Start practicing

Periodontics · patient case with 3 questions

Soft Tissue Assessment and Gingival Biotype

demo: 26-year-old female

chief: Consultation before orthodontic treatment.

history: Non-contributory.

meds: None

findings: Photographic assessment shows highly scalloped gingival architecture with a translucent margin through which the underlying periodontal probe is visible, and minimal keratinized tissue at the mandibular incisors. The dorsal tongue shows deep grooves radiating from a central fissure.

Question 1

The gingival appearance described corresponds to which biotype?

  1. Average biotype
  2. Thick biotype
  3. Biotype cannot be assessed clinically
  4. Thin biotype
Show answer and explanation

Correct answer: D. Thin biotype

  • A. Average biotype falls between the two extremes; the description given is clearly the thin end.
  • B. Thick biotype shows flat architecture, dense fibrotic tissue, a wide keratinized band, and no probe visibility through the margin.
  • C. Biotype is routinely assessed clinically by probe transparency and by measuring the keratinized tissue band.
  • D. Correct. Thin biotype is characterized by highly scalloped architecture, a delicate translucent margin through which a probe is visible, and a narrow band of keratinized tissue. It is more susceptible to recession following orthodontic movement or surgery.

Note: Probe transparency through the gingival margin is the simplest chairside test: if you can see the probe, the tissue is thin.

Permanent page for this question

Question 2

The deep grooves radiating from a central fissure on the dorsal tongue represent:

  1. Oral hairy leukoplakia requiring HIV testing
  2. Squamous cell carcinoma requiring urgent biopsy
  3. Median rhomboid glossitis requiring antifungal therapy
  4. Fissured tongue — a benign developmental variant requiring only brushing of the dorsum
Show answer and explanation

Correct answer: D. Fissured tongue — a benign developmental variant requiring only brushing of the dorsum

  • A. Hairy leukoplakia is a corrugated white lesion of the lateral border, not the dorsum.
  • B. Carcinoma presents as an indurated ulcer or mass, not symmetric fissuring.
  • C. Median rhomboid glossitis is a smooth depapillated rhomboid patch, not a fissure pattern.
  • D. Correct. Fissured tongue is a common benign developmental variant. Debris and Candida can accumulate in the grooves, so gentle brushing of the dorsum is the only management required. It is often seen with geographic tongue and in Down syndrome and Melkersson-Rosenthal syndrome.

Permanent page for this question

Question 3

A fractured cusp is discovered on tooth #30 with a traumatic ulcer on the lateral tongue directly opposing the sharp edge. What is the appropriate treatment?

  1. Biopsy the ulcer immediately
  2. Restore the fractured cusp to eliminate the source of trauma, then reassess the ulcer
  3. Prescribe systemic antibiotics
  4. Prescribe a topical corticosteroid for the ulcer
Show answer and explanation

Correct answer: B. Restore the fractured cusp to eliminate the source of trauma, then reassess the ulcer

  • A. Immediate biopsy is reserved for lesions with no identifiable cause or with suspicious features; here the cause is evident.
  • B. Correct. When a clear mechanical cause is identified, removing it and reassessing in about two weeks is the correct sequence. An ulcer that fails to heal after the irritant is gone then requires biopsy.
  • C. Antibiotics play no role in a traumatic ulcer.
  • D. Steroids may mask a lesion whose cause has not been addressed.

Permanent page for this question

Practice patient cases Periodontics study notes