Smiles for Life

What is the most common chronic disease of childhood?
Dental caries
What is a consequence of untreated dental caries?
Cellulitis
What condition is associated with periodontal disease?
Preterm labor
Which of the following medication is linked to gingival hyperplasia?

A. Phenytoin
B. Amoxicillin
C. Digoxin
D. Coumadin

A. Phenytoin
What can a primary care clinician do to promote oral health?
Collaborate with dental and other health professionals
Which of these classes of medications is NOT generally associated with decreased salivary flow?
Antibiotics
A patient undergoing chemotherapy for cancer is at risk for which of these oral complications due to the effects of chemotherapy?

A. Osteonecrosis of alveolar bone
B. Gingival hyperplasia
C. Oral mucositis
D. Tooth fractures

C. Oral mucositis
Which of the following infections is NOT potentially caused by direct extension from a dental source?

A. Otitis media
B. Sinusitis
C. Brain abscess
D. Facial cellulitis

A. Otitis media
What is the suggested common pathway linking chronic periodontitis and conditions such as diabetes, coronary artery disease and adverse pregnancy outcomes?
Inflammation
Which of the following is NOT a mechanism for inter-relationships between oral and systemic disease?

A. Behavioral
B. Iatrogenic
C. Neurologic
D. Inflammatory

C. Neurologic
What is ECC?
An infectious, chronic disease
Oral bacteria and dietary sugars are two of the three parts of the “Etiology Triad” of ECC. What is the third part of the triad?
The enamel and dentine of teeth, which is vulnerable to demineralization.
What is a risk factor for developing ECC?
Caries in siblings or caretakers
How can primary care clinicians prevent ECC?
Counsel a child’s caregivers about the child’s diet
The mother of your 10-month-old patient asks for a prescription for supplemental fluoride. She reports that the family obtains their water from a well. What is your best course of action?
Test the well’s fluoride level prior to prescribing a dietary fluoride supplement
What is the first step in performing a knee-to-knee oral examination of a child’s mouth?
Have the caregiver hold the child facing him or her in a straddle postion
What guidance about teething should a primary care clinician provide to a toddler’s caregiver?
A child who is teething may be fussy
Periodontal disease can be clinically distinguished in which of the following ways?

A. Inflammation of the gums
B. White discoloration of the permanent teeth
C. Enlarged pockets at the gum base
D. Gingival hypertrophy

C. Enlarged pockets at the gum base
Which of the following is NOT a common site for oral cancers?

A. The tongue
B. Floor of mouth
C. Hard palate
D. Lower lip

C. Hard palate
Which dental procedure does NOT require prophylaxis for individuals at high risk of bacterial endocarditis?

A. Dental extractions
B. Periodontal procedures
C. Postoperative suture removal
D. Prophylactic cleaning of teeth if bleeding is anticipated
E. Reimplantation of avulsed teeth

C. Postoperative suture removal
Which of the following is most likely to lead to poorer oral health in the elderly?

A. Alzheimer’s dementia
B. Coronary artery disease
C. Hypothyroidism
D. All of the above

A. Alzheimer’s dementia
Which of the following is not a normal age-related tooth change?

A. Gingival recession
B. Root caries
C. Yellowing of teeth
D. Wearing away of teeth with exposed dentin

B. Root caries
Which of the following patients require bacterial endocarditis antibiotic prophylaxis?

A. A 26-year-old woman with mitral valve prolapse undergoing routine teeth cleaning with no anticipated bleeding.
B. A 64-year-old man with a prosthetic mitral valve who is undergoing a tooth extraction.
C. A 16-year-old boy with a ventricular septal defect completely repaired in infancy who requires extraction of an impacted wisdom tooth.
D. A 32-year-old man who had bacterial endocarditis 5 years ago who is undergoing orthodontic appliance adjustment.

B. A 64-year-old man with a prosthetic mitral valve who is undergoing a tooth extraction
Risk factors for adult caries may include all the following except:

A. Low socioeconomic status
B. Existing tooth restoration
C. Decreased salivary flow
D. A vegetarian diet
E. Physical disabilities

D. A vegetarian diet
Which of the following factors is NOT involved in the development of “Meth Mouth”:

A. Poor oral hygiene
B. Increased carbohydrate consumption
C. Night time mouth breathing
D. Teeth grinding
E. Xerostomia

C. Night time mouth breathing
Which of the following is considered to be involved in the development of recurrent aphthous ulcers?

A. Trauma
B. Vitamin C deficiency
C. Sickle Cell Anemia
D. Herpes simplex virus infection

A. Trauma
Which of the following statements concerning xerostomia, or dry mouth, is not true?

A. Xerostomia is caused by a decrease in the production of saliva.
B. Xerostomia can cause a burning sensation, change in taste, and difficulty swallowing.
C. Medications can contribute to xerostomia.
D. Xerostomia can increase the development of caries.
E. Xerostomia is rarely a problem for patients wearing complete dentures.

E. Xerostomia is rarely a problem for patients wearing complete dentures.
Concussion
Tooth is tender but not displaced or mobile
Subluxation
Tooth is mobile with no displacement, though it may have hemorrhage from the gingival crevice
Luxation
Tooth is loose with some degree of lateral displacement
Intrusion
Tooth is pushed deeper into its socket
Extrusion
Tooth is partially displaced axially from its socket
Avulsion
Tooth has been completely displaced or knocked out of its socket
When should an avulsed tooth in a three-year-old be optimally reimplanted?
It should NOT be reimplanted
Tongue piercings put patients at risk for all of the following conditions except:

A. Mucositis
B. Periodontal disease
C. Abscessed teeth
D. Tooth fractures

A. Mucositis
The treatment of choice for an abscessed tooth is?
Dental referral for extraction or root canal treatment
Which type of mouth guard provides the most protection against oral injury in sports?
Custom made
Which of the following requires treatment with antibiotics?

A. Periapical abscess
B. Cellulitis
C. Caries
D. Pulpitis

B. Cellulitis
Which of the following is an indication for hospitalization of a child with facial cellulitis?

A. Localized facial swelling
B. Fever
C. Tracking of swelling into the neck
D. Difficulty chewing

C. Tracking of swelling into the neck
Which antibiotic is the drug of choice for intraoral infections?
Penicillin
What should you do first in evaluating a patient with facial trauma?
Assess the patient’s airway, breathing, and circulation
What is the appropriate treatment for a chipped tooth?
Routine referral to a dentist to smooth or restore the chip
When should an avulsed tooth in a 35-year-old patient be optimally reimplanted?
Within 5 minutes
Which of the following is a FALSE statement?

A. Gingivitis is very common in pregnancy
B. Periodontitis is associated with preterm birth
C. Treatment of periodontitis in pregnancy decreases the risk of preterm birth
D. Deep root scaling to improve periodontitis is safe during pregnancy

C. Treatment of periodontitis in pregnancy decreases the risk of preterm birth
Which of the following is a TRUE statement:

A. Mothers with caries pass their genetic predisposition for caries on to their babies
B. Mothers with caries pass caries-causing bacteria to their babies in utero
C. Mothers with caries pass caries-causing bacteria to their infants early in life via saliva transmission
D. All of the above

C. Mothers with caries pass caries-causing bacteria to their infants early in life via saliva transmission
A pregnancy granuloma:
Can be observed
A pregnant patient asks you for guidance about having dental treatment during her pregnancy. What would you say?
Dental treatment can be done during any trimester
What guidance should you give a pregnant patient about having dental x-rays during her pregnancy?
Dental x-rays should be taken as necessary to reach a full diagnosis
What oral health guidance should you give a pregnant patient?
A. Brush twice daily with fluoridated toothpaste.
B. Use chlorhexidene mouthwash three times per day.
C. Avoid sugary drinks and snacks between meals.
D. Take fluoride dietary supplements.
E. A and C only.
E. A and C only
Chewing over-the-counter xylitol gum at least twice daily helps reduce the risk of a mother passing caries-causing bacteria to her children: T or F?
True
If a pregnant woman has an oral abscess in the first trimester, what should she do regarding treatment?
Have the tooth treated or extracted under local anesthesia immediately
Amalgam restorations placed during pregnancy can lead to which negative outcome in the fetus?

A. Birth defects
B. Neurologic sequelae
C. Spontaneous abortions
D. None of the above

D. None of the above
What could pregnant women do after vomiting to reduce the risk of enamel erosion?
Swish with baking soda and water
The mother of a 9 month old patient asks what causes early childhood caries (ECC). Which of the following is the most accurate reply?

A. The majority of ECC results from thin or “weak” tooth enamel inherited from the parents.
B. Bacteria in the child’s mouth break down dietary sugars into acids which break down tooth enamel.
C. A lack of protective saliva is the most common cause of ECC.
D. A calcium deficiency during the time teeth are formed produces teeth that lack a sufficiently thick covering of enamel.

B. Bacteria in the child’s mouth break down dietary sugars into acids which break down tooth enamel
Which of the following factors places a child at the most risk for developing early childhood caries?

A. Having a diagnosis of severe asthma.
B. Living with family members who smoke tobacco or drink excessive amounts of alcohol.
C. Breast feeding for longer than six months.
D. Having plaque on the teeth.

D. Having plaque on the teeth
Which of the following is NOT a mechanism of action for topical fluoride?

A. It inhibits demineralization of the teeth.
B. It promotes remineralization of the teeth.
C. It inhibits bacterial metabolism.
D. It promotes the release of saliva.

D. It promotes the release of saliva
Which of the following is a benefit of fluoride varnish?

A. Fluoride varnish permanently seals the pits and fissures of teeth.
B. Fluoride varnish decreases the need for routine dental care.
C. Fluoride varnish can reverse early decay (i.e., the “white spots”) and slow enamel destruction.
D. Fluoride varnish replaces the need to take systemic fluoride supplements.

C. Fluoride varnish can reverse early decay (i.e., the “white spots”) and slow enamel destruction
What guidance would you provide the mother of your 20-month-old patient who expresses concern about her child developing fluorosis? The family lives in a town that adds fluoride to the water supply, and the child has already had two cavities.
Tell the mother to use only a small smear of fluoridated toothpaste brushing the child’s teeth
Which children should receive fluoride varnish in the medical office?
High risk children without a dental home
When applying fluoride varnish to an infant what is the gauze used for?
The gauze is used to dry the child’s teeth and to remove gross plaque
What guidance do you give the grandmother of a child who has just had fluoride varnish applied to his teeth?
Avoid giving the child hot or hard good for 24 hours
What constitutes a tooth’s outer layer?
Enamel
What is a full complement of adult teeth?
32
A caregiver ask you how many teeth her 3 year old child should have. How would you respond?
20
At what age do teeth typically begin to erupt in children?
9-15 months
Oral cancer is most common in which area of the mouth?
Posterolateral tongue
When performing the “knee-to-knee” oral exam on a young child, in what position should the child start?
Facing the caregiver
Which of the following is NOT needed by a primary care clinician to conduct a thorough oral exam?
A. An exam light to illuminate key features in the mouth
B. Tongue depressors to lift the lip and retract the cheek
C. A mouth mirror to view lingual surfaces of teeth
D. Dental explorer
E. Gauze pads to grasp the tongue
D. Dental explorer
When examining a 9 month old child’s mouth, what is a reason for an early referral to a dentist?
Developmental tooth defects are present
You are performing an oral exam on your 21 year old patient who has been using smokeless tobacco for 4 years. What part of this patient’s oral cavity is especially important for you to examine?
The inner aspect of the patient’s lips and cheeks
A complete oral examination includes each of the following EXCEPT:

A. Temporomandibular joint (TMJ) exam
B. Cervical node exam
C. Palpation of the floor of the mouth
D. Sinus exam
E. Exam of the skin around the mouth

D. Sinus exam
What is the most common site for caries in the elderly?
The site of a previous restoration
Which of the following is not a risk factor for oral cancer?

A. Sunlight
B. Alcohol
C. Herpes infection
D. Tobacco

C. Herpes infection
What is the adverse intraoral effect with which calcium channel blockers are most associated?
Gingival hyperplasia
Which statement is true regarding dental prostheses?

A. Implants are commonly placed in a jaw to replace teeth lost due to severe osteoporosis.
B. Dentures should be removed and cleaned daily.
C. Bridges should be removed daily to facilitate cleaning of teeth.
D. A partial denture is permanently fixed to adjacent teeth and therefore does not need to be removed to perform a complete oral assessment.

B. Dentures should be removed and cleaned daily
What is a prominent risk factor for denture stomatitis?
Continuous wearing of dentures
What is the most significant reason why complete tooth loss has declined in the US from 50% to 18% in the last 60 years?
The addition of fluoride to most community water systems
Which of the following statements is true regarding the oral health of elderly patients with dementia?

A. Aging alone is the major contributor to poor oral health of older individuals with dementia.
B. Medications used to treat hypertension, depression, and behavioral disturbances seen in this population have little effect on their oral health.
C. Since this population struggles with Activities of Daily Living (ADLs), they are at high risk for poor oral health unless caregivers assist with oral care.
D. Reminding these individuals to brush their teeth each day is adequate to achieve and maintain good oral health

C. Since this population struggles with ADLs, they are at a high risk for poor oral health unless caregivers assist with oral care
Elderly with poor oral hygiene, missing teeth, and dental pain are at risk for worsening oral health due to which of the following nutritional factors?

A. Lack of foods rich in vitamins such as vitamin C and beta carotene.
B. Compensating for taste alteration due to prescribed medication with soft, sugared foods such as ice cream, pudding and white bread which can lead to caries in remaining teeth.
C. Use of mints or sweetened beverages to relieve dry mouth.
D. All of the above.

D. All of the above