CE Questions The answer sheet and further instructions are located on the tear-out card that appears on page 37, or take the test online at dimensionsofdentalhygiene.com. 1. What is the prevalence of cleidocranial dysplasia (CCD)? A. Occurs in approximately one in 100 individuals B. Occurs in approximately one in 1,000 individuals C. Occurs in approximately one in 1 million individuals D. Occurs in approximately one in 2 million individual 2. CCD was initially thought to exclusively involve which of the following bones? A. Face B. Skull C. Clavicle D. All of the above 3. CCD is considered a dysostosis. True False 4. Which of the following is a clinical feature of CCD? A. Short stature B. Abnormally long neck C. Abnormal teeth development D. All of the above 5. The clavicles are completely absent in what percentage of CCD cases? A. 10% B. 20% C. 30% D. 40% 6. Which of the following is a common dental anomaly associated with CCD? A. Abnormal permanent teeth morphology B. Midface retrusion C. Delayed eruption of permanent teeth D. All of the above 7. In a study of patients with CCD, what percentage displayed dental anomalies? A. 39.5% B. 93.5% C. 95.3% D. 98% 8. Which of the following should be recommended for patients with CCD at moderate caries risk? A. Over-the-counter fluoride toothpaste B. Fluoride mouthrinse C. Xylitol D. All of the above 9. Those with CCD at high caries risk may benefit from which of the following? A. Prescription-strength fluoride products B. Antibacterial agents C. Restorative therapy D. A and B 10. Following oral surgery, patients with CCD must be educated on minimizing the risk of bacterial contamination by maintaining a good oral hygiene routine at home. True False SECTION 1 SECTION 2 SECTION 3 dimensionsofdentalhygiene.com January/February 2024 • Dimensions OF DENTAL HYGIENE 31 pigeon or conical shape of chest, abnormally long neck, prominent forehead with a verti- cal groove down the middle, and narrow and sloping shoulders. Patients’ health histories should be reviewed and updated at the beginning of every appointment. Oral health pro- fessionals should ask patients if they are currently undergoing treatment with other health- care professionals. When conducting an oral examination, the oral hygiene professional should be aware of the manifestations associated with CCD including delayed exfoliation of primary teeth, delayed eruption of permanent teeth, multiple supernumerary teeth, and protrud- ing mandible.18 Radiographs are necessary to assess the number of supernumerary teeth and whether permanent teeth are present to replace retained primary teeth. All present primary, permanent, and supernumerary teeth should be documented in the patient’s dental chart. Occlusion must be noted, as malocclusion is a common oral consideration in this patient population. Overcrowding of teeth and malocclusion may create challenges to maintaining adequate oral self-care, thus promoting the formation and retention of plaque and calculus, resulting in gingival inflammation. Not only does malocclusion present oral health implications, it also general health implications, such as sleep apnea, which is associated with significant morbidity.28,33 Therefore, oral health professionals should screen patients with CCD for malocclusion and refer high-risk individuals to a specialist. CCD treatment commonly involves surgery-orthodontics, so patients may have ortho- dontic appliances. Patient education on effective biofilm removal with appropriate oral hygiene aids is essential. Oral health professionals should recommend a power toothbrush for more effective biofilm removal around orthodontic wires and brackets. For interproxi- mal biofilm removal, a floss threader or other specialized floss can be recommended. In addition to flossing, an oral irrigator may be used to achieve optimal oral hygiene espe- cially around crowded teeth, supernumerary teeth, and orthodontia. Patients with orthodontic appliances are at increased risk of tooth decay so performing a caries risk assessment is key. Over-the-counter fluoride toothpaste, fluoride mouthrinse, and xylitol should be recommended for patients with CCD at moderate caries risk. Those at high caries risk may benefit from prescription-strength fluoride products and antibacter- ial agents such as chlorhexidine and xylitol. The application of in-office fluoride treatments, such as a varnish, is indicated for patients at moderate and high risk levels. Patients who have undergone oral surgery will need postoperative instructions about surgical extraction site healing. Aside from the biological factors of tissue healing and regeneration, the patient’s post-operative care of the wound is also essential. Excessive rinsing of the mouth on the day of the operation, tobacco or alcohol consumption, and exerting strenuous physical effort can cause disruption of the tissue coagulation and lead to infection. Patients must be aware that biofilm also impacts healing. Excessive biofilm contamination of the wound can hinder recovery. Educating the patient on minimizing the risk of bacterial contamination by maintaining a good oral hygiene routine at home is essential.34 Conclusion CCD is a rare genetic disorder that affects the entire skeleton with a variety of characteris- tics including abnormal development of the dentition. Dental anomalies are a common manifestation and include supernumerary teeth, retention of primary teeth, and malocclu- sion. Dental professionals should be familiar with the signs and symptoms of CCD, provide referrals to specialists when indicated, and offer appropriate oral health education and interventions. The references that accompany this article appear with the web version at: dimensionsofdentalhygiene.com. D
