National Boards Dental Hygiene Exam

Sharpey's fibers

connect periosteum to bone

What fibers of the PDL are the most prominent?

Oblique fibers

Stillman's cleft

v shaped loss of gingiva. Due to bad flossing habits

McCall's festoon

innertube shaped swelling at the marginal gingiva

Drug induced gingival hyperplasia

Dilantin (Phenytoin)

Procardia (Nifedipine)

Cyclosporin (immunosuppressant)

dihiscence

loss of alveolar bone

oval shaped root exposure apical to CEJ

Fenestration

a window-like opening in the bone covering the root of a tooth bordered by alveolar bone on the coronal aspect of the tooth.

Bacteria shape present in early plaque formation

cocci shaped, aerobic

Bacteria shape in periodontal disease

baccilli, anaerobic

Bacteria shape present in NUG/NUP

spirochetes

periodontal bacteria in health

aerobic, cocci, gram +

Periodontal bacteria in diease

anaerobic, baccilli, gram -

Names of the bacteria that cause periodontal disease

P. Gingivalis

F. Nucletum

T. Forsythia

A. Actinomycetescomatins

Bacteria responsible for NUG

P. Gingivalis

T. Dentacolo

P. Intermedian

Fusobactrium

Bacteria responsible for caries

S. Mutans

Lactobacillus

S. Sobrinus

What bacteria is most commonly associated with aggressive periodontitis

A. Actinomycetescomatins

Is plankton plaque adherent or non adherent?

non adherent

how do endotoxins contribute to tissue destruction?

Stimulate osteoclast

periodontal disease

apical migration of the junctional epithelium

CAL

measures attachment loss

CEJ to base of pocket

What instrument is best to detect a furcation

Nabers Probe

Suprabony pocket

The pocket is located above the level of the bone, NOT visible on a radiograph.

Infrabony pocket

base of pocket is apical to crest of alveolar bone

Does occlusal trauma cause periodontal disease

No

Primary Herpetic Gingivostomatitis

HSV type 1

usually affects children younger than 6

Inflamed, enlarged marginal gingiva; gingival bleeding

pin point vesicles -> ulcers throughout the mouth and lips w/ sig pain

Malise

low grade fever

sore throat, lymphadenopathy

doesnt want to drink water

Is a patient with down syndrome at a greater risk for caries

No, but they are at an increased risk for perio

How to treat NUG/NUP

Tetracycline

Can a periodontal abscess be a result of periodontal debridement

yes

First step of hemodynamic changes

1. Temporary (transient) vasoconstriction THEN vasodialation takes place

Hyperemia

excess of blood in an area of the body

Margination

Movement of WBC to periphery vessel wall

Pavementing

WBC line walls of blood vessel

Diapedesis

neutrophils squeeze through capillary walls and begin phagocytosis

Chemotaxis

cells move to the site of inflammation

Neutrophils (PMNs)

Function in phagocytosis, it is the most common cell in acute inflammation. It is a key WBC in the development and progression of disease

WBC associated with chronic inflammation

Macrophage

What biochemical mediator allows cells to leave the blood vessels?

Interleukins

What biochemical mediator is associated with pain and swelling?

Prostaglandins

P=Pain

What biochemical mediator causes bronchoconstriction?

Leukotrienes

L=Lungs

What are the stages of a periodontal lesion?

Stage I: Initial lesion (2-4 days)

Stage II: Early lesion (4-7 days)

Stage III: Established Lesion (2-3 weeks)

Stage IV: Advanced lesion (3 weeks- years)

In which stage of a periodontal lesion is there no clinical changes?

Stage I

Gingivitis begins to appear at what stage of a periodontal lesion?

Stage II, bleeding will occur

What stage of a periodontal lesion is periodontal disease considered to be?

Stage IV

Gingival edema begins to occur at what stage of a periodontal lesion?

Stage III

Diabetes mellitus

-Pts at greater risk for xerostomia, caries, and periodontal disease

-candidiasis

-delayed wound healing

Scurvy

Vitamin C deficiency, it is needed for collagen production and wound healing

What bacteria is associated with pregnancy gingivitis?

Prevotella intermedia, campylobacter retus

How does smoking affect the periodontium?

Vasoconstriction

impaired neutrophil response to perio pathogens

oral mucositis

inflammation of oral tissues

often seen in cancer pts

dysgeusia

altered taste

urticaria

hives

emesis

vomiting

Periodontal presentation of HIV

- Oral hairy leukoplakia

-Linear Gingival erythrma

- NUP

- Kaposi's sarcoma

Kaposi's Sarcoma (HHV-8)

malignancy of blood vessels

presents as a blue/ purple macule

Post SRP

Have a re-evaluation appoint 4-6 weeks later

1st step is to assess the gingiva

What has a better prognosis? A 3 wall defect or a 1 wall defect?

a 3 wall defect. The more walls (higher #) means there are more walls supporting the tooth

Active ingredient in Arestin?

minocycline

Active ingredient in Periochip?

Chlorahexidine

What is the most common procedure to reduce periodontal pockets?

Gingivectomy.

Removal of soft tissue only. For hyperplasia/ pseudo pockets

Gut sutures are placed after surgery. What does this mean?

The stiches are bioabsorbale

Silk sutures are

non-absorbable

Does a periodontal dressing prevent plaque build up?

no

How do you treat an infrabony defect?

Guided tissue regeneration

osseous or soft tissue graft

(the picture is of a dogs mouth, but still helpful as a visual)

What are the four stages of fibrous repair?

1. Blood clotting

2. Wound cleansing

3. Tissue rebuilding

4. Wound remodeling

At which stage of fibrous repair is granulation tissue introduced?

3. Tissue rebuilding

In which stage of fibrous repair are macrophages introduced?

wound cleansing

Tobacco use affects the periodontium by

a. vasodilation

b. loss of protective keratin

c. reduced blood supply to the tissues

d. enhanced phagocytosis

C. Reduced blood supply to the tissues

The most common type of bacteria on the dorsum of the tongue and other soft tissues in a healthy mouth?

a. Streptococci

b. Staphylococci

c. Fusobacterium

d. porphyromonas

a. streptococci

Porphyromonas gingivalis are?

Pathogenic bacillus bacteria that are prevalent in many chronic periodontal diseases

Initial gingival lesion (stage I) will exhibit

no clinical signs

What bacteria is not associated with chronic periodontitis ?

A) T. Denticola

B) P. Intermedia

C) S. Mutans

D) P. Gingivalis

S. mutans

Which of the following is a characteristic of the progression of periodontal disease?

a. Cocci

b. Motile organisms

c. Aerobic organisms

d. gram + organisms

motile organism

Endotoxins

A) Is produced by a mast cell

B) Stimulates osteoclast activity

C) Is produced by B-lymphocytes

D) Stimulates the secretion of immunoglobulins

Stimulates osteoclast activtity

Which assessment finding indicates that a pts periodontal disease progressing?

a. periodontal pockets

b. BOP

c. evidence of radiographic bone loss

d. attachment loss increasing over time

attachment loss increasing over time

Sharpeys fibers are found in

Cementum and alveolar bone

when probing a class II furcation

the probe will penetrate the furcation but not pass complete through

After perio surgery, patients who smoke

heal slower due to reduced fibroblast migration and a reduction in the positive effects of the inflammatory response

circular fibers

a. resist horizontal tooth movements

b. supply nutrient to periodontal structures

c. resist intrusive and extrusive forces on a tooth

d. assist in maintaining marginal gingival integrity with a tooth surface

What is the only bone that is not attached to another bone

hyoid bone

which foramen does the 7th cranial nerve run through

stylomasto foramen

through which bone does all three divisions of the trigeminal nerve run through

sphenoid bone

superior orbital fissure of sphenoid bone

the ophthalmic division of the trigeminal nerve runs through here

foramen rotundum of sphenoid bone

maxillary division of trigeminal nerve division of the trigeminal nerve runs through here

foramen ovale of sphenoid bone

mandibular branch division of the trigeminal nerve run through here

what muscles of the tongue protrudes it outwards

genioglossus

how many cranial nerves are there?

12

"Oh, Oh, Oh, To, Touch, And, Feel, Very, Good, Velvet"

"Some Say Marry Money But My Brother Says Big Boobs Matter More"

What is cranial nerve V?

trigeminal nerve

What is cranial nerve VII?

facial nerve, it supplies the facial muscles, taste to anterior 2/3 of tongue, and the parasympathetic intervention of the submandibular and sublingual salivary glands

What is cranial nerve IX

Glossopharyngeal; responsible for senses, taste of the posterior 1/3 of tongue and parasympathetic innervation of the parotid gland

what is cranial nerve XII?

Hypoglossal; controls most of the tongue movements, important for speech and swallowing. It does not include the palatoglossal muscle

PSA block anesthetizes:

Maxillary molars EXCEPT the MB root of the first molar and facial gingival tissue

MSA block will provide anesthesia to what areas?

Max Premolars and the MB root of Mx 1st molar, AND the facial gingival tissue

ASA block will provide anesthesia to what areas?

Max anterior teeth and facial gingival tissue

IA block will provide anesthesia to what areas?

All areas of the manible except the buccals of the 1st, 2nd and 3rd molars

Mental block will provide anesthesia to what areas?

first mandibular premolar to midline. No teeth are anesthetized!! Soft tissue only

Buccal block will provide anesthesia to what areas?

Buccal gingival tissue of molars

What branch of the trigeminal nerve innervates the muscles of mastication?

V3: the mandibular branch of the trigeminal nerve

What muscles open the mouth?

lateral pterygoid, and hyoid muscles

What are the muscles of mastication?

temporalis, masseter, lateral pterygoid, medial pterygoid

Trismis

condition that causes reduced mobility of the jaw