Plaque biofilm should be removed by the client through self care efforts at a minimum of every
24 hours
The name of the structure that surrounds the tooth and creates a cuff or collar of epithelium extending approximately 1.5mm coronally is
Free marginal gingival
A periodontal probe is inserted into the gingival crevice and measures 6 mm from the tip of the probe to the cementoenamel junction. Which of the following statements best describes this finding?
There is 6 mm of clinical attachment loss (CAL)
In mature bacterial plaque biofilm (aged 3 weeks or more), the predominant bacteria are
Anaerobic
Clinical probing depths increase in Stage III gingivitis because:
The margin of the gingival moves coronally as a result of swelling in the gingival
The probe penetrates more deeply into the junctional epithelium
The tissues become engorged with inflammatory cells
Collagenase is an enzyme produced by
Periodontal pathogens and the host’s inflammatory cells that causes the breakdown of collagen fibers.
Which of the following cells arrive first on the scene in acute inflammation?
PMNs (neutrophils)
The bacteria associated with localized aggressive periodontitis (formerly called juvenile periodontitis) is
Aggregatibacter actinomycetemcomitans (Aa)
Corncob formation of bacterial congregations is best described as
The coating of filamentous bacteria on the external surface of the plaque by cocci
Mast cells release histamine which intensifies the inflammatory response.
True
When considering the prognosis of an infrabony pocket, which type of defect has the best prognosis?
Three-wall – it has the most attachment still
Radiographic changes evident in gingivitis include
No answers are correct
Understanding that plaque is a biofilm is significant because
It highlights the importance of mechanical removal
The periodontal ligament does not contain
cartilage
Which of the following immunoglobulins is the largest and is found in the primary immune response?
IgM (Think M for Monster Big)
Which of the following alterations is associated with the progression from a healthy gingival sulcus to gingivitis?
Predominance of spirochetes in supragingival plaque biofilm
A furcation involvement that allows an explorer to penetrate under the tissue all the way through the involved roots is classified as
Type III
A periodontal pocket, as distinguished from a soft tissue pocket, is characterized by
Apical movement of the junctional epithelium
In early periodontal disease, the interdental alveolar crestal bone can appear radiographically as or with
The same radiopacity as that of the lamina dura.
Irregular and diffuse with decreased radiographic density
Loss of bone height
Biological width is defined as
The distance from the most coronal part of the junctional epithelium to the most apical extent of the gingival connective tissue fibers.
What is the normal width of attached gingiva?
No answer is correct
Plaque biofilm microbiota produces enzymes that protect the tissues from destruction.
False
The scientific rationale for a DH clinician to teach clients good plaque control is?
To keep plaque biofilm in an immature state.
Microorganisms colonize the pellicle randomly. The pellicle is composted of glycoproteins derived from saliva.
The first is false, the second is true.
Loss of attachment is damage to the structures that support the teeth. This occurs with periodontitis and is characterized by:
Destruction of the fibers of the gingivaLoss of alveolar bone support around the tooth
Relocation of junctional epithelium to the tooth root
Destruction of the periodontal ligament fibers
Endotoxin is:
A component of the cell wall of Gram-negative organisms
Tooth mobility greater than 1mm in both facial and lingual directions and easy depression is?
Type III
Clinical attachment loss (CAL) defines the severity of periodontal disease. Pocket depths of 5-6mm define advanced periodontal disease.
The first statement is true, the second is false. (?)
During a periodontal exam, a 6mm pocket is detected on the direct facial of tooth #29. The gingival margin is located at the CEJ, what type of pocket is this?
Periodontal pocket
Gingivitis and periodontitis share all of the following characteristics EXCEPT one. Which one is the exception?
Alveolar bone loss
All of the following are possible factors in the development of mucogingival defects EXCEPT one. Which is the exception?
Class II restorations
Which of the following indicates that gingivitis has progressed to periodontitis?
Loss of attachment
The effector molecule that is the most potent destroyer of bone is?
Interleukin 1
Which of the following is characterized by inflammation that extends from the gingiva into the supporting apparatus with loss of attachment?
Periodontitis.
A tough connective tissue membrane that covers the outside surface of bone is the?
Periosteum
Periodontal ligament does not contain?
Cartilage
A product of plaque bacteria that may attract large numbers of leukocytes to the gingival area is?
Chemotactic factor
Which of the following statements describes the correct adaptation of a periodontal probe in an interproximal area?
The probe should touch the contact area and the tip should angle slightly beneath and beyond the contact area.
The primary immunoglobulin found in saliva is?
Ig A
All of the following conditions contribute to the retention of plaque biofilm except one? Which one is the exception?
Cigarette Smoking.
Which of the following alterations is associated with the progression from a healthy gingival sulcus to gingivitis?
Predominance of spirochetes in supragingival plaque biofilm.
Plaque induced gingivitis is reversible. Gingival healing occurs when bacterial plaque biofilm is removed regularly.
Both statements are TRUE
What is the principle etiologic agent of periodontitis?
Dental plaque biofilm.
In early periodontal disease, the interdental alveolar crestal bone can appear radiographically as or with?
a. The same radiopacity as that of the lamina dura
b. Irregular and diffused with a decreased radiographic density
c. Erosion of the alveolar crest
d. Loss of bone height
B, C, D are correct answers
The dentogingival unit collectively refers to?
The epithelial attachment and gingival connective tissue attachment to the cementum.
Recession is of significance to the patient for all of the following reasons except one. Which is it?
Exposed root surfaces can become sensitive
Exposed root surfaces can be harder for the patient to clean
Exposed root surfaces can lead to periodontitis
Exposed root surfaces can decay
When evaluating gingival characteristics, which of the following terms describes a healthy consistency or gingival tone?
firm
Gingiva normally occupies which of the following embrasures?
Cervical
Gingiva normally occupies the cervical embrasure, unless there are open contacts or recession and blunting of the papillary gingiva.
The facial embrasures function as ‘spillways’ for food, to assist in the distribution of forces during mastication. The lingual embrasures function as 'spillways'. The occlusal-incisal embrasures facilitate the masticating and incising functions of teeth.
The attached gingiva is demarcated from the alveolar mucosa by the
mucogingival junction
The tissue at the junction between the labial or buccal mucosa and the alveolar mucosa is the
mucobuccal fold
The epithelium of the oral mucous membrane may be
keratinized
parakeratinized
nonkeratinized
all of the above
The epithelium of the oral mucous membrane may be keratinized, parakeratinized, or nonkeratinized, depending on its location in the oral cavity. Keratinized tissue is composed of cells that form scales of keratin on the superficial layers and the cells lose their nuclei. A stratum granulosum is present. The superficial layers of parakeratinized tissue have cells that retain pyknotic nuclei and show some signs of being keratinized. The stratum granulosum is usually absent. Nonkeratinized cells are nucleated and show no signs of keratinization.
Which of the following types of oral mucosa is NOT keratinized under normal conditions?
buccal mucosa
Normal keratinized areas of the oral mucosa include the vermilion border of the lips, the hard palate, and the gingiva. The buccal mucosa, floor of the mouth, inferior surface of the tongue, and soft palate are nonkeratinized oral mucosa under normal conditions. All oral mucosa, whether keratinized, parakeratinized or nonkeratinized, is of the stratified squamous type of epithelium
The two mineralized connective tissues of the periodontium are cementum and alveolar bone. The two fibrous connective tissues are the periodontal ligament and the lamina propria of the gingiva.
Both statements are true. The two mineralized connective tissues of the periodontium are cementum and alveolar bone; the two fibrous connective tissues are the periodontal ligament and the lamina propria of the gingiva. The periodontium is a connective tissue organ, covered by epithelium that attaches teeth to the jaw bones and functions to support teeth.
Keratinized oral epithelium has four layers. Which of the following is NOT a layer of keratinized oral epithelium?
laminal layer
Keratinized oral epithelium has four layers; the basal layer, the spinous layer, the granular layer, and the cornified layer. These layers are named due to their microscopic structure. The basal layer is the deepest layer and the cornified layer is the outermost layer.
The name of the structure that surrounds the tooth and creates a cuff or collar of epithelium extending approximately 1.5 mm coronally is
free marginal gingiva
At the cementoenamel junction, which of the following occurs?
D. any of the above
The slight depression in the gingiva appearing between the buccal and lingual interdental papillae is called the
col
The histologic sulcus depth is approximately
1 mm to 3 mm
The periodontal ligament consists predominantly of
regularly arranged bundles of collagenous fibers
The periodontal ligament consists predominantly of regularly arranged bundles of collagen fibers. These fibers are described as white, collagenous, wavy bundles extending from bone to cementum.
A window in the normal bone structure covering the surface of the root is called a dehiscence. The dehiscence is a significant structure in periodontal disease.
The first statement is false, the second is true.
Which of the following principal fiber groups has (have) NO attachment into the bone of the alveolar process?
The free gingival and transseptal fibers do not attach to the bone of the alveolar process. The free gingival fibers are attached to the lamina propria of the gingiva, while the transseptal fibers attach the cementum of one tooth to another.
The periodontal ligament does NOT contain
cartilage
The periodontal ligament does not contain cartilage. It is made up of collagenous fibers, cells, penetrating blood vessels, lymphatics and nerves
A tough connective tissue membrane that covers the outside surface of bone is the
periosteum
The outside surface of bone is covered by a tough connective tissue membrane, the periosteum. The endosteum covers the inner surface of compact bone. The perimysium is a covering of muscle fibers. The periochondrium is a connective tissue membrane that covers cartilage.
Biologic width is defined as
the distance from the most coronal part of the junctional epithelium to the most apical extent of the gingival connective tissue fibers.
What is periodontal disease?
1. Periodontal disease is any degenerative process which alters the supporting structures of the teeth.
2. Periodontal disease can affect the attachment apparatus, the gingiva and/or the alveolar bone. 4. Periodontal disease is not a single pathological entity; it includes many different disease classifications.
answer: 1, 3 and 4
What is cementum and what is its main function?
Cementum is a connective tissue structure that attaches the PDL fibers to the surface of the tooth.
Why is the periodontal ligament important?
It attaches the tooth to the bone. it produces cells which participate in formation of cementum.
It produces cells which participate in formation of bone.
It supplies nutrients to other periodontal structures.
All of the above.
What is the dentogingival junction (DGJ)?
The connection between the gingiva and the tooth is called the dentogingival junction. This junction has three epithelial types: gingival, sulcular, and junctional epithelium.
One part of the DGJ is the epithelial attachment which adheres to the tooth at the base of the sulcus
One part of the DGJ is the junctional epithelium which is continuous with the gingival and sulcular epithelium.
The DGJ is made up of two parts; the epithelial portion and some fibers of the lamina propria.
What is the normal width of the attached gingiva?
It is generally 3.8 to 4.5 mm in width throughout the mouth.
Width varies in different areas but is usually wider on the mandible than it is on the maxilla.
Attached gingiva is usually wider on the mandible than it is on the maxilla.
All of the above
None of the above
A pseudopocket (or gingival pocket) is formed by the
coronal migration of the gingival margin.
The enlargement of the gingival margin coronally (as an inflammatory reaction) is the process that creates a deeper gingival sulcus Coronal migration of the epithelial attachment would constitute a longer epithelial attachment, as can be seen in periodontal regeneration following therapy. Apical migration of the gingival margin constitutes gingival recession Apical migration of the epithelial and connective tissue attachment is the formation of a true pocket. A pseudopocket does not involve any changes in the bone; the alveolar crest is located at its normal level, whereas it is the gingiva that enlarges to create the pocket depth.
Which of the following nonsurgical periodontal (initial) therapies is appropriate for a client with early chronic periodontitis?
periodontal scaling and root planing/periodontal debridement.
Scaling, periodontal debridement and root scaling are indicated for initial therapy as essential procedures in nonsurgical treatment of early chronic periodontitis Oral prophylaxis is for healthy periodontium, or conversion of gingivitis to oral health. Gingival curettage is not justified for treatment of chronic periodontitis. Gingivectomy is indicated for gingival overgrowth, not bone loss. Periodontal maintenance therapy follows nonsurgical or surgical active therapy to monitor periodontal status and to prevent recurrence of active disease and disease progression.
A pseudopocket (or soft tissue pocket) is formed by the
coronal migration of the gingival margin due to soft tissue enlargement.
The radiographic findings of soft tissue pockets will demonstrate a (an)
normal bone pattern
The mucogingival junction is located between the
attached gingiva and alveolar mucosa
Which of the following is one of the first clinical features of gingival or periodontal disease?
change in gingival tissue color or contour
Which tissue(s) has (have) little or no keratinization?
sulcular epithelium and alveolar mucosa
During a periodontal examination a 6 mm pocket is detected on the direct facial surface of tooth #19. The gingival margin is located at the cementoenamel junction. What type of pocket is this?
periodontal pocket
According to textbook information, a mucogingival problem exists when
the base of the pocket extends to or apically to the mucogingival junction.
A furcation involvement that allows an explorer to penetrate under the tissue all the way through the involved roots is classified as
Type III
Tooth mobility greater than 1 mm in both facial and lingual directions and easy depression is
Class III
Bleeding upon periodontal probing indicates
ulceration of the crevicular epithelium
The crevicular epithelium of a periodontal pocket consistently differs from that seen in normal gingiva in that the epithelial lining of a pocket is
ulcerated
The primary cause of the increased redness that accompanies gingivitis is
capillary proliferation
Which of the following is characterized by inflammation that extends from the gingiva into the supporting apparatus with loss of attachment?
periodontitis
In determining the severity of periodontitis affecting a tooth, the most important criteria is
loss of attachment
In gingivitis, poor tissue tone is due to
destruction of collagen fibers
Resilience and firmness of the gingiva are due primarily to
collagenous tissue
The redness of early gingivitis is most likely caused by
proliferation and dilation of blood vessels
Which of the following are indications that gingivitis has progressed to periodontitis?
loss of alveolar bone and periodontal pocket formation
A periodontal pocket, as distinguished from a soft tissue pocket, is characterized by
apical movement of the junctional epithelium
A 25-year old man, who has a history of generalized gingivitis, is seen on a six-month maintenance visit. During his appointment, which of the following clinical signs will likely confirm that this patient’s disease has progressed to periodontitis?
clinical attachment loss
Which of the following best represents why the probe must be walked along the entire gingival sulcus?
depth of epithelial attachment varies
A patient reports to a dental hygienist that a tooth restored three weeks ago seems high and is sensitive to mastication. Gingival assessment reveals periodontal probing depths of less than 3 mm with no bleeding upon probing. This condition is most likely to cause which of the following?
Fremitis
Which of the following radiographic findings is associated with early periodontitis?
loss of crestal bone
Fibrotic tissue may shrink as a result of scaling and root planing, but the amount of shrinkage most often will be considerably less than edematous tissue.
True
The attachment apparatus is made up of?
The periodontal ligaments, cementum, and alveolar bone.
The window of bone in healthy bone structure covering the surface of the root is called dehiscence. The dehiscence is a significant structure in periodontal disease.
the first statement is false (a window in bone is a fenestration) and the second statement is true.
Cells attracted to areas of the body by stimuli such as microbial influence or trauma are referred to as?
Chemotactic Cells
Inflammatory cells perform all of the following functions EXCEPT one. Which one is it?
Lyse cells
Phagocytize bacteria
Removed damaged tissue
Reduce osteoclastic activity
Reduce osteoclastic activity
B lymphocytes come from the liver, spleen, and bone marrow, B lymphocytes are important in the antigen - antibody response
Both statements are true.
The term probing depth is more accurate than the term sulcus depth for the clinician because the latter term is for histologic description only.
the statement is correct but the reason is NOT correct
The periodontal ligament fiber group that runs from the cementum to the crestal bone is termed?
Alveolar crest ligament
The presence of gingival fluid will increase?
with inflammation
Describe the color,size, shape, texture, and consistence of the normal gingiva?
Normal gingiva is pink or coral color, smooth and firm with a knife edge and fills the interproximal spaces in an V or inverted V formation.
List the protective effects of Saliva.
Lubricates, cleanses, buffers, provides Calcium and Potassium for remineralization, and antimicrobial action.
Plaque biofilm microbiota produces enzymes. Some of the enzymes produced by biofilm organisms enhance tissue destruction by activating the host immune response.
Both statements are true.
The scientific rationale for the dental hygienist to teach patients good plaque biofilm control is to?
Keep plaque in an immature state.
Plaque biofilm should be removed by the patient at a minimum of every?
24 hours
Understanding that plaque is a biofilm is significant because?
It highlights the importance of mechanical removal.
Gingivitis, which is considered to be a nonspecific infection, is a disease process that is unlikely to be progressive. Chronic periodontitis is likely caused by a limited number of organisms and is a disease process the is likely to progress.
Both statements are true
The morphotype of mature biofilm microbiota are different than those generally found in gram-positive biofilms because the environment becomes conducive to gram-negative and motile bacteria.
both the statement and the reason are correct and related.
The most commonly found periodontal pathogen in chronic periodontitis is?
red complex of bacteria
Necrotizing ulcerative gingivitis is referred to as necrotizing ulcerative periodontitis when which event occurs?
The infection invades the deeper tissues and bone loss occurs.
Describe the effects of lipopolysaccharides (endotoxins)?
induces inflammatory reactions and simulates osteoclast-mediated bone resorption, toxins that affect fibroblasts and inhibit the synthesis of collagen and noncollagenous substances.
Describe the formation of pellicle in the formation of dental plaque biofilm?
Most bacteria are unable to attach to the enamel surface however there are specific bacteria that are able to bind to the pellicle. S. mutans being one of the most influential in the beginning stages of plaque formation.
Which of the following is the clinical descriptor of swelling
Edema
Which of the following may contribute to the development of gingivitis?
Plaque control is critical in the resolution of gingivitis.
Gingivitis is classified based on?
Histologic Events
Dental plaque biofilm-induced gingivitis may lead to periodontal disease. Like gingivitis, periodontal disease is curable.
the first statement is true and the second statement is false.
What is the etiology of pregnancy gingivitis?
the influence of hormones on oral tissues.
What is the principle etiological agent of periodontitis?
Dental plaque biofilm
Gingivitis and periodontitis share all of the following cherecteristics except?
Pocket formation
All of the following conditions contribute to the retention of the dental plaque biofilm except?
Cigarette smoking
Chronic periodontitis is?
Usually signicant before age 35
Locolized aggressive periodontitis in its juvenile form is associated with all the following cherecteristics except?
Presence of P. gingivalis
Which bacteria is associated with localized juvenile periodontitis?
acitomycetemcomitans
Refactory periodontitis never responds adequetly to treatment and disese essentially continues unabated because of the failure of nonsurgical therapy?
First statement is true the second is false
Cigarette smokers are more likely to have toothloss and impaired healing than nonsmokers. Its is important for patients to refrain from smoking during periodontontal therapy.
Both statements are true
Why are tetracyclines useful in the treatment os some periodontal infections?
The drug is released in high concentrations in the gingival fluid
What are the roles of the dental hygienist in the treatment of periodontal disease?
Diseases identification, patient education, therapy and maintanence.
The goal of periodontal instrumental is to return the periodontium to a state of health. Periodontal health is achieved through surgical therapy techniques.
The first statement is true the second is false
The conceptof periodontal pathogens associated with different types of periodontal disease is called?
Specific plaque hypothosis
Complete calculus removal with hand or powered instruments is the goal for the dental hygienist. Calculus is the etiological agent in periodontal disease.
The first statement is true the second is false
Experimental evidence indicates that rough root surfaces are mechanical irritants. Rough root surfaces delay healing.
The first statement is true the second is false
Air powder polishing works by application of a mechanical abrasion slurry of:
sodium bicarbonate and water
Root smoothness achieves all of the following except:
delay tissue attachment
Attachment gain after nonsurgical therapy should be measured carefully because inflamed tissues may not provide an accurate reading.
Both the statement and and reason are correct and related.
Fibrotic tissue is always enlarged even in a healthy state:
True
Color change is the most reliable indication of active periodontal disease:
False
If the gingival tissue is enlarged, its consistency cannot be normal:
True
Fibrotic tissue can be considered clinically healthy if no bleeding occurs upon probing and the color is normal:
True
A fenestration or dehiscence can exist even when not seen clinically:
True
On clinical examination, you recorded the following data on the facial surface of the tooth #24: Probing: Distal=3mm, Facial=3mm, Mesial=3mm. Measurement from mucogingival line to gingival margin is 6 mm. What is the width of the attached gingival?
3mm
A pseudopocket (or soft tissue pocket) is formed by the:
coronal migration of the gingival margin due to soft tissue enlargement
Which of the following is not a sign of inflammation in gingival tissues?
Enlarged fibrotic tissue without bleeding or redness
CAL can best be detected by:
: radiographic detection, probing and recording the depth of the sulcular area and noting areas of recession
The radiographic findings of soft tissue pockets will demonstrate a:
normal bone pattern
Tissue consistency refers to:
thickness, resiliency and texture
On completion of a patients gingival assessment, you have noted that the gingival are normal in appearance except on the facial area of teeth #28 and #29. In this area you noted inflammation of the gingival margin. All sulcular readings are between 1 and 3mm, and the bases of the sulci are the CEJ. The most accurate description would be :
localized marginal gingivitis
The characteristics of gingivitis are:
swelling of the soft tissue and bleeding when probing
An isolated area where the root is denuded of bone when the marginal bone is intact is:
fenestration
The cervical epithelium of a periodontal pocket consistently differs from that seen in normal gingival in that the epithelial lining of a pocket is:
ulcerated
The most important reason for using the periodontal probe is that if:
determines CAL
Which of the following statements describes the correct adaptation of a periodontal probe in an interproximal area?
The probe should touch the contact area and the tip should slightly beneath and beyond the contact area
The redness of early gingivitis is most likely caused by:
proliferation and dialation of blood vessels
Cardinal signs of inflammation include:
Heat, edema, vasodilation
Changes in tissue consistency are determined by visual examination only
False
Fibrotic tissue can be considered clinically healthy if no bleeding occurs upon probing and color is normal
True
Stippling can be present on the surface of edematous tissue
False
The mandibular and maxillary buckle soft tissues are the only areas that need to be assessed for an adequate amount of attached
False
Which of the following radiographic findings is associated with early periodontitis?
Loss of crestal bone
Plasma cells produce antibodies.
True
Mast cells release histamine, which intensifies the inflammatory response.
True
Noxious products of plaque cause release of chemotactic agents from within the connective tissue which attract PMN'S to destroy the invading agents (bacteria).
True
"Random Burst" Hypothesis implies pocket bacteria are active in a linear fashion, i.e., each day.
False
Periodontal diseases are caused by bacteria and not calculus.
True
Bacteria are site specific and not patient specific, i.e., one pocket on one tooth may become active and deepen while rest of pockets remain stable.
True
Pockets can form in the absence of bacteria.
True
Most of the pathogenic bacteria are Gram- (negative), anaerobic motile rods.
True
Rapidly progressive periodontitis is associated with poor chemotaxis of PMN'S.
True
The "specific plaque hypothesis" refers to the fact that certain types of bacterial plaque cause certain types of periodontal disease.
True
All plaque is "bad" and will cause periodontal disease.
False
Certain microbes in plaque may be protective to the host by suppressing a potentially disease causing bacteria(s).
True
There is no marked difference in bacterial composition between the supragingival and subgingival microflora associated with healthy sites.
True
Most of the organisms found in plaque from sites with gingivitis can also be isolated in plaque from healthy sites.
True
The metabolic end products of bacteria are more destructive to the periodontium than the specific bacteria themselves.
True
Endotoxins are produced mainly by Gram + bacteria.
False
Smoking is a major contributing factor to periodontal disease.
True
IgG and IgM form immune complexes which can activate the complement system.
True
Ab levels correlate with periodontal disease severity.
True
Antibodies are most important in ensuring that any bacteria entering the tissues are eliminated rapidly by the action of complement, neutrophils, and macrophages.
True
IgM is a weak activator of complement and is a strong factor in opsinization of bacteria.
True
The humoral immune response is the most effective against extracellular bacteria or soluble factors.
True
IgA is found principally in the saliva and in supra and subgingival plaque.
False
Collagenase is dependent upon activation by metallic ions as zinc.
True
Immune complexes are formed when IgG binds to bacteria and then undergoes phagocytosis more easily.
True
Prostaglandin E-2 is secreted by cells (as macrophages) and is a potent destroyer of bone.
True
Cytokines are soluble proteins secreted by cells which act on nearby cells to regulate and mediate inflammatory and immunological processes.
True
Histamine is released by plasma cells and intensifies the inflammatory response.
False
With effective plaque control inflammation ceases or resolves within 7 days.
