Periodontics

Question 1

1. 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

Answer 1

 D. Shigella sonnei
 All of the bacteria in the list are responsible for adult periodontitis except S. sonnei which is responsible for acute diarrhoea.

Question 2

2. 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

Answer 2

 D. Pockets within colour-coded area, 3.5-5.5mm

Question 3

3. 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

Answer 3

 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.

Question 4

4. 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.

Answer 4

 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.

Question 5

5. 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

Answer 5

 D. Grade 3 = movement of the crown of a tooth in the horizontal plane is greater than 3mm

Question 6

6. 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

Answer 6

 B. Chediak-Higashi disease
 None of the others are relevant to periodontal disease.

Question 7

7. 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

Answer 7

 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.

Question 8

8. 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

Answer 8

 D. Williams

Question 9

9. 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

Answer 9

 C. Actinobacillus actinomycetemcomitans
 A. actinomycetemcomitans is a capnophilic, non-motile rod that possess a potent leukotoxin, which causes lysis of polymorphonuclear leucocytes.

Question 10

10. 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

Answer 10

 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

Question 11

11. 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

Answer 11

 B. All surfaces of anterior teeth

Question 12

12. What pressure should be used when probing for BPE?
    a. 5g
    b. 25g
    c. 75g
    d. 150g
    e. 500g

Answer 12

 B. 25g

Question 13

13. 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

Answer 13

 C. It is the primary cause of periodontitis
 The primary cause of periodontitis is plaque, not calculus.

Question 14

14. Match the names of the instruments with the letters underneath.

Answer 14

 A. Chisel, sickle, hoe, curette

Question 15

15. 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

Answer 15

 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.

Question 16

16. 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

Answer 16

 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.

Question 17

17. Which one of the following drugs does not cause gingival hyperplasia?
    a. Ciclosporin
    b. Phenytoin
    c. Phenobarbital
    d. Nifedipine
    e. Diphenylhydantoin (Dilantin)

Answer 17

 C. Phenobarbital
 Ciclosporin is an immunosuppressant, phenytoin and diphenylhydantoin are anti-epileptics and nifedipine is a calcium channel blocker. They all cause gingival hyperplasia.

Question 18

18. 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

Answer 18

 C. Apically repositioned flap

Question 19

19. 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

Answer 19

 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.

Question 20

20. 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.

Answer 20

 D. OHI, scaling and correction of any iatrogenic factors.

Question 21

21. 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

Answer 21

 B. Stillman’s cleft

Question 22

22. 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

Answer 22

 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.

Question 23

23. 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

Answer 23

 D. IgG
 The most prevalent immunoglobulin is IgG followed by IgA.

Question 24

24. Which teeth are assessed in Ramfjord’s index (periodontal disease index)?

Answer 24

 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.

Question 25

25. 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

Answer 25

 D. Only one tooth or no teeth were present in the sextant  Furcation lesion is indicated by *

Question 26

26. 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

Answer 26

 D. Stippling  Gingivitis there is a loss of stippling.

Question 27

27. What is the name for the lesion shown in the figure below? a. Polyp b. Epulis c. Abscess d. Normal anatomy e. Granuloma

Answer 27

 B. Epulis

Question 28

28. 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

Answer 28

 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.

Question 29

29. 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

Answer 29

 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.

Question 30

30. 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

Answer 30

 D. Diabetes  All of the above except pregnancy are local factors, whereas diabetes is a systemic or host factor.

Question 31

31. 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

Answer 31

 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.

Question 32

32. Which types of microorganisms are found in supragingival plaque?

Answer 32

 D. Gram-positive, aerobic bacteria, fermentative bacteria.

Question 33

33. Which types of micro-organisms are found in subgingival plaque?

Answer 33

 E. Proteolytic bacteria, Gram-negative, anaerobic bacteria.

Question 34

34. 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

Answer 34

 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.

Question 35

35. 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

Answer 35

 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.

Question 36

36. Which interleukin (IL) is most responsible for neutrophil chemotaxis? a. IL-1 b. IL-4 c. IL-8 d. IL-15 e. IL-20

Answer 36

 C. IL-8  IL-8 is most responsible for neutrophil chemotaxis.