Perio Flashcards
Loss of tooth substance by mechanical wear is \_\_\_\_\_. A. Abrasion B. Attrition C. Erosion D. Abfraction
A. Wasting diseases of the teeth include erosion
(corrosion; may be caused by acidic beverages),
abrasion (caused by mechanical wear as with
toothbrushing with abrasive dentifrice), attrition
(due to functional contact with opposing teeth),
and abfraction (flexure due to occlusal loading).
The width of keratinized gingiva is measured
as the distance from the _____.
A. Free gingival margin to the mucogingival
junction
B. Cementoenamel junction to the mucogingival
junction
C. Free gingival groove to the mucogingival
junction
D. Free gingival margin to the base of the pocket
A. Keratinized gingiva extends from the free gingival
margin to the mucogingival junction. The attached
gingival extends from the free gingival groove to
the mucogingival junction.
Which of the following best distinguishes peri-
odontitis from gingivitis?
A. Probing pocket depth
B. Bleeding on probing
C. Clinical attachment loss
D. Presence of suppuration
C. Gingivitis is characterized by inflammation of the
gingival tissues with no loss of clinical attachment.
Periodontitis is characterized by inflammation with
loss of clinical attachment.
A 22-year-old college student presents with oral
pain, erythematous gingival tissues with blunt
papillae covered with a pseudomembrane,
spontaneous gingival bleeding, and halitosis.
There is no evidence of clinical attachment
loss. What form of periodontal disease does
this patient most likely have?
A. Gingivitis associated with dental plaque
B. Localized aggressive periodontitis
C. Generalized chronic periodontitis
D. Necrotizing ulcerative gingivitis
D. Because there is no loss of attachment, the diag-
nosis would not be periodontitis. The clinical
description of pain, erythema, blunt papillae,
pseudomembrane, and halitosis is consistent
with necrotizing ulcerative gingivitis.
Which of the following methods of radi-
ographic assessment are best for identifying
small volumetric changes in alveolar bone density? A. Bitewing B. Periapical C. Subtraction D. Panoramic
C. Radiographs must be taken in a standardized
format at repeated visits to be assessed for small
changes in bone density over time, using sub-
traction radiography. Radiographs are usually
standardized by using a bite registration block to
relocate the x-ray at the same place and angula-
tion each time.
What tooth surfaces should be evaluated for
furcation involvement on maxillary molars?
A. Palatal, facial, and distal
B. Mesial, distal, and palatal
C. Facial, palatal, and mesial
D. Facial, mesial, and distal
D. Maxillary molars usually have three roots (mesio-
buccal, disto-buccal, and palatal). Furcation
involvement can be assessed on these teeth from
the facial (bifurcation between the mesio-buccal
and disto-buccal roots), mesial (bifurcation
between the mesio-buccal and palatal roots) and
distal (bifurcation between the disto-buccal and
palatal roots).
What bacterial species are found in increased
numbers in the apical portion of tooth-
associated attached plaque?
A. Gram-negative rods
B. Gram-positive rods
C. Gram-positive cocci
D. Gram-negative cocci
A. Subgingival plaque can be in the cervical area
or more apical. In both areas it can be either
tooth-associated or tissue-associated. The apical
tooth-associated plaque is composed primarily of
gram-negative rods.
What are the major organic constituents of bacterial plaque? 1. Calcium and phosphorous 2. Sodium and potassium 3. Polysaccharides and proteins 4. Glycoproteins and lipids A. 1 and 2 B. 2 and 3 C. 3 and 4 D. 2 and 4
C. Calcium, phosphorous, sodium, and potassium
are inorganic components of dental plaque.
Polysaccharides, proteins, glycoproteins, and
lipids are organic components of dental plaque.
Although many plaque bacteria coaggregate,
which of the following bacteria is believed to
be an important bridge between “early coloniz-
ers” and “late colonizers” as plaque matures
and becomes more microbiologically complex? A. Porphyromonas gingivalis B. Streptococcus gordonii C. Hemophilus parainfluenzae D. Fusobacterium nucleatum
D. Fusobacterium nucleatum can be found in health
and disease. This bacterium is an important bridge
between early and late colonizers of the dental
plaque biofilm.
What features best characterize the predomi-
nant microflora associated with periodontal
health?
A. Gram-positive, anaerobic cocci and rods
B. Gram-negative, anaerobic cocci and rods
C. Gram-positive, facultative cocci and rods
D. Gram-negative, facultative cocci and rods
C. Periodontal health is characterized by a
microflora dominated by gram-positive, faculta-
tive cocci and rods.
- Which of the following microorganisms is fre-
quently associated with localized aggressive
periodontitis? A. Porphyromonas gingivalis B. Actinobacillus actinomycetemcomitans C. Actinomyces viscosus D. Streptococcus mutans
B. Porphyromonas gingivalis has been associated
with chronic periodontitis. Actinomyces viscosus
is usually associated with health or gingivitis.
Streptococcus mutans is associated with dental
caries. Actinobacillus actinomycetemcomitans
has been associated with localized aggressive
periodontitis.
Which of the following is the primary etiologic
factor associated with periodontal disease?
A. Age
B. Gender
C. Nutrition
D. Bacterial plaque
D. Although age, gender, and nutrition may have an
impact on periodontal disease, the accumulation
of the bacterial plaque biofilm is the primary ini-
tiator of the disease.
Inadequate margins of restorations should be corrected primarily because they \_\_\_\_\_. A. Cause occlusal disharmony B. Interfere with plaque removal C. Create mechanical irritation D. Release toxic substances
B. Inadequate or overhanging margins serve as a
nidus for dental plaque accumulation and make
plaque removal difficult.
Light smokers are likely to have less severe
periodontitis than heavy smokers. Former
smokers are likely to have more severe peri-
odontitis than current smokers.
A. Both statements are true.
B. Both statements are false.
C. The first statement is true, the second statement
is false.
D. The first statement is false, the second
statement is true.
C. Individuals who smoke cigarettes are more likely
to have periodontal disease than are nonsmok-
ers. The number of cigarettes smoked and the
number of years of smoking affect the severity of
disease. Former smokers usually have less dis-
ease than do current smokers.
Well-controlled diabetics have more periodon-
tal disease than nondiabetics. Well-controlled
diabetics can generally be treated successfully
with conventional periodontal therapy.
A. Both statements are true.
B. Both statements are false.
C. The first statement is true, the second statement
is false.
D. The first statement is false, the second
statement is true.
D. The extent and severity of periodontal disease
in a patient with well-controlled diabetes is
usually no more than the extent and severity of
disease in patients without diabetes. Patients
with well-controlled diabetes can usually
be treated with conventional periodontal
therapy.
Oral contraceptives can cause gingivitis. Oral
contraceptives can accentuate the gingival
response to bacterial plaque.
A. Both statements are true.
B. Both statements are false.
C. The first statement is true, the second statement
is false.
D. The first statement is false, the second
statement is true.
D. Oral contraceptives can exacerbate the impact of
bacterial plaque on the gingival tissues. However,
they cannot cause gingivitis.
Which of the following cells produce anti-
bodies?
A. Neutrophils
B. T-lymphocytes
C. Macrophages
D. Plasma cells
D. Neutrophils are one of the primary defense cells of
the innate immune system. T-lymphocytes are
important activators of the adaptive immune sys-
tem. Macrophages are antigen-presenting cells.
Plasma cells produce antibodies.
Defects in which inflammatory cell have most
frequently been associated with periodontal
disease?
A. The T-lymphocyte
B. The mast cell
C. The plasma cell
D. The neutrophil
D. Although defects in any of the host defense cells
could impact periodontal disease susceptibility,
defects in neutrophils have been most frequently
described.
What is the major clinical difference between
the established lesion of gingivitis and the
advanced lesion of periodontitis?
A. Gingival color, contour, and consistency
B. Bleeding on probing
C. Loss of crestal lamina dura
D. Attachment and bone loss
E. Suppuration
D. The initial, early, and established lesions of gingivitis
do not have attachment loss associated with them.
Which interleukin (IL) is important in the acti- vation of osteoclasts and the stimulation of
bone loss seen in periodontal disease? A. IL-1 B. IL-2 C. IL-8 D. IL-10
A. IL-1 is important in the activation of osteoclasts
and stimulation of bone loss.
Scaling and root planing are used in which phases of periodontal therapy? 1. Initial (hygienic) 2. Surgical (corrective) 3. Supportive (maintenance) A. 1 only B. 1 and 2 only C. 2 and 3 only D. 1 and 3 only E. 1, 2, and 3
E. Scaling and root planing are used in all phases of
periodontal therapy where there has been loss of
attachment through periodontitis.
What is the most objective clinical indicator of inflammation? A. Gingival color B. Gingival consistency C. Gingival bleeding D. Gingival stippling
C. Although changes in gingival color and consis-
tency and loss of gingival stippling can be indica-
tors of gingival inflammation, bleeding on
probing is the most objective clinical indicator.
A 25-year-old patient presenting with general-
ized marginal gingivitis without any systemic
problems or medications should be classified with which periodontal prognosis? A. Good B. Fair C. Poor D. Questionable
A. Marginal gingivitis not complicated by systemic
problems or medications usually can be treated
successfully with phase 1 therapy, and a patient
with this diagnosis would have a good prognosis.
Instrumentation of the teeth to remove plaque, calculus and stains is defined as \_\_\_\_\_. A. Coronal polishing B. Scaling C. Gingival curettage D. Root planing
B. Polishing is used to remove plaque and stains
from the teeth. Gingival curettage is used to
remove the epithelial lining of a periodontal
pocket. Root planing is used to create a smooth
root surface through the removal of calculus and
rough cementum. Scaling is used to remove
plaque, calculus, and stains from the tooth.
Scalers are used to remove supragingival
deposits. Curettes are used to remove either
supragingival or subgingival deposits.
A. Both statements are true.
B. Both statements are false.
C. First statement is true. Second statement is
false.
D. First statement is false. Second statement is
true.
A. Scalers, with their pointed ends and back, are
designed for supragingival instrumentation;
curettes, with their rounded ends and back, can
be used for both supragingival and subgingival
instrumentation.
Which of the following is not a characteristic of
sickle scalers?
A. Two cutting edges.
B. Rounded back.
C. Cutting edges meet in a point.
D. Triangular in cross section.
E. Used for removal of supragingival deposits.
B. Scalers have a pointed back; curettes have a
rounded back, making them suitable for subgin-
gival instrumentation.
The modified Widman flap uses three separate
incisions. It is reflected beyond the mucogingi-
val junction.
A. Both statements are true.
B. Both statements are false.
C. First statement is true. Second statement is
false.
D. First statement is false. Second statement is
true.
C. Three incisions are made in the modified Widman
flap—internal bevel, crevicular, and interdental. It
is designed to provide exposure of the tooth roots
and alveolar bone. However, the flap is not
reflected beyond the mucogingival junction.
The free gingival graft technique can be used to
increase the width of attached gingival tissue.
Apically displaced full-thickness or partial-
thickness flaps can also be used to increase the
width of attached gingiva.
A. Both statements are true.
B. Both statements are false.
C. First statement is true. Second statement is
false.
D. First statement is false. Second statement is
true.
A. Surgical techniques designed to increase the
width of attached gingiva include free gingival
grafts and apically repositioned flaps.
Miller Class I recession defects can be distin-
guished from Class II defects by assessing the
_____.
A. Location of interproximal alveolar bone
B. Width of keratinized gingiva
C. Involvement of the mucogingival junction
D. Involvement of the free gingival margin
C. The Miller classification system for mucogingival
defects takes into consideration the degree of
recession (whether or not it extends to the
mucogingival junction) and presence or absence of
bone loss in the interdental area. Both Class I
and Class II defects are characterized by no loss
of bone in the interproximal areas. In Class I
defects, the marginal tissue recession does not
extend to the mucogingival junction. In Class II
defects, recession does extend to or beyond the
mucogingival junction.
The reshaping or recontouring of nonsupport-
ive alveolar bone is called _____.
A. Ostectomy
B. Osteoplasty
C. Osteography
D. All of the above
B. Ostectomy is the removal of supporting alveolar
bone. Osteoplasty is the reshaping or recontouring
of nonsupporting alveolar bone.
An interdental crater has how many walls? A. One wall B. Two walls C. Three walls D. Four walls
B. An interdental crater has two bony walls remain-
ing. These walls are usually the facial and lingual
walls.
- During the healing of a surgically treated intra-
bony (infrabony) pocket, regeneration of a new
periodontal ligament, cementum, and alveolar
bone will only occur when cells repopulate the
wound from which of the following sources?
A. Gingival epithelium
B. Connective tissue
C. Alveolar bone
D. Periodontal ligament
D. Cells from the periodontal ligament are pro-
posed to allow for regeneration of the periodontal
tissues.
Which of the following is least likely to be suc-
cessfully treated with a bone graft procedure?
A. One-walled defect
B. Two-walled defect
C. Three-walled defect
D. Class III furcation defect
D. Through-and-through (Class III) furcation defects
are least likely to be treated with bone graft
procedures.
When osseointegration occurs, which of the fol-
lowing best describes the implant–bone inter-
face at the level of light microscopy following
osseointegration? A. Epithelial attachment B. Direct contact C. Connective tissue insertion D. Cellular attachment
B. When evaluated by light microscopy, there
appears to be direct contact at the bone-implant
interface.
The most effective topical antimicrobial agent currently available is \_\_\_\_\_. A. Chlorhexidine B. Stannous fluoride C. Phenolic compounds D. Sanguinarine
A. Chlorhexidine is the most effective antimicrobial
agent currently available.
What is the active ingredient in PerioChipTM? A. Doxycycline B. Tetracycline C. Metronidazole D. Chlorhexidine
D. PerioChip® is a biodegradable local delivery agent
for chlorhexidine.
How many days does it usually take for surface
epithelialization to be complete following a gin-
givectomy?
A. 3–7
B. 5–14
C. 14–18
D. 20–27
B. Epithelial cells migrate approximately 0.5 mm/day.
Following a gingivectomy, it takes 5 to 14 days for
surface epithelialization to be complete.
The most obvious clinical sign of trauma from
occlusion is increased tooth mobility. The most
obvious radiographic sign of trauma from
occlusion is an increase in the width of the
periodontal ligament space.
A. Both statements are true.
B. Both statements are false.
C. The first statement is true, the second statement
is false.
D. The first statement is false, the second
statement is true.
A. Increased tooth mobility is the most common
clinical sign of trauma from occlusion. Increased
periodontal ligament width is the most common
radiographic sign.
Trauma from occlusion refers to \_\_\_\_\_. A. The occlusal force B. The damage to the tooth C. The injury to the tissues of the periodontium D. The widened periodontal ligament
C. The term trauma from occlusion refers to the tis-
sue injury that occurs when occlusal forces
exceed the adaptive capacity of the tissues. An
occlusion that produces such an injury is called a
traumatic occlusion. The tooth may become
damaged as a result of excessive occlusal forces.
The periodontal ligament also may become
widened as a result of the force.
Which of the following is the primary reason for splinting teeth? A. For esthetics B. To improve hygiene C. For patient comfort D. As a preventive measure
C. Teeth are usually splinted to improve patient
comfort during mastication.
In the treatment of an acute periodontal abscess, the most important first step is to \_\_\_\_\_. A. Prescribe systemic antibiotics B. Reflect a periodontal flap surgery C. Obtain drainage D. Prescribe hot salt mouth washes
C. Establishment of drainage is the first step in treat-
ing an acute periodontal abscess. The patient may
then use self-applied mouth rinses and be
prescribed antibiotics if there is evidence of sys- temic involvement (e.g., fever, lymphadenopathy).
A flap would be reflected in a subsequent
appointment if the abscess did not resolve and
became a chronic problem.
Which of the following medications often result
in overgrowth of gingival tissues?
A. Penicillin, calcium channel blockers, phenytoin
B. Calcium channel blockers, phenytoin, and
cyclosporin
C. Cyclosporin, penicillin, and cephalosporins
D. Ampicillin, tetracycline, and erythromycin
B. Calcium channel blockers, cyclosporin, and
phenytoin often result in overgrowth of gingival
tissues.
Which of the following is the most important
preventive and therapeutic procedure in peri-
odontal therapy?
A. Professional instrumentation
B. Subgingival irrigation with chlorhexidine
C. Patient-administered plaque control
D. Surgical intervention
C. Patient cooperation and effectiveness in removing
bacterial plaque is of primary importance in main-
taining a healthy periodontium.
How many hours after brushing does it usually
take for a mature dental plaque to reform?
A. 1–2
B. 5–10
C. 12–24
D. 24–48
D. Mature dental plaque usually reforms on the
teeth within 24 to 48 hours after effective plaque
removal.
Placing the toothbrush bristles at a 45-degree
angle on the tooth and pointing apically so the
bristles enter the gingival sulcus describes
which brushing technique?
A. Charter
B. Stillman
C. Bass
D. Roll
C. The Bass technique of brushing is designed to
direct the bristles of the brush toward the gingival
sulcus.
Dental wear caused by tooth-to-tooth contact is \_\_\_\_\_. A. Abrasion B. Attrition C. Erosion D. Abfraction
B. Wasting diseases of the teeth include erosion
(corrosion; may be caused by acidic beverages),
abrasion (caused by mechanical wear as with
toothbrushing with abrasive dentifrice), attrition
(due to functional contact with opposing teeth),
and abfraction (flexure due to occlusal loading).
Occlusal loading resulting in tooth flexure,
mechanical microfractures, and loss of tooth
substance in the cervical area is _____.
A. Abrasion
B. Attrition
C. Erosion
D. Abfraction
D. Wasting diseases of the teeth include erosion
(corrosion; may be caused by acidic beverages),
abrasion (caused by mechanical wear as with
toothbrushing with abrasive dentifrice), attrition
(due to functional contact with opposing teeth),
and abfraction (flexure due to occlusal loading).
The distance from the CEJ to the base of the pocket is a measure of \_\_\_\_\_. A. Clinical attachment level B. Gingival recession C. Probing pocket depth D. Alveolar bone loss
A. The periodontal examination includes probing pocket depth (distance from the gingival margin
to the base of the pocket) and clinical attach- ment level (distance from the CEJ to the base of
the pocket). Both of these measures are made
using a periodontal probe. Gingival recession can
be measured as the distance from the CEJ to the
free gingival margin. Alveolar bone loss is meas-
ured radiographically.
Your examination reveals a probing pocket
depth of 6 mm on the facial of tooth 30. The free
gingival margin is 2 mm apical to the CEJ (there
is 2-mm recession on the facial). How much
attachment loss has there been on the facial of
this tooth?
A. 6 mm
B. 2 mm
C. 8 mm
D. 4 mm
C. When the free gingival margin is apical to the
CEJ, recession has occurred. Attachment loss is
the measure from the CEJ to the base of the peri-
odontal pocket. With the free gingival margin 2
mm apical to the CEJ and the probing pocket
depth measurement 6 mm, there has been 8 mm
loss of attachment.
In general, what species are predominant in
supragingival tooth-associated attached plaque?
A. Gram-negative rods and cocci
B. Gram-negative filaments
C. Gram-positive filaments
D. Gram-positive rods and cocci
D. Supragingival plaque is either tooth-associated or
outer layer. Tooth-associated is composed pri-
marily of gram-positive cocci and short rods.
The inorganic component of subgingival plaque is derived from \_\_\_\_\_. A. Bacteria B. Saliva C. Gingival crevicular fluid D. Neutrophils
C. Saliva is the source of inorganic components
(calcium, phosphorous) for supragingival plaque.
Gingival crevicular fluid is the source of inorganic
components of subgingival plaque.
What are the characteristics of the primary
(initial) bacterial colonizers of the tooth in
dental plaque formation?
A. Gram-negative facultative
B. Gram-positive facultative
C. Gram-negative anaerobic
D. Gram-positive anaerobic
B. Streptococcal and Actinomyces species are ini-
tial colonizers of dental plaque. They are gram-
positive, facultative micro-organisms.
Which of the following is an important constituent of gram-negative microorganisms that contributes to initiation of the host inflammatory response? A. Exotoxin B. Lipoteichoic acid C. Endotoxin D. Peptidoglycan
C. Endotoxin or lipopolysaccharide is an important
constituent of the gram-negative outer mem-
brane that contributes to initiation of the host
inflammatory response.
Calculus is detrimental to the gingival tissues because it is \_\_\_\_\_. A. A mechanical irritant B. Covered with bacterial plaque C. Composed of calcium and phosphorous D. Locked into surface irregularities
B. Calculus is calcified dental plaque. It is always
covered by a layer of uncalcified plaque, which is
detrimental to the gingival tissues.
Restoration margins are plaque-retentive and
produce the most inflammation when they are
located _____.
A. Supragingival
B. Subgingival
C. At the level of the gingival margin
D. On buccal surfaces of teeth
B. Supragingival margins are least detrimental to
the gingival tissues; subgingival margins are the
most detrimental due to the accumulation of
dental plaque.
Which of the following are cells of the innate immune system? a. Neutrophils and monocytes/macrophages b. T cells and B cells c. Mast cells and dendritic cells d. Plasma cells A. a and b B. a and c C. b and d D. b and c
B. Cells of the innate immune system include neu-
trophils, monocytes/macrophages, mast cells,
and dendritic cells. Cells of the specific (adap-
tive) immune system include T cells, B cells, and
plasma cells.
Which of the following are antigen-presenting cells? A. Neutrophils B. T-lymphocytes C. Macrophages D. Plasma cells
C. Neutrophils are one of the primary defense cells
of the innate immune system. T-lymphocytes are
important activators of the specific (adaptive)
immune system. Macrophages are antigen-
presenting cells. Plasma cells produce anti-
bodies.
Which of the following are the most important
proteinases involved in destruction of the
periodontal tissues?
A. Hylauronidase
B. Matrix metalloproteinases
C. Glucuronidase
D. Serine proteinases
B. Matrix metalloproteinases are the most impor-
tant proteinases involved in the destruction of
periodontal tissues.
The predominant inflammatory cells in the periodontal pocket are \_\_\_\_\_. A. Lymphocytes B. Plasma cells C. Neutrophils D. Macrophages
C. Neutrophils are the predominant inflammatory
cells in the periodontal pocket and have mig-
rated across the pocket epithelium from the
subgingival vascular plexus.
Which of the following are part of Preliminary Phase therapy? a. Treatment of emergencies b. Extraction of hopeless teeth c. Plaque control d. Removal of calculus A. a, b, and c B. b, c, and d C. a and b only D. b and d only
C. Preliminary Phase therapy is used to treat emer-
gencies and remove hopeless teeth.
Polymorphisms in which of the following genes have been associated with severe chronic periodontitis? A. IL-6 B. IL-1 C. TNF D. PGE2
B. Polymorphisms in the IL-1 genes have been asso-
ciated with severe chronic periodontitis.
Given the same amount of attachment loss and
same pocket depth, a single-rooted tooth and a
multirooted tooth have the same prognosis. The
closer the base of the pocket is to the apex of the
tooth, the worse the prognosis.
A. Both statements are true.
B. Both statements are false.
C. First statement is true. Second statement is false.
D. First statement is false. Second statement is true.
D. Single-rooted teeth have a poorer prognosis than
do multirooted teeth with comparable loss of
attachment. Loss of attachment that extends to
the apex of the root alters the crown-to-root ratio
and makes the prognosis worse.
Which of the following is most important in determining the prognosis for a tooth? A. Probing pocket depth B. Bleeding on probing C. Clinical attachment level D. Level of alveolar bone
C. The amount of clinical attachment loss is most
important in determining the prognosis. Deep
pocket depths and bleeding on probing can be
found in both gingivitis and periodontitis.
Although the level of alveolar bone is usually con-
sistent with the amount of clinical attachment
loss, there are circumstances under which these
two measures are not comparable.
Offset angulation is a characteristic feature of \_\_\_\_\_. A. Sickle scalers B. Universal curettes C. Area-specific curettes D. Chisels
C. Sickle scalers and universal curettes do not have
offset angulation of the blade. The working ends
of area-specific curettes are offset at a 60-degree
angle relative to the terminal shank. The working
ends of sickle scalers and universal curettes are
not offset—they are at a 90-degree angle relative
to the terminal shank.
Patients with which of the following should not be treated with ultrasonic instruments? A. Deep periodontal pockets B. Edematous tissue C. Infectious diseases D. Controlled diabetes
C. Patients with active infectious diseases should
not be treated with ultrasonic instruments
because of the aerosol that is created when using
this type of instrument.
What is the most important procedure to perform
during the initial postoperative visits following
periodontal surgery?
A. Plaque removal
B. Visual assessment of the soft tissue
C. Periodontal probing
D. Bleeding index
A. Plaque removal during the initial postoperative
visits following periodontal surgery is essential to
healing of the periodontal tissues.
When performing a laterally repositioned flap,
which of the following must be considered
relative to the donor site?
A. Presence of bone on the facial
B. Width of attached gingiva
C. Thickness of attached gingiva
D. All of the above
D. Laterally positioned flaps should only be per-
formed when there is adequate bone and ade-
quate width and thickness of attached gingiva on
the facial of the donor site.
Which class of bony defect responds best to regenerative therapy? A. One-walled B. Two-walled C. Three-walled D. Shallow crater
C. Three-walled defects respond best to regenera-
tive therapy.
The most common clinical sign of occlusal trauma is \_\_\_\_\_. A. Tooth migration B. Tooth abrasion C. Tooth mobility D. Tooth attrition
C. Although tooth migration can be a sign of
occlusal trauma, tooth mobility is the most com-
mon clinical sign.
For most periodontitis-affected patients, what is the recommended interval for maintenance appointments? A. 1 month B. 3 months C. 6 months D. 1 year
B. The majority of patients who have been treated for
periodontitis should be seen at 3-month intervals
for supportive periodontal therapy (maintenance).
Controlled diabetes has same perio problems as those who don’t have diabetes:
TRUE
What is not true regarding patient with diabetes and perio? either increase of crevicular fluid or increase of sugar in crevicular fluid
increase of crevicular fluid
QUESTION: Patient with diabetes, which finding is not consistent?
Increase collagenase in crevicular fluid
Increase glucose in crevicular fluid
Increase gram negative in crevicular fluid
Decrease in thickness of basilar lamina of blood vessels in periodontium
Increase gram negative in crevicular fluid
Diabetic patients have more of the following except: higher glucose levels in gingiva, increased anaerobic bacteria in pockets,
increased IL-1, increased collagenase
increased anaerobic bacteria in pockets,
Diabetics are more prone to perio and are less resistant to the effects of bacteria.
Both statements are true.
By recent studies, which one has a correlation with periodontitis?
Diabetes - diabetics are 15x higher at risk.
Pt presents with aggressive bone loss, bleeding gums, mobile teeth. What condition?
- uncontrolled diabetes
- non-Hodgkin’s lymphoma
• uncontrolled diabetes
ASA III:
uncontrolled diabetes
Periodontal disease is associated with what systemic diseases?
Diabetes and HIV
Which ethnic group has the most chronic periodontitis?
Black males
syndromes assoc with periodontitis
papillon-lefevre
chediak-higashi
ehlers-danlos
down
Red complex has 3 bacteria’s:
P. Gingivalis, Tannerella forsythia, Treponema denticola
what is red complex responsible for
BOP, deep pockets
which complex is earlier, red or orange
orange
what is orange complex responsible for
plaque formtaion and maturation, precedes red complex
orange complex bacteria
fusobacteria, prevotella, campylobacter
Which cells are predominant in sulcular fluid?
PMN’s
What cells predominate in established gingivitis?
plasma cells
Which of the following species is a usual constituent of floras that are associated with periodontal health?
Streptococcus gordonii
What bacterial species is not associated with periodontal disease?
A. Actinomyces species
B. P. gingivalis
C. Capnocytophaga
A. Actinomyces species
Bacteria that is not in chronic periodontitis? Actinomyces viscosus C. rectus T. forsytiaas P. gingivalis.
Actinomyces viscosus
Which is related to periodontal disease?
Gram negative bacteria
What is the 1st step in bacterial plaque formation on a tooth?
Pellicle formation (glycoproteins, enzymes, proteins,
phosphoproteins) .
- 2nd step is adhesion and attachment of bacteria
- 3rd step is colonialization and plaque maturation
Which is not part of plaque formation? Host antigen, extracellular bacterial polymers, bacterial interactions
Host antigen
Most plaque retentive thing –
calculus
Gingival recession, other than plaque amount, is related to – age, tobacco, etc
age
Plaque index is used for what? track gingivitis progression track disease activity to know plaque amount patient motivation
patient motivation
Which one is not a periodontal risk factor? Smoking, oral hygiene, malnutrition, diabetic mellitus
malnutrition
Which of the following things are associated w/ periodontal disease? Atheroschlerosis, Diabetes Mellitus, Low birth weight of
babies
Diabetes Mellitus
Difference between primary and secondary occlusal trauma?
Periodontal support/healthy periodontium in primary
normal bone level, normal attachment level, but excessive occlusal forces
Healthy patient, probing shows bleeding, what could this be due to?
Gingivitis
Which is least likely to occur with occlusal trauma?
Gingivitis
Gingival index/perio index. Know their flaws:
Perio index flaws are that the gingival recession was not taken into account.
Gingival index: each of the 4 gingival areas of the tooth is given a score from 0 (normal) to 3 (severe inflamed), mostly based on color.
Score is totaled per tooth or added all together/ (total teeth #) to give GI person score.
- GI doesn’t consider PD, degree of bone loss or any other qualitative changes in periodontium.
What is Gingival Plaque Index?
a. Nominal
b. Ordinal
c. Interval
d. Ratio
ordinal
a. Nominal like mild, moderate, severe
b. Ordinal include numbers: like furcation involvement 1,2,3
c. Interval like Celsius degree
d. Ratio e.g. Kelvin degree, or BP measurement (cannot be zero), length (cannot be negative), weight
What is CPITN?
Community Periodontal Index of Treatment Needs
What is predominant in plaque 2 days after prophy?
Gram (+) cocci and rods
- gram + cocci and rods normally present, gingivitis transition includes Gram (–) rods and filaments followed by spirochetal and motile
organisms.
With the development of gingivitis, the sulcus becomes predominantly populated by
a. gram-positive organisms.
b. gram-negative organisms.
c. diplococcal organisms.
d. spirochetes.
a. gram-positive organisms.
QUESTION: Supragingival calculus main crystals
main crystals are hydroxylapatite 58%
Chronic periodontitis has which bacteria
G (–) anaerobes.
Chronic periodontitis: has which bacteria
P. gingivalis (gram -)
Fusobacteria nuceatum has what specific characteristic?
Bridging microorganism between early & late colonizers of dental plaque
All syndromes are associated w/ periodontal problems except
a. Stevens-Johnson syndrome
b. Pap-lefev syndrome
c. down syndrome
d. hypophosphatasia
e. acrodynia
Stevens-Johnson
a. Stevens-Johnson syndrome (target lesions - conjunctiva and genital problems)
b. Pap-lefev syndrome (palmoplantar keratoderma with periodontitis)
c. down syndrome (related)
d. hypophosphatasia (bone disease similar to rickets, premature loss of primary teeth)
e. acrodynia (pain, discoloration of hand/feet, chronic heavy metal
Least cause of bone loss around primary teeth? Hypophosphatsia, leukemia, plaque
plaque
Which of the following causes bone loss?
a. C3a, C5a
b. Endotoxin
c. Interleukin
d. B glucorinidase
Interleukin
What cytokine responsible for osteoclasts? IL-1, IL-8, IL-5, IL-3
IL-1
Stress long term cause problem in periodontium b/c
it increases cortisone and cortisone and brings immune system down
fenestration in perio
isolated areas where root is denuded of bone and root surface is covered by gingiva and periosteum, but marginal bone is intact
dehiscence in perio
denuded areas extend through marginal bone
What is it called when you have a hole in the bone that exposes the root?
Fenestration
QUESTION: Dehiscence:
Loss of buccal or lingual bone overlying a tooth root, leaving the area covered by soft tissue only
which side is dehiscence usually on and what shape
facial, lingual is rare
characteristic oval shape
QUESTION: Each of the following osseous defects would be classified as infrabony EXCEPT one. Which one is this EXCEPTION? A. A trough B. A dehiscence C. A hemiseptum D. An interdental crater
B. A dehiscence
Biological width is
2 mm.
Biological width is from
the alveolar crest to the base of the sulcus.
Biologic width definition: junctional epithelium and _______ attachment to the tooth above the alveolar crest (at least 2mm)
a. gingival sulcus
b. epithelial attachment
c. connective tissue
c. connective tissue
How to determine attachment loss?
From CEJ to sulcus (depth of pocket)
Which of the following factor is most critical in determining the prognosis of periodontal disease?
- Probing depth
- Mobility
- Class 3 furcation
- Attachment loss
- Attachment loss
Attachment loss:
loss of connective attachment w/ apical migration of the JE away from the CEJ
QUESTION: The depth of sulcus is 5mm, the distance between CEJ and the base of sulcus is 2mm.what is the attachment loss:
2 mm
If recession is 2 mm and probing is 1 mm, how much attachment loss?
3 mm
If you have 1 mm recession and can probe 3 mm, how much attachment loss is there?
4mm
Perio treatment sequencing for mild-moderate chronic periodontitis?
Plaque control, Sc/Rp, caries control, perio surgery
When is the perio prognosis that poor?
Class 2 mobility
deep class 2 furcation
deep probing with suppuration
deep probing with suppuration (indicates tooth fracture)
Which teeth commonly relapse after perio tx (poor long-term prognosis)?
maxillary molars due to furcation anatomy
Where perio Tx is more difficult?
Maxillary molars due to trifurcations.
Which tooth is most commonly lost due to long term care in periodontal patients? max molar, max pm, man molar, man pm
max molar
QUESTION: If you have a through-and-through furcation involvement (class III furcation) on a tooth with 5 mm of root left in the bone, what do you do? Extract the tooth Splint Place Implant
Extract the tooth (preferred treatment)
QUESTION: Patient with class III furcation and 3 mm exposure?
Extract
If you have a grade III furcation, you can do all of the following except
a. Section it and crown both as PFMs
b. Tunneling procedure
c. GTR
GTR - Better for Class II, least successful for class III
Tx option: Class 2 almost class 3 furcation?
Main goal of tx on class 2 is converted to class 1 furcation by doing GTR
Recommended treatment for a Class II that is almost a class III:
- convert class II to a class I by doing GTR
- tunneling
- extraction
- convert class II to a class I by doing GTR
Most likely shape of furcation is?
Wide but still not very accessible to dental tools,
When you have a through and through furcation (Grade 3 at least),
a. It’s wide enough and you can clean it
b. It’s wide enough and the curette is too big to clean it
c. It’s narrow enough and you can’t clean it
d. Its narrow enough and the currete is too small to clean it
b. It’s wide enough and the curette is too big to clean it
Root amputation of MB root –
cut at furcation and smoothen for patient to keep clean
What is most common periodontitis in school-aged children: aggressive PD, ANUG, marginal gingivitis
marginal gingivitis
Which therapy in which adding antibiotic + debridement have minimal effect for? anug, Localized aggressive, chronic periodontitis
chronic periodontitis
How do you treat gingivitis in puberty:
debridement and OHI
Percentage to be considered generalized perio?
> 30%
Diagnosis for 40-year-old female w/ generalized bone loss, localized vertical bone defect, and gross calculus:
Chronic periodontitis
