Newman and Carranza's Essentials of Clinical Periodontology Quiz
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Questions and Answers

What are the principles of evidence-based decision-making according to the American Dental Association?

  • Best scientific evidence, clinician experience, and judgment
  • Patient values and preferences
  • Clinical/patient circumstances
  • All of the above (correct)

    • Filtered information includes primary sources like articles in peer-reviewed journals.

    False

    What is the skill learned with time in the 'Appraise' step of evidence-based clinical practice?

    Critically appraising all the evidence collected

    What is the process called by which allocation of interventions is concealed to individuals involved in a clinical study?

    <p>Blinding</p> Signup and view all the answers

    What are the types of blinding in clinical studies?

    <p>Single blinded study</p> Signup and view all the answers

    Case-control studies compare individuals with the primary endpoint of interest (cases) with individuals without the primary endpoint of interest (control) to identify the exposure. Is this statement true or false?

    <p>True</p> Signup and view all the answers

    In studies exploring the association between an exposure and an endpoint, it is important to take into consideration the variable(s) related to the exposure and causally associated with the endpoint, known as _______.

    <p>confounders</p> Signup and view all the answers

    Match the following terms with their explanations:

    <p>PICO format = The question formulation in evidence-based dentistry Randomized clinical trial (RCT) = Study design for testing intervention efficacy Temporality = Establishing that the cause preceded the effect True versus surrogate endpoints = Differentiating between direct and substitute endpoints</p> Signup and view all the answers

    What are some advantages of evidence-based dentistry? (Select all that apply)

    <p>Efficient way for clinicians to stay current</p> Signup and view all the answers

    Depending on the design and the inherent bias in a study, the evidence quality/level can range from ______ to high.

    <p>low</p> Signup and view all the answers

    Systematic reviews are predominantly qualitative and meta-analysis is quantitative in nature.

    <p>True</p> Signup and view all the answers

    What does EBDM stand for?

    <p>Evidence-Based Decision-Making</p> Signup and view all the answers

    Match the following with their descriptions:

    <p>Primary sources of evidence = Evidence derived from original research studies and publications Secondary sources of evidence = Evidence derived from combination of multiple original studies Clinical practice guidelines = Represent the highest level of clinical evidence Expert opinions = Evidence derived from case reports, case series, or expert opinions</p> Signup and view all the answers

    Why is it important for a clinician to practice evidence-based decision-making?

    <p>To identify valid and useful information for treatment planning</p> Signup and view all the answers

    What are tonofilaments?

    <p>Structural filaments of keratin</p> Signup and view all the answers

    What are the three zones of oral mucosa? (Select all that apply)

    <p>Masticatory mucosa (gingiva, hard palate)</p> Signup and view all the answers

    Architectural integrity of gingival epithelium is maintained by cell-cell attachments via ____, adherens junctions, gap junctions, and tight junctions.

    <p>desmosomes</p> Signup and view all the answers

    The width of attached gingiva is always the same as keratinized gingiva.

    <p>False</p> Signup and view all the answers

    What does GCF stand for? ______ is minimal in health and increases during inflammation.

    <p>Gingival crevicular fluid</p> Signup and view all the answers

    Which cells are predominantly found in the Periodontal Ligament?

    <p>Fibroblasts, Cementoblasts, and Osteoblasts</p> Signup and view all the answers

    What are the two types of forces that the Periodontal Ligament helps transmit?

    <p>Occlusal forces</p> Signup and view all the answers

    Continuous turnover occurs in all periodontal tissues except cementum.

    <p>True</p> Signup and view all the answers

    Match the following types of cementum with their locations:

    <p>Cellular afibrillar cementum = Most coronal Acellular extrinsic-fiber cementum = Cervical third Cellular mixed stratified cementum = Apical third Cellular intrinsic-fiber cementum = Location not specified</p> Signup and view all the answers

    Which of the following is NOT a possible outcome in the compiled PICO question related to this patient? For a patient with replanted teeth (P), will long-term splinting (2–4 weeks) (I) compared with short-term splinting (7–14 days) (C) increase:

    <p>The risk of tooth resorption</p> Signup and view all the answers

    Before treating this patient, the clinician reads a clinical practice guideline (CPG) in order to make a clinical decision. CPGs are _________ resources:

    <p>Secondary</p> Signup and view all the answers

    From the type of study designs mentioned below, identify the one with the highest level of evidence:

    <p>Systematic review</p> Signup and view all the answers

    Is post-treatment evaluation of outcomes a part of evidence-based dentistry process?

    <p>True</p> Signup and view all the answers

    What is ankylosis in relation to the periodontium?

    <p>Fusion of the cementum and the alveolar bone with obliteration of the periodontal ligament</p> Signup and view all the answers

    What are the four main types of cells seen within bone?

    <p>osteogenic cells, osteoblasts, osteocytes, osteoclasts</p> Signup and view all the answers

    _____ is the absence of cementum.

    <p>Cemental aplasia</p> Signup and view all the answers

    Match the following terminologies with their explanations:

    <p>Howship lacunae = Eroded bone surfaces containing osteoclasts tight junctions = Involved in cell-cell attachment, allowing small molecules to pass from one cell to another periosteum = The tissue that covers the outer surface of bone stippling = Presents as microscopic elevations and depressions on the surface of the gingiva due to connective tissue projections within the tissue</p> Signup and view all the answers

    Define active eruption and passive eruption.

    <p>Active eruption is the movement of the teeth in the direction of the occlusal plane. Passive eruption is the exposure of the teeth via apical migration of the gingiva.</p> Signup and view all the answers

    Explain the process of epithelial attachment regeneration.

    <p>Epithelial attachment regeneration involves migration of cells from cut oral epithelial edge towards the root surface over at least 2 weeks, forming a complete junctional epithelium.</p> Signup and view all the answers

    What tissue components make up the periodontium working as a single unit?

    <p>periodontal ligament, cementum, alveolar process</p> Signup and view all the answers

    Which of the following zones divide the gingiva macroscopically? (Select all that apply)

    <p>Interdental gingiva/papilla</p> Signup and view all the answers

    The Mucogingival junction __________ throughout adult life, while teeth move in an occlusal direction.

    <p>remains stationary</p> Signup and view all the answers

    Aging has a significant impact on an individual's response to periodontal treatment.

    <p>False</p> Signup and view all the answers

    Study Notes

    Essentials of Clinical Periodontology Study Guide

    Evidence-Based Clinical Practice

    • Blinding: process of concealing allocation of intervention(s) to one or multiple individuals involved in a clinical study
      • Single blinded study: allocation concealed only from study participant
      • Double blinded study: allocation concealed from two individuals in the research team
      • Triple blinded study: allocation concealed from three individuals in the research team
    • Case-Control Study: comparing individuals with the primary endpoint of interest (cases) with those without it (controls) to identify exposure
    • Cohort Study: monitoring individuals exposed to a specific exposure and comparing them with non-exposed individuals for the occurrence of the primary endpoint
    • Confounding Variables: variables related to exposure and causally associated with the endpoint, masking the real effect of the exposure
    • Evidence: synthesis of all valid research conducted earlier that answers a specific PICO question
    • PICO Format: formulating a clinical question containing information on problem/population, intervention, comparison group, and outcomes
    • Randomization Methods: methods used to randomize study participants in RCTs
    • Randomized Clinical Trial (RCT): clinical study design for testing the efficacy of interventions, minimizing bias
    • Temporality: establishing that the cause preceded the effect in studies looking into causality

    Fast Facts

    • Components of Evidence-Based Dentistry: patient values/preferences, clinical experience/judgment, and scientific evidence
    • Steps in Evidence-Based Clinical Decision-Making: formulate a clinical question, search for and acquire evidence, appraise the evidence, apply the evidence in a given clinical scenario, and evaluate the outcomes
    • Advantages of Evidence-Based Dentistry: efficient way for clinicians to stay current, maximizes potential for successful clinical outcomes
    • Research Design Types: randomized controlled trials, case-control, cohort, preclinical (animal), case series, and case reports
    • Sources of Evidence: primary (original research studies and publications), secondary (combination of multiple original studies)
    • High Levels of Clinical Evidence: clinical practice guidelines, systematic reviews, and meta-analysis
    • Low Levels of Clinical Evidence: case reports, case series, and expert opinions
    • Systematic Review vs. Meta-Analysis: systematic reviews are qualitative, while meta-analysis is quantitative, both identifying and combining studies to answer a specific research question

    Core Knowledge

    • Introduction to Evidence-Based Decision-Making: a formalized process that allows clinicians to search for the best current scientific evidence and integrate it into practice

    • Key Advantage of Systematic Reviews and Meta-Analysis: combining multiple studies increases the effective sample size and power of the study### EBDM (Evidence-Based Decision-Making) Process

    • The EBDM process involves five steps to achieve a high level of clinical competence

    • The five steps are: Ask, Acquire, Appraise, Apply, and Assess & Adjust

    Step 1: Ask (PICO Format)

    • Ask the right question using the PICO format, which requires defining four components to a clinical problem
    • The four components are: Problem/Population, Intervention, Comparison, and Outcome

    Step 2: Acquire (Filtered and Unfiltered Information)

    • Use biomedical databases like PubMed, EMBASE, DARE, and NCG to find filtered and unfiltered information
    • Use Boolean operators like AND and OR to search efficiently for relevant literature
    • Use PubMed's "Clinical Queries" feature to quickly find relevant citations

    Hierarchy of Evidence

    • Hierarchies exist among types of experimental and observational studies, guiding clinical decision-making
    • The quality/level of evidence is directly related to the type of clinical question asked
    • For example, clinical questions on therapy would consider clinical practice guidelines (CPGs) based on meta-analyses and systematic reviews of RCT studies as the highest levels of evidence

    Types of Studies and Sources of Evidence

    • Best scientific evidence: systematic reviews (SR), meta-analyses (MA), randomized controlled trials (RCT), cohort studies, and clinical practice guidelines (CPGs)
    • Secondary sources: valid studies and publications synthesizing and generating clinically applicable information
    • Primary sources: original peer-reviewed research studies and publications

    Step 3: Appraise (Critical Appraisal)

    • Critically appraise all the evidence collected using checklists and forms to guide the appraisal process
    • Common appraisal tools used are: CONSORT statements for reviewing RCTs, PRISMA for reviewing SRs, and CASP for reviewing other types of studies

    Step 4: Apply (Integrating Evidence with Clinical Judgment)

    • Integrate the results of the best scientific evidence with good clinical judgment and patient preferences
    • Apply the evidence to the clinical scenario to make competent clinical decisions

    Step 5: Assess & Adjust

    • Evaluate the effectiveness of the intervention in achieving a good clinical outcome
    • Share the results with other care providers or make adjustments to interventions to provide better patient care### Evidence-Based Decision-Making Process
    • The process involves five A's: ask, acquire, appraise, apply, and assess
    • It is structured to achieve desired clinical outcomes

    Clinical Performance and Outcome

    • The goal is to determine if the evidence-based intervention achieved the desired outcome
    • The process involves assessing the outcome during follow-up visits

    Case-Based Learning Exercise

    • A 13-year-old female patient suffered dental trauma from a softball
    • The patient's teeth were replanted, and a stable and accurate Ribbond and flowable composite splint were used to stabilize the teeth
    • The clinician evaluated the outcome of the rendered treatment during follow-up visits

    Study Designs

    • A systematic review represents the highest level of evidence
    • It involves a comprehensive search of the literature to identify all relevant studies on a specific topic

    Anatomy, Structure, and Function of the Periodontium

    • The periodontium consists of the alveolar bone, periodontal ligament, cementum, and gingiva
    • The alveolar bone proper is the inner socket wall of thin, compact bone with the cribriform plate
    • Ankylosis is the fusion of the cementum and the alveolar bone with obliteration of the periodontal ligament
    • Bone cells include osteogenic cells, osteoblasts, osteocytes, and osteoclasts
    • Bone marrow is the red hematopoietic marrow of the newborn that becomes fatty or yellow inactive marrow with aging
    • Bundle bone contains a great number of Sharpey fibers and resorbs after tooth extraction
    • Cancellous bone is trabeculae enclosing marrow spaces and is predominantly found in interdental and interradicular spaces

    Relevant Terminology

    • Alveolar bone: the inner socket wall of thin, compact bone with the cribriform plate
    • Ankylosis: fusion of the cementum and the alveolar bone with obliteration of the periodontal ligament
    • Bone cells: cells seen within bone, including osteogenic cells, osteoblasts, osteocytes, and osteoclasts
    • Bundle bone: bone adjacent to the periodontal ligament that contains a great number of Sharpey fibers
    • Cancellous bone: trabeculae enclosing marrow spaces
    • Cemental aplasia: absence of cementum
    • Cemental hyperplasia/hypercementosis: excessive deposition of cementum
    • Cemental hypoplasia: paucity of cementum
    • Cemental resting lines: incremental lines parallel to the long axis of the root viewed in microscopic sections, separating lamellae of cementum
    • Cemental reversal line: a deeply staining irregular line that demarcates newly formed (reparative) cementum from the root, delineating the border of a previous cemental resorption

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    Description

    Test your understanding of clinical periodontology with this quiz based on Newman and Carranza's Essentials of Clinical Periodontology. Covers key concepts and topics in periodontology.

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