Sjögren Syndrome and Blood Pressure Screening

Correct answer: C. Multiple oral ulcerations

• A. Recession follows from the associated periodontal disease and mucosal atrophy.
• B. Gingivitis is common because reduced salivary flow impairs plaque clearance and buffering.
• C. Correct — this is the exception. Sjögren syndrome causes dryness, atrophy, and secondary infection; frank ulceration is not a characteristic feature. Recurrent oral ulcers would point toward Behçet disease or an autoimmune blistering disorder instead.
• D. Xerostomia is the cardinal oral feature, arising from lymphocytic destruction of the salivary parenchyma.

Correct answer: B. Anti-SSA (Ro) and anti-SSB (La)

• A. Anti-desmoglein 3 antibodies are directed against desmosomes in pemphigus vulgaris.
• B. Correct. Anti-SSA/Ro and anti-SSB/La are the serologic markers of Sjögren syndrome, alongside labial minor salivary gland biopsy showing focal lymphocytic sialadenitis.
• C. Anti-CCP is specific for rheumatoid arthritis; it may coexist here but does not establish Sjögren syndrome.
• D. Anti-dsDNA is highly specific for systemic lupus erythematosus.

Correct answer: C. Tetracycline

• A. Chlorhexidine is a well-recognized cause of extrinsic brown staining, worst in interproximal and stagnation areas.
• B. Chromogenic bacteria produce black or green extrinsic stain, particularly along the gingival margin and interproximally.
• C. Correct — this is the exception. Tetracycline produces intrinsic discoloration by chelating with calcium during tooth development, giving banded grey-brown staining through the whole tooth — not surface interproximal stain.
• D. Iron supplements produce black extrinsic staining on tooth surfaces.

Correct answer: D. Stage 2 hypertension

• A. Hypertensive crisis is above 180/120 mmHg and requires urgent medical attention.
• B. Stage 1 is 130–139 systolic or 80–89 diastolic. Under the older JNC 7 scheme this reading would have been Stage 1, which is the source of the confusion on this item.
• C. Elevated blood pressure is 120–129 systolic with diastolic under 80.
• D. Correct. Under the 2017 ACC/AHA classification, Stage 2 begins at 140/90 mmHg, so 145/92 falls into Stage 2. Routine dental care may proceed with monitoring and medical referral for management.

Note: Know both frameworks. JNC 7 called 140–159/90–99 Stage 1; the 2017 ACC/AHA guideline lowered the thresholds so that the same reading becomes Stage 2. The recall answer follows ACC/AHA.

Correct answer: A. Refer to a physician for evaluation while deferring elective care

• A. Correct. An asymptomatic reading in this range warrants medical referral and deferral of elective treatment; urgent care may proceed with monitoring and stress reduction.
• B. Ignoring a reading this high misses an opportunity to intervene in a modifiable cardiovascular risk.
• C. EMS activation is reserved for hypertensive crisis with end-organ symptoms — chest pain, visual change, neurologic deficit, or severe headache.
• D. Dentists do not initiate antihypertensive therapy; that is the physician's role.