Prof. Khalid A. Al Wazzan

Clinically oriented reading material sent to fifth year students by e-mail along with one MCQ quiz. The students should answer the quiz within one week.

 

Q10:  

يعد موقع المركز الوطني للوثائق والمحفوظات أهم موقع لمن يبحث عن الأنظمة واللوائح والتعليمات والاتفاقيات والمعاهدات السعودية.

اذهب لموقع المركز على  الرابط التالي:  http://www.ncda.gov.sa/

اختر: الأنظمة واللوائح والتنظيمات السعودية.

ثم اختر الأنظمة الصحية.

حمل نظام مزاولة المهن الصحية (ملف pdf).

اقرأ الفرع الثاني من الفصل الثاني بعنوان (واجبات الممارس الصحي نحو المريض)، ثم أجب عن السؤال التالي

 

س10)    لا يجوز لطبيب الأسنان أن يفشي أسرار المريض التي علم بها عن طريق مهنته، إلا في الحالة/الأحوال الآتية:

a.         إذا كان الإفشاء مقصوداً به الإبلاغ عن مرض معدٍ.

b.         دفع طبيب الأسنان لاتهام وجهه إليه المريض، أو ذووه يتعلق بشخصيته.

c.         إذ وافق صاحب السر مشافهة على إفشائه.

d.         إذا صدر له أمر بذلك من الشرطة.

e.         الإجابات a، و b صحيحة.

f.          الإجابات b، و d صحيحة.

g.         جميع الإجابات السابقة صحيحة.

 

Q9:

A recent review about "Electric pulp testing" prepared by J. Lin & N. P. Chandler and published by International Endodontic Journal. Use the internet resources to search for its abstract then answer the following question.

  

Q9: The following is (are) True about Electric pulp testing:

a. is a valuable test in general and specialist endodontic practice.

b. is not reliably interpret and diagnose all pulpal conditions.

c. is often unreliable in testing immature and concussed teeth.

d. Careful collection of patient history concerning the problem tooth and examination of appropriate radiographs are essential.

e. a & c.

f. b, c & d.

g. All of the above.

 

      Go down to see the answer

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Q8:

Dentin bonding

Please read the following document then answer the question.

Swift Jr EJ. Dentin bonding. journal of esthetic and restorative dentistry, 16, 2004: 271.

 

Q8: The following is (are) True about Self-etching dentin bonding systems:

a. Do not require a separate etching step.

b. involve sequential application of three separate agents.

c. The chemistry of these materials can achieve dentin demineralization and resin infiltration simultaneously.

d. Associated with very low incidence of postoperative sensitivity.

e. Can produce excellent bond to uncut enamel.

f. a & c.

g. a, c & d.

h. All of the above.

 

     Go down to see the answer

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Q7:

American Board of Endodontics Pulpal & Periapical Diagnostic Terminology

Historically the American Board of Endodontics had relied upon the American Association of Endodontists Glossary of Terminology for the diagnostic categories of pulpal and periradicular pathosis. At the April 22, 2007 Board Meeting, the Directors considered and approved a simplified pulpal and periradicular diagnostic terminology.

PULPAL:

Normal pulp – A clinical diagnostic category in which the pulp is symptom free and normally responsive to vitality testing.

Reversible pulpitis – A clinical diagnosis based upon subjective and objective findings indicating that the inflammation should resolve and the pulp return to normal.  

Irreversible pulpitis – A clinical diagnosis based on subjective and objective findings indicating that the vital inflamed pulp is incapable of healing.

            Additional descriptions:

            Symptomatic – Lingering thermal pain, spontaneous pain, referred pain

            Asymptomatic – No clinical symptoms but inflammation produced by caries, caries excavation, trauma, etc.

Pulp necrosis – A clinical diagnostic category indicating death of the dental pulp.  The pulp is non-responsive to vitality testing.

Previously Treated – A clinical diagnostic category indicating that the tooth has been endodontically treated and the canals are obturated with various filling materials, other that intracanal medicaments. 

Previously Initiated Therapy – A clinical diagnostic category indicating that the tooth has been previously treated by partial endodontic therapy (e.g. pulpotomy, pulpectomy).

 

APICAL (PERIAPICAL):

Normal apical tissues – Teeth with normal periradicular tissues that will not be abnormally sensitive to percussion or palpation testing. The lamina dura surrounding the root is intact and the periodontal ligament space is uniform.

Symptomatic apical periodontitis – Inflammation, usually of the apical periodontium, producing clinical symptoms including painful response to biting and percussion. It may or may not be associated with an apical radiolucent area.

Asymptomatic apical periodontitis – Inflammation and destruction of apical periodontium that is of pulpal origin, appears as an apical radiolucent area and does not produce clinical symptoms.

Acute apical abscess – An inflammatory reaction to pulpal infection and necrosis characterized by rapid onset, spontaneous pain, tenderness of the tooth to pressure, pus formation and swelling of associated tissues.

Chronic apical abscess – An inflammatory reaction to pulpal infection and necrosis characterized by gradual onset, little or no discomfort and the intermittent discharge of pus through an associated sinus tract.

 

Please answer the following question according to the previous information.

Q7: A 22 years old male student reported to the emergency clinic complaining of severe pain when chewing food on the lower first left molar. Radiographically there is no caries and the periapical area is normal.  The clinical examination revealed good oral hygiene and positive response to thermal test, electric pulp tester and percussion test.  The patient said that his dentist cemented a bridge on the upper right molar area three days ago.  The diagnosis is:

a. Acute apical abscess.

b. Symptomatic apical periodontitis.

c. Reversible pulpitis.

d. Irreversible pulpitis.

   Go down to see the answer

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Q6:

The Centers for Disease Control and Prevention (CDC) is an agency of the United States Department of Health and Human Services. It focuses national attention on developing and applying disease prevention and control (especially infectious diseases), environmental health, occupational safety and health, health promotion, prevention and education activities designed to improve the health of the people.

1. Open your Internet browser.

2. Go to the URL http://www.cdc.gov/OralHealth/ , which is the address for the CDC.

3. Click on Infection Control in Dental Settings.

4. Click on Guidelines.

5. Download the PDF file about Guidelines for Infection Control in Dental Health-Care Settings, 2003.

Read the section about Hepatitis B Virus then answer the following question.

Q6: the following is/are true about Hepatitis B Virus.

a. Vaccination can protect both dentists and patients from HBV infection.

b.   HBV can survive in dried blood at room temperature on environmental surfaces for 1 week.

c.   the risk of developing clinical hepatitis from a needle contaminated with HBsAg-positive, HBeAg-negative blood was 1%–6%.

d. (a) and (b).

e. All of the above.

f. none of the above.

 

Go down to see the answer

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Q5:

PubMed is a search interface to Medline, a database consisting of over 12 million citations from over 4,000 journals indexed by the National Library of Medicine in the United States. Some citations have links to online full-text articles from participating publishers.

 Starting a Search

1. Open your Internet browser.

2. Go to the URL http://www.nlm.nih.gov, which is the address for the National Library of Medicine.

3. Click on Health Information.

4. Click on Medline/PubMed. This will take you to the simple search interface page for PubMed.

 Simple Searching

1. To perform a search, type a keyword related to your topic into the search window.

2. Multiple keywords will automatically be combined with AND. You may also search using the Boolean operators OR or NOT. Please note that Boolean operators must be in upper case letters, or they will be ignored.

3. You may search phrases by enclosing a phrase in quotations, eg. “intraoral cameras.”

4. To execute the search, click the “Go” button.

5. By default, your results will be displayed in summary format.

 Changing the Display:

1. To change the display, click the “Display” button and choose another format from the pull down menu of options. For example, you may wish to display abstracts.

2. If you wish to see abstracts for only selected records, use the check boxes beside the records to select the ones you wish to view.

3. PubMed provides some links to full text articles from participating publishers.

 Go to the PubMed and search for the following article.

 Title of the article: Lingual nerve damage after mandibular third molar surgery: a randomized clinical trial.

Authors: Gomes AC, Vasconcelos BC, de Oliveira e Silva ED, da Silva LC.

Journal:  J Oral Maxillofac Surg. 2005 Oct;63(10):1443-6.

 Read the abstract of the article then answer the following question.

Q5: Lingual nerve retraction represented a risk factor to temporary lingual nerve damage during mandibular third molar surgery.

a.   True.

b.   False.

Go down to see the answer

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Q4:

Read the following abstract then answer question 

Title of the article: Temperature Rise Produced by Different Light-curing Units through Dentin.

Authors: Yazici AR, Müftü A, Kugel G.

Journal:  J Contemp Dent Pract 2007 November; (8)7:021-028.

Abstract:

Aim:  This study investigated the temperature rise caused by different light curing units and the temperature increase in dentin of different thicknesses.

Methods and Materials:  Dentin discs of 1.0 and 2.0 mm thicknesses were prepared from extracted human mandibular molars. Temperatures were recorded directly at the surface of the light guide tip, under dentin discs with different thicknesses, and through a sandwich composed of 2 mm thick cured composite and dentin using a K-type thermocouple. The curing units used were two quartz-tungsten-halogen lights (Spectrum and Elipar Trilight-ET) and a light-emitting diode (LED).

Results:  The highest temperature rise was observed under a Mylar strip using ET standard mode. Under 1 and 2 mm thick dentin barriers, the lowest temperature rise was measured for the LED curing light. Significant differences in temperature rise existed among all curing units except between the Spectrum and ET exponential modes under a 1 mm thick dentin barrier with cured composite. Temperature rises were insignificant between the Spectrum and ET exponential modes and between two modes of Trilight when the same experimental setup was used under a 2 mm thick dentin barrier.

Table 2. Mean values and standard deviations of temperature rise (ºC) induced by different light curing units (LCU).

                         

For full text of the paper, go to: http://www.thejcdp.com/issue036/yazici/01_page.htm

 

Please answer the following question:

Q4: from the above information the following conclusion(s) can be made:

a.   For all curing units, temperature elevation through 2 mm of dentin was less than for 1 mm of dentin thickness.

b.   The ET standard mode produced the highest and the LED produced the lowest temperature rise for all tested conditions.

c.    The thickness of dentin and light-curing unit might affect temperature transmission.

d.   b & c.

e.   a & c.

f.    all of the above.

 

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Q3:

Read the following abstract then answer question 

 

Title of the article: The Visible Portion of Anterior Teeth at Rest.

Authors: Al Wazzan KA.

Journal:  J Contemp Dent Pract. 2004 February; 5(1): 53-62.

 

Abstract:

The visibility of anterior tooth surfaces with lips at rest or during function is an important factor in determining prosthodontic outcome. There is a lack of sufficient information published on this subject.

The aim of this study was to investigate the degree of visibility of maxillary and mandibular anterior teeth surfaces when the lips are at rest.

Four hundred seventy three adults were examined. All the subjects had maxillary and mandibular anterior teeth present with no caries, restorations, severe attrition, mobility, extrusion, or obvious deformities. The portions of anterior teeth that were visible were measured vertically using a Boley gauge from the border of the lip to the incisal edge for the incisors and to the cusp tip for the canines. The measurement was taken at the midpoint of the tooth when the lips and lower jaw were at the rest position. The length of the upper lip was measured from the base of the columella to the tip of the philtrum at the midline of the face.

Males showed more of the maxillary lateral, canine, and mandibular anterior teeth than females. With increasing age, the amount of maxillary anterior teeth that was visible at rest decreased. The subjects with shorter upper lips displayed more maxillary central incisor structure than those with longer upper lips. Racial differences were not found.

The amount of visible portions of anterior teeth is determined by muscle positions that vary from person to another. It provides an excellent starting point for vertical positioning anterior teeth that can be modified as necessary in any clinical situation. The findings of this study should help the dentist in providing aesthetic prosthodontic treatment that involves replacement of anterior teeth. A useful guideline for positioning anterior teeth is suggested.

 For full text of the paper, go to: http://www.thejcdp.com/issue017/al_wazzan/01al_wazzan.shtml

  

Please answer the following question:

Q3: More of the maxillary lateral incisor expected to be exposed, with lips at rest, in the following groups:

a.   50-60 years group age.

b.   Men.

c.   Subjects with shorter lower lips.

d.   b & c.

  

Go down to see the answer

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Q2:

Read the following abstract then answer question

Summary of the 2007 American Heart Association (AHA) Guidelines for Infective Endocarditis (IE) Prophylaxis

 Cardiac conditions associated with the highest risk of adverse outcome from endocarditis for which prophylaxis with dental procedures is recommended

1.      Prosthetic cardiac valve

2.      Previous IE

3.      Congenital heart disease (CHD)*

a.       Unrepaired cyanotic CHD, including palliative shunts and conduits

b.      Completely repaired congenital heart defect with prosthetic material or device, whether placed by surgery or by catheter intervention, during the first six months after the procedure+

c.       Repaired CHD with residual defects at the site or adjacent to the site of a prosthetic patch or prosthetic device (which inhibit endothelialization)

4.      Cardiac transplantation recipients who develop cardiac valvulopathy

*Except for the conditions listed above, antibiotic prophylaxis is no longer recommended for any other form of CHD.

+Prophylaxis is recommended because endothelialization of prosthetic material occurs within 6 months after the procedure.

 Regimens for dental procedure

Regimen: Single dose 30 to 60 min before procedure

Situation	Agent	Adults	Children
Oral	Amoxicillin	2 g	50 mg/kg
Unable to take oral medication	Ampicillin OR Cefazolin or ceftriaxone	2 g IM or IV   1 g IM or IV	50 mg/kg IM or IV   50 mg/kg IM or IV
Allergic to penicillins or ampicillin-oral	Cephalexin*+ OR Clindamycin OR Azithromycin or clarithromycin	2 g   600 mg   500 mg	50 mg/kg   20 mg/kg   15 mg/kg
Allergic to penicillins or ampicillin and unable to take oral medication	Cefazolin or ceftriaxone+ OR Clindamycin	1 g IM or IV   600 mg IM or IV	50 mg/kg IM or IV   20 mg/kg IM or IV

IM indicates intramuscular; IV, intravenous.

*Or other first- or second-generation oral cephalosporin in equivalent adult or pediatric dosage.

+Cephalosporins should not be used in an individual with a history of anaphylaxis, angioedema, or urticaria with penicillins or ampicillin.

 Recommendation for Dental procedures

Prophylaxis is recommended for dental procedures that involve manipulation of gingival tissue or the periapical region of teeth or perforation of the oral mucosa (includes routine cleanings, extractions, biopsies, suture removal, & placement of orthodontic bands).

Prophylaxis is not recommended for routine anesthetic injections through noninfe