ADC Practice Question — Management of Sharps

Why does periodontitis cause secondary spacing, and why must the spaces NOT be closed orthodontically without treating the periodontal disease first?

Infection control in the ADC exam tests decision-making around exposure incidents, instrument classification, and decontamination protocols. This exam-level vignette tests your ability to work through clinical details and arrive at the correct management.

A patient develops progressive spacing of the upper anterior teeth with proclination. They have advanced periodontitis with significant bone loss. Why does periodontitis cause secondary spacing, and why must the spaces NOT be closed orthodontically without treating the periodontal disease first?

A. Spacing from periodontitis is purely cosmetic
B. Periodontitis causes spacing through: (1) loss of periodontal support
C. Periodontitis does not cause tooth spacing
D. Orthodontic closure eliminates the need for periodontal treatment

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Sources cited

Therapeutic Guidelines v4 Odell's 3rd & 4th Ed IADT 2020 Code of Conduct CMS (Evans) Infection Control + more

Show the answer and cited explanation

Correct answer: B

Periodontitis causes spacing through: (1) loss of periodontal support (reduced bone → teeth become mobile → tongue pressure and occlusal forces push teeth labially), (2) loss of interdental bone and papillae (creates visible spaces), (3) inflammatory destruction of the transseptal fibres that maintain tooth contact. Orthodontic closure without first treating the periodontitis is contraindicated because: orthodontic forces in the presence of active inflammation accelerate bone loss dramatically (force-induced osteoclast activation in already-compromised bone), and the teeth will simply drift apart again without periodontal stability. Sequence: control periodontitis → confirm stable attachment → THEN orthodontic closure if indicated

Source: Odell 4th Ed, Case 31: A Sharps Injury

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How are Management of Sharps questions structured in the ADC written exam?

ADC Management of Sharps questions present as clinical vignettes requiring management decisions. The correct answer is always traceable to a guideline source.

Should I memorise guidelines word-for-word for Management of Sharps?

Focus on decision points — when the guideline says X vs Y. The exam tests application, not recitation.

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Why does periodontitis cause secondary spacing, and why must the spaces NOT be closed orthodontically without treating the periodontal disease first?

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