Question 1

A medical and social history can indicate whether a patient is at risk of nutrient deficiencies due to alcoholism or anorexia. A lack of nutrients from such conditions frequently initiates gingival inflammation.

Accepted Answer

After reviewing the medical and social history of a patient with nutrient deficiencies, the dental hygienist should consider whether a patient would benefit from medical nutrition therapy by a registered dietitian to normalize nutrient levels before dental therapy. Note that a lack of nutrients does not cause gingival inflammation, however it may be a predisposing factor in that it disrupts the process of tissue repair. Adequate nutrients can hasten healing and repair processes.

Question 2

The physical effects of food on periodontal health are varied. Each of the following accurately describes aspects of the physical effects of food on periodontal health except one. Which one is the exception?

Accepted Answer

Chewing firm, coarse, and fibrous foods such as fruits and vegetables stimulates salivary flow. Conversely, foods with soft and spongy texture tend to stick in pits and fissures, and they have minimal ability to stimulate salivary flow. Supragingival plaque and biofilm adhesion is influenced by frequent consumption of both monosaccharides and disaccharides, particularly sucrose. Note that frequency of consumption is more of a determinant of cariogenicity than the amount of carbohydrate consumed is.

Question 3

Recommendations the dental hygienist can make to a patient with lip and tongue ulcers include each of the following except one. Which one is the exception?

Accepted Answer

For patients with painful lip and tongue ulcers, a full liquid diet for 1 to 3 days may be warranted. Avoiding spicy and acidic foods is imperative to protect fragile tissues. Eating foods from each food group and consuming additional protein enables tissues to heal and regenerate. Frequent, small meals are beneficial for these patients as they typically have difficulty eating.

Question 4

In later stages of periodontal disease, excess glucose and sucrose result in increased bacterial growth because biofilm development is continual and never reaches a steady state.

Accepted Answer

In later stages of periodontal disease, the influence of diet is considered less important to the maturation of the plaque biofilm. Biofilm development eventually reaches a steady state. At that point, the influence of diet is thought to be less important to the maturation of the plaque biofilm. Conversely, in early stages excess glucose and sucrose significantly contribute to biofilm development.

Question 5

Protein or vitamin C deficiencies are contributing factors to necrotizing ulcerative gingivitis (NUG). These deficiencies commonly occur in nursing mothers and overweight older adults.

Accepted Answer

Nutrient deficiencies, such as protein or vitamin C or B complex deficiency, are contributing factors to NUG because of lowered host resistance. These deficiencies commonly occur in young adults with poor eating habits (high kilocalorie and low nutrient intake) or those who rely primarily on convenience or fast food meals.

Question 6

Which nutrient is essential for normal growth and development of salivary glands and epithelial tissue?

Accepted Answer

Normal growth and development of periodontal and oral mucosal tissues depend on sufficient intake of vitamin A. Vitamin C is essential for collagen and connective tissue health. Vitamin B complex is essential for epithelial and connective tissue. Zinc, a mineral, is integrally involved in maintenance of oral tissues and integrity of the immune and repair processes.

Question 7

For patients with both gingivitis and periodontitis, intake of nutrients slightly beyond recommended levels is advised because slightly elevate nutrient levels enhance the healing process.

Accepted Answer

Intake of nutrients beyond the recommended levels is not advised. Elevated levels might not improve or accelerate the healing process and can be detrimental because of interference with other nutrients or drugs.

Question 8

Supragingival plaque biofilm adhesion and formation is influenced by frequent consumption of polysaccharides and protein. Subgingival plaque biofilm seems to be protected from local effect of sugars.

Accepted Answer

Supragingival plaque biofilm adhesion and formation is influenced by frequent consumption of monosaccharides (glucose) and disaccharides, particularly sucrose. As noted in earlier chapters, protein has cariostatic properties because it diminishes the likelihood of decreased salivary pH from other foods. In this manner, protein decreases biofilm adhesion and formation.

Question 9

When nutrient intake is poor because of oral pain, which of the following is the best recommendation the dental hygienist can make?

Accepted Answer

A liquid nutritional supplement can be recommended to ensure such patients receive adequate nutrition and accelerate recovery. Another viable consideration is a multivitamin with minerals with or without the liquid nutritional supplement. The blender option is the best alternate choice. The remaining selections have little nutritional value. Note that most liquid nutritional supplements contain cariogenic sweeteners; these should be followed by appropriate oral hygiene care.

Question 10

Which of the following is most likely to initiate periodontal disease?

Accepted Answer

The primary initiating agent of periodontal disease is plaque biofilm accumulation around teeth and gingiva. Nutrient deficiencies, excesses, or imbalances do not initiate periodontal disease. Megadoses of supplements neither prevent nor cure periodontal disease.

Question 11

Each of the following is true of a full liquid diet except one. Which one is the exception?

Accepted Answer

The kilocalorie value of a full liquid diet is usually inadequate. For this reason, it should be used only temporarily, typically 1 to 3 days after surgery. It should consist of a high-protein, high-kilocalorie fluids and semi-solid foods to promote optimal healing.

Question 12

Bacterial growth and plaque formation are enhanced by a diet with frequent intake of retentive carbohydrates. Gingivitis is an irreversible change in the interdental papillary tissues.

Accepted Answer

Retentive fermentable carbohydrates are prime culprits in the propagation of bacteria responsible for initiation of gingivitis. Tissue changes in gingivitis are numerous, including alterations in the interdental papillary tissues; however, gingivitis is often reversible with appropriate oral hygiene techniques. This disease illustrates the preventive and therapeutic role of dental hygienists in helping patients learn to prevent and treat oral diseases.

Question 13

Plaque biofilm is physically removed by eating firm foods, because the increased salivary flow elicited by chewing these foods enhances oral clearance.

Accepted Answer

This question illustrates subtle but significant effects of food selection because it affects both salivary flow and oral clearance. Chewing firm foods increases salivary flow, but plaque biofilm is not physically removed by this mechanism. Rather, the increased salivary flow from chewing the foods enhances oral clearance, reducing food retention. Cariogenicity is reduced by the decreased amount of debris remaining in the mouth, resulting in less debris accumulation on the teeth.

Question 14

Periodontal disease is the leading reason for tooth loss for patients older than 65 years. Nutritional deficiencies can modify the body's response to periodontal disease.

Accepted Answer

Periodontal disease is the leading cause of tooth loss for patients older than 65. It is important that dental hygienists convey to patients that periodontal disease can occur from adolescence through adulthood. Regarding the effect of nutritional deficiencies on the body's response to periodontal disease, the inflammatory process is affected by the host's ability to protect itself from periodontal pathogens and infection.

Question 15

Calcification of the alveolus and cementum requires which nutrients? (Select all that apply.)

Accepted Answer

Calcification of the alveolus and cementum requires amino acids, calcium, phosphorus, vitamin D, and magnesium. Note that vitamins A, C, D, and E and carbohydrates are among the essential nutrients for maintenance of oral tissues and integrity of the host's immune and repair responses.

Question 16

Each of the following is a factor to consider prior to making dietary recommendations for a patient who is scheduled for periodontal surgery except one. Which one is the exception?

Accepted Answer

In preparation for surgery and after surgery, patients should consume adequate kilocalories to meet anabolic (formation of new cells and tissues) needs. Before surgery, the patient should be given a tailored meal plan listing nutrient-dense foods and beverages to consume during recovery. The patient's food preferences and dislikes are other factors to be considered.

Question 17

Which of the following combination of situations is most likely to increase risk of severity of periodontal disease?

Accepted Answer

In combination with local irritating factors, such as plaque biofilm or tobacco use, systemic factors can increase risk of severity of periodontal disease of a host, but systemic factors are not solely responsible for periodontal disease.

Question 18

Gingivitis is usually reversible because there is no loss of connective tissue or bone support.

Accepted Answer

Gingivitis is categorized as a reversible disease because there is no loss of connective tissue or bone support. Although pocket readings may be deeper than normal in a patient with gingivitis, the increase in depth is due to inflammation of the gingival tissues. After removal of local irritants (plaque and calculus) by a dental hygienist and optimal oral hygiene procedures by the patient, gingival tissues can return to normal. If left untreated, gingivitis can progress to periodontal disease.

Question 19

Although a balanced diet is essential to tissue healing and repair, which of the following should the dental hygienist identify as the nutrient of highest priority for a patient with gingivitis or periodontal disease?

Accepted Answer

The dental hygienist should stress consumption of vitamin C for the periodontal or gingivitis patient. Vitamin C is especially important for collagen and connective tissue formation, which are two important components of periodontal and gingival wound healing. In general, the dental hygienist should encourage a nutrient-dense food that are not retentive as well as the RDA for vitamin C.

Question 20

As with dental caries, nutrition has direct involvement in periodontal disease. Suppuration, an increased oral clearance time of food, contributes to both periodontal disease and dental caries.

Accepted Answer

The involvement of nutrition in periodontal disease is not as clear as it is for dental caries. The predisposing, etiologic, and contributing factors of periodontal disease are diverse; however, the primary initiating agent is biofilm accumulation around teeth and gingiva. Suppuration is the formation or discharge of pus.

Quiz 19: Nutritional Aspects of Gingivitis and Periodontal Disease