KNOW your bacterial byproducts (like

liposaccarides from G- and

Lipotechoic acids from G-) and
immune products (like prostglands, TNF, MMP)!

Which of the following is signs of gingivitis? (Bleeding. Not loss of attachment or

deep pockets)
Gingivitis
Periodontitis
Colour change- red
Inflammation spread beyond gingiva
Contour
Marginal alveolar bone resorption
Consistency of gingiva
Continued degradation of collagen
Bleeding
fibres (apically)
inflammation
Deepened periodontal pocket
ANSWER: NOT ATTACHMENT LOSS
What inflammatory mediator causes osteoclast activity
ANSWER: PGE2, IL -1, TFNa
What directly leads to bone resportion?
ANSWER: Inflammatory mediators triggering osteoclast action

What did Salvy et al study find regarding smoking over 3 weeks

ANSWER: Smokers and non smokers have the same initial stages
Which of these diseases is not linked to periodontitis
Pregnancy
COPD
Diabetes
low pre-term birth weight
ANSWER: SQUAMOUS CELL CARCINOMA)
What is the primary goal of periodontal therapy
ANSWER: Make the oral environment compatible with health
o remove calculus or reduce inflammation

Which of these is not secreted by bacteria

Protease- release by colonies instead of inflammatory response

Lipopolysaccharide ve
Leukotoxins- target WBC
Lipteichnoic acid- +ve

ANSWER: liposacchyries, Tumour Necrosis Factor, etc)

Which of the following is not an inflammatory mediator

ANSWER: lipotechoic acid
What is characterised in the initial phase by Page & Schoder?
ANSWER: blood vessel vascularity)

What is biofilm: PLAQUE is a biofilm

SOFT ADHERENT STRUCTURED DEPOSITS On THE TEETH AND OTHER
STRUCTURES IN THE MOUTH, CONSISTING OF A CONTINUALLY GROWING
MICROBIAL COLONY IN AN INTER-MICROBIAL MATRIX.

What is not part of the periodontium?

a. Investing & supportive structures
b. Cementum- support fibres of the periolegament
c. Periodontial Ligament- attachment apparatus
d. Alveolar bone
e. Gingiva, protection of underlying tissues
Cementum? What does it do?
f. Supports fibres of the PDL
g. Harder than dentin
h. Has acellular & cellular components
i. None
j. All of the above
2. Which one is not a periodontial classification?
a. Refractory periodontitis
What are things that can modify chronic periodontitis
Modifying factors or associated with systemic diseases (e.g. diabetes, HIV).
Other modifying factors: cigarette smoking and emotional stress
Chronic periodontitis:
1. Localised
2. Aggressive
Infectious disease = inflammation of supporting structure (tissue, teeth, progressive attachment loss)
Characterised:
o Pocket formation
o Gingival recession
Clinical features & charcteristics:
o Prevalence adults/ ?occurs children
o Amount destruction = consistet with local factors
o Subgingival calculus = present (frequent finding)
o Slow to moderate rate of progression
Periods: rapid progression
Further classified:
a. LOCALISED: <30% sites are affected
b. GENERALISED: >30% sites are affected
c. Mild slight 1-2mm clinical attachment loss (CAL)
d. Moderate: 3-4mm (CAL)
e. Severe: >4mm (CAL)

PERIODONTITIS AS A MANIFESTATION OF SYSTEMIC DISEASE:

haematological disorders:
o Acquired neutropenia
o Leukemia
Associated with genetic disorders:
o Cyclic neutropenia
o Downs syndrome
Which disease is not associated:
o Leukocyte adhesion deficiency syndrome
Ans: Squamous cell carcinoma
o Papillion-Lefevre syndrome
o Histiocytosis
o Cohen syndrome
o Hypophosphatasia
o Glycogen storage disease
o Infantile genetic agranulocytosis
o Ehlers-Danlos syndrome (types IV and VIII)

What is characterised in the established phase by Page & Schoder?

plasma cells dominate
Which bacteria are/arent part of the RED PYRAMID
a. T. forsyth
b. T. denticola
c. P.gingivalis

When is plaque mature enough to cause inflammation?

Takes around 21 days for plaque to be mature enough to incite and inflammatory
response from the host
Antigenic bacteria products are:
a. Protease- release by colonies instead of inflammatory response
b. Lipopolysaccharide ve
c. Leukotoxins- target WBC
d. Lipteichnoic acid- +ve

Features of aggressive periodontitis

b. rapid bone distruction
which is not associated with periodontitis in a systemic disease?
c. Squamous cell carcinoma
Chronic vs aggressive periodontitis which is not true?
d. Aggressive periodontitis is not consistent with local factors
What are the main inflammatory mediators:
a. Cytokines
b. Prostaglandins
c. Interleukins
d. Tumour necrosis factor
e. Liptotic acid: antigenic bacteria- product not mediator

What is a biofilm?
a. Food mass
b. Supragingival accumulations
c. Microbial colony deposits on the teeth
What are bacteria in disease?
e. Gram ve
f. Anaerobic bacteria
g. P. gingivalis
h. T. denticola
i. A.actinomycetemcomitans
Which bacteria are found in health
ANSWER: aerobes and gram postitive)
What angle do you hold a scaler
ANSWER: 60-80degree
What is the difference between Gracey and Universal scalers
ANSWER: universal have two working sides on each end
gracey have one)
Which is a *fancy word for definite confirming indicator* of periodontitis
ANSWER: irreversible attachment/bone loss, NOT bacteria, inflammation etc)
Classifications of periodontal disease they asked which one wasnt an existing
classification

ANSWER: Refractory ..

Differences of the features of Gingivitis and Periodontitis e.g. bone loss, loss of
attachment, bacteria assoc., with perio; and gingivitis has bleeding gums, know the
bacteria assoc. as well.
When does gingivitis occur?

ANSWER: 2-3 days without mechanical removal of plaque

How do you treat chronic perio?

ANSWER: with mechanical removal of plaque, not sure if it was right though

Main pathogonomic finding of periodontitis

ANSWER: bone loss

Primary goal of perio therapy

ANSWER: stop the inflammation and bleeding

What is the next phase of treatment for PSR of 2? PSR 2 has calculus, so I think
the answer was something along the lines of OHI, mechanical debridement and one
other thing that I forgot
KNOW the different types of bacteria in the biofilm:
a. In health
b. And in periodontal disease
KNOW which bacteria are in Socranskys (?) red complex of the pyramid in the
pyramid picture these are at the tip of the apex
What do cytokines do?
What causes the production of antibodies? plasma cells

Which of the following is an osteoclast stimulator? just to be safe, the ones he

talks about are PGE2, IL-1 and TFNa
Causes of tooth mobility bruxism is NOT a factor
What is the definition of a modifying factor?
Which of the following are predisposing factors? overhangs
What are the effects of uncontrolled diabetes
KNOW about aggressive perio

1. Perio can cause:

a. Can cause cardiovascular disease through a variety of pathological
mechanisms
b. Can cause cardio through spread of bacteria from subgingival plaque
c. Can cause artheroma on vessel
WHICH SYSTEMIC DISEASES HAVE BEEN ASSOCIATED WITH
PERIODONTAL DISEASE?
1. Cardiovascular disease
2. Pulmonary disease COPD and Bacterial pneumonia
3. Low birth weight and preterm pregnancy
4. diabetes
2. What is the most appropriate Tx for a Max molar grade III furcation?
a. Resection (root amputation), tunnel exo
b. GTR
c. Crown lengthening
d. ?
WHAT ARE THE MAIN TREATMENTS FOR FURCATION
INVOLVEMENT
Severity
Tx options
Non-surgical therapy (ARP)
Class I
Furcation plasty
SRP
Class II
Furcation plasty
Regeneration (Mandibular molars)
Resectve surgeries (root resection/hemisection)
Tunnel preparation
Extraction
SRP
Class III
Resective surgeries
Tunnel preparation
extraction
3. What is the most appropriate Tx for a Mand molar Grade III furcation?
a. Occlusal splinting
b. Crown lengthening
c. Fill furcation
d. tunnel prep

4. What is GTR?
a. The repopulation of defected cells derived from PDL and bone at the
expense of gingval epithelium and CT
WHAT ARE THE BIOLOGICAL PRINCIPLES BEHIND:
GUIDED TISSUE REGENERATION
GTR by excluding the epithelium and preventing it from attaching to the root
surface therefore allowing development of PDL, cementum and bone.
EMDOGAIN
EMD uses the porcine foetal amelogenin which promotes PDL fobroblast
proliferation and inhibits epithelial proliferation
NOTE* Both seek to mimic the natural embryonic development of the
periodontium.
5. Which of the following is correct regarding chemical plaque control?
a. Long term substitute to tooth-brushing
b. Short term sub to toothbrushing i.e. after perio surgery
c. Essential in everyday use
d. Reduces perio disease
6. When do you use Perio surgery?
a. No improvement after hygienic phase
b. Poor oral hygiene
c. Improvement after hygienic phase
d. Pocket depths greater the 5mm
WHAT ARE THE INDICATIONS FOR PERIODONTAL SURGERY
1. Areas with irregular bony contours, deep contours and other defects.
2. Pockets on teeth which prevent complete removal of plaque, commonly
molars (deep pocket depths)
3. Grade II or III furcation involvement
4. Infrabony pockets on distal side of last molars
5. Persistant inflammation that is unresponsive to non-surgical treatment

WHEN DO WE USE PERIODONTAL SURGERY FOR THE TREATMENT

OF PERIODONTITIS?
1. When conservative non-surgical treatment has failed, after phase 1 therapy
(scaling and root planning)
2. Assessed at the review session 1-3 months after treatment.

7. What is regeneration of tissue?

a. Reconstruction of periodontial tissue, PDL, cementum and bone over a
disease root surface
WHAT S THE DEFINITION OF PERIODONTAL REGENERATION & HOW
DOEA IT DIFFER FROM OTHE TYPES OF PERIODONTAL HEALING?
1. REGENERATION is defined as a reproduction or reconstitution of a lost or
injured part in such a way that architecture and function are completely
restored. Histologically characterised by restoration of all of the tooths
supporting tissues including alveolar bone, PDL and cementum over a
diseased root surface.
2. HEALING is restoration of new tissue that does not replicate the structure
and function of the lost tissue. Eg the formation of an elongated epithelial
junction but there is no PDL, cementum or bone replacement.
3. NEW ATTACHMENT- is the reunion of connective tissues with a
pathologically exposed root surface that is deprived of its periodontal ligament
and may or may not include new cementum
8. What is different about the bone around an implant?
a. no PDL
b. Incr elasticity
c. Harder bone
d. More blood supply
9. What is different about the soft tissues around an implant?
a. No CT
b. No blood vessel
c. NO inserting fibres
10. What is the treatment for a perio-endo lesion?
a.
b. Endo Tx then Perio is the lesion reduces in size
c. Endo then Perio is necessary
d. Perio then Endo

11. What are the common side effects of periodontal surgery?

a. Root sensitivity and recession
b. Gingival hyperplasia and pain
c. Pain and infection
d. ?

12. What is involved in the maintenance of implants?

a. Radiograph and OH frequently
b. Refer to specialist
c. Clinical exam
d. Clinical and radiographic exams frequently
13. Grade II furcation is:
a. Horizontal bone loss 3mm through furcation
b. Horizontal bone loss 3mm through furcation and bleeding on probing
c. Horizontal bone loss 3mm through furcation and does not
penetrate all the way through
d. Probe penetrates all the way through
14. The prognosis of 44
a. Good, secure
b. Doubtful
c. Bad, irrational to Tx
15. 37
16. 21
17. 28
18. What type of Perio does this pt have?
a. Chronic generalised gingivistis
b. Chronic localised ging
c. Chronic generalised perio
d. Chronic localised perio
e. Aggressive perio
19. What is the Tx for the pt
a. Disease info, OHI, S/C, review
b. Disease info, OHI, CHX for 4 week, S/C, review
c. OHI, S/C, review
d. Disease info, OHI, antibiotics, S/C, review
e. Disease info, OHI, occlusal splinting and stabilisation, S/C, review