Periodontology for the Dental Hygienist

4th Edition Perry Test Bank

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Chapter 07: Periodontal Diseases
Perry/Beemsterboer/Essex: Periodontology for the Dental Hygienist, 4th Edition

MULTIPLE CHOICE

1. Periodontal disease can be assumed to be progressing when:

a. Pockets are present.
b. Bone loss is evident in radiographic images.
c. Attachment loss increases over time.
d. Bleeding occurs with gentle probing.
ANS: C

Feedback
A Incorrect. Periodontal pockets are present from the onset of periodontal disease.
B Incorrect. Bone loss is evident from the onset of periodontal disease.
C Correct! Increasing attachment loss over time indicates that periodontal disease
is progressing.
D Incorrect. Bleeding with gentle probing is a factor in the diagnosis of periodontal
disease.

REF: Clinical Attachment Loss, page 92

2. Cigarette smoking is a risk factor for periodontal disease because:

a. Gingival healing is retarded.
b. Fibroblast function increases.
c. Gingival bleeding is increased.
d. Smokers have poor plaque control.
ANS: A

Feedback
A Correct! The effects of tobacco alter gingival healing, making it slower.
B Incorrect. Cigarette smoking decreases the function of fibroblasts.
C Incorrect. Cigarette smoking causes vasoconstriction, therefore decreasing
gingival bleeding.
D Incorrect. The level of plaque control in a smoker is no different than in a
nonsmoker.

REF: Tobacco Use, page 106

3. All of the following diseases are forms of aggressive periodontitis except one. Which disease
is the exception?
a. Chronic periodontitis
b. Refractory periodontitis
c. Localized juvenile periodontitis
d. Rapidly progressive periodontitis
ANS: A
 Feedback
A Correct! Chronic periodontitis is not a form of aggressive disease.
B Incorrect. Refractory periodontitis, localized juvenile periodontitis, and rapidly
progressive periodontitis are all forms of aggressive periodontitis.
C Incorrect. Refractory periodontitis, localized juvenile periodontitis, and rapidly
progressive periodontitis are all forms of aggressive periodontitis.
D Incorrect. Refractory periodontitis, localized juvenile periodontitis, and rapidly
progressive periodontitis are all forms of aggressive periodontitis.

REF: Aggressive Periodontitis, page 96-97

4. Systemic antibiotic therapy may be useful in the treatment of some forms of periodontitis. The
microbial flora in chronic periodontitis is made up of known amounts of specific pathogens.
a. Both statements are TRUE.
b. Both statements are FALSE.
c. The first statement is TRUE, and the second statement is FALSE.
d. The first statement is FALSE, and the second statement is TRUE.
ANS: C

Feedback
A Incorrect. The first statement is true. Antibiotic therapy can be helpful in those
with periodontal disease who do not respond to standard mechanical therapy.
However, plaque biofilm associated with periodontal disease varies widely from
site to site and from individual to individual; therefore the disease is not
generally treated with antibiotics that target specific classes of microorganisms.
B Incorrect. The first statement is true. Antibiotic therapy can be helpful in those
with periodontal disease who do not respond to standard mechanical therapy.
However, plaque biofilm associated with periodontal disease varies widely from
site to site and from individual to individual; therefore the disease is not
generally treated with antibiotics that target specific classes of microorganisms.
C Correct! The first statement is true. Antibiotic therapy can be helpful in those
with periodontal disease who do not respond to standard mechanical therapy.
However, plaque biofilm associated with periodontal disease varies widely from
site to site and from individual to individual; therefore the disease is not
generally treated with antibiotics that target specific classes of microorganisms.
D Incorrect. The first statement is true. Antibiotic therapy can be helpful in those
with periodontal disease who do not respond to standard mechanical therapy.
However, plaque biofilm associated with periodontal disease varies widely from
site to site and from individual to individual; therefore the disease is not
generally treated with antibiotics that target specific classes of microorganisms.

REF: Systemic Antibiotics, page 106

5. Penicillin is the most useful antibiotic for augmenting the treatment of juvenile periodontitis.
The microbial flora of this form of the aggressive disease is composed of up to 90%
Actinobacillus actinomycetemcomitans.
a. Both statements are TRUE.
b. Both statements are FALSE.
c. The first statement is TRUE, and the second statement is FALSE.
 d. The first statement is FALSE, and the second statement is TRUE.
ANS: D

Feedback
A Incorrect. The second statement is true. The antibiotics used to treat localized
aggressive (juvenile) periodontitis are forms of tetracycline, and a large
proportion of A. actinomycetemcomitans characterizes the disease.
B Incorrect. The second statement is true. The antibiotics used to treat localized
aggressive (juvenile) periodontitis are forms of tetracycline, and a large
proportion of A. actinomycetemcomitans characterizes disease.
C Incorrect. The second statement is true. The antibiotics used to treat localized
aggressive (juvenile) periodontitis are forms of tetracycline, and a large
proportion of A. actinomycetemcomitans characterizes the disease.
D Correct! The second statement is true. The antibiotics used to treat localized
aggressive (juvenile) periodontitis are forms of tetracycline, and a large
proportion of A. actinomycetemcomitans characterizes the disease.

REF: Systemic Antibiotics, page 106

6. All of the following statements are true concerning combined endodontic-periodontic lesions
except one. Which statement is the exception?
a. The lesion may develop at the furcation.
b. The tooth may be sensitive to percussion.
c. A single isolated deep pocket is usually found.
d. Endodontic therapy should be performed first.
e. Thorough subgingival root planing should be performed first.
ANS: E

Feedback
A Incorrect. In combined endodontic-periodontic lesions, the lesion may develop at
the furcation. In addition, the tooth may be sensitive to percussion, and a single
isolated deep pocket is usually found. Endodontic therapy should be performed
before periodontal therapy.
B Incorrect. In combined endodontic-periodontic lesions, the lesion may develop at
the furcation. In addition, the tooth may be sensitive to percussion, and a single
isolated deep pocket is usually found. Endodontic therapy should be performed
before periodontal therapy.
C Incorrect. In combined endodontic-periodontic lesions, the lesion may develop at
the furcation. In addition, the tooth may be sensitive to percussion, and a single
isolated deep pocket is usually found. Endodontic therapy should be performed
before periodontal therapy.
D Incorrect. In combined endodontic-periodontic lesions, the lesion may develop at
the furcation. In addition, the tooth may be sensitive to percussion, and a single
isolated deep pocket is usually found. Endodontic therapy should be performed
before periodontal therapy.
E Correct! In combined endodontic-periodontic lesions, the lesion may develop at
the furcation. In addition, the tooth may be sensitive to percussion, and a single
 isolated deep pocket is usually found. Endodontic therapy should be performed
before periodontal therapy.

REF: Periodontitis Associated with Endodontic Lesions, page 102-103

7. Local site-specific antimicrobial pocket therapy may be useful as an adjunct to periodontal

scaling and root planing for which of the following reasons?
a. The antibiotic effect may last up to 3 months.
b. Many organisms develop resistance to the antibiotic.
c. The most common antibiotics used are bactericidal agents.
d. A high dose of antibiotic is placed at the site of the infection.
e. A high level of the antibiotic in the circulation may lead to an allergic response.
ANS: D

Feedback
A Incorrect. This is not a characteristic of antimicrobial pocket therapy.
B Incorrect. This is not a reason why antimicrobial pocket therapy is useful.
C Incorrect. This is not a characteristic of antimicrobial pocket therapy.
D Correct! Site-specific antibiotic therapy can be useful because it places a high
dose of the antibiotic at the location of the infection.
E Incorrect. Site-specific antimicrobial therapy actually reduces the allergic side
effects.

REF: Locally Delivered Controlled-Release Antibiotics, page 107

8. Genetic testing for chronic periodontal diseases is of interest because:

a. A specific gene for chronic periodontitis is present in people of all races.
b. Cigarette smoking does not interfere with the test.
c. The test is becoming the standard of care for treating patients with periodontal
disease.
d. Studies of twins show that chronic periodontitis may be genetically linked.
e. Findings are useful for common diseases such as leukocyte adhesion deficiency.
ANS: D

Feedback
A Incorrect. No specific genes have been identified for chronic periodontitis.
B Incorrect. Tobacco use, which is a known risk factor for periodontal disease, has
been clearly associated with increased attachment loss.
C Incorrect. Genetic testing has not become a standard; however, the opportunity
for advances in therapy is tremendous, based on the increasing knowledge of the
genetics of periodontal disease.
D Correct! Studies of twins have shown that a genetic link to periodontal disease
may exist.
E Incorrect. Rare periodontal diseases in systemic conditions, such as
Papillon-Lefèvre syndrome, Chédiak-Higashi syndrome, and leukocyte adhesion
deficiency, have been known for some time to be genetically induced.

REF: Genetic Factors Promoting Periodontitis, page 106

 9. Certain aggressive forms of periodontal disease may cause tooth loss at an early age because:
a. Affected teeth must be extracted before the disease spreads.
b. Progression of these diseases is associated with host factors.
c. Periodontal surgery may be required to reduce the level of pathogens.
d. These diseases are mostly found in individuals who are immunocompromised.
e. Antibiotics are not helpful in controlling the progression of the disease.
ANS: B

Feedback
A Incorrect. Tooth extraction is not the proper treatment for aggressive
periodontitis.
B Correct! Host factors make periodontal therapy less successful in very young
patients and often lead to early tooth loss, despite treatment.
C Incorrect. Periodontal surgery is not the proper treatment for aggressive
periodontitis.
D Incorrect. Aggressive periodontitis is often associated with young people.
E Incorrect. Antibiotics are not the proper treatment for aggressive periodontitis.

REF: Aggressive Periodontitis, page 96-97

10. The most important host factor in determining the progression of periodontitis and bone loss
is:
a. Effective scaling and root planing
b. Corrosive factors in dental calculus
c. Bacteria acid eroding the crestal alveolar bone
d. Direct tissue damage by the bacteria in plaque
e. Inflammation from the host response to plaque antigens
ANS: E

Feedback
A Incorrect. Prepubertal periodontitis responds poorly to conventional treatment
techniques, such as scaling and root planing.
B Incorrect. The inflammatory response of the host is the single most important
determinant of disease progression.
C Incorrect. The inflammatory response of the host is the single most important
determinant of disease progression.
D Incorrect. The inflammatory response of the host is the single most important
determinant of disease progression.
E Correct! The inflammatory response of the host is the single most important
determinant of disease progression.

REF: Pathogenesis of Periodontitis, page 89

11. Developmental conditions that may contribute to periodontitis include all of the following
except one. Which condition is the exception?
a. Cemental spurs on root surfaces
b. Lingual groove on some lateral incisors
 c. Gingival recession, resulting in bone loss
d. Carabelli cusps on maxillary first molars
e. Pseudopockets on the distal of second molars
ANS: D

Feedback
A Incorrect. Cemental spurs, lingual grooves, gingival recession, and
pseudopockets all contribute to periodontitis.
B Incorrect. Cemental spurs, lingual grooves, gingival recession, and
pseudopockets all contribute to periodontitis.
C Incorrect. Cemental spurs, lingual grooves, gingival recession, and
pseudopockets all contribute to periodontitis.
D Correct! The Carabelli cusp is a developmental feature of the crowns of molar
teeth and is not related to periodontal disease.
E Incorrect. Cemental spurs, lingual grooves, gingival recession, and
pseudopockets all contribute to periodontitis.

REF: Developmental or Acquired Deformities and Conditions, page 103-104

12. A painful periodontal condition characterized by punched out dental papilla crestal bone loss
with a white pseudomembranous surface is called:
a. Periodontal abscess
b. Juvenile periodontitis
c. Refractory periodontitis
d. Chronic periodontitis
e. Necrotizing ulcerative periodontitis
ANS: E

Feedback
A Incorrect. Periodontal abscess is an acute, localized purulent infection of the
periodontium.
B Incorrect. Aggressive periodontal disease is often associated with young people
but not exclusively. In fact, these diseases were long identified as localized and
generalized juvenile periodontitis.
C Incorrect. Refractory periodontitis is a term used to describe periodontal disease
that is not responsive to appropriate treatment.
D Incorrect. Chronic periodontitis is the most common form of periodontal disease.
E Correct! Punched out dental papilla crestal bone loss with a white
pseudomembranous surface characterizes necrotizing ulcerative periodontitis. In
addition, the development of pseudomembrane is always related to this infection.

REF: Aggressive Periodontitis, page 97

13. All of the following systemic conditions have been associated with untreated advanced
periodontal diseases except one. Which condition is the exception?
a. Stroke
b. Heart attack
c. Osteoporosis
 d. Bacterial pneumonia
e. Low–birth-weight preterm births
ANS: C

Feedback
A Incorrect. Strokes, heart attacks, bacterial pneumonia, and low–birth-weight
preterm births are all systemic conditions associated with untreated periodontal
disease.
B Incorrect. Strokes, heart attacks, bacterial pneumonia, and low–birth-weight
preterm births are all systemic conditions associated with untreated periodontal
disease.
C Correct! Osteoporosis is not associated with periodontal bone loss.
D Incorrect. Strokes, heart attacks, bacterial pneumonia, and low–birth-weight
preterm births are all systemic conditions associated with untreated periodontal
disease.
E Incorrect. Strokes, heart attacks, bacterial pneumonia, and low–birth-weight
preterm births are all systemic conditions associated with untreated periodontal
disease.

REF: Periodontitis As a Risk Factor for Systemic Diseases, page 94

14. All of the following are characteristics of chronic periodontitis except one. Which
characteristic is the exception?
a. Slow progression of bone loss occurs.
b. Subgingival calculus is frequently present.
c. Chronic periodontitis is often isolated to incisors and first molars.
d. The disease process is modified by tobacco use.
e. Destruction is consistent with the amount of local factors.
ANS: C

Feedback
A Incorrect. Slow progression of bone loss, subgingival calculus, disease process
modified by tobacco use, and destruction consistent with the amount of local
factors are all characteristics of chronic periodontitis.
B Incorrect. Slow progression of bone loss, subgingival calculus, disease process
modified by tobacco use, and destruction consistent with the amount of local
factors are all characteristics of chronic periodontitis.
C Correct! Chronic periodontitis can be found on any tooth in the mouth and is not
isolated to the lower anterior and maxillary molar teeth.
D Incorrect. Slow progression of bone loss, subgingival calculus, disease process
modified by tobacco use, and destruction consistent with the amount of local
factors are all characteristics of chronic periodontitis.
E Incorrect. Slow progression of bone loss, subgingival calculus, disease process
modified by tobacco use, and destruction consistent with the amount of local
factors are all characteristics of chronic periodontitis.

REF: Chronic Periodontitis, page 91

15. All of the following treatment options are useful in treating moderate chronic periodontitis
except one. Which treatment option is the exception?
a. Systemic antibiotic therapy
b. Assisting the patient with a smoking cessation program
c. Removing local factors such as overhanging restorations
d. Educating the patient in improved personal plaque-biofilm control
e. Completely removing plaque biofilm and calculus from the root surfaces
ANS: A

Feedback
A Correct! Systemic antibiotic therapy has not been shown to be useful in treating
chronic periodontitis; targeting organisms in this mixed infection is not helpful.
B Incorrect. Smoking cessation, removing overhanging restorations, improving
plaque biofilm control, and removing biofilm and calculus from the root surfaces
are all useful in treating moderate chronic periodontitis.
C Incorrect. Smoking cessation, removing overhanging restorations, improving
plaque biofilm control, and removing biofilm and calculus from the root surfaces
are all useful in treating moderate chronic periodontitis.
D Incorrect. Smoking cessation, removing overhanging restorations, improving
plaque biofilm control, and removing biofilm and calculus from the root surfaces
are all useful in treating moderate chronic periodontitis.
E Incorrect. Smoking cessation, removing overhanging restorations, improving
plaque biofilm control, and removing biofilm and calculus from the root surfaces
are all useful in treating moderate chronic periodontitis.

REF: Clinical Note 7-6, page 93

16. Dental plaque biofilm associated with chronic periodontitis is predominantly:

a. Rod-shaped
b. Gram positive
c. Gram negative
d. Gram positive and gram negative
e. Actinobacillus actinomycetemcomitans
ANS: C

Feedback
A Incorrect. In chronic periodontitis, elevated levels of spirochetes are also present.
B Incorrect. The plaque associated with periodontal diseases is predominantly
gram negative.
C Correct! The plaque associated with periodontal diseases is predominantly gram
negative.
D Incorrect. The plaque associated with periodontal diseases is predominantly
gram negative.
E Incorrect. Of the primary pathogens associated with periodontal diseases,
Porphyromonas gingivalis, one of the red complex bacteria, is perhaps the most
commonly identified species.

REF: Plaque Biofilm, page 92

17. The dental hygienist should consider referring the patient with periodontitis:
a. When the disease is advanced
b. Before the disease becomes advanced
c. After completing dental hygiene care
d. When any sign of bone loss is recognized
e. After the dentist completes the comprehensive care treatment
ANS: A

Feedback
A Correct! The dental hygienist working with the dentist should consider referring
the patient with advanced periodontal disease for specialist care.
B Incorrect. The dental hygienist working with the dentist should consider
referring the patient with advanced periodontal disease for specialist care.
C Incorrect. The dental hygienist working with the dentist should consider
referring the patient with advanced periodontal disease for specialist care.
D Incorrect. The dental hygienist working with the dentist should consider
referring the patient with advanced periodontal disease for specialist care.
E Incorrect. The dental hygienist working with the dentist should consider
referring the patient with advanced periodontal disease for specialist care.

REF: Treatment, page 93

18. Poor oral hygiene is of concern in the development of bacterial pneumonia in the older adult
nursing home population because:
a. Oral hygiene procedures can spread the disease.
b. Virulent species that cause bacterial pneumonia are found in plaque biofilm.
c. As older adults age, they develop a resistance to the disease.
d. The older adult nursing home population is susceptible to mixed infections from
plaque biofilm.
ANS: B

Feedback
A Incorrect. Virulent bacteria that cause pneumonias are found in the plaque
biofilm; therefore patients who are weak, such as those living in nursing homes,
are susceptible to these serious infections.
B Correct! Virulent bacteria that cause pneumonias are found in the plaque
biofilm; therefore patients who are weak, such as those living in nursing homes,
are susceptible to these serious infections.
C Incorrect. Older adult patients are more susceptible to bacterial pneumonia
because their resistance decreases as they age.
D Incorrect. Virulent bacteria that cause pneumonias are found in the plaque
biofilm; therefore patients who are weak, such as those living in nursing homes,
are susceptible to these serious infections.

REF: Periodontitis and Bacterial Pneumonia, page 94

19. Prepubertal periodontitis, the severe form of aggressive periodontitis, is:

 a. Common among certain populations.
b. Associated with white blood cell defects.
c. Associated with only slight amounts of plaque biofilms.
d. Known to affect deciduous teeth but not permanent teeth.
e. Known to cause attachment loss but not progress to cause loss of the teeth.
ANS: B

Feedback
A Incorrect. Prepubertal periodontitis is very rare.
B Correct! Prepubertal periodontal disease is associated with host factors including
white blood cell defects.
C Incorrect. Usually large amounts of plaque biofilm are present in prepubertal
periodontitis.
D Incorrect. Prepubertal periodontitis may affect both the primary and secondary
dentitions.
E Incorrect. Severe gingival inflammation, rapid bone loss, and early tooth loss are
usually evident in prepubertal periodontitis.

REF: Aggressive Periodontitis, page 97

20. The plaque biofilm associated with juvenile periodontitis is present in small amounts
considering the severity of the periodontal defects because:
a. All of the plaque biofilm is supragingival.
b. The primary pathogen in the biofilm does not create much extracellular matrix.
c. The primary pathogen creates extracellular matrix that forces the bacteria out of
the pocket.
d. The primary pathogen creates a significant amount of extracellular matrix, leaving
no space for bacteria to grow.
ANS: B

Feedback
A Incorrect. Actinobacillus actinomycetemcomitans, found in aggressive juvenile
periodontitis, does not form much extracellular matrix; therefore bacteria cannot
coaggregate into large masses of plaque biofilm.
B Correct! A. actinomycetemcomitans, found in aggressive juvenile periodontitis,
does not form much extracellular matrix; therefore bacteria cannot coaggregate
into large masses of plaque biofilm.
C Incorrect. A. actinomycetemcomitans, found in aggressive juvenile periodontitis,
does not form much extracellular matrix; therefore bacteria cannot coaggregate
into large masses of plaque biofilm.
D Incorrect. A. actinomycetemcomitans, found in aggressive juvenile periodontitis,
does not form much extracellular matrix; therefore bacteria cannot coaggregate
into large masses of plaque biofilm.

REF: Aggressive Periodontitis, page 97

21. The dental hygienist should consider recommending a thorough medical evaluation for all
patients with:
 a. Heavy plaque and calculus
b. Moderate plaque and calculus
c. Gingiva that does not bleed when probed
d. Plaque and calculus levels consistent with the amount of observed periodontal
destruction
e. Plaque and calculus levels not consistent with the amount of observed periodontal
destruction
ANS: E

Feedback
A Incorrect. Patients who have periodontal destruction beyond what is expected,
considering the amount of plaque biofilm and calculus on the teeth, may have
some additional systemic problems. These patients may need further
consultation regarding other diseases or conditions that are affecting their
periodontal health.
B Incorrect. Patients who have periodontal destruction beyond what is be expected,
considering the amount of plaque biofilm and calculus on the teeth, may have
some additional systemic problems. These patients may need further
consultation regarding other diseases or conditions that are affecting their
periodontal health.
C Incorrect. Patients who have periodontal destruction beyond what is expected,
considering the amount of plaque biofilm and calculus on the teeth, may have
some additional systemic problems. These patients may need further
consultation regarding other diseases or conditions that are affecting their
periodontal health.
D Incorrect. Patients who have periodontal destruction beyond what is expected,
considering the amount of plaque biofilm and calculus on the teeth, may have
some additional systemic problems. These patients may need further
consultation regarding other diseases or conditions that are affecting their
periodontal health.
E Correct! Patients who have periodontal destruction beyond what is expected,
considering the amount of plaque biofilm and calculus on the teeth, may have
some additional systemic problems. These patients may need further
consultation regarding other diseases or conditions that are affecting their
periodontal health.

REF: Aggressive Periodontitis, page 96-97

22. The significance of probing depth measurements is that it provides the millimeter:
a. Amount of recession
b. Depth of the periodontal pocket
c. Amount of clinical attachment loss (CAL)
d. Amount of loss of support for the tooth
ANS: B

Feedback
A Incorrect. Probing depth measurements tell only the depth of the pocket, not its
relationship to the tooth and gingiva.
 B Correct! Probing depth measurements tell only the depth of the pocket, not its
relationship to the tooth and gingiva.
C Incorrect. Probing depth measurements tell only the depth of the pocket, not its
relationship to the tooth and gingiva.
D Incorrect. Probing depth measurements tell only the depth of the pocket, not its
relationship to the tooth and gingiva.

REF: Clinical Note 7-4, page 91

23. The significance of the CAL measurement is that it provides the millimeter:
a. Amount of recession
b. Depth of the gingival pocket
c. Depth of the periodontal pocket
d. Amount of loss of support for the tooth
ANS: D

Feedback
A Incorrect. CAL measurements provide an assessment of the amount of
attachment remaining on the tooth.
B Incorrect. CAL measurements provide an assessment of the amount of
attachment remaining on the tooth.
C Incorrect. CAL measurements provide an assessment of the amount of
attachment remaining on the tooth.
D Correct! CAL measurements provide an assessment of the amount of attachment
remaining on the tooth.

REF: Clinical Attachment Loss, page 92

24. Bone is an active tissue characterized by continuous formation and resorption. It is possible to
determine the precise time that bone loss caused by periodontal disease begins.
a. Both statements are TRUE.
b. Both statements are FALSE.
c. The first statement is TRUE, and the second statement is FALSE.
d. The first statement is FALSE, and the second statement is TRUE.
ANS: C

Feedback
A Incorrect. The first statement is true. Bone is constantly remodeling; therefore
determining the precise moment when periodontal disease begins its destructive
processes is not possible.
B Incorrect. The first statement is true. Bone is constantly remodeling; therefore
determining the precise moment when periodontal disease begins its destructive
processes is not possible.
C Correct! The first statement is true. Bone is constantly remodeling; therefore
determining the precise moment when periodontal disease begins its destructive
processes is not possible.
D Incorrect. The first statement is true. Bone is constantly remodeling; therefore
determining the precise moment when periodontal disease begins its destructive
 processes is not possible.

REF: Pathogenesis of Periodontitis, page 89

25. Systemic antibiotic therapy should be used in the treatment of periodontal diseases when:
a. Specific organisms have been identified.
b. Dental hygiene treatment has been successful, and specific organisms can be
identified.
c. Dental hygiene treatment has been successful, and specific organisms cannot be
identified.
d. Dental hygiene treatment has been unsuccessful, and specific organisms have been
identified.
ANS: D

Feedback
A Incorrect. The best use of antibiotics in periodontal therapy is as an adjunct to
treatment. When the patient is not responding well to therapy, although the
therapy was performed well and good daily plaque control is occurring, specific
microorganisms can be identified that may result in the antibiotic treatment
improving the outcome.
B Incorrect. The best use of antibiotics in periodontal therapy is as an adjunct to
treatment. When the patient is not responding well to therapy, although the
therapy was performed well and good daily plaque control is occurring, specific
microorganisms can be identified that may result in the antibiotic treatment
improving the outcome.
C Incorrect. The best use of antibiotics in periodontal therapy is as an adjunct to
treatment. When the patient is not responding well to therapy, although it was
performed well and good daily plaque control is occurring, specific
microorganisms can be identified that may result in the antibiotic treatment
improving the outcome.
D Correct! The best use of antibiotics in periodontal therapy is as an adjunct to
treatment. When the patient is not responding well to therapy, although it was
performed well and good daily plaque control is occurring, specific
microorganisms can be identified that may result in the antibiotic treatment
improving the outcome.

REF: Systemic Antibiotics, page 106-107

26. Treatment for patients with slight-to-moderate chronic periodontitis typically includes:
a. Plaque biofilm education, removal of local etiologic factors, and control of
associated factors
b. Removal of local etiologic factors and a referral to a specialist for evaluation
c. Plaque biofilm education, removal of local etiologic factors, control of associated
factors, and a referral to a specialist for evaluation
d. Removal of local etiologic factors, control of associated factors, and a referral to a
specialist for evaluation
ANS: C

Feedback
 A Incorrect. The patient must also be referred to a specialist for evaluation.
B Incorrect. The patient must also be educated about plaque biofilm and control of
associated factors.
C Correct! For patients with slight-to-moderate chronic periodontitis, treatment
typically includes plaque biofilm education, removal of local etiologic factors,
control of associated factors, and a referral to a specialist for evaluation.
D Incorrect. The patient must also be educated about plaque biofilm.

REF: Clinical Note 7-6, page 93

27. Treatment for patients with advanced chronic periodontitis typically includes:
a. Plaque biofilm education, removal of local etiologic factors, and control of
associated factors
b. Removal of local etiologic factors and a referral to a specialist for evaluation
c. Plaque biofilm education, removal of local etiologic factors, control of associated
factors, and a referral to a specialist for evaluation
d. Removal of local etiologic factors, control of associated factors, and a referral to a
specialist for evaluation
e. Referral to a specialty periodontics practice for evaluation, plaque biofilm
education, removal of local etiologic factors via surgical and nonsurgical means,
and control of associated factors
ANS: E

Feedback
A Incorrect. The patient must also be referred to a specialist for evaluation.
B Incorrect. The patient must also be educated on plaque biofilm and control of
associated factors.
C Incorrect. The patient must also be referred to a specialist for evaluation.
D Incorrect. The patient must also be educated on plaque biofilm.
E Correct! For patients with advanced chronic periodontitis, treatment typically is
best provided by a specialty periodontics practice. Care often includes plaque
biofilm education, removal of local etiologic factors via surgical and nonsurgical
means, control of associated factors, and a referral to a specialist for evaluation.

REF: Clinical Note 7-6, page 93

28. Users of tobacco are at greater risk for developing periodontal disease because of:
a. Cytotoxic components
b. Vasoconstriction
c. Diminished neutrophil function
d. Impairment of fibroblast function
e. All of the above
f. None of the above
ANS: E

Feedback
A Incorrect. Cytotoxic components make up only one of the risk factors.
B Incorrect. Vasoconstriction is only one of the risk factors.
 C Incorrect. Diminished neutrophil function is only one of the risk factors.
D Incorrect. Impairment of fibroblast function is only one of the risk factors.
E Correct! Cytotoxic components, including nicotine, vasoconstriction, diminished
neutrophil function, and impaired fibroblast function all combine to diminish the
capacity for periodontal tissues to heal.
F Incorrect. Users of tobacco have all of these risk factors.

REF: Tobacco Use, page 106

29. Studies documenting adverse health effects as related to chronic infections, which are
mediated by inflammatory agents triggering the development of atherosclerosis in coronary
arteries, have been implicated in which of the following diseases?
a. Periodontitis and cardiovascular disease
b. Periodontitis and preterm birth
c. Periodontitis and bacterial pneumonia
d. Periodontitis and diabetes
e. All of the above
f. None of the above
ANS: A

Feedback
A Correct! When other factors are controlled, scientific data identify 14% increase
in the risk for heart attack and 10% increase in sites with 3 mm or more of CAL.
Studies suggest adverse health effects are related to chronic infections
(periodontitis).
B Incorrect. When other factors are controlled, scientific data identify 14%
increase in the risk for heart attack and 10% increase in sites with 3 mm or more
of CAL. Studies suggest adverse health effects are related to chronic infections
(periodontitis).
C Incorrect. When other factors are controlled, scientific data identify 14%
increase in the risk for heart attack and 10% increase in sites with 3 mm or more
of CAL. Studies suggest adverse health effects are related to chronic infections
(periodontitis).
D Incorrect. When other factors are controlled, scientific data identify 14%
increase in the risk for heart attack and 10% increase in sites with 3 mm or more
of CAL. Studies suggest adverse health effects are related to chronic infections
(periodontitis).
E Incorrect. When other factors are controlled, scientific data identify 14%
increase in the risk for heart attack and 10% increase in sites with 3 mm or more
of CAL. Studies suggest adverse health effects are related to chronic infections
(periodontitis).
F Incorrect. When other factors are controlled, scientific data identify 14%
increase in the risk for heart attack and 10% increase in sites with 3 mm or more
of CAL. Studies suggest adverse health effects are related to chronic infections
(periodontitis).

REF: Periodontitis and Cardiovascular Disease, page 94

 30. Which oral diseases are caused by pathogenic bacterial plaque biofilm inhabiting the oral
cavity and subgingival environment?
a. Periodontitis and cardiovascular disease
b. Periodontitis and preterm birth
c. Periodontitis and bacterial pneumonia
d. Periodontitis and diabetes
e. All of the above
f. None of the above
ANS: E

Feedback
A Incorrect. Periodontitis is caused by bacterial plaque biofilms in the oral cavity
and subgingival environment. All of the choices listed are also connected with
either systemic considerations or another disease, and each is individually
addressed in the text. Studies suggest adverse health effects are related to
chronic infections (periodontitis).
B Incorrect. Periodontitis is caused by bacterial plaque biofilms in the oral cavity
and subgingival environment. All of the choices here are also connected with
either systemic considerations or another disease, and each is individually
addressed in the text. Studies suggest adverse health effects are related to
chronic infections (periodontitis).
C Incorrect. Periodontitis is caused by bacterial plaque biofilms in the oral cavity
and subgingival environment. All of the choices listed are also connected with
either systemic considerations or another disease, and each is individually
addressed in the text. Studies suggest adverse health effects are related to
chronic infections (periodontitis).
D Incorrect. Periodontitis is caused by bacterial plaque biofilms in the oral cavity
and subgingival environment. All of the choices listed are also connected with
either systemic considerations or another disease, and each is individually
addressed in the text. Studies suggest adverse health effects are related to
chronic infections (periodontitis).
E Correct! Periodontitis is caused by bacterial plaque biofilms in the oral cavity
and subgingival environment. All of the choices listed are also connected with
either systemic considerations or another disease, and each is individually
addressed in the text. Studies suggest adverse health effects are related to
chronic infections (periodontitis).
F Incorrect. Periodontitis is caused by bacterial plaque biofilms in the oral cavity
and subgingival environment. All of the choices listed are also connected with
either systemic considerations or another disease, and each is individually
addressed in the text. Studies suggest adverse health effects are related to
chronic infections (periodontitis).

REF: Periodontitis As a Risk Factor for Systemic Diseases, page 94

TRUE/FALSE

1. Clinicians often interchangeably use the terms periodontitis and periodontal disease when
indicating chronic periodontitis.
 ANS: T
Clinicians often use the terms periodontitis or periodontal disease when indicating chronic
periodontitis.

REF: Chronic Periodontitis, page 91

2. Chronic periodontitis can be localized or generalized.

ANS: T
Chronic periodontitis can be either localized or generalized, progressing intermittently until
teeth are lost.

REF: Chronic Periodontitis, page 91

3. Chronic periodontitis is associated with systemic disease or abnormalities in host defense

mechanisms.

ANS: F
Chronic periodontitis is not associated with systemic disease or abnormalities in host defense
mechanisms; rather, it is directly related to the accumulation of plaque biofilm and calculus on
tooth surfaces.

REF: Chronic Periodontitis, page 91

4. In chronic periodontitis, disease activity is exacerbated when host resistance controls the
disease through therapy or natural defenses.

ANS: F
In chronic periodontitis, disease activity halts when host resistance controls the disease
process through therapy or natural defenses.

REF: Chronic Periodontitis, page 91

5. Disease progression in chronic periodontitis is episodic in nature, having a burst of activity

that causes attachment loss.

ANS: T
Disease progression is cyclic in nature, having periods of exacerbation followed by periods of
remission. The disease progresses in the presence of pathogenic dental plaque biofilm.

REF: Chronic Periodontitis, page 91

6. The defining element for classifying periodontal disease is probe depth.

ANS: F
False. The defining element for classifying periodontal disease is CAL from the
cementoenamel junction, which indicates bone loss.

REF: Clinical Attachment Loss, page 92

7. The defining element for classifying periodontal disease is CAL.

 ANS: T
The defining element for classifying periodontal disease is CAL from the cementoenamel
junction, which indicates bone loss.

REF: Clinical Attachment Loss, page 92

8. Probing pocket depth is not significant; the patient’s ability to cleanse deeper pockets is not a
factor in developing periodontal disease.

ANS: F
Probing pocket depth is a significant factor; the patient’s ability to clean deepened pockets
adequately is greatly reduced.

REF: Clinical Attachment Loss, page 92

9. The diagnosis of periodontal disease can be definitively made through the analysis of bacterial
plaque.

ANS: F
Diagnosis of periodontal disease through the analysis of bacterial plaque biofilms remains an
adjunctive, versus definitive technique because composition of plaque biofilms varies.

REF: Plaque Biofilm, page 92

10. Clinical rather than bacterial diagnosis is not the primary method of classifying periodontal
disease.

ANS: F
Clinical, rather than bacterial diagnosis is the primary method of classifying periodontal
disease.

REF: Plaque Biofilm, page 92

SHORT ANSWER

1. List three of the five methods for clinically detecting periodontal disease.
_______________________
_______________________
_______________________

ANS:
The methods for clinically detecting periodontal disease are: (1) bleeding upon probing, (2)
probed attachment levels, (3) radiographic images, (4) mobility, and (5) longitudinal analysis
of probe depths, that is, a comparison of probe depths over time.

REF: Methods of Detecting Periodontal Disease, page 104

2. Explain the effects of cigar smoking and smokeless tobacco.

________________________________________________________________________
________________________________________________________________________
 ________________________________________________________________________
________________________________________________________________________

ANS:
Correct responses include: The effects of cigar smoking and smokeless tobacco, are less clear,
although the effects are likely to be similar to cigarette smoking. Localized gingival recession
is commonly evident in the oral areas where smokeless tobacco is held, often between the
gingiva and vestibular mucosa.

REF: Tobacco Use, page 106

3. The most reliable method of determining disease activity is documenting the loss of
periodontal attachment by measuring _________________ over time.

ANS:
Clinical attachment loss
The most reliable method of determining disease activity is documenting the loss of
periodontal attachment by measuring clinical attachment loss over time.

REF: Clinical Attachment Loss, page 92

4. Periodontal disease also can have periods of _________________, in which the disease is
static and periodontal pockets do not deepen.

ANS:
Quiescence (remission)
Periodontal disease also can have periods of quiescence or remission, in which the disease is
static and periodontal pockets do not deepen.

REF: Disease Activity, page 90

5. The term used to describe the periodontal diseases of the supporting tissues of the teeth is
________________________________.

ANS:
Periodontitis
Periodontitis is an inclusive term used for describing any disease of the tissues surrounding
the teeth, including gingival diseases and diseases of the supporting structures.

REF: Introduction, page 88

6. A pathologically deepened gingival sulcus is called a ______________________.

ANS:
Periodontal pocket
A periodontal pocket is formed when the clinical attachment apically migrates.

REF: Periodontal Pocket, page 88