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PERIO FINAL

Total questions: 191

Worksheet time: 2hrs 37mins

Name
Class
Date
1.

Which of the following lymph nodes drain most of the periodontal tissues?

a)

Deep cervical 

b)

Submental

c)

Jugulodigastric 

d)

Submandibular

2.

Innervation of the teeth and periodontal ligament of the maxillary arch is from the ____ alveolar nerves, and innervation of the teeth and periodontal ligament of the mandibular arch is from the ____ alveolar nerves.

a)

Superior, Inferior

b)

Nasopalatine, Buccal

c)

Infraorbital, Mental

d)

Supramaxillary, inframandibular

3.

The ____ is the part of the mucosa that surrounds the cervical portions of the teeth and covers the alveolar processes

a)

Gingiva

b)

Periodontal ligament

c)

Cementum

d)

Alveolar mucosa

4.

Which of the following tissues is NOT part of the periodontium?

a)

Periodontal ligament 

b)

Gingiva

c)

Cementum 

d)

Alveolar mucosa

5.

A dental hygienist inserts a calibrated periodontal probe into a healthy sulcus until the tip reaches the base of the sulcus. What anatomical structure forms the base of the sulcus?

a)

Periodontal ligament

b)

Gingiva

c)

Cementum

d)

Junctional epithelium

6.

While assessing the gingival tissue, the hygienist notes there appear to be "open spaces" apical to the contact areas of many of the patient's teeth. Which anatomical area of the gingiva is missing resulting in open spaces?

a)

Attached gingiva

b)

Interdental gingiva

c)

Gingival sulcus

d)

Interdental col

7.

The coronal-most edge of the gingiva is the alveolar mucosa. Alveolar mucosa is distinguished by its dark red color and smooth, shiny surface.

a)

Both statements are true

b)

Both statements are false

c)

The first statement is true, the second is false

d)

The first statement is false, the second is true

8.

What shallow linear depression separates the free and attached gingiva?

a)

Gingival sulcus

b)

Mucogingival junction

c)

Free gingival groove

d)

Gingival margin

9.

The space between the free gingiva and tooth surface is called:

a)

Interdental gingiva

b)

Gingival sulcus

c)

Junctional epithelium

d)

Periodontal ligament 

10.

The depth of a clinically normal gingival sulcus is no greater than:

a)

1 mm

b)

3 mm

c)

5 mm 

d)

7 mm

11.

Which of the following is NOT a function of the periodontal ligament?

a)

Suspends the tooth in its socket

b)

Provide feeling to the tooth

c)

Build and maintain cementum

d)

Prevent food from becoming packed in the sulcus

12.

A thin layer of yellow, hard, mineralized tissue that is attached to dentin of the root refers to which tissue?

a)

Alveolar bone

b)

Cementum

c)

Periodontal Ligament

d)

Enamel

13.

The existence of alveolar bone is dependent on the presence of teeth. .. teeth are extracted, alveolar bone resorbs.

a)

Both statements are true

b)

Both statements are false

c)

The first statement is true, the second is false 

d)

The first statement is false, the second is true

14.

Which of the following is NOT one of the layers of the alveolar process?

a)

Alveolar bone

b)

Cortical bone

c)

Ramus

d)

Cancellous bone

15.

The periodontal ligament can remodel alveolar bone in response to pressure. The periodontal ligament can provide nutrients to cementum and bone.

a)

Both statements are true

b)

Both statements are false

c)

The first statement is true, the second is false

d)

The first statement is false, the second is true

16.

The thin layer of bone that lines the socket to surround the root of the tooth is called: 

a)

Cancellous bone

b)

Periosteum

c)

Alveolar bone proper

d)

Compact bone

17.

Physiologic pigmentation appears: 

a)

Light to dark coral pink

b)

More frequently in light-skinned people

c)

In anterior regions only; is never seen in posterior region

d)

More frequently in dark-skinned people 

18.

Nerve supply to the periodontium is derived from branches of the _____

a)

Transseptal 

b)

Trigeminal

c)

Transoral

d)

Trigingival

19.

The primary function of cementum is to provide attachment for the fibers of the PDL. The terminal endings of the PDL fibers are called Sharpey’s fibers.

a)

Both statements are true 

b)

Both statements are false

c)

The first statement is true, the second is false

d)

The first statement is false, the second is true

20.

Lattice-like bone that fills the interior portion of the alveolar process refers to:

a)

Cortical bone

b)

Cancellous bone 

c)

Periosteum

d)

Cribriform plate

21.

A patient has a healthy periodontium. If the hygienist could see the microscopic structures of this patient's periodontium, how would the interface of the junctional epithelium with the gingival connective tissue appear?

a)

It would have a smooth interface.

b)

It would have a parallel interface.

c)

It would have a sloping interface.

d)

It would have a wavy interface

22.

The difference between a gingival pocket and a periodontal pocket is that:

a)

A gingival pocket is a result of gingival enlargement, and a periodontal pocket is a result of apical migration of junctional epithelium and alveolar bone loss

b)

A gingival pocket does not have exudate, and periodontal pocket exhibit exudate

c)

A gingival pocket occurs when there is horizontal bone loss, and a periodontal pocket occurs when there is vertical bone loss

d)

A periodontal pocket is a "false" pocket while a gingival pocket is a "true" pocket

23.

Continued apical migration of the junctional epithelium indicates a:

a)

Site of active disease

b)

Inflammation

c)

Gingivitis

d)

Pseudopocket

24.

All of the following are functions of the periodontal ligament EXCEPT which one?

a)

 It attaches the tooth to the bony socket.

b)

It provides sensory and nutritive function.

c)

 It unites the free gingiva with the cementum.

d)

It produces osteoclasts to resorb the bone.

25.

Which of the following tooth structures is an example of epithelial tissue?

a)

)Dentin

b)

 Cementum

c)

Enamel

d)

Pulp

26.

All of the following are functions of the cementum EXCEPT which one?

a)

It seals (covers) the dentinal tubules.

b)

It attaches periodontal fibers to the tooth.

c)

 It lines the bony sockets and protects the roots of the teeth.

d)

 It compensates for the loss of the tooth tissue caused by attrition.

27.

Gingivitis always progresses into periodontitis. Gingivitis can be observed clinically as soon as 2 days after cessation of oral self-care.

a)

Both statements are true. 

b)

Both statements are false.

c)

The first statement is true; the second is false.

d)

The first statement is false; the second is true.

28.

Without cementum, there can be no tissue reattachment after periodontal therapy. For enhanced healing, it is necessary to remove bacteria-laden cementum during subgingival instrumentation.

a)

Both statements are true.

b)

Both statements are false. 

c)

The first statement is true, the second is false.

d)

The first statement is false; the second is true

29.

A patient exhibits a bacterial infection of all parts of the periodontium. Which of the following is the state of her periodontium?

a)

gingival health on

b)

gingival health

c)

Gingivitis

d)

Periodontitis

30.

A dental hygienist gently inserts a calibrated periodontal probe into a sulcus. One side of the working-end of the probe touches the tooth surface as the probe is inserted. During the process of insertion, the other side of the probe is touching which of the following anatomical structures?

a)

Junctional epithelium

b)

 Sulcular epithelium

c)

Basal epithelium

d)

Oral epithelium

31.

The difference between a desmosome and hemidesmosome is that:

a)

a desmosome connects two cells together, and hemidesmosomes connects a cell to the basal lamina

b)

a desmosome is found in the gingival epithelium, and hemidesmosome is found in connective tissue

c)

a desmosome connects a cell to the basal lamina, and hemidesmosome connects one cell to another

d)

A desmosome is found in connective tissue, and hemidesmosome is found in gingival tissue

32.

When performing a clinical examination on your patient, you note that her gingival tissues are light pink with scalloped margins. There was no bleeding upon probing. Probing depths range from 1-2 mm in depth with no bone loss present. Which of the following is the state of her periodontium?

a)

Gingival health on an intact periodontium

b)

Gingival Health on a reduced periodontium 

c)

 Gingivitis

d)

Periodontitis

33.

It is possible for a patient to have gingivitis because of poor nutrition. Gingivitis can be caused from an allergic reaction or fungal infection.

a)

Both statements are true.

b)

Both statements are false.

c)

The first statement is true, the second is false.

d)

The first statement is false; the second is true

34.

Which of the following is a classification of periodontal disease that involves infection or death of dental pulpal tissues?

a)

Chronic periodontitis

b)

Aggressive periodontitis

c)

Periodontitis associated with endodontic lesions

d)

. Necrotizing periodontal disease

35.

 All of the following are “good” reason for classifying periodontal diseases EXCEPT:

a)

Present accurate information to the patient about the condition of their periodontium

b)

Communicate clinical findings accurately and universally to other dental providers

c)

Formulate individualized treatment plan

d)

. To determine the fee that the patient should be charged 

36.

All of the following are true of the oral epithelium, EXCEPT:

a)

It may be keratinized or parakeratinized

b)

. The junction with connective tissue in health has a wavy interface

c)

 It is permeable allowing for flow of cervical fluid

d)

 it covers the outer surface of free gingiva an attached gingiva

37.

All of the following are components of a comprehensive periodontal assessment EXCEPT

a)

 level of mucogingival junction

b)

level of free gingival margin

c)

 fremitus

d)

detection of occlusal caries

38.

During a periodontal assessment, the hygienist records the following findings on the periodontal chart for the facial aspect of a tooth:

Gingival margin level = +2 mm

Probing depth measurement = 5 mm

What is the clinical attachment loss for the facial surface of the tooth?

a)

2mm

b)

3 mm

c)

7 mm

d)

9mm

39.

A mandibular second molar has an 8-mm attachment loss. The hygienist is able to depress the tooth in its socket by applying downward pressure. This finding indicates that the tooth has ___ mobility.

a)

class 1

b)

class 2

c)

class 3

d)

class 4

40.

The importance of assessing calculus deposits on teeth during a comprehensive periodontal assessment is which of the following?

a)

Calculus deposits must be removed during nonsurgical therapy.

b)

Calculus is a local contributing factor in disease.

c)

Calculus deposits are a necessary factor for the initiation of periodontal disease.

d)

calculus deposits must be removed during nonsurgical therapy, and calculus is a local contributing factor in disease

41.

A PSR uses a Naber’s probe as part of the assessment procedure. A WHO probe is used to complete a comprehensive periodontal assessment.

a)

Both statement are true

b)

Both statement are false

c)

The first statement is true, the second is false

d)

The first statement is false, the second is true

42.

All of the following are true about detecting calculus deposits on a radiograph EXCEPT

a)

Only large calculus deposits usually are evident on radiographs

b)

Deposits on the facial or lingual can be seen when severe bone loss is present

c)

The ability to see the calculus depends on the degree of mineralization of the deposit 

d)

Radiographic evidence of calculus is an accurate assessment tool for the detection of all calculus deposits

43.

Radiographs usually show more interradicular bone between the roots of the teeth than what is actually present. Facial and lingual bones can be superimposed over a furcation.

a)

Both statements are true

b)

Both statements are false

c)

The first statement is true, the second is false

d)

The first statement is false, the second is true

44.

Radiographs reveal the bone remaining rather than the amount of bone lost. The amount of bone loss can be roughly estimated on a radiograph as the difference between the level of the remaining bone and normal bone height

a)

Both statements are true

b)

Both statements are false

c)

The first statement is true, the second is false

d)

The first statement is false, the second is true

45.

Which of the following statements is true about viewing periodontal pockets on radiographs?

a)

A periodontal pocket appears radiolucent on radiographs

b)

A periodontal pocket appears radiopaque on radiographs

c)

A periodontal pocket is not visible on radiographs

d)

A periodontal pocket is less deep than it appears on a radiograph

46.

Associated symptoms of NPD include all of the following EXCEPT:

a)

Pigmented gingiva

b)

Fetid odor

c)

Excessive salivation

d)

Swollen lymph nodes

47.

One critical component of Necrotizing Periodontal Disease (NPD) is advanced age. NPD is more commonly found in the 40 years and older age group.

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

48.

A patient who presents with clear, thin delicate gingiva is said to have which periodontal biotype?

a)

Thick flat

b)

Thick scalloped

c)

Thin flat

d)

Thin scalloped

49.

A patient who exhibits INITIAL loss of interproximal attachment associated with horizontal bone loss is said to have which Cairo Classification?

a)

RT0

b)

RT1

c)

RT2

d)

RT3

50.

A palatolingual groove can enhance plaque retention thereby contributing to initiation of periodontal disease. Poorly fitting orthodontic appliances have been known to initiate periodontal disease.

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

51.

The portion of the implant that protrudes through the tissue into the mouth is called the: 

a)

Implant fixture

b)

Abutment

c)

Prosthesis 

d)

Implant Body

52.

Osseointegration is regarded as successful if there is:

a)

Absence of gingival inflammation of peri-implant tissues

b)

Only slight radiographic evidence of bone loss around the implant 

c)

No more than class II clinical mobility

d)

Discomfort only when in fucntion

53.

A local risk factor for periodontitis can be acquired OR anatomical. Concavities and furcations are local risk factors acquired over time.

a)

Both statements are true

b)

The first statement is true; the second false

c)

The first statement is false; the second true

d)

Both statements are false

54.

Which of the following factors is considered the MOST significant risk factor for developing periodontal disease?

a)

Long-term use of medicines that cause gingival overgrowth

b)

Smoking cigarettes

c)

Chronic poor home-care

d)

Stress

55.

Gingival recession is the most common mucogingival deformity. Absence of attached gingiva predisposes a person to gingival recession.

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

56.

All of the following questions are considered fundamental in guiding the dental team during the diagnosis process EXCEPT:

a)

What type of gingivitis or periodontitis?

b)

Is the disease gingivitis or periodontitis?

c)

Does the clinical assessment indicate disease or health?

d)

Have all the clinical assessment procedures been completed correctly?

57.

Red, swollen gingival tissues are examples of clinically visible, overt signs of inflammation. An example of a hidden sign of inflammation is:

a)

Changes in tissue contour

b)

Alveolar bone loss

c)

Changes in tissue consistency

d)

Recession of the gingival margin

58.

The clinical measurement that determines the difference between gingivitis and periodontitis is  ____________

a)

Clinical loss of attachment 

b)

Level of the free gingival margin

c)

Pocket depth readings

d)

Clinical mobility and furcation involvement 

59.

Nicotine cessation counseling is part of which phase of a periodontal master treatment plan?

a)

Preliminary therapy phase

b)

Nonsurgical periodontal therapy phase

c)

Surgical therapy phase 

d)

Maintenance therapy phase  

60.

The two sources of expertise that bring equally important forms of experience to decision-making processes are: 

a)

Treatment options and values

b)

Clinician and patient

c)

Dental hygienist and dentist 

d)

Standard of care and textbooks

61.

Biologic equilibrium in periodontal health means there is a balance between:

a)

Bacterial plaque biofilms and local risk factors

b)

Local risk factors and acquired risk factors

c)

Local contributing factors and systemic factors

d)

Bacterial plaque biofilms and the host response

62.

Risk factors for periodontal disease other than plaque biofilms include all of the following EXCEPT:

a)

Pregnancy

b)

Heredity

c)

Systemic diseases

d)

Environmental pollution

63.

The dentist has a legal responsibility to arrive at a periodontal diagnosis for every patient. The dental hygienist plays an important role in planning for nonsurgical periodontal therapy.

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

64.

A sequential outline of the measures to be carried out by the dentist, the dental hygienist, and the patient to eliminate disease and restore a healthy periodontal environment is termed:

a)

Master periodontal treatment plan

b)

Periodontal maintenance

c)

Collective outline of treatment

d)

Nonsurgical periodontal instrumentation

65.

A patient has periodontal disease with moderate plaque biofilm. The hygienist informs the patient that she is going to develop periodontitis if she does not improve her oral self-care. Is this hygienist providing accurate educational advice to the patient? 

a)

Yes, without good self-care periodontal disease progresses from chronic gingivitis to periodontitis 

b)

No, because if this patient has periodontal disease, she obviously is not interested in improving her daily self-care and may feel that the hygienist is “nagging” her

c)

No, because in most patients, chronic gingivitis never progresses to periodontitis

d)

Yes, because the terms “periodontal disease” and “periodontitis” are synonymous (words that mean the same thing) 

66.

Which of the following is a non-modifiable risk factor for periodontal disease?

a)

Age

b)

Stress

c)

Nutrition

d)

Diabetes

67.

The descriptive modifier “generalized” is a term used to determine disease _____

a)

Extent

b)

Severity

c)

Progression

d)

Duration

68.

All of the following are true about documenting disease severity and extent EXCEPT:

a)

If there is 3-4 mm clinical attachment loss, the diagnosis is stage II

b)

If less than 30% of the teeth have attachment loss, disease is localized

c)

If there is up to 8 mm of attachment loss in multiple teeth with many missing teeth, disease is Stage IV

d)

If there is no attachment loss but generalized gingival inflammation, it is Stage 0

69.

All of the following are steps in the SHARE approach for decision-making EXCEPT:

a)

Prioritize

b)

Assess

c)

Reach

d)

Evaluate

70.

Letting the patient know there are several options for home care or treatment is:

a)

More effective if you explain in professional terms

b)

Builds trust in the relationship

c)

Not recommended. Keep the options to yourself

d)

Serves to just confuse the patient when trying to explain the care plan

71.

Legal claims against healthcare providers usually consist of three parts including not informing the patient properly. It is the job of the receptionist to ensure that informed consent is documented before treatment is provided.

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

72.

Failure for the dental hygienist to obtain consent before providing treatment to a patient can result in all of the following EXCEPT:

a)

Battery

b)

Negligence

c)

Noncompliance

d)

Malpractice

73.

When examining a bacterium under a microscope you note the following features: a double cell membrane and a red stain. Which type of bacteria are you examining?

a)

Innocuous bacteria

b)

Gram-negative bacteria

c)

Gram-positive bacteria

d)

Nonpathogenic bacterium

74.

Periodontitis is associated with high proportions of:

a)

Aerobic bacteria

b)

Nonmotile bacteria

c)

Gram-negative bacteria

d)

Innocuous bacteria

75.

 Periodontal pathogens can be passed from the oral cavity of one person to another by direct contact. Periodontal pathogens also can be spread by contact with inanimate objects, such as a spoon. 

a)

Both statements are true

b)

Both statements are false

c)

The first statement is true, the second is false

d)

The first statement is false, the second is true

76.

 How do bacteria adhere during the process of coaggregation to a tooth surface?

a)

The bacteria randomly attach to one another

b)

Only one species of bacteria can exist within a biofilm community

c)

Each bacterial strain only has a limited set of bacteria to which it can adhere

d)

The late bacterial colonizers determine the nature of the biofilm colony and more significant than the earlier colonizers

77.

 Early colonizers of the plaque biofilm are:

a)

Gram-negative bacteria

b)

Gram-positive bacteria

c)

Motile bacteria

d)

Anaerobic bacteria

78.

Can invade gingival connective tissue and be found within connective tissues on the surface of alveolar bone

a)

Streptoccus mitis

b)

Prevotella intermedia

c)

Actinomyces viscous

d)

Streptococcus sanguis

79.

Which of the following characteristics is typical of biofilm?

a)

Bacteria communicate with each other by sending out chemical signals

b)

The biofilm has a consistent pH throughout with no variation

c)

Generally, only one type of bacteria exists in each biofilm

d)

Mature biofilm is easily disrupted with a mouth rinse 

80.

The protective factor that can prevent biofilm from being killed with antibiotics, antimicrobials, or the body's immune system is called:

a)

Extracellular polymeric substance

b)

Fluid channels

c)

Acquired channels

d)

Microbial blooms

81.

The most successful means of destroying plaque biofilm on teeth is

a)

Double dose of antibiotics

b)

Oxygen

c)

Mechanical removal

d)

Microbial rinse 

82.

Within minutes of a professional prophylaxis, the pellicle attaches to tooth surfaces. Within hours of the pellicle formation, bacteria begin to attach to the outer surface

a)

Both statements are true

b)

Both statements are false

c)

The first statement is true, the second is false

d)

The first statement is false, the second statement is true 

83.

When applying gram staining, which of the following bacteria would appear red?

a)

Actinomyces naeslundii

b)

Lactobacillus oris

c)

bifidobacterium dentium

d)

fusobacterium nucleatum

84.

Which of the following bacteria would be considered an early colonizer of the biofilm?

a)

Actinomyces israelii

b)

Capnocytiphaga gingivalis

c)

Streptococcus oralis

d)

Treponema denticola

85.

During which stage of biofilm development does coaggregation begin?

a)

Stage 1

b)

Stage 2

c)

Stage 3

d)

Stage 4

86.

Your friend got a large splinter while while splitting wood yesterday. Today his finger is twice its normal size. What is the cause of the SWELLING?

a)

Entry of fluid and cells into the connective tissues of the finger

b)

A bacterial infection in the open cut in her finger

c)

Increased blood flow rushing to the area of the cut in her finger

d)

Destruction of epithelial tissue cells in the area of the cut

87.

In a bacterial infection of the periodontium, the cells that arrive to the infection site first (the rapid responders) are the

a)

Polymorphonuclear leukocytes (PMNs)

b)

Macrophages

c)

Monocytes

d)

T-lymphocytes

88.

The complement system carries out all of the following functions EXCEPT

a)

Puncturing the cell membranes of certain bacteria

b)

Phagocytosis

c)

Recruiting additional phagocytic cells to the infection site

d)

Removal of immune complexes from circulation

89.

Biologically active compounds secreted by cells that activate the body’s immune system are termed:

a)

Degranulation proteins 

b)

Chemotaxic chemicals

c)

Biochemical mediators

d)

C-reactive proteins

90.

 The liver produces this type of acute phase protein during episodes of acute inflammation

a)

Degranulation proteins

b)

Chemotaxic chemicals

c)

Biochemical mediators

d)

C-reactive proteins

91.

When an area of the mouth becomes inflamed, there is an increased blood flow in affected tissues to:

a)

Wash the offending invaders from the site

b)

Create heat for healing

c)

Deliver immune defenders to the site

d)

None of the above

92.

B-lymphocytes support the immune response by:

a)

Engulfing and phagocytizing invading organisms

b)

Secreting antibodies that neutralize microorganisms

c)

Intensifying the immune system 

d)

Killing microorganisms on contact

93.

 The most important function of the complement system is

a)

Opsonization

b)

Lysis

c)

Activation of the inflammatory response 

d)

Immune clearance

94.

All of the following are symptoms of acute inflammation EXCEPT:

a)

Bruising

b)

Heat

c)

Swelling

d)

Pain

95.

Which of the following cells is considered a phagocyte?

a)

Plasma cell

b)

T-cell

c)

Macrophage

d)

B-cell

96.

A leukocyte exits the blood vessel and enters the connective tissue to travel to the site of an infection. What is the process called whereby leukocytes are attracted to an infection site?

a)

Opsonization

b)

Chemotaxis

c)

Trans-endothelial migration

d)

Phagocytosis

97.

Pus at site of inflammation consists of:

a)

Leukocytes that have engorged on bacteria and died

b)

Edematous fluid that leaked out of capillaries

c)

Plaque biofilm mixed with blood

d)

B-Lymphocytes

98.

In which phase of periodontal disease progression does the coronal-most portion of the junctional epithelium first detach from the tooth surface?

a)

Early Gingivitis/ Early lesion

b)

Established gingivitis/ Established lesion

c)

Bacterial Accumulation/ Initial lesion

d)

Periodontitis/ Advanced lesion  

99.

Initiation of professional care and good patient self-care can result in a return to a healthy periodontium during all of the following stages of disease progression EXCEPT:

a)

Early Gingivitis/ Early lesion

b)

Established gingivitis/ Established lesion

c)

Established gingivitis/ Established lesion

d)

Periodontitis/ Advanced lesion

100.

The host’s response

a)

Is a minor component in the pathogenesis of periodontal disease

b)

Is the process of returning to homeostasis

c)

Secretes powerful acids that affect the immune response of other cells

d)

Is the way in which the body to respond to periodontal pathogens

101.

Cytokines function to:

a)

Send macrophages to the site of infection

b)

Potentially initiate tissue destruction and bone loss in chronic periodontitis

c)

Increase vascular permeability

d)

All of the above

102.

Which phase of periodontal disease progression includes bacterial colonization near gingival margins?

a)

Bacterial accumulation phase/ Initial lesion

b)

Early Gingivitis / Early lesion

c)

Established gingivitis / Established lesion

d)

Periodontitis / Advanced lesion

103.

Which cytokine inhibits bone formation?

a)

IL-1

b)

IL-6

c)

TNF-A

d)

All of the above

104.

All of the following are phases of the bone remodeling cycle EXCEPT:

a)

Resting phase

b)

Reversal phase

c)

Initial phase

d)

Formation phase

105.

Tobacco smoking is a known risk factor for periodontal disease. Which of following risk factor categories does it fall under?

a)

Genetic

b)

Acquired

c)

Environmental

d)

Nonacquired

106.

Osteoblasts are cells that create erosion cavities in the bone. Osteoclasts are cells that specialize in forming bone.

a)

Both statements are true

b)

Both statements are false

c)

The first statement is true, the second is false

d)

The first statement is false, the second is true

107.

 In which phase of periodontal disease progression are macrophages first recruited to the gingival connective tissue?

a)

Initial lesion

b)

Established lesion

c)

Early lesion

d)

Advanced lesion

108.

 In which phase of periodontal disease progression does PGE2 and MMPs intiate collagen destruction but cause no bone destruction?

a)

Initial lesion 

b)

Established lesion

c)

Early lesion

d)

Advanced lesion

109.

If plaque biofilms were allowed to stay near the gingival tissues, the first clinical sign of inflammation would be:

a)

Redness and swelling

b)

Pus in the infected area

c)

Bone loss evident on radiographs

d)

Gingival recession

110.

Resolution of inflammation and return to a noninflammatory state is called:

a)

Outcome host response

b)

RANKL/RANK/OPG Pathway

c)

 Catabasis

d)

Pathogenesis

111.

 In which phase of periodontal disease progression does PGE2 mediate bone destruction by stimulating large numbers of osteoclasts to resorb alveolar bone?

a)

Initial lesion

b)

Established lesion

c)

Early lesion

d)

Advanced lesion

112.

Prostaglandins function to:

a)

Reduce destruction of MMP enzymes

b)

Initiate alveolar bone destruction in periodontal disease

c)

Trigger osteoblasts to repair bone loss

d)

Constrict blood vessels causing edema and erythema of connective tissue 

113.

Which of the following species is considered to be the bridge or transition bacteria that facilitates the shift from gram positive bacteria to gram negative bacteria?

a)

A. odontolyticus

b)

A. actinomycetemcomitans

c)

Fusobacterium nucleatum

d)

Porphyromonas ginigivalis

114.

Socransky grouped microorganisms into complexes and assigned each a color. Which color signifies bacterial species that are dominant in the late stages of biofilm?

a)

Green

b)

Yellow

c)

Purple

d)

Red

115.

Your neighbor has a chronic inflammation in her foot due to diabetes. What signs and symptoms would you expect your neighbor to experience with this chronic inflammation? 

a)

Redness

b)

Heat

c)

Pain

d)

None of the above

116.

Which immunoglobulin can pass the placental barrier?

a)

IgG

b)

IgM

c)

IgE

d)

IgA

117.

Which of the following biochemical mediators inhibits  bone resorption? 

a)

IL-1

b)

IL-4

c)

IL-8

d)

PGE2

118.

Metabolic Syndrome includes a combination of all of the following diseases/conditions EXCEPT:

a)

Body fat around the waist

b)

Chronic allergies

c)

Hypertension

d)

Hypercholesteremia

119.

A patient with uncontrolled diabetes is more likely to have periodontal disease than a patient with well-controlled diabetes. A patient with well-controlled diabetes is more likely to have periodontal disease than a patient without diabetes.

a)

Both statements are true

b)

Both statements are false

c)

The first statement is true, the second is false

d)

The first statement is false, the second is true

120.

HIV/AIDS associated linear gingiva erythema includes all of the following EXCEPT:

a)

Pyogenic granuloma

b)

2- to 3-mm band of intense redness in free gingiva

c)

Most commonly affects entire dentition

d)

Conventional plaque control and instrumentation therapy is ineffective

121.

Signs of leukemia-associated gingivitis include all of the following EXCEPT

a)

Candida albicans

b)

Swollen, glazed spongy tissue

c)

Red to deep purple gingival color

d)

Gingival enlargement beginning at the interdental papilla followed by the marginal and attached gingiva

122.

All of the following medications can cause gingival overgrowth EXCEPT:

a)

Alprazolam

b)

Cyclosporin

c)

Nifedipine

d)

Phenytoin

123.

Traumatic tooth brushing can create a defect known as dehiscence. A dehiscence is a window in the bone on the root of a tooth.

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

124.

A cervical enamel projection is a normal landmark on the CEJ. The flat, triangular shaped projection points away from the furcation.

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

125.

The length of the biologic width of tissue covering a tooth is approximately

a)

1mm

b)

2mm

c)

3mm

d)

4mm

126.

The common act of chewing causes ______ occlusal forces.

a)

Functional 

b)

Parafunctional

c)

Primary

d)

Secondary

127.

Which of the following best describes the shape of supragingival calculus deposits?

a)

Localized, flattened deposits that are beneath the gingival margin

b)

Irregular large deposits are beneath the gingival margin

c)

Localized, flattened deposits that are coronal to the gingival margin

d)

Irregular large deposits that are coronal to the gingival margin 

128.

Increased levels of hormones during puberty can cause a(n) ____ response to plaque biofilm. 

a)

Decreased

b)

Exaggerated

c)

Typical

d)

Optimal

129.

The connection between stress and periodontal disease is that stress can cause:

a)

A patient to neglect self care

b)

An increase in hormone levels

c)

An exaggerated response to plaque biofilm

d)

An increase in a number of systemic diseases

130.

One of the most common side effects of phenytoin is:

a)

Decrease in salivary production

b)

Gingival overgrowth

c)

Widening of the PDL

d)

Red band along the gingival margin

131.

Individuals with HIV/AIDS are at increased risk for 

a)

Infection and certain cancers

b)

Osteoporosis

c)

Diabetes mellitus

d)

Hormonal variations

132.

AGE-RAGE interaction is associated with which of the following diseases/disorders?

a)

HIV/AIDS

b)

Leukemia

c)

Diabtetes Mellitus

d)

Down Syndrome

133.

Tobacco smoking may have any of the effects on the periodontium listed below, EXCEPT:

a)

Changes in the pocket environment resulting in different bacterial  pathogens

b)

Reduced bleeding due to decreased vascularization of the periodontium

c)

Increased effectiveness of PMN and monocyte-macrophage defensive functions

d)

Less inflammation of the periodontium than that seen in nonsmokers

134.

Implant success rates for smokers are about the same as those for nonsmokers. Tobacco smoking impairs healing after periodontal instrumentation. 

a)

Both statements are true

b)

Both statements are false

c)

The first statement is true, the second is false

d)

The first statement is false, the second is true

135.

The periodontal health status of former smokers is not as good as that of never smokers. The periodontal health status of former smokers is better than that of current smokers.

a)

Both statements are true

b)

Both statements are false 

c)

The first statement is true, the second is false

d)

The first statement is false, the second is true

136.

All of the following are systemic contributing factors for periodontal disease EXCEPT:

a)

Tobacco use

b)

Psychological stress

c)

Hormone alteration

d)

Tongue thrust

137.

The typical appearance of gingival tissue of a smoker may include:

a)

Fibrotic gingival tissue

b)

Edematous tissue

c)

Inflamed gingival tissue

d)

Heavy bleeding upon probing

138.

The majority of research studies show a positive relationship between stress and periodontal disease. One behavioral change when under stress that can contribute to the development of periodontal disease is making poor nutrition choices.

a)

Both statements are true

b)

Both statements are false

c)

The first statement is true, the second is false

d)

The first statement is false the second is true

139.

All of the following statements about RAGE expression are true EXCEPT:

a)

Enhanced RAGE expression in periodontium leads to exaggerated inflammation

b)

Enhanced RAGE expression in periodontium leads to impaired repair

c)

Enhanced RAGE expression can accelerate severe periodontal destruction

d)

Enhanced RAGE expression in a result of normal glycation

140.

Food impaction can contribute to

a)

Dental caries

b)

Alterations in gingival contours

c)

Stripping gingival tissues away from tooth surface

d)

All of the above

141.

The rate of development of periodontal disease in diabetic patients is ____ times greater than that of patients without diabetes.

a)

 Two to three

b)

Five to ten

c)

Thirty to fifty

d)

One hundred

142.

Which of the following conditions does not respond to periodontal instrumentation and daily oral self-care control?

a)

Necrotizing gingivitis

b)

Necrotizing periodontitis

c)

Linear gingival erythema

d)

Periodontitis associated with Down Syndrome

143.

Local contributing factors alone can initiate gingivitis. Local contributing factors alone cannot cause periodontal disease. 

a)

Both statements are true

b)

Both statements are false

c)

The first statement is true, the second is false

d)

The first statement is false, the second is true 

144.

As plaque biofilm matures it becomes more pathogenic. Some local factors can allow plaque biofilm to mature and increase in pathogenicity.

a)

Both statements are true

b)

Both statements are false

c)

The first statement is true, the second is false

d)

The first statement is false, the second is true

145.

Your patient practices good daily self-care, including flossing. She complains, however, that she cannot floss between tooth #3 and #4. The floss simply shreds in this interproximal area and is impossible to use. What local factor might be causing this problem?

a)

Bacterial plaque biofilm

b)

Root concavities on the roots of these teeth

c)

A palatogingival groove

d)

A poorly contoured restoration 

146.

How do calculus deposits adversely impact the health of the periodontium?

a)

Calculus deposits always have a layer of living plaque biofilm

b)

The surface of a calculus deposit is rough and can scratch the gingiva

c)

Calculus is unattractive leading many patients to avoid dental care

d)

Calculus deposits release enzymes into the oral cavity that irritate the gingiva 

147.

Primary trauma from occlusion is excessive occlusal forces on a sound (healthy) periodontium. Secondary trauma from occlusion is normal occlusal forces on an unhealthy periodontium previously weakened by periodontitis.

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 

148.

Common adverse effects of oral piercings may include all of the following EXCEPT:

a)

Tongue thrusting

b)

Gingival recession

c)

Allergic reactions

d)

Tooth fractures

149.

Bone loss can be caused by the encroachment of a restoration on the biologic width. Biologic width includes the junctional epithelium and gingival fiber bundles.

a)

Both statements are true

b)

Both statements are false

c)

The first statement is true, the second is false

d)

The first statement is false, the second is true 

150.

All of the following can act as a protected environment that allows a plaque biofilm to flourish and grow, EXCEPT:

a)

A root concavity

b)

A smooth enamel surface

c)

Untreated dental decay

d)

A palatogingival groove

151.

Six months ago, your patient had generalized gingivitis with moderate plaque biofilms present. With the help of professional care and new daily self-care techniques, at today’s appointment the periodontium is healthy with very little plaque biofilm present. The one exception is the facial of tooth #29 that exhibits gingivitis. All of the following factors might contribute to the gingivitis in one site, EXCEPT:

a)

A rough edge on facial margin of the restoration on tooth #29

b)

Failure to use dental floss daily in this area

c)

A residual deposit of calculus on the facial aspect of tooth #29

d)

An ill-fitting partial denture that is supported by tooth #29

152.

All of the following are symptoms of trauma from occlusion EXCEPT:

a)

Tooth mobility

b)

Sensitivity to hot and cold

c)

Sensitivity to pressure

d)

Tooth migration

153.

Which of the following describes one way in which smoking impacts oral biofilm?

a)

There is a lower oxygen tension which favors the development of anaerobic bacteria

b)

The biofilm of smokers indicates higher levels of Tannerella forsythia

c)

The biofilm composition of smokers in consistent with nonsmokers but the biofilm forms more rapidly

d)

smoking causes vasodialtion

154.

Environmental tobacco smoke is also known as

a)

Primary smoke

b)

Second hand smoke

c)

Third hand smoke

d)

Air pollution

155.

Which of the following is not one of the 5As of smoking cessation? 

a)

Ask

b)

Advise

c)

Affirm

d)

Assist

156.

Each of the following is a way in which smoking affects the immune system EXCEPT one. Which one is the EXCEPTION? she ended up dropping this one

a)

Smokers have decreased gingival blood flow

b)

Smokers have a reduced number of effective neutrophils

c)

The neutrophils of smokers have decreased phagocytic abilities

d)

Smoking decreased IgG antibody production

157.

Nonsurgical therapy should be planned for all patients with dental biofilm-associated gingivitis and initial and established/moderate periodontitis. Patients requiring periodontal surgical therapy should undergo nonsurgical therapy first.

a)

Both statements are true

b)

Both statements are false

c)

The first statement is true; the second is false

d)

The first statement is false; the second is true

158.

Host modulation refers to which of the following:

a)

Altering the patient's immune defense responses.

b)

Assisting the patient's ability to limit damage to the periodontium.

c)

Both A and B

d)

Neither A nor B

159.

All of the following are goals of nonsurgical therapy EXCEPT:

a)

Eliminate or control local risk factors for periodontal disease

b)

Assess the extent of tissue damage caused by periodontal disease

c)

Minimize the impact of systemic risk factors for periodontal disease

d)

Stabilize attachment levels

160.

The measures for nonsurgical therapy are carried out by the:

a)

Dentist

b)

Dental hygienist

c)

Patient

d)

All of the above

161.

Bacteria and toxins are firmly embedded in cementum, so it is necessary to remove the cementum during periodontal instrumentation. Periodontal instrumentation using firm pressure with many, many scraping strokes is needed to convert a root surface from a site of disease to one of health.

a)

Both statements are true

b)

Both statements are false

c)

The first statement is true; the second is false

d)

The first statement is false; the second is true

162.

What is the primary pattern of healing after periodontal instrumentation?

a)

Formation of new cementum on roots

b)

Regeneration of lost alveolar bone

c)

Reattachment of periodontal ligament fibers to the root surface

d)

Formation of a long junctional epithelium

163.

What is the minimum amount of time the hygienist should wait before reassessing tissue response and healing after periodontal instrumentation?

a)

3 days

b)

2 weeks

c)

1 month

d)

3 months

164.

All exposed dentin is hypersensitive until it is desensitized. Instrumentation of root surfaces can result in dentinal hypersensitivity.

a)

Both statements are true

b)

Both statements are false

c)

The first statement is true; the second is false

d)

The first statement is false; the second is true

165.

Dental hypersensitivity is associated with:

a)

Exposed dentin

b)

Exposed cementum

c)

Cementum that overlaps the enamel of the crown

d)

Residual calculus deposits

166.

An odontoblastic process is:

a)

Part of the connective tissue matrix of dentin

b)

A living part of an odontoblast

c)

Also called an enamel pearl

d)

A calcified tubular structure that extends throughout the dentin

167.

The hydrodynamic theory for the origin of dentinal hypersensitivity proposes the following cause of sensitivity in open dentinal tubules:

a)

Periodontal pathogens enter the open tubules and travel throughout the dentin causing sensitivity

b)

Hot or cold beverages consumed by the patient enter the dentinal tubules and shock the dentin

c)

Saliva and all its many contaminants enter the open tubules, spread throughout the dentin and infect it

d)

Fluid movement within the tubules stimulates nerve endings associated with the odontoblastic processes

168.

How long does the natural process of blocking open dentinal tubules on exposed (open) dentinal tubules usually take?

a)

24 hours

b)

A few weeks

c)

3 months

d)

6 months

169.

All of the following are steps in the re-evaluation appointment EXCEPT:

a)

Update the medical history

b)

Perform periodontal clinical assessment

c)

Periodontal instrumentation of the entire dentition

d)

Compare initial assessment data with re-evaluation data

170.

At a re-evaluation appointment following nonsurgical periodontal therapy for Stage II periodontitis, the assessment findings show a moderate amount of generalized supragingival plaque biofilm and inadequate daily oral self-care, which of the following would you suggest?

a)

Recommend surgical periodontal therapy

b)

Retrain the patient in oral self-care procedures

c)

Refer the patient to a periodontist

d)

Schedule a 6-month maintenance appointment

171.

During the initial periodontal assessment, it is determined that your patient has gingivitis. Re-evaluation assessment data indicate that the patient continues to have clinical signs of gingivitis. Which of the following procedures would you recommend for your patient?

a)

Recommend surgical periodontal therapy

b)

Retrain the patient in oral self-care procedures

c)

Refer the patient to a periodontist

d)

Schedule a 6-month maintenance appointment

172.

Members of the dental team usually schedule an appointment for the re-evaluation of Stage II periodontitis __________ after the completion of nonsurgical periodontal therapy.

a)

2 weeks

b)

4 to 6 weeks

c)

8 to 12 weeks

d)

6 months

173.

All of the following are anti-inflammatory biochemical mediators EXCEPT:

a)

IL-10 (interleukin-10)

b)

IL-Ira (receptor antagonist)

c)

IL-1 (interleukin 1)

d)

TIMPs (tissue inhibitors of matrix metalloproteinases)

174.

All of the following are pro-inflammatory biochemical mediators EXCEPT:

a)

IL-6

b)

IL-4

c)

MMPs

d)

TNF (tumor necrosis factor alpha)

175.

Which of the following are considered to be pro-inflammatory biochemical mediators?

a)

IL-4 (interleukin-4) and IL-10 (interleukin-10)

b)

IL-1 (interleukin-1) and IL-6 (interleukin-6)

c)

IL-1 and IL-6

d)

IL-8

176.

Which of the following is approved by the FDA for use in treating periodontitis patients?

a)

Bisphosphonates

b)

Low-dose doxycycline

c)

NSAIDs

d)

Cocaine

177.

All of the following commonly may serve as microbial reservoirs for periodontal pathogens, EXCEPT

a)

Residual calculus not removed during periodontal therapy

b)

Irregularities in the tooth surface

c)

The tooth pulp

d)

Gingival connective tissue adjacent to the periodontal pocket

178.

A therapeutic mouth rinse characteristic which allows the rinse to have a reasonable shelf life is:

a)

Efficacy

b)

Stability

c)

Substantivity

d)

Therapeutic

179.

The most effective antibiotic for treatment of certain periodontal diseases is

a)

Tetracycline

b)

Amoxicillin

c)

Penicillin

d)

Doxycycline

180.

Therapeutic mouth rinses are helpful in controlling

a)

GINGIVITIS

b)

Periodontal abscesses

c)

PeriodONTAL DISEASE

d)

ORAL CANCER

181.

Placement of a chemical agent into a periodontal pocket is termed:

a)

TOPICAL DELIVERY

b)

SYSTEMIC DELIVERY

182.

A chemical agent delivered via capsule or tablet is termed:

a)

SYSTEMIC DELIVERY

b)

TOPICAL DELIVERY

183.

A therapeutic mouth rinse characteristic in which the active ingredient is slowly released over several hours is:

a)

Efficacy

b)

Stability

c)

Substantivity

d)

Therapeutic

184.

Possible side effects of Chlorhexidine Include all of the following EXCEPT

a)

Discoloration of the tongue

b)

Taste alteration

c)

Increased extrinsic stain

d)

Bitter taste

185.

Biochemical compounds that protect the host from periodontal infection are termed ________________.

a)

Anti-inflammatory mediators

b)

Leukocytes

c)

White blood cells

d)

B & T Cells

186.

What are some examples of microbial reservoirs for periodontal pathogens?

a)

Residual calculus not removed during periodontal therapy

b)

poor margins on restorations

c)

gingival connective tissue adjacent to the periodontal pocket

d)

irregularities in the tooth surface

187.

The most effective antimicrobial agent for long-term control of plaque biofilm and gingivitis is:

a)

Chlorohexidine

b)

Doxycycline

c)

Cyclosporine

d)

Tetracycline

188.

an antibacterial chemical agent that is placed directly into a periodontal pocket is called controlled-release delivery device

a)

True

b)

False

189.

What is a characteristic of a therapeutic mouth rinse that inhibits or kills periodontal pathogens?

a)

efficacy

b)

safety

c)

stability

d)

substantivity

190.

What is the characteristic of a therapeutic mouth rinse that does not produce any harmful effects on local tissues?

a)

safety

b)

efficacy

c)

therapuetic

d)

substantivity

191.

What are the characteristics that an ideal mouth rinse should possess?

Efficacy Stability Substantivity Safety

a)

Efficacy

b)

Stability

c)

Safety

d)

Substantivity

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