Performing Periodontal Procedures
QUESTIONS
1. The therapeutic end point of periodontal debridement is
A restoration of gingival health.
B creation of nonretentive root surfaces.
2. When performing periodontal debridement procedures on multirooted tooth surfaces, it is recommended that each root be instrumented as a separate tooth. The use of longer-shanked, miniature-bladed, area-specific curettes is helpful in accessing these surfaces.
C The first statement is true, and the second statement is false.
D The second statement is true, and the first statement is false.
3. Frequent periodontal debridement of subgingival root surfaces for the purpose of removing biofilm is important for the treatment of periodontal disease because most subgingival biofilm is not easily reached during patient self-care.
A Both the statement and the reason are correct and related.
B Both the statement and reason are correct but NOT related.
4. Each of the following is a common response to successful periodontal debridement EXCEPT one. Which one is the EXCEPTION?
5. The “gross scale” technique of removing only the large deposits of supragingival calculus at the first appointment is no longer recommended because of the potential problems from incomplete calculus removal.
A Both the statement and the reason are correct and related.
B Both the statement and reason are correct but NOT related.
6. Which of the following instruments is designed for removal of fine deposit in a deep, narrow pocket on the distal root surface of tooth #27?
7. Chronic periodontitis may be either localized or generalized. The disease progresses continuously over time.
C The first statement is true, and the second statement is false.
D The first statement is false, and the second statement is true.
8. Phase I of periodontal therapy, or the etiologic phase, includes each of the following procedures EXCEPT one. Which one is the EXCEPTION?
9. The severity of periodontal disease is most accurately measured over time by
10. Which of the following is NOT an underlying objective of periodontal maintenance?
B Maintenance of alveolar bone height
C Preservation of clinical attachment levels
11. Probing depth is usually equal to clinical attachment loss. Periodontal surgery is most successful when treating periodontal pockets with probing depths of 5 to 9 mm.
C The first statement is true, and the second statement is false.
D The first statement is false, and the second statement is true.
12. Periodontal surgery is not indicated for patients under 30 years old who present with pocket depths exceeding 5 mm and loss of half of their supporting bone because they likely have a slowly progressing form of periodontal disease.
A Both the statement and the reason are correct and related.
B Both the statement and reason are correct but NOT related.
13. Which of the following is the preferred form of excisional surgery for the treatment of drug-induced gingival enlargement?
14. The goal of periodontal flap procedures is
15. Which of the following is a contraindication to osseous recontouring?
A Reverse alveolar bone architecture
B Bone defect too deep to allow removal of osseous walls
C Thick bony ledges interfering with gingival flap procedures
D Periodontal pockets that extend below the level of the osseous crest
16. The surgical procedure which only involves removal of bony ledges or nonsupporting bone is called
17. The type of periodontal bone grafting created from synthetic bone minerals is a/an
18. Lasers are considered an adjunct therapy for removal of soft tissue within the periodontal pocket. The Er:YAG laser has been shown to be safe for use around implants.
C The first statement is true, and the second statement is false.
D The first statement is false, and the second statement is true.
19. Evaluating mobility is a critical tool in assessment of implant success. Probing is a less useful assessment tool in evaluating implant success.
C The first statement is true, and the second statement is false.
D The first statement is false, and the second statement is true.
20. Professionally placed controlled-release local drug delivery is indicated for deep pockets and nonresponsive sites because it routinely provides superior results in reducing pocket depths and attachment levels compared with periodontal debridement.
A Both the statement and the reason are correct and related.
B Both the statement and reason are correct but NOT related.
21. Which of the following regions of the dentition has the narrowest width of attached gingiva?
22. Which of the following types of tissue makes up the outer layer of gingival tissue?
23. For each numbered term listed, select the most closely associated description.
Term | Definition |
____ 1. Interdental gingiva | A. Coronal border of gingiva |
____ 2. Mucogingival junction | B. Separates the free and attached gingiva |
____ 3. Gingival margin | C. Below mucogingival junction |
____ 4. Sulcus | D. Contains two papillae |
____ 5. Alveolar mucosa | E. Suspends the tooth |
____ 6. Free gingival groove | F. Point where attached gingiva meets alveolar mucosa |
____ 7. Col | G. Marks the border of the free gingiva and the attached gingiva |
____ 8. Periodontal ligament | H. Gingival depression between two teeth |
24. Crevicular fluid increases its flows in the gingival sulcus during gingival health. It decreases in flow in the presence of plaque biofilm and inflammation.
C The first statement is true, and the second statement is false.
D The first statement is false, and the second statement is true.
25. Each of the following is a function of the periodontal ligament EXCEPT one. Which one is the EXCEPTION?
A Supports the tooth in alveolar bone
B Stimulates formation of secondary dentin
C Transmits sensations of touch and pressure
26. Order the steps (from first to last) in the spread of inflammation seen with vertical bone loss. Match each letter with its appropriate number.
27. There is a greater prevalence and severity of periodontal disease among the female population in the United States than among the male population. A person in his or her 60s is at greater risk for periodontal disease than an individual in his or her 40s.
C The first statement is true, and the second statement is false.
D The first statement is false, and the second statement is true.
28. Which of the following are local contributing factors for periodontal disease? (Select all that apply.)
29. For each numbered component of the immune system listed, select the function that most closely matches it from the list provided. Not all functions will be used.
Immune System Component | Function |
____ 1. B-lymphocyte | A. First white blood cell at site of injury; begins phagocytosis; releases cytokines and lysosomes |
____ 2. Polymorphonuclear neutrophils (PMNs) | B. Neutralizes bacterial toxins; activates complement system; coats bacteria for phagocytosis |
____ 3. T-lymphocytes | C. Generates chemotaxis; activates lysis of cell membrane and phagocytosis; recruits phagocytic cells |
____ 4. Immunoglobulins | D. Produces plasma cells, which produce immunoglobulins; make antibodies; destroy antigens |
____ 5. Macrophage | E. Stimulates production of prostaglandins |
____ 6. Complement system | F. Second inflammatory cell to arrive; ingests and digests microorganisms; releases cytokines, prostaglandins, and lysosomes |
G. Further stimulates immune response; secretes cytokines and kills infected cells | |
H. Proteins that regulate cell activity |
30. All the following describe the plaque biofilm overgrowth phase of early gingivitis EXCEPT one. Which one is the EXCEPTION?
C Polymorphonuclear neutrophils (PMNs) are recruited by cytokines.
D Macrophages are recruited to connective tissue.
E PMNs (neutrophils) destroy healthy gingival connective tissue.
31. Which systemic risk factor for periodontitis is characterized by a gradual onset, an inadequate supply of insulin, or the inability to use produced insulin effectively?
32. A person with uncontrolled type 2 diabetes mellitus is at greater risk for periodontal disease compared with a person with controlled type 1 diabetes mellitus because the uncontrolled diabetic has an impaired host response, disruption in collagen formation, and higher glucose levels in the gingival crevicular fluid.
A Both the statement and reason are correct and related.
B Both the statement and reason are correct but NOT related.
C The statement is correct, but the reason is NOT.
33. Smoking affects the periodontium in all the following ways EXCEPT one. Which one is the EXCEPTION?
34. Your patient presents with gingival redness, inflammation, bleeding, sensitivity, and tenderness. There is visible plaque biofilm at the gingival margin. There is no bone loss indicated on dental images. This individual most likely has
35. Rapid periodontal destruction, including bone loss, tissue necrosis, severe pain, tissue sloughing, spontaneous bleeding, and fiery red erythematous tissue, all describe which of the following conditions?
A Primary herpetic gingivostomatitis
B Gingivitis induced by malnutrition
36. For each numbered inherited disease with risk of periodontal disease listed below, select the most closely linked description from the list provided.
Disorder | Characteristics |
____ 1. Leukocyte adhesion deficiency | A. Developmental delay; small head; hyperelasticity of skin; weak muscle tone; short philtrum; vaulted palate; prominent maxillary central incisors |
____ 2. Papillon-Lefévre syndrome | B. Pale-colored hair, eyes, and skin; neutrophil chemotactic defect; early tooth loss in both dentitions; high risk for fatal bacterial infection; extractions recommended to decrease dental infections |
____ 3. Cohen syndrome | C. Disorders that affect the bone marrow and neutrophil levels; possible severe bone and tooth loss; possible early exfoliation of deciduous teeth; permanent teeth exfoliation as soon as they erupt |
____ 4. Chediak-Higashi syndrome | D. Inherited disorder of severe chronic neutropenia; severe bone and tooth loss resulting in exfoliation on deciduous and permanent teeth |
____ 5. Down syndrome | E. Hyperkeratosis of palms of hands and soles of feet (palmoplantar keratoderma); severe periodontal defects; bone and tooth loss; all primary teeth by age 5 years; all permanent teeth by age 15 years |
____ 6. Cyclic neutropenia | F. Additional chromosome 21; mild to moderate retardation; severe early-onset aggressive periodontitis; generalized heavy plaque; deep pocketing; gingival inflammation |
____ 7. Glycogen storage disorder | G. Problem with storage of carbohydrates as glycogen; neutropenia; bone and tooth loss; exfoliation of deciduous and permanent teeth |
37. Periodontal disease is associated with coronary heart disease, diabetes mellitus, preeclampsia, hospital-acquired pneumonia, and some types of cancer. Association indicates causation.
C The first statement is true, and the second statement is false.
D The first statement is false, and the second statement is true.
38. Which of the following nutrients is MOST critical for wound healing and collagen formation in the periodontium?
39. Order the five phases of therapy in the periodontal treatment plan. Match each letter with its proper sequence number.
40. Periodontal debridement is beneficial for each of the following conditions EXCEPT one. Which one is the EXCEPTION?
41. Most cases of halitosis originate in the oral cavity. Pyridine has been identified as the leading cause of halitosis.
C The first statement is true, and the second statement is false.
D The first statement is false, and the second statement is true.
42. Tetracyclines are bacteriocidal. They are broad-spectrum antibiotics that affect gram-positive and gram-negative bacteria.
C The first statement is true, and the second statement is false.
D The first statement is false, and the second statement is true.
43. The reestablishment of junctional epithelium after periodontal debridement occurs within
44. All the following are characteristics of chronic periodontitis EXCEPT one. Which one is the EXCEPTION?
A Periodontal disease is communicable.
B Prevalence and severity increases with age.
C Chronic periodontitis is the most common form of periodontitis.
D The amount of dental biofilm is disproportionate to the amount of tissue destruction.
45. A patient who has previously had nonsurgical periodontal surgery returns for the 4-month periodontal maintenance appointment. The patient presents with visible plaque, increased pocket depth and clinical attachment loss, inflammation with exudate, and bleeding on probing in the maxillary right molar region. There is also some evidence of increased bone loss on dental images. All other areas have remained stable. Which of the following is the BEST course of action?
A Localized periodontal surgery
B Evaluation of the patient’s systemic condition
C Increasing the number of periodontal maintenance appointments
D Decreasing the number of periodontal maintenance appointments
46. The maintenance interval schedule for the first year after the placement of an implant is
47. Which gram-negative, nonmotile pathogen is found in small numbers in the healthy periodontium and in large numbers in recurrent disease sites with deep periodontal pockets?
48. Dentinal sensitivity can only be managed with the use of fluoride toothpaste because the sensitivity is more often related to root caries than exposure of root surfaces.
A Both the statement and reason are correct and related.
B Both the statement and reason are correct but NOT related.
C The statement is correct, but the reason is NOT.
49. Periodontal disease is almost always preceded by gingivitis. Gingivitis almost always leads to periodontal disease.
C The first statement is true, and the second statement is false.
D The first statement is false, and the second statement is true.
50. To determine immediate success of scaling and root planning, the clinician must rely on
51. Order the healing events after treatment for gingivitis. Match each letter with its proper sequence number.
1. ______A.Stippling reappears.
2. ______B.Collagen is deposited.
3. ______C.Clinical probing depth is reduced.
4. ______D.Tissues return to normal coloration.
52. The most common form of gingivitis is plaque-induced gingivitis. The most common symptoms of the disease are pain and bleeding.
C The first statement is true, and the second statement is false.
D The first statement is false, and the second statement is true.
53. From the following list, select the three items that characterize gingivitis.
54. Systemic factors may modify the patient’s reaction to plaque biofilm. The patient’s reaction to plaque biofilm may be caused by alterations in the immune system caused by stress, endocrine-related changes, and drug-induced changes.
C The first statement is true, and the second statement is false.
D The first statement is false, and the second statement is true.
55. Pregnancy gingivitis is a condition that occurs because the elevation of female hormones cause exaggerated cellular and vascular proliferation, and microvessel leakage in response to oral biofilm. Pregnancy gingivitis is an unavoidable outcome of pregnancy.
C The first statement is true, and the second statement is false.
D The first statement is false, and the second statement is true.
56. From the following list, select the three items that are characteristic of the contents of the inflamed periodontal pocket.
57. Periodontal disease activity is
58. Bleeding on probing is a sign of active periodontal disease. Bleeding sites are indicative of increasing bone loss and soft tissue destruction.
C The first statement is true, and the second statement is false.
D The first statement is false, and the second statement is true.
59. Chronic periodontal disease is consistent with the amount of oral biofilm found in the mouth, including the presence of subgingival calculus. Chronic periodontitis progresses at a slow rate, with short bursts of disease progression.
C The first statement is true, and the second statement is false.
D The first statement is false, and the second statement is true.
60. Clinical characteristics such as the rate of bone loss and age of onset are the most reliable distinguishing features between aggressive periodontal disease and chronic periodontal disease because both conditions present with a similar bacterial microflora.
A Both the statement and the reason are correct and related.
B Both the statement and the reason are correct but NOT related.
C The statement is correct, but the reason is NOT.
61. After periodontal surgery, all of the following postoperative instructions should be given EXCEPT one. Which one is the EXCEPTION?
62. Which of the following BEST describes the progress of surgical wound healing at the 1-week postoperative visit?
A The wound is completely healed.
B The wound is completely reepithelialized.
63. Which of the following is the earliest period after surgery when it is safe to probe the surgical site?
64. In the first few days after periodontal surgery, the dental hygienist is likely to see all of the following clinical signs or symptoms in the periodontal patient EXCEPT one. Which one is the EXCEPTION?
65. The MOST common type of implant used in clinical dentistry is the
66. The formation of an intimate lattice between the implant surface and bone is referred to as
67. Plaque biofilm and calculus removal for dental implants should be performed with
68. Home care for patients with implants is very important because they require the same cleaning aids as do patients with natural teeth.
A Both the statement and the reason are correct and related.
B Both the statement and the reason are correct but NOT related.
C The statement is correct, but the reason is NOT.
69. Maintenance visits for implant patients should occur every 3 months during the first year. After the first year, recall intervals may be extended to 4 to 6 months if the gingival health is good and home care is excellent.
70. Implant-supported removable prostheses should be removed at home daily by patients because the supporting abutments need to be cleaned thoroughly with soft toothbrushes, single-tufted toothbrushes, and other devices, as needed.
A Both the statement and the reason are correct and related.
B Both the statement and the reason are correct but NOT related.
C The statement is correct, but the reason is NOT.
71. The expected outcome after treatment is termed the overall or global prognosis for the periodontal patient. Risk factors such as diabetes or tobacco use may alter the prognosis for the individual.
C The first statement is true, and the second statement is false.
D The first statement is false, and the second statement is true.
72. The overall, or global, prognosis may be different from the prognoses for individual teeth because periodontal disease is site specific and may affect some teeth in the dentition more severely than others.
A Both the statement and the reason are correct and related.
B Both the statement and the reason are correct but NOT related.
C The statement is correct, but the reason is NOT.
73. Periodontal maintenance is BEST defined as
C scaling, root planning, and polishing at appropriate intervals.
D periodic assessment and preventive treatment for early detection and treatment of recurrent disease.
74. Successful periodontal therapy, including maintenance, is likely to result in slowing the rate of tooth loss to approximately
75. There is a high dropout rate for maintenance patients because they often do not understand that periodontal therapy is not complete after phase I therapy.
A Both the statement and the reason are correct and related.
B Both the statement and the reason are correct but NOT related.
C The statement is correct, but the reason is NOT.
76. Recurrent periodontal disease may be linked to all of the following factors EXCEPT one. Which one is the EXCEPTION?
77. A patient presents with periodontal probing depths of 3 to 4 mm and attachment loss of 1 to 2 mm. This patient would be classified as having ___________________ periodontitis.
78. The use of prophylactic antibiotic coverage for dental procedures is recommended for which of the following conditions?
79. For each numbered description listed below, select the MOST closely linked term or procedure from the list provided.
Description | Term or Procedure |
____ 1. Disruption or removal of plaque biofilm | A. Root planning |
____ 2. Instrumentation of the crown and root of teeth to remove plaque, calculus, and stains | B. Polishing |
____ 3. Definitive removal of cementum or surface dentin that is rough or is impregnated with calculus, toxins, or microorganisms | C. Maintenance |
____ 4. Preventive procedure to remove local irritants from the gingiva, including calculus removal | D. Periodontal debridement |
____ 5. Application of agents to remove stains and plaque biofilm from teeth | E. Plaque control |
____ 6. Scaling and root planing and disruption or removal of plaque biofilm with minimal tooth structure removal | F. Endotoxins |
____ 7. Lipopolysaccharides found in the cell wall of gram-negative bacteria that trigger a strong inflammatory response | G. Prophylaxis |
____ 8. Periodic assessment and prophylactic treatment to permit detection and treatment of disease | H. Scaling |
80. From the following list, select three items that will decrease the relative risk of root caries after periodontal surgery.
81. Clinical response to nonsurgical therapy can be measured with a periodontal probe. Measurement of clinical attachment is computed by measuring the periodontal probe depths and then subtracting the distance to the cementoenamel junction (CEJ).
C The first statement is true, and the second statement is false.
D The first statement is false, and the second statement is true.
82. All of the following chemical agents are used to treat sensitivity EXCEPT one. Which one is the EXCEPTION?
83. Informed consent is a process that allows the patient full understanding of the disease process, treatment options, and probable outcomes. This consent must always be in writing and signed by the patient.
C The first statement is true, and the second statement is false.
D The first statement is false, and the second statement is true.
84. Continuous or intermittent closure of the jaws under vertical pressure is termed