Performing Periodontal Procedures
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.
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.
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.
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.
|____ 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|
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.
|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|
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.
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?
|____ 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|
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?
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.
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.
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?
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.
|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|
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).
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.