Periodontal disease in older adults increases the risk for
1. root caries.
2. diabetes mellitus.
3. respiratory disease.
4. cardiovascular disease.
A. 1, 2, 3
B. 1 and 2
C. 2 and 3
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. Correlation 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.
In crown construction, prefabricated fibre posts are more successful than metal posts.
Bonding characteristics of coronal dentine and radicular dentine are similar.
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. Compared to metal post crowns the fibre post is shown to be superior both in “in vivo” and “in vitro” studies. For improved bonding of resin cements and core material to the fibre posts chemical and/or micromechanical treatment of the post surface is being investigated.
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.
Compared to orthodontic treatment of a malaligned maxillary central incisor in a 20 year old patient, a porcelain veneer restoration (PVR) is
1. quicker.
2. minimally invasive.
3. cheaper.
4. more esthetic.
A. 1, 2, 3
B. 1 and 3
C. 2 and 4
D. 4 only
E. All of the above.
Rationale
Realignment of a healthy tooth using a PVR cannot be considered a minimal invasive procedure. Although providing a speedier and less costly result, it is doubtful if restorative correction can be justified ethically. Three types of malalignment are recognized – rotation, labial and lingual displacement and spacing. For a rotated tooth the amount of enamel removed on the labial surface can vary from little to actual dentine exposure, the amount depending upon the angle of tooth rotation. Lingually and labially tipped teeth also vary considerably in the required reductions of both enamel and dentine. An unesthetic 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%). Therefore, the more conservative option of orthodontic realignment must be considered the ethical approach especially in the younger patient.
REFERENCE
1. Jacobson, N. and Frank, C.A. The myth of instant orthodontics: An ethical quandry. JADA 139 : 424 – 433, 2008.
Which of the following has/have cariostatic properties?
1. Cow’s milk.
2. Peanuts.
3. Cheese.
4. Tea.
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.
Cranberries, a good source of flavonoids that have antimicrobial effects, have been shown to lower S.mutans counts. Eating an apple after a meal has been promoted as a means to clean teeth. However, early clinical trials on caries prevention have shown inconclusive results. Tea is also a rich source of flavonoids and fluoride. Fibrous plant foods have been viewed as nature’s toothbrushes. However, their effectiveness in caries prevention is more likely to be related to mechanical stimulation of salivary flow than effective plaque removal. Promoting foods that are known to protect against dental decay is an important part of dietary advice that enables delivery of more positive dietary messages.
REFERENCE
1. Moynihan, P. Foods and dietary factors that prevent dental caries. Quintessence International 38 : 320 – 324, 2007.
1. C
2. C
3. C
4. C
5. A
6. A
7. A
8. D
9. A
10. C
11. C
12. A
13. E
14. E
15. C
