Review questions (1-8, 12-15) Flashcards
(112 cards)
1
Q
Which large leukocyte with one kidney-shaped nucleus and some granulesis is located in the bloodsteam?
A
Monocytes
2
Q
The immune biochemical mediators secreted by the immune cells are responsible for which of the following tissue destruction seen in periodontitis?
A. Destruction of gingival connective tissue
B. Resorption of alveolar bone
C. Breakdown of periodontal ligament
D. All of the above
A
D. All of the above
3
Q
Which large leukocyte with one kidney-shaped nucleus and is located in tissues?
A
Macrophages
4
Q
Redness, swelling, bleeding, and tenderness of the gingiva in response to dental plaque only are clinical signs of which of the following?
A. Periodontitis
B. Non–plaque-induced gingival diseases
C. Plaque-induced gingival diseases
D. Gingivostomatitis
A
C. Plaque-induced gingival diseases
5
Q
Gingivitis as a result of an exaggerated inflammatory response to plaque and hormone changes in a pregnant woman that includes a localized mushroom-shaped mass projecting from a gingival papilla is termed:
A. Non–plaque-induced gingival disease
B. Puberty-associated gingivitis
C. Leukemia-associated gingivitis
D. Pregnancy-associated pyogenic granuloma
A
D. Pregnancy-associated pyogenic granuloma
The gingival mass is characterized by a mushroom-like tissue mass that most commonly occurs in the maxilla and interproximally
6
Q
In which of the following phases of periodontal disease progression does the plaque biofilm extend subgingivally into the gingival sulcus?
A. Plaque accumulation phase (Initial lesion)
B. Established gingivitis phase (Established lesion)
C. Inflammatory mediator phase
D. Periodontitis phase (Advanced lesion)
A
B. Established gingivitis phase (established lesion)
Initial lesion = Bacteria colonize the tooth surface near the gingival margin
Early lesion = Bacterial accumulation continues and biofilm maturation occurs.
Established lesion = Plaque biofilm extends subgingivally into the gingival
sulcus, disrupting the attachment of the coronal-most portion of the JE from the tooth surface
Advanced lesion = This phase is characterized by periodontal pocket formation, bleeding on probing, alveolar bone loss, furcation involvement, and tooth mobility.
7
Q
Connective tissue is comprised of a gel-like substance, fibers, and few cells
A. True
B. False
A
True
The gingival connective tissue is comprised of a gel-like substance,
protein fibers, and cells.
8
Q
In the junctional epithelium, epithelial cell attaches to neighboring epithelial cells via:
A. Desmosomes
B. Hemidesmosomes
C. External basal lamina
D. Internal basal lamina
A
A. Desmosomes
Desmosome—a specialized cell junction that connects two
neighboring epithelial cells and their cytoskeletons together.
9
Q
What are S. mitis, S. sanguis, and Actinomyces viscosus associated with?
A
Tooth-associated plaque biofilm
bacteria that are attached to the tooth surface.
10
Q
A cell junction that connects an epithelial basal cell to the basal lamina is termed:
A. Hemidesmosome
B. Desmosome
C. Epithelial ridge
D. Connective tissue papilla
A
A. Hemidesmosome
Hemidesmosome—a specialized cell junction that connects the
epithelial cells to the basal lamina. You might think of
hemidesmosomes as specialized structures that represent half of a desmosome.
1. A cell-to-basal lamina connection
2. An important form of cell junction found in the gingival epithelium
11
Q
. What type of bone resorption occurs in an uneven oblique direction affecting only one tooth?
A. Osseous crater
B. Horizontal bone loss
C. Vertical bone loss
D. Infrabony defect
A
D. Infrabony defect
Infrabony defects result when bone resorption occurs in an uneven,
oblique direction. In infrabony defects, the bone resorption
primarily affects one tooth.
- Infrabony defects are classified on the basis of the number of osseous
walls. Infrabony defects may haveone, two, or three walls
12
Q
The deep extensions of epithelium that reach down into the connective tissue are termed:
A. Hemidesmosomes
B. Desmosomes
C. Epithelial ridges
D. Connective tissue papillae
A
C. Epithelial ridges
Epithelial ridges—deep extensions of epithelium that reach down
into the connective tissue. The epithelial ridges are also known as rete pegs.
13
Q
With the Cairo classification system, which type is associated with recession from traumatic toothbrushing?
A. RT1
B. RT2
C. RT3
A
A. RT1
Recession Type 1 (RT1)**: Gingival recession with **no loss of interproximal attachment.** Interproximal **CEJ** is **clinically not detectable at both mesial and distal** aspects of the tooth. **RT1 recession** defects represent defects that are most likely associated with **traumatic toothbrushing** in **healthy periodontal tissues.
14
Q
Identify the hypothesis:
Accumulation of plaque biofilm leads to gingival inflammation
A
Non-Specific Plaque Hypothesis
15
Q
Which of the following forms the base of a gingival sulcus?
A. Interdental gingiva
B. Attached gingival
C. Junctional epithelium
D. Periodontal Ligament
A
C. Junctional epithelium
16
Q
Which of the following are the three major forms of periodontitis?
A. Necrotizing periodontitis, periodontitis, periodontitis as a manifestation of systemic disease
B. Stage I, Stage II, Stage III
C. Grade A, Grade B, Grade C
A
A. Necrotizing periodontitis, periodontitis, periodontitis as a manifestation of systemic disease
17
Q
All of the following are classic symptoms of acute inflammation, EXCEPT:
A. Loss of function
B. Bruising
C. Swelling
D. Heat
A
B. Bruising
18
Q
Class II Miller Classification for Gingival Recession indicates:
A. Recession does not extend into MGJ
B. Recession is so severe that root surfaces are not covered
C. Recession extends to the MGJ but all of the root is covered
A
C. Recession extends to the MGJ but all of the root is covered
- Class II: Marginal tissue recession, which extends to or beyond the
- *MGJ**. There is no periodontal loss (bone or soft tissue) in the
- interdental area**, and 100% root coverage can be anticipated.
19
Q
Identify the hypothesis:
This theory postulates that it is a shift in the local environment that drives the changes in microbial composition that lead to periodontal disease.
A
Ecological Plaque Hypothesis
20
Q
Which of the following is a normal process that protects and heals the body?
A. Acute inflammation
B. Chronic inflammation
A
A. Acute inflammation
21
Q
Which of the following tissues fills the spaces between the tissues and organs of the body?
A. Basal lamina
B. Connective tissue
C. Epithelial tissue
D. Keratinized tissue
A
B. Connective tissue
22
Q
Gingivitis in an adolescent as a result of an exaggerated inflammatory response to a relatively small amount of plaque and increased levels of sex hormones is termed:
A. Non–plaque-induced gingival disease
B. Puberty-associated gingivitis
C. Diabetes-associated gingivitis
D. Cyclosporine-induced gingivitis
A
B. Puberty-associated gingivitis
puberty-associated gingivitis is characterized by an exaggerated inflammatory response of the gingiva to a relatively small amount of plaque biofilm around the
time of puberty. The exaggerated response is modulated by hormones released during puberty.
23
Q
A bacterial infection of the periodontium characterized by a slow destruction of the periodontal ligament, slow loss of supporting bone, and a good response to periodontal therapy is termed:
A. Periodontitis
B. Refractory periodontitis
C. Necrotizing periodontal disease
D. Recurrent periodontal disease
A
A. Periodontitis
Periodontitis is a complex microbial infection that triggers a host mediated
inflammatory response within the periodontium, resulting in progressive destruction of the periodontal ligament and supporting alveolar bone.
24
Q
Current perspective on the etiology of periodontal disease states plaque biofilm is necessary for initial inflammation, and plaque biofilm alone is not sufficient for periodontal destruction.
A. The first phrase is true, second phrase is false
B. The first phrase is false, second phrase is true
C. Both phrases are true
D. Both phrases are false
A
C. Both phrases are true
Nonspecific Plaque Hypothesis**
This theory proposed that the **accumulation of plaque
biofilm**—an abundance of bacteria in the biofilm—adjacent to the
gingival margin led to **gingival inflammation** and the **subsequent tissue
destruction seen in periodontitis.
25
In what ways do antibodies participate in the host defense?
**Neutralize bacteria** or bacterial toxins to **prevent bacteria** from **destroying host cells**
**Coat bacteria** making them more susceptible to **phagocytosis**
Activate the **compliment system**
26
Identify the hypothesis:
The presence of certain microbial pathogens—even in low numbers—can cause a shift from beneficial to pathogenic microbes in the biofilm community. The key concept of this theory is that **even at low levels, keystone pathogens can have a significant impact on the oral biofilm** that initiates an uncontrolled host immune response.
**Keystone Pathogen Hypothesis**
27
Ascorbic acid--deficiency gingivitis is a severely low level of:
A. Vitamin B
B. Vitamin K
C. Vitamin A
D. Vitamin C
D. **Vitamin C**
28
A single microscopic organism is termed:
A. Bacteria
B. Bacterium
C. Nucleoli
D. Aerobic
B. **Bacterium**
**Bacterium** (**plural, bacteria**). Bacteria are the **simplest organisms**
and can be seen only through a **microscope**.
29
Which pattern of bone loss results in a fairly even, overall reduction in the height of the alveolar bone?
A. Horizontal bone loss
B. Vertical bone loss
C. Both A and B
A. **Horizontal bone loss**
30
An important function of the cementum of the tooth is to attach the periodontal ligament fibers to the tooth.
A. True
B. False
**True**
*The attachment of the fiber bundles occurs when the cementum and
bone are forming. As cementum forms, the tissue calcifies around the
ends of the periodontal fibers (Sharpey fibers) surrounding them with
cementum.*
31
Examples of medications that cause gingival enlargement include all EXCEPT:
A. Calcium channel blockers
B. Anticonvulsants
C. Nonsteroidal anti-inflammatories
D. Immunosuppressants
C. **Nonsteroidal anti-inflammatories**
**Drug-influenced gingival enlargements** are an increase in size of the
gingiva associated with **certain systemic medications**, most commonly
**anticonvulsants, calcium channel blockers**, and **immunosuppressants**.
The **pattern of tissue enlargement** is **irregular**, usually first observed in the **papillae**, beginning as a painless area of enlargement on the papilla and then proceeding to the **marginal gingiva.**
32
Which of the following tissues serves as a covering tissue for the outer surfaces of the body and a lining tissue for body cavities such as the mouth, stomach, and intestines?
A. Basal lamina
B. Connective tissue
C. Epithelial tissue
D. Keratinized tissue
C. **Epithelial tissue**
*The epithelial tissue is the tissue that makes up the outer
surface of the body (skin or epidermis) and lines the body cavities such
as the mouth, stomach, and intestines (mucosa). The skin and mucosa of
the oral cavity are made up of stratified squamous epithelium—a type
of epithelium that is comprised of flat cells arranged in several layers.*
33
Which of these immune cells secrete antibodies?
A. Macrophages
B. Polymorphonuclear leukocytes
C. B-lymphocytes
D. T-lymphocytes
C. **B-lymphocytes**
**B-lymphocytes**: small **leukocytes** that help in the **defense against bacteria,** **viruses**, and **fungi**; principal function is to **make antibodies**. B-lymphocytes can further differentiate into one of the two types of cells: **plasma B-cells** and **memory B-cells.**
34
. If gingival tissues are healthy they will ALWAYS have a stippled appearance.
A. True
B. False
**False**
Healthy gingival tissue showing a stippled appearance.
Stippling varies greatly from individual to individual. In some patients,
healthy tissue **may not exhibit** a **stippled appearance.**
35
Gingivitis from poor self-care that has existed for years without progressing to periodontitis is termed:
A. Localized gingivitis
B. Generalized gingivitis
C. Necrotizing Gingivitis
D. Plaque-induced gingivitis
D. **Plaque-induced gingivitis**
36
The primary purpose of the immune system is to:
A. Defend the life of the host (the individual)
B. Identify bacterial invaders
C. Cause swelling and redness at the infection site
D. Phagocytize bacteria
A. **Defend the life of the host (the individual)**
*The **prime purpose** of the **human immune system** is to **defend the life** of the **individual (host)** by **identifying foreign substances** in the body (**bacteria, viruses, fungi, or parasites**) and **developing a defense against them***
37
Non--plaque-induced gingival lesions:
A. Heal after meticulous plaque control
B. Are not affected by the presence of plaque
C. May have various causes
D. Always require periodontal therapy
C. **May have various causes**
**non–plaque-induced gingival diseases—are not caused by plaque biofilm and do not resolve after plaque biofilm removal.**
38
Why is frequent periodontal instrumentation important in the control of dental plaque biofilms located in periodontal pockets?
A. A toothbrush and floss cannot clean root surfaces within a periodontal pocket
B. Few patients take the time for self-care at home
A. **A toothbrush and floss cannot clean**
## Footnote
**root surfaces within a periodontal pocket**
39
Which phase of periodontal disease progression is characterized by tissue destruction?
A. Plaque accumulation phase
B. Established gingivitis phase
C. Inflammatory mediator phase
D. Periodontitis phase
D. **Periodontitis phase**
***Periodontitis phase = Advanced lesion***
*This phase is characterized by periodontal pocket formation, bleeding on probing, alveolar bone loss, furcation involvement, and tooth mobility.*
40
In MOST places in the body, the epithelium meets the connective tissue in a wavy, uneven junction.
A. True
B. False
**True**
* In **most cases**, the **epithelium** meets the **connective tissue** at*
* an **uneven, wavy** border.*
* **Epithelial ridges** extend **down** into the **connective tissue.**
* *Connective tissue** papillae **extend upward** into the epithelium.*
41
Identify the hypothesis:
**Specific groups of bacteria** (T. forsythia, P.gingivalis, and Treponema denticola) cause various periodontial diseases.
**Orange, red = Perio**
Yellow, green blue and purple = health
**Socransky’s Microbial Complexes**
42
Cytokines that play an important role in periodontitis are:
A. PGE
B. IL-1, IL-6, IL-8, and TNF-a
C. PPT
D. MMP
B.
**IL-1, IL-6, IL-8,** and **TNF-a**
43
A well-organized community of bacteria that adheres to surfaces and is embedded in an extracellular slime layer is termed:
A. Aerobic
B. Anaerobic
C. Biofilm
D. Bacterial microcolony
C. **Biofilm**
*A biofilm is a complex and dynamic microbial community— containing a diverse array of many types of microbial species (bacteria, fungi, and viruses)—embedded within a self-protective matrix that adheres to a living or nonliving surface*.
44
The junctional epithelium attaches to the connective tissue via the:
A. Desmosomes and the internal basal lamina
B. Desmosomes and the external basal lamina
C. Hemidesmosomes and the internal basal lamina
D. Hemidesmosomes and the external basal lamina
D. **Hemidesmosomes and the external basal lamina**
The epithelial cells of the **JE attach** to the underlying **gingival
connective tissue**via**hemidesmosomes**and the**external basal lamina**
45
Which of the following structures is intact in gingivitis?
A. Supragingival fiber bundles
B. Periodontal ligament fibers
C. Alveolar bone
D. All of the above
E. Only B and C
F. None of the above
E. **Only B and C**
## Footnote
**Periodontal ligament fibers; Alveolar bone**
46
. Bacteria that have double cell membranes and that do not stain purple with crystal violet are called:
A. Aerobic
B. Anaerobic
C. Gram-positive
D. Gram-negative
D. **Gram-negative (red stain)**
* Sandwiched in between the outer membrane and inner cytoplasmic membrane is a thin, **single-layered cell wall layer** composed of **peptidoglycan**. The **thin cell wall does not allow** for the **retention** of the **purple stain**. Therefore, the **gram-negative**
* *microbe appears red or pink under light microscope.***
47
Probing depth of _5 mm or less_ that shows as even horizontal bone loss on radiographs occurs in which of the following stages of periodontitis?
A. Stage I
B. Stage II
C. Stage III
D. Stage IV
B. **Stage II**
1. **Interdental CAL of 3 to 4 mm** at the site of greatest loss
2. Radiographic bone loss extending to the **coronal one-third** of the root
3. **No tooth loss due to periodontitis**
b. Complexity of Management
1. **Maximum probing depths of 5 mm or less**
2. **Mostly horizontal bone loss**
48
Identify the hypothesis:
This theory postulates that a **shift from beneficial to pathogenis bacteria** triggers an uncontrolled host inflammatory response. It is this **uncontrolled host response** that is responsible for the tissue destruction seen in periodontitis.
**Microbial Homeostasis–**
**Host Response Hypothesis**
49
Healthy gingival tissue **ALWAYS** has a dimpled
appearance known as stippling.
T/F
**False**
*In health, the surface of the attached gingiva **may** have a dimpled appearance known as gingival stippling.*
50
Which structure of a biofilm facilitates the movement of nutrients to the bacteria?
A. Acquired pellicle
B. Extracellular slime layer
C. Fluid channels
D. Primitive communication system
C. **Fluid channels**
These **fluid channels direct fluids in and around the biofilm** **bringing nutrients** and **oxygen** to the **microbes** and **carrying waste products away.** The **fluids include** everything from **saliva** to any **beverages consumed.**
51
A papilla that is enlarged and appears to bulge out of the interproximal space is called:
A. Bulbous
B. Blunted
C. Cratered
D. Scooped
A. **Bulbous**
52
Periodontal diseases involving inflammation limited to the gingiva in response to dental plaque are termed:
A. Periodontitis
B. Non--plaque-induced gingival diseases
C. Plaque-induced gingival diseases
D. Gingivostomatitis
C. **Plaque-induced gingival diseases**
**Plaque-induced gingivitis** is an inflammatory response of the **gingival
tissues**resulting from**bacterial plaque biofilm accumulation** located
at and below the **gingival margin.**
53
Which of the following is a classification of periodontal disease that is described as a group of periodontal diseases that could be associated with
an ascorbic acid deficiency?
A. Non--plaque-induced gingivitis
B. Endocrine, nutritional, and metabolic diseases
C. Genetic/developmental disorders
D. Drug-induced gingival enlargement
B. **Endocrine, nutritional, and metabolic diseases**
**Ascorbic acid-deficiency gingivitis**: an inflammatory response of the
gingiva caused by dental plaque that is **aggravated by chronically low
vitamin C (ascorbic acid) levels**; manifests clinically as**bright red,
swollen, ulcerated gingival tissue**that bleeds with the**slightest
provocation.**
54
Which of the following describes Stage III Periodontitis?
A. Moderate periodontitis
B. Severe periodontitis with potential for additional tooth loss
C. Periodontitis with a rapid rate of progression
B. **Severe periodontitis with potential for additional tooth loss**
* *Stage III** represents severe periodontitis with
* *significant destruction** to the **attachment apparatus** and **potential tooth loss.**
1. **Interdental CAL 5 mm or greater** at the site of greatest loss
2. Radiographic **bone loss** extending to the **mid-third of the root** and beyond
3. **Tooth loss** due to periodontitis of **4 or less teeth**
55
Gingivitis as the result of an allergic reaction to an ingredient in toothpaste is termed:
A. Intraoral allergic reaction
B. Erythema multiforme
C. Lichen planus
D. Gingivostomatitis
A. **Intraoral allergic reaction**
56
Which of the following is defined as a complex series of proteins circulating in the bloodstream that facilitates the destruction of bacteria by phagocytosis or puncturing bacterial cell membranes?
A. PMN
B. Antigen
C. B-lymphocytes
D. Complement system
D. **Complement system**
**Destruction of Pathogens** = protein unit called the **membrane attack complex** that can **puncture the cell membranes** of certain bacteria (**lysis**).
**Opsonization of Pathogens** = **engulfment** and **destruction** of **microorganisms** by **phagocytes**.
**Recruitment of Phagocytes** = recruits additional **phagocytic cells** to the **site of the infection.**
**Immune Clearance =** **removal** of **immune complexes** from **circulation**.
57
If the bacterial pathogens in early gingivitis continue to proliferate, what is the next phase of disease progression?
A. Early plaque accumulation
B. Early gingivitis
C. Established gingivitis
D. Periodontitis
C. **Established gingivitis**
1. Cytokines, PGE2, and MMPs are produced by macrophages exposed
to gram-negative bacteria.
2. Cytokines recruit additional macrophages and lymphocytes to the area.
3. PGE2 and the MMPs initiate collagen destruction.
4. Gingival fibroblasts are stimulated to produce additional PGE2 and MMPs.
58
Periodontitis has a multifactorial etiology, and social atmosphere can be a contributing risk factor for periodontal disease.
A. The first phrase is true, the second phrase is false
B. The first phrase is false, the second phrase is true
C. Both phrases are true
D. Both phrases are false
C. **Both** phrases are **true**
***Periodontitis** has a **multifactorial etiology**. Additional factors—**other than the presence of bacteria**—play a significant role in **determining why some individuals
are more susceptible to periodontal disease than others.***
59
The sequence of events that occur during the development of a disease is termed:
A. Pathogenesis
B. Periodontal disease
C. Periodontitis
D. Pericardium
A. **Pathogenesis**
*Disease progression* (**pathogenesis**) is the sequence of events that occur
during the **development of a disease or abnormal condition.** The
periodontium exists in three basic states: **health, gingivitis,** and
**periodontitis**
60
Peri-implant disease includes all of the following EXCEPT:
A. Peri-implant health
B. Peri-implantitis
C. Peri-implant mucositis
D. All of the above
D. **All of the above**
61
Chronic inflammation is a pathological condition characterized by tissue destruction. In chronic inflammation, the inflammatory process can become so intense that it inflicts permanent damage to body tissues.
A. Both statements are true
B. Both statements are false
C. The first statement is true, the second false
D. The first statement is false, the second true
A. **Both** statements are **true**
62
New signs and symptoms of destructive periodontitis that reappear after periodontal therapy because the disease was not adequately treated and/or the patient did not maintain adequate self-care is termed:
A. Refractory form of disease
B. Recurrent form of disease
B. **Recurrent form of disease**
***Recurrent form of periodontitis**—a return of destructive periodontitis
that had been previously arrested by conventional periodontal therapy.*
*Recurrence of periodontitis is a common event, especially in patients
with poor self-care or who are noncompliant with routine professional
care.*
63
Which of the following is the thin layer of bone that lines the tooth socket?
A. Alveolus
B. Alveolar bone proper
C. Cortical bone
D. Cancellous bone
B. **Alveolar bone proper**
* The **alveolar bone proper (or cribriform plate)** is the **thin layer of bone***
* that **lines the socket** that **surrounds the root of the tooth.***
64
Which of the following is NOT a function of the supragingival fiber bundles:
A. Brace the free gingiva against the tooth
B. Suspend the tooth in its bony socket
C. Allow the free gingiva to withstand the frictional forces
D. Connect adjacent teeth to one another
B. **Suspend the tooth in its bony socket**
* *Functions of the Gingival Fiber Bundles**
1. Brace the free gingiva firmly against the tooth and reinforce the attachment of the JE to the tooth.
2. Provide the free gingiva with the rigidity needed to withstand the masticatory (chewing) forces.
3. Unite the free gingiva with the cementum of the root and alveolar bone.
4. Connect adjacent teeth to one another to maintain tooth positioning within the dental arch.
65
In gingivitis, the position of the junctional epithelium is _____ to the cementoenamel junction.
A. Apical
B. Coronal
C. Distal
D. Mesial
B. **Coronal**
66
A person’s complexion can determine the shade of pink in healthy tissues.
A. True
B. False
**True**
Healthy gingival tissue has a uniform, pink color. The precise color depends on the **number and size of blood vessels** in the **connective tissue** and the **thickness** of the **gingival epithelium**. The shade of pink usually is lighter in persons with fair complexions and **darker in individuals with dark complexions**
67
Periodontitis in which 30% or LESS of the sites in the mouth have experienced attachment loss and bone loss is termed:
A. Non--plaque-induced gingivitis
B. Localized periodontitis
C. Generalized periodontitis
B. **Localized periodontitis**
***Localized periodontitis** is periodontitis in which **30% or less** of the
teeth in the mouth have experienced attachment loss and bone loss.*
***Generalized periodontitis** is periodontitis in which **more than 30%** of
the teeth in the mouth have experienced attachment loss and bone
los*s.
68
One function of the attached gingiva is to prevent the free gingiva from being pulled away from the tooth when tension is applied to the alveolar mucosa.
A. True
B. False
**True**
69
When PMNs rush to the site of infection of the periodontium, they release substances that destroy healthy gingival connective tissue. What is the advantage of connective tissue destruction in this instance?
A. The tissue needs to be destroyed just in case some bacteria are in the tissue
B. The connective tissue destruction existed before the PMNs arrived in the tissue C. Tissue destruction allows the blood vessels to dilate
D. This creates a pathway for the PMNs to move quickly through the tissue
D. **This creates a pathway for the PMNs to move quickly through the tissue**
***PMNs** are the **first leukocytes** to arrive at the **injured site**. These cells **phagocytose** and **kill invading microorganisms** through the release of **nonspecific toxins**. These nonspecific toxins **kill pathogens** as well as **adjacent host cells, sick and healthy** alike. The **PMNs release cytokines**, including **IL** and **tumor necrosis factor (TNF)**.*
70
The epithelium that forms the base of the sulcus and joins the gingiva to the tooth is called the:
A. Oral epithelium
B. Sulcular epithelium
C. Junctional epithelium
D. Squamous epithelium
C. **Junctional epithelium**
Junctional epithelium (JE) is the specialized epithelium that forms the **base of the sulcus** and **joins** the **gingiva to the tooth surface.** The gingiva **surrounds the cervix of the tooth** and **attaches to the tooth** by means of the **junctional epithelium**. The base of the sulcus is made up of the coronal-most cells of the junctional epithelium. In health, the **JE attaches to the tooth at a level that is slightly coronal to the cementoenamel junction (CEJ).**
71
The primary purpose of the immune system when it responds to a bacterial infection of the periodontium is to:
A. Defend the life of the host (the individual with the bacterial infection)
B. Identify the bacterial invaders
C. Preserve the tooth and its periodontium so that no teeth are lost
D. Phagocytize bacteria at the site
A. **Defend the life of the host (the individual with the bacterial infection)**
72
A pseudomembrane is evidence of necrotizing periodontal disease. Necrotizing periodontitis has associated CAL and bone loss.
A. True
B. False
**True**
***Necrotizing periodontitis**—tissue **necrosis** of the **gingival tissues**
combined with **loss of attachment** and **alveolar bone loss**. The **necrotic areas** of the gingiva are covered by a **yellowish-white or grayish tissue** slough, which is termed a **pseudomembrane**.*
73
Which of these epithelial layers is comprised of cells with nuclei that act as a cushion against mechanical stress and wear?
A. Nonkeratinized layer
B. Keratinized layer
C. Extracellular ground layer
D. Collagen layer
A. **Nonkeratinized layer**
***Nonkeratinized epithelial cells** have **nuclei** and act as a **cushion
against mechanical stress and wear.**Nonkeratinized epithelial cells
are **softer and more flexible.** Nonkeratinized epithelium is found in areas*
* such as the **mucosal lining of the cheeks**—permitting the mobility*
* needed to speak, chew, and make facial expressions.*
74
In gingivitis, increased probing depth of a gingival pocket is the result of which of the following?
A. Enlarged tissue
B. Apical migration of the junctional epithelium
C. Destruction of the periodontal ligament fibers
D. All of the above
E. Only A and B
A. **Enlarged tissue**
## Footnote
Gingival enlargement may be caused by swelling (acute gingivitis) or fibrosis (chronic gingivitis).
1. Tissue enlargement causes the gingival margin to cover more of the crown of the tooth and results in deeper probing depths.
2. This enlargement of the gingival tissue is said to produce a false or gingival pocket, known as a pseudopocket.
3. A gingival pocket has a sulcus depth over 3 mm. **This increased probing depth is caused solely by enlarged gingival tissue.** Microscopically, the **junctional epithelium remains in its normal position coronal to CEJ on the tooth in a gingival pocket.**
75
Periodontal risk questionnaires may be helpful in:
A. Identifying individual who are at high risk for periodontal disease
B. Eliciting the presence of common periodontal risk factors
C. Initiating a discussion with patients about periodontal risk factors
D. All of the above
D. **All of the above**
76
Which of the following would be most effective in controlling the bacteria in a dental plaque biofilm?
A. Systemic antibiotic (an antibiotic pill)
B. Antimicrobial agent
C. Very high doses of an antibiotic
D. Toothbrush and floss
D. **Toothbrush and floss**
***Control of bacteria** in dental plaque biofilms is best achieved by the **physical disruption** (such as **brushing**, **flossing**, and **periodontal instrumentation**) of the **biofilm structure.***
77
Which tissue of the periodontium maybe
pigmented in dark-skinned individuals?
**Attached Gingiva**
78
All of the following are Gingival Diseases EXCEPT:
A. Drug-induced gingival enlargement
B. Traumatic lesions
C. Gingival pigmentation
D. Necrotizing stomatitis
D. **Necrotizing stomatitis**
79
Which of the following falls in the category of _“other conditions_” affecting periodontium?
A. Dental plaque--induced gingival diseases
B. Gingival disease modified by medications
C. Traumatic occlusal forces
D. Necrotizing periodontal disease
C. **Traumatic occlusal forces**
Other Conditions Affecting the Periodontium:
**systemic diseases** affecting the periodontium,
**periodontal abscesses** or **endodontic-periodontal lesions**,
**mucogingival deformities** and conditions,
**traumatic occlusal forces**, and
**tooth** and **prosthesis-related factors.**
80
Which of the following are considered periodontal diseases?
A. Gingivitis
B. Periodontitis
C. Both A and B
C. **Both A and B**
## Footnote
**Gingivitis; Periodontitis**
81
In gingivitis, the position of the gingival margin is:
A. Coronal to the CEJ
B. Apical to the CEJ
C. May be coronal or apical to the CEJ
A. **Coronal to the CEJ (further above the CEJ)**
The tissue swelling in gingivitis may cause the position of the gingival margin to move coronally—further above the CEJ—than in health.
**Gingivitis** = **no destruction** of **periodontal ligament fibers** or **alveolar bone**
82
The sulcular and junctional epithelia are keratinized epithelial tissues.
A. True
B. False
B. **False**
83
Permanent destruction of the tissues of the periodontium occurs in which state?
A. Gingivitis
B. Periodontitis
C. Periodontal disease
D. Only A and C
B. **Periodontitis**
84
Factors that increase an individual’s susceptibility to periodontitis by modifying the host response to bacterial infection are called:
A. Contributing factors
B. Genetic influences
C. Neutrophils
D. Biologic equilibrium
B. **Genetic influences**
**Systemic risk factors:** conditions or diseases that increase an individual’s susceptibility to periodontal infection by modifying or amplifying the host response to the bacterial infection; proven systemic risk factors include **diabetes mellitus, osteoporosis, hormone alteration, medications, tobacco use,** **and**
**genetic influences.**
85
Epithelial cell junctions are cellular structures that can attach:
A. An epithelial cell to a neighboring epithelial cell
B. An epithelial cell to a basal lamina
C. An epithelial cell to elastin fibers
D. Both A and B
D. **Both A and B**
**Desmosome**—a specialized cell junction that **connects two
neighboring epithelial cells** and their cytoskeletons together.
**Hemidesmosome**—a specialized cell junction that **connects the
epithelial cells to the basal lamina**
86
Which of the following is the cause of nearly all the tissue destruction seen in periodontitis?
A. Bacteria
B. Host response
B. **Host response**
* The way that an **individual’s body responds** to an **infection** is known as*
* the **host response.***
87
Which of the following are types of periodontal disease?
A. Gingivitis
B. Periodontitis
C. Both A and B
C. **Both A and B**
Gingivitis; Periodontitis
88
All of the following are categories of periodontitis EXCEPT:
A. Necrotizing periodontal disease
B. Periodontitis
C. Periodontitis as a manifestation of systemic disease
D. Gingivitis
D. **Gingivitis**
89
Cementum does not have its own blood supply; it receives its nutrients from the periodontal ligament.
A. True
B. False
**True**
*Functions of the PDL has five functions in the periodontium:
A. Supportive function
B. Sensory function
C. **Nutritive function—provides nutrients to the cementum and bone.**
D. Formative function
E. Remodeling function*
90
What are the following bacteria associated with?
**S. o**ralis**, S. i**ntermedius,
**P. g**ingivalis, **P**revotella **i**ntermedia,
**T**annerella **f**orsythia,
and
**F**usobacterium **n**ucleatum.
**Tissue-Associated Plaque Biofilms**
bacteria that adhere to the epithelium.
91
What causes the following:
Dilation of the blood vessels
Enhanced permeability of the bold capillaries
Increased blood flow
Leukocyte movement to tissue
**Inflammation Characteristics**
92
All of the following are components of the immune system, EXCEPT:
A. Hemidesmosomes
B. Immunoglobulins
C. Macrophages
D. Complement system
A. **Hemidesmosomes**
*Hemidesmosome: a specialized cell junction that connects the epithelial
cells to the basal lamina. Hemidesmosomes also attach the junctional
epithelium to the enamel in teeth without gingival recession.*
93
Gingivitis as the result of a severe reaction to the initial infection with the
herpes simplex type-1 virus is termed:
A. Ascorbic acid--deficiency gingivitis
B. Primary herpetic gingivostomatitis
C. Diabetes-associated gingivitis
D. Leukemia-associated gingivitis
B. **Primary herpetic gingivostomatitis**
The initial infection with HSV-1 usually occurs in children or in young adults, but it can occur at any age. **Severe oral pain** can be associated with **primary herpetic gingivostomatitis**, and this **discomfort results in difficulty in eating and drinking.**
**The gingival tissues appear swollen (edematous), red (erythematous)
and bleed quite easily when disturbed.**
94
The junctional epithelium attaches to the tooth surface via the:
A. Desmosomes and the internal basal lamina
B. Desmosomes and the external basal lamina
C. Hemidesmosomes and the internal basal lamina
D. Hemidesmosomes and the external basal lamina
C. **Hemidesmosomes and the internal basal lamina**
The **JE cells** next to the tooth surface form **hemidesmosomes** that
enable these cells to **attach** to the **internal basal lamina**
and the **surface of the tooth.**
95
Which structure of a biofilm protects the bacterial microcolonies from systemic antibiotics and the body’s immune system?
A. Acquired pellicle
B. Extracellular slime layer
C. Fluid channels
D. Primitive communication system
B. **Extracellular slime layer**
**Extracellular slime layer**: a **protective barrier** that surrounds the **mushroom-shaped bacterial microcolonies** of a **biofilm**; protects the **bacterial microcolonies** from **antibiotics**, **antimicrobials**, and the **body’s immune system. Microbes** in a biofilm can **resist factors** that would **easily kill these same
microbes when in a free-floating state**
96
Continued apical migration of the junctional epithelium is:
A. Pseudo pocket
B. Site of active disease
C. Gingivitis
D. Inflammation
B. **Site of active disease**
**Active disease site**—a disease site that shows **continued apical
migration**of the**junctional epithelium** over time.
97
Gingival recession is considered a mucogingival deformity. Gingival recession can be a result of tooth malpositioning in the arch.
A. True
B. False
**True**
*Recession of the gingival margin is the **most common** mucogingival
deformity. **Recession** of the **gingival margin** is defined as the **apical
displacement**of the**gingival margin**with respect to the**CEJ.***
***Recession** of the GM **reduces the thickness of the alveolar bone** due to **abnormal tooth position in the dental arch.***
98
Periodontitis in which MORE than 30% of the sites in the mouth have experienced attachment loss and bone loss is termed:
A. Non--plaque-induced gingivitis
B. Localized periodontitis
C. Generalized periodontitis
C. **Generalized periodontitis**
**Localized periodontitis** = **30% or less** of the teeth in the mouth have
experienced attachment loss and bone loss.
**Generalized periodontitis** = **more than 30%** of the teeth in the mouth have experienced attachment loss and bone loss.
99
The pathologic deepening of the gingival sulcus is:
A. Suprabony pocket
B. Apical migration
C. Periodontal pocket
D. Infrabony pocket
C. **Periodontal pocket**
A **periodontal pocket** is a **pathologic deepening** of the **gingival sulcus.**
Pocket formation occurs as the result of the
(1) **apical migration** of the **junctional epithelium,**
(2) **destruction** of the **periodontal ligament fibers**, and
(3) **destruction** of **alveolar bone**.
100
Papilla that appears to have been “scooped” out leaving a concave depression in the midproximal area is called:
A. Bulbous
B. Blunted
C. Cratered
D. Scooped
C. **Cratered**
**Cratered papillae** = **necrotizing gingivitis (NG)**
101
. Tissue destruction that is characterized by increased CAL of 2 mm or more over a 5-year period has a grade of:
A. Grade A
B. Grade B
C. Grade C
C. **Grade C**
Grade C = Rapid Rate of Disease Progression.
The **grade modifiers** for **Grade C** are:
1. **Smoking 10 or more cigarettes** a day and/or
2. An **HbA1c of 7% or greater** in patients with **diabetes**.
102
Which of the following is NOT one of the tissues of the periodontium?
A. Periodontal ligament
B. Body of the Mandible
C. Gingiva
D. Cementum
B. **Body of the Mandible**
103
In which stage of inflammation is pain a common symptom?
A. Acute inflammation
B. Chronic inflammation
A. **Acute inflammation**
104
Cementum is NOT necessary to the health of the periodontium because the underlying dentin will protect the root if the cementum is removed by toothbrush abrasion or from dental procedures.
True or False
**False**
105
Alveolar bone is mineralized connective tissue.
A. True
B. False
**True**
**Alveolar bon**e is **mineralized connective tissue** made by
cells called **osteoblasts (“bone builders”).**
106
Inflammation of the gingival margin, papilla, and attached gingiva may be classified as:
A. Generalized
B. Marginal
C. Diffuse
D. Papillary
C. **Diffuse**
**papillary gingivitis** = inflammation of **interdental papilla**
**marginal gingivitis** = inflammation of **gingival margin** and a portion of the contiguous **attached gingiva**
**diffuse gingivitis =** inflammation of the **interdental papilla, the marginal gingiva,** and the **attached gingiva**
107
On the tooth side, the periodontal ligament fibers are embedded in which of the following structures?
A. Alveolar bone
B. Attached gingiva
C. Interdental gingiva
D. Cementum
D. **Cementum**
The fibers of the **PDL attach** on one side to the **root cementum** and on
the other side to the **alveolar bone** of the tooth socket.
108
Gingivitis in which the inflammation affects only one group of teeth is termed:
A. Localized gingivitis
B. Generalized gingivitis
C. Acute gingivitis
D. Chronic gingivitis
A. **Localized gingivitis**
**Localized inflammation** is **confined** to the **gingival tissue** of a **single
tooth**—such as the maxillary right first molar—or to a**group of teeth**
—such as the mandibular anterior sextant.
109
The function of cell _junctions_ is to:
A. Make it easy for cells to detach from each other to facilitate migration of cells
B. Allow cells to bind together to function as a strong structural unit
C. Fill the spaces between neighboring epithelial cells
D. Both A and B
B. **Allow cells to bind together to function as a strong structural unit**
*Cell junctions bind cells together so that they can function as a
strong structural unit. Tissues, such as the epithelium of the skin that
must withstand severe mechanical stresses, have the most abundant
number of cell junctions.*
110
Identify the hypothesis:
Presence of **specific bacteria** in the biofilm
directly causes the **tissue destruction**
**Specific Plaque/**
**Microbial Shift Hypothesis**
111
All of the following are predisposing factors for necrotizing periodontal disease EXCEPT:
A. Alcohol use
B. Cigarette smoking
C. Chewing gum
D. Insomnia
C. **Chewing gum**
*Poor self-care (plaque control), Emotional stress,*
*Inadequate sleep, fatigue,
Alcohol use, Caucasian background
Cigarette smoking, Increased levels of personal stress,*
* Poor nutrition, Pre-existing gingivitis or tissue trauma*
* and Young age*
112
Which of the following is the most common type of periodontal disease?
A. Non--plaque-induced gingival diseases
B. Plaque-induced gingival diseases
C. Periodontitis
D. Both B and C above
B. **Plaque-induced gingival diseases**
