midterm review Flashcards
1
Q
Normal CEJ bone level width is:
A
1-2 mm
2
Q
Biological width is the distance between….
A
the junctional epithelium and the connective tissue attachment
3
Q
Randomized control trials have what aspect to prevent selection bias?
A
Randomization
4
Q
Curette efficiency depth = ____
Critical root planing depth = ____
A
4 mm,
3 mm
5
Q
Randomized controlled trials (RCT) are the best because they have ____ and ____
A
Randomization; Masking
6
Q
As part of DM (Diabetes Mellitus), glycated proteins and lipids called ____ accumulate and are the primary link between many DM complications
A
AGEs:
Advanced
Glycation
End products
7
Q
What is the most common genetic variation?
A
SNPs:
Single
Nucleotide
Polymorphisms
8
Q
T/F:
- Graceys are site specific
- You should only use the terminal 1-3 mm of the cutting edge
A
True, True
9
Q
T/F:
- The Gracey curette working stroke involves a push and vertical movement
- The terminal shank should be parallel to the target tooth
A
False, True
10
Q
What is the best way to hold a periodontal instrument?
A
Modified pen grasp
11
Q
T/F:
- Supragingival calculus most frequently found in lingual of anterior mandible.
- Supragingival is harder than subgingival calculus
A
True; False
[Two most common locations where supra-gingival calculus is found: Buccal of maxillary molars & Lingual of mandibular anterior teeth]
12
Q
Color of supra-gingival calculus
A
White - white/yellow
13
Q
T/F:
-Sub-gingival calculus extends to the base of the perio pocket and reaches the junctional epithelium
A
False
14
Q
T/F:
- Sub-gingival calculus contributes directly to inflammation
- Stress contributes directly to inflammation
A
?; ?
15
Q
T/F:
- Chronic periodontitis is the most prevalent in adults.
- Destruction is consistent with presence of local factors.
A
True; True
16
Q
T/F:
- Ordinal includes interval
- Ordinal revers to severity of disease
A
False; False
- ordinal includes rank & ordered categories
- ordinal refers to stage of illness
17
Q
T/F:
Gingival index is a ranked-ordered measurement. Ordinal measurements include all interval criteria.
A
True; False
-ordinal includes rank & ordered categories
18
Q
The validity of the test can be estimated by
calculating its ____ and ____
A
sensitivity & specificity
19
Q
The perfect diagnostic test’s sensitivity and specificity will be ___
A
1
20
Q
Specificity is measured in _____
A
a healthy population
21
Q
Sensitivity is measured in _____
A
a diseased population
22
Q
Positive and negative predictive values are measured in ____
A
a mixed (healthy/diseased) population
23
Q
The sensitivity of a diagnostic test is…
A
the probability of the test being POSITIVE when the disease is truly present
24
Q
The specificity of a diagnostic test is…
A
the probability of the test being NEGATIVE when the disease is truly NOT present
25
The positive predictive value of a diagnostic test is...
the probability that the disease is present when the test is positive
26
The negative predictive value of a diagnostic test is...
the probability that the disease is NOT present when the test is negative
27
Predictive values are influenced by...
the prevalence of disease in a population
28
T/F:
- Ordinal measurement data have all the qualities of nominal data and include gingival and plaque indexes.
- Ordinal measurement data imply severity of disease
True; False
[-ordinal measurement data includes categories like nominal data, but these categories can be ranked in some way
-ordinal measurement data imply stage of disease]
29
T/F:
- Clinical Attachment Loss (CAL) is probing depth to gingival margin.
- CAL is an ordinal measurement
False; False
- CAL is measurement from CEJ to junctional epithelium
- CAL is an interval measurement
30
3 different classifications of periodontitis based on pathophysiology:
- necrotizing periodontal diseases
- periodontitis
- periodontitis as a manifestation of systemic disease
31
Stages of periodontitis are based on...
severity and complexity of management
32
```
Stages of periodontitis:
I -
II -
III -
IV -
```
I - initial periodontitis
II - moderate periodontitis
III - severe periodontitis with potential for additional tooth loss
IV - severe periodontitis with potential for loss of the dentition
33
Steps to staging periodontitis:
- initial staging - look at CAL
- look at RBL
- tooth loss may modify stage definition
- complexity factors may shift to higher level
34
3 parts to staging periodontitis
- severity (CAL, RBL, & tooth loss)
- complexity (local factors or need for complex rehabilitation)
- extent and distribution
35
Goal of grading periodontitis
- estimate future risk
| - estimate potential health impact
36
Osseous craters have been found to make up ____ of all defects and ____ of all mandibular defects. They occur ___ times more often in posterior as in anterior segments.
- 1/3
- 2/3
- two
37
heights of facial and lingual crests of an osseous crater have been found to be identical in ____ % of cases
85
38
bulbous bone contours are found more frequently in the ____ than the ____
maxilla; mandible
39
in reversed architecture, aka ____, the position of the crest of interdental bone is ____ to the crest of buccal bone
apical
40
Radiographic features of occlusal trauma
- widening of PDL space
- thickening of lamina dura also on the lateral aspects of the root and furcation areas
- vertical bone loss & formation of infrabony pockets
- radiolucency and condensation of alveolar bone
- root resorption
41
```
all contribute to occlusal trauma EXCEPT:
A. force on oblique surface
B. force from bulky restoration
C. force on reduced periodontium
D. force on long axis of tooth
```
D - force on long axis of tooth DOES NOT contribute to occlusal trauma
42
Tissues affected by occlusal trauma
PDL
alveolar bone
pulp
cementum
43
Tissue NOT affected by occlusal trauma
Epithelium
44
T/F:
- Occlusal trauma can be caused by a repetitive force that overcomes capacity of periodontal ligament.
- This is reversible when force is stopped and periodontium is healthy
True; True
45
Occlusal trauma diagnosed clinically by...
- tooth mobility (clinical hallmark!)
| - fremitus
46
In order to diagnose occlusal trauma you must have...
tooth mobility
47
Definition of secondary occlusal trauma
*normal* forces on unstable teeth
48
What happens if patient has both occlusal trauma and periodontitis?
- mobility and width of PDL increase without approaching a stable plateau
- enhanced loss of alveolar bone height and volume as compared with periodontitis alone
49
Vibratory displacement of teeth is ____
fremitus
50
Patient has fremitus upon regular occlusion and protrusion. Also has disruption of attachment and increased pocket. What is the most likely cause?
secondary occlusal trauma
51
T/F:
- Occlusal trauma begins at the dentogingival junction.
- Occlusal Trauma causes Increased pocket depth and gingival inflammation
False; False
52
T/F:
- Everyone is equally susceptible to advanced PD.
- Chronic gingivitis always progresses to PD.
False; False
53
Which is/are true of PRA (Periodontal Risk Assessment):
A. If there are two high risk categories, then the PRA will be defined as high risk
B. Bleeding on probing is the highest weighted of all 6 characteristics
C. If patient has a systemic disease then it will be ranked as moderate risk
A
[If there are two high risk categories, then the PRA will be defined as high risk]
54
```
All are parts of PRA (Periodontal Risk Assessment) EXCEPT:
A. Bleeding on probing
B. Systemic disorders
C. Loss of teeth
D. Age
E. Plaque Free Score
F. Residual pockets
G. Environmental factors:
```
E - plaque-free score
55
```
Which is NOT a characteristic of severe PRA?
A. 29% Bleeding on probing
B. 40 years old with 50% bone loss
C. 15 cigarettes
D. 9 missing teeth
```
C
[Cutoff between moderate and high risk is 1 ppd smoking--20 cigarettes / pack]
56
A ___ Modified O'Leary Index means cleaner teeth
higher
| measures percentage of plaque-free teeth
57
On the Loe Gingival Index, a ___ score means less inflamed gingiva
lower
58
Examples of risk determinants are...
- age
- gender
- socioeconomic status
- stress
59
What is the primary etiology of periodontal disease?
bacterial plaque
60
T/F:
- A high Modified O'leary plaque score means a lot of plaque.
- Plaque is a good risk indicator for progression of periodontal disease
False; False
[Plaque is a good indicator for patient compliance, but not for disease progression]
61
T/F:
- PRA assesses multiple parameters.
- Pockets with depth of >4mm are weighed the most
True; False
[No factor is weighted more than any other in PRA]
62
____ is the single most important assessor of gingival inflammation and indicates histological inflammation
Bleeding on probing
63
T/F:
- HIV and Osteoporosis are risk indicators for periodontitis.
- Risk markers are nonmodifiable.
True; False
[risk DETERMINANTS are non-modifiable]
64
a characteristic or exposure of an individual that increases the likelihood of developing a disease
risk factor
65
risk factors that cannot be modified
risk determinant / background characteristic
66
probable risk factors that have been identified in cross-sectional studies but not confirmed through longitudinal
studies
risk indicators
67
although associated with increased risk for disease, do not cause the disease
risk predictor / markers
68
Risk factors for PD:
- tobacco smoking
| - diabetes
69
Risk determinants / background characteristics for PD:
```
genetic factors
age
gender
socioeconomic status
stress
```
70
Risk indicators for PD:
HIV / AIDS
Osteoporosis
Infrequent dental visits
71
Risk markers / predictors
- previous history of PD
| - bleeding on probing
72
Do risk factors for periodontal disease increase plaque accumulation?
No.
- No difference found in people with and without DM.
- There is no effect on rate of plaque accumulation in smokers.
[**Risk factors modify host responses to bacteria**]
73
Reverse architecture means ___ is apical to ____
Reverse architecture means interdental bone is apical to radicular bone
74
biologic width is the sum of:
Junctional epithelium width and connective tissue attachment width
75
T/F:
- Positive architecture is when the radicular bone is more coronal than the interproximal bone.
- Buccal and lingual have parabolic shape
False; True
76
Which is not present?
cervical enamel projection
77
Local contributing factors for PD:
- dental calculus
- iatrogenic factors
- malocclusion
- dental stains
- food impaction
- dental caries
- anatomic factors
78
T/F:
- Cervical enamel projections (CEPs) are local contributing factors.
- They contribute to clinical attachment loss because they’re covered with junctional epithelium instead of cementum and connective tissue.
True; True
79
T/F:
- Mineral salts for subgingival plaque come from saliva.
- Calculus in subgingival plaque reaches junctional epithelium.
False; False
[mineral salts for subgingival plaque come from GCF]
80
NOT a contributing factor to PD
bacterial plaque
81
T/F:
- Calculus is the main etiologic factor of periodontitis.
- Local contributing factors should be addressed during initial periodontal treatment
False; True
82
T/F:
- Supragingival calculus is most frequently found in lingual of anterior mandible
- Supragingival calculus is harder than subgingival
True; False
83
T/F: Pregnancy affects healthy gums through increased hormone levels
False
[pregnancy affects the severity of previously inflamed gingiva, but it does not alter healthy gingiva]
84
Ranges for prediabetes:
Fasting plasma glucose:
2-hour PG:
HbA1C:
Ranges for prediabetes:
Fasting plasma glucose: [100, 126)
2-hour PG: [140, 200)
HbA1C: [5.7, 6.5)
85
Which is/are correct about diabetes:
A. Immunoinflammatory response is decreased
B. Decrease in matrix metalloproteinase
C. Increased collagenase
D. Increase in advanced glycation end products
D only
86
____ are the primary link among numerous diabetic complications because they induce marked changes in cells and extracellular matrix components.
AGEs
87
What is true of type 2 diabetes:
A. Insulin resistance to receptors will occur in type two diabetes
B. Reduces insulin secretion
C. If you have gestational diabetes you will have an increased risk of type II DM
A and C only
88
Adults with poorly controlled diabetes had an ____ increased risk of having periodontitis compared with that in adult without diabetes
almost threefold
89
Perio treatment and antimicrobial treatment can help get diabetes under control for ____ after perio treatment
3-9 months
[Periodontal therapy--scaling and root planing with systemic doxycycline therapy--led to short-term (3-9 months) improvement in diabetic control]
90
Adults with type 2 DM have a ____ increased risk of progressive alveolar bone loss
four-fold
91
Type 1 DM associated with ____ more periodontitis in teens
5x
92
Patients were ____ as likely to have a worsening of HbA1c over ____ when severe periodontitis was present at baseline
twice; 2-3 years
93
T/F:
- Type II diabetes is caused by destruction of pancreatic B-cells leading to loss of insulin secretion.
- Type II diabetes can often remain undiagnosed for many years because hyperglycemia appears gradually and often without symptoms.
False; True
94
T/F:
- Hba1c is used to provide an estimate of blood glucose levels over the preceding 30-90 day period.
- 6.5 would be pre-diabetic
True; False
[6.5 is the minimum value for diabetic]
95
T/F:
- In diabetes you have a decrease in matrix metalloproteases.
- There is an increase in advanced glycation end products (AGEs).
False; True
96
Examples of simple / complex traits
Simple:
- Genetic syndromes
- Cystic fibrosis
Complex:
- Type II diabetes
- AIDS
97
T/F:
| IL-1β is not a significant marker (for PD?) in GWAS (Genome-wide association studies)
True
98
hereditary pattern for aggressive periodontitis is ____; determined by ____ studies
- autosomal dominant with reduced penetrance
| - familial aggregation studies
99
T/F:
- IL-1 gene variations alter the level of IL-1 protein expression
- IL-1 is relevant for aggressive periodontitis
True; False
100
Michaelowicz twin studies showed that chronic perio was estimated to have about ____% heritability
50%
101
T/F:
- Familial aggregation is based more on shared genes than shared environmental exposures.
- Aggressive periodontitis showed X-linked inheritance according to marazita et al.
False; False
102
T/F:
- Most syndromic perio conditions are neutrophil disorders.
- Syndromic conditions disorders are mainly based on a simple disease inheritance/single loci mutation
True; True
103
T/F:
- Everyone is equally susceptible to advanced PD.
- Chronic gingivitis always progresses to PD.
False; False
104
T/F:
- Chronic periodontitis is the most prevalent in adults.
- Destruction is consistent with presence of local factors
True; True
105
47. Select two features of periodontitis
a. No loss of bone
b. No loss of clinical attachment
c. No loss of connective tissue attachment
d. Apical migration of junctional epithelium
e. Gingival inflammation
D and E
106
T/F: Alveolar bone loss is expected in pyogenic granuloma of pregnancy
False
107
T/F:
- The prevalence of periodontitis increases in older people
- Periodontal disease is an inevitable consequence of the aging process and does increase disease susceptibility.
True; False
108
You are NOT able to distinguish chronology of disease and exposure in randomized control trials.
False
109
Pregnancy and gingivitis: which are true?
A. Increased gingival bleeding during the second trimester
B. Pregnancy has no effect on clinically healthy gums
C. Pregnancy hormones have an effect in the presence of local contributing factors
D. Increases in estrogen and progesterone have an effect on healthy gingiva
A, B, and C
110
T/F:
-Papillon lefevre involves mutations in cathepsin C gene.
-it is a condition in which the clinical presentation shows various degrees of periodontitis severity as well as great
variation in the level of abnormal keratosis.
True; True
111
T/F:
- Prevalence and incidence both give us information about the extent of disease in populations.
- Prevalence includes people who have been previously diagnosed and are still living with the disease along with new cases.
True; True
112
T/F:
- Case control studies are exposure based
- Case control can be prospective.
False; False
113
Which of the following are true regarding cohort studies?
A. Cohort studies are cross sectional
B. Cohort studies do not have time component
C. They can help identify risk
D. Can be retrospective or prospective
C and D
114
T/F:
- As a single test, bleeding on probing is a good predictor for attachment loss
- Absence of BOP is an excellent predictor of periodontal stability
False; True
115
The single most important marker for gingival inflammation
Bleeding on probing
116
T/F:
- Pyogenic granuloma found most on posterior teeth.
- Pyogenic granuloma associated with alveolar bone loss.
False; False
117
Most studies underestimate the prevalence of chronic periodontitis. Why was the CDC 2010 study better?
Full mouth exam for 1st time (except 3rd molars)
118
What instruments do you use on implants since you can't use metal?
- end tuft brush
| - interproximal brush w/ blue nylon strip
119
How does the periodontium heal after scaling and root planing?
long junctional epithelium
120
The cells primarily affected in periodontitis
neutrophils
121
What is/are the role of local contributing factors for periodontal disease?
a) Initiating detachment of connective tissue attachment
b) Keeping plaque in close contact to gingiva
c) Initiating apical migration of junctional epithelium
B only
122
When should you correct the local contributing factors of PD?
a) Acute phase
b) Disease control phase
c) Definitive phase
d) Maintenance phase
B ?
123
T/F:
- Phase I therapy involves removing calculus and plaque
- Long term success depends on maintenance of phase I therapy
True; True?
124
What is the maximum for classifying periodontitis as localized?
30%
125
T/F:
- rapid onset and attachment loss are characteristic of aggressive periodontitis
- aggressive periodontitis is seen in a healthy person who has an increased response to bacteria
True; True?
126
T/F:
- The prevalence and severity of CP increases with age.
- The best description is that age of the patient causes increase in disease prevalence
True; False
127
Validity of a diagnostic test can be determined by ____ and ____
sensitivity; specificity
128
T/F:
- Positive architecture is when the radicular bone is more coronal than interproximal.
- Buccal and lingual have parabolic shape
False; True
129
Which is/are true:
A. Supra-gingival calculus is usually white/yellow in color but influenced by contact with tobacco/food pigments
B. Subgingival calculus usually extends to base of perio pocket and reaches junctional epithelium
C. Sub- and supra-gingival calculus always occur together since subgingival calculus becomes supragingival when gingiva recedes
D. Subgingival calculus contributes directly to inflammation
A only
130
Clinical significance of each type of measurement scale:
- nominal:
- ordinal:
- interval:
- nominal --> diagnostic status
- ordinal --> stage of illness
- interval --> severity of illness
131
T/F:
- Occlusal wear causes ging recession
- It does so by disturbing JE
False; False
132
An agnostic approach that identifies SNP markers enriched in cases (disease) compared to controls. Identification of candidate variants of genes involved in the disease of interest.
Genome-wide association study
133
BOP low / med / high cutoffs:
low: <10%
high: >25%
134
Prevalence of residual pockets >= 5mm-- low / med / high cutoffs:
low: <= 4
high: >8
135
Loss of teeth from 28-- low / med / high cutoffs:
low: <=4
high: >8
136
Loss of periodontal support in relation to patient's age-- low / med / high cutoffs:
low: <0.5
high: >1.0
137
Systemic and genetic factors-- low / med / high cutoffs:
if absent or unknown --> low
| if present --> high
138
Smoking-- low / med / high cutoffs:
low: non-smokers or >5 yrs since cessation
high: >= 20 cigarettes per day
139
T/F:
- The main overall goal of disclosing tablets is to get the patient to reduce amount of bacteria.
- Disclosing tablets have been shown to be not educational for patients.
False; False
140
```
Consequences of diabetes include
A. Impaired wound healing
B. Poor immune system
C. Increased infection
D. Increased cytokines
```
all of the above
141
```
Perio is diagnosed based on
A. pocket depth
B. clinical attachment loss
C. alveolar bone loss
D. BOP
```
B and C
142
T/F:
- During periodontal probing of inflamed gingiva the probe can pass through the JE into the supra-alveolar CT.
- Taking probe readings at line angles can increase the measured value.
True; False
143
T/F:
- The cavitron can go subgingivally/ remove subgingival calculus.
- Cavitron can be used to remove exogenous stains.
True; True
144
T/F:
- Polymorphisms are normal variants of population
- Twin study showed there is a 50% inheritance to aggressive periodontitis
True; False
145
Person has furcation bone loss, probing depth greater than 6, CAL 2-6, vertical bone loss. what stage?
Stage III
146
Osseous bone defects are seen ____ in the posterior mandible
2/3 of the time
147
T/F:
- Terminal shank of a curette should be parallel to target tooth.
- Should use the last 1-3 mm of terminal cutting edge
True; True
148
What is true about risk factors
they modify the host's response
149
T/F:
- Occlusal trauma is not reversible.
- Permanent damage occurs with excessive occlusal trauma
False; False
150
What is incorrect about diagnostic testing?
A. Specificity perfect score is 1.0
B. Positive Predictive Value is for screening large populations
C. Sensitivity is for diseased population
D. Validity of diagnostic test is with sensitivity and specificity
B
151
T/F:
- Specificity is the probability of the test being negative when the disease is not present.
- When there is a high specificity, a positive result rules the diagnosis out
True; False
152
When a test has a high ____, a positive result effectively rules the diagnosis in.
When a test has a high ____, a negative result effectively rules the diagnosis out.
Specificity;
| Sensitivity
153
T/F:
- Occlusal trauma can be handled if force is parallel to long axis of tooth.
- A force of the same magnitude but in oblique would cause harm.
True; True
154
T/F:
- Gingival index and Plaque index are rank-ordered measurements.
- Ordinal measurements include all interval criteria.
True; False
155
cutoffs for PRA--low / med / high risk
low: <=1 in moderate; rest in low
med: at least 2 in moderate; <=1 in high
high: >=2 in high
156
Person has inflamed gingiva/gingivitis. When probing, the tip of the probe will actually go:...
0.45 mm apical to JE, into connective tissue
