ADEX Dental Hygiene Periodontal Concepts Questions and Answers — Questions and Answers
Question 1: A patient presents with moderate periodontitis. According to the 2017 AAP classification system, which factor is the PRIMARY determinant for assigning the initial Stage (I-IV) of periodontitis?
- Probing depth measurements
- Radiographic bone loss percentage
- Clinical Attachment Loss (CAL) (Correct answer)
- Presence of bleeding on probing
Correct answer: Clinical Attachment Loss (CAL)
The 2017 AAP classification system for periodontitis uses Clinical Attachment Loss (CAL) as the primary determinant for establishing the initial stage of the disease. While radiographic bone loss, probing depths, and tooth loss also contribute to determining the final stage and complexity, interdental CAL at the worst site is the first factor to consider.
Question 2: The primary objective of non-surgical periodontal therapy (NSPT) is to:
- Regenerate lost alveolar bone.
- Eliminate all periodontal pathogens from the oral cavity.
- Create a smooth root surface to promote new cementum formation.
- Remove and control microbial biofilms and their byproducts. (Correct answer)
Correct answer: Remove and control microbial biofilms and their byproducts.
The main goal of non-surgical periodontal therapy, which includes scaling and root planing, is to eliminate the primary etiological factor of periodontitis: the bacterial plaque biofilm. By disrupting and removing this biofilm and the associated calculus, inflammation is reduced, allowing the periodontal tissues to heal.
Question 3: A patient with a history of periodontitis returns for a maintenance appointment. Which of the following findings would indicate disease progression and place them in Grade C (Rapid Progression) according to the AAP staging and grading system?
- The patient is a smoker of 5 cigarettes per day.
- Radiographs show 1 mm of bone loss over the past 5 years.
- The patient has heavy biofilm deposits with minimal destruction.
- Radiographs show ≥2 mm of bone loss over a 5-year period. (Correct answer)
Correct answer: Radiographs show ≥2 mm of bone loss over a 5-year period.
The grading system estimates the future risk and rate of progression. Grade C indicates rapid progression. Direct evidence for this includes radiographic bone loss or clinical attachment loss of ≥2 mm over a 5-year period. Smoking >10 cigarettes/day is a Grade C modifier, but the radiographic evidence is a primary criterion.
Question 4: A patient presents with a localized, painful, swollen lesion on the lateral aspect of tooth #14, which has a 7mm periodontal pocket. The tooth tests vital. What is the MOST likely diagnosis?
- Gingival abscess
- Periapical abscess
- Periodontal abscess (Correct answer)
- Pericoronal abscess
Correct answer: Periodontal abscess
A periodontal abscess is a localized purulent infection within the periodontal tissues, typically associated with a pre-existing deep periodontal pocket. Key diagnostic features include location on the lateral aspect of the root and a vital pulp, distinguishing it from a periapical abscess which originates from a non-vital pulp.
Question 5: Which of the following microorganisms acts as a critical bridging species between early and late colonizers in the development of mature dental plaque biofilm?
- Streptococcus sanguinis
- Fusobacterium nucleatum (Correct answer)
- Porphyromonas gingivalis
- Aggregatibacter actinomycetemcomitans
Correct answer: Fusobacterium nucleatum
Fusobacterium nucleatum is a key bridging microorganism in biofilm formation. Its unique surface structures allow it to co-aggregate with both early colonizers (like Streptococcus species) and the more pathogenic late colonizers (like Porphyromonas gingivalis), facilitating the maturation of the plaque biofilm associated with periodontitis.
Question 6: An increase in which component within the Gingival Crevicular Fluid (GCF) is MOST indicative of active periodontal tissue destruction and inflammation?
- Albumin
- Keratinocytes
- Host-derived enzymes like MMP-8 (Correct answer)
- Glucose concentration
Correct answer: Host-derived enzymes like MMP-8
Gingival Crevicular Fluid (GCF) analysis can be a diagnostic tool. An increase in host-derived enzymes, specifically Matrix Metalloproteinase-8 (MMP-8, or collagenase-2), is strongly associated with the breakdown of collagen in the periodontal ligament and alveolar bone, indicating active disease. These enzymes are released by host cells like neutrophils during an inflammatory response.
ADEX Dental Hygiene Periodontal Concepts Questions and Answers
A patient presents with moderate periodontitis.
According to the 2017 AAP classification system, which factor is the PRIMARY determinant for assigning the initial Stage (I-IV) of periodontitis?