Practice questions Flashcards
1
Q
Although no causal relationships between particular bacteria and periodontal diseases have been determined, there does appear to be an association between localized juvenile periodontitis (localized aggressive periodontitis) and the presence of:
A
Actinobacillus actinomycetemcomitans (A.a.)
2
Q
Which bacteria is associated with generalized aggressive periodontitis?
A
Porphyromonas gingivalis (P.g.)
3
Q
Which bacteria is associated with gingivitis and root caries?
A
Actinomyces viscosis (A.v.)
4
Q
Which bacteria is associated with chronic periodontitis?
A
No specific bacteria, mixed infection with many pathogens involved
5
Q
After a free gingival graft, the primary source of nutrition for the graft during the first 24 hrs is the:
A
Diffusion of nutrients from the underlying connective tissues
6
Q
2-4 days into the healing progress, what is the primary source of nutrition for the graft?
A
capillary buds that grow into the graft and provide vascular supply
7
Q
In treating patient’s chronic periodontal disease, dentists should use tetracylcines in conjunction with scaling and root planing. Tetracyclines help to prevent suprainfection of pockets with candida albicans.
A
Both statements are false
8
Q
How is chronic periodontal disease treated?
A
S/RP
9
Q
How to treat suprainfection with candida?
A
Anti-fungal medication- nystatin rinse, antifungal troches
10
Q
What is the empiric therapy for aggressive periodontitis?
A
combination of metronidazole 25mg TID and amox 500mg TID for 7-10 days
11
Q
What is the effect of chlorhexidine rinse on subgingival flora?
A
no substantial effect
12
Q
What are the histopathologic changes in chronic gingivitis?
A
the disruption of the gingival fibers and an inflammatory infiltrate of plasma cells, lymphocytes and neutrophilic leukocytes
there is breakdown of collagen in the supracrestal connective tissue fibers. Inflammatory infiltrate starts with neutrophils in the initial lesion that progresses to lymphocytes in the early lesion and has plasma cells dominating in established lesion
13
Q
Which primary substance or material is removed during the root planing procedure?
A
cementum
14
Q
What is the soft tissue-tooth interface that forms most frequently after flap surgery in an area previously denuded by inflammatory disease?
A
long junctional epithelium
15
Q
In a state of gingival health, the narrowest width of keratinized gingival tissue is usually found on the facial aspect of which teeth?
A
mandibular first premolars
also frequently mandibular centrals
16
Q
The depth of the clinical gingival sulcus is the distance from the gingival margin to the:
A
most apical penetration of the periodontal probe
17
Q
What is the primary requirement for a free gingival graft procedure to succeed?
A
immobilization of the grafted tissue
18
Q
The primary advantage of an external splint over an internal splint is:
A
conservation of tooth structure
19
Q
What is the most appropriate initial treatment for a patient with HIV-associated necrotizing ulcerative gingivitis or periodontitis?
A
debridement and antimicrobial rinses
mechanical reduction of bacterial load is the first step to resolve the acute problem
20
Q
During experimental gingivitis, supragingival plaque undergoes which of the following changes?
A
plaque microflora becomes more gram-negative
21
Q
Gingivectomy (GV) is not likely to be the treatment of choice for the elimination of pockets when the base of the pocket is located at the mucogingival junction or:
A
apical to the alveolar crest
22
Q
Which kinds of pockets are gingivectomy procedures contraindicated?
A
pocketing that reaches or goes beyond the mucogingival junction because it would create a mucogingival defect by resecting the remaining gingiva over the root
23
Q
Which procedure can eliminate very deep pockets which retaining keratinized gingiva?
A
apical positioned flaps
24
Q
which situation is an indication for splinting?
A
mobility with patient discomfort
25
which of the following factors is the most critical in the determination of prognosis of a tooth with periodontal disease?
amount of attachment loss
26
which osseous defect is not considered infrabony?
dehiscence
27
what are the characteristics of infrabony defects?
pocket that extends apical to the crrest of bone, this occurs in a trough, hemiseptum and interdental crater
28
when amputating a root for periodontal reason, which is the usual treatment sequence?
root canal therapy followed by periodontal therapy
29
which root of which tooth is most indicated for root resection?
distobuccal root of maxillary molars because it has the least area of attachment
30
is root resection therapy still common?
no, typically resected teeth fail due to fracture or caries
31
which of the following mesial root surfaces are unlikely to be thoroughly cleaned with the use of floss?
maxillary first premolar
32
Guided tissue regeneration is most commonly used to treat which of the following classes of furcations?
class/grade II
| horizontal penetration into the furcation should be 3mm or greater for this to be worth the cost
33
What is the appropriate treatment for grade I furcations?
scaling and root planing and periodontal maintenance or through osseous surgery
34
which class II furcations are the best for GTR?
mandibular facial and lingual and maxillary facial furcations are the best candidates
35
which class II furcations are poor candidates for GTR?
maxillary proximal furcations
36
what is the regeneration potential of Class III and IV furcations?
no chance of regeneration because PDL and bone that provides regenerative cells come from apical direction only
37
what is not a mode of ultrasonic instrumentation?
sharp cutting edge of tip
38
Porphyromonas gingivalis, Eubacterium and Campylobacter recta are all indicated in what oral pathosis?
periodontitis
39
which periodontal disease causes the most rapid destruction of alveolar bone?
periodontal abscess
40
Initial therapy involves which procedures?
S/RP, adult prophy, OHI, occlusal adjustment, strategic extractions, endodontics, removal of overhangs, provisional restorations
primary objective is to reduce inflammation, tooth mobility so that periodontal re-evaluation may be done
41
Streptococcus sanguis is common to which lesion?
early colonizer of supragingival plaque
42
Streptococcus gordonii is common to which lesion?
part of normal flora associated with periodontal health
43
Neutrophil chemotactic defects have been associated with which periodontal conditions?
LAP
44
what is the main objective of the maintenance phase of periodontal therapy?
prevention of the recurrence of disease
45
Before undergoing any periodontal surgery, a patient should be controlling the accumulation of plaque; BECAUSE, in the plaque-infected dentition after surgery, the incidence of disease recurrence will be greater.
both STATEMENT and REASON are true
46
which cells in the inflammatory infiltrate of an acute periodontal abscess are the MOST numerous?
neutrophils
47
Following the cleaning of a tooth, new plaque growth accumulates principally on which tooth surfaces?
interproximal
48
Phasing for tx planning:
| 1. Acute and urgent phase involves:
Pulpal involvement, ANUG, deep caries, pulpitis
49
Phasing:
| 2. Anti infective process involves:
SRP, initial perio and initial restorative
50
Phasing: Name the following:
3.
4.
5.
3. Perio sx, pre prosth sx.
4. Reconstructive phase (FPDs, implants)
5. Maintenance.
Why they had to change the fucking phases, I don't know. Fucking perio, man.
51
Which factors are most critical when determining perio prognosis?
a. probing depth
b. mobility
c. amount of attachment loss
d. presence of furcation involvement
c.
Reasoning: Attachment loss combines probing depth and gingival margin/recession. Gives you the big picture.
52
Each of the following is a mode of action of ultrasonics except:
a. lavage
b. vibration
c. cavitation
d. sharp cutting edge
d.
53
Radiographic signs of trauma include all except:
a. hypercementosis
b. root resorption
c. lamina dura alteration
d. pdl alteration
e. vascular infiltraiton of pdl
e.
Vascular infiltration can definitely occur, but it won't be visible radiographically.
54
Which represents the most common form of gingival or perio disease in children?
a. LAP
b. Localized acute gingivitis
c. primary herpetic gingivostomatitis
d. NUG
c.
Primary herpes is extremely common.
55
Probling depth = 5mm, gingival recession = 3 mm. Attachment loss?
8 mm
56
```
Ideally a bone graft should do all except:
a. induce osteogenesis
b withstand mechanical forces
c produce an immunologic response
d become replaced by host bone
```
c.
57
GTR is most commonly used to treat which of the classes of furcation?
a. 1
b. 2
c. 3
d. 4
b. GTR is to gain new attachment and bone. 3 and 4 are too far gone to really work.
58
FGG success depends on what?
a. graft being immobilized
b. donor tissue being as thick as possible
c. a thick blood clot being present between donor and recipient tissue
a.
59
Which perio disease causes the most rapid alveolar bone destruction?
a. perio abscess
b. chronic periodontitis
c. drug influenced gingival enlargement
d. NUG
a.
60
During gingivitis development, supragingival plaque undergoes which changes?
a. plaque mass decreases
b. plaque microflora becomes more aerobic
c. plaque microflora becomes more gram -
d. plaque microflora becomes predominately spirochaetal
c.
61
Each of the following is part of initial prep in perio tx except:
a. root planing
b. sx pocket elimination
c. home care instructions
d. occlusal adjustment
e. extraction of hopeless teeth
b. all of the others are preparing to control local etiologic factors.
62
After a FGG, the primary sources of nutrtion for a graft during the first 24 hours is the:
a. primary vascular anastomosis
b. residual nutrients in the graft
c. diffusion of nutrients from underlying connective tissue
d. diffusion of nutrients from adjacent PDL vessels
c.
Vascular supply is severed, anastomosis begins at 4-7 days through vascular budding. Until then, the graft depends on underlying and adjacent vascular periosteal bed for nutrients.
63
Water irrigation devices in oral health regimens are useful in
a. eliminating plaque
b. diluting bacterial products
c. reducing perio pockets
d. eliminating gingival inflammation
b.
NBDE tends to prefer older info (poor chlorhexidine)
64
Although no casual relationships between particular bacteria and perio diseases have been determined, tere does appear to be an association between LAgP and:
a. Aa
b. Pg
c. Av
d. Td
a.
65
Which of the following is most likely indication for splinting
a. primary occlusal trauma
b. mobility with pt discomfort
c. mobility with a decrease in tissue quality, secondary to hormonal imbalance
d. mobility related to unilateral skid from CR to CO.
b. It's not a, because that should be corrected with occlusal adjustment
66
Which of the following is the most appropriate tx plan for a pt with HIV associated NUG/NUP?
a. debridement and antimicrobial rinses
b. definitive root planning and curettage
c. admin of antibiotics
d. gingivectomy and gingivoplasty
a.
For this, treat with the conservative stuff first.
67
A freeze dried decalc. bone graft from a human donor is placed in a perio defect in another pt. What kind of graft is this?
a. allograft
b. autograft
c. isograft
d. alloplastic graft
a.
allograft is from same species
68
Gingivectomy is not likely to be tx of choice for the elimination of pockets when the base of the pocket is located at the mucogingival junction or:
a. apical to alveolar crest
b. below free gingival groove
c. coronal to CEJ
d. apical to the cervical convexity of the tooth crown
a.
69
Which of the following represents an early affect of primary traumatic occlusion?
a. vertical pocket formation
b. generalized alveolar bone loss
c. undermining resorption of alveolar bone
d. hemorrhage and thrombosis of blood vessels in the PDL
d.
this is primary occlusal trauma.
70
Which of the following is the current method of choice for removing or disrupting bacterial masses in the mouth
a. biologic
b. chemical
c. mechanical
d. antibiotics
c.
71
Which of the following mesial root surfaces are unlikely to be thoroughly cleaned with floss
a. max central incisor
b. mand 1st premolar
c. max 1st premolar
d. mand 1st molar
c
dat mesial root concavity
72
A dentist is resecting a root for perio reasons. Which of the following represents the usual tx sequence?
a. Perio tx followed by RCT
b. RCT followed by perio
c. RCT followed by a period of observation
d. Perio tx followed by a period of observation
b.
73
Each of the following osseous defects would be classified as infrabony except one:
a. a trough
b. dehiscence
c. a hemiseptum
d. an interdental crater
b.
in a dehiscence, the alveolar crest has resorbed, leaving the root exposed. The root is not within alveolar housing.
74
When diseas factors (pocketing, bone loss, inflammation) are equal in a younger and older pt, prognosis is usually better for the younger pt.
The distribution of the remaining teeth can be an important factor in determining prognosis
a. T, T
b. , F, F
c. T, F
d. F, T
D.
Destruction is more rapid in younger pts, indicates poorer prognosis.
75
Which of the following clinical findings has the greatest influence on the type of incision to use in the perio flab sx?
a. probing depth
b. frenum attachment
c. depth of vestibule
d. amount of attached gingiva
e. presence of intrabony defects
d.
76
Secondary trauma from occlusion is seen in cases where:
a. healthy gingiva and osseous tissues are present
b. traumatic changes are occuring in perio tissues of teeth with normal supporting bone
c. normal occlusal forces cause trauma to attachment apparatus of teeth with inadequate bone support
d.
c
77
Which of the following species is a usual constituent of flora that are associated with perio health?
a. Campylobacter recta
b. Eubacterium nodatum
c. Pg
d. Streptococcus gordonii
d. This is a gram+ cocci.
78
Which of the following has been associated with LAgP?
a. Cyclic eosinophilia
b. lysis of neutrophils
c. increased phagocytosis
d. neutrophil chemotactic defects
d.
This is an inherited trait.
79
Which of the following represents the main objective to the maintenance phase of perio therapy.
a. to maintain rapport with pt
b. to prevent recurrence of disease
c. to perform touch-up of secondary sx procedures
d. to complete remaining aspects of tx plan
b
80
Which of the following is necessary to allow for apically positioning a flab margin on the palatal surface of molar teeth?
a. use a sulcular incision
b. trim the flap margin to the proper length during the procedure
c. avoid making the initial incision deep enough to reach bone
d. extend the vertical releasing incision beyond mucogingival junction
b.
81
Which of the following cells in the inflammatory infiltrate during an acute perio abscess are the most numerous?
a. b-lymph
b. t-lymph
c. macrophages
d. plasma cells
e. neutrophils
e.
These are the cells of acute inflammation, and are the first line of defense and on the scene first.
82
Before undergoing any perio sx, a pt should control the accumulation of plaque because in a plaque-infected dentition, the incidence of disease recurrence will be greater
a. t, t + related
b. t, f
c. f, t
d. f, f
a.
83
Dentists often use barrier membranes (usually collagen) to treat osseous defects in an attempt to block which fo the following:
a. Osseous regen
b. Connective tissue attachment
c. formation of long junctional epithelium
d. coronal migration of PDL cells
c.
In GTR, you want to allow PDL and bone cells to migrate in. Some are multipotent, and can create new-ish attachment. Junctional epithelium will get there first and mess it up unless managed.
84
To determine the exact form of a bony defect, it will be necessary for the dentist to do which of the following?
a. expose the area surgically
b. examine in detail the gingival architecture
c. take two radiographs using different angulations
d. measure pocket depths from the CEJ
e. relate the septal bone height to the CEJ
a.
Only way to completely tell (no CBCT love I see)
85
Which of the following is most likely to cause gingival recession?
a. Occlusal trauma
b. Systemic disease
c. Toothbrush abrasion
d. Improper defecting contour
e. NUG
C.
86
To prevent exposure of a dihescence or fenestration on a prominent root, the dentists best approach when evaluating a flap is to use a:
a. double flap
b. stripping procedure
c. full thickness flap
d. apically positioned flap
e. partial or split thickness flap.
e. In this flap, connective tissue remains on the bone/dehiscence. This can help protect the site, but these are difficult to raise and are easy to perf. If a flap is raised where there is a dehiscence, the area may heal by reattachment if it is not root planed.
87
Which of the following is the primary etiology of gingivitis during puberty and pregnancy?
a. plaque
b. estradiol
c. calculus
d. estrogen
e. progesterone
a.
During pregnancy and puberty, there is an altered response to bacterial plaque. If plaque isn't present, you won't get gingivitis in the first place.
88
Which of the following is related to an enzyme deficiency and invovles periodontal destruction around primary teeth?
a. hypophosphatasia
b. cyclic neutropenia
c. LAP
d. Papillon-Lefevre syndrome
a.
Hypophosphatasia leads to lowered alkaline phosphatase activity resulting in defective information of bone and cementum.
89
Root planing should be avoided during the modified widman flap procedure because the modified widman flap margin will be placed apically to the level of altered root surfaces.
a. t, t related
b. t, t not related
c. t, f
d. f, t
e. f, f
e.
The objective of the modified widman is access for root planing. This is a conservative approach similar to curettage which is indicated especially anteriorly where recession should be minimized therefore the flaps are replaced and not apically positioned.
90
Cervicular epithelium is one example of non-keratinized gingival tissue. Another example is:
a. gingival col
b. marginal gingiva
c. attached gingiva
d. outer gingival epithelium
a.
The interdental col, apical to the contact, is non-keratinized as is the crevicular and junctional epithelium. Alveolar mucosa is also non-keratinized.
91
OH improvement in the presence of systemic or nutritional deficiencies affects the incidence of chronic inflammatory perio disease. It also affects the severity of chronic inflammatory perio disease.
a. t, t
b. f, f
c. t, f
d. f, t
a
92
A 50 year old male presents with deep fibrotic pockets and angular bone loss. The dentist reflects the flap, debrides the area and performs scaling and root planing. He/she finds two and three walled osseous defects. Which procedure should the dentist do next?
a. gingivectomy
b. osseous grafts
c. modified widman flap
d. apically positioned flap
b.
93
During SRP, each of the following can take place except one - which is the exception?
a. Dentin removal
b. Enamel removal
c. Calculus removal
d. Cementum removal
Well shit, I fucking wonder which one this is?!?!??!
b.
94
There are 4 basic stages in the pathogenesis of the perio lesion. In order they are:
a. initial, established, early, advanced
b. early, incipient, established, advanced
c. initial, early, established, advanced
d. incipient, early, established, advanced
c.
Initial lesion occurs 2-4 days after cessation of plaque control. Breakdown of collagen around blood vessels and increased PMN migration occurs.
Early lesion: 4-10 days, there is further loss of collagen, proliferation of junctional epithelium basal cells and an increase in lymphoid cells.
Established lesion - 10-21 days, following cessation of plaque control. B-lymphocytes and plasma cells dominate. Further loss of collagen and proliferation of pocket epithelium.
Advanced lesion - may follow or may never occur. IN this lesion there is extension of destruction into alveolar bone and the PDL.
95
The highest incidence of fibrous gingival enlargement is related to
a. puberty
b. diabetes
c. leukemia
d. pregnancy
e. medication
e.
Phenytoin, calcium channel blockers (-ipines, verapamil), immuno-suppresant agent cyclosporin.
96
Bone marrow for grafting defects in the jaws is generally obtained from:
a. ribs
b. tissue bank
c. illiac crest
d. max. tuberosity
e. mandibular parasymphysis
c
97
Which of the following characterizes freeze-dried bone?
a. usually rejected by host
b. exfoliated after a short time
c. contains cells with osteogenic potential
d. eventually replaced by host bone
d.
98
A pt will receive a free gingival graft. The graft epithelium will undergo which of the following alterations?
a. dysplasia
b. degeneration
c. proliferation
d. orthokeratinization
b.
When this is performed, the initial plasmatic circulation is not sufficient to allow the superficial cells to survive. Most or all of the epi will slough, but the connective tissue survival is what is critical.
99
Which of the following antibiotics is found at much higher concentration in crevicular fluid than in serum?
a. clinda
b. penicillin
c. metronidazole
d. tetracycline
d.
| Tetracycline has an affinity for calcium and will bind to the root surface and be slowly released.
100
Plaque accumulation has a direct effect on which of the following?
a. the level of material alba
b. severity of gingivitis
c. accumulation of calculus
d. severity of perio
b
101
Each of the following describes the experimental gingivitis model except one:
a. it demonstrates the relationship between plaque formation and gingivitis
b. it supports the non-specific plaque hypothesis
c. it demonstrates that gingivitis is a reversible disease
d. it proves that gingivitis progresses to periodontitis
b.
In progressive perio, disease progresses apically and laterally to create a wide attachment loss area. Any time the destruction is narrow, endo involvement, root fracture, or root anomolies should be suspected.
102
NUG/NUP species involvement
Spirochaetes (Treponema)
103
Which type of flap should be used when trying to avoid fenestration or dehiscence on a prominent root?
Partial thickness flap
| If at least 0.5 mm of tissue remains overlying bone, the osteoclastic activity will be minimal
104
What is the primary etiology of gingivitis during puberty and pregnancy?
plaque
105
what is the determining factor in flap choice during periodontal surgery?
-amount of attached gingiva
106
Dental plaque is believed to adhere to teeth because
dextrans are insoluble and sticky
107
what is the most effective means of controlling post surgical root sensitivity after a periodontal surgery?
plaque control
| also Prevident
108
What is an early effect of primary traumatic occlusion?
-hemorrhage and thrombosis of blood vessels in the periodontal ligament
109
Crevicular epithelium is one example of non-keratinized gingival tissue. Another example is the:
gingival col
110
When disease factors are equal in a younger patient and in an older patient, prognosis is usually better in a younger patient. The distribution of the remaining teeth can be an important factor in determining prognosis
The first statement is FALSE
| The second statement is TRUE
111
What is necessary to allow for apical positioning a flap margin on the palatal surface of molar teeth?
Trim the flap margin to the proper length during the procedure
112
What is the best way to determine the exact form of a bony defect?
expose the area surgically
| CBCT?
113
Root planing should be avoided during the modified Widman flap procedure BECAUSE the modified Widman flap will be placed apical to the level of the altered root surfaces.
Neither the statement nor reason are correct
114
This patient has generalized adult periodontitis (chronic periodontitis). The primary cause of this patient's periodontal disease is heavy subgingival colonization by Actinomyces viscosus and Streptococcus mutans/
The first statement is TRUE, the second is FALSE
115
The brown and black stains of the mandibular anterior teeth are produced primarily by pigment-forming plaque bacteria. Included among the oral bacteria capable of producing black pigment are certain strains of Porphyromonas gingivalis.
The first statement is FALSE the second is TRUE
| Stains in question apparently are caused by smoking or coffee
116
This patient's periodontal disease has caused his root surfaces to become exposed. Which of the following will be MOST effective in reducing this patient's risk of root caries?
Self-applied fluoride gels at daily intervals
117
The successful treatment of this patient's periodontitis will require the administration of antibiotics, in conjunction with mechanical therapy. This patient's pattern of bone loss strongly suggests the presence of an infection with Porphyromonas gingivalis
Both statements are false
| P.g. is part of a microbial complex and cannot be singled out as the single pathogen
118
This patient has rapidly progressive periodontitis (generalized aggressive). The primary cause of this patients patient's peridontal disease is A.a.
Both statements are false
| A.a. is the primary pathogen in localized aggressive only
