A Name_____________________________

Write name on scoring sheet and on exam!! Seat No.__________________________ DAPE 731 - Year II Periodontology First Examination, March 5, 2009 Neal W. Roller, D.D.S., M.S. Exam # _______

Mark the correct answer on the Scantron answer sheet. 2 points per question

1. Vessel canals, a normal radiographic finding, might be confused with radiolucency resulting from periodontal disease. Where in the mouth are you most likely to notice this phenomenon?

A. Maxillary Anterior region. B. Maxillary Posterior region. C. Mandibular Anterior region. D. Mandibular Bicuspid region. E. Mandibular Molar region.

2. The width of the attached gingiva is the distance between the mucogingival junction and the:

A. Free gingival groove. B. Gingival margin. C. CEJ. D. Bottom of the sulcus or pocket. E. None of the above.

3. Tissue necrosis, pain and bleeding are significant criteria used in the clinical diagnosis of:

A. Lichen planus. B. Necrotizing ulcerative gingivitis. C. Chronic inflammatory periodontal disease. D. A and B only. E. B and C only.

4. In humans, the periodontal probe tip usually penetrates:

A. 1 mm coronal to the attachment of the junctional epithelium. B. To the most coronal site of attachment of the junctional epithelium. C. 1 mm above the crest of bone. D. To the most coronal intact fibers of the connective tissue attachment.

5. Which of the following grade of mobility is distinguished by depressability (vertical displacement)?

A. Grade One. B. Grade Two. C. Grade Three. D. Grade Four.

6. Which one of the following periodontal pathogens is not evaluated in the DMDx test?

A. Eikenella Corrodes. B. Campylobacter Rectus. C. Fusobacterium Nucleatum. D. Treponema Denticola.

E. Peptostreptococcus Micros.

7. The best way to determine the location of the mucogingival junction is to:

A. Observe the color changes in the different tissues. B. Use a periodontal probe to see where the movable alveolar mucosa joins the immovable

attached gingiva. C. Use a disclosing solution. D. Combination of A and B.

8. Gingival recession has clinical significance, in that:

A. Exposed root surfaces are susceptible to caries. B. The teeth may become extremely sensitive to touch, cold, etc. C. Plaque frequently accumulates in areas of recession. D. A and B only. E. All of the above.

9. Your 26-year-old patient has isolated pockets on the buccal surfaces of teeth #19 and 30. The

most likely etiology would be: A. Plunger cusps. B. Bone dehiscence. C. Occlusal trauma. D. Enamel projections.

10. The level of attachment of the base of a pocket on a tooth surface is of greater diagnostic

significance than the depth of the pocket because: A. The level of attachment affords a better indication of the severity of periodontal disease. B. The level of attachment is more easily measured clinically. C. The level of attachment has minimal variation over a 24-hour period. D. A and B only. E. B and C only.

11. Which of the following have an influence on the extent and severity of chronic periodontitis? A. Emotional stress. B. Smoking. C. Prior history of periodontitis. D. A and B only E. A B and C are all true

12. Papillon-Lefevre Syndrome is characterized by:

A. Hyperkeratotic skin lesions. B. Poor cranial bone formation. C. Profound defects in peripheral blood neutrophils and monocytes. D. All of the above.

13. Which of the following statements about Localized Aggressive Periodontitis are true? A. Immunologic defects associated with aggressive periodontitis may be inherited. B. Bacterial invasion of the connective tissue by bacteria. C. Several studies have shown that patients with LAP display functional defects of the gingival

fibroblasts D. A and B only. E. All of the above are true.

2

14. Following treatment, a significant reduction in tissue size and pocket depth is expected when the patient presents for root planing with:

A. Gingival recession. B. Edematous tissue. C. A history of heavy smoking. D. All of the above. E. None of the above.

15. The daily removal of dental biofilm can be improved by:

A. Using unwaxed rather than waxed floss. B. Applying the floss very lightly to the tooth and moving in an up and down direction. C. Keeping the fingers 3 to 4 inches apart when using dental floss. D. All of the above. E. None of the above.

16. Measuring probing depth on our clinic patients involves utilizing the probe:

A. With 25g of force. B. To measure eight (8) surfaces per tooth. C. Parallel to the vertical axis of the tooth. D. A and B only. E. A, B, and C are all true.

17. What is the fluoride content of toothpaste?

A. 1000 ppm. B. 2000 ppm. C. 3000 ppm. D. 5000 ppm. E. 10000 ppm.

18. Occlusal trauma without inflammation results in:

A. Attachment loss (migration of the junctional epithelium. B. Loss of crestal bone. C. Tooth mobility. D. A and B only. E. A, B, and C are all true.

19. The PASS Plaque Index:

A. evaluates six teeth when six or more teeth are present. B. requires a disclosing solution to identify plaque. C. with a score of 20, indicates 20 percent of the teeth are plaque free. D. A and B only. E. None of the above is true.

20. Which zone(s) of NUG contain spirochetes?

A. The bacterial zone. B. The neutrophil rich zone. C. The necrotic zone.

3

D. A and B only. E. All of the above.

21. Which of the following techniques permit a determination of antibiotic sensitivity?

A. DMDx Test. B. Immunologic assays C. Culturing. D. A and B only E. All of the above.

22. Which of the following devices is utilized to accurately measure tooth mobility?

A. Perio-check. B. Perio-test. C. Interpore. D. Perioscan. E. Florida Probe

The following answers continue on the same Scantron answer sheet with a series of true or false questions.

Mark A if your answer is True; mark B if your answer is False.

Mark your Scantron sheet: A or B

23. T F Horizontal bone loss is usually associated with suprabony pockets.

24. T F In general, the largest brush that fits into the interproximal space will clean the

most efficiently.

25. T F Loose teeth are more susceptible to plaque induced infections.

26. T F A striking feature of localized aggressive periodontitis is the severe clinical inflammation associated with the deep periodontal pockets.

27. T F Systemic antibiotics do not play an important role in the management of chronic

periodontitis.

28. T F According to Armitage (1994) bleeding upon probing and purulent exudate can be

seen at healthy gingival sites.

29. T F The clinician should consider occlusal trauma as a likely cause when gingival recession is observed.

End of separate scoring sheet

4

Fill in the correct answers directly on the page.

1. Which Mobility Classification is utilized in our clinical examination? ____________.

2. What is the average distance from the CEJ to the beginning of the furcation entrance on the distal of a maxillary 1st molar? ____ mm.

3. You have identified A. actinomycetemcomitans as a predominate microorganism in your aggressive periodontitis patient. Why would scaling and root planing be less likely to succeed in this situation?

_____________________________________________________________________________

_____________________________________________________________________________

4. The diameter of a soft toothbrush bristle is: _____ inch; or _____ mm.

5. In 1965 Harold Loe had dental students withhold plaque removal and these students all

developed gingivitis in _____ to _____ days. Upon reinstitution of plaque removal, the clinical

signs of gingivitis were gone in _____ days.

6. Name the immunosuppressant that is most associated with gingival enlargement?

7. Severe chronic periodontitis has attachment loss of ____________.

8. What is the name of the explorer used in the periodontal clinic to detect calculus and root roughness?

9. The red complex consists of three microorganisms: (1.) Porphyromonas gingivalis; (2.) Treponema denticola; and (3.)

10. What is met by a diffuse change when describing gingivitis? ________________________________________________________________

11. The two earliest signs of gingivitis preceding established gingivitis are:

5

(1)

(2)

12. What position of the gingival margin would result in the probing depth being the same as the attachment loss?

___________________________________________________________________________

13. Define secondary occlusal trauma:

14. How is plaque-associated gingivitis treated?

15. Mustapha in 2007 did a meta-analysis evaluating the relationship between periodontal disease and coronary artery disease. What was the significant conclusion of this article?

16. What type of a periodontal pocket is illustrated? ____________________________

17. By looking at a radiograph how can you determine if the horizontal angulation is correct?

6

18. Which method of tooth brushing is illustrated? _______________________________________________________________

19. How would you determine if a patient has ongoing attachment loss without pocket formation?

20. Subgingival calculus is considered an important factor in the progression of periodontitis because its rough surface causes irritation producing gingival inflammation.

Do you agree or disagree with this statement and why?

21. In which country was a bristle toothbrush first utilized?

_______________________________________________________________

7

Name_____________________________ Write name on scoring sheet and on exam!! Seat No.__________________________ DAPE 731 - Year II Periodontology First Examination, March 5, 2009 Neal W. Roller, D.D.S., M.S. Exam # _______

Mark the correct answer on the Scantron answer sheet. 2 points per question

30. Vessel canals, a normal radiographic finding, might be confused with radiolucency resulting from periodontal disease. Where in the mouth are you most likely to notice this phenomenon?

A. Maxillary Anterior region. B. Maxillary Posterior region. C. Mandibular Anterior region. D. Mandibular Bicuspid region. E. Mandibular Molar region.

31. The width of the attached gingiva is the distance between the mucogingival junction and the:

A. Free gingival groove. B. Gingival margin. C. CEJ. D. Bottom of the sulcus or pocket. E. None of the above.

32. Tissue necrosis, pain and bleeding are significant criteria used in the clinical diagnosis of:

A. Lichen planus. B. Necrotizing ulcerative gingivitis. C. Chronic inflammatory periodontal disease. D. A and B only. E. B and C only.

33. In humans, the periodontal probe tip usually penetrates:

A. 1 mm coronal to the attachment of the junctional epithelium. B. To the most coronal site of attachment of the junctional epithelium. C. 1 mm above the crest of bone. D. To the most coronal intact fibers of the connective tissue attachment.

34. Which of the following grade of mobility is distinguished by depressability (vertical displacement)?

A. Grade One. B. Grade Two. C. Grade Three. D. Grade Four.

35. Which one of the following periodontal pathogens is not evaluated in the DMDx test?

8

A. Eikenella Corrodes. B. Campylobacter Rectus. C. Fusobacterium Nucleatum. D. Treponema Denticola. E. Peptostreptococcus Micros.

36. The best way to determine the location of the mucogingival junction is to:

A. Observe the color changes in the different tissues. B. Use a periodontal probe to see where the movable alveolar mucosa joins the immovable

attached gingiva. C. Use a disclosing solution. D. Combination of A and B.

37. Gingival recession has clinical significance, in that:

A. Exposed root surfaces are susceptible to caries. B. The teeth may become extremely sensitive to touch, cold, etc. C. Plaque frequently accumulates in areas of recession. D. A and B only. E. All of the above.

38. Your 26-year-old patient has isolated pockets on the buccal surfaces of teeth #19 and 30. The

most likely etiology would be: A. Plunger cusps. B. Bone dehiscence. C. Occlusal trauma. D. Enamel projections.

39. The level of attachment of the base of a pocket on a tooth surface is of greater diagnostic

significance than the depth of the pocket because: A. The level of attachment affords a better indication of the severity of periodontal disease. B. The level of attachment is more easily measured clinically. C. The level of attachment has minimal variation over a 24-hour period. D. A and B only. E. B and C only.

40. Which of the following have an influence on the extent and severity of chronic periodontitis? A. Emotional stress. B. Smoking. C. Prior history of periodontitis. D. A and B only E. A B and C are all true

41. Papillon-Lefevre Syndrome is characterized by:

A. Hyperkeratotic skin lesions. B. Poor cranial bone formation. C. Profound defects in peripheral blood neutrophils and monocytes. D. All of the above.

42. Which of the following statements about Localized Aggressive Periodontitis are true? A. Immunologic defects associated with aggressive periodontitis may be inherited. B. Bacterial invasion of the connective tissue by bacteria.

9

C. Several studies have shown that patients with LAP display functional defects of the gingival fibroblasts

D. A and B only. E. All of the above are true.

43. Following treatment, a significant reduction in tissue size and pocket depth is expected when the patient presents for root planing with:

A. Gingival recession. B. Edematous tissue. C. A history of heavy smoking. D. All of the above. E. None of the above.

44. The daily removal of dental biofilm can be improved by:

A. Using unwaxed rather than waxed floss. B. Applying the floss very lightly to the tooth and moving in an up and down direction. C. Keeping the fingers 3 to 4 inches apart when using dental floss. D. All of the above. E. None of the above.

45. Measuring probing depth on our clinic patients involves utilizing the probe:

A. With 25g of force. B. To measure eight (8) surfaces per tooth. C. Parallel to the vertical axis of the tooth. D. A and B only. E. A, B, and C are all true.

46. What is the fluoride content of toothpaste?

A. 1000 ppm. B. 2000 ppm. C. 3000 ppm. D. 5000 ppm. E. 10000 ppm.

47. Occlusal trauma without inflammation results in:

A. Attachment loss (migration of the junctional epithelium. B. Loss of crestal bone. C. Tooth mobility. D. A and B only. E. A, B, and C are all true.

48. The PASS Plaque Index:

A. evaluates six teeth when six or more teeth are present. B. requires a disclosing solution to identify plaque. C. with a score of 20, indicates 20 percent of the teeth are plaque free. D. A and B only. E. None of the above is true.

49. Which zone(s) of NUG contain spirochetes?

10

A. The bacterial zone. B. The neutrophil rich zone. C. The necrotic zone. D. A and B only. E. All of the above.

50. Which of the following techniques permit a determination of antibiotic sensitivity?

A. DMDx Test. B. Immunologic assays C. Culturing. D. A and B only E. All of the above.

51. Which of the following devices is utilized to accurately measure tooth mobility?

A. Perio-check. B. Perio-test. C. Interpore. D. Perioscan. E. Florida Probe

The following answers continue on the same Scantron answer sheet with a series of true or false questions.

Mark A if your answer is True; mark B if your answer is False.

Mark your Scantron sheet: A or B

52. T F Horizontal bone loss is usually associated with suprabony pockets.

53. T F In general, the largest brush that fits into the interproximal space will clean the

most efficiently.

54. T F Loose teeth are more susceptible to plaque induced infections.

55. T F A striking feature of localized aggressive periodontitis is the severe clinical inflammation associated with the deep periodontal pockets.

56. T F Systemic antibiotics do not play an important role in the management of chronic

periodontitis.

57. T F According to Armitage (1994) bleeding upon probing and purulent exudate can be

seen at healthy gingival sites.

58. T F The clinician should consider occlusal trauma as a likely cause when gingival recession is observed.

11

End of separate scoring sheet

Fill in the correct answers directly on the page.

1. Which Mobility Classification is utilized in our clinical examination? MILLER___.

2. What is the average distance from the CEJ to the beginning of the furcation entrance on the distal of a maxillary 1st molar? _5_ mm.

3. You have identified A. actinomycetemcomitans as a predominate microorganism in your aggressive

periodontitis patient. Why would scaling and root planing be less likely to succeed in this situation?

1). AA IS NOT A CALCULUS FORMER AND 2). AA INVADES THE SOFT TISSUES, THUS, TREATING ONLY THE ROOT

SURFACE IS INEFFECTIVE.

4. The diameter of a soft toothbrush bristle is: .007 inch or 0.2 mm. 5. In 1965 Harold Loe had dental students withhold plaque removal and these students all

developed gingivitis in 7 to 21 days. Upon reinstitution of plaque removal, the clinical signs of gingivitis were gone in 7 days.

6. Name the immunosuppressant that is most associated with gingival enlargement?

CYCLOSPORINE

7. Severe chronic periodontitis has attachment loss of >5 mm.

8. What is the name of the explorer used in the periodontal clinic to detect calculus and root

roughness? Exd 11/12

9. The red complex consists of three microorganisms: (1.) Porphyromonas gingivalis; (2.)

Treponema denticola; and (3.) T. Forsythus

10. What is met by a diffuse change when describing gingivitis?

Diffuse involves all of the gingiva: marginal, attached, interdental. 12

11. The two earliest signs of gingivitis preceding established gingivitis are:

1. Increase in gingival crevicular fluid 2. Bleeding upon probing

Textbook p. 364

12. What position of the gingival margin would result in the probing depth being the same as the attachment loss?

At the CEJ

13. Define secondary occlusal trauma:

NORMAL OCCLUSAL FORCES ON A TOOTH WITH WEAK

PERIODONTAL SUPPORT.

14. How is plaque-associated gingivitis treated?

1. REMOVE LOCAL FACTORS 2. EFFECTIVE ORAL HYGIENE

15. Mustapha in 2007 did a meta-analysis evaluating the relationship between periodontal disease and coronary artery disease. What was the significant conclusion of this article?

SYSTEMIC BACTERIAL EXPOSURE IS THE PERTINENT FACTOR

REGARDING CARDIOVASCULAR RISK IN PATIENTS WITH PERIODONTAL DISEASE.

Correlation between clinical periodontal findings and cardiovascular disease is not as conclusive.

16. What type of a periodontal pocket is illustrated? INFRABONY

13

17. Which method of tooth brushing is illustrated? STILLMAN OR ROLL

18. By looking at a radiograph how can you determine if the horizontal angulation is correct?

Proximal contacts do not overlap unless the teeth are out of line anatomically

19. How would you determine if a patient has ongoing attachment loss without pocket formation?

Measure and Record Gingival Recession

20. Subgingival calculus is considered an important factor in the progression of periodontitis because its

rough surface causes irritation producing gingival inflammation. Do you agree or disagree with this statement and why?

Disagree. Has nothing to do with irritation. Calculus retains plaque

which causes the gingival inflammation.

21. In which country was a bristle toothbrush first utilized?

CHINA

Textbook p 729

14

15