TEST BANK
, CHAPTER LIST
Part 1: The Periodontium in Health Chapter 16: Local Factors Contributing to
Periodontal Disease
Chapter 1: Chapter 17: Tobacco, Smoking, and
Periodontium: The Periodontal Disease
Tooth Supporting Chapter 18: Nutrition, Inflammation, and
Structures Chapter 2: Periodontal Disease
Microscopic Anatomy of
the Periodontium Part 4: Assessment and Planning for Patients with
Periodontal Diseases and Peri-Implant
Part 2: Diseases Affecting the Periodontium and Diseases/Conditions
Peri-Implant Tissues
Chapter 19: Clinical Periodontal Assessment
Chapter 3: Overview of Diseases of the Chapter 20: Radiographic Analysis of the
Periodontium Periodontium
Chapter 4: Classification of Periodontal Chapter 21: Clinical Decision-Making for
Diseases, Peri-Implant Diseases, and Periodontal Care
Conditions Chapter 22: Shared Decision-Making for
Chapter 5: Periodontal Health, Gingival Periodontal Care
Diseases, and Conditions Chapter 23: Encouraging Patient Behavior
Chapter 6: Periodontitis Change with Motivational Interviewing
Chapter 7: Mucogingival Deformities and Chapter 24: Best Practices for Periodontal
Conditions Around Teeth Care
Chapter 8: Peri-Implant Health and Disease
Chapter 9: Acute Periodontal Diseases Part 5: Implementation of Therapy for Patients with
Periodontal Diseases and Peri-Implant
Part 3: Etiologic Factors for Periodontal Diseases Diseases/Conditions
and Peri-Implant Diseases/Conditions
Chapter 25: Nonsurgical Periodontal Therapy
Chapter 10: Risk Factors for Periodontal Chapter 26: Patient's Role in Nonsurgical
Diseases and Peri-Implant Periodontal Therapy
Diseases/Conditions Chapter 27: Supragingival and Subgingival
Chapter 11: Oral Biofilms Irrigation
Chapter 12: Basic Concepts of Immunity and Chapter 28: Chemotherapeutics in Periodontal
Inflammation Care
Chapter 13: Host Immunoinflammatory Chapter 29: Host Modulation Therapy
Response to Dental Biofilm Chapter 30: Periodontal Surgical Concepts for
Chapter 14: Impact of Systemic Diseases on the Dental Hygienist
Periodontal Health Chapter 31: Maintenance for the Periodontal
Chapter 15: Impact of Periodontal Patient
Inflammation on Periodontal Health
,Part 6: Other Aspects of the Management of Chapter 34: Comprehensive Patient Cases
Patients with Periodontal Diseases and PeriImplant
Diseases/Conditions Part 8: Online Resources
Chapter 32: Documentation and Insurance Chapter 35: Periodontal Disease in the
Reporting of Periodontal Care Pediatric Population
Chapter 33: Future Directions for Chapter 36: Iatrosedation: Easing and
Management of Periodontal Care Managing Pediatric Patient Fears
Chapter 37: Oral Malodor and Xerostomia
Part 7: Comprehensive Patient Cases Chapter 38: Patient Cases: Radiographic
Analysis
CHAPTER 1
Periodontium: The Tooth-Supporting Structures
MULTIPLE CHOICE QUESTIONS
1. Which of the following BEST defines the term 'periodontium'?
A) The hard tissues of the tooth including enamel, dentin, and cementum
B) The functional system of tissues that surrounds and attaches the teeth
to the jawbone
C) The soft tissue lining of the oral cavity excluding the gingiva
D) The lymphatic drainage system associated with the oral cavity
Answer: B
Rationale: The periodontium (peri = around; odontos = tooth) is defined as the functional
system of tissues that surrounds the teeth and attaches them to the jawbone. It includes
the gingiva, periodontal ligament, cementum, and alveolar bone.
,2. A dental hygienist inserts a periodontal probe to a depth of 2 mm on a
healthy anterior tooth. This probe tip is most likely resting at the level of the:
A) Mucogingival junction
B) Free gingival groove
C) Base of the gingival sulcus / junctional epithelium
D) Alveolar crest
Answer: C
Rationale: The clinically healthy gingival sulcus measures 1–3 mm in depth. A probe
inserted to 2 mm is at the base of the sulcus, which interfaces with the most coronal
portion of the junctional epithelium.
3. Which anatomical structure separates the free gingiva from the attached
gingiva and is often NOT visible to the naked eye?
A) Mucogingival junction
B) Free gingival groove
C) Gingival margin
D) Interdental col
Answer: B
Rationale: The free gingival groove is a shallow linear depression that separates the free
and attached gingiva. It is rarely visible to the naked eye, unlike the mucogingival
junction which is clinically visible.
4. The attached gingiva is WIDEST in which region of the mouth?
A) Premolar regions of both arches
B) Canine regions only
C) Incisor and molar regions
D) Third molar regions exclusively
Answer: C
Rationale: The attached gingiva is widest in the incisor and molar regions (3.3–3.9 mm
mandible; 3.5–4.5 mm maxilla) and narrowest in the premolar regions (1.8 mm mandible;
1.9 mm maxilla).
,5. Gingival stippling is CORRECTLY described as which of the following?
A) A smooth, glossy surface seen in all healthy individuals
B) A dimpled orange-peel texture present on the free gingiva only
C) A dimpled texture seen on the attached and interdental gingiva, present
in approximately 40% of healthy adults
D) A pathological surface change indicating early gingivitis
Answer: C
Rationale: Stippling is a dimpled, orange-peel appearance of the attached and
interdental gingiva (NOT the free gingiva). It is present in only about 40% of periodontally
healthy adults; its absence does not indicate disease.
6. The PRIMARY function of the periodontal ligament (PDL) is best described as:
A) Providing the blood supply to cementum and gingival tissues
B) Anchoring the tooth in its socket and absorbing mechanical loads during
mastication
C) Forming the junctional epithelium that seals the gingival sulcus
D) Producing the alveolar bone that supports the tooth roots
Answer: B
Rationale: The PDL is a network of soft connective tissue fibers that connects root
cementum to alveolar bone. Its primary function is to suspend and maintain the tooth in
its socket and absorb mechanical loads. Cementum receives nutrients from the PDL.
7. Which of the following CORRECTLY describes acellular cementum versus
cellular cementum?
A) Acellular cementum covers the apical third; cellular covers the cervical
twothirds
B) Acellular cementum forms before teeth reach occlusion; cellular
cementum forms after teeth reach occlusion
C) Acellular cementum contains cementocytes; cellular cementum does not
D) Both types form simultaneously before tooth eruption
,Answer: B
Rationale: Acellular cementum forms before teeth reach occlusion, is devoid of cells, and
covers the cervical two-thirds of the root. Cellular cementum forms after the teeth reach
occlusion, contains cementocytes, and covers the apical one-third.
8. Sharpey's fibers are best described as:
A) Nerve fibers that innervate the periodontal ligament space
B) The calcified terminal ends of PDL fibers embedded in cementum and
alveolar bone
C) Epithelial extensions of the junctional epithelium into the connective
tissue
D) Collagen fibers of the supragingival fiber bundles
Answer: B
Rationale: Sharpey's fibers are the calcified terminal ends of the PDL fiber bundles that
are embedded into both the root cementum and the alveolar bone proper, anchoring the
tooth in its socket.
9. In a periodontally healthy individual, the alveolar crest is located:
A) At the level of the cementoenamel junction (CEJ)
B) 1 to 2 mm apical to the CEJ
C) 3 to 4 mm apical to the CEJ
D) 1 to 2 mm coronal to the CEJ
Answer: B
Rationale: In health, the alveolar crest is located 1 to 2 mm apical to (below) the
cementoenamel junctions of the teeth, conforming to a scalloped form that follows the
CEJ contours.
10. Which of the following BEST explains why the alveolar bone resorbs after a
tooth is extracted?
A) The absence of saliva leads to bone destruction over time
B) The alveolar bone's existence is dependent on the presence of teeth
, C) Bacteria colonize the socket and destroy the remaining bone
D) The trigeminal nerve supply is severed, causing bone atrophy
Answer: B
Rationale: The existence of alveolar bone is directly dependent on the presence of teeth.
When teeth are extracted, the alveolar bone resorbs over time. Conversely, if teeth do not
erupt, alveolar bone does not develop.
11. The primary nerve responsible for innervation of the periodontium is:
A) Facial nerve (Cranial Nerve VII)
B) Glossopharyngeal nerve (Cranial Nerve IX)
C) Trigeminal nerve (Cranial Nerve V)
D) Hypoglossal nerve (Cranial Nerve XII)
Answer: C
Rationale: Innervation of the periodontium occurs via branches of the trigeminal nerve
(Cranial Nerve V). The maxilla is innervated by V2 (maxillary) and the mandible by V3
(mandibular).
12. Gingival crevicular fluid (GCF) flow is clinically significant because:
A) It is abundant in health and decreases with gingival inflammation
B) It flows from the connective tissue into the sulcus and increases with
inflammation, serving as an index of gingival inflammation
C) It contains no immune cells and therefore has no diagnostic value
D) It is only present in disease states and is absent in healthy sulci
Answer: B
Rationale: GCF seeps from underlying connective tissue into the sulcular space. Flow is
minimal in health but increases dramatically with dental plaque biofilm accumulation
and resultant gingival inflammation. It can be measured with a filter strip as an index of
inflammation.
13. The interdental col is ABSENT in which of the following clinical situations?
A) When teeth are in normal contact with each other
, B) When there is a diastema (space) between two adjacent teeth
C) When stippling is present on the attached gingiva
D) When the gingival sulcus is 2 mm in depth
Answer: B
Rationale: The interdental col is a valley-like depression in the interdental gingiva that
lies directly apical to the contact area of two adjacent teeth. It is absent when adjacent
teeth are not in contact (i.e., there is a space between them), when there is no adjacent
tooth, or if the interdental gingiva has receded.
14. Which of the following is a FORMATIVE function of the periodontal ligament?
A) Relaying pain and pressure sensations to the central nervous system
B) Suspending and maintaining the tooth within the alveolar socket
C) Housing fibroblasts, cementoblasts, and osteoblasts that build and
maintain the attachment apparatus
D) Transporting oxygen and nutrients to periodontal tissues via blood
vessels
Answer: C
Rationale: The formative function of the PDL involves specialized cells (fibroblasts,
cementoblasts, osteoblasts) that build and maintain the attachment apparatus
throughout the lifetime of the tooth. Dormant epithelial cells and undifferentiated cells in
the PDL may also play a role in periodontal regeneration.
15. A patient presents with a maxillary molar that requires local anesthetic.
Which lymph nodes are most responsible for draining the gingiva of the third
molar region?
A) Submental lymph nodes
B) Submandibular lymph nodes
C) Jugulodigastric lymph nodes
D) Deep cervical lymph nodes
Answer: C
Rationale: According to Gehrig & Shin, the jugulodigastric lymph nodes drain the gingiva
in the third molar region. Submental nodes drain the mandibular incisor region,
, CHAPTER LIST
Part 1: The Periodontium in Health Chapter 16: Local Factors Contributing to
Periodontal Disease
Chapter 1: Chapter 17: Tobacco, Smoking, and
Periodontium: The Periodontal Disease
Tooth Supporting Chapter 18: Nutrition, Inflammation, and
Structures Chapter 2: Periodontal Disease
Microscopic Anatomy of
the Periodontium Part 4: Assessment and Planning for Patients with
Periodontal Diseases and Peri-Implant
Part 2: Diseases Affecting the Periodontium and Diseases/Conditions
Peri-Implant Tissues
Chapter 19: Clinical Periodontal Assessment
Chapter 3: Overview of Diseases of the Chapter 20: Radiographic Analysis of the
Periodontium Periodontium
Chapter 4: Classification of Periodontal Chapter 21: Clinical Decision-Making for
Diseases, Peri-Implant Diseases, and Periodontal Care
Conditions Chapter 22: Shared Decision-Making for
Chapter 5: Periodontal Health, Gingival Periodontal Care
Diseases, and Conditions Chapter 23: Encouraging Patient Behavior
Chapter 6: Periodontitis Change with Motivational Interviewing
Chapter 7: Mucogingival Deformities and Chapter 24: Best Practices for Periodontal
Conditions Around Teeth Care
Chapter 8: Peri-Implant Health and Disease
Chapter 9: Acute Periodontal Diseases Part 5: Implementation of Therapy for Patients with
Periodontal Diseases and Peri-Implant
Part 3: Etiologic Factors for Periodontal Diseases Diseases/Conditions
and Peri-Implant Diseases/Conditions
Chapter 25: Nonsurgical Periodontal Therapy
Chapter 10: Risk Factors for Periodontal Chapter 26: Patient's Role in Nonsurgical
Diseases and Peri-Implant Periodontal Therapy
Diseases/Conditions Chapter 27: Supragingival and Subgingival
Chapter 11: Oral Biofilms Irrigation
Chapter 12: Basic Concepts of Immunity and Chapter 28: Chemotherapeutics in Periodontal
Inflammation Care
Chapter 13: Host Immunoinflammatory Chapter 29: Host Modulation Therapy
Response to Dental Biofilm Chapter 30: Periodontal Surgical Concepts for
Chapter 14: Impact of Systemic Diseases on the Dental Hygienist
Periodontal Health Chapter 31: Maintenance for the Periodontal
Chapter 15: Impact of Periodontal Patient
Inflammation on Periodontal Health
,Part 6: Other Aspects of the Management of Chapter 34: Comprehensive Patient Cases
Patients with Periodontal Diseases and PeriImplant
Diseases/Conditions Part 8: Online Resources
Chapter 32: Documentation and Insurance Chapter 35: Periodontal Disease in the
Reporting of Periodontal Care Pediatric Population
Chapter 33: Future Directions for Chapter 36: Iatrosedation: Easing and
Management of Periodontal Care Managing Pediatric Patient Fears
Chapter 37: Oral Malodor and Xerostomia
Part 7: Comprehensive Patient Cases Chapter 38: Patient Cases: Radiographic
Analysis
CHAPTER 1
Periodontium: The Tooth-Supporting Structures
MULTIPLE CHOICE QUESTIONS
1. Which of the following BEST defines the term 'periodontium'?
A) The hard tissues of the tooth including enamel, dentin, and cementum
B) The functional system of tissues that surrounds and attaches the teeth
to the jawbone
C) The soft tissue lining of the oral cavity excluding the gingiva
D) The lymphatic drainage system associated with the oral cavity
Answer: B
Rationale: The periodontium (peri = around; odontos = tooth) is defined as the functional
system of tissues that surrounds the teeth and attaches them to the jawbone. It includes
the gingiva, periodontal ligament, cementum, and alveolar bone.
,2. A dental hygienist inserts a periodontal probe to a depth of 2 mm on a
healthy anterior tooth. This probe tip is most likely resting at the level of the:
A) Mucogingival junction
B) Free gingival groove
C) Base of the gingival sulcus / junctional epithelium
D) Alveolar crest
Answer: C
Rationale: The clinically healthy gingival sulcus measures 1–3 mm in depth. A probe
inserted to 2 mm is at the base of the sulcus, which interfaces with the most coronal
portion of the junctional epithelium.
3. Which anatomical structure separates the free gingiva from the attached
gingiva and is often NOT visible to the naked eye?
A) Mucogingival junction
B) Free gingival groove
C) Gingival margin
D) Interdental col
Answer: B
Rationale: The free gingival groove is a shallow linear depression that separates the free
and attached gingiva. It is rarely visible to the naked eye, unlike the mucogingival
junction which is clinically visible.
4. The attached gingiva is WIDEST in which region of the mouth?
A) Premolar regions of both arches
B) Canine regions only
C) Incisor and molar regions
D) Third molar regions exclusively
Answer: C
Rationale: The attached gingiva is widest in the incisor and molar regions (3.3–3.9 mm
mandible; 3.5–4.5 mm maxilla) and narrowest in the premolar regions (1.8 mm mandible;
1.9 mm maxilla).
,5. Gingival stippling is CORRECTLY described as which of the following?
A) A smooth, glossy surface seen in all healthy individuals
B) A dimpled orange-peel texture present on the free gingiva only
C) A dimpled texture seen on the attached and interdental gingiva, present
in approximately 40% of healthy adults
D) A pathological surface change indicating early gingivitis
Answer: C
Rationale: Stippling is a dimpled, orange-peel appearance of the attached and
interdental gingiva (NOT the free gingiva). It is present in only about 40% of periodontally
healthy adults; its absence does not indicate disease.
6. The PRIMARY function of the periodontal ligament (PDL) is best described as:
A) Providing the blood supply to cementum and gingival tissues
B) Anchoring the tooth in its socket and absorbing mechanical loads during
mastication
C) Forming the junctional epithelium that seals the gingival sulcus
D) Producing the alveolar bone that supports the tooth roots
Answer: B
Rationale: The PDL is a network of soft connective tissue fibers that connects root
cementum to alveolar bone. Its primary function is to suspend and maintain the tooth in
its socket and absorb mechanical loads. Cementum receives nutrients from the PDL.
7. Which of the following CORRECTLY describes acellular cementum versus
cellular cementum?
A) Acellular cementum covers the apical third; cellular covers the cervical
twothirds
B) Acellular cementum forms before teeth reach occlusion; cellular
cementum forms after teeth reach occlusion
C) Acellular cementum contains cementocytes; cellular cementum does not
D) Both types form simultaneously before tooth eruption
,Answer: B
Rationale: Acellular cementum forms before teeth reach occlusion, is devoid of cells, and
covers the cervical two-thirds of the root. Cellular cementum forms after the teeth reach
occlusion, contains cementocytes, and covers the apical one-third.
8. Sharpey's fibers are best described as:
A) Nerve fibers that innervate the periodontal ligament space
B) The calcified terminal ends of PDL fibers embedded in cementum and
alveolar bone
C) Epithelial extensions of the junctional epithelium into the connective
tissue
D) Collagen fibers of the supragingival fiber bundles
Answer: B
Rationale: Sharpey's fibers are the calcified terminal ends of the PDL fiber bundles that
are embedded into both the root cementum and the alveolar bone proper, anchoring the
tooth in its socket.
9. In a periodontally healthy individual, the alveolar crest is located:
A) At the level of the cementoenamel junction (CEJ)
B) 1 to 2 mm apical to the CEJ
C) 3 to 4 mm apical to the CEJ
D) 1 to 2 mm coronal to the CEJ
Answer: B
Rationale: In health, the alveolar crest is located 1 to 2 mm apical to (below) the
cementoenamel junctions of the teeth, conforming to a scalloped form that follows the
CEJ contours.
10. Which of the following BEST explains why the alveolar bone resorbs after a
tooth is extracted?
A) The absence of saliva leads to bone destruction over time
B) The alveolar bone's existence is dependent on the presence of teeth
, C) Bacteria colonize the socket and destroy the remaining bone
D) The trigeminal nerve supply is severed, causing bone atrophy
Answer: B
Rationale: The existence of alveolar bone is directly dependent on the presence of teeth.
When teeth are extracted, the alveolar bone resorbs over time. Conversely, if teeth do not
erupt, alveolar bone does not develop.
11. The primary nerve responsible for innervation of the periodontium is:
A) Facial nerve (Cranial Nerve VII)
B) Glossopharyngeal nerve (Cranial Nerve IX)
C) Trigeminal nerve (Cranial Nerve V)
D) Hypoglossal nerve (Cranial Nerve XII)
Answer: C
Rationale: Innervation of the periodontium occurs via branches of the trigeminal nerve
(Cranial Nerve V). The maxilla is innervated by V2 (maxillary) and the mandible by V3
(mandibular).
12. Gingival crevicular fluid (GCF) flow is clinically significant because:
A) It is abundant in health and decreases with gingival inflammation
B) It flows from the connective tissue into the sulcus and increases with
inflammation, serving as an index of gingival inflammation
C) It contains no immune cells and therefore has no diagnostic value
D) It is only present in disease states and is absent in healthy sulci
Answer: B
Rationale: GCF seeps from underlying connective tissue into the sulcular space. Flow is
minimal in health but increases dramatically with dental plaque biofilm accumulation
and resultant gingival inflammation. It can be measured with a filter strip as an index of
inflammation.
13. The interdental col is ABSENT in which of the following clinical situations?
A) When teeth are in normal contact with each other
, B) When there is a diastema (space) between two adjacent teeth
C) When stippling is present on the attached gingiva
D) When the gingival sulcus is 2 mm in depth
Answer: B
Rationale: The interdental col is a valley-like depression in the interdental gingiva that
lies directly apical to the contact area of two adjacent teeth. It is absent when adjacent
teeth are not in contact (i.e., there is a space between them), when there is no adjacent
tooth, or if the interdental gingiva has receded.
14. Which of the following is a FORMATIVE function of the periodontal ligament?
A) Relaying pain and pressure sensations to the central nervous system
B) Suspending and maintaining the tooth within the alveolar socket
C) Housing fibroblasts, cementoblasts, and osteoblasts that build and
maintain the attachment apparatus
D) Transporting oxygen and nutrients to periodontal tissues via blood
vessels
Answer: C
Rationale: The formative function of the PDL involves specialized cells (fibroblasts,
cementoblasts, osteoblasts) that build and maintain the attachment apparatus
throughout the lifetime of the tooth. Dormant epithelial cells and undifferentiated cells in
the PDL may also play a role in periodontal regeneration.
15. A patient presents with a maxillary molar that requires local anesthetic.
Which lymph nodes are most responsible for draining the gingiva of the third
molar region?
A) Submental lymph nodes
B) Submandibular lymph nodes
C) Jugulodigastric lymph nodes
D) Deep cervical lymph nodes
Answer: C
Rationale: According to Gehrig & Shin, the jugulodigastric lymph nodes drain the gingiva
in the third molar region. Submental nodes drain the mandibular incisor region,
