Reading Skill Builder 3: Text Reference & Pronoun Cohesion

Goal: Identify what reference words and pronouns (it, they, these, this) refer to across multi-sentence paragraphs.

Read the sentences from the reading text. What does the bold word refer to? Circle the correct answer.

  1. "Flossing removes trapped food particles and plaque that your toothbrush cannot reach, which prevents gum disease."

What causes gum disease?

A) Using a soft toothbrush

B) Trapped food and plaque

C) Brushing twice a day

2. "You should limit sweet snacks like chocolate, candy, and carbonated soda... Sugar feeds harmful bacteria in your mouth and causes cavities."

What causes cavities?

A) Bacteria fed by sugar 

B) Chocolate with milk

C) Drinking water between meals

3."Furthermore, do not use your teeth as tools to open plastic bags or bite hard objects like ice. This can crack your teeth."

What does "This" refer to?

A) Visiting the clinic

B) Using teeth as tools or biting ice

C) Brushing before bed


Skill Builder 4 Reading Text: Understanding Cohesion & Reference – Going to the Dentist

Directions: Read the text below about dental clinic visits. Pay attention to how sentences connect to each other.

Paragraph 1

Visiting a dental hygienist regularly is essential for keeping your mouth healthy. This healthcare professional uses specialized tools to remove hard tartar and plaque from your teeth. During a cleaning, she will also check your gums for signs of infection or swelling. If the hygienist finds any deep cavities, she will inform the dentist immediately. These routine check-ups prevent small dental problems from turning into severe pain.

Paragraph 2

Many patients feel nervous before a clinic appointment, but they should know that modern dental care is usually painless. Hygienists often offer fluoride treatments to strengthen weak tooth enamel. This procedure only takes a few minutes and protects your teeth against decay. If you experience anxiety about dental visits, discuss it with the clinic staff. They can take extra steps to make sure you are comfortable.

Learner Task Sheet: Tracking Cohesive Devices & Substitution

When we write, we do not repeat the same noun over and over. We use pronouns (like she, they, it) or other noun phrases (like this procedure, these check-ups) to refer back to ideas mentioned earlier.

Section A: Pronoun Reference (What do these words mean?)

1.     In Paragraph 1, line 2, who does the pronoun "she" refer to?

o   Answer: ______________________________________________________________

2.     In Paragraph 2, line 1, who does the pronoun "they" refer to?

o   A) Dental hygienists

o   B) Many patients

o   C) Specialized tools

3.     In Paragraph 2, line 4, what does the pronoun "it" refer to in the phrase "discuss it with the clinic staff"?

o   A) Fluoride treatment

o   B) Tooth enamel

o   C) Anxiety about dental visits

4.     In Paragraph 2, line 4, who does the pronoun "They" refer to in the last sentence ("They can take extra steps...")?

o   Answer: _______________________________________________________________

Section B: Noun Phrase Substitution & Synonyms (Replacing Nouns)

5.     In Paragraph 1, line 1, the writer introduces "Visiting a dental hygienist regularly." In line 2, what 3-word phrase does the writer use to describe the hygienist so they don't repeat her title?

o   Answer: This __________________ __________________

6.     In Paragraph 1, lines 4–5, the writer mentions cleanings and check-ups. What 3-word phrase is used at the end of Paragraph 1 to summarize these visits?

o   Answer: These __________________ __________________

7.     In Paragraph 2, line 2, the text mentions "fluoride treatments." In the next sentence, what 2-word phrase replaces "fluoride treatments"?

o   Answer: This __________________

8.     In Paragraph 2, line 3, the writer uses the phrase "protects your teeth against decay." Which word earlier in Paragraph 1 means the same thing as "decay"?

o   A) Plaque

o   B) Cavities

o   C) Swelling

Section C: Sentence-Level Cohesion Practice 

Connect the two sentences by replacing the underlined noun with a correct pronoun (he, she, it, they, these).

9.     The dentist examined my broken tooth. The dentist said I need a filling.

The dentist examined my broken tooth. ________ said I need a filling.

10.  You should brush and floss every day. Brushing and flossing will prevent gum disease.

You should brush and floss every day. ________ habits will prevent gum disease.


GRAMMAR REVIEW: COHESIVE DEVICES - PRONOUNS

Pronoun Cohesion 1

Pronoun Cohesion 2

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