y REFERENCE BOOKS TAKEN: nee 1. _Stippling is seen on 2) Marginal gingiva ©) Interdental gingiva b) Attached gingiva @) None of the above 2 (MAN ~02, AIPG 95) With the increase in age keratinisation of gingiva 2) Increases b) Decreases ©) Remains the same 4) Increases and then decreases 8. (MAN -02) “The colour of gingiva is due to - 2) Capillaries b) Thickness of epithetium ©) Thickness of keratinisation and pigmentation 9. ¢) All the above (MAN -99, KAR -01) 2) Lines the gingival sulcus ) Is permeable 10. “€) Is derived initially from the outer enamel epithelium 4) Is attached to enamel by desmosomes . (AIIMS -93, MAN -94) Dentogingival unit comprises of Gingival fibres 7m. Gingival fibres and junctional epithelium (AP -99, AP-03) 12. PERIODONTICS 1, Carranza's Clinical Periodontology by Newman — 11" ed Volume - | (Pg 1 - 475) 7 2. Carranza's Clinical Periodontology by Newman — 11" ed Volume - II (Pg 476 - 1371) _ 3. Carranza's Clinical Periodontology by Newman - 10" & 11" Editions 4, Essentials of Community Dentistry by Soben Peter ~ 4” & 5" Editions — eee eae 1. GINGIVA & TOOTH SUPPORTING STRUCTURES ) None of the above (AIIMS -89) Stippling is absent in: a) Infants only b) Older men ©) Children d) Both infants and old (AIPG -97) Junctional epithelium is attached to enamel by: a) Reticular fibers 'b) Desmosomes c) Hemidesmosomes ) Collagen (AIPG -97) Which type of cells are most numerous in gingiva 2) Melanocytes b) Keratinocytes ¢) Giant cells 4) Polymorphonuclear leukocytes (AIPG -96) Gingival Coli a) Orthokeratinized —_b)_ Para keratinized ©) Both pata and ortho keratinized d) Non-keratinized (KAR -99) Gingiva is supplied by 4) Supraperiosteal vessels b) Subperiosteal vessels ©) Apical vessels @) AlLof the above (AIPG -2k) The junctional epithelium is attached to the tooth by: a) Bas b) Desmosomes ©) Enamel cuticle d)Nasmyth’s membrane (AlPG -99) MB) 1) 0 MmpA i2)A * pee. aR Scanned with CamScanner13, 714 15. 16. ay, 18. 19. 20. 2A, 22. ry __ Dental Pulse Volum: Gingiva is attached by: a) Junctional epithelium b) Epithelial attachment ‘c) Reduced enamel epithelium 4) None of the above {AIPG -93) The length of junctional epithelium is: a) 0.25 ~ 1.35 mm b) 0.5 = .75 mm ©) 10-20 mm d) 1.0- 1.5 mm (PGI -99, COMEDK- 06, MHCET-15) Least width of attached gingiva is found on the facial aspect of a) T¥ premolar ©) Lateral incisor b) 2% premolar @) Canine (PGI -01) The area, which is most prone to infection a) Marginal gingiva). Sulcular epithelium ©) Interdental cot d) Attached gingiva (PGI -02) The “V" shaped space that encircles the tooth and resent between tooth and gingiva is known as: ) Inter dental papilla b) Free gingiva ©) Attached gingiva d)_ Gingival sulcus (KAR -02) Normal consistency of the gingiva is: a) Soft b) Hard ©) Firm 4) Fim and leathery (KAR -02) After the tooth emerges to the occlusal plane the clinical ‘crown height increases by: a) Passive eruption b) Active eruption ©) Post-emergence growth spurt 4) Juvenile occlusal equilibrium (AIPG -01) Gingiva in children 2) More keratinised more stippled b) More keratinised less stippled ©) Less keratinised more stippled d) Less keratinised less stippled (PGI -99) Normal depth of gingival Sulcus in adult does not exceed a) 0.5 - 1mm b) 2-3mm ©) 1-2mm d) 1-3mm (PGI -03, AIPG-05) Eulanin fibers are found in 2) Givigiva b) cementum ©) Alveolar ) Periodontal ligament (COMEDK-07) The function of Langerhan’s cells is a) Melanin synthesis —_b) Protein synthesis ‘Antigen presentation to neutrophils “Antigen presentation to lymphocytes w (KceT-2012) ian’s cells are absent in ntional epithelium b) Sulcular epithelium Oral epithelium 4) All of the above 7 (COMEDK -04) 25. 26. 27. 28. 29. 30. 31. 32. 33, 34, 35. Which periodontal fibres are consistent ang reconstructed even after the destruction of the alea® bone? a) Apical b) Alveolar crest group ©) Oblique d) Transseptal (AIIMS -93, MAN gg In periodontal ligament there is: ) a) Type I collagen b) Type IT collagen ©) Type Ht collagen _d)_ Type IV collagen (A160) Periodontal ligament is a) Narrower on mesial surface b) Wider on mesial surface ©) Equal on both the surfaces 4) Wider in the anterior teeth (AIPG ~99) The periodontal ligament a) Derives its blood supply primarily from the branches of vessels entering the pulp b) Has a slow rate of turnover ©) Contains epithelial cells of malassez 4) Comprises primarily of type 2 collagen (AIMS -93, AIPG -99) PDL is thinnest at: a) CE) b) Apex ©) Middle d) None of the above (Pol 99) What type of fibers are principal fibers of the PDL? a) Elastic b) Reticular ©) Collagenous d) Collagenous and elastic {AIPG -03, AIIMS 03) Periodontal fibers which are most resistant to forces along the long axis are: a) Apical b) Oblique ©) Transeptat d) Alveolar crest (AIPG -92, 98) The thixotropic theory claims that: a) The principle fibres of the periodontal ligament has the major responsibility in supporting the tooth and transmitting forces to the bone ') The periodontal ligament has the rheologic behaviour of a thixotropic gel. ©) The displacement of the tooth is largely controlled by fluid movements, d) None of the above (KAR -97) Alveolar bone is: a) Compact bone b) Cancellous bone ©) Spongy bone dd) None of the above (kan 98) Anatomic form of roots of teeth is determined by a) Dental tamina ) Neural crest cells ©) Hertwig’s root sheath d) Hammock ligament (ates -22) Gingival sulcus is V shaped and it barely permits th entrance of a ) Periodontal hoe b) Periodontal curette Scanned with CamScanner39. a) Lead Periodontal probe d) Periodontal sickle (BHU-2012) Which of the following are the predominant connective 48. ‘issue cells of the periodontal ligament? a) Cementoblasts b) Fibroblasts ¢) Osteoblasts a) Rests of Malassez (ATIMS -93) “Indifferent fibres” are a) Elastic fibres ©) Collagen fibres b) Oxytalan fibres d) None of the above (atPG-2011) With aging changes in periodontal ligament are 4a) Decrease in number of cells and increase in collagen fibers b) Increase in numberof cells and decrease in collagen fibers, ©) Increase in number of elastic fibers 4) Hyatinisation changes 49. 50. (AIMS -2k) Functions of periodontal ligament Al a) Nutritive Sensory ©) Formative a) Al (aP -02) Feature of aging periodontium is ) Lacunae in bone and cementum bb) Increased cell size ) Increased cell number d) Scalloping of cementum & alveolar bone surface (AIPG-10) 52. Unattached gingiva: a) Is interdental gingiva b) 1s below mucogingival fold 6) Cannot be separated by probe 4) Is marginal gingiva (AIINS-06) “The oxygen consumption of normal gingiva is: 2) 1640.3 b) 0.9 0.22 ©) 2740. d) 192021 (at6-05) " Ablack line on the gingiva which follows the contour of “the margin is due to: b) Argyria 6) Tron 4) Mercury | Basal lamina consists of °*t”""? S26 4) Type I collagen fibres b) Type II collagen fibres 0) Type IV collagen fibres di) Type II collagen fibres (KaR-04) (AIPG-05) cells located among keratinocytes at all 56. levels and belonging to reticuloen dothetial from bone marrow are b) Langerhans cells d) Merkel cell 57. (KAR-04) present in the lamina propria Elastin Collagen 58. (KcET-09) 53. 54. PERIODONTICS | \ we c) Langerhan’s Cell d) Grey Cell (COMEDK-05) Cementum found on the cervical third of the root a) Acellular afibrillar cementum ‘b) Acellular extrinsic fiber cementum: c) Cellular mixed stratified cementum d) Cellular intrinsic fiber cementum (COMEDK-05) The cell that is present in stratum spinosum and stratum basale is: a) Basket cell c) Keratinocytes b) Metanocytes @) Merkel cells (AIPG-07) Periodontal ligament is thinnest at a) Apex ) Coronal c) Crestal ) Fulcrum of axis of rotation (aP-07) The inter radicular bone is: a) Compact b) Cancellous ©) Exophytic @) Osteophytic (AIIMS-06) Biological width means a) Sum of connective tissue and junctional epithelium ) Distance from the tip ofthe papilla tothe base of the sulcus )_ Distance from marginal gingiva to muco-gingival junction ) Distance from incisal edge of the tooth to muco-gingival Junction (KCET-08) Reticular fibers found in periodontal ligament consist of a) Type ©) Type W b) Type I d) Type XII (KCET-09) Collagen fibers are absent in: a) Acellular extrinsic fibre cementum ) Acellular aibrillar cementum ©) Mixed stratified cementum 4) Intermediate cementum (MCET-07) Which is true of alveolar bone a) Most stable of the periodontal tissues b) Its in a constant state of flux ) Its not requlated by systemic and local influences @) All of the above (aP-08) The gingiva is attached to the tooth by: a) Lamina propria ) Periosteum ) Epithelial attachment d)_ Gingival fibers (aP-08) Stippling of gingiva indicates all, EXCEPT: a) Surface keratinisation b) Healthy gingiva ()_ Adaptive specialization for reinforcement of function d) None of the above (MCET-07) Lamina densa of the basal lamina beneath the epithelium is composed of a) Type I Collagen b) Type II Collagen 45) B 46) 0 47) C 48) A&B Scanned with CamScannerxy 61. 62, 64. 65. 67. Repnpmte © Type UII Collagen) Type 1V Collagen (UPSC-09) Stratification specific keratins present in gingival epithelium are a) Ki, K2 b) Kio, K12 ©) K16, K6 4) ks, K14 (KCET-10) The gingival fibre group which inserts in two adjacent teeth is the? ) Horizontal group b) Circular group ©) Trans-septal group d) Oblique group (AIPG-09) ‘An isolated area in which root is denuded of bone is intact and covered only by periosteum and overlying gingiva is called a) Fenestration ©) Infracrestal pocket b) Dehiscence ) Hemiseptum defect (AIINS-09) The type of bone present in the inter-radicular area is a) Cortical b) Cancettous ©) Osteophytic 4) Exophytic (AIPG-09, AIIMS MAY 2012) One of the following group of fibers in the lamina propria of the gingiva, help to bind the free gingiva to the tooth a) Alveologingival b) Circular ©) Dentoperiosteal 4) Dentogingival (comeD-10) The periodontium does not include: a) Cementum ) Dentin ©) Periodontal ligament d) Bone lining the socket (IGNOU-10) Bioactive glass (Perio glass) bone graft material is a type of: a) Autograft material b) Allograft material c) Xenograft material d) Non bone graft material. (IGNOU-10) Gingiva is attached to enamel by a) Hemidesmosomes 'b) Desmosomes ©) Tight Junction 4) Gap Junction (PGI-08) The sulcular epithelium acts as a semi permeable membrane through which a) Bacterial products pass in to the gingiva b) Fluids from the gingiva seeps in to the sulcus c) Both of the above d) None of the above (AIIMS-08) Pick the correct statement. Collagen is a) the major protein in gums 'b) a protein with a high turnover rate ) rich in basic amino acids 4) ‘rich in essential amino acids (AP-09) Osteoblast covering the periodontal surface of the alveolar bone constitute a ) Modified periosteum b) modified endosteum 70. Keratin specific to epidermal type differentia . on a) Ki, ke, Kio, 12, b) K1, K3, K10, K12 ©) Ki, ke, K10, K13.——d)_ KA, K2, KI, K13 (cer 71. Which of the following fibre groups are NOT attayq alveolar bone te a) Transeptal b) Oblique _ ) Horizontal d) Dentoperiosteat (AP.ay 72. The normal gingival color is a) Red b) Yellow ©) Coral pink d) Whitish gray (APay 73. The occurrence of keratinization on the human gingiva, 8) Dependent upon the functional stimulation the attacn gingival receives b) A reflection of inflammation in the underlying ging connective tissue ’ ©) Avariable factor directly related to age ) Lacking in the gingival crevice (PGI JUNE-2014 74. The main component of keratins in the stratum corneum 8) Keratin polypeptide (68kD) )_K19 Keratin polypeptide (40kD) )_Ki2 keratin polypeptide (40kD) «) 1 keratin polypeptide (68k0) (APPG-15) 75. Bacteria are populated most commonly on a) Buccal surface b) Lingual surface ©) Interproximal surface 4) Occlusal surface (ATIMS MAY-2015) 76. All the following cells of periodontal ligament are resorptive cell EXCEPT a) Fibroblast ©) Odontoclasts b) Cementoclasts 4) Osteoclast (COMEDK-2018) 77. A curvature of gingiva towards the roots found in the middle of the interproximal area between molars is termed as a) Cot b) Self cleansing area ) Interproximal embrasure 4) Cervix (KERALA - 2016) fed when resisting b) Horizontal forces 4) Stiding forces (KERALA-2016) 78. Most periodontal fibres are acti a) Torquing forces ©) Vertical forces Scanned with CamScanner“B' [Carranza 11" ed 26 / 10% ed 62] Stippling is seen in attached gingiva and central core of interdental papilla. Tt is absent in marginal gingiva. Stippling is a form of adaptive specialization or reinforcement for function. It is produced by alternate ounded protuberances and depressions in the gingival surface. Stippling is a feature of healthy gingiva. Loss of stippling is reversible and is a common sign of gingival disease, Stippling fs absent in infancy and in old aged people. It appears in children about the age of 5 years. 2‘ [Carranza 11% ed 18 / 10% ed 52] With the increase in age: © Keratinisation of gingiva decreases. © Width of the attached gingiva increases. * Number of elastic fibres in the periodontal ligament increases. Number of collagen fibres decreases. The decreasing order of keratinisation in different areas is palate (most keratinised), gingiva, tongue, cheek (least keratinised) Le, nQar> TOngME> oe ee, n 3. ‘D' [Carranza 11° ed 25 / 10” ed 61] 48 ‘B! [Carranza 11% ed 20 / 10% ed 54] ‘The attachment of the junctional epithelium to the tooth is reinforced by the gingival fibres therefore the junctional epithelium and the gingival fibres are together of 12, as the dento gingival unit.- 72 pi {+ guquad [Carranza 11" ed 13 / 10” ed 46] 41.8 mm 2- 3mm ‘D’ [Carranza 11" ed 26 / 10" ed 63) 13. ‘C [Carranza 11" ed 20 / 10° ed 54] 14, ictional epithelium is attached to the tooth surface by eans of hemidesmosomes. Keratinocytes are connected to 15, 1, GINGIVA & TOOTH SUPPORTING STRUCTURES - ANSW aering cells te lungs DenditicVeels acta at Slipra basal] +/?* layers. Considered as, acrophages with Langerhans | possible antigenic ~ ‘© Absent in the junctional , eee Sao ae Located in deep layers of epithelium and Merkel cells | harbour nerve endings. They serve as tactile receptors (PGI-13). ov defile ‘Amongst the non-keratinocytes of oral epithelium the non-dentritic tactile sensory cells present in the | basal cell layer (MHCET-15) a) Melanocytes {c) Lymphocytes b) Langerhan cells d) Merkel cells ‘ [Cavanan A814 10% e847) riedontium more susceptible tan eakiown Because * It is thin, non-keratinisedtAIIMS-2012, Comedk-2016) # It is the site where oral hygiene accessibility is not possible. + It is the area of food entrapment. Junctional and sulcular epithelium are also non-keratinised, ‘'N’ [Carranza 11" ed 23 / 10% ed 58) The 3 sources of blood supply to the gingiva are: ‘© Supraperiosteal arterioles. ‘© Vessels of periodontal ligament, and ‘+ Arterioles that emerge from the crest of interdental septa. ‘n [Carranza 11® ed 20 / 10° ed 54] The junctional epithelium is attached to the tooth by means of an internal basal lamina and to the gingival connective tissue by means of an external basal lamina. The internal basal lamina contains lamina densa and lamina lucida to which hemidesmosomes are attached. ‘W [Carranza 11" ed 20 / 10” ed 54) ‘N [Carranza 11% ed 20 / 10% ed 53] Junctional epithelium is a collar like band of non keratnising epithelium, It is 3-6 layers thick in early life and increases . jth age. Its length from 0. 5 GHOSE ge. Its length ranges from 0.25 ~ 1.35 —— ‘N [Carranza 11" ed 13 / 10% ed 47] 4) Width of attached gingiva is greatest in the incisor region. © Maxilla - © Mandible - 3. Scanned with CamScanner16. 17. 18, 19. 20. — Dental Pulse Volume-2 fi) Least width in the first premolar region © Maxilla ~ 1.9 mm © Mandible - 1.8 mm 24, iii) The width of attached gingiva increases with age and in, supra erupted teeth 25. " [Carranza 11” ed 13 / 10" ed 53] ‘D' [Carranza 11" ed 13 / 10% ed 46] ‘C [Carranza 11" ed 26 / 10° ed 62) The consistency of gingiva is firm and resilient. It is due to its collagenous nature and its contiguity with the mucoperiosteum of alveolar bone. 26. ‘N’ [Carranza 11% ed 27 / 10” ed 64] Active eruption | Movement of teeth in a occlusal direction. i The exposure of teeth by apical Fassive eruption | migration of the gingiva, [Carranza 11" ed 18 /10* ed 52,63) ‘Summary of periodontium characteristics in children: a) Gingiva Less stippled '* redder than adults due to increased vascularity ‘© Interdental col formation and saddle areas © Thinner, less keratinized epithelium + Affinity for melanin pigmentation ‘© Attached Gingiva is narrower in primary dentition and narrower in the mandible ‘* Interdental papillae is shorter and rounder b) PDL & Bone ‘© Wider periodontal membrane space ‘© Fewer and less dense periodontal fibers © Less dense and differentiated collagen fibers © Increased blood and lymphatic supply © Thinner tamina dura © Flatter alveolar crests an © Fewer trabeculae [Carranza 11” ed 13 / 10" ed 47) ate modified monocytes derived from bone basal level. They acts as antigen phocytes. They contain g-specific Birbeck granules are seen in a) Merkel cells ©) Lymphocytes (APPG-15) b) Langerhans cells d) Monocytes ‘'R’ [Carranza 11° ed 17 / 10% ed 52] ‘0’ [Carranza 11% ed 29 / 10% ed 70] ‘Significance of the transeptal fibres © Considered as both gingival and periodontal ligament fibres © They are remarkably constant finding and are reconstruct even after the destruction of the alveolar bone, © They form a dense firm covering over the bone, which i seen after the removal of granulation tissue (AP-2004) during the pocket eradication procedures. ‘'N (Carranza 11® ed 28 / 10 ed 69] The most important elements of the periodontal ligament are the principal fibres. They are composed mainly of type 1 collagen, Type IIT collagen is present in reticular fibres and Type IV collagen is seen in basal lamina. ‘Type one | Bone, GINGIVAN, principal fibers collagen _| of periodontal ligament. Type two sl. collagen CARtWOLAGE Cot! ‘Type III Reticular fibers, Granulation tissue, Circum collagen | maxillary suture (PGI JUNE- 2011) | “Floor on the four’. Basement membrane of| floor is supplied by type four collagen (Note:- The syndrome associated with a| - ( pre defect in type IV collagen in basement] membrane of renal glomeruli is Alport| syndrome. The patient exhibit hematuria and renal diseases) Note: * Cementum is rich in type 1 (AIPG-2015) collagen fibers * The main types of collagen in periodontal ligament are Type 1 and 3 (MHCET-2016) ‘R' [Carranza 11" ed 33 / 10 ed 73] is i is * The mesial surface of teeth due to physiological mesial migration. ‘* At the fulcrum of rotation of the tooth. * Teeth that are in hypo function i.e, teeth in unilateral chewing habits, open bite and whose antagonist has been lost. Wide periodontal ligament is seen in: '* Trauma from occlusion © Scleroderma ‘* Osteosarcoma Scanned with CamScanner4€: (Carranza 11” ed 30 / 10% ed 71] Epithelial rests of malassez are the derivatives of the hertwigs epithelial root sheath, which may become cementicles or participate in the formation of periapical cysts and lateral root cysts. PL derives its blood supply from apical vessels before entering the pulp, anastomosing vessels of the gingiva and transalveolar branches of the intraseptal vessels. The vessels fn the P.L. form a net like plexus, which is eloser to the bone than to the cementum. PL. has high turnover rate of collagen. The rapid turnover rate of cells occurs more towards the side of bone. ‘© [Carranza 11° ed 33 / 10° ed 73] The P. narrowest at the axis of rotation. | No. of roots: Single rooted Multi rooted Location of axis of rotation unetion of middle and apical third ofthe root In the bone between the roots. “© [Carranza 11" ed 28 / 10" ed 68] Periodontal ligament consists of principal fibres and elastic fibres. Principal fibres are made up of collagen type I. They are purely collagenous. ‘The elastic fibres are present in two immature forms called coxytalan and elaunin (AIIMS-07). Oxytalan fibres run parallel to the root surface and are attached to the blood vessels thus they regulate the vascular flow. PDL does not have? (ATINS Nov-14) a) Mature elastic fibers b) Angioblasts and undifferentiated mesenchymal cells ©) Myelinated nerve fibers d) Fibroblasts ‘B [Carranza 11" ed 28 / 10” ed 70] The principal fibres of PL, are arranged in 6 groups T ] Runs between adjoining teeth and gives | interproximal support. ‘This fiber group is also called as interdental ligament. ‘These run from cementum in a apical ction to the alveolar crest. ‘un from cementum to alveolar yn. They are 34. 35. 36. 37. PERIODONTICS | (iN) They fan out from the eavcsslitut eve cruetaeried ao ‘multirooted teeth, : [Carranza 11" ed 31) ‘© Option A is Tensional theory. ‘© Option B is Thixotropic theory. ‘© Option C is Viscoelastic theory. ‘N’ [Carranza 11° ed 37 / 10” ed 79] ‘an external plate of compact bone. inner socket wall of thin compact bone called ‘alveolar bone proper. ‘© Cancellous or spongy trabecular bone, in between these ‘two compact bones. It acts as a supporting bone. So the alveolar bone is predominantly compact bone. [Carranza 11 ed 42 / 10° ed 85] °C [Carranza 11th ed 13 / 10th ed 12] Gingival sulcus is a shallow ‘V’ shaped crevice around the tooth bounded by the surface of the tooth on one side and the epithelium lining the free margin of the gingiva on the other, side, The clinical evaluation used to determine the depth of the gingival sulcus involves the introduction of the periodontal probe and the estimation of the distance it penetrates. ‘(Carranza 11” ed 30 / 10 ed 71) Fibroblasts perform the dual role of synthesizing new collagen and degrading old collagen. ‘C [Carranza 11th ed 30 / 10% ed 71] Indifferent fiber plexus are small collagen fibers, which are/ associated with the ager principal collagen bes, running ital directions forming a plenus ial 38. 39. 40. ‘C [Carranza 11% ed 53 / 10% ed 95] With aging increase inelastic fibres occurs whereas the number of fibroblasts and collagen fibres are decreased with aging. ‘The number of fibroblasts in the periodontal ligament with age a) Increases b) Decreases ) Remains same 4) May increase or decrease (COMED-14) [Carranza 11° ed 31 / 10° ed 72] ‘0’ [Carranza 11th ed 52 / 10% ed 93-96] [EFFECTS OF AGING ON THE PERIODONTIUM: A) Gingival epithelium: ‘© Thinning and decreased keratinization ‘© Increase in epithelial permeability ‘+ Flattening of retepegs ‘Migration of junctional epithelium to 2 more apical position on the root surface ‘© Width of attached gingiva increases Scanned with CamScanner42. 43, 44. 45. 47. 8) Connective tissue: * Coarser and denser gingival connective tissues * Collagen content increases + Rate of collagen synthesis decreases ©) Periodontal tigament: ‘+ Number of fibroblasts decreases ‘© Decreased organic matrix production and epithelial cell rests D) Cementum: Increase in cemental width 5-10 times ‘© Increase in width is greater apically and lingually © Accumulation of resorption bays explains the finding of increasing surface irregularity £) Alveolar bone: '* More irregular periodontal surface of bone and less SS * Cellular mixed stratified cementum (CMSC) - Compe, of extrinsic and intrinsic fibers and may contain oa Found primarily in apical third of roots and apice. in furcation areas. © Cellular intrinsic fiber cementum (CIFC) - con cells but not extrinsic fibers. Tt fs the resort’ lacunae. | San 49. ‘B' [Carranza 11th ed 16 / 10th ed 51] 50. ‘D' [Carranza 10" ed 235] 51. ‘B' [Carranza 11th ed 41 / 10"ed 80) Facial and lingual portions of sockets Alveolar bone proper Compact Bone Thin compact bone Cancellous bone enclosed within a compact border Cancellous bone Interdental septum Interradicular bone regular insertion of collagen fibers 52. ‘A’ [Carranza 11th ed 989 / 10th ed 1044] Biological width is defined as the physiologic dimension of (Carranza 11th ed 12 / 10th ed 46] the functional epithelium and connective tissue attachment, This has been found to be approximately 2mm (+ 30%) [COMEDK-2016] Q' et ss = Bi Ar, Hq Dood We 2 [caranza 8% ed 227) © 4 Pp—blabl-! te has been theorized that infringement on the biolosial papers ticpeielfnercury produce ay black’ tne in width by the placement of a restoration within its zone may Pee eee acest comnur of the margin. Oral result in gingival inflammation, pocket formation and loss of eee ie ee nis consisting ofa bluish -back alveolar bone. Consequently, it is recommended there should fine following the contours of the marginal gingiva. be atleast 3.0 mm between gingival margin and bone crest. P This allows for adequate biologic width when the restoration (C [Carranza 11th ed 17 / 10th ed 52] is placed 0.5mm within the gingival sulcus. ‘B' (Carranza 11th ed 16 / 10ed 51] 53. ‘B' [Carranza 11th ed 28 / 10" ed 69] For explanation refer to Q.No. 9 ‘D’ [Carranza 11th ed 30 / 10" ed 57] The elastic fiber system is composed of oxytalan, elaunin and elastin fibres. 'C [Carranza 11th ed 17 / 10%ed 51] Langerhan's cell is a non keratinocyte seen in epithelium of ‘mucous membranes. Langhans cell is a multinuclear giant cell seen in chronic inflammatory diseases like Tuberculosis. “W &B' (Carranza 11th ed 33 / 10th ed 75] ‘Schroeder classification of cementum: © Acellular afibrillar cementum (AAC) - Conains neither cells nor extrinsic or intrinsic collagen fibres, except for a mineralized ground substance. Found in coronal cementum. * Acellular extrinsic fiber cementum (AEFC) - Contains densely packed bundles of Sharpey’s fibres and lacks cells, Found in cervical third of roots, 54. ‘B' [Carranza 11th ed 33 / 10th ed 75] Acellular afibrillar cementum contains neither cells no extrinsic or intrinsic collagen fibers, except for a mineralized ‘ground substance. AAC is formed by cementoblasts and is found as coronal cementum in humans with a thickness of 1 to 15ym, 55. 'B’ 56. ‘D' [Carranza 11th ed 22 / 10th ed 54) 57. ‘D! [Carranza 11th ed 26 / 10th ed 63] Stippling is produced by alternate rounded protuberances and depressions in the gingival surface. It is seen i” attached gingiva and central core of interdental papilla It is a form of adaptive specialization or reinforcement fo" function. It is a feature of healthy gingiva, and reductio” or loss of stippling is a common sign of gingival diseas. When the gingiva is restored to health after treatment, the stippled appearance returns, Scanned with CamScanner61. “62. ‘0’ [Carranza 11th ed 20 / 10" ed 52] The epithelium is joined to underlying connective tissue by basal lamina. It consists of lamina lucida and lamina densa, Hemidesmosomes of the basal epithelial cells abut the lamina lucida, The lamina densa is composed of type IV collagen, The hemidesmosomes of the basal epithelial cells of ‘the gingival epithelium abut the... (MHCET-15) a) Lamina propria ) Lamina lucida 6) Lamina densa d) Lamina dura ‘0’ [Carranza 11th ed 20 / 10 ed 52] | ki, k2,k10-k12 | Epidermal type differentiation [fence Characteristic of highly proliferative lee” epithelia ks, kag Stratification specific cytokeratines a Present in parakeratinized only areas, es & absent in orthokeratinized areas ‘€ [Carranza 11th ed 29 / 10" ed 57] [Carranza 11th ed 42 / 10% ed 84] Fenestration: olated areas in which the root is denuded of bone and is covered by periosteum and overlying gingiva only. The marginal bone is intact (APPG-2016). Dehiscence: Denuded areas extend through the marginal bone. Occur ‘more often on the facial bone than on the lingual. ‘8! [Carranza 11th ed 41 / 10% ed 82] Facial and lingual portions hess Compact Bone Alveolar bone proper Thin compact bone dicular bone Cancellous bone | Cancellous bone enclosed enaveeeein within a compact border | sacl . ‘B [Carranza 11th ed 22 / 10" ed 57) *B! [Carranza 11th ed 12 / 10" ed 68] D' [Carranza 11th ed 876 / 10” ed 981, 982] ‘Gheck explanation of 0.17 in treatment of furcation and osseus surgery ranza 11th ed 20 / 10" ed 54] {1th ed 19 / 10° ed 52, 53] the sulcular epithelium is permeable. ae ad fom the mulpotat mesenchymal 70. nm 72. 2B. 4 75. 76. 7. 78. st regarded as an interior surface of the bone. This surface of ‘the bone is covered by osteoblasts in various stages. The collagen fibres of ligament that penetrate the alveolar bone are present between the cells, ‘K [Check 0.No.59] [Check Explanation of 0.No.31] ‘C [Carranza 11th ed 25] The coral pink color of gingiva is produced by the vascular supply, the thickness & degree of keratinization of the epithelium and the presence of pigment containing cells. ‘D' [Carranza 11th ed 17] The sulcular epithelium tines the gingival sulcus. It is the thin, non-keratinized stratified squamous epithelium without rate pegs. Keratinization is inversely proportional to age and inflammation. “D' [Carranza 11th ed 15] K1 polypeptide (68 KO) is the main component of the stratum comeum. While in basal cells, the main kerati k19 (40K) ‘W [Carranza 11th ed 457] Most dental and periodontal diseases originate in interproximal areas because of accumulation of bacteria, Tissue destruction associated with periodontal disease often leaves large, open spaces between teeth and long, exposed root surfaces with anatomic concavities and furcations. These areas are both difficult for patients to clean and poorly accessible to the toothbrush. Patients need to Understand that the purpose of interdental cleaning is to remove microbial plaque, not just dislodge food wedged between teeth ‘C [Orbans 11th ed 207] Cells of the periodontal ligament are divided into 3 categories: © Synthetic cells: Osteoblasts, Fibroblasts, Cementoblasts Resorptive cells: Osteoclasts, Fibroblasts, Cementoclasts Epithelial rests of Malassez ‘K (Carranza 11th ed 13] The interdental gingiva occupies the gingival embrasure, which is the interproximal space beneath the area of tooth contact. It can be pyramidal or can have a “col” shape. In the former the tip of one papilla is located immediately beneath the contact point; the latter presents a valley like depression that connects a facial and lingual papilla and ‘conforms to the shape of the interproximal contact. °C [Carranza 10th ed 70] Oblique fibers, the largest group in the periodontal ligament, extend from the cementum in a coronal direction obliquely to the bone. They bear the brunt of vertical masticatory stresses and transform them into tension on the alveolar bone, Scanned with CamScannerPERIODONTAL MICROBIOLOGY a, 7. OF the following four bacterial species, which is LEAST LIKELY to be found in plaque? ) Actinomyces viscosus b) Streptococcus mutans ©) Streptococcus salivarius ) Streptococcus sanguis (MAN -95) The common etiology of periodontitis is a) Occlusal trauma b) Systemic factors ©) Local irritating factors 4) Hormonal defects (MAN -02) Predominant bacteria found in two days old plaque a) Streptococci b) Bacteroides ©) Spirocheates d) Actinomyces (MAN -98, AIPG -98) In deep older plaque a) Streptococci and actinomyces are replaced by rod like organism ) Streptococci are completely replaced by neisseria ©) Streptococci actinomyces and veilonella remain prominent 4) Actinomyces are completely replaced by streptococci (MAN ~98) Actinobacillus actinomycetam comitans is a) Gram positive aerobe b) Gram negative aerobe ©) Obligate anaerobe 4) Facultative anaerobe (MAN -01) ‘Actinobacillus actinomycetamcomitans is commonly associated with a) Juvenile periodontitis b) Adult periodontitis ©) Refractory periodontitis d) All the above (MAN -01) ‘Supra gingival plaque causes 2) Gingivitis b) Periodontitis ©) Pericoronitis, d) Aphtous ulcers (MAN -2k) The organism least likely to be found in normal gingival crevices is a) Fusobacterim sp. ©) Diphtheroids b) Actionomyces sp. d) Streptococci sps. (MAN -01) ‘The sticky polysaccharide present in dental plaque is a) Dextran b) dextrin ) Glycogen d) sucrose (NAN -95) Which of the following organisms is NOT implicated in the etiology of Periodontal disease a) Bacteroides ) Wolinetla ) Neisseria ) Fikenella (KAR-2K, AIIMS MAY 2012) Bacteria, which are not found in normal healthy b) Capnocytophaga dé) Eubacterium 5 (KAR-2k) 12. Most important initiative factor for periodontitis ig: a) Dental plaque b) Calculus ) Trauma from occlusion d) Food debris layer (ATIMS -95) 13. Dental plaque adheres to the tooth because: a) Levans are gummy b) Dextrans are insoluble and sticky c) Plaque grows into the irregularities 4) Microorganisms produce sticky lipoproteins (ATIMS, APPSC 09) 14, In which of the following conditions is the role of microbial plaque most obscure: a) Periodontitis b) Juvenile periodontitis ) Desquamative gingivitis d) Necrotising ulcerative gingi , (AIIMS -98, 99, AP- 08, AIIMS MAY 2012) “Corn-Cob” appearance seen in a) Supragingival calculus b) Subgingival calculus ©) Supragingival plaque d) Subgingival plaque (KAR -00) 16. Central gram negative core supporting outer coccal cells is called: a) Bristle brush arrangement. ») Corncob arrangement ©) Bottle brush arrangement: d) Hourglass arrangement (KAR -02) 17. Breakdown of periodontal fibres in periodontitis is due to bacterial enzyme: (OR) Which of the following bacterial products have been implicated in initiation of inflammatory periodontal disease? a) Collagenase b) Hyaluronidase ©) Coagulase @) None of the above (AIIMS -97) 18. Pellicle formation involves a) Adsorption of acidic glycoproteins from saliva b) Focal areas of mineralisation ©) Focal areas of necrosis d) Bacterial colonization (AIIMS -2X) 19. Which of the following is the common factor for the initiation of both dental caries and periodontal disease a) bacterial plaque —_b) lactic acid ©) calculus 4) no common factor (AIMS -24) 20. Severe alveolar bone loss, as observed in juvenile periodontitis is associated with: a) Cyctic neutropenia _b)_ Lysis of neutrophils ¢)_ Increased phagocytosis d) Neutrophil chemotactic defects or Impaired neutrophil chemotaxis. (ATIMS 2K, AIIMS MAY 2012) 21, The inorganic component of plaque is primary a) Calcium and fluoride b) Calcium and sodium ) Calcium and phosphorus i) 8 10) C 4a) D 12) A ce Scanned with CamScanner) Sodium and calcium (KAR -97, COMEDK-15) Co-aggregation is mainly predominated by 4) interaction between Gm + bacteria __b) interaction between Gm — bacteria ¢) interaction between Gm + and Gm ~ bacteria d) none of the above 2. (AP -99, 03) Which of the following is a periodontal pathogen a) S. sanguis b) S. mutans ©) A. viscosus d) P. gingivalis 23. (KAR ~02) 24, Increases in steroid hormones are associated with significant increases in a) Actinomyces viscosus b) Prevotella intermedia ©) Streptococcus sanguis d) Campylobacter rectus (ComeD-2012) 25. The carbohydrate not associated with dental plaque is: a) Dextrose b) Levans ) Glucose @) Rhamnose (PGI -99, 2k) 26. Specific plaque hypothesis was put forward by: a) Jenco b) Listgarten ©) Loesche d) None of the above (KAR -98) 27. Which is the most numerous component of plaque? a) Minerals b) Food debris ©) Microorganisms d) Leucocytes (AIIMS -92) 28. Which surface of tooth has most of plaque? a) Gingival third of tooth surface b) Incisal one third of tooth surface ) Middle third of tooth surface ) Uniform on all surfaces (AIMS -93) Bacterial “finger printing” illustrate that periodontal pathogens are é a) Contagious b) Non-contagious ©) Transmissible within member of same colonies 4) Non transmissible (GCET-14) predominates a) Staphylococci ©) Rods and filaments b) Streptococci 4) Vibrio and spirochetes (KAR -01) “Which of the following plaque is most harmful and spread of Inflammation to the connective tissue ding to bone destruction: ingival epithelial attached (PGI -2k, 01) reaction of enzymes on: ) Glucose and proteins d) Sucrose and saliva (AIIMS -95, AIPG ~01) 34, VS 33. The bacteria of oral flora which plays least role in periodontitis is: a) Actinomyces: ©) Spirocheates bb) Actinomycetam comitans d) Bacteriodes {AIIMS -97) Majority of oral microorganisms are: a) Strict anaerobes —_b)_ Gram-positive baci ©) Spirochetes @) Facultative anaerobes (AIIMS -NoV 02) 35. The bacterial flora associated with Juvenile periodontitis is mainly: a) Gram 4ve aerobic cocci b) Gram +ve anaerobic cocci ©) Gram ~ve aerobic cocci d) Gram ~ve anaerobic cocci (KAR -01) 36. Specific plaque hypothesis state that 4) All plaque is pathogenic b) Only specific micro-organisms are responsible for pathogenicity of plaque €)_ Only specific microbes cause caries @) Plaque is pathogenic only when signs of associated disease are present (ALIMS MAY-14) 37. Which of the following is the most likely source of collagenase? a) Staphylococcus aureus b) Bacteroides gingivalis )_ Treponema microdentum d) Veillonelta alkalescens (AIPG -91, 92) 38, Plaque differs from materia alba in a) Presence of bacteria b) Presence of glycoprotein c) Presence of saliva d) Absence of glycoprotein (APPSC -99) 39. Bacteria in plaque form a) Intracellular polysaccharides b) Extra cellutar polysaccharides ©) Both A and B ) Complex polysaccharides (PGI -2k) 40. Which of the following is first formed after tooth brushing In later phases of plaque development the organism g 41. Pellicle is a a) Materia alba b) Plaque c) Pellicle d) Calculus (PGI -97, 99) 8) Salivary protein b) Plaque ©). Micro organisms 4) Calculus (PGI -03) 42, Pre-requisite for plaque formation a) Pellicle ) alycoprotein ©) mucopoly saccharide d) dextran (AP -04) 43, Tanerella forsythus is @ periodontal pathogen a) Gram positive, non-obligate ) Non-pleomorphic rod ©) Non = obligate anaerobe 4d) Non-motile, spindle shaped organism (GcET-14) Electronic instrument used to measure gingival crevicular fluid is a) Pericheck 44, ») Periotemp Bama Scanned with CamScanner©) Perioscan d) Peiotron (KAR -02) Ecologic determinants of plaque depend on all, except: a) Sugar content of diet b) Host resistance ©) Age and sex of the patient wy ) Status of dentition 57. (ATPG-05) 46. Salivary pellicle is composed of the following except: @) Immunoglobulin —b) Immunoglobulin A 58. 45. @) Albumin. ©) Amylase Biofitms in general have a) Crystalline structure ©) Organized structure (AIPG-05) 4 b) Stereoline structure @) Disorganized structure (BHU-2012) 47. Which fs the enzyme that prevents the Y actinomyces to adhere to the tooth structure? sion a) Enolase bb) Glucosyt transferase ) Xanthine oxidase) Myeloperoxidase ty 3, Port) Commonly isolated organism from oral cavity is a) Streptococcus sanguis b) Streptococcus pyogens ©) Neisseria gonorrheoa d) Streptococcus pneumoniy . (ATPG-o4) ‘mary Colonization of plaque is dominated by a) Facultative Aerobic Gram + ve rods ) Facultative Anaerobic Gram - ve rods ©) Facultative Aerobic Gram - ve cocci d) Facultative Anaerobic Gram + ve cocci (COMEDK-07, AIMS NoV.14 48. The concept of calculus formation in which seeding 59. Periodontitis is caused by agents induce small foci of calcification which enlarge a) Malnutrition b) Supra gingival plaque and coalesce to from a calcified mass is termed as ©) Bio-film 4d) Faulty tooth brushing 8) Mineral precipitation b) Calculus adapation (KcEr-97 ©) Heterogenous nucleation d) None of the above 60. The Gram negative bacteria most numerous in ora cavity are 49. A test that can be used for typing of class I a) Streptococci ) Veillonetlae histocompatibility antigens is ©) Selenomous 4) Eikenella 2) Cell mediated Iympholysis (CML) (Kcer-07 ) Donor-recipient mixed Iymphocyte response 61. Which one of the following species of streptococci is ©) Primed Iymphocyte typing usually not found in human dental plaque. 4) Antibody and complement mediated cytotoxicity a) S.mutans b) S.sanguis (COMEDK-05) ) S.pyogens d) S.salivarius 50. Sub-gingival scaling alters the microflora of periodontal (AP-03) pocket 62. Which component of diet effects plaque composition 2) Never gets altered b) Aerobes only a) Carbohydrate b) Mineral ©) Gets altered @) Anaerobes only ©) Protein 4) Fats/lipids (COMEDK-06) (BHU-07) 51. The primary etiologic factor in the development of .63. Micro organism which uses steroids as growth factor is furcation defect is my ma) P.gingivalis b) Pintermedia a) Gleulus b) Plaque GR 9) Sssanguis d) S.mutans \ (Kcer-<8) ©) Cemental caries d) Root infection (COMEDK-06) 64. A glycoprotein that promotes new attachment and increased cell proliferation is: 2) Fibronectin b) Fibro pectin ©) Glycogen d) Glycoaminologlycan By 53. In periodontal disease, ground substance is dissolved by a) Hyaluronidase b) Coagulase oa, ©). Phosphorylase Acid phosphatase 6 (AP-06) 154. The biofilms found on tooth surfaces are termed 66. a) Enamel b) Dera canes Dental plaque 4) Saliva g ; (AIPG-06, AIIMS-07) thiocynate system present in saliva 67. What is/are the method/methods of transferring information in a biofilm? a) Quorum Sensing ©) Plasmid transfer b) Conjugation d) AlLof the above (UPSC-09, KCET-11) The growth of porphyromonas gingivalis is enhanced Y a metabolic byproduct succinate produced by a) Streptococcus b) Capnocytophaga «) Actinomyces 4d) Veitlonella (uPsc-08) AlLof the following organisms can be detected by BANA analysis EXCEPT 'b) Porphyromonas gingivalis a) Tannerella forythia ) A. actinomycetemcomitans ©) Capnocytophaga (KCET-201) Bacteria in plaque are held together by a) Hydrophobic forces b) Covalent bonds ) Vander waal's forces d) All of the above (cers) Scanned with CamScannerWhich one of the following complexes of periodontal 78. micro-organisms is associated with bleeding on probing?, 4) Red Complex ) Orange Complex “ ©) Green Complex 4) Yellow Complex on (UPSC-09) facterial communication with each other in a biofilm is known as 4) Comcob formations b) Coaggregation 0) Quorum sensing d) Translocation 79. (COMED-10) Which is characteristic of supragingival plaque and not of subgingival plaque in humans? a) Motile bacteria are predominant ') Spirochetes are evident microscopically ©) Gram negative bacteria are predominant 80. d) Bacterial composition is altered by dietary sugar : composition (AIPG-09) 81. 71. The number of bacteria in the oral cavity is greater a) in the morning b) after meals ; c) at night d) after brushing (aP-09) 72. Which of the following substances play a major role ‘in regulating cell-cell and cell-matrix interaction me cementum? a) Sharpey's fibers b) Intrinsic fibers ©) Proteoglycans d) Phosphoproteins (KceT-09) 83. 73, Enterococcus faecalis in post treatment periodontitis a) Cultured easily and disinfected b) Disinfected with saline and hydrogen peroxide c) Tolerate pH upto 11.5 4) Treated with intra canal medicaments 84, (kceT-10) "After enamel has been exposed to bacteria, irreversible bacterial colonization takes place in about a) 24 hrs. b) Few minutes ©) 12hrs. d) 2-4 hrs. (AIPG-09) 85. ‘Supragingival plaque undergoes which of the following changes with time? a) Plaque mass decreases b) Plaque microflora becomes more gram positive ©) Plaque microflora becomes gram negative ) Plaque microflora becomes predominantly spirochetal (AIMS MAY 13, AIPG-09, 11) 86. “Red complex’ associated with bleeding on probing is us, Fusobacterium, Campylobacter 87. (COMEDK-10) Which of the following is true about tooth associated subgingival plaque? a) Has both gram positive and negative bacteria b) Extends till the junctional epithelium ©) May penetrate cementum d) Associated with gingivitis and periodontitis (KAR-2013) According to Glickman, maximum accumulation of plaque. takes place in approximately a) 7 days b) 15 days ©) 30 days @) 60 days (ATIMS MAY 2012) After cleaning and pumicing the tooth surface, plaque formation takes place within a) A few minutes b) % to 1 hour ) 2 to 4 hour d) After 1 hour (ATIMS MAY 2012) Which of the following species is found in abundance in. adult plaque? ‘) Fusobacterium ) Bacteroids b) Leptotrichia d) Allof the above (KAR-2013) Structures resembling corncob can be seen in a plaque sample that is: a) One week old c) Three week old b) Two week old 4) Four week old (PGI JUNE-2014) Which of the following bacteria do not invade host tissue cell? a) T. denticola ©) P. gingivalis ) P. intermedia 4) F.nucleatum (PGI DEC-2013) Lactic acid is produced in mouth by a) Saccharolytic bacteria in supragingival region b) Saccharolytic bacteria in subgingival region ©) Non-saccharolytic bacteria in supragingival region @) Non-saccharolytic bacteria in subgingival region (PGI JUNE-2014) A complex interaction among lymphocytes, inflammatory cells and other cellular elements in connective tissue are mediated by a series of low molecular weight proteins aalled a) Bradykinin ©) Cytokines b) Histamine 4d) Kallikrein (COMEDK-15) Not significant in pathogenicity of periodotic problems? a) Endotoxins from live bacteria b) Endotoxins from dead bacteria )_ Microbial interactions @) Enzyme by microbes (PGI JUNE-13) The process of primary colonizing bacteria adhering to tooth surface providing new receptors for attachment of other bacteria fs known as a) Attachment b) Translocation ©) Co-adhesion ) Biofilm (APPG-2016) Scanned with CamScannerne aR Naor Bese Scanned with CamScanner2. PERIODONTAL MICRO} 'C [Carranza 11" ed 309 / 10° ed 137) = “Streptococcus sanguis, S.mitis, S.mutans and actinomyces _iscosus are present in plaque, 9. Streptococcus salivarius is the first organism to appear in the mouth after birth and is the predominant organism fn saliva, It is not usually found in plaque. It is a non, pathogenic bacterium and forms the longest chains, — [Carranza 11° ed 316 / 10” ed 134] local factors are the common etiological agents of periodontitis. Systemic factors cause periodontitis in the presence of local factors by exaggerating the tissue response Systemic factors are important in the pathogenesis of periodontal disease because they can (COMEDK-15) a) Be the direct cause of periodontal disease b) Have direct effect on pocket depth ) Usually determine the pattern of bone loss 4) Intensify the response of the periodontitium to the etiologic and local factors The initial bacteria colonizing the pellicle coated toot} surface are predominantly gram+ve facultative anaerobic / cocdi followed by rods, such as streptococcus sanauis and ‘Actinomyces viscosus. The secondary colonizers adhere to cells of bacterif already present in plaque. They are predominantly gram ve anaerobic rods and filaments such as p. gingivalis, _ piintermedia, Fusobacterium and Capnocytophaga species. 13, dary colonizer of plaque are all except (AIPG-14) revotella intermediate 14, iS sanguis 4) Porphyromonas gingivalis 11" ed 218 / 10" ed 160] 15. tem comitans is a gram -ve, capnophilic ¢ anaerobic rod type of organism often implicated of localized juvenile periodontitis. with chronic adult periodontitis and to local factors. 10. | 3 fearama 11 04322 /10° e414 te LOGY-ANSWERS °C [Carranza 11° ed 312 / 10" ed 138] Diphtherofds are usually not seen in the gingival crevices. “N [Carranza 11% ed 316 / 10 ed 140] The interbacterial_matrix accounts for 20-30% of the plaque mass. It is made of dextrans and levons. Dextran is the glucose moiety of sucrose, which is ‘insoluble, sticky, and levan is the fructose mofety of sucrose synthesized by the plaque bacteria. Calcium, phosphorus, fluoride, etc., are the inorganic components of plaque. “C [Carranza 11" ed 343 / 10" ed 153] * The bacteria associated with periodontal health (protective species) are S.sanguis, S.mitis, A.viscosus, Capnocytophaga, Neisseria, Veillonella, etc * The bacteria associated with periodontal disease are P.gingivalis, P.intermedia, A.actinomycetam comitans, Eikenella, Fusobacterium and Eubacterium species, et. [Carranza 11" ed 309 / 10 ed 153] '® (Carranza 11° ed 316) Plaque is a biofilm with a regular intercellular matrix consisting predominantly of microorganisms responsible for periodontitis. The most common cause of gingivitis and periodontitis is bacteria laden local plaque. Which of following is related to gingivitis? (PGI-2011) a) Plaque b) Calculus 6) Tooth brush trauma __d) Abrasive powder “8 [Carranza 11% ed 316 / 10% ed 140} “C [Carranza 11” ed 152 / 10 ed 411] Plaque does not cause desquamative _ gingivitis, Desquamative gingivitis fs a non-specific manifestation of certain autoimmune diseases (Lichenplanus, Pemphigoid ‘Gnd Pemphigus) and Rormonal changes (menopause), “C [Carranza 11" ed 324 / 10" ed 143] Corncob structures are highly specific cell-to-cell Tiferactions. The corncob formations have rod shaped bacterial cells (Eg. Bacterionema or nucleatum) oo form the inner core of the structure and coccal cells (Eg. Streptococci) that attach along the surface of the rod shaped cell. Supra gingival plaque typically demonstrates comcob structures. The ability of different species and genera of plaque bacteria to adhere one another is known as ‘Co-aggregation’ (or) ‘test tube arrays’. Co-agaregation is predominant among gram ~ve organisms. Scanned with CamScanner17. “A’ [Carranza 11" ed 268) , Collagenase is responsible for the breakdown of periodontal fibres in periodontitis, Its released by bacteria (P.gingivalis. mostly), polymorpho-nuclear leukocytes, and some Populations of fibroblasts. Hyaluronidase causes breakdown of ground substance and helps in spread of inflammation (cellulitis). Dental Pulse Volume-2 18, ‘A’ [Carranza 11" ed 321 / 10% ed 140] e is © © Formation of pellicle. ‘* Initial colonization of the tooth surface. * Secondary colonisation and plaque maturation. Jette formation occurs by selective adsorption of salivary Glycoproteins by electrostatic, vanderwalls and hydrophobic forces. [Carranza 11 ed 322 / 10° ed 135] 4) Early supragingival plaque contains - gmsve cocci and rods while mature supragingival plaque contains gm ~ve rods and filaments. These organisms cause gingivitis. Bacteria found in gingivitis are localized in gingival Sulcus and very few may be present in connective tissue. i) Subgingival tooth associated plaque contains -gm sve cocci and rods which result in rot surface caries, Eg.2 A. viscosus. iif) Subgingival tissue attached bacteria. Eg.: P.gingivalis, bacteroides, etc., destruction of the periodontal plaque contains gm —ve which may cause issue, ‘D' [Carranza 11" ed 221] In juvenile periodontitis there is functional defect of PMN chemotaxis (AIIMS MAY 2012) and phagocytosis of Imicroorganisms. This defect may be induced by the invading bacteria viz., A. actinomycetam comitans, “C [Carranza 11" ed 317 / 10" ed 140] “Plague contains about 5% of inorganic components. The Fincipal inorganic components of plaque matrix are calcium and phosphorus. Other itS-are magnesium, potassium, sodium and fluoride. (C2 nbs, Ms aK 24. 25. 26. 27. 28, 29, 11 ed 346 / 10th ed 150] Korman tl in 1982 concluded that increase j hormones are associated with significant increas proportions of P. intermedia in subgingival plaque, te cin ‘C [Carranza 11 ed 339] Both specific and non-specific plaque hypotheses ae proposed by Loesche. hat periodontal dis Non-specific hypothesis states t na result from elaboration of noxious products by the eng plaque flora. The periodontal disease can be treated debridement (surgical or non surgical) and oral hygiene measures, Even though non-specific hypothesis is dscarey, much of clinical treatment is still based on non-specge plaque hypothesis only. Alternative or specific hypothesis states that only certain plaque is pathogenic and recognizes plaque as pathogenic conly only when signs of of associated disease are present. Option 8’, “Listgarten” described four zones (Bacterial zone, ‘neutrophil rich zone, necrotic zone and zone of spirochaetal infiltration) in ANUG. Specific plaque hypothesis is a) Specific microbes can cause caries b) All microorganisms in plaque are pathogenic ©) Specific microorganisms pathogenicity of plaque All microbes cause caries [aiP6-2012] are responsible for 4) ‘C [Carranza 11 ed 318 / 10% ed 137] ‘A [Carranza 11" ed 327) Plaque preferentially Plaque accumulates 0} due to lack of mo mastication and also forms on non self cleansing areas. n the gingival third of tooth surface vement of food and tissues during in cracks, pits and fissures. ‘C [Carranza 11th ed 332] Molecular finger printing techniques clearly ilustrated tht Periodontal pathogens are transmissible within. membes Of a family. This bacterial transmission between subjects should not be confused with contagious. © [Carranza 11 ed 326 / 10% ed 142] ‘W' [Carranza 11% ed Subsingival tissue attached plaque consists of gram -¥© {Os and filaments. Due to the physical proximity of tw bacteria to the host tissues they invade the connectiv® the destruction of supporting tissue! 328 / 10% ed 138] Scanned with CamScanner33. ‘A’ [Carranza 11” ed 343 / 10” ed 156) ____ Actinomyces are associated with periodontally healthy sites, |__ They have least capacity to invade host tissues, [Carranza 11° ed 309) [Carranza 11" ed 218 / 10" ed 158) ‘D' [Carranza 11th ed 257, 258] Walter Loesche proposed the two hypothesis of plaque. ‘+ Nonspecific plaque hypothesis: This assumes that all plaque is pathogenic ‘+ Specific or alternative plaque hypothesis: This recognizes plaque is pathogenic only when signs of associated disease are present. [Carranza 11° ed 268] ist: P.gingivalis ‘+ Aactinomycetemcomitans * gingivalis © T.denticola © A.actinomycetemcomitans © P. intermedia P. melaninogenica Trypsin like enzyme Phospholipidase-A “B’ [Carranza 11 ed 318 / 10" ed 176] Materia alba is a yellowish or white soft sticky deposit and is less adherent than dental plaque. Tt consists of microorganisms, desquamated epithelial cells, "salivary proteins but lacks the regular internal pattern that ‘is observed in plaque. “© [Check Explanation Below] The bacteria found in plaque form both extracellular polysaccharides (dextran and levan) and intracellular polysaccharide (amylopectin) from carbohydrates. The external polysaccharides causes the attachment of the bacteria to the tooth as microbial plaque; and the intracellular polysaccharides are stored in cells and then to lactic acid. 11" ed 321 / 10 ed 147) 1/11" ed 321 / 10" ed 147) aliv glycoprotein without bacteria, It r Plaque. Bacteria to form dental plaque. werobie spindle shaped ete ment of $n 44, ‘D! [Carranza 11 ed 95 / 10” ed 345) 45. 'C [Carranza 11" ed 327) 46. "0 47. (C (Carranza 11” ed 328 / 10th ed 138) Biofilms, in general, have an organized structure, composed of microcolonies, of bacterial cells non randomly distributed in a shaped matrix, 48 [Carranza 11 ed 295 / 10 ed 175] ena Epitactic concept (er) Heterogenous nucleation kd * Seeding agents induce small foci of calcification that enlarge and coalesce to form a calcified mass. ma * Occur due to rise in pH of saliva which causes precipitation of calcium phosphate, * Colloidal proteins in saliva bind calcium and phosphate fons and maintains supersaturated solution leading to its precipitation. * Phosphatase liberated from plaque precipitates calcium phosphateby hhydrolyzing organic phosphates Mineral precipitation 49. ‘D' [Rubins Pathology 6th ed 123] Major histocompatability complex (MHC) classes I, II and IIL molecules are involved with antigen uptake, processing and presentation. MHC Class I molecules are used to present intracellular antigens to CDB*T cells and NK cells. MHC class ITT molecules {include complement factors, B, C, and C,. 50. ‘Cc 51. ‘B' [Carranza 11° ed 897 / 10 ed 463) Primary etiologic factor for the development of furcation defect is plaque. The contributing etiologic factor is Trauma from occlusion. 52. ‘A’ (Carranza 10%ed 974] 53. ‘A’ [Carranza 11" ed 268 / 10" ed 597] _— Gollagen dearadation is caused by collagens like: ‘© Aspartate aminotransferase Alkaline phosphatase + PGlucoronidase + Matrix metalloproteinases Ground substance is degraded by Hyaluronidase. 54, ’C [Carranza 11" ed 316 / 10%ed 138] Scanned with CamScanner55. 56. 57. 58. 59. ‘B' [Carranza 11" ed 98 / 10" ed 349] The lactoperoxidase-thiocyanate system in saliva has been shown to be bactericidal to some strains of Lactobacillus and Streptococcus by preventing the accumulation of lysine and glutamic acid, both of which are essential for bacterial growth. Another antibacterial finding includes lactoferrin, which is effective against Actinobacillus species. TMystoneratigesan emyme sintatta salary ernst. iy leukocytes and is bactericidal for Actinobacillus” 61. but has the added effect of inhibiting the-attachment of — ‘Actinomyces strains to hydroxyapatite. Lysozyme works on both gram negative and gram-positive organisms”; Veillonella species and Actinobacillus actinomycetemcomitans are some of their targets. It probably repels certain transient bacterial invaders of the mouth. ‘D’ [Carranza 11" ed 259) ‘A’ [Carranza 11° ed 343 / 10%ed 156] S.sanguis is found in high numbers in sites that do not demonstrate attachment loss (inactive sites). These species probably function in preventing colonization or protiferation ‘ofpathogenicmicroorganisms. TheH,0, producedby S.sanguis is known to be lethal to cells of A. actinomycetem comitans. is lethal to (PGI June-13) Which of the following bacteria A, actino- mycetemcomitans? a) S. sanguis b) S. mitis ©). salivarius d) S. mutans ‘D' [Carranza 11" ed 322 / 10% ed 146] Streptococcus sanguis is most dominant. ‘C [Carranza 11° ed 344 / 10 ed 436] *B' [Carranza 11 ed 343 / 10" ed 156) * S.sanguis * Veillonella parvula + Cochraceus * Capnocytophaga * Fnucleatum * Pagingivalis ‘= Pintermedia * Fikenella Beneficial species (facultative gram +ve | species) * A.actinomycetem comitans * Eubacterium 62. 63. 64. ‘¢ [Carranza 11" ed 344 / 10th ed 135-37] pit and fissure caries __ | « smooth surface caries S. mutans” | « Seen in plaque + often called as obligate peri S, mitis | © Seen in tooth-associated cervical plaque Have been found in tongue, throat and ig 5, salivarius | saliva but is not found in high number in dental plaque One of the most commonly isolated , bacteria in the oral cavity S. mitior |. atong with S. sanguis forms the mass predominant organisms in dental plaque ‘A’ [Carranza 11" ed 316 / 10th ed 137] [Carranza 11" ed 346 / 10th ed 150] Organisms ume rs_| Use oxygen and lower redox potential Early color like streptococci | of the environment, which then favours and actinomyces | the growth of anaerobic species, Its growth is enhanced by metabolic by products produced by other microorganisms such as Porphyromonas /« succinate from Capnocytophaga Eee ‘ochraceous (PGI-13) | *Protoheme from Campylobacter rectus (MHCET-16) Pgingivatis | Its growth is enhanced by Hemin iron ging from the breakdown of host hemoglobin Increased in steroid harmones are associated with significant increases Peintermedia |, prevotella intermedia in subgingival plaque. ‘Salmonella typhi | Tryptophan a Gonococci Glutathione Niactntest To differentiate human tubercle bacilli from atypical mycobacteria ! [Carranza 11" ed 330 / 10” ed 150] Quorum sensing: The capacity of bacteria to communicate with each other in a biofilm involves the regulation of expression of specific genes through accumulation of signaling compounds. Whe? these compounds reach a threshold level (quorum cel density) gene expression is activated. Such quorum seems to play a role in expressing the growth of beneficial specie® to the biofilm and discouraging growth of competitors: Conjugation ia Exchange of genes through a direct interbacterial connectio formed by a sex pilus. ‘Transformation . ‘Movement of small pieces of DNA from the environme' the bacterial chromosome. nt int Scanned with CamScanner67. p' [Carranza 11" ed 331 / 10” ed 150} ‘Other similar interactions Lactate and formate are the byproducts of the metabolism of streptococci and actinomycetes and are used in the metabolism of other plaque microorganisms. «Bacteria degrade host proteins, release ammonia which may be used by bacteria as a nitrogen source, Hemin iron from the breakdown of host hemoglobin may be important in the metabolism of p.gingivals. ‘D' [Carranza 10 ed 591] B. forsythus, P. gingivalis, small spirochete Treponema denticola, and Capnocytophaga species share a common enzymatic profile, since all have in common a typsin like enzyme. The activity of this enzyme can be measured with the hydrolysis of the colourless substrate N-benzoyl-dl-arginine-2-naphthylamide (BANA). When the hydrolysis takes place, it releases the chromophore b-naphthylamide, which turns orange red when a drop of fast gamet is added to the solution. Diagnostic kits have been developed using this reaction for the identification of this bacteria profile in plaque isolates (Perioscan). One of the potential difficulties of this test is that it may be positive at clinically healthy sites and remains to be proven whether this test can detect sites undergoing periodontal destruction. BANA > OrdngerALe Colwh) * duu : ‘(Carranza 11" ed 316 / 10% ed 143] ‘N [Carranza 10% ed 143] Ref. Synopsis [Carranza 11® ed 330 / 10 ed 150] ‘D' [Carranza 10" ed 137, 140] [Carranza 10 ed 144-146] 1 [Carranza 11% ed 33 / 10° ed 75] Proteoglycans are most likely to play a role in regulating cell-cell and cell matrix interactions both in normal development as well as in regeneration of cementum. © [Ingle 6th ed 302] ‘D' [Carranza 10" ed 144-146) “€ [Carranza 11" ed 324 / 10" ed 137) 78. 79. 20. 81. 82. 83, 85. (Three wel ‘C [Refer 0. No. 19 Explanation] Options B and D are characteristic of subgingival tissue attached plaque. The bacteria may extend to cementum and initiate root caries. “C [Carranza 11th ed 269] After tooth surface is cleaned during prophylaxis, a dental pellicle from saliva appears on the surface within 1 minute. Supragingival plaque may form within one hour after the teeth are thoroughly cleaned, with maximum accumulation reached in approximately 30 days. ‘B' [Carranza 8th ed 375] [Shantipriya Reddy 2nd ed 178) Bred Leptotrichia ‘+ Capnocytophaga + Selenomonas * Bacteroides ‘© Fusobacterium Eubacterium Microbial species in child Species in greater numbers in children’s plaque ‘Species in greater numbers in adult's plaque 'C [Clinical Oral Microbiology by T. Wallace Macfarlane 30] ‘Thick zone of early colonizers and column or cteek, | Uke structures that resut from rapid old plague | prolfeation of streptococci. —__|+ Composition changes markedly ‘Filamentous organisms now predominate Les wet of ogee observed-on the outer surface of plaque. ‘8 [Carranza 11th ed 200] The two means of tissue invasion are: 4) Bacteria may enter host tissues through ulcerations in the epithelium of the gingival sulcus or pockets. 2) Direct penetration of bacteria into host epithelial or connective tissue cells. A. actinomycetemcomitans, P. gingivalis, F nucleatum and Trepanoma denticola hhave the ability to directly invade the host tissue cells, “K [Dental Caries a treatable infection by Loesche 28] ‘* Insupragingival sites, saccharolytic microorganisms split carbohydrates into lactic acid and create a temporary acidic environment. In subgingival sites, asaccharolytic microorganisms metabolize nitrogenous compounds derived from GCF and create a neutral pH with anaerobic environment abundant in short chain fatty acids and ammonia. ‘C [Carranza 11th ed 201] Cytokines are low molecular weight, soluble proteins that act as messengers to transmit signals from one cell to another. They are effective in very low concentrations and primarily act locally in the tissues in which they are produced. They are produced by a large number of cell types such as PMNS, Scanned with CamScanner86. 87. Dental Pulse Volume-2 macrophages, lymphocytes, fibroblasts and epithelial cells. They signal, broadcast and amplify immune responses and are fundamentally important in regulating immune- inflammatory responses and in combating infections, ‘K [Microbiology: A clinical approach by Anthony Stretkauskas 95] Exotoxins are proteins secreted by living organism. They are highly antigenic. Endotoxins (LPS) are contained in or are the part of the bacterial cell membrane. They are released on the death of the organism. Endotoxin from live bacteria does not contribute to pathogenicity, The microbial virulence factors are: 1, Endotoxin (LPS) released by dead bacteria 2. Bacterial enzymes 3. Noxious agents such as NH3, H2S, fatty acids 4. Microbial interactions and tissue invasion 5. Fimbriae and bacterial DNA. ‘C [Lindhe 4th ed 135] While many species attach directly to host surfaces, other species attach to bacteria attached to such surfaces. This phenomenon is called coaggregation, In some instances, coaggregation between non- Coaggregating species may be mediated by cellular Constituents (e.g. vesicles) of a third species, * Further, the mechanism of attachment of cells of a siven pair of species appears to be mediated by specific Teceptor-adhesin interactions, * Many of these interactions are lectin-like in that they are based on the attachment of a specific protein on the surface of one species to a specific carbohydrate on the surface of the other [Carranza 10th ed 231) Periodontal bacteria neutralize or evade host defenses via numerous other mechanisms. For example, immunoglobulins might function to facilitate Phagocytosis of bacteria by opsonization or block adherence by binding to the bacterial cell surface and restricting access to bacterial adhesins. * The production of immunoglobulin-degrading proteases by specific micro-organisms may counteract these host defenses, Scanned with CamScannerthe: a) Mast cell 1) Macrophage b) Plasma celt 4) Polymorphonuctear leukocyte (AIPG -91, 03) Gingival crevicular fluid is measured using: Vs filter paper b) Ph paper. ©) Mylar strip d) Litmus paper. (KAR -98) The predominant immunoglobulin in sulcular fluid is: a) TA b) 196 9 IgM a) IgE (KAR ~2K) Orogranulocytes are: 4) Granulocytes present in the gingival connective tissue ) Mast cells present in the G.C.F ©) PAM.Ns. reaching oral cavity through subepithelium 4) Allof the above (KAR -2k) 5, Drug which reaches maximum concentration in gingival fluid is: a) Tetracycline b) Penicittin ©) Erythromycin 4) Sulphonamide (AIPG -94) 6. Which cell type migrates into the gingival sulcus in large numbers in response to dental plaque: 2) Mast cells )_ Neutrophils ©) Lymphocytes d)_ Plasma cells (AIPG -99) 7. Suleular fluid does not perform one of the following functior 2) Contains plasma proteins which may improve adhesion bb) Possesses antimicrobial properties c) Exerts antibody activity “Provides nutrition to junctional epithetium via diffusion (KAR -2K) Levels in gingival crevicular fluid (GCF) are: “Equal to glucose level in serum 4-4 times greater than serum levels than 10 times the serum levels (COMED-14, AIPG-05) ‘that cell mediated immune reactions (delayed ‘occur in periodontitis because subjects tis have levels of histamine in involved gingival tissue reactive with plaque bacterial antigens wsitized to bacterial plaque antigens ingival fluids 2013, 2K, AIPG -01) ictivit e ures an he ‘The predominant cell type in gingival crevicular fluid is _A1. -___:3. DEFENSE MECHANISMS OF GINGIVA & HOST RESPONSE 12. 13. 14. 15. 17. 18, 19. SS _\Ug) _ ‘The most potent bone resorbing interleukin is: a) IL-8 b) 1-18 9 I-5 d) 1-3 (KAR -02) Leukotoxin is released by: a) P. nucleatum ) A. naestundit. ©). forsythna d) A. actinomyctem comitans. (KAR -02) Plaque is considered as infection because 4) Antibiotics prevents its formation b) Its presence is evidence of bacterial growth ) It is communicable between experimental animals and. probably humans d) All of the above (KAR -01) The gingival crevicular fluid is increased in all except: a) Gingivitis ) Smoking c) Periodontal pocket d)_ Trauma from occlusion (PGI-06) ‘The inorganic component of subgingival plaque is derived from a) Saliva b) Gingival erevicular fluid «)_ Inorganic matter of tooth 4) Food debris (KAR-04) Gingival fluid is a: a) Transudate b)_Exudate ©) Can be either of the two (Trasudate & Exudate) d) Neither of the two (Trasudate & Exudate) What are the cells that produce PGE2 in the Periodontium? a) Macrophages bb) Fibroblasts ©), Neutrophils d) aandb (COMEDK-2013) To identify key microorganism in periodontal disease, Koch's postulate have been modified by a) Socransky ) Glickman’ ©) Russell ) Vermition (ATIMS MAY-13) The bacterial enzyme detected in gingival crevicular fluid is a) Fibronectin ©) Phospholipase b) Cytokines d) Myeloperoxidase (APPG-15) Scanned with CamScannera 2h 3h 4 ‘D' [Carranza 11 ed 95 / 10th ed 348] The predominant cell type in GCF is the PMN. They account for 92% of the total leukgcytes whilg the mononuclear cells ‘account for 8%, ed eal: 3¢) GOFi TiB=ast2 ‘Among the mononuclear cells, 58% are B-lymphocytes and 24% are T-lymphocytes. The normal T:B lymphocyte ratio in Peripheral blood is 3:1 is and the value is reversed to about, 1:3 in GCF. ‘R [Carranza 11" ed 95 / 10th ed 345] * Placing filter paper into the sulcus (intracrevicular) ‘+ Placing paper at the entrance of sulcus (extra crevicular) ‘Placing preweighed twisted threads or micropipettes and crevicular washings. Methods of measuring the amount of GCF: * The wetted area of the filter paper is stained with Ninhydrin and is measured planimetrically under microscope. * Electronic method by using fluid collected on a blotter (perio paper) and employing electronic transducer called Periotron ———— ee Paper points, micropipette and preweighed twisted | threads are used to collect? (PGI June 2011) | a) GCF b) Saliva ©) Bacteria 4) Serum [Carranza 11% ed 283 / 10th ed 349] ‘+ Predominant immunoglobulin in GCF - IgG * Predominant immunoglobulin in Saliva ~ IgA ‘C [Carranza 11° ed 98 / 10th ed 350] Orogranulocytes are the PMNs that reach the oral cavity by ‘migrating through the lining of the gingival sulcus. ‘W’ [Carranza 11° ed 97 / 10th ed 347] Tetracycline and Metronidazole are excreted through the gingival fluid which can be used advantageously in periodontal therapy, Concentration of tetracycline in gingival fluid is 2-10 times (average 7 times) that of plasma, Which antibiotic has higher levels in GCF as compared to plasma? (PGI Dec-2013) a) Penicillin b) Tetracycline |) Amoxicillin d) Metronidazole : 11 ed 95 / 10th ed 348] a major protective mechanism against. aque into sulcus. They are attracted by 10. a1, 12, 13, 14, 15. . d 57) ‘D' [Carranza 11° ed 96 / 10th e¢ mae ‘A,B, Care the functions of GCF. ‘C! [Carranza 11% ed 96 / 10% ed 346] Glucose concentration in GCF is 3-4 times greater than serum. This is not only due to the metabolic acti adjacent tissues, but also asa function of the loca mc flora. The protein content of GCF is less than that of serum, *C’ [Carranza 11" ed 281) Cell mediated immune reactions or delayed hypersensity, does not involve antibodies but is based on the interacting of antigens with surface of T-lymphocytes. ‘N’ [Carranzai1® ed 219 / 10th ed 233] Leukotoxin is an exotoxin produced by A. actinomyceten comitans which has toxic effect on PMN's. This enables thee microorganisms to evade the host defense of phagocytosis ‘B' [Carranza 11" ed 269 / 10th ed 203} AInterluekin_1_(a_and_b) includes Osteoclast Activating Factor (OAF) which causes bone resorptiorrand Lymphocyte Activating Factor (LAF) which has the ability to-stimulate proliferation of T cells. ILI and TNF (Tumor necrosis factor) are key cytokines inthe pathogenesis of periodontitis. ‘D' [Carranza 11 ed 281 / 10th ed 233] ‘D' [Carranza 11" ed 341) Robert Koch developed the criteria by which a microorganism can be judged to be the causative agent in human infections These are called as “Kach’s postulates”, SIGMOND SOCRANSKY. Proposed criteria by which periodontal microorganisms may be judged to be potential pathogen. They are * Be associated with disease with increase in number of organisms at diseased sites, Be eliminated or decreased with treatment. © Demonstrate host response, * Demonstrate virulence factors, Be capable of causing disease in experimental animals The pathogenic potential of bacteria within the plaque varies from individual to individual and from one gingival site to other gingival site, ‘D [Carranza 11 ed 94 / 10% ed 347] ‘B’ [Carranza 11 ed 318 / 10 ed 140] The inorganic component of supragingival plaque is derive? from Option A ice, saliva, Scanned with CamScannerPERIODC "B' [Carranza 11" ed 97) Some considered GCF as a transudate while others considered it as an inflammatory exudate. 17. ‘D' [Carranza 11th ed 269] The cells that produce PGE, (Prostoglandin £,) in periodontium are macrophages and fibroblasts. PGE, induces the secretion of metallomatrix proteins and osteoclasic bone resporption and contributes to the loss of alveolar bone loss as seen in periodontitis. 18. ‘A’ [Refer explanation of Q. 13] 19. ‘C’ [Carranza 11th ed 67] The enzymes in GCF can be host derived or produced by the bacteria in the gingival crevice. The following enzymes are detected in GCF: Beta-glucuronidase (lysosomal enzyme) Lactic acid dehydrogenase (Cytoplasmic enzyme) © Collagenases (from PMN, fibroblasts or bacterial origin) * Phospholipases (lysosomal enzyme) The majority of GCF elements detected thus far are the enzymes. Scanned with CamScannerCT eis inteenc seas 2 7. The green stains frequently seen on children’s teeth are ‘caused by a) Materia alba ©) Dentinal defects b) Enamel defects, d) Chromogenic bacteria (MAN -94, AP -98, AIMS MAY 2012) Mineralization inhibitors of calculus formation include all of the following except a) Triclosan b) Pyrophosphate ©) Zine salts 4d) Diphosphates (KAR -99) Calculus attaches to tooth structure by the following ways exce} a) By means of an organic pellicle b) Mechanical locking in surface irreqularities ©) Close adaptation to undersurface depressions 8) Tags of calcium phosphate reacting chemically with enamel walls (AIPG -94) In periodontal disease, calculus is considered as @) Contributing factor b) Primary factor ©) Etiological factor —_d)_ Governing factor (KAR -03) CALCULUS all are true except: ) Supragingival calculus is brown in colour ) Hard and gritty ©) Calcified from plaque 4) Subgingival calculus is more difficult to remove than supragingival calculus (AIPG -02) Hard deposits found on tooth and appliances in an uncleaned mouth is called a) Plaque b) Calculus: ©) Materia alba d) None (AP -01) ‘A white soft sticky deposit on tooth surface a) Materia alba ) Linea alba ©) Plaque @) Calculus (MAN =2002) The yellowish white soft sticky deposit loosely adherent present on tooth surface is a) Materia alba b) Food debris ©) Plaque 4) Calculus (AIIMS -92) Materia alba 4) Lack microorganisms ) Has an iritating effect on gingiva (AP 98) he following is true in case of AIDS patient? d lesion of the attached gingiva, | with pseudomembrane d) Gingival itching. (ALPG 09 11, Lateral food impaction occurs mainly due to 4) Un even alteration of occlusal surface ) Open proximal contact ©) Open gingival embrasure d) Allof the above (AP -t4) 12, In AIDS patients, occurrence of severe and acut, periodontal disease are due to a) Reduced number of T cells b) Release of lymphokines ©) Cytotoxic reaction 4) All of the above (KAR -98) 13. Predominant inorganic component of supragingival calculus is: a) Magnesium phosphate b) Calcium carbonate ©) Galcium phosphate 4) Carbon dioxide (IGNOU-10) 14, The gingiva in a patient of HIV is similar to the gingiva in a) Lichen planus b) ANUG ) Acute gingivitis 4) Chronic gingivitis (Pst -01) 15. Apatient has cheilosis, angular stomatitis, glossitis, e, itching eyes. The periodontal surgery that was performed fone week ago has not healed properly. Deficiency of which of the following vitamin is most likely: a) Thiamin b) Riboflavin ©) Tocopherol ) Calciferot 16. Which of the following soft tissue responses may occur as a reaction to orthodontic bands? a) Marginal gingi b) Gingival fibrosis ©) Ulcerative gingivitis d) Fulminating periodontitis (AIPG-06) 17. Subgingival calculus @) cannot occur without supragingival calculus ') contains less hydroxyapatite than supragingival calculus ¢) is uncommon in children @) derives its minerals from same source as supragingivl calculus (aP-08) 18. Calculocementum a) Non-calcified structures ) Calculus embedded deeply in cementum ©) Non-attachment mechanisms ) Non similar to cementum (ccer-4) 19, ieeicohatteney of the subgingival calculus is descr a) Clay tike b) Flint like ©) Brick like 4) Soft ome Scanned with CamScanner“The proteins found in attachment plaque 2) Albumin and globutin b) Ametogenin and enamelin ©) Sialoproteins 4d) Desmoplakin and plakoglobin (KCET-08) The difference in the colour between sub and supragingival calculus is related to? 2) pH of plaque b) Death of leucocytes ©), Hemolysis of erythrocytes 4) Allof the above (AIPG-09) Scanned with CamScanner4, CALCULUS & IATROGENIC DISEASES - ANSWERS ~ CT 1 5. [Carranza 8th ed 158] Brown stain | lack of oral hygiene Tobacco stain tenacious dark brown or black deposit Black stain Chromogenic bacteria, F Chromogenic bacteria like aspergillus ESS | arden Orange 5 Serratia marcescens Chlorhexidine Yellowish brown discoloration of stain teeth due to prolonged use, _ Triclosan, Pyrophosphate and zinc salts inhibit, mineralisation, so used as anti-tartar agents. [Carranza 11 ed 293 / 10th ed 173] fh calculus By means of an organic pellicle, Mechanical interlocking in surface irregularities, * Close adaptation to under surface depressions Galculus embedded deeply into the cementum appearing ‘morphologically as cementum is called “calculocementum’, ‘A [Carranza 11" ed 295 / 10th ed 175] Galculus does not directly irritate the gingiva but it provides a fixed nidus for the continued accumulation of plaque and holds it against gingiva and thus acts as a contributing factor. [Carranza 11” ed 293 / 10th ed 170) ei Pieter White or whitish yellow Sra eer Dense, dark brown or greenish black Hard flint like consistency Mineral source is GCF and so called as serumal calculus Hydroxyapatite and magnesium whitlockite are Hard clay like consistency ‘Mineral source is saliva so as salivary calculus the major crystal forms Lesinejorarystal forms | | “B' [Carranza 11° ed 293 / 10% ed 170) 'N (Carranza 11" ed 296 / 10th ed 176] ed 176] 9. 10. ait 12, 123. 14, [ste atba se accurmation COMMIS a) Is a white cheese like accumulation b) Lack organized structure 6) Is easily displaced by a water spray d) All of the above aay ‘B! [Carranza 11" ed 296 / 10th ed 176) The iritating effect of materia alba on the gingiva is causy by bacteria and their products. ‘B' [Carranza 11° ed 238 / 10th ed 528) ‘The periodontal lesions seen in HIV-infected patients a. + Linear gingival erythema / HIV-Gingivits: 1 erythematous, easily bleeding gingiva may be linity to marginal gingiva or may be diffuse extending iy attached gingiva (AP-16) ‘+ Necrotising ulcerative gingivitis. + Necrotising ulcerative periodontitis or HIV-periodontits “C [Carranza 11% ed 298] Factors causing vertical food impaction are: + Uneven occlusal wear. ‘+ Opening of the contact point. * Improperly constructed restorations, The cusps that tend to forcibly wedge food into interproxinal embrasures are known as PLUNGER CUSPS. Disto lingua cusp of upper 2" molar is commonest plunger cusp. tateral pressure from the lips, cheeks and tongue maj force food interproximally. This is called as lateral foot impaction. This is more likely to occur when the gingival embrasure is enlarged by tissue destruction in periodora disease, 2 (Carranza 11” ed 225 / 10th ed 513] (Oz T- lymphocyte levels less than 200 /mm are defritve for AIDS and indicate severe immunodeficiency, ac (Carranza 11" ed 293 / 10” ed 172) The inorganic content of supragingival calculus whith constitutes about 70-90% includes + Calcium phosphate - 75.9% * Calcium carbonate = 3.1% * Magnesium phosphate traces (Carranza 11% ed 239 / 10th ed 527) Scanned with CamScanner45, ‘B' [Carranza 11" ed 433 / 10th ed 303] ' Uae Pere oie Maen ctsy { Prue) i ra Hyperkeratosis, hyperplasia of YB increased pocket formation. Vit D Osteoclastic resorption of alveolar bone. Niacin Necrosis of gingiva. , g_._| Severe lesions of the gingiva and Riboflavin | periodontal tissues. ___., _ | Necrosis of gingiva, periodontal ligament Folic acid | and alveolar bone without inflammation, al Haemorrhage, collagen destruction one and edema of gingiva (boggy gums) A interference with bone formation and retarded healing. Excessive keratinization of the skin and mucous membranes may result from (KERALA-2016) a) Vitamin B deficiency _b) Vitamin C deficiency ¢) Vitamin A deficiency __d) Vitamin E deficiency 16. ‘A’ [Carranza 11" ed 299] 17. ‘C' [Textbook of Periodontology and Oral Implantology by Nayak 1st ed 84] 18. ‘B' [Check Explanation of Q.3] 19. ‘B' [Carranza 8" ed 151] “D’ [Check Explanation Below] Desmosomes are adhesion complexes that link various cells to each other. They consist of two principal groups of proteins i.e., desmosomal cadherins and cytoplasmic plaque associated proteins. The cytoplasmic plaque associated Proteins include plakoglobin, desmoplakin, plakophilins, envoplakin and periplakin. 20. 21. ‘C [Carranza 10 ed 171] Subgingival calculus is brown - black due to hemorrhagic elemei m Scanned with CamScanner————— a -d) Sunctional epit! A thin bluish tine around the gingival margin is due to, the absorption of 2) Silver b) Mercury ) Drugs like tetracyctines d) Lead (MAN -94) McCall's festoons are a) Also called Stillman’s Clefts ') Due to poor oral hygiene ©) Congenital abnormality ) Due to trauma from occlusion (MAN -99) Most objective sign of gingivitis is a) Increase in gingival size ») Increase in crevicular fluid ©) Increase in gingival redness ) Bleeding on probing. (MAN ~2K) Life-saver shaped enlargements of the marginal gingival are called a) Gingival crater ©) Stillman’s cleft b) McCall festoons @) Window peaks (MAN -2k) Which of the following cells are predominant in the stage 1 of gingivitis are a) Plasma cells b) Neutrophits ©) Mast celts ¢) Lymphocytes (MAN 2k) The most common form of gingival disease is: a) Gingivitis b) Periodontitis ©) Gingival recession _d) None of the above (KAR -97) Earliest clinical sign of gingivitis is: 8) Bleeding on probing —b) Change in colour ©) Change in contour). Change in size (AIPG -91, PGI -03, AP- 05) Which single factor could contribute most of the development of simple gingivitis in children? a) High fever b) Poor oral hygiene ©) Oral habits d) Physical nature of food ingested (KAR -2k) When P.D. probing in gingivitis done, depth is measured from a) Base of pocket to CEJ 'b) Base of pocket to free marginal gingiva ©) Marginal gingiva to CE lium to free gingival margin. (PGI -02) found in gingivitis are localized in: ive tissue fibres b) Gingival sulcus 4) Periodontal tigament (AIPG -98) picture of chronic gingivitis: b) Widening of capillaries and venules ©) Increased plasma cells and neutrophils Infiltration of neutrophils, lymphocytes and plasma cy (ATG 95 12. Gingivitis 2) Inevitably progresses to periodontitis b) Affects approximately 40% of adolescents c) Is characterized by true pocketing d) Isa reversible lesion (AIPG -90, AIIM -39 13. Gingivitis is initiated most frequently by: a) Pregnancy b) Malocctusion ) Vitamin deficiency) Local irritating factors (APG -50, 3 14, The most common sequel of gingivitis: 2) Pericoronitis b) Periodontitis ©) Periodontosis d) Periapical pathology (AIPG -90, APPSC 99 15. Mc Call Festoons are seen in which teeth a) Central Incisors b) Canine and Premotars ) Lateral incisors d) Molars (PGI -99, 2) 16. Clinical signs of gingivitis appear in a) Initial gingivitis b)_ Early gingivitis ¢) Late gingivitis 4) Advanced gingivitis (PGI -02) 17. Which of the following is not influenced by systemic disease: a) Periodontitis, ) Destructive periodontitis ©) Hereditary fibromatosis gingivitis, d) Chronic gingivitis (AIPG -2¢) 18. A key feature that differentiates stage III gingivitis from the stage II Lesion is an increase in the number of a) Lymphocytes b) Plasma cells ©) Mast cells 4) Polymorphs (PGI -06, A1PG-07) 19. Mc Calls festoon result from a) Normal physiological process b) Tooth brush trauma c) Inflammation d) Food lodgment (Pot 03,11) 20. Apostrophe shaped area a) Stillmans cleft b) Mc Calls Festoon ©) Gingival sulcus d) None of above (PGI -93) 21, Bleeding on probing will tell us the: @) Gingival health of a child ) Status of gingival health on the day of examination ) 7 days after prophylaxis d) 14 days after Pre Scanned with CamScannerPigmentation of chemicals in mucosa is due to a) Increased permeability of blood vessels ) Local deposition of chemicals in mucosa ) Sub epithelial precipitation in connective tissue at the site due to increased capillary permeability d) None of the above (PGI -95) Features of gingivitis a) Inflamed tissue b) Bleeding on probing ) Increased Gingival fluid d) All of above (AP -02) Gingival Recession is most common due to 35. ) Tooth brush trauma b) TFO ©) Deflective contacts) ANUG (AP -04, ALIMS -95) Plasma cells are mostly seen in one of the stages of | gingivitis | a) Initial lesion c) Established lesion b) Early Lesion 36. d) Advanced lesion (KCET-08) In gingivitis, the immunoglobulins are consistent with the increase in number of a) Fibroblasts b) Neutrophils 26. ©) Lymphocytes d) Plasma cells 37. (AP-08) The following condition do not create gingival defects necessitating gingivoplasty except 4) Acute necrotizing ulcerative gingivitis 38. b) Desquamative gingivitis _ ©) Erosive lichen planus d) Acute herpetic gingivostomatitis (AIIMS-08) One common radiographic finding in clinical gingivitis is 2) Vertical bone loss b) Normal bone pattern ©) Horizontal bone loss d) Increase in bone density (AIIMS-08) The most important cell which contributes to the severity of periodontal disease is a) lymphocyte ) mast cell b) neutrophil d) plasma cell (AP-09) . ‘The change in color, shape and texture of gingiva are bb) stage 2 gingivitis d) stage 4 gingivitis (AIPG-14) fibrils have a transverse striation with a (COMEDK-09) ablished stage of gingivitis is differentiated | number of 33. Which stage of gingivitis is also called subclinical gingivitis - a) Initial stage ©) Early stage b) Advanced stage d) Established stage (KCET-09) regnancy gingivitis is caused by: a) Bacteriodes melaninogenicus b) Actinobacillus actinomycetemcomitans ©) Streptococcus sanguis d) Fusobacterium (AIIMS May 2012) When the dental plaque is allowed to accumulate in the absence of any plaque control procedures, it results in gingivitis within a) 1 to 3 days b) 7 to 21 days c) 2months to 3 months d) 24 hours to 48 hours (COMED-14) Atypical gingivitis is a) other name of plasma cell gingivitis ) gingivitis seen in HIV patients )_ Gingivitis seen in leukaemia patients 4) gingivitis seen in aggressive periodontitis (GceT-14) Not responsible for chronic gingival inflammation? a) Neutrophil b) Macrophages )_ lymphocytes d) Plasma cells (AIIMS Nov-14) Localized diffuse gingivitis extends from a) the interdental papillae to attached gingiva in a limited area ) the margin to attached gingiva in a limited area ©) the interdental papillae to mucobuccal fold in a limited area 4) the margin to the mucobuccal fold in a limited area (KERALA-2016) Scanned with CamScanner‘D' [Carranza 11% ed 113 / 10th ed 366] Heavy metals cause gingival pigmentation in areas of {inflammation only, where the increased permeability permits, the seepage of metal into the surrounding tissue. {ead line Bluish red or deep blue linear -(Burtonian tine) | pigmentation in marginal gingiva Silver (arayria) | Violet marginal tine Bismuth, arsenic = a Raticy, Black marginal line Delicate, brown or black pigmented non Mesentric line | cariogenic plaque found on the enamel. at the cervical margin of the tooth ‘D' [Carranza 11" ed 116 / 10th ed 370] ‘+ Stillman’s clefts- apostrophe shaped indentations from and into the gingival margin. + MC calls festoons - Life preserver shaped enlargements of the marginal gingiva occur most frequently in canine ‘and premolar areas. Both stillman’s clefts and Mc call’s festoons are considered to be the result of trauma from occlusion. But this association was never substantiated. They represent peculiar inflammatory changes of the marginal gingiva. “D' [Carranza 11" ed 110 / 10th ed 364) The two earliest signs of gingival inflammation are: * Increased GCF production rate * Bleeding on probing Bleeding is a more objective sign that requires less subjective estimation by the examiner. ‘B' [Carranza 11 ed 116 / 10th ed 364] B' [Carranza 11” ed 103 / 10th ed 356] Bera sea arp Gora ital) | a4days PHN [GCF ow = Vascular | proliferation, erythema, bleeding (interleukin-8, C5a) and products derived from biofilm (Lipopolysaccharide). + The predominant cel in acute (Stage Tl) gingivitis yg T-lymphocyte (75% of the total lymphocytes), * unctional epithelium shows formation of retepegs ang wide intracellular spaces in stage 11 gingivitis and thw bleeding on probing is evident before any colour change, (PGI Dec-13). 70% of collagen is destroyed around the cellular infiltrate. ‘© Then main fiber groups affected in Stage II appers tobe Circular and dentogingival assemblies. ‘© In Stage ITT, extravasation of RBCs into the connective tissue and breakdown of hemoglobin into its componeng pigments can also deepen the colour of chrorcaly inflammed gingiva. Also the junctional epithelium is nq longer closely attached to the tooth surface. * In Stage 1V, the junctional epithelium migrates apicaly from CEJ. the ‘'n’ [Carranza 11" ed 60] Gingivitis is the most common form of gingival disease. Ony some cases of gingivitis progress to periodontitis. About 90% of population is affected by gingivitis by the time they cross their puberty. " [Carranza 11 ed 103 / 10th ed 364] ‘B' [Carranza 11” ed 60 / 10th ed 407] Local conditions such as materia alba and poor oral hygiene favour the accumulation of plaque. Calculus formation is less common in children, Generalized calculus formation occurs in children with ojstic fibrosis ‘This is related to the increased concentrations of phosphate calcium and protein in the saliva, “B’ [Check Explanation Below] In gingivitis there is no true pocket formation. Whatever the probing depth measured is the depth of the gingival sucus ‘B' [Carranza 11 ed 107 / 10th ed 355] Bacteria found in gingivitis are localized in the gingival sulcus. There is no connective tissue invasion. It periodontitis the microorganisms are localized in connectiv® tissue and result in periodontal destruction. ‘D' [Carranza 11 ed 106 / 10th ed 359) Engorgement of blood vessels, bluish red appearance f gingiva and changes in the size, texture are the clinic features in stage III or chronic gingivitis. Histologically there js infiltration of connective tisue 24 junctional epithelium with neutrophils, lymphocytes predominance of plasma cells. 'D' [Carranza 11" ed 61] Scanned with CamScanner15. 17. 18. 19, 20. ag 22, 23. 26, ‘p' [Carranza 11° ed 60] 1 [Carranza 11" ed 107 / 10th ed 360] Extension of inflammation into the supporting structures ‘occurs in stage IV (Advanced) gingivitis which is the phase of periodontal breakdown, Periodontitis is always preceded by gingivitis, but not all gingivitis progresses to periodontitis. The transition from gingivitis to periodontitis occurs with increase in the umber of spirochetes, motile organisms and when the prepandérant EC ‘ [Carranza 11° ed 116 / 10th ed 370) ‘B [Carranza 11° ed 104 / 10th ed 358] Stage I (01) initial gingivitis is subclinical. Erythema and bleeding on probing occurs in stage I (or) early lesion. Options A, B and C are influenced by systemic diseases. ‘B [Carranza 11" ed 104 / 10th ed 356) Refer question No. 5 ‘€ [Carranza 11" ed 116 / 10th ed 370] ‘W [Carranza 11" ed 116 / 10th ed 370] ‘B' [Carranza 11° ed 110 / 10th ed 364] [Carranza 11” ed 113 / 10th ed 366] ‘D’ [Carranza 11" ed 110 / 10th ed 355] ‘N [Carranza 11° ed 115] Etiological factors for gingival recession: ‘© Faulty tooth brushing technique ‘© High frenal attachment * Gingival inflammation * Tooth malposition * Gingival ablation C [Carranza 11" ed 104 / 10th ed 355] ted 106 / 10th ed 359] ed lesion of gingivitis is characterized by ‘cells and B-lymphocytes. The lesion are predominantly 196, 28. 29. 30, 31. 32, 33. 34, 35. 36. 37. 38, 'B’ [Carranza 11" ed 109 / 10* ed 362) [Carranza 11" ed 104 / 10% ed 438, 360] ‘C [Carranza 11th ed 106] In chronic (stage I11) gingivitis, the blood vessels become engorged and congested, venous return is impaired and blow flow becomes sluggish. This results in reddened ingiva with superimposed bluish hue. Also the breakdown (of haemoglobin into its component pigments can further, deepen the color. ‘8! [Carranza 11" ed 28 / 10” ed 69] ‘N [Carranza 11" ed 104 / 10 ed 359, 360] ‘N' [Carranza 11° ed 103 / 10% ed 356] IN [Carranza 11th ed 3461) ‘*” Prevotella intermedia species are increased during ‘pregnancy gingivitis whereas capnocytophaga species, cre meTeasedn puberty gingivitis. © Refer synopsis point 11 for the new names of bacteroides species © Prevotella is a new genus that includes bacteroides intermedia, bacteroides melaninogenius and related species. ‘B [Carranza 11th ed 106] Chronic gingivitis occurs 2-3 weeks after the beginning of plaque accumulation. ‘X [Shafer 6th ed 393] Other names of plasma cell gingivitis are atypical gingivitis or plasma cell gingivostomatitis or plasmacytosis of gingiva. ‘N [Carranza 11th ed 72] ‘D' (Carranza 11th ed 76, 77] + Localized diffuse-gingivitis-extends-from-the margin to the mucobuccal fold in a limited area. +” Localized marginal gingivitis is confined to one or more areas of the marginal gingiva. © Localized papillary gingivitis is confined to one or more interdental spaces in a limited area, © Generalized marginal gingivitis involves the gingival, margins in relation to all the teeth. The interdental papillae are usually affected. * Generalized diffuse gingivitis involves the entire gingiva. The alveolar mucosa and attached gingiva are affected, 0 the mucogingival junction is sometimes obliterated Scanned with CamScanner

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