Stages of Gingivits

 All the questions have been directly picked from Carranza 11th edition

 


1.      Periodontitis fall under which stage of gingival inflammation

a.       Stage I gingivitis: the initial lesion 

b.      Stage II gingivitis: the early lesion 

c.       Stage III gingivitis: the established lesion 

d.      Stage IV gingivitis: the advanced lesion

Ans: D

 

2.      The initial lesion of gingivitis

a.       focused on acute inflammation

b.      accumulation of polymorphonuclear leukocytes

c.       seen as early as 2 days after plaque accumulates

d.      all of the above

ans: D



 


                  

3.      The predominant cells in early lesions are

a.       PMNs

b.      B-Lymphocytes

c.       Plasma cells

d.      T-lymphocytes

Ans: B

 

 

4.      Gingival fluid flow and the numbers of transmigrating leukocytes reach their maximum between

a.       2-3 days after the onset of clinical gingivitis

b.      4-6 days after the onset of clinical gingivitis

c.       6-12 days after the onset of clinical gingivitis

d.      Before the onset of clinical gingivitis

Ans: C

 

5.      Rete-pegs in junctional epithelium

a.       Present in case of inflammation only

b.      Present in the absence of inflammation only

c.       Present throughout regardless of the inflammation

d.      Never present whether the tissue is inflamed or normal

Ans: A

The junctional epithelium may begin to show development of rete pegs or ridges in the early lesion.

 

 

6.      The B cells found in the established lesion are predominantly of the immunoglobulin

a.       G2 (IgG2) and G3 (IgG3) subclasses

b.      G1 (IgG1) and G2 (IgG2) subclasses

c.       G1 (IgG1) and G3 (IgG3) subclasses

d.      G1 (IgG1) and G4 (IgG4) subclasses

Ans: G1 (IgG1) and G3 (IgG3) subclasses

 

 

7.      Localized gingival anoxemia is seen in

a.       Stage I gingivitis: the initial lesion 

b.      Stage II gingivitis: the early lesion 

c.       Stage III gingivitis: the established lesion 

d.      Stage IV gingivitis: the advanced lesion

Ans: C

·         Stage III corresponds to chronic gingivitis.

·         In chronic gingivitis, which occurs 2 to 3 weeks after the beginning of plaque accumulation, the blood vessels become engorged and congested, venous return is impaired, and the blood flow becomes sluggish.

·         The result is localized gingival anoxemia, which superimposes a somewhat bluish hue on the reddened gingiva

 

 

8.      Untrue about established lesions

a.       May remain stable and do not progress for months or years

b.      May become more active and convert to progressively destructive lesions

c.       Reversible

d.      All of them are true

Ans: D

Established lesions of two types appear to exist;

·         some remain stable and do not progress for months or years, and

·         others seem to become more active and to convert to progressively destructive lesions.

·         Also, the established lesions appear to be reversible in that the sequence of events occurring in the tissues as a result of successful periodontal therapy seems to be essentially the reverse of the sequence of events observed as gingivitis develops.

 

 

9.      In advanced lesion or phase of periodontal breakdown,

a.       Plasma cell predominates both connective tissue and junctional epithelium

b.      Neutrophil predominates both connective tissue and junctional epithelium

c.       plasma cell predominates connective tissue and neutrophils dominate the junctional epithelium

d.      Neutrophil predominates connective tissue and plasma cells dominate the junctional epithelium.

Ans: C

 

 

10.  Not a feature of Gingivitis:

a.       sponginess of the gingival tissue

b.      changes in contour

c.       bleeding on provocation

d.      radiographic evidence of crestal bone loss

ans: D

 

 

11.  earliest clinical sign of gingivitis

a.       decreased GCF flow

b.      color change

c.       bleeding on probing

d.      loss of stippling

ans: C

 

 

12.  Gingivitis that involves the gingival margin of upper right canine and include a portion of the contiguous attached gingiva is

a.       Papillary gingivitis

b.      Diffuse gingivitis

c.       Marginal gingivitis

d.      Generalized marginal gingivitis

Ans: C

·         Marginal gingivitis involves the gingival margin and may include a portion of the contiguous attached gingiva.

·         Papillary gingivitis involves the interdental papillae and often extends into the adjacent portion of the gingival margin.

·         Papillae are involved more frequently than the gingival margin, and the earliest signs of gingivitis often occur in the papillae.

·         Diffuse gingivitis affects the gingival margin, the attached gingiva, and the interdental papillae.

 

 

13.  If a patient quits smoking, bleeding on probing

a.       Increases

b.      Decreases

c.       Remains the same

d.      No relation between bleeding on probing and smoking

Ans: A

·         Cigarette smoking suppresses the gingival inflammatory response, and gingival bleeding on probing

·         Hence, there is an increase in gingival bleeding on probing in patients who quit smoking

·         Thus people who are committed to a smoking cessation program should be informed about the possibility of an increase in gingival bleeding associated with smoking cessation.

 

 

14.  The cellular infiltrate of sites that bleed on probing predominantly is

a.       Neutrophils

b.      Macrophage

c.       Lymphocyte

d.      Basophils

Ans: C

·         Bleeding on probing is a characteristic of stage II, or early gingivitis.

 

 

15.  Bleeding in probing is due to

a.       Thinning of epithelium

b.      Atrophy of the epithelium

c.       Engorged and dilated capillaries

d.      All of them

Ans: D

 

 

16.  Not a sign of gingivitis

a.       Increased pocket depth

b.      Loss of attachment

c.       Spontaneous bleeding from gums

d.      Increased gingival crevicular fluid flow

Ans: B

 

 

17.  The color of the gingiva is determined by all except

a.       Number and size of blood vessels

b.       Epithelial thickness

c.       Quantity of keratinization

d.      Presence of inflammatory cells

Ans: D

·         The color of the gingiva is determined by several factors, including the number and size of blood vessels, epithelial thickness, quantity of keratinization, and pigments within the epithelium.

 

 

18.  Disease that increase melanin pigmentation include all except

a.       Cushing syndrome

b.      Peutz-Jeghers syndrome

c.       von Recklinghausen's disease

d.      Albright's syndrome

Ans: A

·         Diseases that increase melanin pigmentation include the following:

         Addison's disease is caused by adrenal dysfunction and produces isolated patches of discoloration varying from bluish black to brown. 

         Peutz-Jeghers syndrome produces intestinal polyposis and melanin pigmentation in the oral mucosa and lips. 

         Albright's syndrome (polyostotic fibrous dysplasia) and von Recklinghausen's disease (neurofibromatosis) produce areas of oral melanin pigmentation.

 

 

19.  Normal consistency of the gingiva is

a.       Firm and leathery

b.      Firm

c.       Soft and edematous

d.      firm and nodular

Ans: B

·         Firm, leathery consistency is associated with Fibrosis and epithelial proliferation associated with long-standing chronic inflammation.

·         Smooth surface texture may be seen in

         chronic inflammation

         epithelial atrophy in atrophic gingivitis

         peeling of the surface occurs in chronic desquamative gingivitis

·         Hyperkeratosis results in a leathery texture

·         Drug-induced gingival overgrowth produces a nodular surface.

 

 

20.  Gingival ablation corresponds to

a.       faulty toothbrushing technique

b.      friction from soft tissues

c.       abnormal frenum attachment

d.      iatrogenic dentistry

ans: B

The following etiologic factors have been implicated in gingival recession:

         faulty toothbrushing technique (gingival abrasion),

         tooth malposition

         friction from soft tissues (gingival ablation)

         gingival inflammation

         abnormal frenum attachment

         iatrogenic dentistry


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