Deck 12: Plaque Biofilm and Disease Control for the Periodontal Patient

Question 1

Why would the dental hygienist place Mrs.RWJ on fluoride therapy?

A) She has a history of caries.
B) Fluoride will help improve her periodontal status.
C) She has a history of caries and active carious lesions.
D) She does not require fluoride therapy because she has not lost any teeth.

Answer 1

She has a history of caries and active carious lesions.

Question 2

Clinical studies with anticalculus toothpastes have shown a reduction in supragingival calculus in the range of:

A) 5% to 10%
B) 10% to 20%
C) 20% to 40%
D) 40% to 60%

Answer 2

20% to 40%

Question 3

Chemical plaque control is effective in a personal homecare regimen:

A) Only as a supragingival irrigant
B) To assist in personal plaque control
C) As a substitute for mechanical plaque control
D) Because biofilm is completely penetrated by effective chemical agents

Answer 3

To assist in personal plaque control

Question 4

The dental hygienist plays an important role in developing a customized homecare regimen for patients with periodontal disease.The use of positive reinforcement and establishing rapport over time with the patient enhance this role.

A) Both statements are TRUE.
B) Both statements are FALSE.
C) The first statement is TRUE, and the second statement is FALSE.
D) The first statement is FALSE, and the second statement is TRUE.

Question 5

Subgingival irrigation of antimicrobial agents applied by the dental hygienist after scaling and root planing enhances tissue healing.Subgingival irrigation of antimicrobial agents applied by the dental hygienist after scaling and root planing has no demonstrated detrimental effects.

A) Both statements are TRUE.
B) Both statements are FALSE.
C) The first statement is TRUE, and the second statement is FALSE.
D) The first statement is FALSE, and the second statement is TRUE.

Question 6

Gingival massage during toothbrushing reduces gingivitis by increasing keratinization of the gingiva.A toothbrushing technique that emphasizes gingival massage also removes plaque biofilm.

A) Both statements are TRUE.
B) Both statements are FALSE.
C) The first statement is TRUE, and the second statement is FALSE.
D) The first statement is FALSE, and the second statement is TRUE.

Question 7

The goals of plaque biofilm control for the patient with periodontal disease include:

A) Education
B) Education and motivation
C) Education, motivation, and patient responsibility
D) Education, motivation, patient responsibility, and caries control

Question 8

Use the following case description to complete the following exercises.
Mrs.RWJ has been diagnosed with chronic periodontitis and has been referred to a dental hygienist for Phase I therapy.She is a widow, 63 years of age, in good health, and is living on her social security benefits.Mrs.RWJ has some arthritis in her hands and feet, particularly affecting her fingers and toes.She has 28 teeth; only her third molars are missing.Her clinical findings include 2- to 4-mm probing depths around all of her teeth, with 1 mm of recession throughout.All of the deeper 4-mm probe depths are on the interproximal surfaces of the maxillary molars.Mrs.RWJ brushes her teeth twice each day, has moderate amounts of plaque on all gingival and interproximal surfaces, and has moderate subgingival calculus throughout the mouth.She has little supragingival calculus.Mrs.RWJ has a history of caries, evidenced by numerous fillings and two crowns.She also has two carious lesions that will be treated by her general dentist after Phase I therapy is complete.Her periodontal prognosis is good, and the periodontist does not expect to perform periodontal surgery after the dental hygienist has completed the treatment.
What combination of mechanical oral hygiene aids would be recommended for Mrs.RWJ?

A) Manual toothbrush and interproximal brushes
B) Mechanical toothbrush and interproximal brushes
C) Manual toothbrush, dental floss, and interproximal brushes
D) Mechanical toothbrush, dental floss, and interproximal brushes

Question 9

Supragingival oral irrigation performed by patients at home on a daily basis can be expected to reduce gingivitis by approximately what amount?

A) 10%
B) 25%
C) 50%
D) 100%

Question 10

Which interproximal cleaning device would likely be the easiest for Mrs.RWJ to use effectively?

A) Floss
B) Floss tool
C) Rubber tip
D) Toothpick and holder
E) Interproximal brushes

Question 11

The types of toothbrushes that have been shown to have slightly better plaque biofilm removing ability by the Cochrane analysis is:

A) Rotating mechanical toothbrushes
B) Oscillating mechanical toothbrushes
C) Manual toothbrushes using the Bass technique
D) Oscillating and rotating mechanical toothbrushes

Question 12

The areas of the tooth where dental floss is likely to miss plaque biofilm are:

A) Furcations
B) Root concavities
C) Proximal contact areas
D) Furcations and root concavities
E) Furcations, root concavities, and proximal contact areas

Question 13

Phenolic compound mouth rinses work by altering bacterial cell walls.Phenolic compound mouth rinses reduce gingivitis approximately as much as quaternary ammonium products.

A) Both statements are TRUE.
B) Both statements are FALSE.
C) The first statement is TRUE, and the second statement is FALSE.
D) The first statement is FALSE, and the second statement is TRUE.

Question 14

The daily plaque biofilm control program is the responsibility of the:

A) Patient
B) Dentist
C) Dental hygienist
D) Dental assistant

Question 15

Anticalculus agents reduce supragingival and subgingival calculus by 20% to 40%.They are useful in the homecare regimen of every patient with periodontal disease.

A) Both statements are TRUE.
B) Both statements are FALSE.
C) The first statement is TRUE, and the second statement is FALSE.
D) The first statement is FALSE, and the second statement is TRUE.

Question 16

Gingival stimulation has been shown to increase keratinization on gingival surfaces and to remove plaque biofilm.The effects on improving periodontal health are related to both actions.

A) Both statements are TRUE.
B) Both statements are FALSE.
C) The first statement is TRUE, and the second statement is FALSE.
D) The first statement is FALSE, and the second statement is TRUE.

Question 17

Supragingival oral irrigation:

A) Reduces gingivitis and helps clean interproximally.
B) Reduces plaque biofilm but does not reduce gingivitis.
C) Should be a component of every personal plaque control regimen.
D) Is only useful for in-office procedures after scaling and root planing.

Question 18

Oral irrigators can cause systemic bacteremia.Patients who require antibiotic premedication for dental treatment should avoid these homecare devices.

A) Both statements are TRUE.
B) Both statements are FALSE.
C) The first statement is TRUE, and the second statement is FALSE.
D) The first statement is FALSE, and the second statement is TRUE.

Question 19

Understanding plaque growth as a biofilm emphasizes the importance of:

A) Chemical plaque control
B) Mechanical plaque control
C) Subgingival irrigation with chemical agents
D) Supragingival irrigation with chemical agents

Question 20

Extrinsic tooth staining has been reported with which of the following products?

A) Cosmetic mouthwash
B) Sanguinarine mouthwash
C) Chlorhexidine mouthwash
D) Quaternary ammonium mouthwash

Question 21

Anticalculus agents include all of the following agents except one.Which agent is the exception?

A) Pyrophosphates
B) Zinc citrate
C) Triclosan or copolymers
D) Sodium lauryl sulfates

Question 22

A mouth rinse containing 0.12% chlorhexidine gluconate would be considered a bactericidal mouthwash.Triclosan is a common phenolic compound found in mouth rinses that are available in the United States.

A) Both statements are TRUE.
B) Both statements are FALSE.
C) The first statement is TRUE, and the second statement is FALSE.
D) The first statement is FALSE, and the second statement is TRUE.

Question 23

Use the following case description to complete the following exercises.
Mr.JEP is referred to a dental hygienist by the periodontist employer for Phase I therapy.He is 54 years old, in good health, and proud of his successful avoidance of both dentists and physicians for the last 30 years.A general dentist who saw Mr.JEP for an emergency, which turned out to be a periodontal abscess, referred him to the periodontist.Mr.JEP has no history of caries but has 3- to 4-mm probing depths throughout his mouth, 2 mm of recession on every tooth, and heavy subgingival deposits of calculus around all teeth.He vigorously brushes every day using fluoride toothpaste but no other oral hygiene aids.After Mr.JEP is introduced to a more thorough way to brush his teeth, he responds by saying, "Honey, I have been brushing my teeth longer than you have been alive."
When Mr.JEP's response suggests that he is offended that the dental hygienist thinks he does not know how to brush his teeth,the best course of action for the dental hygienist would be to:

A) Tell him he is doing an ineffective job, and show him his plaque.
B) Tell him he should keep brushing the way he is but show him how to clean between his teeth.
C) Agree with him, and try to encourage him to improve the results of his brushing by, perhaps, using a new brush and cleaning around the gums more effectively.
D) Explain to him that the signs and symptoms of his periodontal disease will only get worse if he does not follow the dental hygienist's instructions.

Question 24

The dental hygienist should consider recommending that Mrs.RWJ use an interproximal cleaning aid to provide access to concavities and furcations because she has:

A) One millimeter of recession around all her teeth
B) Deep pockets throughout her dentition
C) Deep pockets on the maxillary posterior teeth
D) Deep pockets on the mandibular posterior teeth

Question 25

MATCHING
Match each of the following techniques with their individual descriptions.
Bass technique

A)Bristles are directed apically at a 45-degree angle to the long axis of the tooth, using short vibratory strokes.The focus of this technique is on sulcular cleaning.
B)Bristles are directed coronally at a 45-degree angle to the long axis of the tooth.Bristles are repeatedly pressed against the gingival margin and then lifted away.The focus of this technique is to massage the tissue and to increase blood flow.
C)This technique is the simplest.Bristles are placed on the teeth and moved back and forth.This technique does not focus on cleaning the gingival margin.
D)Bristles are directed apically but not at a right angle to the gingival.Pressure is applied to flex the bristles and blanch the tissues.The focus of this technique is to increased blood flow through gingival stimulation and to use salt water and sodium bicarbonate solutions.

Question 26

The dental hygienist transfers the critical elements of education,reinforcement,and periodontal maintenance to the patient.Often,multiple sessions are needed to master the recommended techniques.

A) Both statements are TRUE.
B) Both statements are FALSE.
C) The first statement is TRUE, and the second statement is FALSE.
D) The first statement is FALSE, and the second statement is TRUE.

Question 27

Substantivity is defined as:

A) Ability to stabilize the shelf life of the product
B) Ability to adhere to structures in the oral cavity
C) Ability to alter cell metabolism and transport activities
D) None of the above

Question 28

Mr.JEP's dental hygienist has always emphasized caries control for her patients.Mr.JEP uses fluoride toothpaste.Would a different caries control regimen be recommended? If so,why?

A) Yes. Mr. JEP has heavy plaque.
B) Yes. Mr. JEP is at risk for root caries.
C) No. Mr. JEP has no caries or history of caries.
D) No. Mr. JEP's caries is not a concern in periodontal disease.

Question 29

MATCHING
Match each of the following techniques with their individual descriptions.
Scrub technique

A)Bristles are directed apically at a 45-degree angle to the long axis of the tooth, using short vibratory strokes.The focus of this technique is on sulcular cleaning.
B)Bristles are directed coronally at a 45-degree angle to the long axis of the tooth.Bristles are repeatedly pressed against the gingival margin and then lifted away.The focus of this technique is to massage the tissue and to increase blood flow.
C)This technique is the simplest.Bristles are placed on the teeth and moved back and forth.This technique does not focus on cleaning the gingival margin.
D)Bristles are directed apically but not at a right angle to the gingival.Pressure is applied to flex the bristles and blanch the tissues.The focus of this technique is to increased blood flow through gingival stimulation and to use salt water and sodium bicarbonate solutions.

Question 30

Powered toothbrushes with sonic components cause hydrodynamic shearing forces of water,which increase the penetration of plaque removal on the proximal surfaces.Sonic toothbrushes should be recommended as a substitution for flossing.

A) Both statements are TRUE.
B) Both statements are FALSE.
C) The first statement is TRUE, and the second statement is FALSE.
D) The first statement is FALSE, and the second statement is TRUE.

Question 31

The most challenging aspect of plaque control to initiate and continue is:

A) Knowledge
B) Attitude
C) Motivation
D) Routine

Question 32

MATCHING
Match each of the following techniques with their individual descriptions.
Charter technique

A)Bristles are directed apically at a 45-degree angle to the long axis of the tooth, using short vibratory strokes.The focus of this technique is on sulcular cleaning.
B)Bristles are directed coronally at a 45-degree angle to the long axis of the tooth.Bristles are repeatedly pressed against the gingival margin and then lifted away.The focus of this technique is to massage the tissue and to increase blood flow.
C)This technique is the simplest.Bristles are placed on the teeth and moved back and forth.This technique does not focus on cleaning the gingival margin.
D)Bristles are directed apically but not at a right angle to the gingival.Pressure is applied to flex the bristles and blanch the tissues.The focus of this technique is to increased blood flow through gingival stimulation and to use salt water and sodium bicarbonate solutions.

Question 33

Stannous fluoride alters bacterial cell metabolism and cell adhesion properties,in addition to reacting with tooth surfaces for caries prevention.Stannous fluoride products may carry the American Dental Association (ADA)seal of approval for both its antigingivitis and its anticaries properties.

A) Both statements are TRUE.
B) Both statements are FALSE.
C) The first statement is TRUE, and the second statement is FALSE.
D) The first statement is FALSE, and the second statement is TRUE.

Question 34

Ultimately,the patient is responsible for long-term maintenance of his or her teeth and gingival health.

Question 35

Mrs.RWJ would benefit from the use of an anticalculus toothpaste.Anticalculus toothpaste is effective in reducing subgingival calculus.

A) Both statements are TRUE.
B) Both statements are FALSE.
C) The first statement is TRUE, and the second statement is FALSE.
D) The first statement is FALSE, and the second statement is TRUE.

Question 36

The dental hygienist anticipates teaching Mr.JEP to brush more effectively.Beyond that,what would be the best type of oral hygiene aid to help him thoroughly clean?

A) Floss
B) Interproximal brushes
C) Floss, interproximal brushes, and subgingival irrigation
D) Floss, interproximal brushes, and supragingival irrigation

Question 37

Which one of the following statements is FALSE concerning oral irrigation?

A) Several methods of application are available.
B) Oral irrigation effectively targets all subgingival plaque and irritants.
C) Oral irrigation can be performed both subgingivally and supragingivally.
D) Oral irrigation is most effective when performed daily as part of the patient's homecare routine.

Question 38

Contraindications for using 0.12% chlorhexidine gluconate include:

A) Altered taste
B) Increased supragingival calculus formation
C) Extrinsic stain
D) All of the above

Question 39

MATCHING
Match each of the following techniques with their individual descriptions.
Stillman technique

A)Bristles are directed apically at a 45-degree angle to the long axis of the tooth, using short vibratory strokes.The focus of this technique is on sulcular cleaning.
B)Bristles are directed coronally at a 45-degree angle to the long axis of the tooth.Bristles are repeatedly pressed against the gingival margin and then lifted away.The focus of this technique is to massage the tissue and to increase blood flow.
C)This technique is the simplest.Bristles are placed on the teeth and moved back and forth.This technique does not focus on cleaning the gingival margin.
D)Bristles are directed apically but not at a right angle to the gingival.Pressure is applied to flex the bristles and blanch the tissues.The focus of this technique is to increased blood flow through gingival stimulation and to use salt water and sodium bicarbonate solutions.

Question 40

The beneficial effects of chemical antiplaque agents include all of the following properties except one.Which property is the exception?

A) Low toxicity
B) Antiplaque action
C) Anticalculus action
D) Low permeability

Question 41

Oral irrigation is associated with bacteremia.

Question 42

Patients needing premedication for dental treatment should not use supragingival irrigation devices.

Question 43

Patients using powered toothbrushes have less periodontal disease.

Question 44

Flossing must be used in conjunction with interdental brushes for thorough biofilm removal.

Question 45

A mouthwash containing 0.12% chlorhexidine gluconate contains alcohol.

Question 46

Using 0.12% chlorhexidine gluconate through an irrigation device eliminates the dark-staining and calculus formation side effects.

Question 47

Negative effects such as self-inflicted wounds,microbial infections of the tissues,and resistant strains have deemed the self-application of subgingival irrigation procedures unsafe.

Question 48

The rubber tip stimulator is a good tool to suggest for the patient who refuses to floss.

Question 49

For the best results,an individualized plaque control program consists of educating the patient on the use of floss and the Bass brushing method and then staying with these methods throughout the treatment.

Question 50

Subgingival irrigation is only effective when performed by the dental hygienist at treatment visits.