1.0 DIAGNOSIS – 6 QUESTIONS

1. Where is the narrowest band of attached gingiva found?

1. Lingual surfaces of maxillary and facial surfaces of maxillary first molars 2. Facial surfaces of mandibular second and lingual of canines 3. Facial surfaces of mandibular canines and first premolars and lingual of mandibular incisors* 4. None of the above

2. All these types of tissue have keratinized EXCEPT

1. Hard 2. Gingival col* 3. Attached gingiva 4. Free gingiva

16. Which group of principal fibers of the periodontal ligament run perpendicular from the alveolar bone to the and resist lateral forces?

1. Alveolar crest 2. Horizontal crest* 3. Oblique 4. Apical 5. Interradicular

33. The width of attached gingiva varies considerably with the greatest amount being present in the maxillary region; the least amount is in the mandibular region.

1. Both statements are TRUE*

39. The forms and supports the sockets of the teeth and consists of two parts, the alveolar bone proper and the supporting alveolar bone; ostectomy is defined as removal of the alveolar bone proper.

1. Both statements are TRUE*

40. Which structure is the inner layer of cells of the and attaches the gingiva to the ?

1. 2. Free gingival groove 3. Epithelial attachment * 4. Tonofilaments

1 49. All of the following are part of the marginal (free) gingiva EXCEPT:

1. 2. Free gingival groove 3. Mucogingival junction* 4. Interproximal gingiva

53. The collar-like band of stratified squamous epithelium 10-20 cells thick coronally and 2-3 cells thick apically, and .25 to 1.35 mm long is the:

1. Junctional epithelium* 2. Spinous epithelium 3. Basement membrane 4. Epithelial rests of Malassez

54. All of the following are functions of the periodontal ligament EXCEPT

1. Physical 2. Formative 3. Nutritive 4. Sensory 5. All of the above* 6. None of the above

64. Which vitamin functions in collagen formation?

1. A 2. B 3. C * 4. D

65. The main functions of cementum include all of the following EXCEPT:

1. To attach the principal fibers of the periodontal ligament to the tooth 2. Compensate for loss of tooth surface by apical deposition of cementum 3. Provide sensory input in hyperocclusion* 4. Allow reattachment of connective tissue following periodontal treatment

66. Which group of resist rotational forces that are applied to a tooth?

1. Transeptal fibers 2. Dentogingival fibers 3. Alveologingival fibers 4. Circumferential fibers*

2 80. Sharpey's fibers are

1. Collagen fibers* 2. Elastic fibers 3. Gingival fibers 4. Oxytalan fibers 5. Transseptal fibers

81. Tissue consistency refers to

1. Thickness 2. Resiliency* 3. Texture 4. The location of the margin 5. The presence or absence of

88. The mucogingival junction is located between the

1. Free gingiva and attached gingiva 2. Free gingiva and tooth 3. Attached gingiva and alveolar mucosa* 4. Base of the sulcus and alveolar mucosa 5. Gingival groove and gingival margin

89. Which tissue(s) has (have) little or no keratinization?

1. 2. 3. Palatal mucosa 4. Sulcular epithelium and alveolar mucosa

91. The fibers of the attached gingiva are mainly

1. Collagen* 2. Elastic 3. Cellulose 4. Keratinized 5. Oxytalan

93. The tissue lining of a healthy consists of 1. Keratinized epithelium with rete pegs 2. Keratinized epithelium without rete pegs 3. Nonkeratinized epithelium with rete pegs 4. Nonkeratinized epithelium without rete pegs* 5. Parakeratinized epithelium with rete pegs

3 94. The gingival fibers

1. Brace the marginal gingiva against the tooth* 2. Help the tooth withstand horizontal forces 3. Keep the tooth from being forced into the bony socket 4. Form and resorbe cementum 5. Transmit sensations of occlusal forces applied to the tooth

97. The area within the most susceptible to tissue breakdown is the

1. Free gingiva 2. Gingival sulcus 3. Interdental col* 4. Interdental papilla 5. Attached gingiva

187. Gingival width apicocoronally is generally least in which of the following?

1. Facial of the maxillary first and second molars 2. Facial of the mandibular first and second molars 3. Lingual of the mandibular first and second molars 4. Facial of the mandibular first premolars*

199. Clinically, the mucogingival junction in the palatal gingiva is

1. a gently sweeping parabolic line with the peaks pointing interdentally. 2. very irregular, sometimes extending almost to the midline or the rugae. 3. a scalloped line. 4. a straight line. 5. not seen in man.*

288. Which of the following may result in an absence of stippling in areas of attached gingiva?

1. Edema of underlying connective tissue 2. Normal variation in gingival topography 3. Inflammatory degradation of gingival collagen fibers 4. Any of the above.*

5. NEITHER statement nor reason is correct.

369. Gingival stippling is a major indicator of gingival health because its presence is dependent upon the integrity of junctional epithelium. (5)

4 518. Nutrient materials for the cells of gingival epithelium are supplied primarily by way of

1. secretions of salivary glands. 2. capillaries in the prickle layer. 3. capillaries in subjacent connective tissue.* 4. reutilization of materials from the cornified layer.

537. Which of the following are normally occurring osseous features that may alter periodontal therapy?

(a) mylohyoid ridge (b) (c) interdental craters (d) reverse architecture (e) external oblique ridge

2. (a), (b) and (e)*

156. Which of the following soft tissue elements (fibers) are commonly associated with relapse following orthodontic rotation of a tooth?

1. Oblique 2. Diagonal 3. Horizontal 4. Supracrestal*

197. Crevicular epithelium is one example of non-keratinized gingival tissue. Another example is (the)

1. Gingival col* 2. Marginal gingiva 3. Attached gingiva 4. Outer gingival epithelium

1. Where is the narrowest band of attached gingiva found?

1. Lingual surfaces of maxillary incisors and facial surfaces of maxillary first molars 2. Facial surfaces of mandibular second premolars and lingual of canines 3. Facial surfaces of mandibular canines and first premolars and lingual of mandibular incisors* 4. None of the above

5 3. When performing a on a patient, you are able to pass a Nabors probe through the buccal furcation from buccal to lingual and vice versa. The gingival margin is located at the CEJ. This furcation involvement is classified as .

1. I 2. II 3. Ill* 4. IV

24. The local signs of inflammation include all of the following EXCEPT

1. Redness 2. Heat 3. Purulence* 4. Swelling 5. Pain

33. The width of attached gingiva varies considerably with the greatest amount being present in the maxillary incisor region; the least amount is in the mandibular premolar region.

1. Both statements are TRUE*

34. When using a to measure probing depths, the tip may or may not stop at the base of the periodontal pocket. What factors can influence accuracy of the measurement?

1. Size of probe 2. Probing force 3. Degree of inflammation 4. Presence of deposits 5. All of the above*

38. In a suprabony pocket the base is located apical to the crest of the alveolar bone; an intrabony pocket's base is coronal to the crest of the bone.

2. Both statements are FALSE*

48. Pseudopockets are not associated with loss of attachment; dilantin (phenytoin) hyperplasia is an example of a condition that can exhibit pseudopockets.

1. Both statements are TRUE*

6 61. All of the following are used to assess the health of gingival tissues EXCEPT

1. Color 2. Contour 3. Consistency 4. Amount*

75. A pseudopocket (or gingival pocket) is formed by the 1. Coronal migration of the gingival margin* 2. Coronal migration of the epithelial attachment 3. Apical migration of the gingival margin 4. Apical migration of the epithelial attachment 5.Apically directed resorption of the alveolar crest

76. Periodontal pockets can BEST be detected by 1. Radiographic detection 2. The color of the gingival tissues 3. The contour of the gingival margin 4. Probing the sulcular area* 5. Noting the presence or absence of

95. Which of the following is the first clinical feature of inflammatory ?

1. 2. Drifting of the anterior teeth 3. Periodontal pocket formation 4. 5. Bleeding on probing*

101. During a periodontal examination a 4 mm pocket is detected on the direct facial surface of tooth no. 19. The gingival margin is located at the cementoenamel junction. What type of pocket is this?

1. Pseudopocket 2. Periodontal pocket* 3. Gingival pocket 4. Combination pseudopocket and periodontal pocket 5. Combination gingival and periodontal pocket

106. A mucogingival problem exists when

1. The base of the pocket extends apically to the mucogingival junction* 2. The base of the pocket is coronal to the mucogingival junction 3. There is less than 3 mm of attached gingiva 4. There is less than 5 mm of alveolar mucosa 5. There is significant bone loss

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126. A probe reading of 6 mm measures the distance from the

1. Marginal ridge to the epithelial attachment 2. Epithelial attachment to the gingival margin* 3. Alveolar crest to the gingival margin 4. Cementoenamel junction to the gingival margin 5. Cementoenamel junction to the epithelial attachment

127. Which of the following is the most reliable clinical sign of gingival inflammation?

1. Redness of the gingiva 2. Loss of stippling 3. Blunted papillae 4. Bleeding upon gentle probing* 5. Probing depth

150. Bleeding upon gentle probing is indicative of

1. food impaction. 2. crestal bone loss. 3. ulceration of the sulcular epithelium.* 4. apical migration of the epithelial attachment. 5. all of the above.

151. When the free margin of the gingiva is enlarged as a result of inflammation, its crest moves

1. apically. 2. distally. 3. mesially. 4. cervically. 5. occlusa11y.*

163. is characterized by

1. increased depth of the gingival sulcus. 2. swollen marginal tissue. 3. bone loss. 4. apical migration of the epithelial attachment. 5. all of the above. 6. only (1) and (2) above.*

8 177. Which of the following are essential characteristics of gingival (pseudo) pockets?

(a) ulceration of lining epithelium (b) apical migration of epithelial attachment (c) depth over 3 mm.. (d) destruction of some or all adjacent transseptal connective tissue fibers (e) bone resorption

2. (a) and (c) only*

187. Gingival width apicocoronally is generally least in which of the following?

1. Facial of the maxillary first and second molars 2. Facial of the mandibular first and second molars 3. Lingual of the mandibular first and second molars 4. Facial of the mandibular first premolars*

288. Which of the following may result in an absence of stippling in areas of attached gingiva?

1. Edema of underlying connective tissue 2. Normal variation in gingival topography 3. Inflammatory degradation of gingival collagen fibers 4. Any of the above.*

199. Clinically, the mucogingival junction in the palatal gingiva is

1. a gently sweeping parabolic line with the peaks pointing interdentally. 2. very irregular, sometimes extending almost to the midline or the rugae. 3. a scalloped line. 4. a straight line. 5. not seem in man.*

240. Gingival width apicocoronally is generally least in which of the following areas?

1. Facial of maxillary first and second molars 2. Facial of mandibular first and second molars 3. Lingual of mandibular first and second molars 4. Facial of mandibular first premolars*

337. An infrabony pocket is a periodontal pocket with the epithelial attachment positioned

1. within alveolar bone. 2. coronal to alveolar crestal bone. 3. apical to alveolar crestal bone.* 4. apical to the mucogingival junction.

9 387. A periodontal pocket that is 6 mm. deep and has the junctional epithelium located coronal to the cementoenamel junction is

1. a pseudopocket.* 2. an infrabony pocket. 3. a bifurcation involvement. 4. a true periodontal pocket. .

442. Which of the following indices would one likely use in assessing severity or extent of periodontitis in epidemiologic studies of a large population?

1. PMA index 2. Plaque Index (PI. 1.) 3. Gingival Index (GI) 4. Periodontal Index (PI)* 5. Sulcus Bleeding Index (SBI)443. Loss of periodontal attachment is determined by measuring the distance between the

1. gingival margin and the cementoenamel junction. 2. gingival margin and the bottom of the periodontal pocket. 3. cementoenamel junction and the bottom of the periodontal pocket.* 4. gingival margin and the most coronal portion of the connective tissue attachment.

454. Apical migration of the epithelial attachment with corresponding recession of the marginal gingiva results in

1. a shallow sulcus.* 2. gingival pocket formation. . 3. infrabony pocket formation. 4. periodontal pocket formation.

460. Areas of isolated recession are frequently seen on teeth that are

1. nonvital. 2. moderately mobile. 3. labially prominent in the arch.* 4. associated with .

470. Which of the following are common characteristics of gingival (pseudo) pockets?

(a) ulceration of lining epithelium . (b) apical migration of the epithelial attachment (c) depth of more than 3mm. (d) destruction of some or all adjacent transseptaI connective tissue fibers (e) bone resorption

2. (a) and (c) only*

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466. Which of the following influence apical termination of a periodontal probe when measuring pocket depth?

(a) periodontitis (b) probe diameter (c) probing force (d) degree of inflammation

5. All of the above*

541. Periodontal probing does not always reflect the histologic pocket. depth because the apical extension of the probe tip is dependent upon the degree of periodontal inflammation. (1)

1. Both statement and reason are correct and related.

554. A is examining a tooth that has a probing depth of 5 mm and gingival recession of 3 mm. The total amount of attachment loss is

A. 2 mm. B. 3 mm. C. 5 mm. D. 8.mm*

44. Periodontal disease in multiple sites in patient who continues to demonstrate attachment loss after apparently appropriate periodontal treatment is called

1. Gingivitis 2. Generalized 3. Refractory periodontitis* 4.

77. Periodontitis may BEST be described as

1. A chronic inflammatory disease with periods of remission and exacerbation* 2. A chronic inflammatory disease that usually does not manifest itself clinically before the age of 40. 3. A degenerative disease of the periodontium 4. An acute inflammatory disease 5. A chronic inflammatory disease that most often affects the entire dentition equally

11 85. Which of the following periodontal diseases is characterized by relatively sparse subgingival plaque, onset at the age puberty, and bilateral angular bone loss in the first molars and incisors?

1. Necrotizing ulcerative gingivitis 2. Generalized aggressive periodontitis 3. Localized aggressive periodontitis* 5. Refractory periodontitis

98. The characteristics of gingivitis are

1. Bone loss, swelling of the soft tissue, apical migration of the epithelial attachment 2. Swelling of the soft tissue, apical migration of the epithelial attachment, bleeding on probing 3. Bone loss, apical migration of the epithelial attachment, widening of the periodontal ligament spaces, bleeding on probing 4. Swelling of the soft tissue, bleeding on probing* 5. Bone loss, swelling of the soft tissue, apical migration of the epithelial attachment, widening of the periodontal ligament space, bleeding on probing

120. Which of the following conditions exists when a patient demonstrates attachment loss and is infected by periodontal pathogens after appropriate treatment?

1. Chronic periodontitis 2. 3. 4. Refractory periodontitis* 5. Aggressive periodontitis

9. In health, the crest of the alveolar bone lies at a level approximately 1 to 2 mm apical to the level of the CEJs of the adjacent teeth; in advanced periodontitis there is usually extensive horizontal and/or vertical bone loss.

1. Both statements are TRUE*

27. Periodontitis begins as gingivitis; all gingivitis leads to periodontitis.

3. The first statement is TRUE, the second is FALSE*

28. In localized aggressive periodontitis, the primary bacteria associated with the condition is Actinobacillus actinomycetemcomitans; the disease is characterized by severe periodontal destruction around most teeth.

3. The first statement is TRUE, the second is FALSE*

12 62. Which of the following must be evident in order to make a diagnosis of periodontitis?

1. Bleeding 2. Probing depths of 5 mm or more 3. Radiographic evidence of bone loss* 4. Purulent exudate 5. All of the above 6. None of the above

77. Periodontitis may BEST be described as

1. A chronic inflammatory disease with periods of remission and exacerbation* 2. A chronic inflammatory disease that usually does not manifest itself clinically before the age of 40. 3. A degenerative disease of the periodontium 4. An acute inflammatory disease 5. A chronic inflammatory disease that most often affects the entire dentition equally

84. The radiographic findings of gingivitis will demonstrate

1. Vertical bone loss 2. Horizontal bone loss 3. Increase in bone density 4. Change in bone trabeculation 5. Normal bone pattern*

98. The characteristics of gingivitis are

1. Bone loss, swelling of the soft tissue, apical migration of the epithelial attachment 2. Swelling of the soft tissue, apical migration of the epithelial attachment, bleeding on probing . 3. Bone loss, apical migration of the epithelial attachment, widening of the periodontal ligament spaces, bleeding on probing 4. Swelling of the soft tissue, bleeding on probing* 5. Bone loss, swelling of the soft tissue, apical migration of the epithelial attachment, widening of the periodontal ligament space, bleeding on probing

120. Which of the following conditions exists when a patient demonstrates attachment loss and is infected by periodontal pathogens after appropriate treatment?

1. Chronic periodontitis 2. Desquamative gingivitis 3. Linear gingival erythema 4. Refractory periodontitis* 5. Aggressive periodontitis

13 121. What is the relationship between gingivitis and periodontitis?

1. Gingivitis will always progress to periodontitis if untreated 2. Both gingivitis and periodontitis result in attachment loss 3. Both gingivitis and periodontitis are manifested by alveolar bone loss 4. Both gingivitis and periodontitis can result in probing depths greater than 3 mm* 5. Periodontitis precedes gingivitis in the periodontal lesion

123. Gingivitis is initiated most often by

1. Malocclusion 2. A hormonal imbalance 3. A vitamin deficiency 4. Microorganisms and their products * 5. Psychosocial factors

238. Which of the following is the most important sign or symptom of marginal gingivitis?

1. Pain 2. Redness* 3. Hyperplasia 4. Pocket formation 5. Absence of stippling 244. In periodontitis, the color of the gingiva may be either reddish or bluish. In the early stages, the teeth may either be loose or firm. (1)

1. Both statements are TRUE.

262. The primary difference between gingivitis and periodontitis is

1. bone infection. 2. depth of pockets. 3. age of the patient. 4. changes in color of the gingiva. 5. lack. of stippling of the gingiva. 6. apical migration of junctional epithelium beyond the cementoenamel junction.*

271. Clinical criteria for diagnosing periodontal and gingival diseases include alteration in the

(a) depth of the gingival sulcus and the level of the epithelial attachment. (b) free gingival groove. (c) color of gingival tissue. (d) contour of gingival tissue

3. (a), (c) and (d)*

14 333. The predominant periodontal disease is

1. gingivitis.* 2. periodontitis. 3. gingival hyperplasia. 4. juvenile periodontitis. 5. periodontal disuse atrophy.

385. According to most epidemiologic studies, what percentage of children have inflammatory periodontal disease (gingivitis or periodontitis) by the age of 15?

1. 1-10% 2. 15-25% 3. 30-40% 4. 45-55% 5. 80-90%*

539. Which of the following changes does NOT occur in gingivitis?

1. Disruption of fiber bundles in gingiva 2. Apical migration of the epithelial attachment* 3. Thinning- and ulceration of crevicular epithelium 4. Formation of a heavy inflammatory infiltrate in connective tissue 5. Proliferation of epithelial projections of the basal layer of the sulcular epithelium

553. Which of the following represents the most common form of gingival periodontal disease in school-aged children?

A. Aggressive periodontitis B. Localized acute gingivitis* C. Primary herpetic gingivostomatitis D. Necrotizing ulcerative gingivitis

559. Which of the following periodontal diseases causes the most rapid destruction of alveolar bone?

A. * B. Chronic periodontitis C. Phenytoin-induced D. Necrotizing ulcerative gingivitis

28. In localized aggressive periodontitis, the primary bacteria associated with the condition is Actinobacillus actinomycetemcomitans; the disease is characterized by severe periodontal destruction around most teeth.

3. The first statement is TRUE, the second is FALSE*

15 85. Which of the following periodontal diseases is characterized by relatively sparse subgingival plaque, onset at the age puberty, and bilateral angular bone loss in the first molars and incisors?

1. Necrotizing ulcerative gingivitis 2. Generalized aggressive periodontitis 3. Chronic periodontitis 4. Localized aggressive periodontitis* 5. Refractory periodontitis

154. The periodontal condition which usually has the worst prognosis is

1. occlusal traumatism. 2. gingivitis. 3. localized aggressive periodontitis.* 4. periodontal atrophy. 5. moderate periodontitis.

205. A 15-year-old black girl complains of spacing between her front teeth. Visible local irritants are minimal. Radiographs are not available. Mesial pocket probing reveals 8-12 mm. pockets on all incisors and first molars. Normal sulci are present on canines, premolars and second molars. The most likely diagnosis is

1. periodontal atrophy. 2. multiple periodontal abscesses. 3. chronic periodontitis. 4. localized aggressive periodontitis * 5. none of the above.

220. Localized aggressive periodontitis is a disease that exhibits

(a) greater frequency in females than in males. (b) early mobility and migration of teeth. (c) early horizontal bone loss. (d) a marked increase in ca1cul us formation. (e) greatest incidence between 15 and 30 years of age.

2. (a), (b) and (e)*

302. The presence of heavy subgingival in localized aggressive periodontitis is compatible with the bacteriology of the condition because bacteria found in localized aggressive periodontitis do not lower pH. (5)

5. NEITHER statement nor reason is correct.

16 391. An 18-year-old woman has good with only minute traces of supragingival calculus. Gingival tissues exhibit no inflammatory edema, stippling is evident, and there is no gross color change. Probing reveals 5-8 mm. pockets around maxillary and mandibular incisors and first molars. . No appreciable bone loss is evident elsewhere in the mouth. The probable diagnosis is 1. gingivitis. 2. chronic periodontitis. 3. desquamative gingivitis. 4. localized aggressive periodontitis.* 5. generalized idiopathic bone resorption.

409. Severe alveolar bone loss, as observed in localized aggressive periodontitis, is associated with

1. cyclic eosinophilia. 2. lysis of neutrophils. 3. increased phagocytosis. 4. neutrophil chemotactic defects.*

453. The bacterial flora in periodontal pockets associated with localized aggressive periodontitis is predominantly

1. gram-positive aerobic cocci. 2. gram-positive anaerobic cocci. 3. gram-negative aerobic rods. 4. gram-negative anaerobic rods.*

455. In localized aggressive periodontitis, the teeth with the earliest and most severe destruction are usually

1. incisors and first premolars. 2. incisors and second premolars. 3. incisors and first molars.* 4. incisors and second molars. 5. premolars and molars.

465. Etiologic factors proposed for localized aggressive periodontitis include which of the following?

(a) A vitamin deficiency may exist in the host. (b) There is a genetic predisposition to this disease. (c) A virulent, gram-positive microorganism may be responsible for alveolar bone destruction. (d) Studies have indicated that a dysfunction of polymorphonuclear leukocytes may be associated with this disease.

5. (b) and (d)*

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482. The presence of heavy subgingival calculus in juvenile periodontitis is compatible with the bacteriology of the condition, because bacteria found in juvenile periodontitis do not lower pH. (5)

5. NEITHER statement nor reason is correct.

565. Although no causal relationships between particular bacteria and periodontal diseases have been determined, there does appear to be an association between localized aggressive periodontitis and the presence of

A. Actinobacillus actinomycetemcomitans.* B. . C. Actinomyces viscosus. D. .

74. Which of the following has been associated with localized aggressive gingivitis?

1. Cyclic eosinophilia 2. Lysis of neutrophils 3. Increased phagocytosis 4. Neutrophil chemotactic defects*

16. Small changes in the volume of bone are best detected using:

1. BWX 2. PAX 3. Subtraction radiography

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