Periodontics Flashcards
- Which one of the following bacterial species is not associated with adult periodontitis?
a. Fusobacterium nucleatum
b. Bacteroides forsythus
c. Porphyromonas gingivalis
d. Shigella sonnei
e. Prevotella intermedia
D. Shigella sonnei
All of the bacteria in the list are responsible for adult periodontitis except S. sonnei which is responsible for acute diarrhoea.
- When looking at the notes of a patient, you see annotation for a BPE. What does BPE 3 mean?
a. Gingival bleeding, no overhangs or calculus, pockets >3.5mm
b. Pockets within colour-coded area 4.6-6.5mm
c. Colour-coded area disappears, pockets >5.5mm
d. Pockets within colour-coded area, 3.5-5.5mm
e. Colour-coded area disappears, pockets >5.5mm
D. Pockets within colour-coded area, 3.5-5.5mm
- Which one of the following statements regarding acute necrotising ulcerative gingivitis (ANUG) is true?
a. It is characterised by Gram-positive anaerobic bacteria.
b. It is characterised by chronic onset
c. It affects non-smokers more than smokers
d. It is caused by acid fast bacilli
e. It is characterised by interproximal necrosis
E. It is characterised by interproximal necrosis
ANUG is caused by gram-negative aerobic bacteria, usually in the mandible, has a very distinctive smell (fetor oris) and is more common in smokers and those with poor oral hygiene.
- Correct treatment of a patient with ANUG is:
a. 20% chlorhexidine mouthwashes twice daily
b. Amoxicillin 500mg three times daily for 5 days and 20% chlorhexidine mouthwashes twice daily
c. Erythromycin 250mg four times daily for 5 days and 2-% chlorhexidine mouthwashes twice daily
d. Scaling and oral hygiene instruction
e. Metronidazole 400mg three time daily for 5 days and hydrogen peroxide mouthwash twice daily.
E. Metronidazole 400mg three time daily for 5 days and hydrogen peroxide mouthwash twice daily.
ANUG is a very painful condition. The most efficacious mouthwash is hydrogen peroxide, and the bacterial component is treated with metronidazole. Amoxicillin and erythromycin would be ineffective in treatment of this condition.
- Which one of the following statements about tooth mobility is incorrect?
a. Movement of a crown of the tooth in the horizontal plane of less than 0.2mm is considered normal.
b. Grade 1 = movement of the crown of a tooth in the horizontal plane is 0.2-1mm
c. Grade 2 = movement of the crown of a tooth in the horizontal plane is greater than 1mm
d. Grade 3 = movement of the crown of a tooth in the horizontal plane is greater than 3mm
e. Grade 3 = movement of the crown of a tooth in the vertical plane
D. Grade 3 = movement of the crown of a tooth in the horizontal plane is greater than 3mm
- Which one of the following clinical conditions predisposes patients with impaired/defective neutrophil function to severe periodontitis?
a. Patterson-Brown-Kelly syndrome
b. Chediak-Higashi disease
c. Hypothyroidism
d. Hyperthyroidism
e. Gardner’s syndrome
B. Chediak-Higashi disease
None of the others are relevant to periodontal disease.
- Which one of the following is associated with abnormal collagen formation leading to periodontal disease?
a. Type 1 diabetes mellitus
b. Papillon-Lefvre syndrome
c. Hypophosphatasia
d. Type 2 diabetes mellitus
e. Hyperphosphatasia
C. Hypophosphatasia
Hypophosphatasia, as well as Ehlers-Danlos syndrome are associated with abnormal collagen formation and periodontal disease.
Papillon-Lefevre syndrome is associated with abnormal neutrophil function, which leads to periodontal disease.
- What probe has markings at 1, 2, 3, 5, 7, 8, 9, 10?
a. Briault’s
b. Community Periodontal Index of Treatment Needs (CPITN)
c. World Health Organisation (WHO)
d. Williams’
e. Florida
D. Williams
- In juvenile periodontitis, which bacteria is the recognised aetiological agent?
a. Porphyromonas gingivalis
b. Prevotella intermedia
c. Actinobacillus Actinomycetemcomitans
d. Borrelia burgdorferi
e. Fusobacterium intermedium
C. Actinobacillus actinomycetemcomitans
A. actinomycetemcomitans is a capnophilic, non-motile rod that possess a potent leukotoxin, which causes lysis of polymorphonuclear leucocytes.
- Which teeth are most commonly affected in juvenile periodontitis?
a. Incisors and first permanent molars
b. Incisors and canines
c. Canines and premolars
d. Premolars and first permanent molars
e. Canines and first permanent molars
Incisors and first permanent molars.
As these are the first teeth to erupt, they seem to be the teeth which are affected most by juvenile periodontitis
- For which teeth/surfaces would you use a Gracey no 1 or 2 curette when scaling?
a. All teeth
b. All surfaces of anterior teeth
c. Mesial surfaces of anterior teeth
d. All surfaces of posterior teeth
e. Mesial surfaces of posterior teeth
B. All surfaces of anterior teeth
- What pressure should be used when probing for BPE?
a. 5g
b. 25g
c. 75g
d. 150g
e. 500g
B. 25g
- Which one of the following statements regarding dental calculus is false?
a. It is a mineralised dental plaque
b. It is composed of hydroxyapatite
c. It is the primary cause of periodontitis
d. The outer surface remains covered by a layer of plaque
e. It forms when plaque is mineralised from calcium and phosphate ions
C. It is the primary cause of periodontitis
The primary cause of periodontitis is plaque, not calculus.
- Match the names of the instruments with the letters underneath.
A. Chisel, sickle, hoe, curette
- What is the active component of Elyzol, a topical antimicrobial placed in deep periodontal pockets?
a. Tetracycline
b. Amoxicillin
c. Clindamycin
d. Erythromycin
e. Metronidazole
E. Metronidazole
Elyzol is 25% metronidazole in a gel form, and is placed in the pocket. It has been shown to be efficacious in the treatment of periodontal disease.
- After a course of periodontal treatment, how long should you wait to perform a six-point pocket examination to see if there has been any improvement?
a. Immediately after treatment has finished
b. 1 week
c. 1 month
d. 3 months
e. 6 months
D. 3 months
It takes at least 2 months for healing in the periodontal pocket to occur. Therefore 3 months would be the ideal length of time to wait before performing a size-point pocket chart.
- Which one of the following drugs does not cause gingival hyperplasia?
a. Ciclosporin
b. Phenytoin
c. Phenobarbital
d. Nifedipine
e. Diphenylhydantoin (Dilantin)
C. Phenobarbital
Ciclosporin is an immunosuppressant, phenytoin and diphenylhydantoin are anti-epileptics and nifedipine is a calcium channel blocker. They all cause gingival hyperplasia.
- What procedure is shown in the diagram?
a. Modified Widman’s flap
b. Simple gingivectomy
c. Apically repositioned flap
d. Coronally repositioned flap
e. Widman’s flap
C. Apically repositioned flap
- Which one of the following is not used in guided tissue regeneration?
a. Gore-Tex
b. Autogenous gingival graft
c. Cellulose barrier membrane
d. Collagen barrier membrane
e. Silica
E. Silica
Silicone not silica is used in guided tissue regeneration. Gore-Tex is a non-resorbable material, and a second procedure is required to remove it.
- If a pt has a BPE2, what is the correct course of treatment?
a. Nothing
b. Oral hygiene instructions (OHI)
c. OHI and scaling
d. OHI, scaling and correction of any iatrogenic factors
e. OHI, scaling and root planing.
D. OHI, scaling and correction of any iatrogenic factors.
- A lesion is described as a small apostrophe-shaped or slit-like fissure of the gingivae extending from the gingival margin to a depth of up to 5 to 6cm. This lesion is normally round between the mandibular central incisors. What is this lesion?
a. McCall’s festoon
b. Stillman’s cleft
c. O’Leary’s cleft
d. William’s festoon
e. Barnes’ festoon
B. Stillman’s cleft
- Interleukins (ILs) are important in the host cell response. Which one of the following interleukins is not derived from T cells?
a. IL-1
b. IL-2
c. IL-3
d. IL-4
e. IL-5
A. IL-1
There are two types of IL-1: IL-1alpha and IL-1beta. They are not derived from T cells but from many other cells including macrophages, dendritic cells, some B cells and fibroblasts.
- As humoral immunity plays a huge part in periodontal disease, which immunoglobulin is found in the greatest quantity in human serum?
a. IgA
b. IgD
c. IgE
d. IgG
e. IgM
D. IgG
The most prevalent immunoglobulin is IgG followed by IgA.
- Which teeth are assessed in Ramfjord’s index (periodontal disease index)?
B. Ramfjord in 1959 developed an index using data representative of the dentition as a whole. Only having to assess six teeth makes it faster to perform than some other periodontal examinations.
- When looking at the notes of a patient, you notice that one of the sextants in the BPE has an X. What does this mean?
a. A furcation lesion is present
b. The dentist was unable to decide what score to give the sextant
c. Only two teeth were present in the sextant
d. Only one tooth or no teeth were present in the sextant
e. Teeth in the sextant are marked for extraction
D. Only one tooth or no teeth were present in the sextant
Furcation lesion is indicated by *
- Which one of the following is not a sign of chronic gingivitis?
a. Marginal redness
b. Swelling
c. Bleeding on probing
d. Stippling
e. Increased probing depth
D. Stippling
Gingivitis there is a loss of stippling.
- What is the name for the lesion shown in the figure below?
a. Polyp
b. Epulis
c. Abscess
d. Normal anatomy
e. Granuloma
B. Epulis
- Which one of the following is not a potential pathway for initiation or spread of periodontal inflammation?
a. Dentinal tubules
b. Lateral and accessory root canals
c. Cracks and fracture lines
d. Iatrogenic perforations
e. Poor irrigation during the drilling of restorations E. Poor irrigation during the drilling of restorations
All the others are putative pathways for periodontal inflammation. Poor irrigation during restorative procedures may lead to pulpal irritation and death, but not periodontal inflammation.
- Which one of the following bacteria involved in periodontal disease is a spirochaete?
a. Porphyromonas gingivalis
b. Fusobacterium nucleatum
c. Actinobacillus actinomycetemcomitans
d. Prevotella intermedia
e. Treponema denticola
E. Treponema denticola
P. gingivalis, F. nucleatum and P. intermedia are obligate anaerobes. A. actinomycetemcomitans is a microaerophilic bacillus. The give away is that the most famous spirochaete, which causes syphilis, is Treponema pallium.
- Which one of the following is not a local factor in periodontal disease?
a. Poor crown margins
b. Badly designed partial dentures
c. Smoking
d. Diabetes
e. Mouth breathing
D. Diabetes
All of the above except pregnancy are local factors, whereas diabetes is a systemic or host factor.
- Which complement component is found in high levels in gingival crevicular fluid and causes chemotaxis and vasodilation.
a. C2
b. C4a
c. C4b
d. C5a
e. C5b
D. C5a
Cell lysis is only one function (and probably not the most important one) of the complement system. The complement system acts in several ways to mobilise defence mechanisms:
o Opsonization by C3b targets foreign particles of phagocytosis
o Chemotaxis by C5a attracts phagocytic cells to the site of damage. This is aided by the increased permeability of the capillary beds mediated by C3a and C5a. The early complement components are also important for solubilising antigen-antibody complexes, assisting in their catabolism and elimination from the body. Failure of this function can lead to immune complex disorders.
o Lysis of antibody-coated cells. In some cases, this causes more harm than good; complement-mediated lysis can cause serious disorders such as:
Rh disease
Immune haemolytic anaemia
Immune thrombocytopenic purpura
o Promoting antibody formation. Breakdown of C3b generates a fragment (C3d) that binds to antigens enhancing their update by dendritic cells and B cells.
- Which types of microorganisms are found in supragingival plaque?
D. Gram-positive, aerobic bacteria, fermentative bacteria.
- Which types of micro-organisms are found in subgingival plaque?
E. Proteolytic bacteria, Gram-negative, anaerobic bacteria.
- Which one of the following is not a primary polymorphonuclear leucocyte abnormality that leads to periodontal disease?
a. Chediak-Higashi syndrome
b. Papillon-Lefevre syndrome
c. Kostmann syndrome
d. Haim-Munk syndrome
e. Kallmann syndrome
E. Kallmann syndrome
Chediak-Higashi syndrome is a rare autosomal recessive disorder that affects multiple systems of the body, and arises from a mutation in the lysosomal trafficking regular gene, LYST.
Kostmann syndrome also known as severe congenital neutropenia (SCN), is a rare inherited form of severe chronic neutropenia, usually detected soon after birth.
Kallmann syndrome is an example of hypogonadism (decreased functioning of the sex hormone-producing glands) caused by a deficiency of gonadotropin-releasing hormone (GnRH), which is created by the hypothalamus. Kallmann syndrome is also known as hypothalamic hypogonadism, familial hypogonadism with anosmia, or hypogonadotropic hypogonadism, reflecting its disease mechanism.
- Which one of the following is used to describe a condition in which a human, who is not himself sick, harbours an infective organism which may cause disease in those to whom it is transmitted?
a. Carrier state
b. Homozygous
c. Karyotype
d. Polyzygous
e. Heterozygous
A. Carrier state
A carrier is a person who is phenotypically normal but may have an underlying genetic disorder. They may be heterozygotes, they may be homozygotes, but you could not say with any certainty that they are of that they are of that genetic state.
- Which interleukin (IL) is most responsible for neutrophil chemotaxis?
a. IL-1
b. IL-4
c. IL-8
d. IL-15
e. IL-20
C. IL-8
IL-8 is most responsible for neutrophil chemotaxis.
