Dental MCQ
Controlling the disease · Periodontics · INBDE Patient Cases

Nonsurgical Periodontal Therapy INBDE Patient Cases

By Dr. Isaac Sun, DDS

7 ADA INBDE-format patient cases on nonsurgical periodontal therapy. Each case is a shared patient box (chief complaint, history, medications, allergies, exam) followed by linked multiple-choice questions with full distractor explanations. Practice the way the real exam is structured.

7 patient cases35 linked questionsADA INBDE formatFull distractor explanations

Seven ADA INBDE-format patient cases on nonsurgical periodontal therapy: scaling and root planing as first-line care for new moderate periodontitis with reevaluation and maintenance, a case showing plaque control as the decisive factor when therapy keeps failing, locally delivered antimicrobials for an isolated residual pocket, adjunctive systemic antibiotics (amoxicillin plus metronidazole) reserved for aggressive periodontitis, the reevaluation decision point sorting resolved sites to maintenance and residual deep sites to surgery, catching recurrence at a supportive periodontal therapy visit, and host modulation with sub-antimicrobial-dose doxycycline plus chlorhexidine rinse as adjuncts. Topics include scaling and root planing, oral hygiene and plaque control, antimicrobial adjuncts, reevaluation, and supportive periodontal therapy.

Case Coverage Map
What each case is testing
First-line care for new moderate periodontitis:
SRP plus oral hygiene as first-line, the long-junctional-epithelium repair expected, reevaluation at 4 to 6 weeks, and lifelong maintenance.
Treatment that keeps failing without home care:
Plaque control as the decisive factor, why surgery before plaque control also fails, and reinforcing home care over more cleanings.
One stubborn pocket after good SRP:
Local antimicrobial delivery for an isolated residual site, why systemic antibiotics are not warranted, and surgery if it still fails.
When systemic antibiotics are justified:
Aggressive periodontitis with adjunctive amoxicillin plus metronidazole, timing with debridement, and reserving antibiotics from routine cases.
The reevaluation crossroads:
Reevaluation timing, moving resolved sites to maintenance and residual deep sites to surgery, and confirming plaque control before surgery.
Catching recurrence at a maintenance visit:
Supportive periodontal therapy purpose, recognizing recurrence by new BOP/deepening, re-instrumentation, and risk-based recall intervals.
Adjuncts that modulate the host and the biofilm:
Sub-antimicrobial-dose doxycycline inhibiting MMPs, chlorhexidine rinse benefits and staining, and adjuncts supplementing (not replacing) debridement.
Patient case: First-line care for new moderate periodontitis
0 of 5 answered, 0 correct
Patient
Male, 47 years old
Chief Complaint
Bleeding gums and some deeper pockets found at exam.
Background and/or Patient History
  • Newly diagnosed generalized moderate periodontitis
  • Generalized 4 to 5 mm pockets with bleeding and calculus
  • No prior periodontal therapy
Allergies
NKDA
Medications
  • None
Current Findings
  • Calculus and biofilm with generalized inflammation and moderate pocketing
  • No teeth currently hopeless
  1. Question 1
    Easy
    The appropriate first-line therapy is:
  2. Question 2
    Moderate
    Alongside instrumentation, the most important component is:
  3. Question 3
    Moderate
    After SRP, the next step is to:
  4. Question 4
    Moderate
    The realistic expectation for these moderate pockets after thorough SRP and good home care is:
  5. Question 5
    Moderate
    Once stable, this patient will need:

Reset this case?

This clears your answers for this patient case only.

Patient case: Treatment that keeps failing without home care
0 of 5 answered, 0 correct
Patient
Female, 50 years old
Chief Complaint
Gum disease that returns despite repeated cleanings.
Background and/or Patient History
  • Has had several rounds of scaling and root planing
  • Plaque control remains poor between visits
  • Inflammation and pocketing recur each time
Allergies
NKDA
Medications
  • None
Current Findings
  • Heavy recurrent plaque and bleeding; recurrence after each SRP
  • No systemic complicating factors identified
  1. Question 1
    Moderate
    The most likely reason therapy keeps failing is:
  2. Question 2
    Moderate
    The most impactful intervention now is:
  3. Question 3
    Moderate
    Performing periodontal surgery before plaque control is achieved would:
  4. Question 4
    Easy
    This case demonstrates that the decisive factor in periodontal outcomes is:
  5. Question 5
    Moderate
    Going forward, maintenance for this patient should be:

Reset this case?

This clears your answers for this patient case only.

Patient case: One stubborn pocket after good SRP
0 of 5 answered, 0 correct
Patient
Male, 55 years old
Chief Complaint
Most of the mouth improved, but one site still pockets and bleeds.
Background and/or Patient History
  • Generalized periodontitis treated with SRP; overall good response
  • One isolated 6 mm pocket with bleeding persists at reevaluation
  • Good overall plaque control
Allergies
NKDA
Medications
  • None
Current Findings
  • Single residual deep, bleeding site in an otherwise improved mouth
  • Good general home care
  1. Question 1
    Moderate
    A reasonable adjunct for this isolated non-responding site is:
  2. Question 2
    Moderate
    Local delivery is appropriate here because:
  3. Question 3
    Moderate
    If this single site still fails to respond after local therapy and re-instrumentation, the next step is:
  4. Question 4
    Moderate
    Because the rest of the mouth responded, a systemic antibiotic is:
  5. Question 5
    Easy
    This case illustrates that local antimicrobials are:

Reset this case?

This clears your answers for this patient case only.

Patient case: When systemic antibiotics are justified
0 of 5 answered, 0 correct
Patient
Female, 28 years old
Chief Complaint
Rapidly progressing severe gum disease at a young age.
Background and/or Patient History
  • Aggressive (rapidly progressing) periodontitis with severe attachment loss for age
  • Family history of early tooth loss
  • Undergoing thorough mechanical debridement
Allergies
NKDA
Medications
  • None
Current Findings
  • Severe, rapidly progressing disease disproportionate to plaque
  • Mechanical therapy in progress
  1. Question 1
    Moderate
    In aggressive periodontitis, systemic antibiotics are:
  2. Question 2
    Moderate
    Systemic antibiotics should be given:
  3. Question 3
    Moderate
    Antibiotics are reserved for cases like this (rather than routine chronic periodontitis) because:
  4. Question 4
    Moderate
    Beyond antibiotics, this young patient needs:
  5. Question 5
    Easy
    The general principle is that systemic antibiotics in periodontics are:

Reset this case?

This clears your answers for this patient case only.

Patient case: The reevaluation crossroads
0 of 5 answered, 0 correct
Patient
Male, 60 years old
Chief Complaint
Reassessment six weeks after deep cleaning.
Background and/or Patient History
  • Generalized periodontitis treated with SRP six weeks ago
  • Most sites resolved (shallow, no bleeding); a few posterior sites remain deep and bleeding
  • Good home care established
Allergies
NKDA
Medications
  • None
Current Findings
  • Mixed response: many resolved sites plus several residual deep, bleeding pockets
  • Reevaluation visit
  1. Question 1
    Moderate
    Reevaluation at this point is timed to:
  2. Question 2
    Moderate
    The resolved sites (shallow, non-bleeding) should be:
  3. Question 3
    Moderate
    The residual deep, bleeding posterior sites are:
  4. Question 4
    Moderate
    Reevaluation is best described as:
  5. Question 5
    Moderate
    Before deciding on surgery for the residual sites, the clinician should confirm:

Reset this case?

This clears your answers for this patient case only.

Patient case: Catching recurrence at a maintenance visit
0 of 5 answered, 0 correct
Patient
Female, 57 years old
Chief Complaint
Routine periodontal maintenance visit.
Background and/or Patient History
  • Treated periodontitis on a 3-month supportive periodontal therapy schedule
  • At this visit, a few sites show new bleeding and slightly deeper pockets
  • Home care has slipped recently
Allergies
NKDA
Medications
  • None
Current Findings
  • New BOP and deepening at isolated sites since the last visit
  • Otherwise stable reduced periodontium
  1. Question 1
    Moderate
    The purpose of supportive periodontal therapy (maintenance) is to:
  2. Question 2
    Moderate
    New bleeding and deepening at these sites indicate:
  3. Question 3
    Moderate
    A contributing factor here is likely:
  4. Question 4
    Moderate
    Appropriate action at this visit includes:
  5. Question 5
    Moderate
    The recall interval in supportive periodontal therapy is set by:

Reset this case?

This clears your answers for this patient case only.

Patient case: Adjuncts that modulate the host and the biofilm
0 of 5 answered, 0 correct
Patient
Male, 53 years old
Chief Complaint
Asks about pills and rinses to help his gum treatment.
Background and/or Patient History
  • Moderate periodontitis undergoing SRP
  • Asking whether a low-dose doxycycline or a chlorhexidine rinse would help
  • Good candidate for adjuncts but expects realistic benefit
Allergies
NKDA
Medications
  • None
Current Findings
  • Moderate periodontitis being managed nonsurgically
  • Considering host-modulation and antiseptic adjuncts
  1. Question 1
    Hard
    Sub-antimicrobial-dose doxycycline used as host modulation works by:
  2. Question 2
    Moderate
    A chlorhexidine mouthrinse is best described as:
  3. Question 3
    Easy
    The realistic role of both adjuncts is:
  4. Question 4
    Moderate
    A practical downside of long-term chlorhexidine rinse use is:
  5. Question 5
    Easy
    The key message for this patient is that adjuncts:

Reset this case?

This clears your answers for this patient case only.

Keep studying
Nonsurgical Periodontal Therapy core recall

Refresh the anatomy facts these cases depend on: nerve numbers, foramina, functions, and lesion findings.

← Back to Nonsurgical Periodontal Therapy