B DAPE 721, Fall, 2006 NAME: ______Periodontics I Exam # ______Mid Term Examination 2006 Seat # ______8:00 – 8:50 AM Course Director: Dr. Keene

Multiple Choice Questions -50 Questions @ 2 points each

1. The probing depth of the healthy in humans most commonly ranges as which of the following numerical values?

A. 0-1 mm B. 0-5 mm C. 2-3 mm D. 4-7 mm E. None of the above

2. In health, the narrowest width of the facial maxillary attached gingiva is associated with the premolars. The narrowest width of the lingual mandibular attached gingiva is associated with the premolars.

A. Both statements are true B. Neither statement is true C. Statement one is false and statement two is true D. Statement one is true and statement two is false

3. In health, the width of the attached gingiva on the lingual of number 28 is the same as:

A. the distance from the coronal portion of the free to the B. the distance from the free gingival margin to the mucogingival junction C. the width of the keratinized gingiva as determined with a D. the depth of the gingival sulcus E. none of the above

4. The human gingival “col” is formed by the facial and lingual papillae of two teeth that are in contact. Which of the following descriptions accurately describes the “col”? 1. keratinized stratified squamous epithelium 2. decreased susceptibility to 3. Shape is determined by adjacent tooth contact 4. Similar in morphology to

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

5. In the presence of inflammation and strong parafunctional movements, multi-rooted teeth often develop which of the following?

1. Furcation bone loss 2. Collagen disorganization within the periodontal ligament (PDL) 3. tears 4. Thrombosis of vasculature within the interstitial spaces of the PDL

A. 1, 2, 3, 4 B. 2, 3, 4 C. 2 and 3 D. 2 only

6. In health, the junctional epithelium within the human oral sulcus does not contain which of the following histological structures:

A. Endoplasmic reticulum B. Mitochondria C. Keratohyaline granules D. Desmosomes

7. The Epithelial Attachment consists of which of the following:

A. Laminin B. Hemi-desmosomes C. Reticular fibers D. Junctional cells arranged parallel to the root surface E. All of the above

8. The Alveolar Bone Proper is histologically described as:

A. Supporting bone B. Sharpey’s bone C. Cancellous bone D. Basal bone E.

9. In the , Prostaglandin E2 (PGE2) is mediated under the direction of which of the following inflammatory cytokines?

A. IL-1 B. TNF C. IL-8 D. IL-2 E. A and B

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10. In periodontal disease, macrophages degrade foreign antigen into peptide fragments, which when presented to lymphocyte cell surface markers such as T-helper cells in the presence of the Major Histocompatability Complex (MHC), initiate a specific cytokine (IL-2) immune response. Macrophages within the periodontium can not participate in both a cell mediated (nonspecific) and humoral (specific) inflammatory/ immune response to foreign bacterial antigen.

A. Both statements are true. B. Both statements are false. C. The first statement is true and the second statement is false. D. The first statement is false and the second statement is true.

11. In periodontal disease, the immunoglobulin found in greatest concentration within the gingival crevice and periodontium is ______.

A. IgE B. IgG C. IgM D. IgA E. IgD

12. Pro-inflammatory cytokines that can mediate host destruction are ______.

A. IL-1β and TNF-α B. IL-2 and IL-4 C. IL-9 and IL-12 D. IL-Ira

13. Mesial drift results in changes within periodontal alveolar bone; these are best described as ______.

1. necrosis and osteoclastic activity on the pressure side. 2. necrosis and osteoclastic activity on the tension side. 3. apical osteoblastic ankylosis. 4. cementoblastic and collagen mineralization on the pressure side. 5. osteoblastic and collagen mineralization on the tension side.

A. 1, 2, 3, 4, 5 B. 1, 2, 3 C. 2, 3, 4 D. 1 and 5

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14. In Stage III , loss of fiber bundles is most associated with collagenase secreted by which of the following cell types?

1. Neutrophils 2. Oral bacteria 3. Plasma cells 4. Langerhans cells 5. Lymphocytes

A. 1, 2, 3, 4, 5 B. 1, 2, 3 C. 1 and 2 D. 2, 4, 5 E. 1 only

15. Measurement of attachment level is defined as the distance from the:

A. gingival margin to the alveolar bone B. gingival margin to the junctional epithelium C. CEJ to the junctional epithelium D. Width of keratininized gingival E. Width of the attached gingival

16. In the healthy periodontium, the biologic width is approximately 2.04 mm. This distance of 2.04 mm is measured as the distance from the epithelial attachment to the crestal alveolar bone.

A. Both statements are true. B. Both statements are false. C. The first statement is true and the second statement is false. D. The first statement is false and the second statement is true.

17. Stage IV gingivitis (Advanced lesion) the ______cells dominate the humoral response.

A. neutrophils B. plasma cells C. macrophages D. lymphocytes

18. “Interstitial areas” within the periodontal ligament contain:

A. Dense connective tissue B. Nerve endings and capillaries C. Cementum irregularities D. Hertwig’s epithelial root remnants E. All of the above

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19. In the human, the ectodermal cell type of the oral is A. Keratinized stratified squamous epithelium B. Non-keratinized simple squamous epithelium C. Pseudo-stratified epithelium D. Transitional epithelium E. Non-keratinized stratified squamous epithelium

20. Induction of gingivitis by release of bacteria and pro-inflammatory cytokines is associated with which of the following: A. Calcium channel blockers B. Cyclosporine C. Dilantin Sodium D. E. None of the above

21. Loss of which of the following fiber bundle groups is associated with the origin of furcation involvement in periodontal disease?

A. Circular B. Alveolar gingival C. Transseptal D. Interradicular E. Dentoalveolar

22. Microbial products in gingivitis activate:

A. Monocytes/macrophages B. Vasoactive subjects such as PGE2 C. Interferon (IFN) D. Cytokines TNF and IL-1 E. All of the above

23. Tooth number 28 has 2 mm of keratinized and no attached gingiva on the facial. Gentle retraction shows an absent of junctional epithelial attachment associated with frenum pull. This is known as what type of periodontal defect?

A. mucogingival defect B. C. residual defect D. none of the above

24. In health, the epithelial mitotic cell turnover rate is highest within:

A. oral sulcular epithelium B. junctional epithelium C. oral epithelium D. alveolar mucosa E. skin 5

25. The epithelial attachment electron-microscopy is termed:

A. Internal basal lamina B. Intermediate plexus C. External basal lamina D. Basement membrane

26. Which of the following are associated with junctional epithelium?

1. hemi-desmosomes 2. laminin 3. rough endoplasmic reticulum 4. glycocalyx

A. 1, 2, 3, 4 B. 1, 2, 3 C. 1, 2, 4 D. 1 and 2 only

27. In inflammation, loss of which of the following fiber bundle groups are primarily associated with the progressive downward proliferation of the junctional epithelium and of lymphocytes into the alveolar crest bone or periodontal ligament during advancing periodontal disease?

A. Dentinopereriosteal B. Alveolar gingival C. Transseptal D. Interradicular E. None of the above

28. The principal fibers of the periodontal ligament are primarily types ______collagen.

A. I and III B. II and III C. III and IV D. I and IV

29. Bundle bone is associated with which of the following anatomic/histological structures within the periodontium?

A. Cribriform plate B. Sharpey’s Fibers C. Alveolar bone proper D. Lamina dura radiographically E. All of the above

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30. The crevicular plexus can be associated with which of the following conditions related to the gingival sulcus?

1. Electrolytic transudate exchange 2. IL-8 induced development and migration of plasma cells 3. Formation of a hemorrhagic exudate 4. Neutrophil migration into the inflammatory site

A. 1, 2, 3, 4 B. 1, 2, 3 C. 1, 3, 4 D. 2, 3, 4 E. 3 only

31. The fibroblast within the periodontal ligament can perform which of the following:

1. phagocytosis of collagen 2. collagenase secretion 3. collagen and elastic fiber synthesis 4. secretion of glycosaminoglycans

A. 1, 2, 3, 4 B. 1, 3, 4 C. 2, 3, 4 D. 2 and 3 E. 3 and 4

32. The periodontal ligament fiber bundle group that best protects the tooth and alveolus during occlusal/axial masticatory force is which of the following?

A. Horizontal B. Oblique C. Apical D. Dentoperiosteal

33. The “looping” within the marginal vasculature of the healthy periodontium is indicative of ______.

A. connective tissue pull upon vasculature B. capillary anastomosis within vasculature C. leukocyte migration through vasculature D. fiber bundle organization within the free gingiva E. alveolar mucosa within the free gingival margin

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34. Tooth #29 has not had an antagonist since 1993. Which of the following listed histological findings are associated with tooth #29?

A. Widened PDL with loss of supporting bone B. Narrow PDL with loss of supporting bone C. Alveolar bone proper density increases D. Increased bone trabeculation density

35. Gingivitis is associated with a hemorrhagic exudate. The transition from gingivitis to periodontitis is primarily related to the Gram negative composition of bacterial subgingival plaque.

A. Both statements are true. B. Both statements are false. C. The first statement is true and the second statement is false. D. The first statement is false and the second statement is true.

36. The predominant immune cell type associated with Stage I (gingivitis) is the:

A. PMN B. Lymphocyte C. Macrophage D. Plasma cell E. Mast cell

37. Pro-inflammatory cytokines can mediate the production of metalloproteinases, collagenases, and prostoglandin E2 in periodontal disease that can be destructive at which of the following host sites?

A. Gingival fiber bundles B. Alveolar bone C. Perodontal ligament D. All of the above

38. A 26-year-old male presents to your office with the following clinical signs: loss of interdental free gingival , cyanotic tissue color of the free gingival and interdental gingiva, and hemorrhagic exudate upon gentle probing with 4 -5 mm pocket depth. No epithelial attachment loss is seen. The attached gingiva is pink and fibrotic. Your diagnosis is ______.

A. acute gingivitis B. C. periodontitis D. lead poisoning E. chronic gingivitis

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39. A 29-year-old female presents to your office with the following clinical signs associated with tooth number 27: no zone of attached gingivae and excessive muscle and frenum pull resulting in 5 mm of root exposure. Your diagnosis is primarily associated with which of the following:

A. Gingival hyperplasia B. Mucogingival involvement C. Lingual position of number 27 in the arch D. Occlusal traumatism

40. An osseous fenestration is more commonly found in which of the following:

1) In the facial bone rather than lingual bone 2) Where facial buttressing bone is present 3) Where a root is facially prominent in the arch 4) Where the denuded area is apical to the marginal bone

A. 1, 2, 3, 4 B. 1, 3, 4 C. 2, 3, 4 D. 3, and 4 E. 2, and 4

41. Periodontal endotoxins are products that are produced by ______microorganisms.

A. Gram (+) B. Gram (-) C. Fungi D. Viruses

42. A linear facial gingival indentation that extends 1-3 mm from the gingival margin parallel to the root surface in an apical direction is termed as a:

A. McCall’s festoon B. Stillman’s cleft C. Fenestration D. Abfraction

43. In periodontal health, the alveolar crest of the mesiodistal interdental alveolar bone parallels a line drawn between adjacent tooth cemento-enamel junctions. The latter statement is a basic concept that is important for clinical and radiographic diagnosis of periodontal health versus periodontal disease related bone resorption.

A. Both statements are true. B. Both statements are false. C. The first statement is true and the second statement is false. D. The first statement is false and the second statement is true. 9

44. A difference between alveolar bone and acellular cementum is the absence of:

A. Hydroxyapatite B. Sharpey’s fibers C. Intercellular matrix D. Lacunae containing osteoblasts E. None of the above

45. Acellular cementum is located at the coronal 1/3 of the tooth root. Acellular cementum because of its thinness and inability to regenerate when compared with cellular cementum can be lost with periodontal disease and/or excessive scaling.

A. Both statements are true. B. Both statements are false. C. The first statement is true and the second statement is false. D. The first statement is false and the second statement is true.

46. Clinical research reports that _____of teeth have a partial absence of cervical cementum forming a space between enamel and cementum.

A. 5 – 10% B. 30 – 50% C. 60 – 65% D. over 65%

47. Enamel projections and “pearls” can occur on the surfaces of the maxillary and mandibular first and second molars. When they occur, they extend downward through the midfacial area of the multi-rooted tooth. The epithelial attachment is weaker on enamel projection then cementum. What is the clinical importance of enamel projections?

A. Periodontal pocket depth B. Need for odontoplasty C. Furcation involvement D. Increase plaque accumulation E. All of the above

48. Innate (nonspecific) immunity in periodontal disease involves oxidative and /or non-oxidative bacterial pathogen destruction by which of the following cell types?

1. Macrophages 2. T and B-cells 3. Plasma cells 4. Neutrophils A. 1, 2, 3,4 B. 1 and 3 C. 1 and 4 D. 3 and 4 E. 4 only 10

49. Pathogenesis in periodontal disease may result from which of the following:

A. Bacterial virulence B. Deficient host resistance C. Overactive host immune response D. A and B E. A, B, C

50. In acute formation, the primary phagocyte cell against virulent microorganisms is the ______.

A. Neutrophile B. Fibrocyte C. Langerhans cell D. Plasma cell E. Macrophage

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