We would like to inform readers that 2011 will be the final year of the SLSA program in Oral Health. The program for 2011 will consist of 20 items. We will publish four items every other month with an 8-question Quiz appearing in the November 2011 issue. Because the program is half its usual length, provincial licensing authorities may alter the allocation of CE credits.
Question 13
Tension type headache is associated with
1. hyperactivity of masseter muscles.
2. hyperactivity of temporalis muscles.
3. clenching.
4. increased tongue pressure on teeth.
A. 1, 2, 3
B. 1 and 3
C. 2 and 4
D. 4 only
E. All of the above.
Rationale
Masseter muscles show essential and significant relationship to headache. Internal derangement of the TMJ increases activity of masseter and temporalis muscles. Pain in the masseters has a distinct connection to headaches. In all headache patients , bruxism and increased tongue pressure against the teeth is more prevalent and is considered to play a role in both migraine and tension type headaches. In a study of headache sufferers who clench, it was found that clenching for 30 minutes could cause immediate headache. It is further thought that bruxism may be a factor in converting episodic tension headaches into chronic ones. The use of an intra oral stabilization occlusal splint can reduce tension type headaches by 70 – 80%.
Reference
1. Lasbovitz, B.M. Tempomandibular disorders and headache: A review of the literature Oral Health June 12 – 17, 2006.
Question 14
Which of the following has the widest margin of safety as a local anaesthetic agent.
A. Mepivacaine 3% plain.
B. Prilocaine 4% plain.
C. Lidocaine 2% with 1 : 100,000 epinephrine.
D. Articaine 4% with 1 : 100,000 epinephrine.
Rationale
Lidocaine 2% with 1:100,000 epinephrine has the widest margin of safety per cartridge of all commercially available formulations. Each lidocaine cartridge of 2% with epinephrine is half as toxic as mepivacaine 3% plain.
Reference
1. Wahl, M.J., Brown, R.S. Dentistry’s wonder drugs: Local anaesthetics and vasoconstrictors. General dentistry March/April 114 – 121 2010.
Question 15
Which of the following can diagnose oral squamous cell carcinoma (SCC)?
A. Toluidine blue stain.
B. Clinical examination.
C. VELScope examination.
D. All of the above.
E. None of the above.
Rationale
It is incumbent on oral health professionals to examine thoroughly the oral cavity and pharynx noting and recording any swellings, changes in colour, texture, or tenderness, identifying leukoplakia, erythroplasia, ulceration, induration or any abnormal mucosa.
New methods to investigate pre-malignant lesions and cancers are in use such as toluidine blue staining and the Visually Enhanced Lesion Scope (VELScope). The VELScope emits a cone of blue light into the mouth that excites various molecules within cells, causing them to absorb the light energy and re-emit it as visible fluorescence. When the light is removed, the fluorescence of the tissue is no longer visible. Because changes in the natural fluorescence of tissue generally reflect light-scattering biochemical or structural changes indicative of developing tumor cells, the VELScope allows dentists to shine a light onto a suspicious sore in the mouth, look through an attached eyepiece and watch for changes in color. Healthy oral tissue emits a pale green fluorescence, while potentially early tumor, or dysplastic cells appear dark green to black. WHATEVER METHOD IS USED TO IDENTIFY A POTENTIAL SCC, NONE CAN DIAGNOSE OTHER THAN BIOPSY.
References
1. Statistics Canada Report 2009.
2. Lomke, M.A. Clinical applications of dental lasers. Gen Dent Jan. – Feb. 47 – 59, 2009.
Question 16
To maximize the efficacy of fluoride varnish, which of the following is/are recommended.
1. Preapplication rubber cup prophylaxis.
2. Application to dry teeth.
3. No tooth brushing for 12 hours.
4. Soft diet for 12 hours.
A. 1, 2, 3
B. 1 and 3
C. 2 and 4
D. 4 only
E. All of the above.
Rationale
A recent review which included recommendations of an expert panel supports the view that for both safety and efficacy fluoride varnish is the preventive treatment of choice for children 3-12 yrs old. Application of the varnish takes less time and causes less discomfort and has more acceptability than foams and gels. Further, there is a decreased chance of swallowing with the risk of gastric irritation, as can occur from gels and foams. The varnish contains 2.26% fluoride from a suspension of 5% sodium fluoride in an alcohol solution of natural varnish. Thus it adheres to the teeth with prolonged release of fluoride interacting with the tooth enamel.
To maximize the potential of the varnish it is recommended that a pre-application rubber cup or toothbrush prophylaxis be followed by varnish application to DRY teeth. Further, post-operative instructions must include both no tooth brushing and a soft diet for 12 hours.
Reference
Miller, E.K., Varn, W.F. The use of fluoride varnish in children: a critical review with treatment recommendations. J Clin Pediatr Dent 32(4) : 259-264, 2008.
Answers to the May 2011 SLSA Questions
9. E 10. E 11. D 12. C
