniques. Oral Health 85 – 94, 2006.
Soft and leathery Primary Root Caries Lesions are considered as active lesions.
Leathery Primary Root Caries Lesions can remineralize to become hard.
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.
Primary Root Caries Lesions (PRCL) have mainly been classified as soft, leathery or hard, based on differences in pattern and degree of lesion mineralization. Soft and leathery PRCL are considered as active lesions, while hard are considered to be arrested. Research suggests that leathery PRCL can remineralize to become hard and even remain hard over time.
Different preventive strategies have been tested to reverse and control PRCL such as meticulous oral hygiene in combination with fluoridated toothpaste and fluoride mouth rinses. Antibacterial methods with chlorhexidine varnish and ozone treatment have also been tested.
A clinical trial was conducted to assess the effect on PRCL of a twice daily use of a fluoride mouth rinse containing 250 ppm F as amine fluoride and potassium fluoride (AmF/KF), compared to a placebo mouthrinse solution without fluoride, both in combination with a fluoride toothpaste. Results showed that rinsing with AmF/KF twice daily, in combination with a fluoride toothpaste, significantly remineralized active soft and leathery PRCL, as well as reducing substantially tooth sensitivity.
1. Petersson, L.G., Hakestam, U., Baigi, A. et. al. Remineralization of primary root caries lesions using an amine fluoride rinse and dentifrice twice a day. American Journal of Dentistry 20 : 93 – 96, 2007.
Saliva
1. is antibacterial.
2. inhibits HIV.
3. remineralises enamel.
4. controls periodontal disease.
A. 1, 2, 3
B. 1 and 2
C. 2 and 3
D. 4 only
E. of the above.
Numerous bacteria are present in saliva and they are removed from the mouth mainly by swallowing. When hyposalivation occurs, patients will develop halitosis from reduced bacterial clearance and their subsequent proliferation. Saliva contains several antibacterial factors such as “lysozyme” which can repel transient bacterial invaders and “histatins” which have strong antifungal activity.
Many types of salivary proteins, such as mucin inhibit bacterial and HIV infections. Because saliva is supersaturated with tooth minerals, it is the “store” for the remineralisation process which is constantly occurring between meals.
There is little evidence that saliva has a direct influence on periodontal disease. It does not enter the periodontal pocket where the pathogens exist. Instead, it meets the crevicular fluid which carries leucocytes and desquamated cells into the mouth.
1. Dawes, C. Salivary flow patterns and the health of hard and soft oral tissues. JADA 139:18S – 24S, 2008.
During the surgical removal of an impacted mandibular third molar, it suddenly disappears from view and cannot be located by the operator. The patient thinks that he has swallowed it. There is no coughing. You would
A. inform the patient that it has been swallowed.
B. instruct the patient to examine his stools for the missing tooth and return when it has been found.
C. arrange for an abdominal x-ray.
D. arrange for abdominal, chest and neck x-rays.
Severe cough, dyspnea and wheezing generally follow tooth aspiration, but although rare, it is possible for an object to be aspirated without any evidence of coughing. Therefore when a tooth disappears from view it is mandatory that neck, chest and abdominal x-rays be taken to identify its location. If in the stomach, the patient can be instructed to search his stools until it is found. If in the lungs, the patient must undergo bronchoscopy to have the foreign body removed. Ingestion and aspiration of avulsed teeth have been reported in maxillofacial trauma, young children and physically and mentally challenged patients. Dentists should suspect that any avulsed or extracted tooth not found in the oral cavity has been aspirated or ingested. The same pertains to crowns, clamps and other objects. Early diagnosis and management is essential.
1. Elgazzar, R.F., Abdelhady, A.I. and Sadakah, A.A. Aspiration of an impacted lower third molar during its surgical removal under local anaesthesia. Int. J. Oral Maxillofac. Surg. 36: 362 – 364, 2007.
1. E
2. A
3. B
4. E
