PERIO Flashcards
During chronic adult periodontitis, bone is:
A. formed only. B. resorbed only. C. formed and resorbed. D. neither formed nor resorbed.
C. formed and resorbed:
Periodontitis involves gradual loss of bone over time through microbial and host interactions. Some of these interactions cause bone resorption. However, all bones undergo constant remodeling by osteoblasts and osteoclasts. Alveolar bone is no exception to this rule. There is an equilibrium of bone deposition and resorption in disease-free individuals. In periodontal disease, however, this balance could be disrupted, leading to greater resorption and less deposition. But, bone deposition still occurs (choice C). Therefore, choices A, B and D are incorrect.
Aggregatibacter actinomycetemcomitans is most commonly associated with:
A. chronic periodontitis. B. acute necrotizing ulcerative gingivitis (ANUG). C. localized aggressive periodontitis. D. gingivitis.
C. Localized aggressive periodontitis (LAP):
is associated with early onset (children and adolescents), rapid bone destruction (unlike that found in chronic adult periodontitis), and preference for first molars and incisors as sites of bone destruction. Lack of clinical inflammation, deep periodontal pockets, and advanced bone loss are the striking features of LAP. The amount of plaque on the affected teeth is minimal, which forms a thin biofilm on the teeth and rarely forms calculus. Although quantity of plaque is limited, it contains elevated levels of:
- Aggregatibacter actinomycetemcomitansand
- P. gingivalis. (in some patients)
In chronic periodontitis, the bacteria most often cultivated at high levels include:
- P. gingivalis
- T. forsythia
- P. intermedia,
- C. rectus
- E. corrodens
- F. nucleatum
- A. actinomycetemcomitans
- P. micros
- Treponema & Eubacterium species.
All of the following are TRUE with regards to a full-thickness flap EXCEPT one. Which one is this EXCEPTION?
A. Dissection of the tissue is done with a blunt surgical instrument. B. It is recommended for osseous recontouring. C. A layer of periosteum must be left on the bone. D. It is recommended for apical repositioning of the flap.
C. A layer of periosteum must be left on the bone:
A full-thickness flap requires the removal of the complete soft tissue from the bone. This tissue will contain the epithelium, the connective tissue, and the periosteum. When it is reflected properly, it will expose the bare bone. After the initial incision is made, the dissection is carried out with a blunt surgical instrument (choice A) to help prevent the tearing of the tissue during the reflection of the flap. This technique is used when surgical osseous recontouring is required (choice B); therefore, you do not want to have attached periosteum remaining on the bone, which makes choice D incorrect.
The two PRIMARY constituents of plaque are:
A. food and bacteria. B. bacterial products and food. C. pellicle and bacteria. D. pellicle and food. E. bacteria and bacterial products.
E. bacteria and bacterial products:
Plaque is composed primarily of bacteria and their products. These products may include secreted dextrans, levans, acids, and other waste products. While the bacteria are dependent on food as an energy source, food particles are not considered part of the actual plaque mass, making choices A, B and D incorrect. Similarly, pellicle is required for initial attachment of bacteria to a clean tooth surface. Pellicle is composed primarily of salivary glycoproteins, but it is not a part of plaque, making choice C incorrect. It is merely an initiator of the bacterial attachment.
The GREATEST advantage of a home oral hygiene program that includes the use of a water irrigation system is:
A. elimination of supergingival calculus. B. reduction of pocket depth. C. elimination of the microflora responsible for periodontal disease. D. reduction of the concentration of bacteria and their products.
D. reduction of the concentration of bacteria and their products:
Water irrigation systems were developed to help reduce the effects of the dental biofilms on the gingival tissues. The primary purpose of oral irrigation is the reduction of harmful bacteria that contribute to periodontal disease (choice D). Irrigation of periodontal pockets may reduce pathogenic bacteria up to 6 mm. Water irrigation may help remove some supragingival calculus if a magnetized water device is used (choice A). Reduction of periodontal pockets is an advantage of water irrigation (choice B), due to generalized bacterial reduction that contributes to the development and advancement of periodontal disease. The microflora is reduced, not eliminated. with oral irrigation (choice C).
Which treatment would be LEAST indicated for patients with acute necrotizing ulcerative gingivitis?
A. Topical steroids B. Analgesics C. Debridement D. Normal saline rinses E. Systemic antibiotics
A. Topical steroids:
act as strong anti-inflammatory compounds. As such, they may relieve symptoms but would inhibit the body’s defenses against infection. Using topical steroids on an acute infection such as ANUG will worsen the infection. Typical treatment of ANUG involves gentle debridement (choice C) (no scaling), rinses (choice D)(saline or dilute peroxide), antibiotics (choice E) if systemic symptoms are present, and analgesics (choice B) to relieve pain during healing. Note: The use of peroxide rinses is controversial. Some practitioners advise them. NDB, in the past, has not included peroxide rinse as part of its ANUG regimen.
All of the following are TRUEabout an autogenous free gingival graft EXCEPT one. Which one is this EXCEPTION?
A. It can be used to help prevent additional gingival recession. B. It receives nutrients from its own blood supply. C. It can be used to widen the attached gingiva. D. The palatal tissue is an acceptable donor site. E. The graft epithelium will eventually slough off.
B. It receives nutrients from its own blood supply:
The autogenous free gingival graft procedure involves the selection of a donor site from which the graft will be taken; this is usually an edentulous region or the palatal area (choice D). Once the tissue is harvested from the donor site, it is placed over a viable connective tissue site. It is very important to understand that the graft receives nutrients from the connective tissue bed. The graft epithelium will degrade over time and will eventually slough off (choice E). This procedure is commonly used to increase the width of attached gingival (choice C) after recession has occurred; once placed, it can help in preventing additional recession (choice A).
Acute necrotizing ulcerative gingivitis (ANUG) has been associated with all of the following organisms EXCEPT:
A. Prevotella intermedia B. Aggregatibacter actinomycetemcomitans. C. Fusobacterium species D. Treponema species E. Spirochete
B. Aggregatibacter actinomycetemcomitans (Aa):
is the causative organism strongly linked to localized aggressive periodontitis(LAP) and not ANUG.
Fusiform-spirochete bacterial flora has been associated with NUG. In addition, P. intermedia, Fusobacterium, Treponema, and Selenomanas species have also been associated with NUG. ANUG is characterized by pathognomonic signs and symptoms: crater-like, punched out depressions at the crest of the interproximal papillae extending into marginal gingiva; craters are covered by grey pseudomembranous slough, and, in some cases, the lesions are denuded, exposing the gingival margin; and are red, shiny, and hemorrhagic. Bleeding gingiva, offensive odor, and increased salivation are other characteristic signs. Local lymphadenopathy and a low-grade fever are systemic signs of low and moderate stages of the disease. It usually occurs in patients ages 18 to 30 years. There are several possible risk factors, including poor oral hygiene, smoking, poor nutrition, fatigue, stress, and immunocompromised status.
In which of the following conditions is plaque NOT a MAJOR etiologic factor?
A. ANUG (Vincent disease) B. Adult chronic periodontitis C. Marginal gingivitis D. Juvenile periodontitis
D. Juvenile periodontitis (JP) has a number of unusual characteristics. It is usually detected through radiographs or when unexpected mobility or migration of incisors or first molars is noticed in a young patient. Large amounts of plaque or calculus are usually absent in JP. JP is related to the presence of Actinobacillus actinomycetemcomitans (Aa).
- ANUG: is acute necrotizing ulcerative gingivitis and mostly associated with plaque formed by Fusobacterium and spirochetes.
- Adult chronic periodontitis is associated with plaque formed by P. gingivalis, T. forsythia, P. intermedia, C. rectus, E. corrodens, F. nucleatum,Aa, P. micros, and Treponema and Eubacterium species.
- Marginal gingivitis is also associated with plaque formed by S. sanguis, S. mitis, A. naeslundi, S.oralis, A. viscosis, P. micros, F. nucleatum, P. intermedia, V. parvula, Capnocytophaga, Haemophilus and Campylobacter species.
Which of the following is the BESTexample of a universal curette?
A. Columbia 4R-4L B. Gracey 3-4 C. Pigtail curette D. Jaquette sickle scaler
A. Columbia 4R-4L:
By definition, a universal curette can be used on any tooth, either anterior or posterior. Examples include the
- Columbia 4R- 4L
- Columbia 13-14
Gracey (choice B) curettes are specific curettes, with specific number curettes used for specific types of teeth and surfaces (anteriors, posterior linguals, etc.). Pigtails (choice C) are explorers rather than curettes or scalers. They are designed to help probe for calculus deposits. Jaquette sickle scalers (choice D) are scalers and not curettes.
Lysozyme is an enzyme:
A. produced by cariogenic streptococci. B. produced by anaerobic periodontal pathogens. C. produced by opportunistic fungi. D. produced by the body and acts on bacterial cell walls. E. produced by the body and acts on bacterial cell membranes.
D. produced by the body and acts on bacterial cell walls:
Lysozyme is a part of the salivary defense mechanism and plays a minor antibacterial role. It is believed to be a hydrolytic enzyme, which attacks glycopeptides in certain bacterial cell walls. Its concentration is higher in the saliva secreted from the submandibular and sublingual glands compared to the saliva secreted from the parotid gland.
Which of the following cells are associated with the production of a large number of immunoglobulins in a patient with advanced periodontitis?
A. Basophils B. Plasma cells C. B lymphocytes D. T lymphocytes E. Macrophages
B. Plasma cells:
In the answer choices, the only cell listed that can secrete a large number of immunoglobulins or antibodies is the plasma cell.
Basophils are responsible for the release of inflammatory mediators such as histamine. When a B cell is activated by an antigen, it differentiates into an effector cell. Effector B cells may start secreting antibody, but they finally mature into large plasma cells, which continuously secrete a large number of antibodies. T lymphocytes are responsible for cell-mediated immunity and delayed hypersensitivity. These cells are influenced by the thymus prior to migrating to the tissues. Macrophages are the cells that ingest microorganisms and other foreign material and help remove them from the site of injury or infection. Macrophages are derived from monocytes; monocytes are formed in the bone marrow, transported to the tissues, and transform into macrophages.
When hydrogen peroxide is used by the patient in a 50/50 mix of over-the-counter peroxide and water, the resulting peroxide solution is what percent hydrogen peroxide?
A. 50% B. 6% C. 3% D. 1.5%
D. 1.5%:
Over-the-counter hydrogen peroxide is a weak solution of 3 parts peroxide to 97 parts water (3%) (choiceC). Peroxide is a powerful oxidant and extremely reactive chemically. Peroxides used in hair bleaching are often 6% (choice B), and 30% in walking bleach for endodontic teeth. A mixture of 50% peroxide (choice A) would be dangerous to have around. So, at home, 3% peroxide is mixed equally with water to form a 1.5% solution.
Which of the following bacteria is LEAST likely to be found in pockets affected by chronic adult periodontitis?
A. Streptococcus mitis B. Campylobacter C. Prevotella D. Treponema E. Eubacterium
A. Streptococcus mitis:
Gingivitis: mostly associated with
S. sanguis, S. mitis, A. naeslundi, S. oralis, A. viscosis, P. micros, F. nucleatum, P. intermedia, V. parvula, Capnocytophaga, Haemophilus,and Campylobacter species.
The bacteria most often cultivated at high levels in chronic periodontitis:
P. gingivalis, T. forsythia, C. rectus, E. corrodens, P. intermedia, F. nucleatum, A. actinomycetemcomitans, P. micros, and Treponema and Eubacterium species.
Note: Acute necrotizing ulcerative gingivitis (ANUG) is mostly associated with Fusobacterium and spirochetes. Also remember that the quantity of plaque in localized aggressive periodontitis (LAP) is limited, but it contains elevated levels of Aggregatibacter actinomycetemcomitans and, in some patients, P. gingivalis.
A chronic periodontal pocket, in which immunoglobulins are found in high concentrations, must also have large numbers of which cell type present?
A. T lymphocytes B. B lymphocytes C. Macrophages D. Plasma cells E. Basophils
D. Plasma cells:
The answer depends on the fact that plasma cells are responsible for the production of large number of antibodies. They are derived from stimulated B lymphocytes (choice B). When a memory B cell is activated by antigen, it differentiates into an antibody-secreting effector cell. Effector B cells can begin secreting antibody while they are still small lymphocytes, but the end stage of their maturation pathway is a large plasma cell, responsible for the production of large number of antibodies. Most of the cells listed can be found in the chronic periodontal pocket. T lymphocytes (choice A) are primarily involved in cell-mediated immunity. Macrophages (choice C) are phagocytic cells derived from monocytes. Basophils (choice E) release several inflammatory response mediators, including histamine.
