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Perio > 2022 > Flashcards

2022 Flashcards

1
Q

Is flossing before brushing ___ than brushing before flossing?

A. Same
B. More effective
C. Less effective

A

B

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2
Q

What are the 4 histological layers in necrotising gingivitis from deep to superficial

A

Spriochete infiltration zone, necrotic, neutrophil, bacterial zone

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3
Q

what are the primary clinical symptoms of necrotising gingivitis

A. gingival pain, inflammation?
B. spontaneous bleeding ,halitosis
C. fever, sth

A

B

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4
Q

Acyclovir is the primary drug choice for which?

A. HSV-1
B. Hsv-2
C. Epstein barr virus

A

A

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5
Q

What is the first choice of antibiotics for periodontal abscess?

A. Amoxicillin
B. Metronidazole
C. Clindamycin
D. Azithromycin

A

B

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6
Q

what is the treatment sequence for trauma from occlusion??

A

ScRD-> correct occlusion -> splint teeth if very mobile

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7
Q

Common clinical signs of trauma from occlusion?

A. Fremitus, Tooth mobility, Widened PDL
B. Wear faucets, fremitus, bone resorption

A

A

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8
Q

Which A. actinomycetecomitans serotype is the most virulent?

A

B

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9
Q

Virulence factor of A.A

A

Leukotoxin and CDT

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10
Q

Percentage of cervical enamel projection in molars

A

Like 10-60% depending on population and tooth

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11
Q

According to Carnevale et. al, what is the 10 year surivival rate of root resected molars

A. 10
B. 30
C. 60
D. 90

A

90+%

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12
Q

What is the mechanism of action for chlorhexidine gluconate

A. Inhibit DNA gyrase
B. Inhibit cell wall synthesis
C. Disrupt cell membrane function
D. Reversibly binding to 30s subunit

A

C

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13
Q

What is the keystone pathogen in periodontitis

A. S. Oralis
B. P. Gingivalis
C. P. intermedia
D. V.parvula

A

B

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14
Q

Which is an orange complex bacteria?

A. actinomyetecomitans
P. gingivalis
P. intermedia

A

C

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15
Q

What are the red complex bacteria

A

P gingivalis
T forsythia
T denticola

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16
Q

The main blood supply to all teeth and supporting structures is from ___ artery

A. Maxillary
B. Lingual
C. Facial

A

A

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17
Q

Smoking impairs healing by?

A. Impairs neutrophil function
B. Increases IgA and IgG production
C. Impairs fibroblast proliferation

A

A

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18
Q

Incidence of bacteremia after ScRD? (Healthy, gingi and perio)

A

10% in healthy
20% in gingivitis
75% in periodontitis

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19
Q

In periodontically inflamed sites, the periodontal probe stops at

Alveolar bone crest
Within Junctional epithelium
Within connective tissue
Base of the sulcus

A

C?

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20
Q

Which is not part of PRA?

Tooth loss
BOP
PD
PI

A

PI

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21
Q

2018 AAP, which is not inside?

Aggressive perio
Necrotising perio
Perio due to systemic disease

A

Aggressive perio

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22
Q

Manual toothbrush or electric toothbrush

Better
Worse
Same

A

Electric toothbrush better

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23
Q

Describe Dx

Endo perio
Perio endo
Combined

A

Primary endo-perio = J shaped lesion, lesion wide at apex and thin at cervical. Sinus tract at mucosa or PDL space, non-responsive to sensibility tests. Moderate to severe pain. Solitary site of increased PD with evidence of plaque and calculus at margin.

Primary perio-endo = Generalized or localized horizontal or angular defect wider at cervical, extending to apex, wide and deep. Sinus tract sometimes near gingival margin, responsive to sensibility tests but lowers over time. None to moderate dull pain. Typical signs of perio.

Combined = extensive bony RL that may have communicated (both perio and endo) Wide conical pocket with severe attachment loss. Commonly see generalized periodontal disease. May have occasional swelling and sinus tract.

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24
Q

How many % of furcations are >1mm wide?
25%
58
81
94

A

25%??

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25
Q

Perio maintenance by professional vs general?

Same
Better
Worse

A

Same

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26
Q

How many % continue to perio maintenance?
10
20
30
40

A

30%

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27
Q

Percentage of people part of continuous model of disease progression?

35
45
65
75

A

76%

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28
Q

Sporadic periods of disease and remission, what model is this?

Random burst
Asynchronous burst
Continuous

A

Asynchronous burst

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29
Q

Essential oil vs triclosan

Better
Same
worse

A

Same

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30
Q

Chlorhex is via which mechanism

Damage cell wall
Damage cell membrane
Interfere with cell mechanism??

A

Damage cell membrane

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31
Q

Clorhex vs essential oil

Same
Better
Worse

A

Chlorhex better

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32
Q

thickness of lamina propia

0.5mm
1mm
1.5mm
2mm

A

1mm

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33
Q

col is
non keratinised simple
non keratinised stratified
Keratinised simple
Keratinised stratified

A

non keratinised stratified

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34
Q

What inhibits chlorhexidine

Sodium saccharin
Sodium laurate sulfate

A

Sodium laurate sulfate

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35
Q

How deep into the sulcus does toothbrush bristles reach
0.5-1mm
1.5-2
2.5-3
3.5-4

A

1.5-2

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36
Q

Which stage does lesion become periodontitis

Initial
Early
Established
Advanced

A

Established

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37
Q

Predominant cell type for established lesion

A

Plasma cells

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38
Q

Acute perio abscess mainly occur at which site

Max molar
Max premolar
Man premolar
Man molar

A

Max molar

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39
Q

First step of biofilm formation

Glycoprotein deposition
EPS formation
Keystone bacteria adhesion

A

Glycoprotein deposition

40
Q

Widest surface area for CT attachment on max molar roots

Mesial
Distal
Palatal

A

Mesial (25%, compared to palatal 24% and distal 19%)

41
Q

What fibre is the main cause drifting/shifting after ortho treatment

Transeptal
Horizontal
Oblique
Alveolar crest

A

Transeptal

42
Q

In periodontal wound healing, what molecules help to resolve inflammation by blocking pro-inflammatory mediator production?

A

Lipoxin and resolvin

43
Q

Ultrasonic vs hand instrument, hand instrument leads to ___ root surface

Smoother
Rougher
Same

A

Smoother

44
Q

Mineralisation of calculus completed in __ days
12
10
6
4

A

12

45
Q

Which of the red complex pathogens is motile

A

T denticola

46
Q

Prognosis of a tooth with repeated abscess and >75% bone loss according to Becker classification

A

Hopeless

47
Q

ScRP critical probing depth
3mm
4mm
5mm
6mm

A

3mm

48
Q

Gram negative bacteria don’t have;

Lipoteichoic acid
Polysaccharide
Peptidoglycan

A

Lipoteichoic acid

49
Q

Main function of toll like receptor

A. Recognize LPS
B. Activate transcription of cytokines
C. Recognise host cells

A

B

50
Q

CD4 cells cell mediated immunity

Th0
Th1
Th2
Th16

A

Th1

51
Q

CD4 Th2 humoral immunity

IL-1
IL-2
IL-4
IL-6

A

IL-4

52
Q

What is not a function of junctional epithelium

Produce GCF
Prevents invasion of bacteria
Wound healing and immune response
Attachment

A

Produce GCF

53
Q

Pyogenic granuloma, which of the following is true

More common in women than men

A

More common in women than men

54
Q

Gingival groove present in __ of adults

A

30-40%

55
Q

Initial PD 6mm, ___ of the root surface is free of plaque and calculus?

A

43%

56
Q

According to Gutman 1978, % of permanent molars have patent accessory canals in the furcation area

A

28-60%

57
Q

Perio abscesses are % of US emergencies and present in % of periodontitis

A

8-14%, 27.5%

58
Q

At maintenance visit which is msot reliable predictor for tooth loss

Residual pocket
BOP

A

Residual pocket

59
Q

According to Cobb 2002, the mean clinical changes that were generally observed after a single course of non-surgical therapy for an initial 6mm probing depth were

A

1mm probing depth reduction, 0.6mm clinical attachment level gain and 1mm gingival recession

60
Q

Clinicians can guess the outcome of ______ tooth in _____ oral hygiene the best

Hopeless, poorly maintained
Hopeless, well maintained
Favourable, well maintained
Favourable, poorly maintained

A

Favourable, well maintained

61
Q

Wilson 1984, 1993, the proportion of complete compliers increased by

A

It increased from 16-32%

62
Q

Jiggling forces on a healthy reduced periodontium result in

Gingiva inflammation
CAL
Bone resorption
Apical growth of JE

A

Bone resorption

63
Q

Commonly found mediodistally across furcation of maxillary molars

Intermediate bifurcation ridge
Cervical enamel projections
Enamel pearl

A

Intermediate bifurcation ridge

64
Q

A microbiological analysis of the periodontal abscess shows that

P.gingivalis predominant species
Aa predominant species
Cocci more than rods

A

P.gingivalis predominant species

65
Q

Which cell releases cytokines that recruit and activate additional leukocytes in the early inflammatory stage of wound healing?

Macrophage
Neutrophil
NK cell
Lymphocyte

A

Macrophage

66
Q

Predominant cell type of early lesion according to Page and Schroeder

A

Lymphocytes

67
Q

Periodontal therapy in 2nd trimester pregnant women was found to ____ rates of early birth

Increase
Decrease
Similar

A

Decrease

68
Q

Why was chronic and aggressive periodontitis changed to only one category?

Same etiological factors
Same microbiology
Unique host response (?)

A

Same etiological factors

69
Q
  1. Where does the probe stop wrt junctional epithelium?
    Coronal to
    Apical to
A

Coronal to

70
Q

What are the causes of perio abscesses? (SAQ)

A

The causes of a periodontal abscess include
> torturous pockets
> vertical osseous defects resulting in deep pockets that are difficult to debride
> microbial shift in the pocket from gram-positive health-promoting bacteria to pathogenic anaerobic gram-negative bacteria
> systemic antibiotic therapy without prior subgingival debridement
> supragingival scaling only resulting in marginal closure of the pocket and inability of pus to drain out of the pocket
> foreign bodies impacted in the pocket
> endodontic perforations
> cervical cemental tears
> root resorption
> root fractures

71
Q

What are the limitations of ScRD? (SAQ)

A

Anatomical limitations may arise as there are intrabony defects that cannot be fully debrided, furcation involvements where the tip of the instruments may not be able to enter and fully clean it. There could also be enamel pearls and cervical enamel projections which prevents us from fully debridement of plaque / calculus at that region as the instrument may be blocked and that is plaque retentive in nature.

Areas of deeper probing depths may not be reached by the instruments tip (ultrasonic tip and curettes) hence preventing the complete removal of calculus.

Scaling and root debridement could be limited in effectiveness due to the defective restorations that are present on the tooth, for example overhanging margins and contour of crowns.These sites could have recurrent plaque trap and disease occuring. For the ultrasonic scaler, restorations like porcelain crowns, implants and amalgams must be avoided and these could prevent the thorough debridement of plaque on the tooth due to these restorations.

It is very much influenced by the operator’s skills, techniques and meticulousness as the closed debridement requires tactile sensation and that could be challenging hence prevents complete removal of plaque and calculus that is subgivival, making it difficult to achieve a glossy smooth root surface.

72
Q

What are the aims of IPT assessment? What is the difference between IPT assessment & perio maintenance? (SAQ)

A

Aim of the assessent of intial phase therapy (IPT) is to review the outcome of the intial phase therapy.

Whereas the aim of periodontal maintenace is to maintain the oral health of a previously treated periondontal patient.

Assessment of IPT is during the active phase of treatment whereas periodontal maintenance is after the active phase, during the maintenance phase

Assessment of IPT reprognosticates the teeth and reconfirms treatment plans whereas periodontal maintenace reprognosticates the teeth.

The future plans of assessment of IPT is to continue with scaling and root debridement or move to surgical periodontal therapy or even extractions for example whereas the future plans of periodontal maintenance is to come back for maintenance visits at regular intervals in order to maintain the patient’s oral health.

73
Q

What are the clinical scenarios you would provide systemic antibiotics? (SAQ)

A
  • Necrotizing ulcerative gingivitis and periodontitis with systemic involvement
  • For patients with acute periodontal abscess / acute apical abscesses with fever and lymphadenopathy
  • Antibiotic prophlaxis in patients with history of endocarditis
  • Patients who present with systemic bacterial infections
  • Immunocompromised periodontitis patients with poor wound healing
  • For patients that present with severely inflamed gingiva due to accumulation of high amount of calculus and plaque and doing full mouth debridement in one visit
74
Q

How to manage perio-endo lesion on #47? (SAQ)

A
  1. Assess restorability and prognosis of #47
  2. If restorable and prognosis is favourable, carry out pulpectomy and fill the canal with intracanal CaOH medicament and temporary dressing. If unrestorable and prognosis is unfavourable, extract #47.
  3. Concurrent treatment - perform scaling and root debridement
  4. Review the tooth in 6-8 weeks. If the deep pockets are resolved, and PARL healing. Remove the temporary dressing and obturate canal. Restore #47 with post-core crown.
  5. If deep pockets persist, or PARL not healing, tooth still symptomatic reassess prognosis, re C&S and re debride and keep in view surgical periodontal treatment. If prognosis drops to hopeless, then extract and consider prosthodontic replacement options.
75
Q

Describe the Page and Schroeder 1976 lesion staging

Initial
Early
Established
Advanced

A

Initial (0-4d): Increased GCF, predominance of PMN leukocytes with migration of leukocytes into JE and gingival sulcus. Acute inflammation limited to JE and most coronal CT

Early (4-8d): BOP, erythema, predominance of lymphocytes. Further loss of collagen fiber network supporting marginal gingiva. Proliferation of JE basal cells.

Established (14-21d): Change in color, texture, size. Predominance of plasma cells, proliferation, apical migration and lateral extension of JE. PERIO!!

Advanced: PD, BOP, suppuration, surface ulceration, bone/soft tissue/tooth loss, mobility/drifting. Persistence of established lesion features. Predominance of plasma cells. Extension of lesion into alveolar bone and PDL, causing significant bone loss.

76
Q

Cytokines involved with CD4+ cells?

A

Helper T cells, or CD4+ cells, can be subdivided into Th1 and Th2.

Th1-type cytokines tend to produce pro-inflammatory responses (e.g. IFN-gamma, TNF-alpha, IL-2)

Th2-type cytokines are involved with B-cell differentiation and maturation, as well as suppressing Th1 responses (e.g. IL-4, IL-5, IL-10, IL-13)

Regulatory T cells inhibit immune responses, secreting cytokines which block macrophage and lymphocyte activation (e.g. TGF-beta, IL-10)

Th17 is activated by TGF-beta, IL-6, IL-1 and IL-21, and requires IL-23 to survive and for pathogenicity. Th17 secretes IL-17 which is inflammatory to kill bacteria, vv involved in perio pathogenesis

77
Q

Triclosan is ___% effectiveness of 0.12% Chx

A. 60%
B. 80%
C. 20%

A

A (50% vs 80% plaque reduction respectively)

78
Q

Someone has 20% bone loss , age 30
a) Grade A
b) Grade B
c) Grade C

A

B

79
Q

Which fiber is not part of pdl
a) Transseptal
b) Alveolar crest
c) Horizontal
d) Oblique

A

A

80
Q

Which antibiotic not for perio abscess
a) Clarithro
b) Amox
c) Azithro
d) Clinda

A

A

81
Q

Someone lost 1-4 teeth due to perio! What perio grading is this?»
a) Stage 1
b) Stage 2
c) Stage 3
d) Stage 4

A

C

82
Q

Supra gingival calculus is ___ homogenous than subgingival calculus

a) More
b) Less
c) Same

A

Less

83
Q

A Non compliant perio patient is x times likely to lose teeth than a compliant patient
a) 45
b) 35
c) 25
d) 15

A

?

84
Q

Cetylpyridinium chloride
a) Quaternary ammonium compound
b) Phenol
c) Bisguanide
d) Anionic surfactant

A

A

85
Q

‘Experimental Gingivitis in men’ by Loe
a) Initial composition of gram +ve rods and cocci is 80%
b) Composition of gram -ve rods and cocci is 45-60% in gingivitis
c) amount of plaque related to severity of disease

A

C

86
Q

Most common adhesion in JE
a) Hemidesmosomes
b) Gap junction
c) Macula adherens
d) D2 failing perio test

A

A

87
Q

Most apically located furcation for maxillary molars
a) mesial
b) palatal
c) buccal
d) distal

A

A

88
Q

which furcation is most predictably managed by surgical technique
a) Class II maxillary buccal
b) Class II mandibular
c) Class III maxillary buccal
d) Class III mandibular buccal

A

B? Best for GTR

89
Q

All are advantages of Kwok and Caton prognostication system except
a) All patients regarded to have equal susceptibility
b) Accounts for clinical ability difference between operators

A

A

90
Q

Open better than Closed debridement?
a) Same
b) Better
c) Worse

A

B

91
Q

_____% of elderly has intrabony defects
a) 30%
b) 40%
c) 50%
d) 60%

A

D?

92
Q

Teeth with constant BOP is __ times more likely at risk for future tooth loss
a) 15
b) 30
c) 45

A

46

93
Q

Microbial shift from sth to sth?
a) Asaccharolytic to saccharolytic
b) Fermenting to proteolytic
c) Motile to non-motile

A

C

94
Q

Better at cleaning furcation
a) Sickle scaler
b) Curettes
c) Ultrasonic scaler

A

C

95
Q

Which of the following factors are not significant in furcation therapy
a) Palato gingival groove
b) Cervical enamel projections
c) Intermediate bifurcation ridge

A

A

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