1. What is the cause of periodontitis?

a. Infection of the pulp

b. Inflammation of the gingiva

c. Inflammation of the periodontal ligament

d. Infection of the periodontal ligament

e. None of the above

Answer: b. Inflammation of the gingiva. Explanation: Periodontitis is caused by the extension of

inflammation from the gingiva into deeper periodontal tissues.

2. What is retrograde periodontitis?

a. Pulpal infection caused by periodontal disease or treatment

b. Infection of the periodontal ligament

c. Infection of the pulp

d. Inflammation of the gingiva

e. None of the above

Answer: a. Pulpal infection caused by periodontal disease or treatment. Explanation: If periodontal

disease or treatment results in pulpal infection, it is called retrograde pulpitis.

3. Which of the following is not a pathway of communication between pulp and periodontium?

a. Apical foramen

b. Accessory canals and lateral canals

c. Developmental grooves

d. Enamel projections and pearls at the cervical portion

e. None of the above

Answer: e. None of the above. Explanation: All of the options listed are pathways of communication
between pulp and periodontium.

4. Which of the following is a pathway of pathologic origin?

a. Apical foramen

b. Accessory canals and lateral canals

c. Tooth fracture
d. Enamel projections and pearls at the cervical portion

e. None of the above

Answer: c. Tooth fracture. Explanation: Pathways of pathologic origin include tooth fracture, idiopathic
resorption, loss of cementum due to external irritants, and empty spaces created by destroyed
sharpey's fibres.

5. What is the effect of acute inflammation on the periodontium?

a. Decrease intrapulpal pressure

b. Inflammatory fluid pushed out through apical fora

c. Increase in pulp vitality

d. No effect on the periodontium

e. None of the above

Answer: b. Inflammatory fluid pushed out through apical foramen. Explanation: Acute inflammation can
increase intrapulpal pressure, which can cause inflammatory fluid to be pushed out through the apical
foramen.

oy the periodontal ligament

•Which of the following is a possible effect of pulpal disease on the periodontium?

A) Decrease in intrapulpal pressure

B) No effect on the periodontium

C) Formation of a periodontal pocket

D) Decrease in inflammatory fluid

E) None of the above

Answer: C) Formation of a periodontal pocket

Explanation: Inflammatory fluid pushed out through the apical foramen or accessory canal due to an
increase in intrapulpal pressure can cause a periapical abscess, which may drain through the
periodontal ligaments into the gingival sulcus. This can lead to the formation of a periodontal pocket in
due course of time.

•Which of the following is a possible effect of periodontitis on pulpal tissues?

A) Pulp necrosis due to periodontal infection entering via the apical foramen

B) No effect on pulpal tissues

C) Pulp inflammation due to scaling and root debridement

D) Pulp inflammation due to a decrease in intrapulpal pressure

E) None of the above

Answer: A) Pulp necrosis due to periodontal infection entering via the apical foramen

Explanation: Periodontal infection may enter via lateral canals or apical foramen and cause pulp
necrosis. Treatment of periodontal disease can also lead to secondary endodontic involvement. Lateral
canals and dentinal tubules may be opened to the oral environment by scaling, root debridement, or
surgical flap procedure. It is possible for a blood vessel within a lateral canal to be severed by a curette
and for microorganisms to be pushed into the area during treatment, resulting in pulp inflammation and
necrosis.

•Which of the following is a classification of periodontal and endodontic lesions?

A) Primary endodontic lesion

B) Primary periodontal lesion

C) Primary endodontic with secondary periodontal lesion

D) Primary periodontal lesion with secondary endodontic involvement

E) All of the above

Answer: E) All of the above

Explanation: The classification of periodontal and endodontic lesions was proposed by Simon et al in
1972 and includes all of the options listed.

pth is noted.

1. What is the typical pattern of bone resorption in endodontic lesions?

a) Apical only

b) Lateral only

c) Both apical and lateral

d) None of the above

e) Not mentioned

Answer: c) Both apical and lateral

Explanation: Endodontic lesions typically resorb bone both apically and laterally, and destroy the
attachment apparatus adjacent to a nonvital tooth.
2. What clinical presentation can mimic the presence of a periodontal abscess or deep periodontal
pocket in a tooth with a necrotic pulp?

a) Acute exacerbation of a chronic periapical lesion

b) Sinus tract of pulpal origin

c) Through-and-through furcation defect

d) Increased probing depth at the tooth apex

e) Not mentioned

Answer: a) Acute exacerbation of a chronic periapical lesion

Explanation: An acute exacerbation of a chronic periapical lesion on a tooth with a necrotic pulp can
drain through the PDL into the gingival sulcus, mimicking the presence of a periodontal abscess or
deep periodontal pocket.

3. What is the nature of the pocket when endodontic infection drains through the PDL?

a) Wide and shallow

b) Narrow and deep

c) Both wide and deep

d) Neither wide nor deep

e) Not mentioned

Answer: b) Narrow and deep

Explanation: When endodontic infection drains through the PDL, the resulting pocket is very narrow
and deep, and is actually a sinus tract of pulpal origin that opens through the PDL, rather than
breakdown due to periodontal disease.

4. What diagnostic tool is imperative for tracing the sinus tract of endodontic origin?

a) Radiographs

b) Probing

c) Scaling and root planing

d) Antibiotics

e) Not mentioned

Answer: a) Radiographs

Explanation: For diagnostic purposes, it is imperative to trace the sinus tract of endodontic origin by
inserting a gutta-percha cone and exposing one or more radiographs to determine the origin of the
lesion.

5. How is the tooth apex affected in a sinus tract of endodontic origin?

a) Increased probing depth is noted

b) No change in probing depth is noted

c) Decreased probing depth is noted

d) The tooth apex is not affected

e) Not mentioned

Answer: b) No change in probing depth is noted

Explanation: The sinus tract of endodontic origin is readily probed down to the tooth apex, where no
increased probing depth is noted.

1. Which type of disease is readily probed down to the tooth apex?

a) Primary Endodontic Disease

b) Primary Periodontal Disease

c) Both

d) Neither

e) Insufficient information

Answer: a) Primary Endodontic Disease

Explanation: The sinus tract of endodontic origin is readily probed down to the tooth apex, where no
increased probing depth would otherwise exist around the tooth.

2. What happens to the sinus tract extending into the gingival sulcus or the furcation area once the
necrotic pulp has been removed and the root canals are well sealed?

a) It disappears at an early stage

b) It becomes more prominent

c) It remains the same

d) It is difficult to determine

e) Insufficient information

Answer: a) It disappears at an early stage

Explanation: The sinus tract extending into the gingival sulcus or the furcation area disappears at an
early stage once the necrotic pulp has been removed and the root canals are well sealed.

3. What type of disease is caused by periodontal pathogens and results from the progression of chronic
periodontitis apically along the root surface?

a) Primary Endodontic Disease

b) Primary Periodontal Disease

c) Both

d) Neither

e) Insufficient information

Answer: b) Primary Periodontal Disease

Explanation: Primary Periodontal Disease is caused by periodontal pathogens and is the result of
progression of chronic periodontitis apically along the root surface.

4. What is frequently seen throughout the dentition in Primary Periodontal Disease?

a) Accumulation of plaque and calculus

b) No accumulation of plaque and calculus

c) Wider periodontal pockets in isolated areas

d) Narrow periodontal pockets throughout the dentition

e) Insufficient information

Answer: a) Accumulation of plaque and calculus

Explanation: Frequently accumulation of plaque and calculus are seen throughout the dentition in
Primary Periodontal Disease.

5. What does the prognosis of Primary Periodontal Disease depend on?

a) The stage of periodontal disease and the efficacy of periodontal treatment

b) The type of periodontal pathogen present

c) The age of the patient

d) The location of the periodontal pockets

e) Insufficient information

Answer: a) The stage of periodontal disease and the efficacy of periodontal treatment
Explanation: The prognosis of Primary Periodontal Disease depends on the stage of periodontal
disease and the efficacy of periodontal treatment.

1. Which of the following is true about pockets in periodontal disease?

a) Pockets are narrower in primary periodontal disease

b) Pockets are wider in primary periodontal disease

c) Pockets are narrower in secondary periodontal disease

d) Pockets are wider in secondary periodontal disease

e) Pockets remain the same width in both primary and secondary periodontal disease

Answer: b) Pockets are wider in primary periodontal disease. Explanation: The content states that
pockets are wider and generalized in primary periodontal disease.

2. What is the etiology of the lack of bony healing in a tooth referred for RCT due to periodontal
disease?

a) Primary endodontic disease

b) Secondary endodontic disease

c) Primary periodontal disease

d) Secondary periodontal disease

e) None of the above

Answer: c) Primary periodontal disease. Explanation: The content states that the etiology of the lack of
bony healing in a tooth referred for RCT due to periodontal disease is primary periodontal disease.

3. What is the pathway of inflammation into the periodontium in primary endodontic disease with
secondary perio?

a) Through the gingival margin

b) Through the apical foramen

c) Through the lateral canal

d) Through the accessory canal

e) None of the above

Answer: b) Through the apical foramen. Explanation: The content states that the pathway of
inflammation into the periodontium in primary endodontic disease with secondary perio is through the
apical foramen.
necrotic due to the

inflammatory process

and bacterial invasion

from the periodontal

pocket

•The tooth requires both

periodontal and endodontic

treatments

1. What is the pathway of inflammation into the periodontium in Primary Endo with Secondary Perio?

a) Through the crown of the tooth

b) Through the lateral canals

c) Through the periodontal ligament

d) Through the apical foramen, accessory and lateral canals

e) Through the gingival sulcus

Answer: d) Through the apical foramen, accessory and lateral canals. Explanation: In Primary Endo
with Secondary Perio, the inflammation enters the periodontium through the apical foramen, accessory
and lateral canals.

2. What is the treatment required for a tooth with Primary Endo with Secondary Perio?

a) Only endodontic treatment

b) Only periodontal treatment

c) No treatment required

d) Both endodontic and periodontal treatments

e) Only restorative treatment

Answer: d) Both endodontic and periodontal treatments. Explanation: In Primary Endo with Secondary
Perio, the tooth requires both endodontic and periodontal treatments.

3. What is the prognosis of a tooth with Primary Endo with Secondary Perio?

a) Good if the endodontic treatment is adequate

b) Good if the periodontal treatment is adequate

c) Good if the tooth is extracted

d) Poor regardless of the treatment

e) Good if the plaque-induced periodontitis is severe

Answer: a) Good if the endodontic treatment is adequate. Explanation: In Primary Endo with Secondary
Perio, if the endodontic treatment is adequate, the prognosis depends on the severity of the
plaque-induced periodontitis and the efficacy of perio treatment.

4. What may present as Primary Endo with Secondary Perio?

a) Gingivitis

b) Periodontal abscess

c) Tooth decay

d) Root fractures and perforations

e) None of the above

Answer: d) Root fractures and perforations. Explanation: Root fractures and perforations may present
as Primary Endo with Secondary Perio.

5. What is required for further healing in a tooth with Primary Endo with Secondary Perio?

a) Only endodontic treatment

b) Only periodontal treatment

c) No treatment required

d) Both endodontic and periodontal treatments

e) Only restorative treatment

Answer: d) Both endodontic and periodontal treatments. Explanation: In Primary Endo with Secondary
Perio, both endodontic and periodontal treatments are required for further healing.

1. What is Secondary Endo?

a) A type of periodontal disease

b) A type of endodontic treatment

c) A condition where the apical progression of a periodontal pocket continues until the apical tissues
are involved
d) A condition where the pulp becomes necrotic as a result of infection entering via the apical foramen

e) None of the above

Answer: c) A condition where the apical progression of a periodontal pocket continues until the apical
tissues are involved

Explanation: Secondary Endo is a condition where the apical progression of a periodontal pocket
continues until the apical tissues are involved.

2. What is Primary Perio with Secondary Endo?

a) A condition where the pulp becomes necrotic as a result of infection entering via the apical foramen

b) A condition where the progression of periodontitis induces a secondary endodontic lesion

c) A condition where the prognosis is usually poor in single-rooted teeth

d) A condition where the treatment of periodontal disease can also lead to secondary endodontic
involvement

e) None of the above

Answer: b) A condition where the progression of periodontitis induces a secondary endodontic lesion

Explanation: Primary Perio with Secondary Endo is a condition where the progression of periodontitis
induces a secondary endodontic lesion.

3. What is the prognosis for single-rooted teeth in Primary Perio with Secondary Endo?

a) Good

b) Poor

c) Unknown

d) Depends on the severity of the periodontal breakdown

e) None of the above

Answer: b) Poor

Explanation: In Primary Perio with Secondary Endo, the prognosis for single-rooted teeth is usually
poor, as the periodontal breakdown is very severe, necessitating extraction.

4. How can the treatment of periodontal disease lead to Secondary Endo?

a) By lateral canal and apex progression

b) By opening lateral canals and dentinal tubules to the oral environment

c) By causing the pulp to become necrotic

d) By inducing a secondary endodontic lesion

e) None of the above

Answer: b) By opening lateral canals and dentinal tubules to the oral environment

Explanation: Even though unusual, the treatment of periodontal disease can also lead to secondary
endodontic involvement. Lateral canals and dentinal tubules may be opened to the oral environment by
scaling and root planing or surgical flap procedures.

5. What evidence of Secondary Endo was found in #13 at initial presentation?

a) Horizontal bone loss

b) Periapical radiolucency

c) Negative vitality tests

d) All of the above

e) None of the above

Answer: d) All of the above

Explanation: At initial presentation, #13 showed evidence of horizontal bone loss as well as a periapical
radiolucency. The crown was intact, but vitality tests were negative. The post-op radiograph shows that
a lateral canal was exposed.

1. What is a potential pathway for bacteria in the given scenario?

a) A lateral canal

b) The crown

c) Bone loss

d) Vitality tests

e) None of the above

Answer: a) A lateral canal. Explanation: The lateral canal was exposed to the oral environment due to
bone loss and could serve as a potential pathway for bacteria.

2. Which of the following statements is true about true combined endo/perio disease?

a) It occurs frequently

b) It is formed when an endodontic disease progressing apically joins with an infected periodontal
pocket progressing coronally

c) The degree of attachment loss in this type of lesion is small

d) The prognosis is good, particularly for single-rooted teeth

e) None of the above

Answer: b) It is formed when an endodontic disease progressing apically joins with an infected
periodontal pocket progressing coronally. Explanation: True combined endo/perio disease occurs less
frequently than other endo/perio problems and is formed when an endodontic disease progressing
apically joins with an infected periodontal pocket progressing coronally. The degree of attachment loss
in this type of lesion is large and the prognosis is thus guarded, particularly for single-rooted teeth.

3. What does the radiograph show in the case of true combined disease?

a) Separate progression of endodontic disease and periodontal disease

b) Combined progression of endodontic disease and periodontal disease

c) No progression of either endodontic disease or periodontal disease

d) The tooth is intact with no signs of disease

e) None of the above

Answer: b) Combined progression of endodontic disease and periodontal disease. Explanation:

Radiograph shows the two lesions joining together due to the tooth remaining untreated.

4. Which of the following is not a microbiological finding associated with true combined disease?

a) Bacteriodes forsythus

b) P gingivalis

c) Treponema pallidum

d) Fusobacteria

e) None of the above

Answer: c) Treponema pallidum. Explanation: The microbiological findings associated with true
combined disease are Bacteriodes forsythus, P gingivalis, Fusobacteria, Spirochetes, and
Peptostreptococcus.

5. Which of the following is not a diagnostic aid for true combined disease?

a) Visual examination

b) Palpation

c) Percuss

d) Radiograph

e) None of the above

Answer: d) Radiograph. Explanation: Radiograph is not listed as a diagnostic aid for true combined
disease. The listed diagnostic aids are visual examination, palpation, and percuss.

1. Which of the following bacteria is associated with periodontitis?

a) P. gingivalis

b) Treponema pallidum

c) Fusobacteria

d) Spirochetes

e) Peptostreptococcus

Answer: a) P. gingivalis

Explanation: P. gingivalis is a gram-negative bacteria that is commonly associated with periodontitis.

2. Which of the following diagnostic aids is used to detect tooth mobility?

a) Visual examination

b) Palpation

c) Percussion

d) Mobility

e) Radiographs

Answer: d) Mobility

Explanation: Tooth mobility is detected by applying gentle pressure to the tooth and observing any
movement.

3. Which of the following treatments is recommended for a primary endodontic lesion?

a) Root debridement

b) RCT

c) Perio treatment

d) Both RCT and root debridement

e) None of the above

Answer: b) RCT
Explanation: A primary endodontic lesion is treated with root canal therapy (RCT).

4. Which of the following treatments is recommended for a primary perio lesion?

a) Root debridement

b) RCT

c) Perio treatment

d) Both RCT and root debridement

e) None of the above

Answer: a) Root debridement

Explanation: A primary perio lesion is treated with root debridement. RCT is not indicated unless there
is a change in pulp vitality later on.

5. Which of the following diagnostic aids is used to detect a fistula?

a) Visual examination

b) Palpation

c) Percussion

d) Pocket probing

e) Fistula tracking by gutta-percha

Answer: e) Fistula tracking by gutta-percha

Explanation: A fistula can be detected by tracking it with gutta-percha.