Comprehensive Periodontics for the Dental Hygienist, 4E Mea A. Weinberg Test Bank

Type:

Test Bank

Resource:

Comprehensive Periodontics for the Dental Hygienist

Edition:

4th Edition

Author(s):

Mea A. Weinberg Cheryl Theile Stuart Froum Stuart Segelnick

Weinberg: Comprehensive Periodontics for the Dental Hygienist, 4e (0133097714

Comprehensive Periodontics for the Dental Hygienist, 4e (Weinberg) Chapter 1 Anatomy of the Periodontal Structures: The Healthy State

Multiple-Choice Questions 1) The bone that lines the tooth socket is referred to as A) lamina propria.

B) lamina dura.

C) trabecular bone.

D) radibular bone.

E) cancellous bone.

Answer: B 2) Which of the following cells are responsible for the synthesis of collagen?

A) Keratinocytes B) Mast cells C) Fibroblasts D) Plasma cells E) Lymphocytes Answer: C 3) All of the following structures are composed of collagen except one. Which one is the exception?

A) Sulcular epithelium B) Principal fibers C) Gingival fibers D) Cementum E) Alveolar bone Answer: A 4) Which of the following structures represents the fusion of the interproximal junctional epithelia of two adjacent posterior teeth?

A) Fenestration B) Col C) Papilla D) Frenum E) Bone Answer: B 5) The alveolar crest is parallel to a line connecting the A) cusp tip.

B) root prominence.

C) cementoenamel junctions.

D) alveolar crest.

E) periodontal ligament.

Answer: C 1 .

Weinberg: Comprehensive Periodontics for the Dental Hygienist, 4e (0133097714

6) Collagen has been found in many types of body tissue. In which of the following oral tissues is collagen not found?

A) Enamel B) Epithelium C) Bone D) Cementum Answer: B 7) Which of the following statements pertains to the function of the periodontal ligament fibers?

A) They support and give contour to the attached gingiva.

B) They transmit occlusal forces to the bone.

C) They protect the interproximal bone from inflammation.

D) They anchor the tooth to the gingival tissues.

E) They attach the gingiva to the alveolar bone.

Answer: B 8) Which of the following definitions is correct for the junctional epithelium?

A) Connective tissue structure involved in the attachment of the gingiva to the tooth B) Connective tissue that functions to hold the gingiva against the tooth and bone C) Epithelial tissue contributing to the adherence of the soft tissue to the tooth D) Epithelial tissue functioning to protect the underlying oral structures and acting as a mechanical barrier Answer: C 9) Which of the following periodontal ligament fibers is last to develop?

A) Oblique B) Horizontal C) Apical D) Circular E) Dentogingival Answer: C 10) Which of the following definitions refers to Sharpey's fibers?

A) Directly embedded into alveolar bone and cementum B) Running from alveolar bone and inserting into the cementum C) Originating from the crest of the interradicular bone and inserting into the furcation area D) Extending from the cementum into the free gingiva Answer: A 11) Which of the following terms also refers to the dentogingival unit?

A) Junctional epithelium + gingival fibers B) Sulcular depth + sulcular epithelium C) Periodontal ligament + gingival fibers D) Periodontal ligament + biologic width Answer: A

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Weinberg: Comprehensive Periodontics for the Dental Hygienist, 4e (0133097714

12) Which of the following fibers function to resist the forces of pulling out and tipping of a mandibular molar?

A) Interradicular B) Intraradibular C) Oblique D) Horizontal E) Transseptal Answer: A 13) Healthy gingival tissues are considered to be firm and resilient because the main component of the gingival connective tissue is about 60% collagen fibers.

A) Both statement and reason are correct.

B) Both statement and reason are incorrect.

C) The statement is correct, but the reason is incorrect.

D) The statement is incorrect, but the reason is correct.

Answer: A 14) All of the following are considered part of the attachment apparatus except one. Which one is the exception?

A) Oral epithelium B) Alveolar bone C) Periodontal ligament D) Cementum Answer: A 15) Which of the following oral structures is considered to be a semipermeable membrane?

A) Oral epithelium B) Lamina propria C) Periodontal ligament D) Junctional epithelium E) Sulcular epithelium Answer: D 16) Which of the following structures is responsible for holding the free gingiva in close contact with the tooth?

A) Periodontal ligament fibers B) Circular fibers C) Lamina propria D) Oral epithelium Answer: B 17) Which of the following substances/cells is found in the gingival epithelium?

A) Keratin B) Collagen C) Fibroblasts D) Collagenase Answer: A 3 .

Weinberg: Comprehensive Periodontics for the Dental Hygienist, 4e (0133097714

18) Which of the following features occurs with aging?

A) Increased cementum thickness B) Decreased cementum thickness C) Increased number of cells in the periodontal ligament D) Increased vascularity of connective tissue Answer: A 19) Which of the following cells are responsible for synthesizing bone?

A) Osteoclasts B) Osteoblasts C) Fibroblasts D) Cementoblasts Answer: B 20) Which of the following features is characteristic of cementum?

A) Contains many blood vessels B) Contains a good supply of nerves C) Periodontal ligament fibers attach to it D) Surface is hard Answer: C Fill-in-the-Blank Questions 1) The most coronal part of the free gingiva is the ________.

Answer: free gingival margin 2) The gingival crevice is the space between the free gingiva and the ________.

Answer: tooth surface 3) Horizontal fibers connect the alveolar bone proper with the ________.

Answer: cementum 4) The gingival epithelium is ________ and relies upon the underlying lamina propria for its nutrients.

Answer: avascular 5) The junctional epithelium is composed of ________ stratified squamous epithelium.

Answer: nonkeratinized 6) Cementum does not contain blood vessels and thus is considered to be ________.

Answer: avascular

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Weinberg: Comprehensive Periodontics for the Dental Hygienist, 4e (0133097714

Critical Thinking Questions 1) Explain the differences between gingival epithelium and gingival connective tissue.

Answer: The gingival epithelium consists of the oral epithelium, sulcular epithelium, and junctional epithelium. It is avascular and does not contain blood vessels or lymphatics. The oral epithelium functions to protect the underlying structure and acts as a mechanical barrier. The oral epithelium is parakeratinized, the sulcular epithelium is less keratinized, and the junctional epithelium is nonkeratinized. Underlying the epithelium is the vascular gingival connective tissue (lamina propria), which is composed of collagen.

2) What is the function of the gingival connective tissue attachment (fibers)?

Answer: The gingival connective tissue attachment comprises the gingival fibers, which are composed of collagen. The gingival fibers include the circular fibers, which encircle the tooth and provide support and contour to the free gingiva, and the dentogingival fibers, which originate from the cementum and flare coronally into the free gingiva, laterally into the attached gingiva, and apically into the periosteum. Fibers contributing to the support of the gingiva are the dentoperiosteal fibers, which function to anchor the tooth; alveologingival fibers, which attach the gingiva to the alveolar bone; and transseptal fibers, which function to keep teeth in alignment (Figure 1-9).

3) List and explain the functions of the principal fibers.

Answer: The periodontal ligament fibers, which are also composed of collagen, run from the alveolar bone proper to the cementum. The fiber groups are alveolar crest, horizontal, oblique, apical, and interradicular. They function to resist lateral movement, oppose lateral forces, absorb occlusal forces, resist tipping of the tooth, and resist forces of luxation and tipping, respectively.

4) What are the clinical features of gingival versus alveolar mucosa?

Answer: The gingiva is more pink in color than the alveolar mucosa because of the presence of keratin in the gingiva. The color of the alveolar mucosa is darker red than the gingiva because of its highly vascular underlying connective tissue. The alveolar mucosa is compressible and movable due to the presence of a submucosa, which the gingiva does not have.

5) What is the difference between junctional epithelium and oral epithelium?

Answer: The junctional epithelium is considered to be a semipermeable membrane because it is more permeable than the oral or sulcular epithelium. It is composed of nonkeratinized squamous epithelium while the oral epithelium is parakeratinized squamous epithelium. The junctional epithelium is thin.

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Weinberg: Comprehensive Periodontics for the Dental Hygienist, 4e (0133097714

Case Study Questions Case Study 1.1 A patient presents to the clinic. During the gingival examination it is noted that the sinterdental papilla between the maxillary lateral and canine is retractable from the tooth surface. The patient has probing depths ranging from 1 to 3 mm and localized bleeding on probing. The color of the gingiva is coral pink with brown areas. On the radiograph there is close root proximity of the mandibular incisors. The right mandibular first molar has extensive caries. After endodontics is completed, the patient will need a crown.

1) Suggest etiologies for the retractable gingiva.

Answer: The gingival fibers are responsible for holding the gingiva in close proximity to the tooth surface. Since the free gingiva is not close to the tooth, the circular fibers are destroyed, thus not holding the free gingiva close to the tooth.

2) Why is the gingiva brown in localized areas?

Answer: In health, the gingiva is a coral pink but in many individuals there is melanin pigmentation, which is a physiologic feature and not indicative of disease.

3) What is the clinical significance of the radiographic finding in this patient?

Answer: Alveolar bone proper or cribiform plate (on the x-ray it is referred to as the lamina dura) lines the tooth socket. Thus, this bone is in direct contact with the tooth. This bone is hard compact bone. Compact bone also consists of buccal and lingual cortical plates that are continuous with the alveolar bone proper. In between the compact bone is spongy, cancellous bone. Think of a peanut butter sandwich. The two slices of bread are the compact cortical bone, and the peanut butter is the cancellous bone. If the roots of two adjacent teeth are close together (root proximity), there may be a very thin layer of cortical bone, but most likely there will be little to no cancellous bone. Thus, this is clinically important because there will be less interdental bone (in between the teeth) so the bone will be more vulnerable to inflammation that develops in the interdental area.

4) Before endodontics is started, what should the dental clinician be concerned about?

Answer: Before root canal therapy is started, the periodontal condition of the tooth must be evaluated because when caries is present, the amount of tooth remaining becomes important. The biologic width of the tooth is important to determine. Crown lengthening may be necessary if the biologic width has been invaded due to caries or a fracture. There must be an adequate biologic width to place a crown. The biologic width consists of the junctional epithelium (0.97 mm) and the gingival connective tissue attachment (1.07 mm). Thus, about 3–4 mm of tooth structure (measured on the x-ray from the alveolar crest to the anticipated finish line of the crown) must be present to have a healthy biologic width.

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Weinberg: Comprehensive Periodontics for the Dental Hygienist, 4e (0133097714

Matching Questions Match the term in Column A with the correct definition in Column B. A) Separates the attached gingiva from alveolar mucosa B) Consists of the cementum, periodontal ligament, and alveolar bone C) Separates the free gingiva from attached gingiva D) Consists of the junctional epithelium and gingival connective tissue attachment E) Is avascular 1) Mucogingival junction 2) Free gingival groove 3) Oral epithelium 4) Attachment apparatus 5) Biologic width Answers: 1) A; 2) C; 3) E; 4) B; 5) D

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Weinberg: Comprehensive Periodontics for the Dental Hygienist, 4e (0133097714)

Comprehensive Periodontics for the Dental Hygienist, 4e (Weinberg) Chapter 2 Epidemiology of Periodontal Diseases

Multiple-Choice Questions 1) Which of the following sources represents where epidemiologic information about periodontal disease comes from?

A) Gallup poll B) Election poll C) Population survey D) Individual survey E) Phone survey Answer: C 2) The definition of extent of periodontal disease is A) amount of periodontal disease involvement.

B) rate of new cases occurring within a year.

C) number of individuals in a population having the disease.

D) number of diseased teeth or sites per individual.

E) number of risk factors present in an individual.

Answer: D 3) Which of the following statements defines an index?

A) Numerical expression of values used to describe a condition B) Rate of old and new cases occurring within a year C) Number of individuals in a population presenting with the disease D) Number of diseased teeth or sites per individual E) Number of risk indicators present in an individual Answer: A 4) All of the following indices are used in periodontics except one. Which one is the exception?

A) Bleeding B) Plaque C) Calculus D) Suppuration E) Gingival inflammation Answer: D 5) The primary purpose of using an index in medicine/dentistry is to A) standardize and reproduce data collected.

B) make data collection more efficient.

C) supplement clinical data with the patient's medical history.

D) formulate a surgical treatment plan.

Answer: A

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Weinberg: Comprehensive Periodontics for the Dental Hygienist, 4e (0133097714)

6) All of the following are criteria for using indices except one. Which one is the exception?

A) Ease of use B) Quick to perform C) Must have validity D) Has sensitivity E) Measures multiple items Answer: E 7) Plaque indices are used in private practice to measure A) oral cleanliness.

B) degree of tooth mobility.

C) periodontal destruction.

D) attachment loss.

Answer: A 8) Which of the following inflammation indices is used in national epidemiologic surveys, including the National Health and Nutrition Examination Survey (1971–1974)?

A) Sulcus Bleeding Index (Mühlemann and Son 1971) B) Gingival Index (GI) (Löe 1967) C) Periodontal Index (PI) (Russell 1967) D) Calculus Index of the National Institute of Dental Research (Miller et al. 1987) E) Periodontal Screening and Recording (PSR) Answer: C 9) Which of the following is measured using an index of periodontal destruction?

A) Total disease destruction B) Disease severity C) Risk factors for disease D) Degree of calculus and plaque E) Bleeding severity Answer: B 10) Which of the following indices was previously used but later modified to the Periodontal Screening and Recording (PSR) system?

A) Periodontal Index (PI) B) Gingival Index (GI) C) Turesky Modification of the Quigley-Hein Index D) Community Periodontal Index of Treatment Needs (CPITN) Answer: D 11) The prevalence of advanced periodontitis in the population was found to be A) 5%.

B) 10%.

C) 15%.

D) 35%.

E) >50%.

Answer: C 2 .

Weinberg: Comprehensive Periodontics for the Dental Hygienist, 4e (0133097714)

12) When compared with earlier national surveys, gingivitis has declined in the United States because of increased awareness of oral hygiene as part of a daily personal hygiene routine.

A) Both statement and reason are correct.

B) Both statement and reason are incorrect.

C) The statement is correct, but the reason is incorrect.

D) The statement is incorrect, but the reason is correct.

Answer: A 13) Which of the following statements was summarized from the NHANES III study?

A) Females had better periodontal health than males.

B) Older individuals had more periodontal disease.

C) Gingivitis was occurring in overall high rates.

D) Aggressive periodontitis was very common.

Answer: A 14) Which of the following studies is used to determine the natural progression of periodontal diseases?

A) Cross-sectional B) Longitudinal C) Split mouth D) Crossover Answer: B 15) Which of the following factors is considered to be a risk indicator for periodontal disease?

A) Plaque B) Smoking C) Aging D) Diabetes mellitus Answer: C 16) Which of the following statements is true about risk factors?

A) Their presence decreases the probability of getting the disease.

B) They definitively cause the disease.

C) They may not be causal.

D) All are not modifiable.

Answer: C 17) The definition of prevalence is A) the number of individuals in a population having the disease.

B) the severity of periodontal disease involvement.

C) the number of diseased teeth in an individual.

D) the number of markers present.

Answer: A

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Weinberg: Comprehensive Periodontics for the Dental Hygienist, 4e (0133097714)

18) Which of the following statements is true about periodontitis when comparing the NHANES III study and the newer NHANES (1999–2000)?

A) Severity has increased.

B) Prevalence has increased.

C) Prevalence has decreased.

D) Extent has increased.

Answer: C 19) Comparing the NHANES III with the more recent NHANES, the percentage of bleeding has A) decreased.

B) increased double.

C) increased triple.

D) remained the same.

Answer: A 20) The overall prevalence of periodontitis for the NHANES III was 7.3%, while for the NHANES 1999–2000 it was A) 1%.

B) 2.5%.

C) 4.2%.

D) 10.3%.

Answer: C

Fill-in-the-Blank Questions 1) Epidemiologic research is used to detect the underlying patterns of a ________.

Answer: disease 2) ________ is defined as the rate of new cases occurring within a certain period of time.

Answer: Incidence 3) Epidemiologic studies focus on ________ rather than individuals.

Answer: populations 4) ________ measure disease outcomes and so measure past disease.

Answer: Indices 5) ________ is the proportion or number of individuals in a population having the disease.

Answer: Prevalence

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Weinberg: Comprehensive Periodontics for the Dental Hygienist, 4e (0133097714)

Critical Thinking Questions Discuss the topics in epidemiology of periodontal diseases. Then write a synopsis of the discussion on a separate sheet of paper.

1) Define epidemiology.

Answer: Epidemiology is defined as the study of health and disease in the human population. It requires knowing the distribution and occurrence of the disease. The rationale for the study of epidemiology is to identify events and risk factors in populations that lead to disease so that future health problems can be anticipated.

2) Discuss the significance of indices.

Answer: Indices are tools designed to quantify and simplify the disease assessment. An index (singular of indices) is a numerical expression of values used to describe a specific condition.

Epidemiology is used to identify disease patterns, and indices are the measurement systems used for collecting the necessary data to evaluate these disease patterns. An index is used so that standardized data is collected and this data can be reproduced by another clinician. Indices measure disease outcomes and so measure past disease.

3) Describe the role of indices in private practice.

Answer: In clinical practice, treatment plans are formulated based on full-mouth data collection.

When a dental hygienist supplements a patient's clinical examination with index scores to monitor patient conditions over time, these data, along with information obtained from population surveys, can help the clinician predict future disease progression and establish a prognosis for the individual patient.

4) Discuss how the prevalence of periodontal diseases is determined.

Answer: Prevalence is defined as the proportion or number of individuals in a population having the disease (old and new) at a given time. National surveys have helped build knowledge of the prevalence of periodontal diseases in the United States.

5) Define risk factors and risk indicators for periodontal diseases.

Answer: Risk indicators are demographic, behavioral, and socioeconomic characteristics that are associated with disease but are not considered the cause of the disease. For example, aging is a risk indicator for periodontal disease, but does not cause the disease. With increasing age, the prevalence of periodontal disease increases, but the aging process is not responsible for the disease. It is important to understand that risk factors are associated with a disease but do not necessarily cause the disease (e.g., diabetes). Identifying causal relationships may help some oral diseases. Risk factors may be modifiable or nonmodifiable. Modifiable risk factors are usually environmental or behavioral in nature, such as smoking, whereas nonmodifiable risk factors are usually intrinsic to the individual and therefore not easily changed, such as age. Nonmodifiable risk factors are also referred to as determinants. Examples of risk factors that may increase the prevalence of periodontal diseases include dental plaque, smoking, and diabetes mellitus.

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Weinberg: Comprehensive Periodontics for the Dental Hygienist, 4e (0133097714)

6) Discuss incidence and periodontal disease progression.

Answer: Incidence is defined as the rate of new cases occurring within a certain period of time.

Disease prevalence and incidence can only be understood by looking at a large number of individuals within a population, thus longitudinal studies are necessary.

Case Study Questions Case Study 2.1 A study looking at the periodontal condition of a certain group of subjects is being conducted in the dental school. Fifty subjects are included in the study. The material and methods includes a complete gingival and periodontal examination. Certain indices will be performed. Also, many patients have periodontitis, which may be a risk factor for certain medical conditions.

1) Why is it important to perform indices during a clinical study?

Answer: Indices are used in epidemiological studies so that clinical measurements can be reproducible by other investigators.

2) Explain the importance of risk factors in this study. Are risk factors causal?

Answer: Risk factors may or may not be causal. A risk factor that does not cause a disease is called a marker of disease because it marks the increased probability of disease. Even though a risk factor may not cause the disease, it is important to identify potential causal relationships so that oral disease can be prevented if a risk factor is modifiable. Note that when the term risk factor is used throughout this textbook, it is referring to factors that predispose an individual to periodontal disease.

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Weinberg: Comprehensive Periodontics for the Dental Hygienist, 4e (0133097714)

Matching Questions Match the statement in Column A with the correct definition or statement in Column B. A) Silness and Löe Plaque Index B) NHANES III C) Risk factor D) Severity E) Index 1) Index that scores plaque thickness and is used in research 2) National survey that reported on different aspects of the prevalence of periodontal diseases 3) Characteristics that cause the disease 4) Measures past disease activity 5) Degree or amount of periodontal disease involvement Answers: 1) A; 2) B; 3) C; 4) E; 5) D

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Weinberg: Comprehensive Periodontics for the Dental Hygienist, 4e (0133097714)

Comprehensive Periodontics for the Dental Hygienist, 4e (Weinberg) Chapter 3 Dental Biofilm: The Microbiology of the Periodontium in Health and Disease

Multiple-Choice Questions 1) Which of the following statements defines a biofilm?

A) Calcified collection of bacteria that is difficult to remove B) Loose collection of free-floating and attached bacteria C) An acellular opaque film covering the tooth surfaces D) Well-organized, cooperating community of bacteria Answer: D 2) It is difficult for locally applied antimicrobials to have an effect on oral biofilms because biofilms act as a protective barrier for the bacteria.

A) Both statement and reason are correct.

B) Both statement and reason are incorrect.

C) The statement is correct, but the reason is incorrect.

D) The statement is incorrect, but the reason is correct.

Answer: A 3) Which of the following pathogens is strongly associated with periodontal disease?

A) Porphyromonas gingivalis B) Treponema denticola C) Prevotella intermedia D) Capnocytophaga sp.

E) Peptostreptococcus micros Answer: A 4) Which of the following is representative of phase III of biofilm formation?

A) Days 1–2 B) Days 2–4 C) Days 4–7 D) Days 5–8 E) Days 9–10 Answer: C 5) Oral biofilms are surrounded or encircled by a(an) A) intermicrobial matrix.

B) microbial pellicle.

C) dental adhesion.

D) dental lectin.

Answer: A

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Weinberg: Comprehensive Periodontics for the Dental Hygienist, 4e (0133097714)

6) Which of the following bacteria is primarily associated with the development of pregnancy gingivitis?

A) Peptostreptococcus micros B) Treponema denticola C) Aggregator actinomycetemcomitans D) Prevotella intermedia E) Fusobacterium nucleatum Answer: D 7) Subgingival bacteria present in the biofilm get nutrients from A) serous saliva.

B) crevicular fluid.

C) bacterial by-products.

D) calcified plaque.

Answer: B 8) Which of the following bacteria have been documented to actually invade the epithelium and gingival connective tissue?

A) Porphyromonas gingivalis B) Capnocytophaga sp.

C) Prevotella intermedia D) Fusobacterium nucleatum E) Peptostreptococcus micros Answer: A 9) All of the following are enzymes that break down periodontal tissues except one. Which one is the exception?

A) Proteases B) Collagenase C) Hyaluronidase D) Elastase E) Lipase Answer: E 10) Which of the following features is characteristic of unattached (free-floating) subgingival bacteria?

A) Loosely packed B) Removed by flushing C) Removed by scaling and root planing D) Densely packed Answer: B

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Weinberg: Comprehensive Periodontics for the Dental Hygienist, 4e (0133097714)

11) Which of the following types of subgingival plaque is the most virulent?

A) Tooth associated B) Tissue associated C) Unattached D) Attached Answer: B 12) Which of the following bacterial characteristics is associated with periodontal health?

A) Gram-positive, aerobic B) Gram-positive, anaerobic C) Gram-negative, aerobic D) Gram-negative, anaerobic Answer: A 13) In health, the primary oral bacteria is A) Streptococcus sanguis.

B) Prevotella intermedia.

C) Spirochetes.

D) Aggregator actinomycetemcomitans.

E) Tannerella forythensis.

Answer: A 14) All of the following cells are present in dental plaque except one. Which one is the exception?

A) Red blood cells B) Polymorphonuclear neutrophils C) Epithelial cells D) Fibroblasts Answer: D 15) Which of the following bacteria is gram-negative?

A) Actinomyces viscosus B) Eubacterium lentum C) Tannerella forsythus D) Peptostreptococcus micros E) Corynebacterium matruchoti Answer: C 16) Which of the following statements is true about lipooligosaccharide?

A) Found in the cell wall of Actinomyces sp.

B) Initiates inflammation C) Type of exotoxin D) Derived from collagenase Answer: B

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Weinberg: Comprehensive Periodontics for the Dental Hygienist, 4e (0133097714)

17) Which of the following bacteria is strongly associated with localized aggressive periodontitis?

A) Actinomyces viscosus B) Eubacterium lentum C) Tannerella forsythus D) Aggregator actinomycetemcomitans Answer: D 18) Which of the following bacteria is strongly associated with puberty gingivitis?

A) Streptococcus sanguis B) Prevotella intermedia C) Aggregator actinomycetemcomitans D) Tannerella forythensis Answer: B 19) Which of the following bacteria is a gram-negative obligate anaerobe?

A) Streptococcus sanguis B) Porphyromonas gingivalis C) Aggregator actinomycetemcomitans D) Tannerella forythensis Answer: B 20) Which of the following bacteria is a gram-negative facultative rod?

A) Streptococcus sanguis B) Porphyromonas gingivalis C) Aggregator actinomycetemcomitans D) Tannerella forythensis Answer: C 21) What is the correct health state for Gram-negative bacteria A) Gingival health B) Periodontal disease Answer: B 22) What is the correct health state for Nonmotile bacteria A) Gingival health B) Periodontal disease Answer: A 23) What is the correct health state for Motile bacteria A) Gingival health B) Periodontal disease Answer: B 24) What is the correct health state for Obligate anaerobic bacteria A) Gingival health B) Periodontal disease 4 .

Weinberg: Comprehensive Periodontics for the Dental Hygienist, 4e (0133097714)

Answer: B 25) What is the correct health state for Saccharolytic A) Gingival health B) Periodontal disease Answer: A 26) What is the correct health state for Assaccharolytic A) Gingival health B) Periodontal disease Answer: B Fill-in-the-Blank Questions 1) ________ are matrix-enclosed bacterial populations adherent to each other and/or to surfaces.

Answer: Biofilms 2) Unattached gram-negative anaerobic microorganisms are in close proximity to the epithelium and appear to play an important role in the initiation and progression of ________.

Answer: disease 3) ________ degrades collagen fibers in the periodontal tissues.

Answer: Collagenase 4) Aggregator actinomycetemcomitans is specifically associated with the development and progression of ________ periodontitis.

Answer: aggressive 5) Dental ________ are the primary risk factor for inflammatory periodontal lesions.

Answer: biofilms Critical Thinking Questions 1) Listed below are terms used in reviewing the etiology of periodontal diseases. Give an explanation for each item.

A. Dental biofilm B. Unattached subgingival plaque C. Direct effects of bacteria D. Tissue invasion of bacteria Answer: A. Dental plaque has all of the characteristics of a biofilm. Dental biofilm is defined as an intermicrobial matrix containing bacterial populations adherent to each other and/or to surface or interfaces. Bacteria in the biofilm live in "communities" as microcolonies and protect one another through communication. The bacteria in the film send out chemical signals. Biofilms contain multiple microenvironments that vary greatly in pH, oxygen tension, and availability of specific nutrients. The intermicrobial matrix protects the bacteria from outside sources that 5 .

Weinberg: Comprehensive Periodontics for the Dental Hygienist, 4e (0133097714)

would kill or hurt the bacteria.

B. There are three types of subgingival plaque: tooth associated, tissue associated, and unattached. Tooth-associated plaque is densely packed and strongly adherent to the tooth surface (biofilm). It is removed by scaling and root planing and contains less virulent bacteria with limited ability to cause disease. Tissue-associated plaque is loosely packed and loosely adherent to epithelial soft tissue wall. The bacteria are mainly gram-negative motile anaerobes. These bacteria are more virulent and are able to cause "disease." Unattached plaque is free floating in the periodontal pocket. The bacteria are gram-negative motile anaerobes. These bacteria can be removed with "flushing" (e.g., use of oral irrigation). The unattached subgingival plaque is more closely associated with the wall of the subgingival tissues than is the attached plaque.

C. Different combinations of bacteria that live in the mouth (indigenous) and bacteria that come from an outside source (enter the mouth via transmission from saliva from another person) produce the pathogenic (disease) potential necessary to cause periodontal disease. Once these pathogenic bacteria are established in the mouth, the microorganisms appear to cause destruction of the supporting structures by two methods: direct toxic effects on the tissues and indirect activation of host cells. With the direct effect, the subgingival (gram-negative) unattached plaque release endotoxins called lipooligosaccharides (LOS), which can cause tissue inflammation, destroy soft tissue, and stimulate bone resorption. Another direct effect of bacteria action is through the release of certain enzymes from the bacteria. For example, bacteria synthesize and release collagenase that destroys collagen fibers (a major component of gingiva, bone, cementum, and periodontal ligament). Bacteria also release hyaluronidase, which is an enzyme that breaks down hyaluronic acid, a carbohydrate that helps hold tissue and cells together.

D. Most of the time, subgingival bacteria will remain in the "pocket" environment and release their by-products and enzymes in the pocket. These products will then go through the epithelial pocket wall into the gingival connective tissue. However, studies have shown that certain bacteria are very virulent and can go through the epithelial pocket wall into the underlying connective tissue. Aggregator actinomycetemcomitans, Porphyromonas gingivalis, and spirochetes can be found within the epithelium, gingival connective tissue, and alveolar bone.

Studies are unsure if these bacteria actually are active within the tissues; they may be inactive.

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Weinberg: Comprehensive Periodontics for the Dental Hygienist, 4e (0133097714)

2) How do you educate the periodontal patient about the role of risk factors in periodontal diseases and in the healing process?

Answer: It is important to discuss with the patient the different risk factors for periodontal diseases and to indicate which risk factors are involved in his or her disease process. Discuss with the patient how improving oral hygiene habits can influence disease progression and improve the healing response following periodontal therapy. Additionally, discuss the importance of smoking cessation in the progression of the disease and improvement in healing response after periodontal therapy.

3) Why is it necessary to explain to the periodontal patient about the importance of scaling and root planing before any antimicrobials are used?

Answer: Patients may come to the dental office and request Periostat or local delivery of antimicrobial agents because they may have seen it in a magazine or heard about it on the radio or on TV. The importance of removing the biofilms (plaque) must be discussed before any adjunctive antimicrobial therapy is initiated. Scaling is necessary to disrupt the biofilms (although it is very difficult to remove) so that the antimicrobial/antibiotic can more effectively enter the bacteria to provide antimicrobial activity.

4) What do you think the future of microbial biofilms will be in the context of clinical periodontics?

Answer: There is a challenge in periodontics because biofilms are notoriously resistant to removal; bacteria tend to adhere to one another. Microbiology presents a challenge in periodontics and future studies need to be done to identify several different types (clones) of specific bacteria.

Case Study Questions Case Study 3.1 A 32-year-old patient presents to the dental office. She is 5 months pregnant and complains of bleeding gums.

1) What do you tell the patient is the cause of her bleeding gums?

Answer: The bacteria involved in causing pregnancy gingivitis is Prevotella intermedia.

2) How do the bacteria exert their action in causing periodontal destruction?

Answer: Prevotella intermedia is a gram-negative obligate anaerobic rod that has both direct and indirect actions on the periodontium. Direct actions involve enzymes that break down tissue (e.g., collagenase breaks down collagen in the connective tissue). Periodontal destruction can occur via indirect action, which involves stimulating the immune response.

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Comprehensive Periodontics for the Dental Hygienist, 4e (Weinberg) Chapter 4 Bacteria and the Host Response: Inflammatory and Immunology Fundamentals

Multiple-Choice Questions 1) The migration of neutrophils (PMNs) to the site of an invading pathogen is due to A) clotting.

B) self-recognition.

C) phagocytosis.

D) chemotaxis.

Answer: D 2) Humoral immunity is provided by A) plasma cells.

B) B-cells.

C) T-cells.

D) neutrophils.

E) macrophages.

Answer: B 3) Which of the following cells is considered to be phagocytic?

A) T-cell B) B-cell C) Macrophage D) Plasma cell Answer: C 4) Neutrophils arrive at the site of infection in the gingival connective tissue from the A) blood vessels.

B) alveolar bone.

C) gingival epithelium.

D) periodontal ligament.

E) lymph vessels.

Answer: A 5) Which of the following theories of periodontal disease activity are believed to occur by clusters or bursts of breakdown in a short time period?

A) Random burst B) Asynchronous multiple burst C) Continuous D) Specific burst Answer: A

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Weinberg: Comprehensive Periodontics for the Dental Hygienist, 4e (0133097714)

6) Which of the following substances specifically kills neutrophils?

A) Leukotoxin B) Endotoxin C) Ammonia D) Sulfur Answer: A 7) All of the following substances released by bacteria are considered toxic to host cells except one. Which one is the exception?

A) Endotoxin B) Leukotoxin C) Histamine D) Exotoxin E) Hyaluronidase Answer: C 8) The host (body) interacts with microorganisms in the pocket via the A) saliva.

B) crevicular fluid.

C) gingival epithelium.

D) gingival connective tissue.

Answer: B 9) Which of the following tissue structures acts as a protective barrier for the passage of antigenic substances?

A) Gingival connective tissue B) Alveolar bone C) Junctional epithelium D) Hemidesmosomes Answer: C 10) The definition of phagocytosis is A) eat and digest.

B) squish and swallow.

C) enzymatic degradation.

D) chemical degradation.

Answer: A 11) Which of the following substances is a type of cytokine?

A) Collagenase B) Proteinase C) Hyaluronidase D) Interleukin-1 E) Gelatinase Answer: D

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12) Which of the following substances "coat" the bacteria to aid in phagocytosis?

A) Opsonins B) Cytokines C) Collagenases D) Elastases Answer: A 13) Which of the following immunoglobulins is found in saliva?

A) IgA B) IgG C) IgM D) IgD E) IgE Answer: A 14) Which of the following cells predominate in the body's response to periodontitis?

A) T-lymphocytes B) B-lymphocytes C) Neutrophils D) Macrophages Answer: B 15) Which of the following systems is activated by the antigen (bacteria)/antibody complex?

A) Phagocytosis B) Opsonization C) Complement D) Humoral Answer: C 16) Which of the following substances/cells are involved in bone destruction?

A) B-cells B) Histamines C) Macrophages D) Neutrophils Answer: B 17) Which of the following substances is released from mast cells and causes vasodilation seen in acute inflammation?

A) Gingival crevicular fluid B) Histamine C) Cytokine D) Ammonia Answer: B

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18) Clinically, vasodilation is seen as A) edema.

B) fibrosis.

C) blunted papillae.

D) destruction of the col.

Answer: A 19) From the tissues, antigenic substances are carried to the A) local blood vessels.

B) local lymph nodes.

C) junctional epithelium.

D) lamina propria.

Answer: B 20) Which of the following substances regulates the activity of different cells in the inflammatory/immune response?

A) Histamine B) Bradykinin C) Cytokine D) Crevicular fluid Answer: C

Fill-in-the-Blank Questions 1) ________ is the loss of clinical connective tissue attachment with subsequent bone loss.

Answer: Periodontitis 2) The ongoing loss of clinical connective tissue attachment and bone is referred to as periodontal disease ________.

Answer: activity 3) The predominant phagocytic cell is ________.

Answer: neutrophil 4) The host response is a natural ________ mechanism.

Answer: defense 5) The major cells of the immune system are the ________.

Answer: lymphocytes 6) ________ are synthesized and released by plasma cells.

Answer: Antibodies 7) Periodontal diseases are involved in ________ immunity.

Answer: humoral 4 .

Weinberg: Comprehensive Periodontics for the Dental Hygienist, 4e (0133097714)

Critical Thinking Questions 1) How can the variation in individual responses to pathogens be explained to patients?

Answer: Everyone reacts differently to the same antigens (bacterial pathogens) because of a unique host response to these antigens. That is also why risk factors do not necessarily cause the disease but rather increase the chances of an individual's getting the disease.

2) What is the difference between the inflammatory and immune responses seen during the periodontal disease process?

Answer: Initiation of the inflammatory system is the initial reaction of the host (body) to an antigen (bacterial pathogen). The neutrophils and macrophages come to the site of infection (gingival connective tissue) to kill the bacteria by phagocytosis. This is a nonspecific protective mechanism. If this fails, then the specific protective mechanism becomes activated. This involves the immune system (humoral immunity) and the lymphocytes.

Case Study Questions Case Study 4.1 A 25-year-old female patient came to the office for a routine maintenance appointment. She admits her hygiene has been poor for the last week because she is under a lot of stress. A gingival assessment revealed erythematous and edematous gingiva that bled easily when probed.

1) Does this patient have acute or chronic inflammation and why?

Answer: The patient has acute inflammation. Bacterial plaque is the antigen (similar to a splinter) that is causing the body to react to it, wall it off, and get rid of it. This process involves the activation of the inflammatory and immune systems. The patient has acute inflammation, not chronic, because she has been on a regular recall schedule so that the inflammation has not been there for a long time. If the acute inflammatory response does not take care of the antigens, then the chronic inflammatory response takes over.

2) Why is the gingiva erythematous and edematous? Why does the gingiva bleed on probing?

Answer: The gingiva is red because of the initial response to the bacterial plaque, which is vasodilation of the blood vessels in the lamina propria (connective tissue). The primary substance responsible for the vasodilation and increased permeability of the blood vessel is histamine. The gingival plexus, which is located in the lamina propria adjacent to the junctional epithelium, is rich in blood vessels. These blood vessels engorge themselves when dilated. This, in conjunction with microulcerations in the epithelium, causes the engorged blood vessels to protrude through the ulcerations, resulting in bleeding on probing. The gingival is edematous or "fluid-filled" or "swollen" because when the blood vessel wall becomes more permeable, this allows blood and fluid to leak out into the connective tissue, which makes the tissue feel "fluidfilled" or edematous with finger pressure. Vasodilation shows up clinically as edema.

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3) Explain how the immune system is involved in this patient's condition.

Answer: The host response in periodontal disease had three parts to it: acute inflammatory response (described above), the humoral immune or antibody response, and the cellular immune response. The humoral immune response is responsible for making antibodies to the different periodontal bacteria. Both B-lymphocytes and T-lymphocytes are involved in the cellular immune response. B-cells are now thought to be involved in bone destruction. However, in this patient only gingivitis is present.

Matching Questions Match the definition/statement in Column A with the correct term in Column B. A) Neutrophil B) B-lymphocytes C) T-lymphocytes D) Antibodies E) Macrophage F) Antigen 1) First inflammatory cell to arrive at the inflamed site 2) Called a monocyte in the blood 3) Proteins produced by plasma cells 4) Considered to be a foreign material (e.g., bacteria) 5) Cells involved in humoral immunity 6) Targets the human immunodeficiency virus Answers: 1) A; 2) E; 3) D; 4) F; 5) B; 6) C

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Weinberg: Comprehensive Periodontics for the Dental Hygienist, 4e (0133097714)

Comprehensive Periodontics for the Dental Hygienist, 4e (Weinberg) Chapter 5 Local Contributory Factors for the Periodontal Diseases

Multiple-Choice Questions 1) Which of the following factors is contributory for periodontal diseases?

A) Cigarette smoking B) Diabetes mellitus C) Dental biofilms D) Tooth anatomy Answer: D 2) Which of the following statements is related to palatogingival grooves?

A) They can cause a narrow deep pocket.

B) They are easy to eliminate.

C) They present no problems.

D) They increase the chances of furcation involvement.

Answer: A 3) Which of the following injuries to the periodontium is considered to be chemical?

A) Toothbrush trauma B) Nail scratching C) Aspirin tablets D) Food impaction E) Overhanging restoration Answer: C 4) Proximal furcation involvement on maxillary molars presents with more problems than buccal furcation involvement because of limited access to proximal surfaces.

A) Both statement and reason are correct.

B) Both statement and reason are incorrect.

C) The statement is correct, but the reason is incorrect.

D) The statement is incorrect, but the reason is correct.

Answer: A 5) Calculus is a contributing factor for the initiation and progression of the periodontal diseases because calculus has a solid surface structure on which plaque will accumulate.

A) Both statement and reason are correct.

B) Both statement and reason are incorrect.

C) The statement is correct, but the reason is incorrect.

D) The statement is incorrect, but the reason is correct.

Answer: C

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Weinberg: Comprehensive Periodontics for the Dental Hygienist, 4e (0133097714)

6) On which of the following teeth is a palatogingival groove most commonly seen?

A) Maxillary canine B) Maxillary lateral incisor C) Mandibular central incisor D) Mandibular canine E) Mandibular first molar Answer: B 7) Radiographic evaluation of calculus is an effective diagnostic method because what is seen on the radiograph is usually what is present clinically.

A) Both statement and reason are correct.

B) Both statement and reason are incorrect.

C) The statement is correct, but the reason is incorrect.

D) The statement is incorrect, but the reason is correct.

Answer: B 8) All of the following are reasons for orthodontic appliances being a contributing factor for periodontal disease except one. Which one is the exception?

A) Limited access for oral hygiene B) Uneven wires and brackets are plaque retentive C) Bands on molar are plaque retentive D) Appliance causes chemical injury to the gingival Answer: D 9) All of the following are modes of attachment of calculus to the tooth surface except one.

Which one is the exception?

A) Mechanical locking B) Chemical locking C) Penetration into bacteria D) Organic pellicle Answer: B 10) Which of the following reasons explains why subgingival calculus is usually black?

A) Supragingival saliva B) Crevicular fluid C) Subgingival enzymes D) Salivary crystals Answer: B 11) Which of the following statements describes what calcified plaque is?

A) Calculus B) Subgingival biofilm C) Enamel pearls D) Cervical enamel projection Answer: A

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Weinberg: Comprehensive Periodontics for the Dental Hygienist, 4e (0133097714)

12) Which of the following factors is the most significant dentally related local factor strongly associated with an increased probability of developing periodontal diseases?

A) Presence of gingivitis B) Presence of established periodontal disease C) Whether patient is right- or left-handed D) Number of bleeding sites Answer: B 13) Which of the following contributory factors is important for the accumulation of dental biofilms?

A) Anatomic B) Chemical C) Traumatic D) Irritational Answer: A 14) Which of the following conditions may occur in a dentition with uneven marginal ridges?

A) Food impaction B) Tooth mobility C) Furcation involvement D) Pulpitis Answer: A 15) All of the following are intrinsic tooth stains except one. Which one is the exception?

A) Nonvital pulp B) Chlorhexidine C) Tetracycline D) Decalcification E) Fluorosis Answer: B 16) Which of the following contributing factors can cause gingival recession?

A) Tongue ring B) Xerostomia C) Phenytoin D) Nifedipine Answer: A 17) Which of the following statements about calculus attachment to dental implants versus natural tooth structure is true?

A) There is greater attachment to an implant surface.

B) There is more superficial attachment to an implant surface.

C) There is more complicated attachment to an implant surface.

D) The attachment to an implant surface is similar to attachment to a natural tooth surface.

Answer: B

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18) Which of the following features is characteristic of dental calculus?

A) It contains more than 500 bacterial species.

B) It is calcified bacterial plaque.

C) It contains specific species of fungi.

D) It is hypomineralized bacterial plaque.

Answer: B 19) All of the following are local contributing factors for periodontal diseases except one. Which one is the exception?

A) Oral piercing B) Dental calculus C) Toothbrush trauma D) Bacterial plaque Answer: D 20) Which of the following substances is found in high amounts in calculus?

A) Fluoride B) Silica C) Hydroxyapatite D) Tricalcium phosphate Answer: C

Fill-in-the-Blank Questions 1) Calculus is an important contributing factor because its surface is ________.

Answer: porous 2) Only ________% of surfaces with clinically visible calculus are detected radiographically.

Answer: 45 3) Palatogingival grooves are predominantly found on maxillary ________ incisors.

Answer: lateral 4) Uneven marginal ridges can cause ________ impaction.

Answer: food 5) ________ restorations can contribute to more advanced periodontitis.

Answer: Overhanging 6) ________ enamel projections are found in the furcation area.

Answer: Cervical 7) A tooth with a palatogingival groove may have ________ probing depths.

Answer: deep

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8) Enamel ________ is a potential plaque trap.

Answer: pearl 9) Supragingival calculus accumulation on the maxillary first molar is due to the location of ________ duct.

Answer: Stensen's 10) Supragingival calculus accumulation on the lingual surfaces of the mandibular incisors is due to the location of the ________ and ________ glands.

Answer: submandibular, sublingual

True/False Questions 1) Dental plaque is an established primary factor for the periodontal diseases.

Answer: TRUE 2) Furcation involvements create a plaque trap.

Answer: TRUE 3) CEP refers to cervical enamel projection.

Answer: TRUE 4) Palatogingival grooves are primarily found on mandibular canines.

Answer: FALSE 5) Enamel pearls are ridges of enamel found on the cementum.

Answer: TRUE 6) Calculus is an established contributory factor for the periodontal diseases.

Answer: TRUE 7) It is not important to control or eliminate contributory factors.

Answer: FALSE 8) Contributory means that the factor does not by itself cause initial periodontal inflammation.

Answer: TRUE

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Critical Thinking Questions Discuss relevant information regarding the development of periodontal diseases.

1) Discuss possible contributing factors for periodontal diseases.

Answer: Contributing factors for periodontal diseases include overhanging restorations, calculus, and traumatic factors (e.g., toothbrush and floss trauma, food impaction).

2) A patient's chief complaint is "food impaction." How do you address the patient's chief complaint?

Answer: The patient's chief complaint is food impaction. The patient has extensive restorations in the mouth that are poorly contoured with open contacts. This may be the cause of the food impaction. Consult with the dentist to redo these restorations.

3) A patient has localized deep probing depths. Should you be concerned about the deep probing depths?

Answer: The deep probing depths are of concern. You should determine why these areas have attachment loss. Most likely considering the patient's age, these localized areas are due to overhanging restorations. Consult with the dentist to redo these restorations.

4) Discuss gingival signs that may be evident when a patient uses an incorrect brushing and flossing technique.

Answer: Contributing factors include flossing and toothbrush trauma. Incorrect flossing can cause "flossing clefts" in which there is a cleft from the gingival margin apically. Teach the patient to hug the tooth with the floss. If he is unable to do so, recommend floss in holder.

Incorrect toothbrushing can damage and/or destroy a narrow band of gingiva and result in gingival recession.

Case Study Questions Case Study 5.1 A 30-year-old female presents to the dental office for restorative care. A dental/periodontal examination revealed crowding of the lower anterior teeth and a deep pocket on the palatal of the maxillary left lateral incisor. There is generalized bleeding and edematous gingiva. She states she brushes "when she feels like it." There are generalized heavy dental plaque and calculus deposits.

Radiographs show no bone loss.

1) What is the primary risk factor in this patient's periodontal condition?

Answer: The primary risk factor that is present in this patient is dental biofilms. The patient admits to not brushing, and there is generalized bleeding and plaque deposits.

2) What are contributory factors involved in this patient's periodontal condition?

Answer: Contributing factors include teeth crowding and the presence of a palatogingival groove on the palatal surface of the maxillary lateral incisor. This groove is usually associated with an isolated deep pocket. The groove can be of any depth and length on the root.

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3) Why are there heavy deposits especially on the lingual surfaces of the mandibular anterior teeth?

Answer: Supragingival calculus accumulates on the mandibular incisors because of the opening of Wharton's duct.

Matching Questions Match the term in Column A with the correct state or definition in Column B. A) Plaque trap B) Porous surface C) Incisor D) Furcation 1) Calculus 2) Palatogingival groove 3) Overhang 4) Cervical enamel projection Answers: 1) B; 2) A; 3) C; 4) D

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Weinberg: Comprehensive Periodontics for the Dental Hygienist, 4e (0133097714)

Comprehensive Periodontics for the Dental Hygienist, 4e (Weinberg) Chapter 6 The Oral-Systemic Disease Connection

Multiple-Choice Questions 1) All of the following are systemic conditions that can cause an increased predisposition to periodontal diseases except one. Which one is the exception?

A) Diabetes mellitus B) Vitamin A deficiency C) AIDS D) Neutropenia E) Stress Answer: B 2) Which of the following conditions can develop in patients receiving chemotherapy and bisphosphonates for more than 3 years?

A) Bacteremia B) Osteonecrosis of the jaw C) Infective endocarditis D) Kidney failure Answer: B 3) Which of the following statements explains the reason stress increases the susceptibility to periodontal infections?

A) Increased red blood cells B) Reduced host immune response C) Decreased neutrophil chemotaxis D) Decreased production of steroids Answer: B 4) Which of the following mechanisms is affected by cigarette smoke, thus increasing the susceptibility to periodontal diseases?

A) Altered PMN function B) Altered monocyte function C) Decreased lymphocytes D) Decreased plasma cells E) Decreased esosinophils Answer: A 5) All of the following medications may cause an exaggerated response to plaque except one.

Which one is the exception?

A) Phenytoin B) Nifedipine C) Cyclosporine D) Aspirin Answer: D 1 .

Weinberg: Comprehensive Periodontics for the Dental Hygienist, 4e (0133097714)

6) Which of the following adverse effects can occur when taking a diuretic?

A) Xerostomia B) Hepatitis C) Pancreatitis D) Osteonecrosis of the jaw Answer: A 7) Periodontal diseases are possible risk factors for all of the following conditions except one.

Which one is the exception?

A) Emphysema B) Bronchitis C) Atherosclerosis D) Hepatitis E) Diabetes mellitus Answer: D 8) Pregnant women with periodontal disease may have a preterm delivery because of elevated levels of A) glucose.

B) thyroid hormone.

C) prostaglandin E2.

D) liver enzymes.

E) sodium and chloride.

Answer: C 9) Which of the following factors is related to periodontal destruction in smokers?

A) Increase in number of periodontal pathogens B) Decrease in healthy bacteria C) Reduced vitamin C levels D) Altered polymorphonuclear leukocyte function Answer: D 10) Which of the following factors may increase the chance of developing respiratory disease in patients with periodontal diseases?

A) Alcohol intake B) Inadequate plaque control C) Increased carbohydrate diet D) Increased fatty diet Answer: B

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Weinberg: Comprehensive Periodontics for the Dental Hygienist, 4e (0133097714)

11) The Parameter of Care (Academy of Periodontology) suggests that the initial therapy for patients with periodontal inflammation should include the elimination, alteration, or control of risk factors because periodontal diseases are infections and may have several associated risk factors.

A) Both statement and reason are correct.

B) Both statement and reason are incorrect.

C) The statement is correct, but the reason is incorrect.

D) The statement is incorrect, but the reason is correct.

Answer: A 12) Which of the following respiratory diseases has been studied in relationship to periodontal diseases?

A) Pneumonia B) Viral infection C) Postnasal drip D) Nasal congestion Answer: A 13) Which of the following substances is the major factor in developing respiratory diseases in patients with periodontal disease?

A) Saliva B) Nicotine C) Neutrophils D) Bacteria Answer: D 14) Which of the following substances is measured to determine genetic susceptibility to periodontal diseases?

A) Neutrophil B) Plasma cell C) Interleukin-1 D) Collagenase E) Elastase Answer: C 15) All of the following congenital diseases have periodontal manifestations except one. Which one is the exception?

A) Papillon-Lefévre syndrome B) Chediak-Higashi disease C) Autism D) Hypophosphatasia E) Cyclic neutropenia Answer: C

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Weinberg: Comprehensive Periodontics for the Dental Hygienist, 4e (0133097714)

16) For which of the following medical/dental conditions is a bisphosphonate indicated?

A) Multiple myeloma B) Type 2 diabetes mellitus C) Stomach ulcers D) Periodontal abscess Answer: A 17) Which of the following cells are inhibited by bisphosphonates?

A) Osteoblasts B) Osteoclasts C) Fibroblasts D) Neutrophils Answer: B 18) There is much concern when a bisphosphonate is taken A) intramuscularly.

B) orally.

C) topically.

D) intravenously.

Answer: C 19) Which of the following features is prominent in osteonecrosis of the jaw (ONJ)?

A) Necrotic bone B) Fistula (sinus tract) C) Bleeding D) Edematous gingival Answer: A 20) Which of the following features is characteristic of bisphosphonates?

A) Osteoblast inhibitor B) Binds to soft tissue C) Short half-life D) Long half-life Answer: D

Fill-in-the-Blank Questions 1) General health affects a patient's ________ to the development of periodontal disease.

Answer: resistance 2) It is now known that ________ susceptibility factors play a role in high-risk periodontal patients.

Answer: host 3) ________ (along with depression, financial problems, and other psychosocial factors) is another systemic risk factor for periodontitis because it may depress the immune response.

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Weinberg: Comprehensive Periodontics for the Dental Hygienist, 4e (0133097714)

Answer: Stress 4) ________ is associated with a reduced ability to cope with infections and with impaired wound healing.

Answer: Diabetes 5) Osteonecrosis of the jaw can occur in patients taking a ________.

Answer: bisphosphonate 6) Patients with uncontrolled diabetes and periodontal disease have multiple or recurrent periodontal ________.

Answer: abscesses 7) ________ women may exhibit an exaggerated gingival response to plaque accumulation.

Answer: Pregnant 8) Patients with human immunodeficiency virus (HIV) or AIDS are more vulnerable to ________ diseases.

Answer: necrotizing 9) Tobacco smoking can impair the ________ and phagocytosis of neutrophils.

Answer: chemotaxis 10) Peri-implant refers to ________ the implant.

Answer: around 11) ________ tobacco leads to cancerous changes in the soft tissue.

Answer: Chewing 12) Several medications, such as nifedipine, can cause gingival ________.

Answer: enlargement 13) ________ diseases may also be risk (causal) factors for developing diabetes mellitus.

Answer: Periodontal 14) Periodontal diseases have been linked with an increased risk for ________ and thromboembolisms.

Answer: atherosclerosis 15) Women with periodontal disease may be more predisposed to deliver ________ infants with low birth weight.

Answer: preterm

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Weinberg: Comprehensive Periodontics for the Dental Hygienist, 4e (0133097714)

Critical Thinking Questions Discuss the role systemic conditions or risk factors have for the development and progression of periodontal diseases.

1) Why are some periodontal patients more susceptible to develop systemic diseases such as diabetes mellitus?

Answer: General health affects a patient's resistance to the development of periodontal diseases.

For example, patients with diabetes mellitus are more susceptible to the development of periodontal disease because of a reduced host immune response. The host (the body) differs between individuals and plays an important role in the susceptibility to diseases. Diabetics have a reduced immune response because of a defect in the function of the polymorphonuclear leukocytes (PMNs; white blood cells), which are responsible for chemotaxis (signals other inflammatory cells to come to the infected area) and phagocytosis (engulfing of bacteria).

Prevention and control of periodontal disease must be considered an integral part of diabetes control.

2) What is the impact of periodontitis on the metabolic control and risk for diabetic complications?

Answer: Periodontal disease may contribute to difficulty controlling sugar levels in patients who are diabetic. Again, host response plays an important role in both periodontal disease and diabetes mellitus. Diabetes mellitus is associated with an increased prevalence and severity of gingivitis and periodontitis. On the contrary, periodontitis may increase the risk for worsening glycemic control in diabetic patients and may increase the risk of developing diabetic complications. This is because of a condition called insulin resistance. Insulin resistance is more commonly found in type 2 diabetes mellitus. Diabetics usually have alterations in carbohydrates, protein, and lipid metabolism, which is manifested as high sugar (glucose) levels, referred to as hyperglycemia. This is due to a lack of insulin secretion by the pancreas or a decrease in insulin activity. Insulin resistance occurs when the body does not respond to insulin properly so that more insulin is required for it to have its effect. Thus, good glycemic control is important for diabetes and periodontal disease.

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Weinberg: Comprehensive Periodontics for the Dental Hygienist, 4e (0133097714)

Case Study Questions Case Study 6.1 A 65-year-old male patient has been taking Zometa on and off for the last year for multiple myeloma. The mandibular first molar has extensive caries and will require endodontic therapy.

There is not enough tooth structure left, so the patient will also have to have crown-lengthening procedures.

1) Explain the medical/dental concerns for this patient.

Answer: There are concerns regarding dental treatment of this patient because intravenous bisphosphonates have been linked to the development of osteonecrosis of the jaw (ONJ) after certain dental procedures.

2) Discuss the adverse effects of bisphosphonates and how to manage them.

Answer: Bisphosphonates are drugs used orally and intravenously for the treatment and prevention of osteoporosis, hypercalcemia (high blood calcium that occurs in cancer), metastatic bone disease (to decrease bone pain), multiple myeloma (cancer of the body's plasma cells), and Paget's disease. Bone is a living tissue with a blood supply. Every year bone dies off and is replaced with new bone. Osteoclasts resorb the bone and osteoblasts lay down new bone.

Bisphosphonates reduce this bone cell turnover by affecting the osteoclasts. Osteoclasts ingest the bisphosphonate and die within 2 days, thus supporting the buildup of new bone, even around the old bone that was not resorbed by the osteoclasts, which helps reduce fractures in the hip, spine, and other areas. Normally, osteoclasts live for 14 days. Also, bisphosphonates reduce high blood calcium levels caused by cancer. Thus, the most concerning adverse effect of bisphosphonates is the development of osteonecrosis of the jaw (ONJ) in patients having dental procedures. The underlying mechanism of action of ONJ is not clearly understood but as described above, if necrotic (old, diseased/dead) bone is inhibited from being resorbed by osteoclasts, then the necrotic bone will inhibit healing and affect blood supply to the area.

Precipitating factors associated with ONJ include extractions, periodontal/implant surgery, and endodontics.

3) Should the patient have the procedures in the treatment plan?

Answer: Since the patient is taking an intravenous bisphosphonate, it is probably best not to extract the tooth but an alternate procedure would be to perform root canal treatment for the meantime.

Matching Questions Match the term in Column A with the correct term in Column B. A) Nifedipine B) Preterm baby C) Diabetes mellitus D) Pneumonia 7 .

Weinberg: Comprehensive Periodontics for the Dental Hygienist, 4e (0133097714)

E) Osteoclasts 1) Aspiration of oral bacteria 2) Impaired wound healing 3) Exaggerated response to biofilms 4) Prostaglandin PGE2 5) Bisphosphonates Answers: 1) D; 2) C; 3) A; 4) B; 5) E

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Weinberg: Comprehensive Periodontics for the Dental Hygienist, 4e (0133097714)

Comprehensive Periodontics for the Dental Hygienist, 4e (Weinberg) Chapter 7 Gingival Diseases

Multiple-Choice Questions 1) Which of the following bacteria has been implicated in pregnancy gingivitis?

A) Prevotella intermedia B) Porphyromonas gingivalis C) Aggregator actinomycetemcomitans D) Streptococcus mutans Answer: A 2) All of the following conditions are classified (AAP Classification 1999) as gingival diseases except one. Which one is the exception?

A) Malnutrition B) Allergic reactions C) Lupus erythematosus D) Physical injury E) Pericoronal abscess Answer: E 3) Gingivitis is a disease affecting the soft tissues because the inflammatory infiltrate is confined to the gingival.

A) Both statement and reason are correct.

B) Both statement and reason are incorrect.

C) The statement is correct, but the reason is incorrect.

D) The statement is incorrect, but the reason is correct.

Answer: A 4) All of the following are local factors associated with gingival diseases except one. Which one is the exception?

A) Medications B) Dental restorative materials C) Systemic diseases D) Occlusal trauma E) Fungal infections Answer: D 5) Which of the following terms describes the gingival condition of a patient taking nifedipine?

A) Loss of attachment B) Gingival enlargement C) Bone loss D) A periodontal pocket Answer: B .

Weinberg: Comprehensive Periodontics for the Dental Hygienist, 4e (0133097714)

6) Which of the following viral diseases is listed as gingival disease of viral origin?

A) Primary herpetic gingivostomatitis B) Hereditary gingival fibromatosis C) Pemphigoid D) Pemphigus vulgaris E) Linear gingival erythema Answer: A 7) All of the following classifications are listed as gingival diseases modified by medications except one. Which one is the exception?

A) Gingival enlargements B) Oral contraceptive-associated gingivitis C) Drug-influenced gingivitis D) Recurrent oral herpes Answer: D 8) Which of the following statements describes a gingival pocket?

A) Sometimes referred to as a periodontal pocket B) Bone loss is present.

C) Gingival enlargement D) Attachment loss is present.

Answer: C 9) Which of the following is true about the host response to gingival inflammation?

A) First response is an acute vasodilation.

B) Migration of lymphocytes C) Increased number of fibroblasts D) Decreased movement of immune cells Answer: A 10) Vascular changes during gingivitis occur in the A) oral epithelium.

B) sulcular epithelium.

C) lamina propria.

D) lamina dura.

E) periodontal ligament.

Answer: C 11) Which of the following risk factors is primarily associated with gingivitis?

A) Dental biofilms B) Dental calculus C) Systemic medication D) Viral diseases E) Fungal diseases Answer: A

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Weinberg: Comprehensive Periodontics for the Dental Hygienist, 4e (0133097714)

12) All of the following statements are true concerning diabetes mellitus except one. Which one is the exception?

A) It presents an important risk factor for gingivitis.

B) It presents an important risk factor for periodontitis.

C) It results in viral infections.

D) It results in hypoglycemia.

E) It alters wound healing.

Answer: D 13) Which of the following microorganisms is associated with puberty gingivitis?

A) Prevotella intermedia B) Porphyromonas gingivalis C) Streptococcus mutans D) Treponema denticola E) Staphylococcus aureus Answer: A 14) Which of the following terms is used to describe a gingival condition that is of long duration to only a few anterior teeth?

A) Acute, localized B) Acute, generalized C) Chronic, localized D) Chronic, generalized Answer: C 15) In which stage of gingival inflammation is bleeding on probing seen?

A) Initial stage B) Early stage C) Established stage D) Advanced stage Answer: B 16) In which of the following lesions does clinical gingivitis first appear?

A) Initial B) Early C) Established D) Advanced Answer: C 17) The inflammatory cells involved in the host's response come from A) blood vessels in the connective tissue.

B) lymph nodes in the tissue.

C) alveolar bone.

D) periodontal ligament.

E) cementum.

Answer: A .

Weinberg: Comprehensive Periodontics for the Dental Hygienist, 4e (0133097714)

18) In which of the following stages is the B-cell found?

A) Initial and early B) Early and established C) Established and advanced D) Initial and advanced E) Early and advanced Answer: C 19) What percentage of collagen is lost in the connective tissue during the early lesion?

A) 10–20 B) 30–40 C) 50–60 D) 60–70 E) 70–80 Answer: D 20) Which of the following cells make up the protective wall between the plaque mass and the junctional epithelium?

A) Neutrophils B) Plasma cells C) B-lymphocytes D) T-lymphocytes Answer: A

Fill-in-the-Blank Questions 1) Page and Schroeder's Stages of Histopathogenesis of periodontal diseases were based on ________ models.

Answer: animal 2) The initial lesion is ________ dominated.

Answer: neutrophil 3) The ________ lesion is considered to be chronic gingivitis.

Answer: established 4) The ________ lesion is T-cell dominated.

Answer: early 5) B-lymphocytes predominate in the body's response to ________.

Answer: periodontitis

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Weinberg: Comprehensive Periodontics for the Dental Hygienist, 4e (0133097714)

Critical Thinking Questions 1) Discuss the importance of including a classification of gingival diseases in the newest 1999 Academy of Periodontology Classification of Periodontal Diseases.

Answer: In the development of a detailed classification of gingival diseases and lesions, dental plaque was not included until the latest 1999 classification from the American Academy of Periodontology. This inclusion was an acknowledgment that the clinical expression of gingivitis can be substantially modified by (a) systemic factors (e.g., endocrine), (b) medications (e.g., phenytoin), and (c) malnutrition. Many plaque and non-plaque-related gingival diseases are frequently encountered in clinical practice.

2) A 22-year-old male patient has not brushed his teeth for the past 2 weeks because he is too busy with school. What are the histopathologic/inflammatory and immune changes that are occurring in the tissues?

Answer: This patient has not brushed for 2 weeks. This is considered the established stage of chronic gingivitis with all of the signs and symptoms of gingivitis. There is gingival redness and bleeding. At this stage the B-lymphocytes predominate and antibodies are being produced that will form a complex with the foreign antigen (bacteria) and will stimulate the complement system.

3) Discuss the clinical features of plaque-induced gingivitis.

Answer: Clinical features of plaque-induced gingivitis include plaque at the gingival margin, change in gingival color, contour, consistency and surface texture, gingival bleeding, and no attachment loss or bone loss. It is reversible with adequate plaque control.

Case Study Questions Case Study 7.1 A 42-year-old pregnant female patient has not brushed her teeth for the past 3 days because of a stressful situation in her life. Examination of the gingival tissues did not reveal any bleeding or redness, and she has no chief complaint. She states she is here because she chipped a tooth.

1) What are the histopathologic/inflammatory and immune changes that are occurring in the tissues?

Answer: This patient's periodontal disease is in the initial phase or lesion. The clinical symptoms of plaque accumulation such as redness and gingival bleeding are not evident because this stage is considered to be subclinical, no signs or symptoms of gingivitis showing yet. Inflammatory changes include dilation of blood vessels found within the gingival connective tissue. As blood vessels dilate because of the inflammation, there is an increased flow of crevicular fluid into the crevice and an increased migration of PMNs out of the blood vessels into the gingival connective tissue (especially directly under the junctional epithelium).

2) What microorganism is implicated in this patient's gingival disease?

Answer: Prevotella intermedia.

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Weinberg: Comprehensive Periodontics for the Dental Hygienist, 4e (0133097714)

3) Explain why this patient is complaining of bleeding and edematous gingival.

Answer: Because of inflammation due to the accumulation of dental plaque. Inflammatory response begins in the gingival connective tissue. There is vasodilation of the blood vessels in the lamina propria, which allows the leakage of fluid, resulting in edema. The increased vascularity, including engorgement and vasodilation of the blood vessels, "peek through" the microulcerations of the epithelium that lines the soft tissue wall of a pocket.

Matching Questions Match the term in Column A with the correct statement/definition in Column B. A) Fluid filled B) No attachment loss C) Mucocutaneous disease D) Exaggerated response to plaque E) Inflammation of the gingival unit 1) Gingivitis 2) Edema 3) Pregnancy gingivitis 4) Lichen planus 5) Gingival pocket Answers: 1) E; 2) A; 3) D; 4) C; 5) B

Essay Questions List the type of histopathologic lesion (initial, early, established, advanced) associated with the following statements.

1) Not clinically visible yet Answer: initial lesion 2) Migration of polymorphonuclear leukocytes Answer: initial lesion 3) Predominated by plasma cells and B-lymphocytes Answer: established lesion 4) Destruction of connective tissue attachment .

Weinberg: Comprehensive Periodontics for the Dental Hygienist, 4e (0133097714)

Answer: advanced lesion 5) Occurs about 7 days after plaque accumulation Answer: early lesion

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Weinberg: Comprehensive Periodontics for the Dental Hygienist, 4e (0133097714)

Comprehensive Periodontics for the Dental Hygienist, 4e (Weinberg) Chapter 8 Periodontitis and Other Periodontal Conditions

Multiple-Choice Questions 1) Which of the following diseases has host cell abnormalities?

A) Chronic periodontitis B) Localized aggressive periodontitis C) Necrotizing ulcerative periodontitis D) Necrotizing ulcerative gingivitis Answer: B 2) High numbers of Aggregator actinomycetemcomitans are found in A) generalized chronic periodontitis.

B) localized chronic periodontitis.

C) generalized severe gingivitis.

D) localized aggressive periodontitis.

E) necrotizing ulcerative periodontitis.

Answer: D 3) Which of the following terms describes periodontal disease that was previously treated, but did not respond favorably?

A) Recurrent B) Refractory C) Aggressive D) Chronic E) Acute Answer: B 4) Which of the following events occurs first during the development of a periodontal pocket?

A) Alveolar and supporting bone loss B) Destruction of periodontal ligament fibers C) Destruction of gingival connective tissue D) Apical migration of the junctional epithelium Answer: C 5) The surface cementum is rough because of the detachment of the previously inserting connective tissue.

A) Both statement and reason are correct.

B) Both statement and reason are incorrect.

C) The statement is correct, but the reason is incorrect.

D) The statement is incorrect, but the reason is correct.

Answer: A

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Weinberg: Comprehensive Periodontics for the Dental Hygienist, 4e (0133097714)

6) Vertical or angular bone loss occurs when the inflammation travels directly from the gingival into the A) cementum.

B) periodontal ligament.

C) enamel.

D) bone.

Answer: B 7) Which of the following is the main mechanism of alveolar and supporting bone resorption?

A) Prostaglandin B) Hyaluronidase C) Collagenase D) Exotoxin Answer: A 8) The inflammatory infiltrate usually spreads from the gingival through the lamina propria into the bone following the A) periodontal ligament.

B) lamina dura.

C) nutrient canals.

D) vascular pathway.

Answer: D 9) Which of the following classifications is a three-wall bony defect?

A) Horizontal bone loss B) Vertical bone loss C) Fenestration D) Dehiscence Answer: B 10) What is the relationship of the base of a suprabony pocket to the crest of bone?

A) Apical B) Coronal C) Lateral D) Subgingival Answer: B 11) Which of the following types of infrabony defects occurs when two bony walls are intact?

A) Crater B) Hemiseptum C) Horizontal D) Circumferential Answer: A

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Weinberg: Comprehensive Periodontics for the Dental Hygienist, 4e (0133097714)

12) Which of the following structures is considered to be the base of a pocket?

A) Junctional epithelium B) Oral epithelium C) Sulcular epithelium D) Crest of alveolar bone Answer: A 13) The extension of the inflammatory infiltrate from the connective tissue to the interdental alveolar bone is by way of the A) collagen fibers.

B) blood vessels.

C) collagen bundles.

D) principal fibers.

Answer: B 14) All of the following descriptions relate to a one-wall bony defect except one. Which one is the exception?

A) One bony wall remains.

B) One bony wall is destroyed.

C) Can be a hemiseptum D) Is a type of vertical defect Answer: B 15) Which of the following pockets is associated with a horizontal pattern of bone loss?

A) Gingival sulcus B) Gingival pocket C) Infrabony D) Suprabony E) Intrabony Answer: D 16) With which of the following histopathologic lesions will a patient experience bone loss?

A) Initial B) Early C) Established D) Advanced Answer: A 17) Which of the following parts of the junctional epithelium migrates apically during the advanced lesions?

A) Coronal B) Middle third C) Middle half D) Apical Answer: D

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Weinberg: Comprehensive Periodontics for the Dental Hygienist, 4e (0133097714)

18) Which of the following statements is true regarding the down-growth of accumulating plaque?

A) Oral epithelium begins to get ulcerations.

B) Alveolar and supporting bone begins to resorb.

C) Gingival crevice migrates coronally.

D) Junctional epithelium migrates.

Answer: C 19) Which of the following occurs for a periodontal pocket to develop?

A) Crestal bone loss B) Interproximal bone loss C) Apical migration of the junctional epithelium D) Ulcerations of the sulcular epithelium Answer: C 20) In which of the following lesions does attachment loss occur?

A) Early B) Initial C) Established D) Advanced Answer: D Fill-in-the-Blank Questions 1) The primary clinical feature of periodontitis is alveolar ________ loss.

Answer: bone 2) The primary histopathological characteristic of periodontitis includes periodontal ________.

Answer: pockets 3) Current concepts of the etiology of periodontitis implicate a ________ infection.

Answer: bacterial 4) The term that replaced adult periodontitis is ________ periodontitis.

Answer: chronic 5) Onset of localized aggressive periodontitis is around the ________ period.

Answer: circumpubertal 6) In periodontitis there is bone destruction and connective tissue ________ loss.

Answer: attachment 7) The primary risk factor in chronic periodontitis is dental ________.

Answer: biofilms

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Weinberg: Comprehensive Periodontics for the Dental Hygienist, 4e (0133097714)

Critical Thinking Questions 1) Discuss the following topics related to periodontitis, and write a synopsis of the discussion on a separate sheet of paper.

A. Why was it necessary to reclassify the different types of periodontitis?

B. Discuss the various types of periodontitis relating to host defects.

Answer: A. According to the American Academy of Periodontology, classification systems are necessary in order to provide a framework in which to scientifically study the etiology, pathogenesis, and treatment of diseases in an orderly way. The older classification system lacked detail necessary for adequate characterization of the many types of periodontal diseases encountered in clinical practice.

B. Some of the periodontal diseases have a host defect component in their development and progression. This means that certain cells in the body are involved with the development and progression of the periodontal diseases. For instance, research has found that aggressive periodontitis, a periodontal disease that occurs early in life with bone loss, occurs quickly and aggressively. In this situation, there is a defect in the function and number of polymorphonuclear leukocytes. This is not seen in chronic periodontitis.

2) Discuss the development of a periodontal pocket.

Answer: A periodontal pocket forms when bacterial by-products and enzymes (e.g., collagenase) break down collagen, which is a component of the gingival fibers or gingival connective tissue attachment. This allows the junctional epithelium to migrate apically along the root surface and also laterally away from the tooth surface, creating a periodontal pocket. Subsequent to attachment loss is bone loss.

3) Discuss the different types of periodontal bone loss.

Answer: There are two patterns of bone loss: horizontal and vertical. The width of the interdental septum will usually determine which pattern of bone loss will occur. Horizontal pattern of bone loss occurs when bone is destroyed equally on both sides of adjacent teeth (e.g., distal of one tooth and the mesial of the adjacent tooth) whereas vertical pattern of bone loss occurs when there is more bone destroyed on one surface than the other surface. Within the vertical pattern of bone loss there are different types of bony defects that occur interproximally: one-, two-, and three-wall defects and circumferential defects (where bone loss "wraps" around from the interproximal surface to the direct facial or lingual).

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Case Study Questions Case Study 8.1 A 22-year-old female patient comes to the dental office. She said that her previous dentist told her she has "pockets." A full periodontal examination was completed on this patient, including radiographs. Periodontal probing depths ranged from 3 to 9 mm with multiple furcation defects and tooth mobility. The mandibular first molars show a vertical pattern of bone loss on the mesial aspect.

1) What are the histopathologic/inflammatory and immune changes that are occurring in the tissues?

Answer: This patient's periodontal disease is in the Page and Shroeder's advanced phase or lesion. Periodontal pocket formation has occurred with alveolar bone loss. It is a predominantly B-lymphocyte lesion in which antibodies to the antigen (the bacteria) are formed to try to "neutralize" the insult.

2) What type of "pockets" does this patient have on the mesial aspect of the mandibular first molars?

Answer: There are two types of pockets: pseudo (or gingival) pocket and periodontal pocket.

There are two types of periodontal pockets: suprabony and infrabony. Since the mandibular first molars on the mesial surface have vertical bone loss, the type of pocket would be infrabony.

3) What is the periodontal disease classification in this case?

Answer: The patient is classified as chronic advanced periodontitis.

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Weinberg: Comprehensive Periodontics for the Dental Hygienist, 4e (0133097714)

Matching Questions Match the term in Column A with the appropriate description in Column B. A) Number of bone walls remaining B) Bone level is not flat C) Slow to moderate rate of progression D) Cytokine E) Localized aggressive periodontitis F) Decreased PMN migration G) Serum antibody response to bacteria H) Associated with HIV-infected patients I) Occurs from the outer aspect of the bone surface 1) Chronic periodontitis 2) Horizontal bone loss 3) Aggressive periodontitis 4) Necrotizing ulcerative periodontitis 5) Smoking 6) Aggregator actinomycetemcomitans 7) Vertical bone loss 8) Three-wall bony defect 9) Interleukin-1 Answers: 1) C; 2) I; 3) G; 4) H; 5) F; 6) E; 7) B; 8) A; 9) D

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Weinberg: Comprehensive Periodontics for the Dental Hygienist, 4e (0133097714)

Match the lesion in Column A with the correct statement or definition in Column B. A) Occurs from 2 to 3 weeks after plaque accumulation B) Occurs within 4 days of plaque accumulation C) Becomes clinically visible 10) Initial lesion 11) Early lesion 12) Established lesion 13) Advanced lesion D) Associated with periodontitis Answers: 10) B; 11) C; 12) A; 13) D

Essay Questions List the type of histopathologic lesion (initial, early, established, advanced) associated with the following statements.

1) Not clinically visible yet Answer: initial lesion 2) Migration of polymorphonuclear leukocytes Answer: initial lesion 3) Predominated by plasma cells and B-lymphocytes Answer: established lesion 4) Destruction of connective tissue attachment Answer: advanced lesion 5) Occurs about 7 days after plaque accumulation Answer: early lesion

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Weinberg: Comprehensive Periodontics for the Dental Hygienist, 4e (0133097714)

Comprehensive Periodontics for the Dental Hygienist, 4e (Weinberg) Chapter 9 Necrotizing Periodontal Diseases

Multiple-Choice Questions 1) Which of the following microorganisms is associated with the pathogenesis of necrotizing ulcerative gingivitis (NUG)?

A) Spirochetes B) Actinobacillus actinomycetemcomitans C) Streptococcus mutans D) Porphyromonas gingivalis Answer: A 2) Which of the following symptoms is always seen in patients with NUG? A) Fetid odor B) Deep pockets C) Abscesses D) Nausea E) Pain Answer: E 3) Clinical features of necrotizing periodontal diseases may be the first sign of A) malnutrition.

B) hepatitis infection.

C) HIV infection.

D) diabetes mellitus.

E) kidney failure.

Answer: C 4) Which of the following terms describes the grayish slough found on the gingival tissue in NUG? A) Pseudomembrane B) Necrosis C) Ulceration D) Abscess Answer: A 5) Which of the following statements is true about NUG? A) Term can be used interchangeably with ANUG (acute necrotizing ulcerative gingivitis) B) Usually resolves within a few days after treatment C) Associated with alveolar bone loss D) Associated with periodontal abscesses Answer: B

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Weinberg: Comprehensive Periodontics for the Dental Hygienist, 4e (0133097714)

6) Which of the following parts of the periodontium does NUG affect?

A) Enamel B) Cementum C) Interdental gingival D) Alveolar bone E) Alveolar mucosa Answer: C 7) Which of the following is a microbial feature associated with the gingival lesion of NUG? A) Degenerative changes in Prevotella intermedia B) Infiltration of the gingival by spirochetes C) Abscesses caused by Fusobacterium sp.

D) Penetration into the bone by Treponema Answer: B 8) All of the following are predisposing factors for the development and progression of necrotizing ulcerative gingivitis except one. Which one is the exception?

A) Stress B) Trauma C) Smoking D) Malnutrition E) Osteoporosis Answer: E 9) Which of the following describes the shape of the papillae seen in NUG? A) Rounded off B) Punched out C) Blunted D) Bulbous Answer: B 10) Which of the following criteria must all be present to make a diagnosis of NUG? A) Bleeding, fetid oral odor, lymphadenopathy B) Fetid oral odor, pain, lymphadenopathy C) Interdental papillae necrosis, pain D) Interdental papillae necrosis, pain, bleeding E) Interdental papillae necrosis, fetid oral odor, bleeding Answer: D 11) Which of the following signs/symptoms of NUG is an infrequent finding?

A) Pain B) Bleeding C) Lymphadenopathy D) Interdental papillae necrosis Answer: C

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Weinberg: Comprehensive Periodontics for the Dental Hygienist, 4e (0133097714)

12) Necrotizing periodontal diseases are listed as a separate classification because they are unique in their clinical presentation and course and are clinically identifiable.

A) Both statement and reason are correct.

B) Both statement and reason are incorrect.

C) The statement is correct, but the reason is incorrect.

D) The statement is incorrect, but the reason is correct.

Answer: A 13) Which of the following conditions is a differential diagnosis of NUG? A) Primary herpetic gingivostomatitis B) Gingival abscess C) Pericoronitis D) Aphthous ulcers Answer: A 14) Which of the following host cells have been found to be decreased in NUG? A) Mast cells B) Plasma cells C) Lymphocytes D) Polymorphonuclear leukocytes E) Macrophages Answer: D 15) All of the following are features of NUG except one. Which one is the exception?

A) Necrosis of the papillae B) Bone loss C) Erythema of the free gingival D) Bleeding Answer: D 16) How long after treatment of NUG do signs and symptoms usually resolve?

A) Few days B) Three weeks C) One month D) Five months Answer: A 17) Which of the following signs/symptoms is not always present in NUG? A) Bleeding B) Pain C) Fetid odor D) Ulcerated papillae Answer: C

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Weinberg: Comprehensive Periodontics for the Dental Hygienist, 4e (0133097714)

18) In which of the following types of patients does NUG usually occur?

A) 70-year-old male B) 52-year-old female C) 19-year-old student D) 5-year-old toddler Answer: C 19) Which of the following features is evident in necrotizing ulcerative periodontitis (NUP)?

A) White plaque-like lesion on gingival B) Alveolar bone loss C) Purulent exudates D) Occlusal trauma Answer: B 20) The older term for NUG was A) smoker's mouth.

B) trench mouth.

C) smoker's gingivitis.

D) bacterial gingivitis.

Answer: B True/False Questions 1) Prevotella intermedia have been shown to invade soft tissue in NUG. Answer: FALSE 2) Fetid odor (from the oral cavity) is one of the three criteria needed to diagnosis NUG. Answer: FALSE 3) Necrotizing periodontal diseases are bacterial infections.

Answer: TRUE 4) NUG may be the first sign of HIV infection.

Answer: TRUE 5) Smoking is a predisposing factor for NUG. Answer: TRUE 6) Necrotizing ulcerative periodontitis involves the bone and periodontal ligament.

Answer: TRUE 7) NUP is limited to HIV infections.

Answer: FALSE 8) NUG and NUP have "punched-out" papillae.

Answer: TRUE 4 .

Weinberg: Comprehensive Periodontics for the Dental Hygienist, 4e (0133097714)

Critical Thinking Questions Discuss relevant information regarding the ulcerative periodontal diseases and write a synopsis of the discussion on a separate page.

1) Ulcerative periodontal diseases Answer: The classification, necrotizing periodontal diseases, is primarily based on clinical manifestations of two diseases: necrotizing ulcerative gingivitis (NUG) and necrotizing ulcerative periodontitis (NUP).

2) Necrotizing ulcerative gingivitis Answer: Necrotizing ulcerative gingivitis has an acute clinical presentation with distinctive features of rapid onset of extreme gingival pain, interdental gingival necrosis, "punched-out" papillae, and bleeding. It is a bacterial infection with associated incidence of stress, increased physical demand, smoking, and decreased nutritional intake. Initial treatment is with analgesics and antibiotics followed by periodontal debridement.

3) Necrotizing ulcerative periodontitis Answer: Necrotizing ulcerative periodontitis is a bacterial infection that has spread from the gingival unit into the periodontal ligament and bone. It is usually present in patients with systemic conditions such as HIV and AIDS. Case Study Questions Case Study 9.1 A 19-year-old college student comes to the dental office as an emergency. The patient said that a bad odor is coming from his mouth, and he is in a lot of pain. The dental hygienist starts to look at the gingival but the patient is in pain. The hygienist carefully extends the lips and observes the gingival papillae of the mandibular incisors are "cut off" with a grayish membrane covering them. The patient smokes and has been under a lot of stress at school. The hygienist starts to do a prophylaxis on the patient, but he is in too much pain.

1) What is the periodontal disease classification?

Answer: The patient has necrotizing ulcerative gingivitis or NUG. 2) What is the cause of the conditions?

Answer: NUG is a bacterial infection caused by Fusobacterium sp., Prevotella intermedia, and spirochetes, which invade into the gingival connective tissue.

3) What should initially be performed on this patient?

Answer: Since the patient is in extreme pain and superficial debridement was impossible, he should be placed on a systemic analgesic. Since this is a bacterial infection, the patient should be placed on a systemic antibiotic. After a few days, the patient should return to the office for periodontal debridement.

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Weinberg: Comprehensive Periodontics for the Dental Hygienist, 4e (0133097714)

Matching Questions Match the terms describing necrotizing periodontal diseases in Column A with the best description in Column B. A) NUP B) NUG C) Predisposing factor D) Primary herpetic gingivostomatitis 1) Stress 2) Involving bone 3) Punched-out papillae 4) Differential diagnosis NUG Answers: 1) C; 2) A; 3) B; 4) D

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Weinberg: Comprehensive Periodontics for the Dental Hygienist, 4e (0133097714)

Comprehensive Periodontics for the Dental Hygienist, 4e (Weinberg) Chapter 10 Occlusal Trauma

Multiple-Choice Questions 1) All of the following are examples of primary occlusal trauma except one. Which one is the exception?

A) A restoration that is "high" in occlusion B) Trauma (e.g., blow) to the teeth C) Orthodontic movement of tooth D) Insufficient bone support Answer: D 2) A patient had an amalgam restoration placed on the mandibular molar 2 days ago. The patient reports to the dental office and complains of pain on that tooth. Which of the following procedures should be done to determine the origin of the pain?

A) Check occlusion with articulating paper B) Probe that tooth and adjacent teeth C) Place a sealant on top of the amalgam D) Apply high concentration of fluoride to the tooth Answer: A 3) Which of the following conditions is seen on a tooth that is in traumatic occlusion?

A) Abrasion B) Erosion C) Extrusion D) Wear facet Answer: D 4) Which of the following activities is considered to be parafunctional?

A) Thumbsucking B) Eating an ice pop C) Drinking soda from a straw D) Frequent swallowing Answer: A 5) All of the following structures are affected by occlusal trauma except one. Which one is the exception?

A) Alveolar bone B) Periodontal ligament C) Attached gingival D) Cementum Answer: C

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Weinberg: Comprehensive Periodontics for the Dental Hygienist, 4e (0133097714)

6) Which of the following is the most common sign of occlusal trauma?

A) Pain B) Sensitivity C) Cracked tooth D) Gingival inflammation E) Increasing mobility Answer: E 7) Of which of the following conditions is pathologic tooth migration indicative?

A) Nonvital tooth B) Severe periodontitis C) Dentinal hypersensitivity D) Daytime bruxism Answer: B 8) Occlusal trauma alone does not cause gingivitis or periodontitis because the junctional epithelium is not affected by occlusal trauma.

A) Both statement and reason are correct.

B) Both statement and reason are incorrect.

C) The statement is correct, but the reason is incorrect.

D) The statement is incorrect, but the reason is correct.

Answer: A 9) Which of the following radiographic findings are seen in occlusal trauma?

A) Infrabony pockets B) Vertical bone loss C) Horizontal bone loss D) Suprabony pockets Answer: B 10) The objective of occlusal therapy is to A) control the direction, magnitude, and frequency of excessive occlusal forces.

B) change the direction of the excessive occlusal forces so that the force is directed axially.

C) eliminate all forces on the tooth or teeth.

D) modify occlusal forces to be directed toward the gingival.

Answer: A 11) Which of the following is an objective for splinting teeth?

A) To increase esthetics of the teeth B) To increase effectiveness of plaque control C) To reduce discomfort for the patient D) To aid in healing of gingival pockets Answer: C

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Weinberg: Comprehensive Periodontics for the Dental Hygienist, 4e (0133097714)

12) Which of the following is a goal of selective grinding?

A) To eliminate premature contacts B) To reduce tooth structure C) To change the direction of occlusal forces D) To increase occlusal loading Answer: A 13) Which of the following materials is used to make a night guard?

A) Orthodontic resin B) Composite resin C) Hard acrylic D) Denture acrylic Answer: C 14) All of the following outcomes of treatment of occlusal trauma are desirable except one.

Which one is the exception?

A) Elimination of fremitus B) Prevention of further tooth migration C) Stability of radiographic changes D) Increased tooth mobility Answer: D 15) Which of the following signs is indicative of inadequate resolution of occlusal trauma?

A) Progressive tooth mobility B) Increased depth of periodontal pockets C) Increased attachment loss D) Presence of intrabony defects Answer: A 16) Which of the following features is a cause of secondary occlusal trauma?

A) Chewing forces on a tooth with advanced bone loss B) Deep infrabony pockets extending beyond the mucogingival junction C) Plaque-induced gingival pockets D) Overhang on amalgam restoration Answer: A 17) Early animal studies on occlusal trauma placed high restoration in order to reproduce A) impaction forces.

B) jiggling forces.

C) normal occlusion.

D) adapted occlusion.

Answer: B

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Weinberg: Comprehensive Periodontics for the Dental Hygienist, 4e (0133097714)

18) It is controversial whether inflammation and occlusal trauma are codestructive. Proponents of this codestructive theory say that in the presence of occlusal trauma, inflammation will be A) slower.

B) accelerated.

C) unchanged.

D) initially slower, but then faster later.

Answer: B 19) All of the following are clinical features of occlusal trauma except one. Which one is the exception?

A) Fremitus B) Wear facet C) Chipped teeth D) Bleeding on probing Answer: D 20) Which of the following are treatment options for teeth in secondary occlusal trauma with shallow probing depths?

A) Splinting B) Orthodontics C) Apply fluoride varnish D) Incision and drainage Answer: A Fill-in-the-Blank Questions 1) A tooth in primary occlusal trauma has a ________ periodontium.

Answer: healthy 2) A tooth in secondary occlusal trauma has a ________ periodontium.

Answer: reduced 3) Bruxism is an example of a ________ habit.

Answer: parafunctional 4) A tooth in occlusal trauma shows increasing ________.

Answer: mobility 5) Radiographically, a tooth in occlusal trauma will usually have a ________ periodontal ligament space.

Answer: widened

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Weinberg: Comprehensive Periodontics for the Dental Hygienist, 4e (0133097714)

Critical Thinking Questions Discuss occlusion and occlusal trauma as they relate to dental hygiene practice. Then write a synopsis of the discussion on a separate sheet of paper.

1) Define primary occlusal trauma.

Answer: Primary occlusal trauma to teeth occurs when forces placed on the occlusal/incisal area of teeth is greater than what the healthy (nondiseased) support tooth structures (e.g., bone, cementum, periodontal ligament fibers) can handle.

2) Define secondary occlusal trauma.

Answer: Secondary occlusal trauma occurs to teeth when forces applied to the tooth, either normal, as in chewing, or excessive, cause injury to the supporting tooth structures. A tooth with insufficient bone support cannot handle any type of force. The distinguishing feature between primary and secondary occlusal trauma is the amount of bony support surrounding the tooth.

3) Recognize occlusal problems that need dental hygiene intervention.

Answer: Clinically, teeth are in occlusal trauma when there is increasing mobility noted. In a patient who just had a restoration placed and reports pain and tooth mobility, adjustment of the "high" restoration is necessary. An appliance (e.g., night guard) is necessary if the patient is a bruxer.

Case Study Questions Case Study 10.1 A 62-year-old female patient presents to the office with the chief complaint "My teeth are moving and getting big spaces between them. Things are getting worse. Even while eating my teeth move." After a complete dental examination and radiographs, a dental and dental hygiene diagnosis was made. Probing depths ranged from 2 to 8 mm with advanced bone loss. The patient does not smoke and has no systemic conditions. The gingival is red, edematous, and bleeding. The maxillary anterior teeth had a mobility of 2–3. The patient was amenable to treatment and follow-up maintenance.

1) What was the dental and dental hygiene diagnosis of this case?

Answer: Dental diagnosis: chronic advanced periodontitis; secondary occlusal trauma. Dental hygiene diagnosis: gingival inflammation and bone loss related to biofilm accumulation; increasing tooth mobility related to bone loss.

2) Explain the cause of the increasing tooth mobility and diastemas.

Answer: The cause of the increasing tooth mobility and diastemas is bone loss. Pathologic migration has occurred where the teeth can no longer stay in alignment because of the extensive bone loss. There is secondary occlusal trauma because there is inadequate bony support of the teeth with increasing tooth mobility even with normal chewing forces.

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3) What is the dental hygiene treatment plan for this case?

Answer: The dental hygiene treatment plan consists of controlling the inflammation caused by dental biofilms. This involves oral hygiene instruction and periodontal debridement. An acceptable maintenance program should be established.

Matching Questions Match the term in Column A with the correct definition in Column B. A) Interferences to closure of opposing tooth B) Activities of mastication beyond the normal range of function C) Normal or excessive occlusal forces cause injury to supporting structures D) Contact relationship of teeth E) Injury to the supporting structures caused by excessive occlusal forces 1) Occlusion 2) Primary occlusal trauma 3) Secondary occlusal trauma 4) Parafunctional habit 5) Premature occlusal contact Answers: 1) D; 2) E; 3) C; 4) B; 5) A

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Weinberg: Comprehensive Periodontics for the Dental Hygienist, 4e (0133097714)

Comprehensive Periodontics for the Dental Hygienist, 4e (Weinberg) Chapter 11 Abscesses of the Periodontium

Multiple-Choice Questions 1) Which of the following microorganisms is highly associated with periodontal abscess and pus formation?

A) Aggregator actinomycetemcomitans B) Porphyromonas gingivalis C) Streptococcus mutans D) Staphylococcus aureus Answer: B 2) Which of the following abscesses is the most common involving the periodontium?

A) Gingival B) Periodontal C) Pericoronal D) Periapical Answer: B 3) Which of the following is a factor that could cause the formation of a gingival abscess?

A) Toothbrushing B) Poppy seeds C) Drinking hot beverages D) Overzealous flossing Answer: B 4) All of the following statements are true about a periodontal abscess except one. Which one is the exception?

A) It develops as a result of a bacterial infection.

B) It occurs as a result of calculus that obstructs sulcular drainage.

C) It can cause alveolar bone destruction.

D) It resolves spontaneously without treatment.

Answer: D 5) Which of the following features describes a gingival abscess?

A) Develops over a long period of time B) Develops fairly rapidly C) Usually ruptures on its own D) Expands rapidly along the gingival margin Answer: B

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Weinberg: Comprehensive Periodontics for the Dental Hygienist, 4e (0133097714)

6) Which of the following happens if an acute periodontal abscess is not treated?

A) Tooth will be lost B) Reverts to a gingival abscess C) Becomes a chronic abscess D) Results in a pericoronal abscess Answer: C 7) All of the following are features of a tooth with a gingival abscess except one. Which one is the exception?

A) Severe periodontitis B) Localized infection C) Usually painful D) Edematous tissue Answer: A 8) In which of the following conditions is trismus usually evident?

A) Periodontal abscess B) Gingival abscess C) Periapical abscess D) Pericoronal abscess Answer: D 9) Which of the following microorganisms is cultivated from pus of a tooth with a periodontal abscess?

A) Gram-negative anaerobic rods B) Gram-negative facultative cocci C) Gram-negative nonmotile cocci and rods D) Gram-positive facultative aerobics E) Gram-positive anaerobic rods Answer: A 10) An operculum will disappear once the tooth is A) orthodontically moved.

B) splinted to the adjacent tooth.

C) intruded into position.

D) extracted.

Answer: D 11) All of the following signs and symptoms are present in a periodontal abscess except one.

Which one is the exception?

A) Suppuration B) Swelling C) Tooth looseness D) Tooth extrusion E) Tooth fracture Answer: E 2 .

Weinberg: Comprehensive Periodontics for the Dental Hygienist, 4e (0133097714)

12) Which of the chief complaints is common for a developing periodontal abscess?

A) "I have pressure in my gums."

B) "I feel the tooth is coming out."

C) "I think my tooth feels big."

D) "My gums are tight."

Answer: A 13) Which of the following statements is associated with a periodontal abscess?

A) Clinical features are similar to peri-implantitis.

B) Tooth intrusion is a common finding.

C) Microflora resembles that of chronic periodontitis lesions.

D) Suppuration comes from the occlusal surface of the tooth.

Answer: C 14) Which of the following techniques will allow pus to be drained from the gingival crevice?

A) Use probe or curet to open pocket entrance B) Brush area with a hard-bristled toothbrush C) Application of cold gauze D) Application of heated gutta percha point Answer: A 15) A periodontal abscess is primarily composed of A) bacteria, dental calculus.

B) bacteria, plasma cells, neutrophils.

C) bacteria, dead tissue, neutrophils.

D) dental calculus only.

Answer: C 16) Which of the following treatments should be performed on a patient with a gingival abscess?

A) Extraction of offending tooth B) Debridement of affected area C) Periodontal surgery with regeneration D) Endodontic therapy Answer: B 17) A radiograph showing a radiolucent area on the lateral aspect of the tooth is most likely diagnosed as A) an endodontic abscess.

B) periocoronitis.

C) a periodontal abscess.

D) a gingival abscess.

Answer: C

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18) A periodontal abscess originates from the A) pulp.

B) soft tissue wall of pocket.

C) root cementum.

D) dentin.

Answer: B 19) Establishing drainage of a periodontal abscess may be difficult because the A) pocket is occluded.

B) pocket is too shallow.

C) tooth is nonvital.

D) tooth is extruded.

Answer: A 20) Which of the following treatments should initially be performed on a patient with a periodontal abscess?

A) Administer an antibiotic B) Perform endodontic therapy C) Periodontal debridement/periodontal surgery D) Recommend antibacterial rinse Answer: C

Critical Thinking Questions Discuss the different features of abscess of the periodontium. Then write a synopsis of the discussion on a separate sheet of paper.

1) Define a gingival abscess.

Answer: A gingival abscess forms in the marginal gingiva or interdental gingiva as a result of lodging of foreign objects such as popcorn kernels or fish bones. It is a localized, painful infection that usually occurs in a previously disease-free area. Bone loss is not a sequela. The surface will appear red and edematous and when a probe is taken slightly subgingivally, pus may extrude.

2) Define a periodontal abscess.

Answer: A periodontal abscess differs from a gingival abscess in that it is a localized infection (accumulation of pus) within the gingival wall of a periodontal pocket, resulting in destruction of collagen fibers and bone. There are usually other periodontitis sites in the patient. Calculus is often found on the roots. Clinical features include red and edematous gingiva, elevation of the tooth in its socket, tenderness to percussion or on mastication, and tooth looseness.

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3) Define a pericoronal abscess.

Answer: A pericoronal abscess is a localized accumulation of pus within the overlying gingival flap (operculum) surrounding the crown of a partially erupted tooth, usually the mandibular third molar. Food and debris collect under the operculum, which makes it difficult to clean. The infection may spread posteriorly into the oropharyngeal area and medially to the base of the tongue and involve the regional lymph nodes. Patients may experience difficulty in swallowing and complain of a dull ache and may demonstrate limited jaw opening (trismus).

Case Study Questions Case Study 11.1 A 55-year-old patient came to the dental office as an emergency. Gingival examination revealed a swelling about 4 mm apical to the gingival margin of the mandibular first molar. The patient said the swelling started the other night, and it is painful and tender to chew on. He also feels some pressure in the gingival. A radiograph was taken that showed bone loss on the mesial surface. Probing depth in that area was 6 mm. It was difficult to initially get the probe into the pocket.

1) What is the classification of the patient's conditions?

Answer: Periodontal abscess: deep probing depths and radiograph evidence of bone loss helped to make the diagnosis of a periodontal abscess originating from the soft tissue pocket wall of the furcation.

2) What is the dental hygiene diagnosis?

Answer: Dental hygiene diagnosis: acute inflammation/infection related to biofilm accumulation in deep pocket.

3) What is the dental hygiene treatment for this case?

Answer: Incision and drainage of the infection (pus) is the most important step to perform. After obtaining profound anesthesia, drainage is usually achieved through the pocket. Drainage is started by inserting a probe or a curet into the pocket to the base of the abscess. The epithelial lining the pocket wall should be curetted. This will aid in drainage. Once drainage is obtained, the root is scaled and root planed.

4) What should be done after initial treatment?

Answer: Referral to a periodontist for definitive treatment, which may involve surgery or extraction.

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Matching Questions Match the term in Column A with the correct statement/definition in Column B. A) Chronic abscess B) Infection located within the tissues of a pocket C) Gingival flap D) Periapical area E) Infection located around the partially erupted mandibular third molar F) Palpable lymph nodes G) Infection located at the marginal gingival 1) Gingival abscess 2) Periodontal abscess 3) Pericoronal abscess 4) Endodontic abscess 5) Operculum 6) Acute abscess that is not resolved 7) Lymphadenopathy Answers: 1) G; 2) B; 3) E; 4) D; 5) C; 6) F; 7) A

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Weinberg: Comprehensive Periodontics for the Dental Hygienist, 4e (0133097714)

Comprehensive Periodontics for the Dental Hygienist, 4e (Weinberg) Chapters 12-16

Multiple-Choice Questions 1) Each of the following terms is used to describe the health or disease of the gingival tissues except one. Which one is the exception?

A) Contour B) Size C) Consistency D) Percussion E) Surface texture Answer: D 2) Several factors affect the probing depths achieved when completing a periodontal chart. One of the limitations is presence of inflammation, which can result in a reading shallower than the actual probing depth.

A) Both statements are true.

B) Both statements are false.

C) The first statement is true. The second statement is false.

D) The first statement is false. The second statement is true.

Answer: C 3) Which of the following describes the presence of bleeding on probing?

A) Occurs when there is a disruption of the sulcular epithelium B) Considered to be an indicator for disease activity C) Determines the amount of attachment loss D) Determines the amount of alveolar bone loss Answer: A 4) The gingival landmark that is the entrance to the crevice is called A) attached gingival.

B) free gingival.

C) marginal gingival.

D) gingival pocket.

Answer: C 5) Clinical attachment level is synonymous with clinical attachment loss because clinical attachment levels are determined by the measurement from the marginal gingival to the apical extent of the periodontal probe.

A) Both statement and reason are correct.

B) Both statement and reason are incorrect.

C) The statement is correct, but the reason is incorrect.

D) The statement is incorrect, but the reason is correct.

Answer: B 1 .

Weinberg: Comprehensive Periodontics for the Dental Hygienist, 4e (0133097714)

6) Suppuration is also referred to as A) gingival bleeding.

B) purulent exudate.

C) dental plaque.

D) dental calculus.

E) dental biofilm.

Answer: B 7) Which of the following terms describes the movement of teeth due to the disruption of forces that normally maintain physiologic tooth position?

A) Tooth fremitus B) Tooth mobility C) Pathologic migration D) Attachment loss Answer: C 8) Which of the following terms describes the loss of interradicular bone?

A) Mucogingival defect B) Furcation involvement C) Attachment loss D) Pathologic migration Answer: B 9) Gingival (soft tissue) recession is measured according to the A) position of the marginal gingival.

B) depth of the pockets.

C) level of the mucogingival junction.

D) level of the soft tissue attachment.

Answer: A 10) All of the following are etiologic factors for gingival recession except one. Which one is the exception?

A) Toothbrushing B) Orthodontic movement C) Oral habits D) Occlusal trauma E) Anatomic variations Answer: D 11) All of the following are causes of pathologic tooth mobility except one. Which one is the exception?

A) Bone loss B) Gingival recession C) Occlusal trauma D) Gingival inflammation Answer: B 2 .

Weinberg: Comprehensive Periodontics for the Dental Hygienist, 4e (0133097714)

12) Which of the following instruments is best for measuring the vertical component of bone loss in a furcation defect?

A) Nabers probe B) Periodontal probe C) 11/12 explorer D) Curet E) Scaler Answer: B 13) Which of the following structures is used for measuring the clinical attachment level?

A) CEJ and free gingival margin B) CEJ and apical extent of probe C) Free gingival margin and apical extent of probe D) Free gingival margin and mucogingival junction Answer: B 14) Which of the following structures is used for measuring the amount of gingival (soft tissue) recession?

A) CEJ and free gingival margin B) CEJ and apical extent of probe C) Free gingival margin and apical extent of probe D) Free gingival margin and mucogingival junction Answer: A 15) Before a periodontal site can be labeled as disease-active, there must be a change in clinical attachment level of A) 1–2 mm.

B) 2–3 mm.

C) 3–4 mm.

D) 4–5 mm.

E) 5–7 mm.

Answer: B 16) The mesiofacial site on the maxillary left canine has a probing depth of 3 mm and 2 mm of soft tissue recession. The clinical attachment level (in mm) is A) 1.

B) 2.

C) 3.

D) 4.

E) 5.

Answer: E

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17) In the above questions, the attachment loss (in mm) is A) 1.

B) 2.

C) 3.

D) 4.

E) 5.

Answer: E 18) The primary purpose of periodontal probing is to determine the extent of detachment of which of the following periodontal structures from the tooth surface?

A) Periodontal ligament fibers B) Gingival fibers C) Junctional epithelium D) Sulcular epithelium Answer: C 19) Which of the following terms describes mobility of a tooth under function (e.g., chewing, lateral excersions)?

A) Tooth fremitus B) Pathologic migration C) Clinical attachment loss D) Tooth mobility Answer: A 20) The periodontal probe is slightly angled when measuring the probing depth on interproximal surfaces of posterior teeth because of the A) deeper pockets.

B) wider root surface.

C) col.

D) bone.

Answer: C

True/False Questions 1) Gingival recession refers to the position of the mucogingival junction.

Answer: FALSE 2) Bleeding sites indicate disease activity.

Answer: FALSE 3) Fibrotic gingival indicates a chronic inflammatory condition.

Answer: TRUE 4) Gingival enlargement refers to the position of the free gingival margin.

Answer: TRUE 4 .

Weinberg: Comprehensive Periodontics for the Dental Hygienist, 4e (0133097714)

5) Contour of the gingival is determined by the shapes and positions of the teeth.

Answer: TRUE 6) Changes in the contour of the gingival can reflect past periodontal tissue destruction.

Answer: TRUE 7) Mouth breathing may cause gingival recession.

Answer: FALSE 8) The gingival of a heavy smoker is usually red and bleeding.

Answer: FALSE Fill-in-the-Blank Questions 1) The purpose of a gingival assessment is to determine noninflammatory and ________ changes of the gingival tissues.

Answer: inflammatory 2) Hormonal levels are a ________ factor for gingival inflammation.

Answer: risk 3) The absence of gingival redness is indicative of the absence of ________.

Answer: disease 4) Papillae of ________ teeth are pyramidal in shape.

Answer: anterior 5) Papillae of ________ teeth are flatter in shape.

Answer: posterior 6) Gingival consistency refers to the ________ of the underlying connective tissue.

Answer: firmness 7) Periodontal disease activity is defined as the ________ loss of connective tissue attachment.

Answer: current 8) ________ is the most commonly used physical screening method for measuring the depth of the gingival sulcus.

Answer: Periodontal probing 9) Probing depth is the measurement of the distance from the ________ to the most apical extent of the periodontal probe.

Answer: free gingival margin 10) Clinical attachment level is the measurement from the ________ to the most apical extent of the periodontal probe.

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Answer: cementoenamel junction 11) Tooth movement is limited to the width of the ________ space.

Answer: periodontal ligament

Critical Thinking Questions Using the description below, determine the clinical attachment level. Draw the scenario in the adjacent margin.

Tooth: maxillary left canine

Mesiofacial Facial Distofacial

Position of Gingival Margin Probing Depths at the CEJ 3 mm 3 mm coronal to CEJ 2 mm 4 mm apical to CEJ 3 mm

1) What is the clinical attachment level on the mesiofacial of the maxillary canine?

Answer: 3 2) What is the clinical attachment level on the facial of the maxillary canine?

Answer: 1 3) What is the clinical attachment level on the distofacial of the maxillary canine?

Answer: 7

Case Study Questions Case Study 12–16.1 A 54-year-old patient presents to the dental office. Medical/social history is unremarkable except that he smokes. Gingival examination reveals erythematous, edematous, and bleeding gingival.

Periodontal examination: 3–8 mm probing depths, bleeding on probing, multiple furcation defects, gingival recession. There is evidence of root caries. The patient's chief complaint is "A tooth hurts when I eat ice cream or drink a cold soda, and it's sensitive even to air when I breathe in."

1) What is the cause of the patient's chief complaint?

Answer: The patient's chief complaint is due to dentinal hypersensitivity. The patient has multiple soft tissue recession areas. This exposes the dentinal tubules in the dentin, which causes hypersensitivity to cold and air. To determine that it is dentinal hypersensitivity, blow air from the air syringe. He will jump.

2) What is the cause of the condition of this patient's gingiva?

Answer: The cause of the gingival condition is inflammation related to biofilm accumulation.

Inflamed gingiva is due to inflammation and increased vascular permeability in the connective tissue of inflamed sites. Increased permeability of blood vessels allows for fluid and blood to 6 .

Weinberg: Comprehensive Periodontics for the Dental Hygienist, 4e (0133097714)

leak out, resulting in edema and bleeding, respectively.

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Weinberg: Comprehensive Periodontics for the Dental Hygienist, 4e (0133097714)

3) How do you assess if this patient has attachment loss?

Answer: This patient has attachment loss. Attachment loss is determined by using a periodontal probe to assess the extent of detachment of the junctional epithelium from the tooth surface.

Clinical attachment loss uses the CEJ as a stable reference point, whereas relative attachment loss uses another stable reference point such as a cusp tip.

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Weinberg: Comprehensive Periodontics for the Dental Hygienist, 4e (0133097714)

Comprehensive Periodontics for the Dental Hygienist, 4e (Weinberg) Chapter 17 Radiographic Assessment

Multiple-Choice Questions 1) Which of the following features will a full mouth series show?

A) Generalized vertical bone loss B) Pulpal tissues on molars C) Periodontal ligament fibers D) Gingival connective tissue E) Fibroblasts within the periodontal ligament space Answer: A 2) Which of the following definitions is accurate for the crown-to-root ratio?

A) Amount of clinical crown exposed to the oral cavity B) Amount of tooth embedded in bone C) Length of root embedded in bone compared with the length of the rest of the tooth D) Length of the clinical crown versus the length of the apical portion of the root Answer: C 3) Which of the following radiograph images is three-dimensional?

A) Computed tomography B) Panoramic films C) Periapical films D) Bitewing radiographs Answer: A 4) In order to have radiographic bone loss, the alveolar crest must be A) 2 mm coronal to the CEJ. B) 2 mm apical to the CEJ. C) 3 mm coronal to the CEJ. D) 3 mm apical to the CEJ. Answer: B 5) Which of the following crown-to-root measurements is desirable when planning for a crown?

A) 1:2 B) 2:1 C) 2:3 D) 4:1 E) 2:4 Answer: B

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Weinberg: Comprehensive Periodontics for the Dental Hygienist, 4e (0133097714)

6) Which of the following radiographs is ideal for visualizing the crestal lamina dura in a patient with moderate periodontitis?

A) Periapical B) Horizontal bitewing C) Vertical bitewing D) Panoramic E) Occlusal Answer: C 7) All of the following are seen on a periapical radiograph except one. Which one is the exception?

A) Deep pockets B) Gold crown C) Bony crater D) Hypercementosis Answer: A 8) Digital subtraction radiology meets which of the following objectives?

A) Detects small changes in osseous loss B) Detects changes in the periodontal ligament space C) Determines alveolar crestal bone level over different times D) Reduces image time Answer: A 9) It is difficult to recognize slight changes in alveolar bone that would indicate early or mild periodontal disease because radiographs represent a two-dimensional view of three-dimensional objects.

A) Both statement and reason are correct.

B) Both statement and reason are incorrect.

C) The statement is correct, but the reason is incorrect.

D) The statement is incorrect, but the reason is correct.

Answer: A 10) Which of the following bony structures is based on the radiographic evaluation?

A) Radicular bone B) Septal bone C) Haversian canal D) Marrow space Answer: B 11) Radiographs and data obtained from the clinical examination are both used to evaluate a patient's periodontal status because radiographs do not show current disease status.

A) Both statement and reason are correct.

B) Both statement and reason are incorrect.

C) The statement is correct, but the reason is incorrect.

D) The statement is incorrect, but the reason is correct.

Answer: A 2 .

Weinberg: Comprehensive Periodontics for the Dental Hygienist, 4e (0133097714)

12) Which of the following types of radiographs is commonly used for postevaluation of implants?

A) Periapical B) Occlusal C) CT scan D) Digital subtraction radiography Answer: A 13) Which of the following parameters determines the quality of the x-rays produced?

A) Kilovoltage B) Exposure time C) Milliamperage D) Film Answer: A 14) All of the following can be viewed on panoramic radiograph except one. Which one is the exception?

A) Maxillary sinuses B) Pathologic lesions C) Dental caries D) Impacted teeth Answer: C 15) For which of the following reasons are vertical bitewings used?

A) To show the alveolar crest in severe bone loss B) To show the entire dentition C) To decrease technique error D) To reduce exposure time Answer: A 16) Which of the following structures cannot be seen on a radiograph?

A) Floor of maxillary sinus B) Infrabony pocket C) Infrabony defect D) Lamina dura Answer: B 17) Which of the following radiographs is best to locate the mandibular canal for implant placement?

A) Occlusal B) Horizontal bitewing C) Vertical bitewing D) CT scan Answer: D

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Weinberg: Comprehensive Periodontics for the Dental Hygienist, 4e (0133097714)

18) Which of the following radiograph techniques uses three-dimensional imaging?

A) Digital subtraction radiography B) Computerized tomography C) Occlusal films D) Panoramic films Answer: B 19) Which of the following imaging techniques uses less radiation and scans both the maxilla and mandible at the same time?

A) Typical CT scan B) Cone beam CT scan C) Panoramic radiograph D) Digital subtraction radiograph Answer: B 20) Which of the following is an advantage of using cone beam computerized tomography?

A) Lower radiation dose B) Color images C) Easy-to-read results D) Does not use radiation Answer: A True/False Questions 1) Radiographs provide information on early or mild periodontal diseases.

Answer: FALSE 2) Panoramic radiographs are best used for diagnosing bone destruction on individual teeth.

Answer: FALSE 3) The periodontal ligament fibers are easily seen on a periapical radiograph.

Answer: FALSE 4) Radiographic evaluation of alveolar bone loss is based on the status of the interdental septum.

Answer: TRUE 5) Amalgam restorations appear radiopaque on radiographs.

Answer: TRUE 6) Radiographic selection criteria is important to reduce radiation exposure.

Answer: TRUE 7) Computed tomography is a type of radiograph used for dental implants.

Answer: TRUE

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Weinberg: Comprehensive Periodontics for the Dental Hygienist, 4e (0133097714)

8) Horizontal bitewings are ideal for visualizing the level of the alveolar bone crest when there is severe bone loss.

Answer: FALSE

Fill-in-the-Blank Questions 1) Only ________ tissues can be identified on a radiograph.

Answer: hard 2) Radiographs serve to detect ________ changes.

Answer: bone 3) The amount of penetration of the x-ray beam is controlled by the ________.

Answer: kilovoltage 4) Conventional radiographs give a history of ________ periodontal disease destruction.

Answer: past 5) Radiographs are used primarily in periodontics to determine the ________ and pattern of bone loss.

Answer: severity

Critical Thinking Questions 1) Can periodontal disease be diagnosed using only radiographs?

Answer: Radiographs are not the only assessment tool used to diagnose periodontal diseases.

Since radiographs only show past disease activity, another tool must be used together with radiographs for diagnosis. This other tool is periodontal probing (clinical attachment levels).

Both periodontal probing and radiographs should be used together to help in a diagnosis.

2) How often should radiographs be taken for monitoring periodontal diseases?

Answer: The following must be reviewed to determine the need for radiographs: (a) the baseline data, (b) individual disease status, (c) patient concerns, (d) radiation safety, and (e) that benefits will outweigh potential risks.

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Case Study Questions Case Study 17.1 A 47-year-old patient wants to have several implants placed in the maxilla and mandible because he does not want a partial denture. The patient has a moderate amount of bone loss. Medical history is unremarkable.

1) Does the patient require imaging? If yes, what is the most recent advancement in implant radiology?

Answer: Yes, the patient requires imaging because he needs multiple implants in the maxilla and mandible. The latest advancement in imaging is cone beam computerized tomography. When comparing cone beam versus traditional CT scan, there are few advantages. Cone beam CT, which is used prior to implant surgery, (a) emits less radiation, (b) scans the maxilla and mandible at the same time, and (c) provides more accurate visualization of anatomic structures such as the mandibular nerve.

2) The patient is concerned about having too much radiation. What do you tell the patient regarding radiation?

Answer: With traditional and cone beam CT, there is far less radiation exposure than with traditional radiographs. Cone beam CT especially emits must less radiation than traditional CT.

Matching Questions Match the radiographic term in Column A with the best description in Column B. A) Slices of edentulous areas B) Views alveolar crest C) Radiopaque line D) Radiolucent E) Small bone changes 1) Lamina dura 2) Periodontal ligament space 3) Vertical bitewing 4) Digital subtraction radiology 5) CT scan Answers: 1) C; 2) D; 3) B; 4) E; 5) A

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Weinberg: Comprehensive Periodontics for the Dental Hygienist, 4e (0133097714)

Comprehensive Periodontics for the Dental Hygienist, 4e (Weinberg) Chapter 18 Advances in Detecting and Monitoring the Periodontal Diseases

Multiple-Choice Questions 1) Which of the following tests is highly sensitive for specific periodontal microorganisms?

A) PST B) DNA probe C) Culture and sensitivity D) GCF enzyme Answer: B 2) Which of the following tests determines a patient's genetic susceptibility to periodontal diseases?

A) PST B) DMDx C) Culture D) GCF enzyme Answer: A 3) Which of the following tests only identifies bacterial size and shape?

A) Culture and sensitivity B) Phase-contrast microscopy C) GCF enzyme D) DNA probe E) PST Answer: B 4) For which of the following reasons would the clinician collect GCF? A) To collect enzymes produced by host cells B) To identify bacterial waste products C) To retrieve serum samples D) To aggregate high levels of collagen Answer: A 5) Which of the following substances is a marker for genetic susceptibility to periodontal diseases?

A) Collagenase B) Glucuronidase C) Protease D) Interleukin-1 Answer: D

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Weinberg: Comprehensive Periodontics for the Dental Hygienist, 4e (0133097714)

6) For patients with which of the following conditions should adjunctive diagnostic tests be used?

A) Chronic periodontitis B) Aggresssive periodontitis C) Refractory periodontitis D) Necrotizing ulcerative gingivitis E) Hormonal-influenced gingivitis Answer: C 7) Which of the following diagnostic tests are used for research purposes rather than in clinical practice?

A) Genetic assays B) Nucleic acid probe analyses C) Enzyme-based assays D) Culture and sensitivity tests Answer: C 8) All of the following bacteria are detected with the DNA probe except one. Which one is the exception?

A) Actinobacillus actinomycetemcomitans B) Prevotella intermedia C) Porphyromonas gingivalis D) Eikenella corrodens E) Peptostreptococcus micros Answer: E 9) Which of following fluids/cells does the PST genetic test utilize?

A) Crevicular fluid B) Mucosa from inner cheek C) Epithelial tongue scrapings D) Saliva Answer: D 10) Which of the following enzymes may be a predictor for clinical attachment loss?

A) Aspartate aminotransferase B) Hyaluronidase C) Proteinase D) Gelatinase Answer: A 11) All of the following are adjunctive diagnostic tests for detecting bacteria except one. Which one is the exception?

A) DNA probe B) Dark-field microscopy C) Culture and sensitivity D) Interleukin-1 genotype Answer: D 2 .

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12) Since the etiology of and risk factors for periodontal diseases are multifactorial, the most important steps for patient evaluation include a comprehensive clinical and radiographic analysis and identification of modifying systemic risk factors.

A) Both statement and reason are correct.

B) Both statement and reason are incorrect.

C) The statement is correct, but the reason is incorrect.

D) The statement is incorrect, but the reason is correct.

Answer: A 13) Since genetics is the most important risk factor for periodontal diseases, it is important to perform a genetic susceptibility test on every periodontal patient.

A) Both statement and reason are correct.

B) Both statement and reason are incorrect.

C) The statement is correct, but the reason is incorrect.

D) The statement is incorrect, but the reason is correct.

Answer: D 14) All of the following features are found in the DNA probe assay except one. Which one is the exception?

A) Highly sensitive B) Specific for targeted periodontal pathogens C) Rapid identification D) Specimen collected from saliva E) Good for screening purposes Answer: D 15) All of the following features are found in the culture test except one. Which one is the exception?

A) Determines antibiotic sensitivity B) Specific for targeted periodontal pathogens C) Rapid identification D) Expensive E) Specimen collected chairside Answer: C 16) Which of the following bacterium is very strongly pathogenic for periodontal disease?

A) Treponema denticola B) Porphyromonas gingivalis C) Prevotella intermedia D) Streptococcus sanguis Answer: B

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17) When performing a DNA probe analysis, which of the following is inserted into the pocket to obtain a subgingival sample?

A) Paper point B) Probe C) Explorer D) Gutta percha Answer: A 18) All of the following are indications for using DNA testing on a patient except one. Which one is the exception?

A) Refractory disease B) Monitoring implant sites C) All periodontal patients D) Monitoring therapy outcome Answer: C 19) To which of the following assays does ELIZA belong?

A) Immunologic B) Genetic C) Enzyme-based D) Microbial Answer: A 20) To which of the following assays does genotype PST belong?

A) Immunologic B) Genetic C) Enzyme-based D) Microbial Answer: B

True/False Questions 1) Testing for bacterial collagenase is done with saliva.

Answer: FALSE 2) Supplemental diagnostic tests in periodontics attempt to detect disease-active sites.

Answer: TRUE 3) Phase-contrast microscopy is good for chairside patient awareness of bacteria.

Answer: TRUE 4) The patient's serum is an abundant source of inflammatory mediators that break down tissue associated with periodontitis.

Answer: FALSE

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5) All living organisms contain DNA, which carries all genetic information needed for the coding of proteins.

Answer: TRUE 6) Culture and sensitivity identifies specific microorganisms.

Answer: TRUE 7) The PST is a test to detect minimal changes in subgingival bacterial population.

Answer: FALSE 8) Immunologic assays are primarily used in research.

Answer: TRUE

Fill-in-the-Blank Questions 1) Gingival ________ fluid increases flow with increasing inflammation.

Answer: crevicular 2) ________ is an enzyme that breaks down collagen.

Answer: Collagenase 3) ________ allows for the growth of certain microorganisms found in periodontal pockets.

Answer: Culturing 4) DNA ________ assay identifies DNA sequences specific for certain subgingival periodontal pathogens.

Answer: probe 5) Aspartate aminotransferase is an ________ enzyme that stays inside the cell until cell death.

Answer: intracellular

Critical Thinking Questions Discuss the questions regarding clinical applications of periodontal assays, and write a synopsis of the discussion on a separate page.

1) Should these supplemental assays be used routinely on every periodontal patient?

Answer: Assessment of subgingival flora can be done in the office by ordering tests that will determine what types of bacteria are on each tooth surface and in the periodontal pockets.

Individual teeth are selected to determine elevated levels of disease-causing organisms. These tests are not routinely used on every periodontal patient but should be reserved for difficult refractory patients and to monitor post-treatment.

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2) Describe the intention for the use of these adjunctive tests to detect disease activity sites.

Answer: These additional assessment tests are intended to shift the focus from determining disease severity (i.e., mild, moderate, severe disease) to evaluating disease progression, disease active sites, and the risk of future periodontal breakdown.

Case Study Questions Case Study 18.1 A 57-year-old male patient has been coming to the dental office for 3 years. His medical history is unremarkable, and he does not smoke or drink. His oral hygiene status is good, but he needs to be monitored. He comes for maintenance visits every 4 months. The patient had periodontal surgery 2 years ago but still has pocketing and bleeding.

1) What periodontal classification does this patient belong?

Answer: The periodontal classification is refractory chronic periodontitis because he has no contributing factors, has had surgery, and keeps up with his oral hygiene.

2) Is adjunctive microbial testing appropriate for this patient? If yes, what are some tests?

Answer: Microbial testing would be appropriate in this patient. The presence of certain marker bacteria is associated with periodontal disease activity. One method is DNA probing, which tests for 11 periodontal pathogens, including Porphyromonas gingivalis, Prevotella intermedia, Actinobacillus actinomycetemcomitans, Fusobacterium nucleatum, Eikenella corrodens, Campylobacter rectus, Tannerlla forsythensis, and Treponema denticola. Subgingival plaque samples are collected from the patient and sent through the mail for analysis. A report is sent back to the clinician with specific antibiotics that the bacteria are sensitive to.

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Matching Questions Match the terms in Column A with the correct description or phrase in Column B. A) Genetic assay B) Viable bacteria needed C) GCF enzyme D) Inflammatory substance E) Motivational tool 1) DNA probe assay 2) β-glucuronidase 3) Prostaglandin E2 4) IL-1 5) Phase-contrast microscopy Answers: 1) B; 2) C; 3) D; 4) A; 5) E

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Comprehensive Periodontics for the Dental Hygienist, 4e (Weinberg) Chapter 19 Problem-/Evidence-Based Treatment Planning

Multiple-Choice Questions 1) Which of the following terms refers to the prediction of the future course of a disease?

A) Diagnosis B) Prognosis C) Treatment D) Assessment Answer: B 2) On the periodontal problem list, which of the following is a concern during treatment of a patient with diabetes and periodontal disease?

A) Increased dentinal hypersensitivity B) Decreased severity of disease C) Accelerated wound healing D) Delayed wound healing Answer: D 3) Which of the following methods is most appropriate for use in formulating a periodontal treatment plan?

A) Problem list B) Patient's desires C) PICO survey D) Previser system Answer: A 4) Based on clinical and radiographic findings, which of the following problems is generally addressed first?

A) Chief complaint B) Occlusal trauma C) Periodontal disease D) Defective restorations Answer: A 5) Which of the following methods of treatment planning is generally followed?

A) Patient dictated B) Four phases C) Least expensive first D) Whatever insurance pays Answer: B

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6) A patient complains of bleeding gums and bad breath. All of the following items from the problem list contribute to her chief complaint except one. Which one is the exception?

A) Gingivitis B) Smoking C) Occlusal trauma D) Periodontitis E) Poor oral hygiene Answer: C 7) Based on the problem list, which of the following treatments is indicated for a patient presenting with fremitus?

A) Permanent splinting B) Replacement of missing teeth C) Adjust occlusion D) Use of orthodontic appliances Answer: C 8) Based on the problem list, which of the following treatments is indicated for a patient presenting with deep probing depths (e.g., 4–6 mm)?

A) Reduction with nonsurgical and surgical procedures B) Stabilize teeth C) Brush biopsy D) Adjust occlusion Answer: A 9) Based on the problem list, which of the following concerns is directed toward a patient presenting with deep probing depths?

A) Oral cancer B) Difficulty with access C) Root caries D) Compliance Answer: B 10) A patient presents with no gingival bleeding, light supragingival plaque, and calculus. The problem list is otherwise noncontributory. Which of the following treatments is best for this patient?

A) Oral prophylaxis B) Subgingival root debridement C) Periodontal surgery D) Referral to periodontist Answer: A

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11) A 50-year-old patient presents with a problem list consisting of deep probing depths, vertical and horizontal bone defects, and soft tissue recession. Which of the following is the sequence of care for this patient?

A) Periodontal debridement, oral hygiene instructions, surgery B) Oral hygiene instructions, periodontal debridement, reevaluation, surgery, and/or referral to periodontist C) Periodontal debridement and periodontal surgery and then referral to periodontist D) Oral hygiene instructions, periodontal debridement Answer: B 12) For which of the following periodontal diseases are systemic antibiotics indicated in treatment?

A) Medication-induced gingivitis B) Plaque-induced gingivitis C) Chronic periodontitis D) Aggressive periodontitis E) Occlusal trauma Answer: D 13) A patient presents with red gingiva that bleeds and blisters when slightly touched. The epithelium peels off from the underlying connective tissue. Which of the following diseases is suggestive of this presentation?

A) Mucocutaneous disorder B) Gingivitis C) Chronic periodontitis D) Periodontitis associated with diabetes mellitus E) Necrotizing ulcerative gingivitis Answer: A 14) A patient presents with mobility of the mandibular incisors. There is a moderate amount of bone loss. Based on the problem list, which of the following concerns is applicable?

A) Poor oral hygiene B) Patient comfort C) Delayed wound healing D) Esthetics Answer: B 15) A patient is diagnosed with aggressive periodontitis. Which of the following treatment plans should initially be followed?

A) Referral to periodontist B) Immediate periodontal surgery C) Place patient on a chlorhexidine rinse.

D) Perform periodontal debridement with the placement of controlled-release device into the deeper pockets.

Answer: A

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16) The primary goal of periodontal therapy is to A) give the patient the most affordable treatment.

B) restore the periodontium to a functional state of health.

C) allow the patient to accommodate parafunctional habits.

D) determine how the patient will react to medications.

Answer: B 17) Which of the following factors is involved in risk assessment?

A) Determine either predisposition for developing periodontal conditions.

B) Do genetic testing.

C) Have patient go to his or her physician.

D) Perform after treatment planning is completed.

Answer: A 18) A document called Guidelines for Management of Patients with Periodontal Diseases is published and released by the A) American Dental Association.

B) American Academy of Oral Medicine.

C) American Medical Association.

D) American Academy of Periodontology.

Answer: D 19) The objective of the Guidelines for Management of Patients with Periodontal Diseases is to A) help determine if a patient needs specialty care.

B) route the patient to the best physician.

C) determine the need for adjunctive periodontal care.

D) aid in treatment planning.

Answer: A 20) According to the Guidelines for Management of Patients with Periodontal Diseases, a level 2 patient should be treated by the A) dental hygienist only.

B) dental hygienist and general dentist.

C) dental hygienist and periodontist.

D) dental hygienist, general dentist, and periodontist.

Answer: D 21) Match the term describing a component of treatment planning for correction of amalgam overhangs A) Phase IV B) Phase II C) Phase III D) Phase I Answer: D 22) Match the term describing a component of treatment planning for extraction of hopeless 4 .

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teeth A) Phase IV B) Phase II C) Phase III D) Phase I Answer: D 23) Match the term describing a component of treatment planning for regenerative surgery A) Phase IV B) Phase II C) Phase III D) Phase I Answer: B 24) Match the term describing a component of treatment planning for final crown and bridge A) Phase IV B) Phase II C) Phase III D) Phase I Answer: C 25) Match the term describing a component of treatment planning for maintenance care A) Phase IV B) Phase II C) Phase III D) Phase I Answer: A 6) Match the term describing a component of treatment planning for periodontal debridement A) Phase IV B) Phase II C) Phase III D) Phase I Answer: D

True/False Questions 1) Treatment of plaque-induced gingivitis requires periodontal surgery.

Answer: FALSE 2) Referral to a periodontist is never necessary.

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Answer: FALSE 3) A tooth has a hopeless prognosis if it has greater than 50% bone loss.

Answer: TRUE 4) Once surgically treated, phenytoin-induced gingival enlargement will not recur.

Answer: FALSE 5) Risk assessment is an important part of periodontal treatment planning.

Answer: TRUE 6) Controlling periodontal inflammation is the initial treatment objective of periodontal therapy.

Answer: TRUE 7) All inflammatory periodontal diseases are caused by dental biofilms.

Answer: TRUE 8) The first step in developing a treatment plan should be to determine individual goals for each patient.

Answer: TRUE

Fill-in-the-Blank Questions 1) Management of most periodontal patients demands continued ________ and adjustments to ongoing care.

Answer: reassessment 2) Periodontal treatment planning is directed toward ________-based learning.

Answer: problem 3) It is important to incorporate ________ assessment into treatment planning.

Answer: risk 4) The goal of phase I periodontal therapy is to ________ all etiologic and risk factors.

Answer: minimize 5) Treatment of patients with chronic periodontitis begins with ________ hygiene instructions.

Answer: oral Critical Thinking Questions 1) A patient has numerous periodontal sites that measure 6–8 mm probing depths with buccal furcation involvement. Mobility is slight. Gingival inflammation and bleeding is generalized.

The patient is a smoker. Write a short treatment plan.

Answer: Treatment plan: A. Phase I 6 .

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1. data collection 2. indices (plaque, bleeding) 3. oral hygiene instructions 4. periodontal debridement 5. reevaluation of debridement B. Phase II 1. surgical procedures C. Phase IV 1. maintenance 2. review oral hygiene 2) Do you think that periodontal diseases will ever be treated exclusively with chemotherapeutics and not surgery?

Answer: Inflammatory periodontal diseases are infectious diseases; selective diseases are currently treated with adjunctive antibiotics/antimicrobials. Surgical procedures are needed to gain access to the underlying bone where destruction and damage occurred. Surgery is needed to correct the bone destruction. More research is needed to determine the ultimate use of antibiotics and the severity of the disease. Genetics is also implicated in the susceptibility to the disease.

Case Study Questions Case Study 19.1 A 56-year-old female patient comes to the dental office with a chief complaint of "my teeth need work." She has hypertension and type 2 diabetes mellitus. She has not seen a dentist in over 10 years. After dental, gingival, and periodontal examinations, a treatment plan was finalized, which the patient accepted. The periodontal classification of this case is mild to moderate chronic periodontitis. After initial therapy, there are unresolved bleeding sites > 5 mm.

1) What should the first step be in the treatment plan?

Answer: Oral hygiene instruction is the first procedure done after the treatment plan, followed by periodontal debridement per quadrant and polishing.

2) What should be done about referring the patient to a specialist?

Answer: According to the Guidelines for the Management of Patients with Periodontal Diseases (American Academy of Periodontology), this patient would be a level 2 and is best treated by both the referring dentist and a periodontist. So, this patient should be referred to a periodontist.

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Comprehensive Periodontics for the Dental Hygienist, 4e (Weinberg) Chapter 20 Oral Hygiene for the Periodontal Patient: Beyond the Basics

Multiple-Choice Questions 1) Which of the following interproximal devices is most effective in a class I embrasure effective in reducing caries?

A) Electric toothbrush B) Dental floss C) Wooden stick D) Rubber tip stimulator Answer: B 2) Which of the following patient-applied substances is most effective in reducing dentinal hypersensitivity?

A) Potassium nitrate B) Sodium fluoride C) Strontium chloride D) Oxalate salts Answer: A 3) Which of the following treatments is most often suggested as the initial step in treating dentinal hypersensitivity?

A) Drink hot beverages B) Soft tissue graft C) Desensitizing dentifrice D) Gold restoration Answer: C 4) Which of the following adverse effects is seen with stannous fluoride?

A) Staining of dentin B) Desquamation of gingiva C) Laceration of soft tissues D) White lesions on buccal mucosa Answer: A 5) Which of the following concentrations is found in stannous fluoride gel preparations?

A) 0.12 B) 0.02 C) 0.04 D) 0.40 E) 0.50 Answer: D

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6) Which of the following substances is found in tartar-control dentifrices?

A) Potassium nitrate B) Strontium chloride C) Pyrophosphate D) Stannous fluoride Answer: C 7) Which of the following statements is correct concerning treatment of dentinal hypersensitivity?

A) Cauterize pulpal nerves.

B) Anesthetize pulpal and dentinal nerves.

C) Block open dentinal tubules.

D) Build up dentinal sensitivity.

Answer: C 8) Which of the following instructions applies to a patient with gingival enlargement?

A) Make frequent maintenance visits to reduce plaque levels.

B) Apply deplaquing agents routinely.

C) Brush with a hard toothbrush to remove all subgingival plaque.

D) Use an interproximal brush for removal of marginal and interdental plaque.

Answer: A 9) Which of the following ingredients helps retain moisture and prevents drying in a dentifrice?

A) Flavoring agents B) Humectant C) Preservatives D) Thickening agent Answer: B 10) It is recommended patients use soft-bristled toothbrushes because only soft bristles reach 1 mm subgingivally.

A) Both statement and reason are correct.

B) Both statement and reason are incorrect.

C) The statement is correct, but the reason is incorrect.

D) The statement is incorrect, but the reason is correct.

Answer: C 11) Which of the following toothbrushing methods is recommended to patients following periodontal surgery?

A) Stillman B) Bass C) Modified Bass D) Modified Stillman E) Horizontal Answer: A

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12) Which of the following toothbrushing methods is recommended to patients with orthodontic bands?

A) Bass B) Roll C) Stillman D) Charters Answer: D 13) Which of the following devices is best for removing plaque from the interproximal surface of an abutment tooth of a bridge?

A) Floss threader B) Dental floss C) Rubber tip stimulator D) Implant floss Answer: A 14) Which of the following concentrations of sodium fluoride is found in most dentifrices?

A) 0.12 B) 0.15 C) 0.20 D) 0.24 E) 0.30 Answer: D 15) Which of the following ingredients is found in Prevident 5000 Plus Gel? A) 1.1% stannous fluoride B) 1.1% sodium fluoride C) 0.4% stannous fluoride D) 0.4% strontium fluoride E) 1.5% sodium fluoride Answer: B 16) Which of the following devices is best used to clean a type I embrasure?

A) End-tuft brush B) Dental floss C) Toothbrush D) Wooden wedge Answer: B 17) Which of the following devices is best used to clean a type III embrasure?

A) End-tuft brush B) Dental floss C) Toothbrush D) Dental tape Answer: A

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18) Which of the following ingredients is found in patient-applied densensitizing agents?

A) Potassium nitrate B) PENTA C) Ferric oxalate D) Hydrogen fluoride Answer: A 19) Which of the following statements is true about implant oral care?

A) Oral hygiene is not necessary because implants are not "real" teeth.

B) Oral care starts immediately after uncovering the implant.

C) Special hard-bristled toothbrushes are recommended.

D) Metal wire interdental brushes are best to use.

Answer: B 20) Which of the following interdental aids is highly recommended for patients with braces?

A) Tufted floss B) Soft-bristled end-tufted brush C) Wooden wedge D) Dental tape Answer: A

Fill-in-the-Blank Questions 1) Oral hygiene self-care is defined as physical ________ for the mouth.

Answer: therapy 2) One way to educate the patient on the importance of dental plaque is using ________ agents.

Answer: disclosing 3) ________ or breath malodor is important in the total assessment of the patient.

Answer: Halitosis 4) ________ bristles are more durable than natural bristles.

Answer: Nylon 5) The ________ stroke technique is activated by sweeping the bristles toward the occlusal surface.

Answer: rolling 6) ________ dentifrices can reduce caries by 20%.

Answer: Fluoride 7) Dental floss is used for ________ cleansing.

Answer: interdental 8) Treatment of dentinal hypersensitivity focuses on blocking the opened ________ tubules.

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Answer: dentinal 9) ________ nitrate is effective in reducing cold and tactile sensitivity.

Answer: Potassium

Critical Thinking Questions 1) How should a patient's home care differ after periodontal surgery?

Answer: Yes, there are changes in the patient's oral home-care regimen. Since the periodontal tissues are healing after surgery, an ultra-soft-bristled toothbrush should be used if a periodontal dressing has not been placed. Instruct the patient to very lightly brush the exposed tooth surfaces and not to push the bristles into the gingival margin. Flossing should be avoided immediately after surgery. A fluoride dentifrice is recommended. Immediately after surgery an antimicrobial mouthrinse is recommended.

2) Explain the oral hygiene regimen for patients with dental implants.

Answer: Plaque-control procedures must start immediately after uncovering the implants. It is important that the dental hygienist customize a home-care regimen based on the patient's awareness and ability and the type of prosthesis present.

There are two specific areas of focus for home-care procedures around implants. The first is the portion of the titanium abutment exposed above the soft tissues in the oral cavity, as well as the small portion just below the gingiva. The second area requiring plaque control is the prosthetic component, consisting of the rigid cast framework and tooth replacement materials.

A multitude of home-care devices exist to assist in mechanical oral hygiene regimes.

These devices include various manual or powered toothbrushes and specific interdental aids. Soft or ultrasoft manual toothbrushes are the traditional means of plaque removal. However, brush heads come in many different shapes and sizes, and brushes should be prescribed individually depending on the implant type and the patient's abilities. An excellent area-specific soft nylon brush is the single-tufted brush. This brush is for use on individual implants, one implant at a time, and the shaft can be bent for better access.

Various interdental devices are available, including interdental brushes, rubber-tip stimulators, wooden cleaners, and numerous types of dental floss. The brush attachment for interdental brushes is available as a plastic or nylon-coated wire rather than a metal wire to prevent scratching of implant surfaces. Interdental brushes are used only if sufficient interdental embrasure exists. Various floss types, such as tufted floss or floss cords (PostCareTM, Sunstar Americas Inc., Chicago), along with folded gauze or traditional floss, are effective and safe interproximal plaque-removal aids.

Clinical use of antimicrobials (chemotherapeutic agents) can adjunctively help to inhibit plaque and gingivitis around implants. These agents may be delivered by rinsing or applied topically (via toothbrush, floss, or cotton-tipped applicator). Irrigation can be used if pathologic changes are present.

The use of chlorhexidine gluconate and Listerine has been shown to be advantageous in the inhibition of bacterial plaque in implant patients.

Some practitioners may recommend home irrigation devices, but patients should be advised to use gentle pressure, ensuring that the irrigant is not forced into the sulcus. Excessive fluid pressure with the tip positioned apically could damage the perimucosal seal. Using either a 5 .

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sideport blunt-tipped canula or a rubber-tip irrigating device is less likely to violate this seal.

Case Study Questions Case Study 20.1 Ms. Smith is a 40-year-old female who has previously had stable oral health and minimal gingival recession on the maxillary right buccal molars. Her lifestyle recently changed, and now she is more stressed, grinding at night, and less likely to floss at bedtime. Her most recent series of dental visits was to replace the mandibular left second molar with an implant due to a failed root canal and root fracture. She also had minor gingival recontouring around the mandibular left first molar. She has just received the prosthetic crown and now must receive home-care instruction. She must also maintain the other areas of her mouth and address the recession on the right maxillary first and second molars that is beginning to be sensitive.

1) Discuss home-care suggestions for the mandibular left second molar.

Answer: The mandibular left second molar has an implant and recontoured gingival margin at tooth 19. The plastic core interproximal brush will cleanse the widened space around the abutment. Tufted floss or tape will also cleanse the interproximal space. Oral irrigation becomes an included step in all home care and in this case will assist in removal of food debris or add a chemotherapeutic rinse.

2) What would be a likely consideration for treatment of the maxillary right first and second molars?

Answer: Desensitizing for the recession and sensitivity around the molars require either office treatments or home therapy on daily use. Caries is not currently listed as a concern but could be considered later if the recession is not maintained as plaque free. The end-tuft brush is not related to cleansing of these teeth. Routine chemotherapeutics is not directly related to the patient need to control sensitivity.

3) There is gingival recession now around the distal surface of the mandibular left second molar and the mesial and distal surfaces of the mandibular left first molar. What could be suggested for plaque removal and gingival care?

Answer: The end-tuft brush will assist in plaque removal around an area of wider embrasure space. The rubber-tip stimulator is recommended for gingival stimulation. It is not adept at plaque removal interproximally. There is no need for floss threaders as the contact is accessible.

Fluoride is not related to plaque control for these teeth.

4) In-office treatment for desensitizing includes: Answer: The office treatment for dentinal hypersensitivity blocks the dentinal tubules. The treatment does not close the gap of the CEJ and enamel as this is a development condition that could lead to sensitivity. The question refers to office treatment, and home fluoride would be a regimen for caries control. Weekly use of dentifrice is a home use and not considered office treatment.

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5) The recountoured gingiva around tooth 19 and the following gingival recession might be a location for which condition?

Answer: All of the above are correct. If the gingival margin is not cleansed, the area could build in bacterial biofilm and cause inflammation. If the plaque is not removed on a daily basis, gingivitis could result. Food impaction could result if the gingival contour and new prosthetic crown do not self-cleanse.

Matching Questions Match the feature in Column A with the proper term or description in Column B. A) Charters B) Interproximal brush C) Halitosis E) Noncompliance F) Triclosan D) Stannous fluoride 1) Volatile sulfur compounds 2) Missing papillae 3) Antibacterial 4) Brushing around braces 5) Major factor in disease recurrence 6) Dentinal hypersensitivity Answers: 1) C; 2) B; 3) F; 4) A; 5) E; 6) D

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Comprehensive Periodontics for the Dental Hygienist, 4e (Weinberg) Chapter 21 Healing after Nonsurgical Periodontal Therapy

Multiple-Choice Questions 1) Treatment outcome after ultrasonic instrumentation is the same as treatment outcome after hand-activated instrumentation because both types of instrumentation remove supra- and subgingival accretions.

A) Both statement and reason are correct.

B) Both statement and reason are incorrect.

C) The statement is correct, but the reason is incorrect.

D) The statement is incorrect, but the reason is correct.

Answer: A 2) In which of the following time intervals does subgingival microflora get reestablished following oral hygiene and mechanical instrumentation?

A) 1–2 days B) 2–4 days C) 4–8 days D) 2–4 weeks E) 4–8 weeks Answer: E 3) According to the literature (Segelnick & Weinberg, 2006), which of the following time interval (in weeks) is appropriate for periodontal reevaluation?

A) 1–2 B) 2–4 C) 4–8 D) 10–14 Answer: C 4) Which of the following depths has been found to be the limit for efficient removal of plaque, calculus, and necrotic cementum?

A) 1.75 mm B) 2.73 mm C) 3.73 mm D) 4.85 mm E) 5.03 mm Answer: C 5) Which of the following statements describes a reason for subgingival debridement?

A) Delay in repopulation of aerobic biofilms B) Increase in anaerobic activity C) Decrease in number of Gram-positive biofilms D) Shift in dental biofilm composition Answer: D 1 .

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6) All of the following statements are true about periodontal debridement except one. Which one is the exception?

A) Periodontal debridement encompasses many procedures.

B) Good tissue response is an outcome of periodontal debridement.

C) An excessive amount of time is necessary for root planing.

D) A smooth root surface is an outcome of root planing.

Answer: C 7) In the presence of supragingival dental biofilms, a subgingival microbiota contains A) > 10% motile rods.

B) > 5% spirochetes.

C) < 2% Gram-positive bacteria.

D) < 10% Gram-negative bacteria.

Answer: B 8) Which of the following tissues/cells replaces the inflammatory infiltrate during healing following periodontal debridement?

A) Basal cells B) Epithelial cells C) Collagen D) Bone E) Cementum Answer: C 9) Which of the following procedures is contraindicated in sites that do not have periodontal pockets?

A) Subgingival root debridement B) Subgingival scaling C) Supragingival scaling D) Oral hygiene Answer: A 10) Which of the following parameters is most commonly used to monitor tissue inflammation?

A) Bleeding B) Color C) Contour D) Texture E) Mobility Answer: A 11) Which of the following is considered to be a treatment goal for nonsurgical therapy?

A) Reduction of supragingival microbiota B) Disruption of the subgingival bacterial population C) Reduction of dental calculus D) Elimination of causative factors Answer: D 2 .

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12) Which of the following substances is released from Gram-negative cell walls?

A) Exotoxin B) Collagen C) Lipooligosaccharide D) Biofilm Answer: C 13) All of the following parameters are limitations of periodontal debridement except one. Which one is the exception?

A) Pocket depth B) Root anatomy C) Clinician skill D) Time spent E) Instrument material Answer: E 14) The best way to determine how much root planing is needed is to A) time about 20 minutes per tooth.

B) count about 50 strokes per surface.

C) evaluate radiographically that the calculus has been eliminated.

D) monitor tissue response.

Answer: D 15) Which of the following healing outcomes is generally seen in gingivitis?

A) Gain in clinical attachment B) Regeneration of alveolar bone C) Formation of cellular cementum D) Reformation of periodontal ligament fibers Answer: A 16) Which of the following statements is true regarding apparent "gain of attachment"?

A) Increased gingival recession + increased resistance to probing B) Coronal migration of the free gingival margin C) Development of excessive gingival fibers D) Thickening of periodontal ligament fibers Answer: A 17) Extensive root planing is not necessary because A) it takes too long.

B) calculus is not deeply embedded in the root.

C) it is not necessary to remove all deposits.

D) deposits will be removed during surgery.

Answer: B

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18) All of the following are limitations to scaling and root planing except one. Which one is the exception?

A) Anatomy of the tooth B) Furcation defects C) Deep pockets D) Minimal amount of mucosa Answer: D 19) After periodontal debridement, most soft tissue healing is by A) periodontal regeneration.

B) periodontal ligament regeneration.

C) long junctional epithelium.

D) reattachment of diseased epithelium.

Answer: C 20) All of the following clinical parameters are usually performed during a reevaluation visit except one. Which one is the exception?

A) Probing depth measurement B) Gingival assessment C) Tooth mobility assessment D) Full mouth radiographs Answer: D 21) What is the correct description for the statement, 4–8 weeks A) Limitation of scaling B) Root surface C) Long junctional epithelium D) Healing period Answer: A 22) What is the correct description for the statement, furcation A) Limitation of scaling B) Root surface C) Long junctional epithelium D) Healing period Answer: C 23) What is the correct description for the statement, gingivitis A) Limitation of scaling B) Root surface C) Long junctional epithelium D) Healing period Answer: D 24) What is the correct description for the statement, endotoxins A) Limitation of scaling 4 .

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B) Root surface C) Long junctional epithelium D) Healing period Answer: A

Fill-in-the-Blank Questions 1) Periodontal debridement has predictably reduced the levels of gingival ________.

Answer: inflammation 2) Local anesthesia for periodontal debridement is best administered by ________.

Answer: quadrant 3) ________ are easily removed from subgingival root surfaces.

Answer: Endotoxins 4) It is important to attain relatively ________ root surfaces.

Answer: smooth 5) A limitation to periodontal debridement is the ________ of multirooted teeth.

Answer: furcation 6) Following periodontal debridement there is an ________ inflammatory reaction.

Answer: acute 7) Subgingival debridement will decrease the number of periodontal ________.

Answer: pathogens 8) Subgingival root debridement is contraindicated in sites that do not have periodontal ________.

Answer: pockets 9) The ultimate long-term outcome for mechanical nonsurgical therapy is ________ of the form and function of the dentition.

Answer: preservation 10) Mechanical instrumentation is ineffective in eliminating ________ from the soft tissue.

Answer: Aggregatibacter actinomycetemcomitans 11) Subgingival microflora originates from ________ sites.

Answer: supragingival Critical Thinking Questions Discuss the tissue healing responses in gingivitis and periodontitis, and write a synopsis of the 5 .

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discussion.

1) Evaluate the tissue healing response following treatment of gingivitis.

Answer: Histologically, in gingivitis, once dental plaque and calculus are removed, the pocket epithelium will reform into junctional epithelium and reattach to the adjacent tooth surface as it was in health. The inflammatory cells in the gingival connective tissue are replaced by collagen; this improvement results in an apparent "gain in clinical attachment."

Clinically, there is a reduction in or elimination of inflammation (e.g., bleeding) and the elimination of edema, both of which result in tissue shrinkage and occasionally gingival recession. Gingiva that is fibrotic will not shrink, as does edematous tissue. The gingiva often returns to its salmon pink color. The greatest reduction in probing depths occurs after 4–6 weeks and is primarily due to (a) tissue shrinkage, which may result in gingival recession, and (b) reformation of collagen, which results in greater resistance to probing. The reductions obtained in probing depths as a result of nonsurgical therapy are in the range of 1–2 mm.

2) Evaluate the tissue healing response following periodontal debridement of a periodontitis case.

Answer: Histologically, in periodontitis, after the removal of dental plaque, calculus, and necrotic cementum, some healing will occur. In most patients, healing occurs by repair rather than regeneration (e.g., formation of new bone, cementum, and periodontal ligament).

Histologically, repair of the root epithelial interface has been described as a long junctional epithelial attachment that prevents the formation of a new connective tissue attachment.

Research has shown, however, that the presence of a long junctional epithelium does not represent an area of less resistance to infection.

Case Study Questions Case Study 21.1 A 53-year-old male patient has a periodontal classification of moderate gingivitis. There was heavy plaque and calculus deposits with gingival inflammation. Periodontal debridement was performed. Six weeks later a reevaluation was performed.

1) At reevaluation a periodontal examination was completed and there was a reduction in probing depths. Explain the healing process in this patient.

Answer: Gingivitis: Once dental plaque and calculus are removed, the pocket epithelium will reform into junctional epithelium and contact the adjacent tooth surface as it was in health. This happens because the basal cells of the junctional epithelium grow out and contact the tooth surface and develop into a new junctional epithelium. Reattachment of "old" junctional epithelium does not occur. Then, the apical part of the junctional epithelium moves apically until the first gingival connective tissue fibers embedded in cementum are reached. This new junctional epithelium is sometimes referred to as a "long junctional epithelium." Also, the inflammatory cells in the gingival connective tissue are replaced by collagen; these improvements result in an apparent "gain in clinical attachment."

2) At reevaluation, it was noted that the probe encountered more resistance. Explain.

Answer: Periodontitis: The same scenario that happens with gingivitis occurs with periodontitis.

Healing will most likely occur by repair or new attachment rather than regeneration, which is 6 .

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formation of new bone, collagen fibers, cementum, and periodontal ligament. Healing by regeneration occurs during periodontal surgery using guided tissue regeneration procedures (discussed in Chapter 26). Essentially, all types of successful periodontal debridement usually heal by new attachment or long junctional epithelium. Histologically, the repair of the root epithelial interface has been described as a long junctional epithelial attachment that prevents the formation of a new connective tissue attachment. Research has shown, however, that the presence of a long junctional epithelium does not represent an area of less resistance to infection.

However, patients who are erratic in their compliance with oral hygiene self-care do not do as well with a long junctional epithelium as patients with complete compliance. The formation of a long junctional epithelium results in closure of the pocket. This reestablishment of the junctional epithelium most likely occurs within 1 or 2 weeks.

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Comprehensive Periodontics for the Dental Hygienist, 4e (Weinberg) Chapter 22 Periodontal Maintenance Therapy

Multiple-Choice Questions 1) All of the following are goals of periodontal maintenance except one. Which one is the exception?

A) Prevent or minimize recurrence of disease progression in treated patients B) Prevent or reduce the incidence of tooth or implant loss C) Increase the probability of locating and treating other conditions or diseases in the mouth D) Predict when untreated gingivitis will progress to periodontitis Answer: D 2) Which of the following is the accepted standard for a stable endosseous implant 1 year after placement?

A) Vertical bone loss less than 0.2 mm per year B) Vertical bone loss more than 0.2 mm per year C) Horizontal bone loss less than 2 mm per year D) Horizontal bone loss more than 2 mm per year Answer: A 3) Which of the following statements is true concerning radiographs and periodontal maintenance?

A) They are not needed during a maintenance visit.

B) They should be current.

C) They are adequate if within 2 years.

D) They are obtained based on judgment of the patient.

Answer: B 4) All of the following are factors when determining the maintenance interval except one. Which one is the exception?

A) Number of teeth or implants B) Patient cooperation C) Oral hygiene compliance D) Previous history of periodontal disease E) Type of health insurance the patient has Answer: E 5) Which of the following items is important in determining the success of a recare appointment?

A) Plaque control B) Radiographic analysis C) Brand of toothbrush used D) Use of waxed or unwaxed floss Answer: A

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6) Which of the following features is evident in a smoker?

A) Increased bleeding on probing B) Shallower probing depths C) Edematous gingiva D) Less gingival inflammation Answer: D 7) The accepted bone loss/year standard for a stable dental implant is A) 0.1 mm.

B) 0.2 mm.

C) 1 mm.

D) 2 mm.

Answer: B 8) Which of the following definitions pertains to recurrent periodontal disease?

A) Severe bone loss on the initial visit B) Generalized increasing tooth mobility on subsequent visits C) No future attachment loss at future visits D) Persistent deep pockets without strict home-care or recare visits Answer: B 9) The scheduling of maintenance appointments is based on the A) repopulation of subgingival microflora.

B) financial status of the patient.

C) scheduled time for new radiographs.

D) replacement time of the patient’s toothbrush.

Answer: A 10) The greatest patient dropout from maintenance therapy occurs during the A) first year.

B) second year.

C) sixth month.

D) ninth month.

Answer: A 11) Which of the following signs is indicative of occlusal problems when observed during a maintenance visit?

A) Wear facets B) Bleeding on probing C) Gingival inflammation D) Deep probing depths Answer: A 12) Which of the following procedures is appropriate if a bleeding site with a probing depth of 5 mm is found during a periodontal maintenance appointment?

A) Perform periodontal debridement.

B) Immediately refer to a periodontist.

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C) Reevaluate the site 8 months later.

D) Prescribe systemic antibiotics.

E) Administer controlled-release antimicrobial.

Answer: E 13) According to Wilson et al. (1984), what percentage of patients never return to the office for periodontal maintenance?

A) 10 B) 23 C) 34 D) 45 E) 59 Answer: C 14) What is the percent of chlorhexidine present in the OTC products?

A) 0.12% B) 1.2% C) 26.5% D) 35.5% Answer: A 15) Which of the following protocols is most appropriate in a patient who shows generalized recurrence of disease at a periodontal maintenance visit?

A) Perform phase I therapy again.

B) Perform periodontal surgery.

C) Prescribe a systemic antibiotic.

D) Use a controlled-release drug.

Answer: A 16) Which of the following factors should be routinely evaluated in a maintenance patient with dental implants?

A) Probing depths B) Attachment level C) Bleeding index D) Mobility Answer: D

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17) The most reliable way to monitor disease activity is by measuring A) clinical attachment levels.

B) probing depths.

C) bleeding on probing.

D) fremitus.

Answer: A 18) In a recent article by Fischer et al. (2008), it is reported that regular maintenance treatment in a population of highly motivated patients with chronic periodontitis seemed to be equally successful in preventing progressive periodontal tissue destruction in A) hypertensive patients.

B) current smokers and current nonsmokers.

C) patients with tuberculosis.

D) patients with kidney implant.

Answer: B 19) According to Armitage (1996), bleeding in sites with deep pockets is indicative of A) inflammation in the connective tissue.

B) superficial inflammation in pocket lining.

C) severe alveolar bone loss.

D) extensive attachment loss.

Answer: A 20) Which of the following types of radiographs is ideal for a periodontal patient with bone loss?

A) Horizontal bitewing B) Vertical bitewing C) Panoramic D) Periapical Answer: B

Fill-in-the-Blank Questions 1) ________ periodontal disease occurs in treated patients who fail to respond to periodontal treatment.

Answer: Refractory 2) ________ periodontal disease occurs in patients who previously responded well to periodontal therapy but later showed signs of disease reactivation.

Answer: Recurrent 3) Periodontal maintenance is usually started ________ periodontal/implant therapy.

Answer: following 4) The absence of ________ on probing is a better indicator of gingival health than its presence is of periodontal disease.

Answer: bleeding 4 .

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5) The dental hygienist should ________ the patient on risk factors that contribute to periodontal diseases.

Answer: counsel 6) Clinical ________-level measurements should be compared from the last maintenance visit.

Answer: attachment

Critical Thinking Questions 1) Once a patient has completed periodontal treatment, he or she may feel as though regular maintenance visits and continued oral hygiene self-care is not important anymore. How would you deal with this patient's attitude?

Answer: The patient needs to be educated with ongoing discussion on the objective of periodontal treatment and compliance. Review with the patient the fact that treatment is needed to eliminate/reduce risk factors and to prevent the progression and/or recurrence of periodontal disease. This treatment does not stop when active therapy is finished, and it is important to continue with everything that was taught to the patient. Review the importance of regular maintenance visits to the general dentist and the periodontist.

2) Discuss maintenance of the dental implant.

Answer: The most important aspect of implant maintenance in preventing peri-implant disease is controlling bacterial plaque. During the first year of implant placement, radiographs should be taken at three-month intervals during maintenance visits. Probing should not be done around a healthy implant. Scaling should be done using the appropriate instruments: plastic, nylon, or graphite. Calculus is not firmly attached to nonporous titanium surfaces, so deposits of calculus are very light. Implant mobility is a good sign that the implant is failing or failed. Mobility should be evaluated at every maintenance visit.

Case Study Questions Case Study 22.1 A 55-year-old female patient is on a 4-month maintenance schedule. The patient has multiple implants. The medical history: She just started to smoke because of stressful situations in her life. She is a one pack/year smoker (equivalent to smoking one pack/day for 1 year). She often misses her appointments, and sometimes comes in past the 6-month visit.

1) What are the maintenance goals for this patient?

Answer: Maintenance goals for this patient include maintaining patient oral status and function, minimizing inflammation and bleeding, and minimizing risk for disease initiation and recurrence.

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2) Discuss the compliance of this patient to periodontal care.

Answer: Unfortunately, this patient as well as many others is not adherent to her maintenance schedule or oral home care. An essential aspect of periodontal maintenance therapy is patient adherence. Most patients do not comply with long-term behavioral changes, especially for conditions that are not life-threatening. There are three types of compliers: full compliers, irregular compliers, and noncompliers. Periodontal maintenance appointments are essential and important for all groups, but noncompliers have less successful surgical outcomes over time.

Better communication may contribute to more successful outcomes. Other methods of improving patient adherence include providing positive reinforcement and attempting to better accommodate patient needs (Wilson, 1996a). Furthermore, the severity of the periodontal problem should be stressed because the more threatening a patient perceives a disease, the higher the adherence.

3) What should be done about her smoking habit?

Answer: The dental hygienist should discuss the adverse effects of smoking on the periodontium as well as general health. The patient should be asked if she wants to stop. If she agrees, there are many steps and guidelines to follow. Written brochures, the 4A Smoking Cessation Program, medications, and behavioral modification are ways to help the patient to stop smoking.

Matching Questions Match the term in Column A with the correct definition or statement in Column B. A) 34% B) Minimize disease recurrence C) Mobility D) primary prevention E) secondary prevention 1) Periodontal maintenance 2) periodontally healthy patient undergoing a prophylaxis 3) Nonadherent to maintenance visits 4) Failed implant 5) patients with active disease undergoing treatment Answers: 1) B; 2) D; 3) A; 4) C; 5) E

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Comprehensive Periodontics for the Dental Hygienist, 4e (Weinberg) Chapter 23 Topical Drug Delivery Systems

Multiple-Choice Questions 1) The concentration of chlorhexidine found in Peridex is A) 0.12.

B) 11.6.

C) 14.0.

D) 21.6.

E) 27.6.

Answer: A 2) All of the following are first-generation agents except one. Which one is the exception?

A) Listerine B) Cepacol C) PerioGard D) Hydrogen peroxide E) Viadent Advanced Care Answer: C 3) To which of the following classifications does Listerine belong?

A) Bisbiguanide B) Quaternary ammonium compound C) Phenolic D) Oxygenating agent E) Fluoride Answer: C 4) Most oral rinses are indicated for periodontitis because these antimicrobial rinses are effective against subgingival anaerobic bacteria.

A) Both statement and reason are correct.

B) Both statement and reason are incorrect.

C) The statement is correct, but the reason is incorrect.

D) The statement is incorrect, but the reason is correct.

Answer: B 5) Which of the following percentage of alcohol is found in original Listerine?

A) 0.12% B) 12.0% C) 14.0% D) 21.6% E) 27.6% Answer: D

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6) It is best not to use chlorhexidine immediately after toothbrushing because the positively charged chlorhexidine binds to the negatively charged fluoride molecules in toothpastes.

A) Both statement and reason are correct.

B) Both statement and reason are incorrect.

C) The statement is correct, but the reason is incorrect.

D) The statement is incorrect, but the reason is correct.

Answer: A 7) Which of the following adverse effects is commonly seen with the use of chlorhexidine?

A) Dentinal sensitivity of exposed root surfaces B) Yellow staining of teeth and tongue C) Supragingival calculus formation D) Dental caries Answer: C 8) Which of the following is an indication for the use of supragingival irrigation?

A) To reduce dentinal hypersensitivity B) To enhance bone regeneration C) To irrigate the periodontal ligament D) To flush away debris Answer: D 9) Which of the following rinses is classified as quaternary ammonium compound?

A) Scope B) Listerine C) Plax D) Periogard E) Peridex Answer: A 10) It is advised to tell the patient to routinely rinse with undiluted 3% hydrogen peroxide because peroxide will kill all of the bacteria.

A) Both statement and reason are correct.

B) Both statement and reason are incorrect.

C) The statement is correct, but the reason is incorrect.

D) The statement is incorrect, but the reason is correct.

Answer: B 11) Which of the following is the primary use of oral irrigation?

A) To nonspecifically reduce bacteria and their by-products B) To reach down to the base of deep pockets C) To convert periodontitis into gingivitis D) To inhibit formation of supra- and subgingival calculus Answer: A

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12) Which of the following statements is true about the use of an oral irrigator?

A) It is recommended to reduce ulcerations of the buccal mucosa.

B) Do not use for a periodontal abscess.

C) It can be used in place of flossing.

D) AHA has established guidelines for patients requiring antibiotic prophylaxis.

Answer: B 13) Oral rinses are classified as which of the following types of delivery systems?

A) Topical B) Controlled-release C) Sustained-release D) Systemic Answer: B 14) Scope is considered as which of the following types of rinses?

A) Therapeutic B) Cosmetic C) Oxygenating D) Fluoride Answer: A 15) Chlorhexidine is an ideal agent to use for adjunctive treatment of gingivitis because it has high substantivity.

A) Both statement and reason are correct.

B) Both statement and reason are incorrect.

C) The statement is correct, but the reason is incorrect.

D) The statement is incorrect, but the reason is correct.

Answer: A 16) Which percentage of alcohol is found in chlorhexidine rinse?

A) .012 B) 0.12 C) 11.6 D) 21.7 Answer: C 17) Which of the following statements is true about an antimicrobial rinse?

A) It is a substitute for a toothbrush.

B) It is used in patients with periodontitis.

C) It helps reduce bacterial load.

D) Patients must use it at least four times a day for it to be effective.

Answer: C

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18) Which of the following features describes chlorhexidine?

A) A bisbiguanide B) Negatively charged molecule C) Available without a prescription in the United States D) Alcohol free Answer: A 19) Which of the following features describes Listerine?

A) A bisbiguanide B) High substantivity C) Contains thymol D) Alcohol free Answer: C 20) Which of the following features describes oxygenating agents?

A) Hydrogen peroxide B) Bisbiguanide C) High substantivity D) Releases nitrogen on contact with tooth Answer: A True/False Questions 1) Oral rinses reach subgingivally.

Answer: FALSE 2) Oral irrigation can be used without supplementation with brushing and flossing.

Answer: FALSE 3) Chlorhexidine gluconate has high substantivity to the oral mucous membranes.

Answer: TRUE 4) Chlorhexidine gluconate is considered to be a second-generation agent.

Answer: TRUE 5) Listerine is considered to be a first-generation agent.

Answer: TRUE 6) It is acceptable and effective to use antimicrobial mouthrinses as the only oral hygiene method of self-care.

Answer: FALSE 7) Hydrogen peroxide should be used undiluted as an oral rinse.

Answer: FALSE 8) Povidine iodine is antibacterial.

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Answer: TRUE

Fill-in-the-Blank Questions 1) Oral rinses are divided into therapeutic and ________ rinses.

Answer: cosmetic 2) Antimicrobial agents ideally should ________ microbial colonization on the tooth surface.

Answer: inhibit 3) First-generation agents have antibacterial properties with ________ substantivity.

Answer: low 4) It is ideal to have a drug with high ________.

Answer: substantivity 5) Chlorhexidine gluconate is poorly ________ from the oral mucous membranes.

Answer: absorbed Critical Thinking Questions 1) Discuss the different indications for using oral rinses.

Answer: A. As an addition to home-care regimens that have failed to achieve plaque-control goals by other means.

B. As an addition to periodontal instrumentation.

C. Where oral hygiene may be inadequate or difficult to accomplish for many people, as in the physically or mentally compromised.

D. Following surgical procedures, when brushing and flossing are generally not practical.

E. As a preprocedural rinse, to reduce aerosolized bacteria in the dental office (when masked, the clinician is protected; however, after the mask is removed, aerosols remain in the dental operatory).

F. For maintenance of dental implants.

Topical antimicrobial agents delivered by a rinse are effective only against supragingival bacteria. No antimicrobial rinse has been shown to be effective against periodontitis because oral rinses do not reach the subgingival area. Mouthrinses may be discontinued if oral health conditions can be maintained without their use.

2) Discuss the term substantivity.

Answer: Substantivity is defined as the ability of the drug to adsorb or bind to intraoral surfaces such as teeth and soft tissues with subsequent release of the drug in its active form. Substantivity involves the ability of the drug to stay at the target site for longer periods of time, thus maintaining therapeutic levels. It is ideal to have a drug with high substantivity that will be bound in the oral cavity and released over a period of hours in order to prolong the effects. Lack of substantivity can be overcome by more frequent use of the agent, but this would likely result in noncompliance and undesirable side effects. Chlorhexidine has high substantivity and 5 .

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Listerine has low substantivity.

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Case Study Questions Case Study 23.1 A 65-year-old female patient is in the dental office for the first time. Periodontal examination revealed deep probing depths and multiple furcation involvements. The patient's oral hygiene is fair because no one ever showed her how to brush and use floss. She regularly uses Scope.

1) The patient requests to use another mouthrinse because she feels it will do a better job at cleaning. How do you respond to that?

Answer: Adjunctive mouthrinses are indicated when oral hygiene is inadequate or difficult to perform in certain people or when all attempts have failed. Since this is a new patient, it is recommended to teach her oral care and then monitor to see if she conforms to this new regimen.

Advise her to discontinue Scope because this is a cosmetic mouthrinse with no therapeutic effect.

2) Periodontal surgery is part of the treatment plan. What oral hygiene regimen do you recommend for this patient?

Answer: After periodontal surgery when adequate home care may be difficult, prescribing a mouthrinse is acceptable. Chlorhexidine is recommended because it has a high substantivity, and clinical studies have shown that it is an adequate antibacterial/antigingivitis rinse. Its benefits outweigh the side effects of teeth and tongue staining.

Matching Questions Match the term/descriptor of an oral rinse or oral irrigation in Column A with the correct statement in column B. A) Flushing action B) Phenolic compound C) Substantivity D) Alcohol free 1) Chlorhexidine 2) Listerine 3) Oral irrigation 4) Rembrandt Answers: 1) A; 2) C; 3) B; 4) D

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Comprehensive Periodontics for the Dental Hygienist, 4e (Weinberg) Chapter 24 Systemic and Local Drug Delivery Systems: Systemic Antibiotics, Local Drug Devices, and Enzyme Suppression Therapy

Multiple-Choice Questions 1) To which of the following delivery systems do Arestin and Atridox belong?

A) Topical B) Local C) Systemic D) Rinse Answer: B 2) In which of the following structures is Atridox placed?

A) Periodontal pocket B) Maxillary sinus C) Alveolar bone D) Connective tissue Answer: A 3) In which of the following situations is doxycycline 20 mg indicated?

A) Chronic gingivitis B) Necrotizing ulcerative periodontitis C) Localized aggressive periodontitis D) Generalized aggressive periodontitis E) Generalized chronic periodontitis Answer: E 4) All of the following statements are true about doxycycline 20 mg except one. Which one is the exception?

A) It is an antibiotic.

B) It has no antibacterial action.

C) It inhibits collagenase production and release from host cells.

D) It is effectively used for nine months.

E) It is used in periodontics and dermatology.

Answer: A 5) Which of the following drugs is highly concentrated in the gingival crevicular fluid (GCF)?

A) Tetracycline B) Amoxicillin C) Clindamycin D) Erythromycin E) Penicillin VK Answer: A 1 .

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6) Which of the following drugs is found in Arestin?

A) Doxycycline hyclate B) Minocycline HCl C) Tetracycline HCl D) Azithromycin HCl E) Clindamycin HCl Answer: B 7) Which of the following antibiotics is contraindicated during pregnancy and in children up to age 8?

A) Erythromycin sterate B) Clindamycin HCl C) Cephalosporin D) Amoxicillin E) Tetracycline HCl Answer: E 8) Which of the following combination antibiotics is typically used in patients with localized aggressive periodontitis?

A) Amoxicillin + tetracycline B) Metronidazole + amoxicillin C) Tetracycline + doxycycline D) Erythromycin + azithromycin E) Clindamycin + erythromycin Answer: B 9) Which of the following antibiotics should not be taken with alcohol?

A) Penicillin B) Erythromycin C) Metronidazole D) Azithromycin E) Clindamycin Answer: C 10) Which of the following antibiotics forms a complex with calcium during enamel formation?

A) Erythromycin B) Amoxicillin C) Ampicillin D) Metronidazole E) Doxycycline Answer: E

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11) Which of the following decides the choice of delivery system for antimicrobials/antibiotics?

A) Target site B) Degree of absorption C) Severity of side effects D) Amount of drug administered Answer: A 12) Which of the following antibiotics concentrates in phagocytes such as PMNs within the inflamed connective tissue?

A) Minocycline B) Doxycycline C) Amoxicillin D) Azithromycin E) Metronidazole Answer: D 13) Which of the following antibiotics is classified as a second-generation macrolide?

A) Penicillin B) Erythromycin C) Metronidazole D) Azithromycin E) Clindamycin Answer: D 14) Which of the following antibiotics is indicated in generalized chronic periodontitis?

A) Quinolone B) Azithromycin C) Amoxicillin D) None Answer: D 15) Which of the following antibiotics is especially indicated for refractory periodontitis?

A) Clindamycin B) Erythromycin C) Metronidazole D) Amoxicillin E) Tetracycline Answer: A 16) Which of the following ingredients is contained in Atridox?

A) Chlorhexidine B) Doxycycline C) Minocycline D) Amoxicillin Answer: B

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17) Which of the following ingredients is contained in PerioChip?

A) Chlorhexidine B) Doxycycline C) Minocycline D) Amoxicillin Answer: A 18) For which of the following conditions are systemic antibiotics indicated?

A) Gingivitis B) Generalized chronic periodontitis C) Localized chronic periodontitis D) Localized aggressive periodontitis Answer: D 19) Which of the following antibiotics is most effective against strict anaerobes such as Porphyromonas gingivalis?

A) Metronidazole B) Tetracycline C) Doxycycline D) Clindamycin Answer: A 20) The development of pseudomembranous colitis is associated with the growth of A) Prevotella intermedia.

B) Porphyromonas gingivalis.

C) Clostridium difficle.

D) Treponema denticola.

Answer: C

Fill-in-the-Blank Questions 1) Arestin is a powder form of ________.

Answer: minocycline HCl 2) Atridox is a gel form of ________ hyclate.

Answer: doxycycline 3) Doxycycline has both antibacterial and ________ properties.

Answer: anticollagenase 4) Doxycycline 20 mg is dispensed as a ________.

Answer: tablet 5) Doxycycline 20 mg inhibits enzymes produced and secreted by ________ in the host body.

Answer: neutrophils 4 .

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Critical Thinking Questions 1) Discuss the indications for systemic antibiotic usage in periodontics.

Answer: Indications include localized/generalized aggressive periodontitis and necrotizing periodontal diseases. Systemic antibiotics should not be given to patients with any form of gingivitis, except NUG. Antibiotics are primarily indicated for periodontal diseases where there is bacterial invasion directly through the junctional/sulcular epithelium into the underlying gingival connective tissue (lamina propria). This is because scaling and root planing will not be able to reach the bacteria that have invaded into the tissues, thus a systemic antibiotic is necessary to reach this target area.

2) Why is periodontal debridement (scaling and root planing) necessary before any form of antimicrobial or antibiotic is administered?

Answer: It is necessary to physically remove the biofilm by instrumentation, then the antimicrobial agent can be administered. For this reason, administration of antimicrobial agents should never be the sole treatment and always should be as an adjunct to periodontal debridement and/or periodontal surgery. The biofilm structure also may account for the rapid rebound or repopulation of the pathogenic flora, which occurs frequently after the use of antimicrobial agents.

3) Discuss enzyme suppression therapy.

Answer: Although bacteria are the culprits in initiating inflammatory periodontal diseases, the inflammatory mediators, including cytokines and prostaglandins produced by the host (body) cells in response to the bacteria, are partly responsible for periodontal tissue breakdown.

Neutrophils in the body synthesize and release collagenase, an enzyme that breaks down collagen, which is what makes up periodontal structures. Periostat is a subantimicrobial form of doxycycline hyclate and specifically will inhibit the production and release of collagenase from the neutrophils. This is the unique feature of Periostat. Additionally, Periostat does not have antibacterial properties.

Case Study Questions Case Study 24.1 A 14-year-old female patient presents with localized aggressive periodontitis. The first molars have severe vertical bone loss with mobility. After a periodontal and radiographic assessment, a treatment plan was completed. Oral hygiene instructions are given. The patient will have quadrant periodontal debridement followed by periodontal surgery. Additionally, the patient will be prescribed an antibiotic.

1) Why is an antibiotic indicated for this patient?

Answer: Systemic antibiotics are indicated for patients with localized aggressive periodontitis because the bacteria involved (Actinobacillus actinomycetemscomitans) invade from the pocket area into the epithelium and connective tissue and evade mechanical instrumentation.

2) Which is the most appropriate antibiotic to prescribe for this patient?

Answer: Common antibiotic regimens include doxycycline, amoxicillin + metronidazole, and 5 .

Weinberg: Comprehensive Periodontics for the Dental Hygienist, 4e (0133097714)

azithromycin.

3) Even though scaling and root planing are indicated, there is a minimal accumulation. Why? Answer: There are minimal plaque and calculus deposits because the bacterium has penetrated the soft tissue and is not found in the pocket area.

Matching Questions Match the description in Column A with the proper antibiotic or nonantibiotic in Column B. A) Doxycycline 20 mg B) Amoxicillin C) Cephalosporins D) Tetracycline E) Azithromycin F) Arestin G) Atridox 1) Controlled-release device containing minocycline microspheres 2) Broad-spectrum erythromycin 3) Used for nonantibiotic effects 4) Destroyed by penicillinases 5) Should not be given with milk 6) Controlled-release device containing doxycycline 7) Cross allergy with pencillins Answers: 1) F; 2) E; 3) A; 4) B; 5) D; 6) G; 7) C

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Weinberg: Comprehensive Periodontics for the Dental Hygienist, 4e (0133097714)

Comprehensive Periodontics for the Dental Hygienist, 4e (Weinberg) Chapter 25 Principles of Periodontal Surgery: Gingivectomy, Osseous Resection, and Periodontal Plastic Surgery

Multiple-Choice Questions 1) All of the following are contraindications or reasons for a delay in periodontal surgery except one. Which one is the exception?

A) Poor oral hygiene B) Uncontrolled diabetes mellitus C) Unstable hypertension D) Intravenous bisphosphonates E) Deep periodontal pockets Answer: E 2) Which of the following steps should be followed for preoperative management of a patient before periodontal surgery?

A) Reinforcement of oral hygiene practices B) Placement of a periodontal dressing C) Instructions for suture maintenance D) Rinsing with 3% hydrogen peroxide Answer: A 3) Which of the following types of surgery is best to treat a periodontal bony lesion with deep pockets and vertical bone loss (three-wall defect)?

A) Periodontal plastic surgery B) Implant surgery C) Regenerative surgery D) Mucogingival surgery Answer: C 4) Which of the following periodontal conditions is best treated with gingivectomy/gingivoplasty?

A) One-wall bony defect B) 6 mm gingival pocket C) 8 mm infrabony pocket D) Class II furcation defect Answer: B 5) Which of the following periodontal conditions is best treated with a subepithelial connective tissue graft?

A) Class III furcation defect B) Class I furcation defect C) Soft tissue recession with exposure of root D) Two-wall bony defect with base of pocket apical to alveolar crest Answer: C 1 .

Weinberg: Comprehensive Periodontics for the Dental Hygienist, 4e (0133097714)

6) Which of the following healing responses of periodontal tissues after surgery describes the reformation of tissues that were destroyed due to periodontal disease?

A) Repair B) Reattachment C) New attachment D) Regeneration Answer: D 7) In which of the following conditions is a gingivectomy contraindicated?

A) 8 mm gingival pocket with no bone loss B) 6 mm pseudopocket as a result of cyclosporine use C) Enlarged interdental papillae with no bone loss D) 3 mm gingival pocket without attached gingiva Answer: D 8) Which of the following steps should be done during administration of a local anesthetic containing epinephrine?

A) Aspirate while injecting.

B) Remove the needle from the site of injection.

C) Move the needle around inside the tissue.

D) Inject until blood is seen inside the carpule.

Answer: A 9) All of the following sutures are absorbable except one. Which one is the exception?

A) Chromic gut B) Vicryl C) Monocryl D) Ethibond Answer: D 10) Which of the following should be used by a patient to help reduce inflammation and swelling immediately after periodontal surgery?

A) Aspirin B) Ice packs C) Heated packs D) Rinsing with water Answer: B 11) Which of the following steps is the first procedure done during the first postoperative visit?

A) Remove the sutures.

B) Count the number of sutures in the mouth.

C) Perform subgingival scaling.

D) Polish the teeth before dressing and sutures are removed.

Answer: B

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Weinberg: Comprehensive Periodontics for the Dental Hygienist, 4e (0133097714)

12) Which of the following problems may arise as a consequence of periodontal surgery?

A) Tooth mobility B) Allergy to antibiotics C) Sensitivity to sweets D) Increased clotting time Answer: A 13) Which of the following reasons is the primary cause of pain following periodontal surgery?

A) Tissue swelling B) Improper oral hygiene C) Anti-inflammatory medication D) Analgesic medication Answer: A 14) Which of the following signs/symptoms may be reduced following periodontal surgery if adequate plaque control is maintained?

A) Swelling B) Root sensitivity C) Pain D) Fremitus Answer: B 15) Which of the following gingival procedures has a donor site for gingival tissue that is located adjacent to the recipient (grafted) site?

A) Connective tissue graft B) Gingivectomy C) Laterally positioned flap D) Guided tissue regeneration Answer: C 16) With which of the following knots are most sutures tied?

A) Surgeon's B) Sling C) Double D) Single Answer: A 17) Which of the following healing processes starts after a gingivectomy?

A) Formation of new bone B) Revascularization of periodontal ligament fibers C) Epithelialization of the wound surface D) Thickening of the connective tissue Answer: C

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18) Which of the following "newer" techniques is approved for sulcular debridement?

A) Laser B) Electrosurgery C) Bleaching under ultraviolet D) Ultrasonic Answer: A 19) Which of the following surgical techniques is indicated for a patient who has gingival enlargement due to nifedipine but no bone loss?

A) Gingivectomy B) Connective tissue graft C) Free gingival graft D) Surgery with apically positioned flaps Answer: A 20) After flap surgery, the flaps were sutured closely together without any gap. This flap will heal by A) primary intention.

B) secondary intention.

C) tertiary intention.

D) It will not heal.

Answer: A 21) What is the correct description of a periodontal condition for the correct surgery procedure that would be used to correct the condition, Crown lengthening needed for a crown preparation A) Gingival plastic surgery B) Regenerative surgery C) Osseous resective surgery D) Gingivectomy/gingivoplasty Answer: C 22) What is the correct description of a periodontal condition for the correct surgery procedure that would be used to correct the condition, Inadequately attached gingiva A) Gingival plastic surgery B) Regenerative surgery C) Osseous resective surgery D) Gingivectomy/gingivoplasty Answer: A 23) What is the correct description of a periodontal condition for the correct surgery procedure that would be used to correct the condition, Vertical (moderately deep) bony defect A) Gingival plastic surgery B) Regenerative surgery C) Osseous resective surgery D) Gingivectomy/gingivoplasty 4 .

Weinberg: Comprehensive Periodontics for the Dental Hygienist, 4e (0133097714)

Answer: B 24) What is the correct description of a periodontal condition for the correct surgery procedure that would be used to correct the condition, Horizontal bone loss with periodontal pocketing A) Gingival plastic surgery B) Regenerative surgery C) Osseous resective surgery D) Gingivectomy/gingivoplasty Answer: C 25) What is the correct description of a periodontal condition for the correct surgery procedure that would be used to correct the condition, Gingival enlargement from taking phenytoin A) Gingival plastic surgery B) Regenerative surgery C) Osseous resective surgery D) Gingivectomy/gingivoplasty Answer: A 26) What is the correct description of a periodontal condition for the correct surgery procedure that would be used to correct the condition, Class II buccal furcation involvement on the mandibular first molar A) Gingival plastic surgery B) Regenerative surgery C) Osseous resective surgery D) Gingivectomy/gingivoplasty Answer: B 27) What is the correct description of a periodontal condition for the correct surgery procedure that would be used to correct the condition, Removal of mandibular exostosis A) Gingival plastic surgery B) Regenerative surgery C) Osseous resective surgery D) Gingivectomy/gingivoplasty Answer: C True/False Questions 1) Total pocket elimination is the primary objective for periodontal surgery.

Answer: FALSE 2) Soft tissue deficiencies are referred to as osseous defects.

Answer: FALSE 3) One of the objectives of periodontal surgery is to arrest disease progression.

Answer: TRUE 5 .

Weinberg: Comprehensive Periodontics for the Dental Hygienist, 4e (0133097714)

4) Regenerative periodontal surgery uses bone grafts as part of the procedure.

Answer: TRUE 5) Periodontal plastic surgery would be necessary to increase the width of attached gingiva.

Answer: TRUE 6) Preoperative management involving patient preparation for surgery involves fabrication of permanent prosthetic crowns and bridges.

Answer: FALSE 7) If a patient is noncompliant with oral hygiene self-care, surgical procedures should not be started.

Answer: TRUE 8) If a patient has controlled hypertension, surgical procedures can be started.

Answer: TRUE

Fill-in-the-Blank Questions 1) A ________ is defined as that loosened part of the gingiva, alveolar mucosa, and/or periosteum that is separated from the underlying periodontal structures except at its base.

Answer: flap 2) In a ________ flap, the gingiva, alveolar mucosa, and periosteum are reflected from the root and underlying bone surface.

Answer: mucoperiosteal 3) ________ is the removal of supporting bone or bone that is in contact with the root.

Answer: Ostectomy 4) ________ is the reshaping or recontouring of nonsupporting bone that is not in contact with the root.

Answer: Osteoplasty 5) Vicryl is a type of ________ suture.

Answer: absorbable 6) ________ should be achieved before a periodontal dressing is placed.

Answer: Hemostasis 7) The primary purpose of using a periodontal dressing after surgery is for patient ________.

Answer: comfort

Critical Thinking Questions 6 .

Weinberg: Comprehensive Periodontics for the Dental Hygienist, 4e (0133097714)

1) Discuss the procedure to inform the patient who questions the use of medications during and after surgery. The patient has seen advertisements about some antibiotics.

Answer: The patient should be told that each case is different and some patients may require antimicrobials or antibiotics as an adjunct to scaling and root planing. Antibiotics should never be taken as the sole therapy.

2) Discuss the effects of smoking on the outcome of periodontal surgery.

Answer: Smoking is a major concern for the general health as well as periodontal health of a patient. Smoking affects the onset and progression of periodontal diseases; smoking is an established risk factor for inflammatory periodontal diseases. Smoking cessation should be a part of the treatment of a periodontal patient. Smoking also has an effect on the general healing of tissues following periodontal surgery, especially healing of soft tissue grafts.

Case Study Questions Case Study 25.1 A 57-year-old patient needs four quadrants of surgery. He mainly has horizontal bone loss with deep pockets. In one area, the maxillary central incisors, the frenum is "high," causing gingival recession with minimal attached gingiva. This site also bleeds. The patient's medical history is unremarkable, but he smokes about one pack per day. The patient is anxious about the procedures but knows it’s for the best. His oral hygiene status is fair but improving.

1) What types of periodontal surgical procedures are indicated for this patient?

Answer: The patient requires two types of surgeries. The first surgery is pocket elimination flap surgery with osseous recontouring, including ostectomy to remove bone and osteoplasty to reshape bone. This surgery is indicated in cases with deep pockets; there will be pocket elimination and osseous recontouring because there is horizontal bone loss, which causes either a flat or negative bony architecture. The objective is to get a parabolic architecture where the radicular bone covering the labial surface is slightly more apical than the interproximal bone.

Sometimes ending up with flat architecture is adequate because too much bone may have to be removed. The second surgery is to correct the high frenum because it is causing gingival recession. A frenectomy with a free gingival graft to prevent the frenum from reattaching is indicated. A free gingival graft is taken from the palate (recipient site) and sutured in place on the prepared donor bed. This procedure will increase the zone of attached gingiva.

2) Does smoking interfere with healing after surgery?

Answer: Yes, especially with a free gingival graft. According to the American Academy of Periodontology (AAP), smoking impairs the body's defense mechanisms and interferes with the healing process.

3) What oral home-care regimen should be recommended to the patient?

Answer: Refer to Box 25-2.

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Weinberg: Comprehensive Periodontics for the Dental Hygienist, 4e (0133097714)

Comprehensive Periodontics for the Dental Hygienist, 4e (Weinberg) Chapter 26 Principles of Periodontal Surgery: Periodontal Regeneration

Multiple-Choice Questions 1) Which of the following defects heals best with periodontal surgical regeneration?

A) Class III maxillary molar furcation B) Class II maxillary molar distal furcation C) One-wall infrabony D) Three-wall infrabony E) Horizontal bone loss Answer: D 2) Which of the following materials is classified as an enamel matrix protein derivative?

A) Perioglas B) Emdogain C) BioGuide D) Gore-Tex Answer: B 3) Which of the following bone grafts is taken from an extraction site in the patient's mouth?

A) Autograft B) Allograft C) Heterograft D) Xenograft E) Alloplast Answer: A 4) Which of the following types of cells is intended to repopulate the wound area in guided tissue regeneration surgery?

A) Periodontal ligament B) Gingival C) Connective tissue D) Epithelial basal Answer: A 5) Which of the following bone grafts is taken from human cadavers?

A) Autograft B) Allograft C) Alloplast D) Xenograft E) Heterograft Answer: B

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Weinberg: Comprehensive Periodontics for the Dental Hygienist, 4e (0133097714)

6) Which of the following materials is used to inhibit epithelial migration into the surgical site?

A) Bone grafts B) Bone substitutes C) Barrier membranes D) Surgical sutures Answer: C 7) Which of the following terms is used for a surgical procedure that will impede the epithelial migration during healing of the periodontal wound?

A) Guided tissue regeneration B) Gingival curettage C) Incision and drainage D) Intracrevicular incision Answer: A 8) Which of the following tissues is the fastest growing?

A) Bone B) Epithelium C) Connective tissue D) Root cementum Answer: B 9) In which of the following tissues do osteoblasts and cementoblasts originate?

A) Alveolar bone B) Cementum C) Periodontal ligament D) Gingival epithelium E) Connective tissue Answer: C 10) Which of the following is most important for a desirable outcome of periodontal regenerative procedures?

A) Meticulous oral hygiene self-care B) Avoiding fluoride-containing toothpastes C) Avoiding hot beverages D) Eliminating hard food from diet Answer: A 11) Which of the following bone grafts/bone substitutes is considered to be a "bone filler" and not osteogenic?

A) Autograft B) Alloplast C) Xenograft D) Allograft E) Heterograft Answer: B 2 .

Weinberg: Comprehensive Periodontics for the Dental Hygienist, 4e (0133097714)

12) Which of the following bony defects has a lesser chance of regeneration with a bone graft or bone replacement material?

A) One-wall infrabony on the maxillary first premolar B) Three-wall infrabony on the mandibular second molar C) Class II buccal furcation of mandibular first molar D) Class II buccal furcation on the mandibular second molar Answer: A 13) Which of the following bone materials is a xenograft?

A) DFDBA B) FDBA C) Bovine bone D) Hydroxyapatite E) Intraoral bone from maxillary tuberosity Answer: C 14) All of the following are goals of using bone grafts/bone substitutes in infrabony defects except one. Which one is the exception?

A) Reduction in probing depths B) Loss of clinical attachment levels C) Filling of osseous defects D) Regeneration of new supporting bone, cementum, and PDL Answer: B 15) All of the following are types of periodontal surgical regenerative procedures except one.

Which one is the exception?

A) Open flap debridement B) Osseous resection C) Guided tissue regeneration D) Surgery with bone grafts Answer: B 16) Which of the following bone materials is an allograft?

A) Bio-Oss B) DFDBA C) Perioglas D) Emdogain Answer: B 17) Which of the following bone materials is an alloplast?

A) Capset B) DFDBA C) Gem 21S D) Bone from extraction socket Answer: A

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18) Which of the following cells is involved in degrading Resolut barrier membrane?

A) Bone B) Periodontal ligament C) Macrophage D) Lymphocytes Answer: C 19) Which of the following membranes is made of collagen?

A) BioGide B) Atrisorb Freeflow C) OsseoQuest D) Resolut Answer: A 20) Which of the following membranes is made of PLA (poly-DL-lactide)?

A) BioMend B) Reguarde C) Epi-Gide D) BioGide Answer: C

Fill-in-the-Blank Questions 1) Demineralized freeze-dried bone is abbreviated as ________.

Answer: DFDBA 2) GTR is an abbreviation for ________ tissue regeneration.

Answer: guided 3) Bone grafts are used during periodontal surgery for vertical bony ________.

Answer: defects 4) BioMend is a type of ________ barrier membrane.

Answer: absorbable 5) A barrier membrane is placed over the ________ defect.

Answer: osseous 6) Formation of periodontal tissue that was destroyed is referred to as periodontal ________.

Answer: regeneration 7) Barrier membranes are used during guided tissue ________.

Answer: regeneration 8) Puros is a type of ________ bone.

Answer: bovine 4 .

Weinberg: Comprehensive Periodontics for the Dental Hygienist, 4e (0133097714)

9) Emdogain is a porcine, enamel matrix ________ derivative.

Answer: protein 10) Epithelium migrates at a rate of ________ to 1.0 mm per day.

Answer: 0.5 11) Gore-Tex Titanium Reinforce is a type of nonabsorbable ________ membrane.

Answer: barrier 12) PDGF is an abbreviation for platelet-derived ________ factor.

Answer: growth Critical Thinking Questions 1) Compare and contrast different bone replacement materials.

Answer: The purpose of using bone replacement materials during periodontal surgery is to enhance the formation of new cementum, bone, and periodontal ligament; they should be osteogenic. That is, they should cause bone cells (osteoblasts) to migrate to and proliferate into the surgical wound. Bone graft materials may be osteoinductive (provide a stimulus for cells to form bone) or osteoconductive, which requires the presence of existing bone around the vertical (infrabony) defect and acts as a framework for surrounding bone cells to lay down bone.

2) A patient is concerned about toothbrushing and flossing after surgery. He had periodontal flap surgery with the placement of BioMend. What postoperative instructions should be given to the patient?

Answer: The patient's oral home care is very important for a successful outcome of regenerative surgery. BioMend is a type of absorbable barrier membrane that does not have to be removed. If a periodontal dressing is placed, the patient should not brush the area, and an antimicrobial rinse (e.g., chlorhexidine) should be used. Following suture removal, the patient may begin to brush with an ultra-soft-bristled brush in a gentle circular movement. The patient should not floss.

Case Study Questions Case Study 26.1 A 61-year-old male patient had four quadrants of periodontal surgery. There were multiple infrabony defects and furcation involvement. The last surgery involved a Class II furcation defect on the buccal of the mandibular first molar. After the surgery the patient was given postoperative instructions.

1) What are the dental hygiene goals for treatment in this patient?

Answer: (A) remove etiologic bacteria; (B) reduce/eliminate bleeding and inflammation; (C) stabilize periodontal condition and prevent disease progression; (D) reduce pocket depth; and (E) regenerate lost periodontal structures.

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2) What type of surgery was indicated for this patient?

Answer: Since the patient has furcation defects (loss of bone in furcation), the type of surgery indicated is guided tissue regeneration (GTR).

3) What are examples of materials used in this type of surgery?

Answer: Materials used in GTR include bone grafts/bone materials and barrier membranes.

4) What are the postoperative instructions and complications that could occur?

Answer: Refer to Table 26-5. Remember not to probe or perform subgingival debridement for 6 months in areas that received a bone graft and/or barrier membrane.

Matching Questions Match the statement in Column A with the correct description/term in Column B. A) Allograft B) Autograft C) Xenograft D) Growth factor E) Enamel matrix derivative F) Alloplast 1) Mandibular tori 2) Demineralized freeze-dried bone 3) Emdogain 4) Hydroxyapatite 5) Bio-Oss 6) PDGF Answers: 1) B; 2) A; 3) E; 4) F; 5) C; 6) D

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Weinberg: Comprehensive Periodontics for the Dental Hygienist, 4e (0133097714)

Comprehensive Periodontics for the Dental Hygienist, 4e (Weinberg) Chapter 27 Implantology

Multiple-Choice Questions 1) Of which of the following materials are dental implants composed?

A) Nickel B) Titanium C) Silver D) Mercury E) Stainless steel Answer: B 2) Which of the following criterion is used for determining dental implant success?

A) 0.2 mm or less of bone loss per year B) Minimum of two sites that bleed on probing C) Slight implant mobility D) Greater than 4 mm of attached gingiva around the implant Answer: A 3) Which of the following is responsible for attaching the implant to the bone?

A) Osseointegration B) Dental calculus C) Dental biofilms D) Acid etching/resin Answer: A 4) Which of the following techniques will augment the height of bone in the maxillary molar area in order to place implants?

A) Socket preservation B) Ramus graft C) Distraction osteogenesis D) Sinus lift Answer: D 5) Which of the following tissues is not found around an implant?

A) Alveolar bone B) Subepithelial connective tissue C) Principal fibers D) Junctional epithelium E) Outer junctional epithelium Answer: C

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Weinberg: Comprehensive Periodontics for the Dental Hygienist, 4e (0133097714)

6) From which of the following is implant microflora derived?

A) Oral cavity B) Abdominal fluids C) Dental calculus D) Does not have associated bacteria Answer: A 7) Which of the following statements is true comparing subgingival implant microflora versus natural healthy teeth?

A) They are similar.

B) They are different.

C) Subgingival microflora is more complex.

D) Subgingival microflora is less complex.

Answer: A 8) In a two-stage surgical procedure for implant placement, how long (minimum) after the first surgery is the second surgery performed?

A) The same day B) 2-3 weeks later C) 1-3 months later D) 3-6 months later E) 1-2 years later Answer: D 9) Proximity to which of the following anatomical structures must be evaluated before placing posterior implants in the maxilla?

A) Sinuses B) Foramen C) Nasal cavity D) Nerve canals Answer: A 10) During the second-stage surgery, which of the following procedures occurs?

A) Placement of implant B) Placement of bone graft in extraction site C) Replacement of implant with cover screw D) Replacement of cover screw with healing abutment Answer: D 11) Which of the following clinical parameters is controversial to perform on implants?

A) Test for mobility B) Soft tissue evaluation C) Probing depths D) Radiographs Answer: C

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Weinberg: Comprehensive Periodontics for the Dental Hygienist, 4e (0133097714)

12) Which of the following terms refers to the junctional epithelium that adheres to implant surfaces?

A) Perimucosal seal B) Gingival cuff C) Epithelial attachment D) Gingival connective tissue attachment Answer: A 13) Which of the following factors is important when extracting a tooth that will be used for an implant?

A) Bony walls remaining B) Length of tooth C) Blood supply to the area D) Depth of periodontal pocket Answer: A 14) Which of the following goals should be attained with periodontal maintenance of dental implants?

A) Monitor for stable condition.

B) Maintain smooth implant surfaces.

C) Perform root planing to reduce plaque accumulation.

D) Maintain the coatings used on implant surfaces.

Answer: A 15) Which of the following indicates implant success?

A) Marginal bone height loss in the first year of 4 mm B) Absence of periapical pathology or pain C) Implant mobility of not more than 2 mm buccal/lingual D) Primary occlusal trauma Answer: B 16) Which of the following procedures describes the lengthening of mandibular bone height for placement of implants?

A) Sinus augmentation B) Socket preservation C) Distraction osteogenesis D) Guided tissue regeneration Answer: C 17) Which of the following procedures is an example of guided bone regeneration?

A) Socket preservation B) Increasing ridge height C) Regeneration in furcation defects D) Sinus lift Answer: B

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Weinberg: Comprehensive Periodontics for the Dental Hygienist, 4e (0133097714)

18) After guided bone regeneration, how long before implants are placed in that area?

A) 1 week B) 2 months C) 4 months D) 6 months Answer: D 19) Which of the following procedures allows placement of a temporary prosthesis just after implant placement?

A) Immediate placement B) Distraction osteogenesis C) Socket preservation D) Two-stage surgery Answer: A 20) Which of the following bone classification describes a thin layer of cortical bone surrounding a core of low-density trabeclar bone?

A) I B) II C) III D) IV Answer: D

True/False Questions 1) Success of an implant is measured by testing for mobility.

Answer: TRUE 2) It is best to have a minimum amount of keratinized gingiva around an implant.

Answer: FALSE 3) Progressive bone loss is a pathologic sign that can lead to implant failure.

Answer: TRUE 4) Stainless steel scalers should be used on dental implants.

Answer: FALSE 5) A dental implant has a junctional epithelium.

Answer: TRUE 6) A dental implant has a functioning and obliquely oriented periodontal ligament.

Answer: FALSE 7) The implant is that part that is surgically placed into bone.

Answer: TRUE 4 .

Weinberg: Comprehensive Periodontics for the Dental Hygienist, 4e (0133097714)

Fill-in-the-Blank Questions 1) The major difference between implants and teeth is the mechanism by which they are attached to the ________.

Answer: jawbone 2) Implants do not have a ________ ligament.

Answer: periodontal 3) A restored crown on an implant should not be in ________ occlusion.

Answer: traumatic 4) Plaque-induced inflammation occurs in a similar way around implants as around natural ________.

Answer: teeth 5) Osseointegration represents a direct connection between ________ and implant without any soft tissue in between.

Answer: bone 6) ________ is the prosthetic replacement that is either screwed or cemented to the abutment.

Answer: Superstructure 7) The ________ is attached to the implant and will be fitted with a restoration that is placed on top of it.

Answer: abutment 8) An implant anchors to the bone during healing by the process of ________.

Answer: osseointegration 9) Minimal criteria for implant success should include clinical tooth ________.

Answer: immobility 10) Dental implants are surrounded by ________ tissues.

Answer: peri-implant 11) Bone loss (e.g., dehiscence) around an implant is referred to as ________.

Answer: peri-implantitis

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Weinberg: Comprehensive Periodontics for the Dental Hygienist, 4e (0133097714)

Critical Thinking Questions 1) Compare and contrast dental implants and natural teeth, focusing on the following.

A. Soft/hard tissue anatomy B. Blood supply C. Microbiology Answer: A. There are many differences between implants and natural teeth. Implants do not develop caries, and there is no pulp; thus, implants do not develop root sensitivity. In natural teeth, the junctional epithelium provides a seal at the base of the sulcus. If this seal is disrupted, the junctional epithelium migrates apically onto the root surface. On the other hand, the implantconnective tissue interface is different from the natural tooth. In the implant, the junctional epithelium is referred to as a perimucosal seal. There is a lack of cementum with no connective tissue fibers inserting into the implant surface.

B. Implants have less blood supply near their neck with more of a scar tissue appearance. Lack of a periodontal ligament limits the blood supply to the area to only the periosteal vessels and bone marrow spaces.

C. Neither implants nor natural teeth are immune to plaque accumulation. The implant microflora are derived from the natural flora of the mouth. Some bacteria, such as Actinomyces viscosus and Streptococcus sanguis, adhere less to implants than to natural teeth. In health, the subgingival implant microflora is similar to that of natural healthy teeth. With the development of inflammation and increasing probing depths, there are elevated levels of spirochetes and gram-negative anaerobes and decreased levels of coccoid cells. Failing implants have a similar microflora to that of periodontal disease.

2) Discuss the difference between guided tissue regeneration and guided bone regeneration.

Answer: Guided bone regeneration (GBR) is a surgical procedure performed to increase the amount of alveolar bone available for the proper placement of a dental implant. The terms guided tissue regeneration and guided bone regeneration are often used interchangeably in literature but are really two different terms; however, they are based on the same basic principles. Guided bone regeneration describes the formation of only bone, not any other tissue, whereas guided tissue regeneration involves the formation of bone, cementum, and periodontal ligament around teeth. Guided bone regeneration surgery is indicated when there is a volume, height, or width deficiency of the residual ridge that prohibits implantation or optimal implant installation for esthetic and functional needs. Bone grafting and use of an absorbable (or nonabsorbable) membrane, which is placed over the bone defect site, is used to stimulate the patient's osteoblasts (bone-producing cells) to develop additional alveolar bone mass. This procedure is done about 6 months prior to placement of dental implants; however, it can be done in conjunction with dental implant placement surgery.

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Case Study Questions Case Study 27.1 A 34-year-old patient presents to the dental office with a failing fixed bridge from the maxillary second molar to the first premolar. The maxillary sinus is only 4 mm from the crest of bone and the two teeth mentioned above need to be extracted due to caries—they are nonrestorable.

During implant placement, bone grafting will need to be done around the implant.

1) What is the treatment plan for this case?

Answer: Extract the bridge. Perform immediate implant placement at the two extraction sites. It can be immediate placement because the teeth were lost due to caries not periodontal problems so the bone quality is good. A sinus lift using a bone graft such as Bio-Oss or Puros (calcified bone not decalcified) at the site of the maxillary second molar is necessary followed by implant placement. The two implants can be temporized but not placed in occlusion. Three months later the permanent bridge can be placed. If site development was performed, wait 4–6 months before implant is placed (site development is when the maxillary second molar is extracted, there was a lot of bone loss around it, and grafting was done) and go back later to put implant in.

2) How should the dental hygienist treat this case?

Answer: If grafting around tooth or implant or membrane is placed, no probing or subgingival scaling for 6 months.

Matching Questions Match the statement in Column A with the correct implant description/term in Column B. A) Two-stage surgery B) Peri-implant mucositis C) Periodontal ligament D) Sinus lift surgery E) Osseointegration 1) Inadequate bone height in maxillary posterior area 2) Not present around an implant 3) No mobility 4) Heals in 3–6 months 5) Soft tissue inflammation around implant Answers: 1) D; 2) C; 3) E; 4) A; 5) B

7 .