10: Performing Periodontal Procedures

Performing Periodontal Procedures

QUESTIONS

1. The therapeutic end point of periodontal debridement is

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.

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.

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.

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.

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?

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.

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.

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?

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.

19. Evaluating mobility is a critical tool in assessment of implant success. Probing is a less useful assessment tool in evaluating implant success.

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.

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.

25. Each of the following is a function of the periodontal ligament EXCEPT one. Which one is the EXCEPTION?

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.

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?

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.

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?

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.

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.

42. Tetracyclines are bacteriocidal. They are broad-spectrum antibiotics that affect gram-positive and gram-negative bacteria.

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?

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?

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.

49. Periodontal disease is almost always preceded by gingivitis. Gingivitis almost always leads to periodontal disease.

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.

52. The most common form of gingivitis is plaque-induced gingivitis. The most common symptoms of the disease are pain and bleeding.

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.

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.

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.

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.

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.

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?

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.

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.

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.

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.

73. Periodontal maintenance is BEST defined as

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.

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).

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.

84. Continuous or intermittent closure of the jaws under vertical pressure is termed

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Jan 1, 2015 | Posted by in Dental Hygiene | Comments Off on 10: Performing Periodontal Procedures
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