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Question 1

Gracey Curettes 1/2, 3/4 used on the

Answer 1

U+L anterior teeth

Question 2

Design and Purpose: Gracey curettes
GCurettes are … instruments with multiple ….. options

The design of these curettes aims to reduce …, to maintain…
This ergonomic feature->prevents ..during

Answer 2

GCurettes are double-ended instruments with multiple handle options. The design of these curettes aims to reduce wrist flexion, to maintain a neutral hand, wrist, and forearm position during use. This ergonomic feature->prevents carpal tunnel syndrome- removal of subgingival plaque, calculus, and root planing.

Question 3

Gracey Curettes- These are used on the buccal and lingual portions of posterior teeth.

Answer 3

7/8 and 9/10

Question 4

Gracey Curettes used on the mesial portions of posterior teeth.

Gracey …is a modification of the …with a more …. angled shank to access the mesial surfaces of posterior teeth allows for …

Answer 4

11/12 and 15/16:
Gracey 15/16 is a modification of the 11/12 with a more acutely angled shank to access the mesial surfaces of posterior teeth[md pm]. The angulation allows better adaptation and a more stable intraoral fulcrum.

Question 5

Gracey Curette used on the distal portions of posterior teeth

Answer 5

13/14 and 17/18:

Question 6

Gracey Curette used on the anterior teeth and premolars

Answer 6

5/6

Question 7

Full Mouth Debridement (FMD) Protocol:

Timing:
tx Regimen:

Answer 7

Complete ScRP all pockets in two sessions (2 hours each) within 24 hours.
Subgingival irrigation with CHX 3x within 10 minutes after each ScRP session.

Rinse with CHX twice daily for two weeks 30sec.
Perform standard oral hygiene including tooth brushing, interdental cleaning, and tongue brushing 1min.

Question 8

Quadrant Debridement Protocol:
Timing:
Oral Hygiene Regimen:

Answer 8

1-hour session of ScRP per quadrant, scheduled at 2-week intervals.

Same as FMD: toothbrushing, interdental cleaning, and tongue brushing, with CHX m/w.

Question 9

Common Aspects of FMD and Quadrant Debridement Protocol:

OR differences

Answer 9

1 Chlorhexidine (CHX) Use: Important in both methods for controlling bacterial load, though detailed CHX use immediately following treatment is emphasized more in the FMD + subgingival pockets.
2 Oral Hygiene Practices: Both protocols stress the importance of comprehensive oral hygiene practices including toothbrushing, interdental cleaning, and tongue brushing.

Question 10

Bacteriophages are viruses that can infect and kill only bacteria.
Bacteriophage (FnpΦ02) which specifically infects and kills Fusobacterium nucleatum was discovered. Based on your knowledge of periodontal microbiology and pathogenesis, describe how FnpΦ02 could be useful in the prevention of periodontitis.

Answer 10

1.Target Bacterium:
Fusobacterium nucleatum- key to maturation of biofilm by bridging early colonizers to late colonizers of plaque
2 Mechanism of Action:
Selectively lyses Fusobacterium nucleatum.
Disrupts biofilm architecture.
Preserves beneficial oral microbiome.

3 Benefits in Preventing Periodontitis:
Disruption of Biofilm Integrity + maturation
Reduction in host Inflammatory Response.

4 Application in Therapy:
i-Could be part of phage-embedded material.
ii-Administered locally in periodontal pockets for sustained release.
iii-Complements mechanical debridement and prevents recurrence.

5 Concerns include safety, specificity, and bacterial resistance. Requires clinical trials to address potential issues.

Question 11

main players are members of red complex [… ppr YEAR] are strongly associated with …

Answer 11

(Socransky et al. 2002)
Porphyromonas gingivalis, Treponema denticola and Tannerella forsythia—> PERIODONTITIS

Question 12

4x Indications for using systemic antibiotics as an adjunct to periodontal therapy include:

Answer 12

1 Severe periodontal tissue breakdown that is either localized or generalized, especially if it is disproportionate to the patient’s age, eg indicating rapidly progressing CAL or bone loss young adult.

2 Severe periodontal tissue breakdown that persists despite the patient maintaining good oral hygiene and a low plaque score.

3 generalized bleeding on probing (BoP), that persists despite good oral hygiene+low plaque score + recent non-surgical/surgical periodontal tx

4 Stage III/Iv especially if the patient has already lost teeth and exhibits severe clinical attachment loss (CAL).

Question 13

4x Contraindications for using systemic antibiotics in periodontal therapy include:

Answer 13

1Allergies to specific antibiotics.
2 Concerns about interactions with other medications -eg tetracycline +warfarin-inc Bleeding
3 tx of periodontal abscess unless the patient exhibits a systemic response to the local infection, such as fatigue, fever, facial swelling, or lymph gland involvement.
4 Refusal of periodontal treatment, as systemic antibiotics should only be considered in addition to non-surgical periodontal therapy, not as a standalone treatment.

Question 14

systemic antibiotics prescribed as an adjunct to periodontal therapy include 3x….

These antibiotics are used to combat the …

Answer 14

Tetracyclines (ie Doxycycline and Minocycline), Metronidazole, and Penicillins (mainly Amoxicillin). bacterial infections that contribute to periodontal disease.

Question 15

MechanismsOf action
Tetracyclines:

Metronidazole:

Amoxicillin

Answer 15

Tetracyclines: They inhibit protein synthesis in bacteria;bacteriostatic +reduces the growth and multiplication of periodontal pathogens.
Have anti-collagenase properties, which help in reducing tissue destruction.

Metronidazole: This antibiotic is effective against anaerobic bacteria and works by causing DNA strand breakage and cell death; bactericidal in bacteria.

Penicillins (Amoxicillin): They work by inhibiting bacterial cell wall synthesis, leading to cell lysis and death; bactericidal.

Question 16

Use of more than one antibiotic may be necessary since periodontal infections often contain a wide variety of bacteria. Common combination of antibiotic regime is:-

studies demonstrated the efficacy of adjunctive treatments in improving …. and …

Answer 16

Metronidazole (± Amoxicillin) 250 mg of each/ 3x/day for 8 days has been used most routinely-additive effect + against Aggregatibacter actinomycetemcomitans. [Newman and Carranza’s Clinical Periodontology, Chapter 13th edition]

tetracycline and bactericidal (e.g., amoxicillin) =not function well together. Thus, they are best given
serially rather than in combination.

clinical parameters + reducing the burden of periodontal pathogens.

Question 17

Single Abx dosage : …mg..?/day..for… days
Amoxycillin ; Metronidazole

Azithromycin
if allergic to penicillin->

Answer 17

Metronidazole/Amoxycillin = 500 mg 3x/day- 8 days

Azithromycin 500 mg OD for 4 - 7 days
Clindamycin 300 mg 3x/day for 10 days //
Doxycycline or Minocycline 100 mg OD 21 days

Question 18

Scaling is the process involving the removal of

Root Planing is the process involving the removal of

Answer 18

plaque, calculus, and stains from the supragingival and subgingival surfaces of the teeth.

• removal of cementum or surface dentin that is rough or impregnated with calculus, toxins, or microorganisms.

Question 19

Benefits SRP

Answer 19

1Remove: microbial plaque and retentive factor -calculus.
2 Disrupt biofilm subgingival.
3 Delay re-population of pathogenic microbes.

Question 20

Risk Factors are variables with … relationship to disease dvlpmt eg

Answer 20

Variables with a direct causal relationship to disease development (e.g., pathogenic bacteria;smoking,DM for periodontal disease).

Question 21

Risk Indicators are Variables associated with a higher… of disease but not… eg

Answer 21

likelihood
proven causal (e.g., obesity,HIV/AIDS,alcohol, osteoporosis and periodontal disease).

Question 22

Risk Determinants are Broad characteristics that influence… but not…

Answer 22

Broad characteristics that influence risk but are not direct causes (e.g., age, gender,race).

Question 23

Mx of periodontitis pt stage iii

MOST IMPORTANT CARD!!!

Answer 23

Treatment sequence for periodontitis stages I to III is described as a stepwise approach with the following outline:-
1 Patient Education & tx Plan Agreement
Goal: Inform patients about diagnosis, causes, risk factors, and treatment options. Establish a personalized treatment plan aligned with patient preferences and health changes.

2 First Step of Therapy EFP: Behavioral Change & Biofilm Control
-Motivate effective supragingival dental biofilm removal through patient education, DM control/smoking cessation-Ramseier et al. (2020)] /stress mx.

3 Phase I Therapy (Cause-Related Non-Surgical SRP)
Focus: Professional Mechanical Plaque Removal (PMPR): Remove supra+ SUBgingival plaque and calculus, and address plaque-retentive factors-caries removal. DONE via subgingival instrumentation, especially in subgingival pockets aimed to reduce or eliminate Periopathogens.
Adjunctive Interventions: May include physical or chemical agents, host-modulating agents[not enough evidence-Subantimicrobial Dose Doxycycline ;NSaids/bisphophonate], subgingival locally delivered antimicrobials, or systemic antimicrobials[only in young adults-stg III]

Phase II Therapy: Addressing Non-Responsive Areas
Techniques deep- ≥6mm: Repeat subgingival instrumentation or escalate to surgical interventions for better access and treatment of complex periodontal structures.
Surgical Options: Access flap surgery, resective surgery, or regenerative period. surgery targeting intra-bony and furcation lesions.

Maintenance Phase: Supportive Periodontal Care
Objective: Maintain periodontal stability through ongoing preventive and therapeutic measures.
Frequency: Regular visits tailored to the patient’s periodontal status, typically every 3, 6, or 12 months, with sessions lasting 45-60 minutes. Monitor osteoporosis/dM etc

Personalized Care: Adjust treatment plans based on clinical findings and patient responses over time

Question 24

HOW TO address the horizontal bone loss not responding to SCRP?

Furcation Treatment? which grade?and rationale

Answer 24

Bone Grafting: Consider regenerative techniques, such as bone grafts, to address the horizontal bone loss.
Furcation Treatment: For Grade 2 furcations, regenerative procedures or tunnel preparations might be indicated. Rationale: To reduce furcation involvement and stabilize affected molars.

Question 25

Stage I Periodontitis:

Answer 25

severity Characterized by 1 interdental clinical attachment loss of 1 to 2 mm and 2 rdgphc bone loss of coronal 1/3 (<15%).
3 NO tooth loss.
complexity - 1 Max probing depth ≤4 mm and mostly mild horizontal bone loss.
generally ,-less complex tx+ non-surgical and aimed at controlling bacterial infection and halting progression of the disease. Good prognosis

Question 26

Stage II Periodontitis:

Answer 26

severity : -Increased destruction with Interdental CAL of 3 to 4 mm and radiographic bone loss extending to the coronal third (15%-33%).
NO tooth loss
complexity - 1 max probing depth is ≤5 mm and mostly horizontal bone loss.
mx: tx may include deeper cleaning/RP and possibly local adjunctive therapies. Prognosis is good

Question 27

Stage III Periodontitis:

Answer 27

Severe destruction with significant deep pockets ≥6 mm, ID CAL ≥5 mm, and Rdgphc bone loss extending to the middle third of the root.
1- 4 teeth lost.
Horizontal and vertical [≥3 mm] bone loss; Furcation involvement Class II or III + and moderate ridge defects.

Treatment complexity increases due to the possible need for surgical /regenerative interventions and management of tooth mobility. Prognosis is fair

Question 28

Stage IV Periodontitis:

Answer 28

Severe destruction with significant deep pockets ≥6 mm, ID CAL ≥5 mm, and Rdgphc bone loss extending to the middle third of the root and beyond.
≥5 teeth lost. Horizontal and vertical bone loss; Furcation involvement Class II or III + and severe ridge defects.
Need for complex rehabilitation dt masticatory dysfx, 2* occl trauma dt Mobility G>2, bite collapse, drifting, flaring, <20 teeth remaining (10 opposing pairs)

Treatment complexity increases due to the possible need for surgical interventions, management of tooth mobility or even tooth loss and regenerative therapies, including augmentation for implants, may be required. Multi-specialty treatment is often necessary, and the prognosis is questionable for maintenance.

Question 29

Grade IN PERIODONTAL classification

Answer 29

Grade A (slow rate of progression- no CAL/RBL over 5 yrs)%bone loss/age <0.25, Heavy biofilm deposits but low lvl of destruction

Grade B (moderate rate of progression <2mm CAL/RBL over 5 yrs) %bone loss/age 0.25-1.0, biofilm consistent with amt of destruction

Grade C (rapid rate of progression ≥2 mm CAL/RBL over 5 yrs) %bone loss/age: > 1.0= aggressive nature. Destruction exceeds
expectations given amt biofilm deposit indicate early onset/rapid progression.

Question 30

Grade modifiers include risk factors such as Smoking and DM

Answer 30

Grade A- Non smoker; no DM
Grade B- <10 cigarettes/day; HbA1c <7.0% with DM
Grade C- ≥10 cigarettes/day; HbA1c ≥7.0% with DM

Question 31

Grade A, B C - biofilm correlation with level of destruction

Answer 31

Heavy biofilm deposits with low levels of destruction

Destruction corresponding with biofilm deposits

Destruction exceeds expectations given biofilm deposits; clinical patterns suggestive of periods of rapid progression and/or
early onset disease

Question 32

Extent and distribution of periodontitis

Answer 32

For each stage, describe extent as:
* Localized (<30% of teeth involved);
* Generalized; or
* Molar/incisor patter

Question 33

staging and Tooth Loss:

The area with the most severe destruction determines the ….

Answer 33

stage. The number of teeth lost due to periodontitis, including those planned for extraction as part of active periodontal therapy .

Eg, if a patient diagnosed with periodontitis had previously lost two teeth due to periodontal disease and now has an additional 3 teeth that clearly require extraction due to periodontal destruction, those teeth planned for extraction should be included in the count of teeth “lost due to periodontitis.” Thus, the patient would
have five teeth lost due to periodontitis and would be classified as Stage IV.

Question 34

What is meant by the consensus statement, “a periodontitis patient is a periodontitis
patient for life”?

Answer 34

A patient who has periodontitis remains at risk for further periodontal destruction even with treatment.

It is important to define a periodontitis patient as an “at-risk” individual because this patient requires a more intensive level of maintenance and evaluation than a patient who has not had periodontitis.

Question 35

Periodontitis definition.

Answer 35

Microbially-associated, host-mediated inflammation leading to gingival inflammation with apical migration of JE forming deep pockets, periodontal attachment loss [CAL]+ radiogphc alv bone loss.

Question 36

signs and symptoms of periodontitis, which include: 9x

Answer 36

1 Red, swollen or tender gums or other pain in your mouth
2 Bleeding while brushing, flossing, or when eating certain foods
3 Gums that are receding or pulling away from the teeth, causing the teeth to look longer than before
4 Loose or separating teeth
5 Pus between your gums and teeth
6 Sores in your mouth
7 Persistent bad breath
8 A change in the way your teeth fit together when you bite
9 A change in the fit of partial dentures

Question 37

The mechanism of action of ultrasonic debridement includes mechanical, irrigation, cavitation, and acoustic microstreaming.
The primary mechanism of deposit removal is cavitation.
1both true?
2 first true, second false?

Answer 37

first true, second false
The mechanism of action of ultrasonic debridement includes mechanical, irrigation, cavitation, and acoustic microstreaming.
The primary mechanism of deposit removal is mechanical. The high-frequency oscillating action of the blunt tip contacting the deposit (biofilm or calculus) mechanically disrupts or fractures the deposit.

Cavitation and acoustic microstreaming are biophysical phenomena that act synergistically to disrupt biofilm up to 0.5 mm from the point of contact of the ultrasonic insert tip.

Question 38

Aerosol management during ultrasonic instrumentation includes: 4x

Answer 38

1 Personal barrier protection for the clinician and patient and surface barrier protection of clinical contact surfaces that cannot be cleaned by sterilization or disinfection.
2 Preprocedural rinsing: An essential oil antiseptic rinse/ 0.12% chlorhexidine gluconate rinse has been shown to reduce the bacterial count in the aerosol generated by ultrasonic scaler use.
3 Retracting the patient’s lip or cheek: Pulling out the patient’s lip or cheek, then up/down (lips) or forward (cheek), forms a cup that helps contain the aerosol to the oral cavity where it can be evacuated.
4 High-volume evacuation (HVE): HVE should be used during the entire debridement procedure to remove as much of the aerosol as possible and minimize the amount that escapes the operative site.

Question 39

Which of the following oral pathogens induce platelet aggregation contributing to cardiovascular disease?
Aggregatibacter actinomycetemcomitans
Tanerella forsythia
F. Nucleatum
Prophyromonas gingivalis

Answer 39

Multiple mechanisms contribute to the association between oral health and cardiovascular disease, including altered immune response, chronic inflammation, and platelet aggregation.
Though many periodontal pathogens contribute to these conditions, only P. gingivalis was found to contribute to platelet aggregation.

Question 40

A sharp cutting edge periodontal hand instruments allows for: 5x

Answer 40

1 Easier calculus removal :by grabs the calculus deposit and removes it more efficiently. A dull cutting edge can increase the possibility of burnishing rather than removing calculus.
2 Improved stroke control: increases tactile sensitivity and reduces force allowing for better control of the instrument. Dull cutting edges require excessive force increasing the likelihood of losing control of the stroke and possibly injuring the patient or clinician.
3 Reduced number of strokes : A sharp cutting edge reduces the number of strokes needed to remove calculus deposits saving energy and time.
4 Increased patient comfort : A sharp cutting edge reduces lateral force and requires fewer working strokes, which improves patient comfort. It also helps prevent unnecessary gingival tissue trauma, which can be uncomfortable for the patient.
5 Reduced clinician fatigue : Just as fewer strokes and less lateral pressure. avoid Carpal tunnel syndrome-Pain/numbness/weakness of hand

Question 41

An incorrectly sharpened instrument is far less effective for calculus removal and may fracture easily. To maintain the 70-80 degree internal angle of the blade at the cutting edge, the visible angle at which the stone should be placed against the blade is 110 degrees. true or false?

Answer 41

True, the internal angle of an instrument’s blade is between 70 and 80 degrees, so the visible angle at which a sharpening stone should be placed against the blade is 110 degrees. While a universal curette and sickle scaler may have a face-to-blade angulation at 90 degrees depending on the specific instrument, a Gracey has an offset blade with a 70-degree angle to the lower shank.

alternatively, can use Gleason Guide eliminates the need for visualizing angulation during sharpening.

Question 42

The moving instrument technique produces a precise, defined cutting edge. In contrast, the moving stone technique produces bevels and wire edges. True or false?

Answer 42

True. The moving instrument technique is utilized by moving the instrument along the stone. The moving stone technique is when the stone is moved along the instrument. Studies show technique that produces the most precise cutting edge without wire edges and irregularities is the moving instrument technique.

Question 43

Which is the functional unit of tissue that surrounds and supports the tooth?

Answer 43

periodontium= gingiva, periodontal ligament, cementum, and alveolar bone support the tooth.

Question 44

five groups of gingival fibers:

Answer 44

1 Dentogingival fibers:give support to free gingiva
2 Alveologingival fibers -provide support to the free gingiva+ attached gingiva
3 Circumferential fibers – help maintain tooth position
4 Dentoperiosteal fibers – attach the tooth to the bone via insertion at the cervical cementum extending over the alveolar crest and attaching to the alveolar bone buccal side
5 Transseptal fibers – provide resistance to the separation of teeth

Question 45

The way bacteria communicate and form biofilm is referred to as which of the following?
This dynamic communication system enables bacteria to …

Answer 45

Quorum sensing. This dynamic communication system enables bacteria to monitor each other’s presence and modulate their gene expression in response to the number of bacteria in the biofilm.

Question 46

prophylactic antibiotics be taken 30-60 minutes prior to dental procedures. If the patient forgets to take their antibiotics, they should be dismissed without treatment. - true /false?

Answer 46

false.
Pophylactic antibiotics be taken 30-60 minutes before dental treatment; however, they can be taken up to 2 hours after dental procedures.

Question 47

air polishing utilizes ….and …

Answer 47

utilizes sodium bicarbonate for supragingival plaque+ stain removal on enamel use only. Contraindicated on restorative materials + implant surfaces.

and glycine powder can be used for the removal of plaque biofilm but < effective VS sodium bicarbonate.

Question 48

What the general combination of phenolic essential oils found in essential oil mouthwashes/Listerine?

mechanisms:5X

Answer 48

eucalyptol, thymol , menthol and methyl salicylate work by the following mechanisms:
1) Rupture cell wall +inhibit enzymatic activity
(2) Penetrate biofilm+exert bactericidal
effect
(3)Extract endotoxins from G-ve pathogens
(4)Slow down bacterial multiplication
(5) Prevent aggregation of bacteria with other pathogen.

Question 49

COMPREHENSIVE PERIODONTAL EVALUATION -includes

1 Full mouth periodontal charting includes documentation of the following data points:
9X PERIO
6X TOOTH
3x OCCL
2 xrays
mh 10
shx3 + 2 mh

Answer 49

1period. pocket depths,
2bleeding on probing,
3suppuration/Inflammation,
4Width of Keratinized Tissue-Biotype (Thin, Moderate, Thick),
5 recession,
6 attachment level/attachment loss
7Furcation Status
8 Presence, Degree, and Distribution of Plaque/ calculus [4site/tooth]
9 Mucogingival- Consistency (Spongy to Fibrotic)
iiColor (Erythematous)
iiiContour (Scalloped, Flat, Rolled, Knife Edge)

TOOTH:
1Caries
2Proximal Contact Relationships
3Endodontic/Periodontal Lesions
4Status of Dental Restorations and Prosthetic
5Appliances
6 Other Tooth or Implant Related Problems

Occlusion
1Degree of Mobility of Teeth and Dental Implants
2Occlusal Patterns
3Fremitus

Diagnostic Quality Radiographs
1Quality/Quantity of Bone
2Bone Loss Patterns

Medical History
Infectious Diseases (HSV-1, VZV)
Endocrine Pathology (Diabetes, Obesity)
3Hormonal Disorders (Puberty, Pregnancy)
Hematological Disorders (Cyclic Neutropenia)
Dermatologic Conditions (MMPemphigoid,PV, Lichenoid)
6 Immune Response (Down’s Syndrome, HIV/AIDS)
Tumors (SCC, Malignant Melanomas)
8Nutritional Deficiencies (Vitamin C - Scurvy;VitD)
Medication Effects (Gingival Hyperplasia-Phenytoin)
10 Allergies

Chief Complaint
Reasons for Tooth Loss
Oral Hygiene Practices
Dental Habits (Clenching, Bruxing)
Dental Visit Frequency

Social History+Discussion of Patient Risk Factors
1Age - cognitive fx + attitude/Overall Appraisal
2Diabetes
3 smoking
4 Cardiovascular Disease
5 Other-alcohol/drug Abuse

Question 50

Vitamin B deficiency can manifest in a range of symptoms such as ….

Answer 50

dermatitis, paresthesia, anemia, and oral manifestations. Oral manifestations include angular cheilitis, glossitis, and in some cases, gingival bleeding. Studies have indicated an inverse association between vitamin B12 serum levels and the severity of periodontal disease.

Question 51

salivary flow rate unstimulated…h… mL/min- waking hr and sleeping time is…

Unstimulated flow rates below …..y…mL/minute are considered hypofunction

stimulatedflow rate is, at maximum,- x mL/min

Answer 51

unstimulated flow rate is 0.3 mL/minute during waking hours being 300 mL. Salivary flow during sleep is nearly zero.
Unstimulated flow rates below 0.1 mL/minute are considered hypofunction

stimulated flow rate is, at maximum, 7 mL/minute - range 0.5-1.5L per day

Question 52

clinical signs-checking intraorally of xerostomia 7x

Answer 52

1Mirror sticks to buccal mucosa/tongue
2Frothy saliva
3 No saliva pooling in the floor of the mouth
4 Tongue shows generalized shortened papillae/ lobulated/fissured
5 Glassy appearance of oral mucosa, especially in the palate
6 Cervical caries (more than two teeth)
7 Debris on palate or sticking to teeth

Question 53

Which salivary gland produces the most unstimulated flow of saliva?

Answer 53

65% from submandibular, 20% from parotid, 7% to 8% from sublingual, and less than 10% from numerous minor glands.

Question 54

Which salivary gland produces the most stimulated flow of saliva?

Answer 54

Stimulated high flow rates drastically change percentage contributions from each gland, with the parotid contributing more than 50% of total salivary secretions.

Question 55

When possible, the initial diagnosis of periodontitis should be based on radiographic bone loss. TRUE / false

if false, explain what is it

Answer 55

initial diagnosis of periodontitis should be based on clinical attachment loss (CAL). CAL is calculated by combining the periodontal probing depth with the distance from the cemento-enamel junction to the gingival margin. FGM above CEJ has negative value.

If CAL is not available, radiographic bone loss should be used. When diagnosing periodontitis, other factors such as tooth loss due to periodontitis, furcation involvement, tooth mobility, ridge defects, should be considered as well.

Question 56

classification of periodontitis

updated to align with emerging scientific evidence, according to the 2017

Answer 56

Periodontitis classifications -updated to align with emerging scientific evidence, according to the 2017 World Workshop on the Classification of Periodontal and Peri-implant Diseases and Conditions.

3 distinct categories are now accepted: necrotizing periodontitis, periodontitis as a manifestation of systemic disease, and periodontitis.
These revised categories focus on the severity of disease and complexity of the disease+include a grading system.

Question 57

clinical periodontal health is defined by …

A gingivitis case is defined by the presence of …

Answer 57

the absence of inflammation [measured as presence of bleeding on probing (BOP) at less than 10% sites] and the absence of attachment and bone loss.

gingival inflammation, as assessed by BOP at ≥10% sites and absence of detectable attachment/bone loss. Localized gingivitis is defined as 10%–30% bleeding sites, while generalized gingivitis is defined as >30% bleeding sites

Question 58

Amount of fluoride in toothpaste is recommended for children

Answer 58

Amount of fluoride in toothpaste is recommended: 1000 ppm for children under the age of 3-smear;
1350-1450 ppm for children between ages 3 and above -pea size

Question 59

ATRIDOX is a subgingival controlled-release product that contains doxycycline. Once inserted into the subgingival pocket, the extruded liquid solidifies which allows for a controlled release of the drug for seven days. TRUE OR FALSE?

Answer 59

TRUE.
ATRIDOX=doxycycline, a broad-spectrum form of tetracycline, to reduce bacteria levels in subgingival areas

Question 60

Current locally applied antibiotics include

Answer 60

periochips [chlorhexidine chips] , AtriDOX =doxycycline gel, and arestIN=mINocycline microspheres.

Question 61

Sickle scalers design includes ..cross-section, face perpendicular to the …, two cutting …., and pointed ….. They are designed to be used for

Answer 61

a triangular cross-section, face perpendicular to the lower shank, two cutting edges, and pointed tip.

designed to be used anterior and posterior for interproximal supragingival deposits.

Question 62

Which instrument is the best choice when trying to reach the midline of the maxillary first molar?

Answer 62

universal curettes extend approximately 5mm toward the midline of the tooth, while other curettes/ sickle scaler have shorter shank

Question 63

Adaptation refers to the alignment of an instrument against …before… stroke.

Answer 63

a tooth before activation of an exploratory or working

Question 64

What is the correct blade angulation for insertion and scaling and root planing?

Answer 64

Zero degree is the correct angulation for blade insertion, 45-90 degrees is the proper angulation for scaling and root planing.

Question 65

Susceptibility for fluorosis occurs in what age group?

Answer 65

Mainly affects children under 8 years (except for third molars). Enamel development concludes around 8 years, ceasing fluorosis risk except for third molars.

Question 66

Sonic brush heads are capable of sweeping at a frequency of …brush strokes per minute. This movement allows a thorough brushing of tooth surfaces both above and below the gingival margin. Manual toothbrushes rely heavily on user technique.

Answer 66

31,000

Question 67

PDL orientation of principal fibres 5x

vs
Gingival tissue CT fibres 5x

Answer 67

Principal fibres Collagen in PDL
1.ALVEOLAR CREST,
2.HORIZONTAL,
3.OBLIQUE,
4.APICAL,
5.INTERORADICULAR (Multiple-Rooted Teeth)

VS CIRCULAR, transeptal, dentogingival, alveologingival, dento-PERIosteal [Gingival tissue CT fibres]

Question 68

Dm and periodontitis relationship :-5x

Answer 68

1 Blood Vessels: microvascular and macrovascular changes->Thickened basement membrane and impaired blood flow reduce leukocyte migration, nutrient delivery, oxygen perfusion, and waste elimination.
2 Host Response: impaired immune system-Neutrophil dysfunction, poor chemotaxis-migrate to site of infection affected, and poor phagocytosis.
3 AGEs: Decreased collagen and bone matrix production, increased degradation, impaired fibroblast/keratinocyte function-> abnormal cross-linking of collagen fibers, reducing the flexibility and functionality of matrix-> poor wound healing.
4 Macrophage Activation: Increased cytokine secretion, prolonged to inflammation.
5 Neuropathy: Reduced sensation peripheral areas, delayed recognition of injuries, worsened infections at time of tx.

Question 69

Direct pathogenecity of biofilm in periodontal disease.

Answer 69

Pathogens produce Virulence Factors[toxins] that lead to:
1 colonization+ multiply at subgingival sites
2 evasion host defencs- eg Aa have Leukotoxin low [ ] / Capsule PG resistance to phagocytosis by PMN;
3 invasion of host tissues- with fimbriae - Aa+Pg,
4 tissue damage- high concentration of [Aa]leukotoxin-cell death
eg LPS-endotoxin- [TD, TF, PG-red], AA- increase cytokine and active osteoclast->bone breakdown

Question 70

indirect pathogenecity of biofilm in periodontal disease.

Answer 70

Subgingival plaque induce host Inflammatory Response,
contributing to tissue damage.

Key Processes:
1 Prostaglandins: Stimulate bone resorption.
2 Cytokine Induction: TNF-α, IL-1 from immune cells activate fibroblasts, leading to collagenase production and subsequent tissue damage.
3 Enzymatic Degradation: Elastase and cathepsin B from immune cells and fibroblasts degrade proteoglycans.
4. HSP - not able to differentiate self from bacterial -molecular mimicry - impaired healing- [TF, PG-red], Aa, CR,PI, FN-Orange

Question 71

Biofilm why resistant to antimicrobial

Answer 71

1. Slow /ineffective penetration of antimicrobial dt ECM -physical barrier
   2iii. Resistant phenotype - presence of neutralizing enzymes, efflux pumps, transfer of resistance genes [via quorum sensing]
2. Slow bacterial replication < effective to antimicrobials.

Question 72

rPlaque’s Role in periodontal Disease:

risk factors and determinants of Disease Severity:

Answer 72

Microbial plaque initiates periodontal disease.

Environmental-smoking/dm, genetic, and host defenses significantly influence disease severity.

Question 73

what is perio maintanence

Answer 73

continuous and essential phase of periodontal therapy that begins after the initiaI non surgical SRP/active treatment phase. // supportive periodontal care programme. 3/4/6/12month

Question 74

What rationale and objective of perio maintanence?
Rationale is to maintain …
The objective include prevent…by…
2 Monitoring …
3 Providing…

Answer 74

Rationale is to maintain periodontal stability.
1 The objective include prevent recurrance in all treated periodontitis patients by reinforcing OHI, reevaluation on the gingival and periodontal status and appriopriate tx.
2 Monitoring pt’s compliance with the recommended oral hygiene regimens and healthy lifestyles. Also, reinforcing the patient’s plaque control efforts.
3 Providing professional care, including subgingival instrumentation and plaque removal, at regular intervals according to the patient’s needs. In any of these recall visits, if recurrent/worsening of disease is detected,a proper diagnosis and treatment planning should be reinstituted.

Question 75

Factors affect compliance with perio maintanence 8x

Answer 75

include the patient’s understanding of the disease and the importance of maintenance [alzhiemer’s disease] , their motivation, manual dexterity, and ability to perform effective oral hygiene. Other factors include the frequency and quality of professional maintenance care, the patient’s socioeconomic status, and systemic health conditions that may affect wound healing, such as diabetes.

Question 76

ddx of periodontitis 9x

Answer 76

Gingivitis
Vertical root fracture
Cervical decay
Cemental tears
External root resorption lesions
Trauma‐induced local recession
Endo‐periodontal lesions
Periodontal abscess
Necrotizing periodontal diseases

Question 77

How is a stable periodontitis patient defined after the completion of periodontal treatment?
important to know!!
Following completion of active periodontal therapy, successfully treated periodontitis patients may fall in one of two diagnostic categories:

These subjects remain high risk for … and..

Answer 77

1 periodontitis patients with a reduced but healthy periodontium=(BOP) in <10% of the sites, shallow probing depths of 4 mm or less with NO BOP

2 [if >10% BOP of pockets <4mm or less] stable periodontitis patients with gingival inflammation

These subjects remain high risk for periodontitis recurrence/progression and require regular recall/ supportive periodontal care (SPC), consisting on a combination of preventive and therapeutic interventions including: appraisal and
on monitoring of systemic [dm/osteop.] and periodontal health, reinforcement of OHI, patient motivation towards continuous risk factor control, professional mechanical plaque removal (PMPR) and localized subgingival instrumentation at residual pockets+ F- therapy.