2011 is the final year of the SLSA program in Oral Health. The 8-question Quiz is coming in the November issue. Because the program is half its usual length, provincial licensing authorities may alter the allocation of CE credits. Unlike previous years, SLSA will not be involved in processing the results or forwarding names of participants to the provinical licensing authority. Do not return Quiz cards to Oral Health. Contact your own CE administrator at your provincial licensing authority.
Question 17
Dry mouth
1. increases risk of oral infections.
2. increases risk of caries.
3. is more common in women.
4. affects taste.
A. 1, 2, 3 D. 4 only
B. 1 and 3 E. All of the above.
C. 2 and 4
Rationale
The known causes of dry mouth include chronic gland inflammation (Sjögren’s disease), diabetes, depression, head and neck radiotherapy, radioiodine therapy, and drugs of various categories. In about 20% of cases the cause is unknown. With dry mouth, chewing, swallowing, and speaking become difficult. Taste acuity diminishes and oral infections, dental caries and halitosis often occur. Dry mouth is more common among women than among men and its prevalence increases with age. It is estimated that 15-40% of the population are affected with dry mouth.
Reference
1. Khosravani, N., Birkhed, D., and Ekkström, J. The cholinesterase inhibitophysostigmine for the local treatment of dry mouth: a randomized study. Eur J Oral Sci 117 : 209 – 217, 2009.
Question 18
Which of the following is/are considered forms of child abuse?
1. Forcing a child to be a caregiver.
2. Sexual abuse.
3. Denial of dental care.
4. Physical abuse.
A. 1, 2, 3
B. 1 and 3
C. 2 and 4
D. 4 only
E. All of the above.
Rationale
Child abuse has been defined as any act (non accidental or trauma) that endangers a child’s physical or emotional health or development. It can be any of the following: physical abuse and/or injury, medical/dental denial, emotional trauma, drug or alcohol involvement, nutritional denial, parental abandonment, withholding of basic needs, cruel tasks or work, inhuman living conditions, sexual abuse, and forcing a child to be a caregiver. In cases of physical injury, a dental professional must decide if the likely cause was an accident or abuse. Document and photograph injuries and ask questions of parents/caregivers. Remember that for every injury there is an explanation or reason. The dentist has to decide if the explanation is reasonable and appropriate or if the injury should be reported.
REFERENCE
1. Yellen, C.N. Mandated reporting for Dental Professionals. RDH Magazine 29 : 71 – 79, 2009.
Question 19
For a patient with pericoronitis, who has fever and trismus, the antibiotic of choice is
A. clindamycin.
B. amoxicillin.
C. metronidazole.
D. penicillin V.
Rationale
In the current climate of evidence-based medicine an attempt is made to rationalize the use of antibiotics for adult patients presenting with acute dentoalveolar infections. Most can be successfully treated with surgical drainage followed by removal of the cause of infection. For those patients who have become systemically unwell, or who are immunocompromised, the same principles are followed along with adjunctive antibiotic therapy to manage their systemic involvement.
Systemic involvement signs include elevated body temperature, gross swelling, trismus, regional lymphadenopathy and tachycardia. For acute dentoalveolar infections, which are mixed infections, the antibiotic of choice is amoxicillin, followed by metronidazole and then clindamycin. For pericoronitis, periodontal abscess and ANUG, which are primarily anaerobic infections, the drug of choice is metronidazole followed by clindamycin. For an antibiotic to be successful, it must be active against the microorganisms present and be given in adequate dose, frequency and duration. Historically antibiotics have been prescribed for between 5 – 10 days. It is now becoming evident that long courses of antibiotics are not required and indeed may destroy the homeostasis of the oral microflora, leading to resistant strains. Antibiotics are prescribed with the intention of eradicating microbial systemic involvement and can be discontinued safely after the resolution of these signs, usually 2 – 3 days. Immunocompromised patients may require more radical use of antibiotics. The ratio of risk to benefit must be considered on an individual patient basis.
REFERENCE
1. Ellison, S.J. The role of phenoxymethylpenicillin, amoxicillin, metronidazole and clindamycin in the management of accute dentoalveolar abscesses – a review. Br Dent J 206 : 357 – 361, 2009.
Question 20
Common presenting symptoms of multiple sclerosis include
1. unilateral facial numbness.
2. impaired ability to articulate words.
3. unilateral facial pain.
4. visual disturbances.
A. 1, 2, 3
B. 1 and 3
C. 2 and 4
D. 4 only
E. All of the above.
Rationale
Multiple sclerosis (MS) is a chronic, inflammatory demyelinating disease of the central nervous system which affects mostly young adults and is increasing in prevalence and incidence. The presentation and course of the disease vary significantly, but it is generally marked by recurrent attacks of neurologic dysfunction, followed by remission which, after numerous relapses, cause permanent neurologic deficits.
The oral health care provider should be able to recognize the signs and symptoms of the orofacial region and be able to distinguish them from signs and symptoms of dental origin. The most common presenting symptoms include intermittent unilateral facial numbness or pain, facial palsy or spasm, impaired ability to articulate words, visual disturbances and diplopia. These attacks typically last for at least 24 hours with an average frequency of three times per year. Patients presenting with this symptomatology should be referred to a neurologist for investigation. There are no contraindications to dental treatment, but optimal time for treatment is during periods of remission.
Reference
1. Fischer, D.J., Epstein, J.B. and Klasser, G. Multiple sclerosis: an update for oral health care providers. Oral Surg, Oral Med, Oral Path, Oral Rad and Endodont 108 : 318 – 327, 2009.
Answers to the July 2011 SLSA Questions
13. E 14. C 15. E 16. E
