Periodontics Practice Quiz: Gum Disease

Patients with aggressive periodontitis and other forms of perio require specialized treatment and management. A periodontist is a dental specialist who has advanced training in diagnosing and treating gum diseases, including aggressive periodontitis. They have expertise in performing surgical procedures, such as gum grafts and pocket reduction surgery, which may be necessary for these patients. Referring these patients to a periodontist ensures that they receive the specialized care and interventions needed to effectively manage their condition.

An infrabony pocket is characterized by having its base located apical to the alveolar crest. This means that the bottom of the pocket is positioned below the level of the surrounding bone, indicating a deeper pocket. This condition is often associated with advanced periodontal disease, where the destruction of the supporting bone results in the formation of a pocket below the normal level of the alveolar crest.

The patient most likely has a parafunctional habit. Parafunctional habits are repetitive movements or actions of the jaw that are not related to normal functions such as eating or speaking. These habits, often caused by stress or anxiety, can lead to soreness in the jaw and wearing down of the teeth. In this case, the patient's stressful problems at work suggest that she may be clenching or grinding her teeth during sleep, leading to the symptoms described.

The first statement is true because in a healthy state, the gingiva (gums) are typically pink in color. The second statement is also true because red tissue in the gingiva can indicate the presence of disease or inflammation.

The correct answer is lamina dura. Lamina dura is a thin radiopaque line that surrounds the entire root of a tooth and is continuous with the alveolar crest. It represents the compact bone that lines the tooth socket and provides support to the tooth.

Clenching and grinding is best treated with a night guard because it helps to protect the teeth from the excessive forces and pressure caused by these habits. A night guard acts as a cushion and prevents the teeth from grinding against each other, reducing the risk of tooth damage, tooth wear, and jaw pain. It also helps to relax the jaw muscles and alleviate symptoms associated with clenching and grinding, such as headaches and facial pain.

A suprabony pocket is characterized by the base of the pocket being coronal to the alveolar crest. This means that the bottom of the pocket is located above the level of the alveolar crest, which is the bony ridge that surrounds and supports the teeth. This condition is typically associated with periodontal disease, where the gum tissue pulls away from the tooth, forming a pocket. The pocket depth is measured from the gingival margin to the base of the pocket, and in the case of a suprabony pocket, this measurement would be above the level of the alveolar crest.

After periodontal debridement, the healing response seen in gingivitis is the reduction of inflammation. Periodontal debridement involves the removal of plaque and tartar from the teeth and gums, which helps to reduce the inflammation in the gingival tissues. This process allows the gums to heal and become healthier, leading to a reduction in inflammation. The other options mentioned, such as the formation of new bone, cementum, and periodontal ligament, formation of new cementum and PDL, and reattachment of the alveolar mucosa, are not typically seen in the healing response of gingivitis after periodontal debridement.

When complete removal of debris is not possible with non-surgical removal, flap surgery may be indicated. Flap surgery involves lifting a section of tissue to gain access to the underlying area for cleaning and removal of debris. This procedure allows for better visibility and access to thoroughly clean the affected area, making it an appropriate choice when non-surgical methods are insufficient.

Furcation involvement refers to the loss of bone and tissue support around the roots of multi-rooted teeth, leading to the exposure of furcation areas. This condition can be seen on radiographs as a darkened area between the roots of the affected tooth. Radiographs are useful in identifying furcation involvement and determining its severity, which helps in planning appropriate treatment strategies for periodontal disease.

When the gingival margin covers less of the tooth than is normal in health, it means that the gum tissue has receded or pulled away from the tooth. This can be caused by factors such as gum disease, aggressive brushing, or aging. As a result, more of the tooth's root surface becomes exposed, which can lead to tooth sensitivity and an increased risk of dental decay.

Tissue response helps determine success after periodontal debridement (reevaluation). This is because the goal of periodontal debridement is to remove calculus and bacteria from the teeth and gums, and the success of this procedure is reflected in the response of the surrounding tissues. If the tissues show signs of healing, such as reduced inflammation and improved attachment, it indicates that the debridement was effective. Therefore, tissue response is an important factor in determining the success of periodontal debridement.

Curettes are the ideal shape to adapt to root surfaces because they have a curved and rounded design that allows for better access and adaptation to the irregularities and contours of the root surface. This shape helps in effectively removing plaque, calculus, and debris from the root surface during dental procedures, promoting better oral hygiene and preventing further damage or infection. The curved shape of a curette also allows for better control and precision during the cleaning process.

The statement is correct because occlusal trauma in combination with chronic inflammatory periodontitis can indeed lead to increased tooth mobility and alveolar bone loss. However, the reason is not correct because occlusal trauma does not directly cause periodontal pocket formation. Periodontal pocket formation is primarily caused by the inflammatory response to bacterial plaque and calculus accumulation in the periodontal tissues.

The normal crest of interproximal bone is located 2.0 mm apical to the CEJ (cementoenamel junction). This means that the crest of the bone, which supports the teeth, is positioned 2.0 mm below the point where the enamel of the tooth meets the cementum. This is an important anatomical landmark for dental professionals to assess the health and stability of the surrounding bone.

After periodontal surgery, it is common for patients to experience temporary tooth mobility. This is due to the healing process and the adjustment of the surrounding tissues. As the tissues heal and stabilize, the tooth mobility will decrease over time. Therefore, it is important to reassure the patient that this is a normal part of the healing process and that the mobility will improve with time.

Primary occlusal trauma refers to excessive occlusal force, meaning that there is more force being applied to the teeth and supporting structures than they can tolerate. However, in primary occlusal trauma, the bone support is still adequate, meaning that the bone surrounding the teeth is healthy and able to withstand the excessive force. This is different from secondary occlusal trauma, where the occlusal force is normal, but the bone support is reduced.

The arteries that supply blood and lymphatics to the free gingiva originate from all parts of the periodontium except the cementum. The cementum is a hard tissue that covers the root surface of the tooth, and it does not have direct blood vessels or lymphatics. The blood supply to the free gingiva mainly comes from the supraperiosteal arteries, which are located in the connective tissue just beneath the gingiva. The periodontal ligament (PDL) and alveolar bone also contribute to the blood supply of the free gingiva.

Localized rinses are not as effective because they do not get into the pocket and need to irrigate. This suggests that localized rinses, which are designed to target specific areas, may not be able to reach deep enough into the pocket to effectively clean and treat the area. Therefore, irrigation, which involves flushing the area with a solution, may be necessary to ensure thorough cleaning and treatment.

Ultrasonic instruments are beneficial for plaque and deposit removal, with lavage. Ultrasonic instruments use high-frequency sound waves to create vibrations that help break up and remove plaque and deposits from teeth and gums. These instruments also have a built-in water irrigation system, which helps flush out debris and keep the area clean during the procedure. This makes ultrasonic instruments an effective and efficient tool for dental professionals in maintaining oral hygiene.

Too dull instruments limit the effectiveness of nonsurgical periodontal debridement procedures because they are unable to effectively remove plaque and calculus from the teeth and gums. Dull instruments do not have sharp edges, which are necessary to efficiently scrape off the buildup of bacteria and debris. As a result, the procedure may not be thorough, leading to incomplete cleaning and ineffective treatment of periodontal disease.

The computed tomographic process provides a three-dimensional view of the area of interest. This means that it can provide a detailed and comprehensive view of the structures within the area being examined, allowing for a better understanding of their spatial relationships and potential abnormalities. This is in contrast to a two-dimensional view, which would only provide a flat representation of the area.

All of the options mentioned (mechanical, brush and floss; scaling and root planing; chemotherapeutic agents) are non-surgical ways to treat a pocket. Mechanical methods such as brushing and flossing help remove plaque and bacteria from the pocket. Scaling and root planing involve deep cleaning of the tooth and root surfaces to remove tartar and smooth the root surface. Chemotherapeutic agents, such as antimicrobial mouth rinses or gels, can be used to kill bacteria and reduce inflammation in the pocket. Therefore, all of the above options are valid ways to treat a pocket non-surgically.

The first statement is true because the position of the gingival margin can indeed change in disease. Gingival margin refers to the edge of the gum tissue that surrounds the teeth, and it can shift or recede in conditions like periodontitis or gingivitis. However, the second statement is false because the shape of a papilla, which is the triangular gum tissue between adjacent teeth, can also change due to disease. Inflammation or infection can cause the papilla to become swollen, distorted, or even disappear.

Indices are the best measure of the severity of periodontal disease in a population. Indices are standardized tools used by dental professionals to assess and quantify the extent and severity of periodontal disease. They provide a systematic and objective way to measure parameters such as gingival inflammation, plaque accumulation, and periodontal pocket depth. By using indices, dental professionals can accurately evaluate the severity of periodontal disease in a population and track its progression over time.

The interdental papilla refers to the triangular gum tissue between adjacent teeth. In a healthy condition, the interdental papilla is pointed, meaning it fills the space between the teeth completely. However, in certain diseases or conditions such as periodontal disease, the interdental papilla might be missing or become significantly reduced in size. Therefore, both statements are true as they describe the appearance of the interdental papilla in different health conditions.

The dentogingival unit is involved in the attachment of the gingiva to the tooth surface. It refers to the anatomical structures that connect the tooth to the gingiva, including the junctional epithelium, connective tissue fibers, and the gingival fibers. These structures help to maintain the stability and integrity of the gingiva around the tooth.

The first statement is true because in a healthy state, the tissue should fit tightly around the tooth. However, the second statement is false because in a healthy state, the margin should be coronal or at the same level as the cementoenamel junction (CEJ), not apical to it.

GTR focuses on the isolation or exclusion of junctional epithelial and gingival connective tissue. This technique aims to create a barrier that prevents the migration of these specific tissue cells, allowing for the regeneration of other tissues such as alveolar bone and sulcular epithelium. By excluding junctional epithelial and gingival connective tissue, GTR promotes the growth of desired tissues and facilitates the regeneration process.

Subgingival debridement refers to the removal of plaque and calculus from below the gum line. This procedure helps disrupt the gram-negative microbial flora, which is associated with periodontal disease. By removing the harmful bacteria, subgingival debridement promotes a healthier oral environment and reduces the risk of further gum inflammation and damage.

Occlusal trauma refers to excessive forces applied to the teeth during biting and chewing. These forces can cause damage to the periodontium, which includes the periodontal ligament, alveolar bone, gingiva, and cementum. However, the exception in this case is the gingiva. While occlusal trauma can cause damage to the other parts of the periodontium, it typically does not directly affect the gingiva. The gingiva is more commonly affected by factors such as poor oral hygiene, inflammation, and periodontal diseases.

Referring a patient to a periodontist does not eliminate the need for the patient to continue seeing their regular dentist. While periodontists specialize in treating gum diseases and other issues related to the gums and supporting structures of the teeth, they do not typically check for cavities. Regular dentists are responsible for monitoring overall oral health, including checking for cavities and addressing other dental concerns. Therefore, even if a patient is referred to a periodontist, they still need to see their regular dentist for comprehensive dental care.

After periodontal debridement, the healing response seen in periodontitis is repair with a long junctional epithelium. This occurs when the epithelial cells migrate along the root surface and form a new attachment, but it is not as strong or functional as the original attachment. This healing response helps to stabilize the periodontal tissues and prevent further progression of the disease.

A gingival pocket (pseudo-pocket)/normal sulcus is characterized by the base of the pocket being at the CEJ (cementoenamel junction). This means that the pocket does not extend beyond the level of the CEJ and is confined within the gingival tissue. This is in contrast to a true periodontal pocket, where the base of the pocket is apical to the alveolar crest.

The width of attached gingiva refers to the amount of gum tissue that is firmly attached to the underlying bone. In general, the width of attached gingiva is greatest in the anterior region of the mouth, particularly around the incisors. Therefore, the correct answer is maxillary lateral incisors.

Gingival curettage is a dental procedure performed to remove granulation tissue, which is a type of tissue that forms as a result of chronic inflammation. This tissue can hinder the healing process and contribute to further inflammation and infection. By removing the granulation tissue, the dentist aims to promote proper healing and reduce inflammation in the gum tissue. This procedure is often recommended for patients with periodontal disease or other gum-related issues.

S. Mutans is not a bacteria associated with perio. The other options, A. actinomycetemcomitans, T. Forsythresin, P. Gingivalis, and T. Denticola, are all bacteria that are commonly associated with periodontal disease. S. Mutans, on the other hand, is primarily associated with dental caries (tooth decay) rather than periodontal disease.

After non-surgical periodontal therapy, the greatest amount of healing takes place within 3-6 weeks. This is because it takes time for the gums and surrounding tissues to recover and regenerate after the therapy. The initial inflammation and swelling subside, and the gums start to reattach to the teeth, reducing pocket depths and improving overall gum health. It is important to wait for this healing period to ensure the success of the therapy and maintain good oral hygiene practices during this time.

In disease, the gingival margin does not meet the tooth in a tapered edge. In health, the tissue does not meet the tooth in a thick, rolled margin. Therefore, both statements are false.

The first statement is false because not all patients are necessarily knowledgeable about the characteristics of healthy gingiva. The second statement is true because it is indeed important to inform patients about any changes in their gingiva caused by disease.

Probing depths greater than 5 mm limit the effectiveness of nonsurgical periodontal debridement procedures because it indicates the presence of deep periodontal pockets. These deep pockets are difficult to clean thoroughly with nonsurgical techniques, such as scaling and root planing. Deeper pockets provide a favorable environment for bacteria to thrive and can lead to continued inflammation and disease progression. Therefore, addressing these deep pockets may require surgical interventions or additional treatments to achieve optimal periodontal health.

The correct answer is lamina propria. The lamina propria is a layer of connective tissue found in mucous membranes, such as those lining the digestive tract. It contains blood vessels, lymphatic vessels, and immune cells, making it vascular. Enamel, cementum, and junctional epithelium are all avascular structures.

Tetracycline is known to cause permanent discoloration in the teeth of a fetus. This occurs when the medication is taken by a pregnant woman during the second half of her pregnancy. Tetracycline can cross the placenta and accumulate in the developing teeth of the fetus, leading to a yellow or gray-brown discoloration that is permanent and cannot be reversed. It is important for pregnant women to avoid taking tetracycline to prevent this potential issue.

The periodontal ligament (PDL) is required for successful periodontal regeneration. The PDL is a specialized connective tissue that connects the tooth root to the alveolar bone. It contains various cell types, including fibroblasts, cementoblasts, and osteoblasts, which are essential for the regeneration of periodontal tissues. These cells play a crucial role in the formation of new periodontal ligament fibers, cementum, and alveolar bone, which are necessary for the successful regeneration of the periodontium.

The first statement is false because a bulbous papilla is not one that is missing, but rather one that is enlarged or swollen. The second statement is true because in disease, a papilla may indeed have a cratered appearance.

The radiographic evaluation of alveolar bone loss associated with periodontitis is based on the status of the interdental septum. The interdental septum is the bone between the teeth, and its condition can indicate the presence and extent of bone loss caused by periodontitis. By assessing the interdental septum on radiographs, dentists can determine the severity of the disease and plan appropriate treatment.

After completing non-surgical therapy, it is recommended to evaluate the treatment after a 4-week interval. If there are any areas that do not show improvement or are nonresponsive to the therapy, it is advisable to refer them for further evaluation or alternative treatments.

Radiographs are commonly used in periodontics for various reasons. They help identify predisposing factors that may contribute to periodontal disease. They also aid in detecting early to moderate bone changes, which can be crucial in diagnosing and monitoring periodontal disease progression. Additionally, radiographs serve as baseline data and allow for the evaluation of posttreatment results. However, determining the shape and depth of periodontal pockets is not a primary purpose of radiographs in periodontics. This information is typically obtained through clinical measurements using a periodontal probe.

After non-surgical periodontal therapy, the Junctional Epithelium takes approximately 1 week to heal, while the connective tissue takes several months to heal.