Perio I Final Exam

Stratefied squamous epithelium

-cellular -- keratinocytes, langerhan cells, merkel cells, melanocytes

Internal basal lamina has 2 layers:

-Lamina densa (adjacent to the enamel) -Lamina lucida (hemidesmosomes attach)

Microbial virulence factors implicated in tissue destruction of the periodontium include:

-Lipopolysaccharides (LPS) -Hydrogen Sulfide (H2S), gingipains -Propionic Acid

Arrangement of vascular network for gingival blood supply

-absence of inflammation (regular pattern, repetitive, layer) -inflammed gingiva (irregular pattern, looped, dilated, convoluted)

Attached Gingiva

-attached to bone -protection -firm, resilient and tightly bound to underlying periosteum of alveolar bone -positioned between marginal and alveolar -demarcated from loose unattached alveolar mucosa and mucogingival junction

Oral gingival epithelium

-keratinized or para-keratinized -selective interchange with oral environment - innate and acquired immune response

The most prevalent bacterium associated with localized aggressive periodontitis is: A- Aggregatibacter actinomycetemcomitans B- Prevotella intermedia C- Fusobacterium nucleatum D-Peptostreptococcus micros

A

The two most common locations for supragingival calculus to develop are the: A. Buccal surfaces of the maxillary molars B. Lingual surfaces of the mandibular anterior teeth C. Lingual surfaces of the maxillary molars D. Buccal surfaces of the mandibular anterior teeth

A and B

All of the following are believed to be factors in aggressive periodontitis EXCEPT: A- A. actinomycetemcomitans B- Nutrition C- Depressed neutrophil chemotaxis D- Genetics E- All of the above

B

Certain risk factors for periodontal disease can be modified. All of the following are modifiable risk factors for periodontal disease EXCEPT: A. Tobacco smoking B. Age C. Nutrition D. Dental plaque

B

When we treat gingivitis in a child/young adult, it consists of all of the following steps/procedures EXCEPT: A. Oral hygiene instruction B. Scaling and root planning C. Prophylaxis D. Recall and maintenance

B

All but which of the following are prognostic for periodontitis? A. Smoking B. Previous periodontal disease C. Presence of systemic disease D. Furcation involvement

B.

All of the following are believed to be factors in localized aggressive periodontitis EXCEPT: A- A. actinomycetemcomitans (AA) B- Nutrition C- Depressed neutrophil chemotaxis D- Genetics

B.

Epidemiologic study designs include all of the following EXCEPT: A. Randomized clinical trial B. Controlled clinical trials C. Case-control studies D. Cohort studies

B.

Koch's postulates stipulate several conditions must exist for an agent to be causative. Which statement is not included in Koch's postulates that the causative agent must do the following:

Be treatable with antibiotics

Underlying connective tissue

less celllar, composed of collagen fibers and ground substance

What bacteria can invade gingival connective tissues:

-Aggregatibacter actinomycetemcomitans -P. gingivalis

The names of "red complex" bacteria are

-Bacteroides forsythus -Porphyromonas gingivalis -Treponema denticola

Beneficial species of bacteria can act

-By passively occupying a niche that may otherwise be colonized by pathogens -By actively limiting a pathogen's ability to adhere to appropriate tissue surfaces -By adversely affecting the vitality or growth of a pathogen -By affecting the ability of a pathogen to produce virulence factors -By degrading virulence factors

Width of the attached gingiva:

-Distance between the mucogingival junction and the external surface of the most apical portion of the gingival sulcus or periodontal pocket -greatest on facial aspect on incisor -narrower in posterior

Radiation therapy in excess of 6000 Gy or equivalent rad to the maxilla or mandible results in an endarteritis and which of the following?

-Exposed soft tissue undergoing ischemia and subsequent fibrosis -Diminished salivary flow and mucositis -Exposed bone that becomes hypovascular and hypoxic

Circular gingival fibers

-circular course through CT of marginal and interdental gingiva; encircle tooth in ring-like fashion (4) -Insertion: marginal CT -Termination: marginal CT

Fxns of GCF

-cleanses gingival sulcus -provides source of plasma proteins which improve adhesion of epithelium to tooth -provides antimicrobial and antibiotic activity

Components of gingival connective tissue lamina propria

-collagen fibers (60% by volume) -fibrobalsts (5%) -vessels, nerves, and matrix; ground substance (35%)

Contents of GCF

-components of connective tissue and epithelium -biochemical markers -inflammatory cells -serum -microbial flora

Gingival description: color

-coral pink, bluish, pink -caused by: --vascular supply --thickness and degree of keratinization of epithelium --melanin content

A comparison of smokers against nonsmokers who have been matched for age and plaque levels should reveal that smokers exhibit:

-deeper pockets and greater attachment -higher prevalence of furcation involvement -greater amounts of alveolar bone loss

Ground Substance

-extracellular -fills space between fibers and cells -amorphous -high water content -composed of proteoglycans an glycoproteins

Gingivodental gingival fibers

-fan-like configuration from cementum to the crest of gingiva (1) -to the other surface of marginal gingiva (2) -external to periosteum of labial/lingual plates (3) -insertion: cementum -termination: marginal and attached gingiva

Cellular elements of gingival tissue lamina propria

-fibroblasts; predominant cells (development, maintenance, and repair of gingival CT) -mast cells -plasma cells -lymphocytes -neutrophils

gingival sulcus

-formed with the tooth erupts into the oral cavity. --at that time, the junctional epithelium and the REE form a broad band that is attached to the tooth. -shallow, V-shaped space/groove between the tooth and the gingiva that encircles the newly erupted top of the crown -bounded by the tooth on one side and sulcular epithelium on the other

Fxn of junctional gingival epithelium

-forms protective barrier: firmly attached to tooth surface -allows access of gingival fluid: inflammatory cells and components of immunologic host defense -rapid cell turn-over contributes to host-parasite equilibrium and rapid repair of damage tissue

Anatomy of the periodontium

-gingiva -periodontal ligament -cementum -alveolar bone

Interdental gingiva

-gingival embrasure space -location and shape of contact -location of alveolar bone height -between teeth -deflects debris -helps with speech -cosmetic -posterior teeth: col -anterior: pyramid

Transseptal gingival fibers

-horizontal bundles extending between cementum of approximating teeth, located between base of gingival sulcus and crest of alveolar bone; also considered periodontal ligament principal fibers -insertion: cementum -termination: cementum

Early plaque formation occurs faster:

-in lower jaw (vs upper) -in molar areas -on the buccal tooth surface (vs palatal) -in the interdental regions (vs buccal or lingual)

Materia alba is an accumulation of

-microorganisms -desquamated epithelial cells -leukocytes -a mixture of salivary proteins and lipids

Junctional gingival epithelium

-non-keratinized -attached to tooth surface by internal basal lamina (external basement membrane) -attached to gingival connective tissue by external basal lamina -renews within 1-6 days

Gingiva

-portion of the oral mucosa that cover the alveolar processes of the jaws and surrounds the necks of the teeth

Oral gingival epithelium functions

-protective barrier --mechanical --water --microbial --chemical

gingival blood supply

-supraperiosteal arterioles along facial and lingual surfaces of alveolar bone -vessels of periodontal ligament -arterioles which emerge from the crest of the interdental septa

Marginal gingiva

-terminal border that surrounds teeth in a collar like fashion -unattached -may be demarcated from adjacent gingiva by a shallow linear depression (free gingival groove) in 50% of cases -forms soft tissue wall of gingival sulcus -AKA free gingiva

Gingival sulcus

-the shallow space that is coronal to the junctional epithelium -bounded by tooth on one side and sulcular epithelium on the other

Gingival description: size

-the sum total of the bulk of cellular and intracellular elements and their vascular supply -edematous -fibrotic

Gingival crevicular fluid

-transudate (extravascular) or exudate (vascular) --> sparse in healthy tissue ; quantity increases with inflammation

Gingival Fibers

-type 1 collagen fxns: --to brace the marginal gingival firmly against the tooth --to provide the rigidity necessary to withstand the forces of mastication without being deflected away from the tooth surface

the following species can be encountered in the oral cavity

-viruses -fungi -archea -protozoa

According to research findings, all but which one of the following characteristics is likely to increase your patient's risk for chronic periodontitis? A. Bleeding on probing B. Smoking C. Diabetes D. Gram-negative bacteria

A

Which statements are true about necrotizing periodontal diseases? A. NUG and NUP represent clinical manifestations of the same disease. B. These diseases are always accompanied by fever, malaise, and lymphadenopathy. C. NUG is usually an acute lesion that responds well to antimicrobial therapy combined with SC/RP. D. NUP is associated with low CD4+ cell counts in HIV-infected patients.

A,C,D

The microorganism implicated as primary pathogen in localized aggressive periodontitis is

Actinobacillus actinomycetemcomitans

Which of the lesions described by Page and Schroeder involves the destruction of the alveolar bone and periodontal ligament?

Advanced

In 1999, changes to the previous classification of periodontal diseases were brought about in the AAP International Workshop based on which of the following reason(s): A. Chronic periodontal destruction caused by the accumulation of local factors can occur before age 35 B. The aggressive disease seen in young patients may be independent of age C. Little evidence supports the idea that refractory periodontitis is indeed a distinct clinical entity

All of the above

Chronic periodontitis is associated with high levels of which of the following subgingival microorganisms

Anaerobic, gram-negative

Linear gingival erythema (HIV-associated gingivitis) is caused by:

Fungal infection

T/F: (1) Compared with the pretreatment clinical status, both smokers and nonsmokers benefit from periodontal treatment. (2) However, smokers demonstrate a diminished response to periodontal treatment as compared with nonsmokers

Both are true

Aggressive periodontitis can be distinguished from chronic periodontitis by all of the following EXCEPT: A. It rapidly progresses. B. It alters the host immune system. C. It typically affects people older than 30 years. D. There is a familial aggregation of diseased individuals.

C

All of the following are major constituents of the organic portion of calculus EXCEPT: A) Protein-polysaccharide complexes B) Desquamated epithelial cells and leukocytes C) Compound lipids D) dead microorganisms

C

According to research findings, your patient with gingivitis is likely to have all but which one of the following characteristics? A. Be an adolescent B. Be male C. Be a smoker D. Have poor plaque control

C.

Each of the following genetic disorders can cause periodontitis in a child/young adult EXCEPT: A. Down syndrome B. Papillon-Lefèvre syndrome C. Progeria D. Ehlers-Danlos syndrome (Types IV and VIII)

C.

Several drugs can cause gingival enlargement. Which of the following DOES NOT cause enlargement? A. Phenytoin B. Cyclosporin C. Simvastatin D. Nifedipine

C.

Which of the following tooth anatomic factors is NOT associated with gingival/periodontal disease? A. Cervical enamel projections B. Enamel pearls C. Tight contacts D. None of the above

C.

The main inorganic component of calculus

Calcium phosphate

In the case where periodontal destruction is clearly the result of local factors but has been exacerbated by the onset of conditions such as diabetes, the diagnosis should be,

Chronic periodontitis modified by the systemic condition

Two of the most common "reliable" clinical measures of gingival inflammation are:

Gingival Index and Bleeding on Probing

A smoker's diminished resistance to periodontal disease may relate to all of the following EXCEPT: A) Depressed number of helper T lymphocytes B) Reduced serum level of IgG C) Impaired phagocytic function of neutrophils D) Enhanced gingival blood flow

D

Localized aggressive periodontitis has all of the following characteristics EXCEPT: A. Begins around puberty B. Affects molars C. Affects incisors D. Affects cuspids

D

Subgingival margins of restorations, as compared with supragingival margins, are associated with all of the following EXCEPT: A) Increased plaque accumulation B) Enhanced gingival inflammation C) Increased flow of gingival crevicular fluid D) Optimal periodontal health

D

The cytokines that are expressed as a host response to putative periodontal pathogens include all of the following EXCEPT: A. Prostaglandins B. Matrix metalloproteinases C.Interleukins D. Interferons E. Tumor necrosis factor

D

Which of the following putative periodontal pathogens has been isolated at a statistically significant higher level from smokers compared with nonsmokers? A) Actinobacillus actinomycetemcomitans B) Porphyromonas gingivalis C) Bacteroides forsythus D) None of the above

D

Which of the following putative periodontal pathogens has been isolated at a statistically significant higher level from smokers compared with nonsmokers? A) Actinobacillus actinomycetemcomitans B)Porphyromonas gingivalis C) Tannerella forsythia D) None of the above

D

The landmark studies of Page and Schroeder described the histologic changes that occur in the gingival tissues. Each lesion was characterized and described. The lesions described included all of the following EXCEPT: A. Initial B. Early C. Established D. Advanced E. Severe

E

What of the following factors is/are considered to differentiate chronic periodontitis from aggressive periodontitis? A. Rate of disease progression over time B. Age of the patient C. Familial nature of disease D. Relative presence/absence of local factors E. All of the above

E.

The microorganisms found in dental plaque associated with periodontal health are predominately....

Facultative, gram-positive

T/F: Cigarette Smoke has no effect on the progression of chronic periodontitis

False

T/F: In cross-sectional studies, incidence can be determined.

False

T/F: The PI and PDI provide information on the extent and severity of disease.

False

In a previous classification, a periodontal disease that appeared around the time of puberty was called localized juvenile periodontitis. In 1999 the Academy of Periodontology changed the classification, and "LJP" is now known as:

Localized aggressive periodontitis

The BEST systemic antibiotic treatment for reducing the amounts of AA in conjunction with scaling and root planing is:

Metronidazole and amoxicillin

A periodontium with previous attachment loss that has received periodontal therapy to stabilize any further attachment loss may be affected by recurrent gingival inflammation but without further attachment loss. These cases may be diagnosed as:

Plaque induced gingivitis

You have the positive result from the diagnostic test described in question 1 that is known to have a high sensitivity. To determine how likely the site is to actually be active, you would want to know the:

Positive predictive value

What's the purpose of epithelium?

Protection -can't expose bone, muscles and ligament

You wish to use a diagnostic test in your practice to help identify people with active periodontal disease sites. Thus, to be most likely to identify a site with active periodontal disease, you would want to select a test with high:

Sensitivity

The term periimplantitis refers to an "inflammatory process" affecting the tissues around an already osseointegrated implant resulting in loss of supporting bone. The microorganisms that cause periimplantitis are:

Similar to the bacteria that cause periodontitis

Several hypotheses have been posed concerning the relationship of plaque to periodontitis. We currently believe in the:

Specific Plaque Hypotheses

T/F: Certain microorganisms in plaque are considered to be beneficial because of their ability to inhibit the growth or colonization of pathogenic species

True

T/F: Radiographic findings for localized aggressive periodontitis show bone defects wider than those usually seen with chronic periodontitis.

True

T/F: The severity of chronic periodontitis can be influenced by systemic diseases such as diabetes.

True

T/F: Scaling and root planing may lead to chronic pulpitis through bacterial penetration of dentinal tubules in combined lesions. The endodontic infection should be controlled after definitive management of the periodontal lesion.

True, then false

Gingival diseases can be modified by malnutrition. The most common deficiency that is associated with gingival diseases is:

Vitamin C deficiency

The "red complex" bacteria are:

associated with sites of bleeding on probing

Gingivitis in children is primarily caused by:

dental plaque

Gingival irritation

derived from nerves within periodontal ligament, and from labial, buccal, and palatal nerves

Mucosa

fragile tissue

The main source of mineralization for subgingival calculus is

gingival crevicular fluid

Sulcular gingival epithelium

non-keratinized

The Specific Plaque Hypothesis states that:

only certain plaque microorganisms are pathogenic

Edematous

swells up quickly

Fibrotic

swells up slowly

main purpose of the epithelium

to protect the deep structures while allowing for a selective interchange with the oral environment - takes place by the proliferation of keratinocytes

Marginal groove

where free/marginal gingiva meets attached gingiva