,TABLE OF CONTENT Chapter 20 Radiographic Analysis of the
Periodontium
Chapter 1 Periodontium: The Tooth Supporting
Structures Chapter 21 Clinical Decision-Making for
Periodontal Care
Chapter 2 Microscopic Anatomy of the Chapter 22 Shared Decision-Making for
Periodontium Periodontal Care
Chapter 3 Overview of Diseases of the Chapter 23 Encouraging Patient Behavior
Periodontium Change with Motivational Interviewing
Chapter 4 Classification of Periodontal Diseases, Chapter 24 Best Practices for Periodontal Care
Peri-Implant Diseases, and Conditions
Chapter 25 Nonsurgical Periodontal Therapy
Chapter 5 Periodontal Health, Gingival Diseases,
and Conditions Chapter 26 Patient’s Role in Nonsurgical
Periodontal Therapy
Chapter 6 Periodontitis
Chapter 27 Supragingival and Subgingival
Chapter 7 Mucogingival Deformities and Irrigation
Conditions Around Teeth
Chapter 28 Chemotherapeutics in Periodontal
Chapter 8 Peri-Implant Health and Disease Care
Chapter 9 Acute Periodontal Diseases Chapter 29 Host Modulation Therapy
Chapter 10 Risk Factors for Periodontal Diseases Chapter 30 Periodontal Surgical Concepts for the
and Peri-Implant Diseases/Conditions Dental Hygienist
Chapter 11 Oral Biofilms Chapter 31 Maintenance for the Periodontal
Patient
Chapter 12 Basic Concepts of Immunity and
Inflammation Chapter 32 Documentation and Insurance
Reporting of Periodontal Care
Chapter 13 Host Immunoinflammatory Response
to Dental Biofilm Chapter 33 Future Directions for Management of
Periodontal Care
Chapter 14 Impact of Systemic Diseases on
Periodontal Health Chapter 34 Comprehensive Patient Cases
Chapter 15 Impact of Periodontal Inflammation Chapter 35 Periodontal Disease in the Pediatric
on Periodontal Health Population
Chapter 16 Local Factors Contributing to Chapter 36 Iatrosedation: Easing and Managing
Periodontal Disease Pediatric Patient Fears
Chapter 17 Tobacco, Smoking, and Periodontal Chapter 37 Oral Malodor and Xerostomia
Disease
Chapter 38 Patient Cases: Radiographic Analysis
Chapter 18 Nutrition, Inflammation, and
Periodontal Disease
Chapter 19 Clinical Periodontal Assessment
,Chapter 1 – Periodontium: The Tooth Supporting Structures
Theme: Anatomy, functions, and clinical relevance of alveolar bone, cementum,
periodontal ligament (PDL), and gingiva.
1. A 45-year-old patient presents with generalized tooth mobility but no signs
of gingival inflammation. Which component of the periodontium is most
likely compromised in this scenario?
A. Alveolar bone
B. Cementum
C. Gingiva
D. Periodontal ligament
Answer: D
Rationale: Tooth mobility is primarily influenced by the integrity of the PDL, which acts
as a shock absorber and maintains tooth attachment to alveolar bone. Gingiva and
cementum provide protection and attachment surfaces, but mobility reflects PDL
compromise.
Key words: Tooth mobility, PDL, shock absorber, attachment
2. Which type of cementum is primarily responsible for the attachment of PDL
fibers to the root surface?
A. Acellular cementum
B. Cellular cementum
C. Intermediate cementum
D. Hypercementosis
,Answer: A
Rationale: Acellular cementum covers the cervical and middle third of the root and
provides the anchorage for Sharpey's fibers from the PDL. Cellular cementum is found
mostly in the apical third and facilitates repair.
Key words: Cementum, acellular, PDL attachment, Sharpey’s fibers
3. A patient exhibits localized gingival enlargement without underlying bone
loss. Which periodontal structure is primarily involved?
A. Alveolar bone
B. Periodontal ligament
C. Gingiva
D. Cementum
Answer: C
Rationale: Gingival enlargement is a soft tissue response; it does not immediately
involve alveolar bone or PDL. Understanding gingival anatomy is key to differentiating
soft tissue changes from deeper periodontal pathology.
Key words: Gingival enlargement, soft tissue, periodontium
4. In which region is the alveolar bone most dense and resistant to resorption?
A. Mandibular anterior region
B. Maxillary posterior region
C. Alveolar crest
D. Apical region
Answer: C
Rationale: The alveolar crest is the most compact bone and resists resorption due to its
dense cortical nature. Apical bone is more trabecular and less resistant.
Key words: Alveolar bone, crest, density, resorption
, 5. Which PDL fiber group resists horizontal forces applied to a tooth?
A. Oblique fibers
B. Horizontal fibers
C. Apical fibers
D. Interradicular fibers
Answer: B
Rationale: Horizontal fibers attach the cementum to alveolar bone and counteract
horizontal forces, whereas oblique fibers resist vertical masticatory forces.
Key words: PDL fibers, horizontal, force resistance
6. A radiograph shows loss of the lamina dura around multiple teeth without
gingival inflammation. Which structure is being evaluated?
A. Cementum
B. Periodontal ligament space
C. Alveolar bone proper
D. Gingival sulcus
Answer: C
Rationale: The lamina dura represents alveolar bone proper. Its radiographic loss
indicates bone changes even in the absence of soft tissue inflammation.
Key words: Lamina dura, alveolar bone, radiograph, bone loss
7. Which gingival epithelial layer provides the primary barrier against
microbial invasion? A. Junctional epithelium
B. Sulcular epithelium
C. Oral epithelium
, D. Basal layer
Answer: C
Rationale: Oral epithelium forms the outer protective barrier of the gingiva. Junctional
epithelium attaches to the tooth but is more permeable and susceptible to bacterial
penetration.
Key words: Gingiva, oral epithelium, barrier, microbial defense
8. During tooth eruption, which periodontal component develops first?
A. Cementum
B. PDL
C. Alveolar bone
D. Gingiva
Answer: C
Rationale: Alveolar bone forms the crypt for the erupting tooth, followed by PDL fiber
formation and cementogenesis. Gingiva develops concurrently to provide soft tissue
coverage.
Key words: Tooth eruption, alveolar bone, PDL, cementum
9. Which periodontal structure is most directly involved in sensory perception
of occlusal forces? A. Cementum
B. Periodontal ligament
C. Alveolar bone
D. Gingiva
Answer: B
Rationale: PDL contains mechanoreceptors that detect occlusal forces, enabling
proprioception and force modulation.
Key words: PDL, mechanoreceptors, occlusal forces, sensory
Periodontium
Chapter 1 Periodontium: The Tooth Supporting
Structures Chapter 21 Clinical Decision-Making for
Periodontal Care
Chapter 2 Microscopic Anatomy of the Chapter 22 Shared Decision-Making for
Periodontium Periodontal Care
Chapter 3 Overview of Diseases of the Chapter 23 Encouraging Patient Behavior
Periodontium Change with Motivational Interviewing
Chapter 4 Classification of Periodontal Diseases, Chapter 24 Best Practices for Periodontal Care
Peri-Implant Diseases, and Conditions
Chapter 25 Nonsurgical Periodontal Therapy
Chapter 5 Periodontal Health, Gingival Diseases,
and Conditions Chapter 26 Patient’s Role in Nonsurgical
Periodontal Therapy
Chapter 6 Periodontitis
Chapter 27 Supragingival and Subgingival
Chapter 7 Mucogingival Deformities and Irrigation
Conditions Around Teeth
Chapter 28 Chemotherapeutics in Periodontal
Chapter 8 Peri-Implant Health and Disease Care
Chapter 9 Acute Periodontal Diseases Chapter 29 Host Modulation Therapy
Chapter 10 Risk Factors for Periodontal Diseases Chapter 30 Periodontal Surgical Concepts for the
and Peri-Implant Diseases/Conditions Dental Hygienist
Chapter 11 Oral Biofilms Chapter 31 Maintenance for the Periodontal
Patient
Chapter 12 Basic Concepts of Immunity and
Inflammation Chapter 32 Documentation and Insurance
Reporting of Periodontal Care
Chapter 13 Host Immunoinflammatory Response
to Dental Biofilm Chapter 33 Future Directions for Management of
Periodontal Care
Chapter 14 Impact of Systemic Diseases on
Periodontal Health Chapter 34 Comprehensive Patient Cases
Chapter 15 Impact of Periodontal Inflammation Chapter 35 Periodontal Disease in the Pediatric
on Periodontal Health Population
Chapter 16 Local Factors Contributing to Chapter 36 Iatrosedation: Easing and Managing
Periodontal Disease Pediatric Patient Fears
Chapter 17 Tobacco, Smoking, and Periodontal Chapter 37 Oral Malodor and Xerostomia
Disease
Chapter 38 Patient Cases: Radiographic Analysis
Chapter 18 Nutrition, Inflammation, and
Periodontal Disease
Chapter 19 Clinical Periodontal Assessment
,Chapter 1 – Periodontium: The Tooth Supporting Structures
Theme: Anatomy, functions, and clinical relevance of alveolar bone, cementum,
periodontal ligament (PDL), and gingiva.
1. A 45-year-old patient presents with generalized tooth mobility but no signs
of gingival inflammation. Which component of the periodontium is most
likely compromised in this scenario?
A. Alveolar bone
B. Cementum
C. Gingiva
D. Periodontal ligament
Answer: D
Rationale: Tooth mobility is primarily influenced by the integrity of the PDL, which acts
as a shock absorber and maintains tooth attachment to alveolar bone. Gingiva and
cementum provide protection and attachment surfaces, but mobility reflects PDL
compromise.
Key words: Tooth mobility, PDL, shock absorber, attachment
2. Which type of cementum is primarily responsible for the attachment of PDL
fibers to the root surface?
A. Acellular cementum
B. Cellular cementum
C. Intermediate cementum
D. Hypercementosis
,Answer: A
Rationale: Acellular cementum covers the cervical and middle third of the root and
provides the anchorage for Sharpey's fibers from the PDL. Cellular cementum is found
mostly in the apical third and facilitates repair.
Key words: Cementum, acellular, PDL attachment, Sharpey’s fibers
3. A patient exhibits localized gingival enlargement without underlying bone
loss. Which periodontal structure is primarily involved?
A. Alveolar bone
B. Periodontal ligament
C. Gingiva
D. Cementum
Answer: C
Rationale: Gingival enlargement is a soft tissue response; it does not immediately
involve alveolar bone or PDL. Understanding gingival anatomy is key to differentiating
soft tissue changes from deeper periodontal pathology.
Key words: Gingival enlargement, soft tissue, periodontium
4. In which region is the alveolar bone most dense and resistant to resorption?
A. Mandibular anterior region
B. Maxillary posterior region
C. Alveolar crest
D. Apical region
Answer: C
Rationale: The alveolar crest is the most compact bone and resists resorption due to its
dense cortical nature. Apical bone is more trabecular and less resistant.
Key words: Alveolar bone, crest, density, resorption
, 5. Which PDL fiber group resists horizontal forces applied to a tooth?
A. Oblique fibers
B. Horizontal fibers
C. Apical fibers
D. Interradicular fibers
Answer: B
Rationale: Horizontal fibers attach the cementum to alveolar bone and counteract
horizontal forces, whereas oblique fibers resist vertical masticatory forces.
Key words: PDL fibers, horizontal, force resistance
6. A radiograph shows loss of the lamina dura around multiple teeth without
gingival inflammation. Which structure is being evaluated?
A. Cementum
B. Periodontal ligament space
C. Alveolar bone proper
D. Gingival sulcus
Answer: C
Rationale: The lamina dura represents alveolar bone proper. Its radiographic loss
indicates bone changes even in the absence of soft tissue inflammation.
Key words: Lamina dura, alveolar bone, radiograph, bone loss
7. Which gingival epithelial layer provides the primary barrier against
microbial invasion? A. Junctional epithelium
B. Sulcular epithelium
C. Oral epithelium
, D. Basal layer
Answer: C
Rationale: Oral epithelium forms the outer protective barrier of the gingiva. Junctional
epithelium attaches to the tooth but is more permeable and susceptible to bacterial
penetration.
Key words: Gingiva, oral epithelium, barrier, microbial defense
8. During tooth eruption, which periodontal component develops first?
A. Cementum
B. PDL
C. Alveolar bone
D. Gingiva
Answer: C
Rationale: Alveolar bone forms the crypt for the erupting tooth, followed by PDL fiber
formation and cementogenesis. Gingiva develops concurrently to provide soft tissue
coverage.
Key words: Tooth eruption, alveolar bone, PDL, cementum
9. Which periodontal structure is most directly involved in sensory perception
of occlusal forces? A. Cementum
B. Periodontal ligament
C. Alveolar bone
D. Gingiva
Answer: B
Rationale: PDL contains mechanoreceptors that detect occlusal forces, enabling
proprioception and force modulation.
Key words: PDL, mechanoreceptors, occlusal forces, sensory
