ADEX Patient Assessment and Diagnosis 3 — Questions and Answers
Question 1: A patient reports taking warfarin for atrial fibrillation. Which laboratory value is most critical to review before initiating periodontal debridement?
- Complete blood count (CBC)
- International Normalized Ratio (INR) (Correct answer)
- Fasting blood glucose
- Serum ferritin level
Correct answer: International Normalized Ratio (INR)
The INR reflects anticoagulation status; an INR above the therapeutic range increases bleeding risk during periodontal procedures.
Question 2: Which radiographic technique best demonstrates the relationship between the alveolar crest and the CEJ in posterior sextants?
- Occlusal projection
- Bitewing radiograph (Correct answer)
- Periapical radiograph using paralleling technique
- Panoramic radiograph
Correct answer: Bitewing radiograph
Bitewing radiographs show both maxillary and mandibular crestal bone levels in relation to the CEJ with minimal distortion.
Question 3: A patient presents with generalized 5-6 mm probing depths, radiographic bone loss, and heavy biofilm accumulation. According to the 2017 AAP classification, this most likely represents:
- Gingivitis associated with biofilm
- Localized Stage II Grade A periodontitis
- Generalized Stage III Grade B periodontitis (Correct answer)
- Necrotizing periodontal disease
Correct answer: Generalized Stage III Grade B periodontitis
Generalized bone loss with probing depths ≥5 mm and heavy biofilm in the absence of rapid progression aligns with Stage III Grade B periodontitis.
Question 4: During an extraoral examination, the hygienist notes asymmetric swelling of the parotid gland bilaterally in a patient with a BMI of 16. Which condition should be considered?
- Sjögren's syndrome only
- Mumps infection
- Bulimia nervosa-related sialadenosis (Correct answer)
- Sarcoidosis
Correct answer: Bulimia nervosa-related sialadenosis
Bilateral parotid enlargement (sialadenosis) combined with a very low BMI is associated with bulimia nervosa due to repeated purging.
Question 5: When using the Ramfjord index teeth for periodontal assessment, which teeth are selected?
- #3, #9, #12, #19, #25, #28 (Correct answer)
- #2, #7, #10, #18, #23, #26
- #3, #9, #12, #19, #25, #28
- #1, #8, #12, #17, #21, #28
Correct answer: #3, #9, #12, #19, #25, #28
Ramfjord index teeth are #3, #9, #12, #19, #25, and #28, representing all six sextants.
Question 6: A patient's health history reveals uncontrolled type 2 diabetes with an HbA1c of 10.5%. How does this most directly affect the periodontal assessment findings?
- Decreased probing depths due to fibrotic gingival changes
- Increased susceptibility to periodontal disease and impaired healing (Correct answer)
- No significant effect on periodontal status
- Reduced plaque accumulation due to elevated salivary glucose
Correct answer: Increased susceptibility to periodontal disease and impaired healing
Uncontrolled diabetes impairs neutrophil function, increases inflammatory mediators, and compromises wound healing, exacerbating periodontal disease.
Question 7: Which finding during intraoral assessment is most consistent with oral candidiasis in a denture-wearing patient?
- Erythematous patches under the denture-bearing mucosa (Correct answer)
- White lesion on the lateral tongue that cannot be wiped off
- Firm white plaque on the attached gingiva
- Yellowish papules on the buccal mucosa
Correct answer: Erythematous patches under the denture-bearing mucosa
Denture stomatitis (chronic atrophic candidiasis) presents as erythema and inflammation of the palatal mucosa under the denture.
ADEX Patient Assessment and Diagnosis 3
A patient reports taking warfarin for atrial fibrillation.
Which laboratory value is most critical to review before initiating periodontal debridement?