HESI Dental Hygiene – Case-Based Practice
Test | Questions And Answers Plus
Rationales | Instant Pdf Download 2026
Total Cases: 10
Case 1: Mrs. Chen – New Patient with Medical Complexity
Demographics: 58-year-old female, non-smoker
Chief complaint: "My gums bleed when I brush, and my mouth feels dry
all the time."
Medical history: Type 2 diabetes (diagnosed 10 years ago, poorly
controlled, A1c = 8.9%), hypertension (lisinopril 10 mg daily),
hypercholesterolemia (atorvastatin 20 mg daily).
Dental history: Last dental visit 4 years ago. Reports using a medium-
bristle toothbrush, brushing 2x/day, no flossing.
Extraoral exam: Unremarkable.
Intraoral exam: Generalized moderate erythema of gingiva, edematous
papillae. Bleeding on probing (BOP) at 70% of sites.
Periodontal probing depths: 4–6 mm on posterior teeth, 3–4 mm on
anteriors. Clinical attachment loss (CAL): 2–4 mm generalized.
Radiographs: Moderate horizontal bone loss (30–50%) on molars and
,premolars. No periapical pathology.
Saliva: Foamy, reduced pooling in floor of mouth.
Question 1
What is the most likely periodontal diagnosis for Mrs. Chen?
A. Gingivitis associated with plaque only
B. Necrotizing ulcerative gingivitis
C. Periodontitis, Stage II (moderate), Grade B
D. Periodontitis, Stage III (severe), Grade C
Answer: C. Periodontitis, Stage II (moderate), Grade B
Explanation: Moderate CAL (2–4 mm) and 30–50% bone loss = Stage
II. Grade B because her diabetes is poorly controlled (A1c 8.9% –
moderate risk modifier). Stage III would be >5 mm CAL or >50% bone
loss. Grade C would be rapid progression (<5 years) or A1c >10%.
Question 2
Which of the following systemic factors is most directly contributing to
her periodontitis severity?
A. Hypercholesterolemia
B. Poorly controlled diabetes mellitus
C. Hypertension
D. Atorvastatin use
,Answer: B. Poorly controlled diabetes mellitus
Explanation: Diabetes is a major risk factor for periodontitis due to
impaired neutrophil function, altered collagen metabolism, and advanced
glycation end products (AGEs). Hyperglycemia worsens inflammation
and healing.
Question 3
Before initiating non-surgical periodontal therapy (scaling and root
planing), what should the clinician do regarding Mrs. Chen's medical
status?
A. Request clearance from her cardiologist.
B. Check her blood glucose level (fingerstick) and note her last A1c.
C. Discontinue lisinopril for 24 hours.
D. Administer antibiotic premedication.
Answer: B. Check her blood glucose level (fingerstick) and note her last
A1c.
Explanation: Patients with uncontrolled diabetes may require morning
appointments, have increased infection risk, and delayed healing. No
antibiotic premedication required unless other high-risk cardiac condition
present. Lisinopril should not be stopped.
Question 4
, Mrs. Chen reports xerostomia. What is the most likely cause?
A. Diabetes and/or antihypertensive medication
B. Atorvastatin side effect
C. Fluoridated toothpaste
D. Gingival inflammation
Answer: A. Diabetes and/or antihypertensive medication
Explanation: Uncontrolled diabetes causes hyposalivation. Lisinopril
(ACE inhibitor) also causes xerostomia as a common side effect.
Atorvastatin does not typically cause dry mouth.
Question 5
Which home care aid would be most beneficial for Mrs. Chen's
xerostomia and caries prevention?
A. Alcohol-containing mouthwash twice daily
B. Prescription 5000 ppm fluoride toothpaste and sugar-free xylitol gum
C. Lemon-glycerin swabs
D. Sodium bicarbonate toothpaste only
Answer: B. Prescription 5000 ppm fluoride toothpaste and sugar-free
xylitol gum
Explanation: High-fluoride toothpaste (Prevident 5000) reduces root
caries risk. Xylitol gum stimulates saliva and inhibits Streptococcus
mutans. Avoid alcohol-based rinses (worsen dryness). Lemon-glycerin
swabs are outdated and erosive.
Test | Questions And Answers Plus
Rationales | Instant Pdf Download 2026
Total Cases: 10
Case 1: Mrs. Chen – New Patient with Medical Complexity
Demographics: 58-year-old female, non-smoker
Chief complaint: "My gums bleed when I brush, and my mouth feels dry
all the time."
Medical history: Type 2 diabetes (diagnosed 10 years ago, poorly
controlled, A1c = 8.9%), hypertension (lisinopril 10 mg daily),
hypercholesterolemia (atorvastatin 20 mg daily).
Dental history: Last dental visit 4 years ago. Reports using a medium-
bristle toothbrush, brushing 2x/day, no flossing.
Extraoral exam: Unremarkable.
Intraoral exam: Generalized moderate erythema of gingiva, edematous
papillae. Bleeding on probing (BOP) at 70% of sites.
Periodontal probing depths: 4–6 mm on posterior teeth, 3–4 mm on
anteriors. Clinical attachment loss (CAL): 2–4 mm generalized.
Radiographs: Moderate horizontal bone loss (30–50%) on molars and
,premolars. No periapical pathology.
Saliva: Foamy, reduced pooling in floor of mouth.
Question 1
What is the most likely periodontal diagnosis for Mrs. Chen?
A. Gingivitis associated with plaque only
B. Necrotizing ulcerative gingivitis
C. Periodontitis, Stage II (moderate), Grade B
D. Periodontitis, Stage III (severe), Grade C
Answer: C. Periodontitis, Stage II (moderate), Grade B
Explanation: Moderate CAL (2–4 mm) and 30–50% bone loss = Stage
II. Grade B because her diabetes is poorly controlled (A1c 8.9% –
moderate risk modifier). Stage III would be >5 mm CAL or >50% bone
loss. Grade C would be rapid progression (<5 years) or A1c >10%.
Question 2
Which of the following systemic factors is most directly contributing to
her periodontitis severity?
A. Hypercholesterolemia
B. Poorly controlled diabetes mellitus
C. Hypertension
D. Atorvastatin use
,Answer: B. Poorly controlled diabetes mellitus
Explanation: Diabetes is a major risk factor for periodontitis due to
impaired neutrophil function, altered collagen metabolism, and advanced
glycation end products (AGEs). Hyperglycemia worsens inflammation
and healing.
Question 3
Before initiating non-surgical periodontal therapy (scaling and root
planing), what should the clinician do regarding Mrs. Chen's medical
status?
A. Request clearance from her cardiologist.
B. Check her blood glucose level (fingerstick) and note her last A1c.
C. Discontinue lisinopril for 24 hours.
D. Administer antibiotic premedication.
Answer: B. Check her blood glucose level (fingerstick) and note her last
A1c.
Explanation: Patients with uncontrolled diabetes may require morning
appointments, have increased infection risk, and delayed healing. No
antibiotic premedication required unless other high-risk cardiac condition
present. Lisinopril should not be stopped.
Question 4
, Mrs. Chen reports xerostomia. What is the most likely cause?
A. Diabetes and/or antihypertensive medication
B. Atorvastatin side effect
C. Fluoridated toothpaste
D. Gingival inflammation
Answer: A. Diabetes and/or antihypertensive medication
Explanation: Uncontrolled diabetes causes hyposalivation. Lisinopril
(ACE inhibitor) also causes xerostomia as a common side effect.
Atorvastatin does not typically cause dry mouth.
Question 5
Which home care aid would be most beneficial for Mrs. Chen's
xerostomia and caries prevention?
A. Alcohol-containing mouthwash twice daily
B. Prescription 5000 ppm fluoride toothpaste and sugar-free xylitol gum
C. Lemon-glycerin swabs
D. Sodium bicarbonate toothpaste only
Answer: B. Prescription 5000 ppm fluoride toothpaste and sugar-free
xylitol gum
Explanation: High-fluoride toothpaste (Prevident 5000) reduces root
caries risk. Xylitol gum stimulates saliva and inhibits Streptococcus
mutans. Avoid alcohol-based rinses (worsen dryness). Lemon-glycerin
swabs are outdated and erosive.
