Analgesia, periodontal risk and ectodermal dysplasia

Correct answer: A. Ibuprofen plus acetaminophen

• A. Correct. A non-opioid combination gives analgesia equal or superior to a low-dose opioid for dental pain, and it avoids putting an opioid in front of a patient in recovery.
• B. Tramadol is also an opioid agonist with additional serotonergic effects, so it is not the safe alternative it is sometimes assumed to be.
• C. Hydrocodone is an opioid. Prescribing it to someone with a substance use history risks relapse and is avoided where an effective alternative exists.
• D. Oxycodone carries the same objection, with a higher abuse liability still.

Note: Because of the hepatitis B, cap the acetaminophen well below the usual maximum and confirm current liver function with the physician. Ibuprofen also needs care if there is any portal hypertension or coagulopathy.

Correct answer: D. Asthma

• A. Diabetes is one of the strongest and best-documented risk factors, with a bidirectional relationship — periodontitis also worsens glycaemic control.
• B. HIV is a genuine risk factor. Immunosuppression predisposes to necrotising periodontal diseases and accelerated attachment loss.
• C. Smoking is the single most important modifiable risk factor, and it also masks bleeding on probing, hiding disease from both patient and clinician.
• D. Correct — this is the exception. Asthma is not an established periodontal risk factor. Inhaled corticosteroids raise candidiasis risk and beta-agonists can dry the mouth, but neither makes asthma itself a risk factor for periodontitis.

Correct answer: D. It is Y-linked

• A. True. Periorbital wrinkling and hyperpigmentation, frontal bossing, a depressed nasal bridge and everted lips form the recognisable facies.
• B. True. Absent or hypoplastic sweat glands produce dry skin and heat intolerance, and hyperthermia is a real danger in these children.
• C. True, and it follows directly from X-linked recessive inheritance: males are fully affected, while female carriers show patchy, milder signs owing to lyonisation.
• D. Correct — this is the exception. The classic form is X-linked recessive. There is no Y-linked pattern, and a Y-linked condition could never be transmitted to a daughter.

Note: Sparse, fine, brittle hair is the third limb of the classic triad, along with hypodontia and hypohidrosis.