Color Atlas of Dental Hygiene. Periodontology

Description

Dental hygiene professionals need the very best scientific and clinical knowledge at their fingertips to effectively assist in the prevention and treatment of periodontal disease. Periodontology puts the needs of hygienists center stage, providing a detailed and brilliantly illustrated reference for daily practice, and a wealth of knowledge to underpin successful diagnosis and treatment.

A firm grasp of the pathogenesis of periodontal disease is essential for the hygienist. This book clearly outlines the vital concepts in immunology, genetics and destruction and repair of periodontal tissues. The innovations and new scientific evidence in these fields are lucidly described and invoke new approaches to etiology, diagnosis and treatment.

The importance of links between oral health and general systemic health cannot be overestimated. Periodontology conclusively demonstrates the necessity for patient and clinician to keep these associations to the forefront of risk assessment and treatment.

The benefits of this integrated approach will be clearly seen in the focus on prevention of oral disease, a primary objective for all hygiene professionals. The book shows how the systemic considerations influence the combination of diagnostic, therapeutic, pharmacological and mechanical treatment strategies.

Frequently encountered disorders such as gingival recession and pathological changes in the peridontium are comprehensively documented and the range of prevention and treatment options set out. The inclusion of specialized subjects such as oral manifestations of HIV disease and the developments in its treatment serve to underline the key position of the hygienist in the wider health care team.

The exceptional color photos throughout will be an indispensable guide to clinicians and students, and indeed a welcome resource for educators. From diagnostic tools such as depictions of levels of bleeding right through to detailed instrumentation techniques, these photos and their concise accompanying text form an outstanding best-practice guide.

Concluding with the American Academy of Periodontology’s Classification of Periodontal Disease, Periodontology will augment the knowledge and skills of dental hygienists, keeping practitioners up to date and providing students with the essential knowledge base for a career in periodontics.

CONTENTS

Fundamentals

1 Introduction
1 Periodontal Diseases
4 The Clinical Course of Untreated Periodontitis
4 Periodontitis—Concepts of Therapy

7 Structural Biology
8 Gingiva
10 Epithelial Attachment
12 Connective Tissue Attachment
14 Root Cementum
16 Osseous Support Apparatus
18 Blood Supply of the Periodontium
19 Innervation of the Periodontium
20 The Coordinated Functions of the Periodontal Structures

21 Etiology and Pathogenesis
22 Periodontitis—A Multifactorial Disease

23 Microbiology
24 Biofilm—Plaque Formation on Tooth and Root Surfaces
25 Supragingival Plague
26 Natural Factors Favoring Plaque Retention
27 Iatrogenic Factors Favoring Plaque Retention
28 Subgingival Plaque
29 Bacterial Invasion Into Tissue?
30 Classification of Oral Microorganisms
31 Cell Walls of Gram-positive and Gram-negative Bacteria
32 Periodontitis—Classical or Opportunistic Infection?
33 Putative Periodontopathic Bacteria
34 Virulence Factors
34 Virulence Transfer
36 Marker Bacteria in Periodontitis
37 Pathogenic “Single Fighters” vs. Pathogenic Complexes?
38 Endotoxins—Lipopolysaccharide (LPS)
38 Interaction Between LPS and the Host

39 Pathogenesis—Reactions and Defense Capabilities of the Host
40 New Concepts of Pathogenesis
– Therapeutic and Diagnostic Consequences
41 Host Response—Mechanisms and “Participants”
42 Non-specific, Congenital Immunity—the First Line of Defense
43 Specific, Acquired Immunity—the Second Line of Defense
44 Components of the Immune System—Summary
45 Interactions Between Non-specific and Specific Immunity
46 Regulatory Cell Surface Molecules: Markers, Receptors
47 Cytokines
49 Eicosanoids—Prostaglandins and Leukotrienes
50 Enzymatic Mechanisms—Matrix Metalloproteinases
51 Risk for Periodontitis—the Susceptible Host
52 Genetic Risk Factors—Diseases, Defects, Variations
54 Alterable Risk Factors, Modifying Co-Factors
55 Pathogenesis I—Initial Inflammatory Reactions
56 Pathogenesis II—Histology
58 Pathogenesis III—Molecular Biology
60 Attachment Loss I—Destruction of Connective Tissue
61 Attachment Loss II—Bone Resorption
62 Pathogenesis—Clinical Features: From Gingivitis to Periodontitis
63 Cyclic Course of Periodontitis
64 Periodontal Infections and Systemic Diseases
65 Etiology and Pathogenesis—Summary

67 Indices
70 Papilla Bleeding Index—PBI
71 Periodontal Indices
72 Community Periodontal Index of Treatment Needs—CPITN
73 Periodontal Screening and Recording—PSR
74 Epidemiology

74 Epidemiology of Gingivitis
75 Epidemiology of Periodontitis
76 WHO Studies

Disease Entities and Diagnosis

77 Types of Plaque-associated Periodontal Diseases
77 Gingivitis—Periodontitis
78 Classification of Periodontal Diseases—Nomenclature

79 Gingivitis
80 Histopathology
81 Clinical Symptoms
82 Mild Gingivitis
83 Moderate Gingivitis
84 Severe Gingivitis

85 Ulcerative Gingivitis/Periodontitis
86 Histopathology
87 Clinical Symptoms—Bacteriology
88 Ulcerative Gingivitis (NUG)
89 Ulcerative Periodontitis (NUP)
90 Ulcerative Gingivoperiodontitis—Therapy

91 Hormonally Modulated Gingivitis
93 Severe Pregnancy Gingivitis—Gravid Epulis
94 Pregnancy Gingivitis and Phenytoin

95 Periodontitis
96 Pathobiology—The Most Important Forms of Periodontitis
96 Type II
96 Type III B
97 Type III A
97 Type IV B
98 Pathomorphology—Clinical Degree of Severity
99 Pockets and Loss of Attachment
100 Intra-alveolar Defects, Infrabony Pockets
102 Furcation Involvement
104 Histopathology
105 Additional Clinical and Radiographic Symptoms
108 Chronic Periodontitis—Mild to Moderate
110 Chronic Periodontitis—Severe
112 Aggressive Periodontitis—Ethnic Contributions?
114 Aggressive Periodontitis—Acute Phase
116 Aggressive Periodontitis—Initial Stage
118 Prepubertal Periodontitis—PP (Aggressive Periodontitis)

119 Oral Pathologic Alterations of Gingiva and Periodontium
120 Primarily Gingival Alterations (Type I B)
120 Gingival and Periodontal Alterations (Type IV A/B)
121 Phenytoin-Induced Gingival Overgrowth
122 Dihydropyridine-induced Gingival Overgrowth
123 Cyclosporine-induced Gingival Overgrowth
124 Gingival Hyperplasia Following Combined Drug Therapies
125 Benign Tumors—Epulis
126 Benign Tumors—Fibrosis, Exostosis
127 Malignant Tumors
128 Gingivosis/Pemphigoid
128 Pemphigus vulgaris
129 Lichen planus: Reticular and Erosive
130 Leukoplakia, Pre-Cancerous Lesions—Oral Granulomatosis
131 Herpes—Herpetic Gingivostomatitis
132 Periodontitis with Systemic Diseases (Type IV)—Diabetes Type I and Type II
134 Periodontitis Associated with Systemic Diseases (Type IV B) Down Syndrome, Trisomy 21, “Mongolism”
136 Pre-pubertal Periodontitis Associated with Systemic Disease Papillon-Lefèvre Syndrome (Type IV B)
138 Papillon-Lefèvre Syndrome—“An Exception for Every Rule”

139 HIV Infection—AIDS
140 HIV Disease—Epidemiology
141 Classification and Clinical Course of HIV Disease
142 Oral Manifestations of HIV Disease
143 Bacterial Infections in HIV
144 Fungal Infections
145 Viral Infections
146 Neoplasms
147 HIV-Associated Lesions of Unknown Etiology
148 Invasion and Replication of the HI Virus— Hurdles for Systemic Medical Treatment
149 Treatment of the HIV Patient—Pharmacologic Aspects
150 HIV—Treatment of Opportunistic Infections
150 Infection Prevention and Post-exposure Prevention—The Dental Team
151 Treatment of HIV-Periodontitis

155 Gingival Recession
156 Fenestration and Dehiscence of the Alveolar Bone
157 Clinical Symptoms
158 Recession—Localized
159 Recession—Generalized
160 Clinical Situations Resembling Recession
161 Recession—Diagnosis
162 Measurement of Recession (Jahnke)
162 Classification of Recession (Miller)
164 Consequences of Recession

165 Data Collection—Diagnosis—Prognosis
166 Data Collection—Examinations
167 General Patient Health History
167 Special Patient Health History
168 Classic Clinical Findings
169 Pocket Probing—Probing Depth, Clinical Attachment Loss
170 Pocket Probing—Periodontal Probes
171 Pocket Probing Depths—Interpretation of the Measured Values
172 Furcation Involvement—Horizontal and Vertical Furcation Invasion
174 Tooth Mobility—Functional Analysis
176 Radiography

178 Additional Diagnosis—Tests
179 Microbial Diagnosis—Test Methods
180 Microbial Pocket Diagnosis—Dark Field and Phase Contrast Microscopy
181 Microbial Pocket Diagnosis—Cultures
182 New Diagnostic Tests—Evaluation
183 Molecular Biological Tests
184 Bacterial Probe Test—Practical IAI PadoTest
185 DNA/RNA Probe Tests—IAI PadoTest 4·5
186 Immunological Tests—Antigen-Antibody Reactions
187 Enzymatic Bacterial Tests—BANA Test

188 Tests of the Host Response—Risks
189 Genetic Risk—Test for IL-1 Gene Polymorphism
190 IL-1 Gene Test—Technique, Evaluation
191 Risk Factor IL-1-positive Genotype—Additional Risk Factors
192 Poor Oral Hygiene as a Risk Factor—Bleeding on Probing (BOP)
193 Periodontal Risk Assessment—Individual Risk Profile
194 Diagnostic Data Collection—Periodontal Charting, I and II
195 Computer-Enhanced Charting—the Florida Probe System
196 Diagnosis
197 Prognosis

198 Prevention—Prophylaxis
198 Maintenance of Health and Prevention of Disease
198 Definition: Prevention—Prophylaxis
199 Prevention of Gingivitis and Periodontitis

Therapy

201 Treatment of Inflammatory Periodontal Diseases
202 Therapeutic Concepts and Techniques
203 Therapy—Problems
204 Periodontitis—Therapeutic Goals, Therapeutic Outcomes

205 Periodontal Wound Healing
206 Wound Healing and Regeneration—Possibilities
208 Treatment Planning—Sequence of Treatment
• Pre-phase—Systemic Health, Oral Hygiene
• Phase 1—Causal, Antimicrobial, Anti-infectious
• Phase 2—Surgical, Corrective
• Phase 3—Preventive, Anti-infectious, “Life Long”
210 General Course of Therapy—Individual Planning

211 Systemic Pre-phase
212 Evaluation—Can the Patient be Safely Treated?
213 Bacteremia—Endocarditis Prophylaxis
214 Dental Procedures Carrying the Risk of Bacteremia
215 Diabetes mellitus (DM)—Risk Factor for Periodontitis
216 Smoking—An Alterable Risk Factor

217 Emergency Treatment

221 Phase 1 Therapy
222 Case presentation—Motivation—Information

223 Initial Treatment 1— Oral Hygiene by the Patient
224 Motivation—Gingival Bleeding
225 Plaque Disclosing Agents
226 Toothbrushes
228 Toothbrushing Technique
229 The Solo Technique—A Different Way to Brush Your Teeth
230 Electric Toothbrushes
231 Interdental Hygiene
234 Dentifrice
235 Chemical Plaque Control—“Soft Chemo” Prevention
236 Irrigators
237 Oral Hygiene for Halitosis—Tongue Cleansing
238 Possibilities, Successes and Limitations of Oral Hygiene

239 Initial Treatment 1— Creating Conditions that Enhance Oral Hygiene
240 Supragingival Tooth Cleaning—Power-driven Instruments …
241 … and their Use
242 Supragingival Tooth Cleaning—Hand Instruments, Prophy Pastes …
243 … and their Use
244 Creation of Conditions that Enhance Oral Hygiene—Removal of Iatrogenic Irritants
246 Correction of Iatrogenic Irritants—Bridge Pontics
247 Removal of Natural Plaque-retentive Areas— Odontoplasty of Grooves, Depressions, Irregularities
248 Reduction of Natural Plaque-retentive Areas—Crowding: Morphologic Odontoplasty
249 Treatment of Plaque-elicited Gingivitis
252 Gingivitis Treatment

253 Initial Treatment 2
“Closed”, Subgingival Therapy
253 Definitions
254 Non-Surgical, Anti-Infectious Therapy—Goals of Treatment
255 Antimicrobial Therapy—Combating the Reservoir
256 Root Planing—With or without Curettage?
257 Closed Therapy—Indication, Instrumentation
258 Hand Instruments for Scaling and Root Planing—Curettes
259 Powered Instruments for Debridement
260 Gracey Curettes—Areas of Use
262 Hand Instruments for Special Problems—Curettes
263 Practical Scaling Technique with Gracey Curettes—Systematic Approach
268 Instrument Sharpening
269 Manual Sharpening of Hand Instruments
270 Automated Sharpening
271 Subgingival Debridement—Closed Root Cleaning
276 Closed Therapy in Quadrant 1 …
277 … and in the Rest of the Dentition
278 Limitations of Closed Therapy
280 Possibilities and Limitations of Closed Therapy

281 FMT—“Full Mouth Therapy”
282 FMT—Instrumental/Mechanical and …
283 … Pharmacologic Therapy
284 FMT—Radiographic Results
285 FMT—Statistical/Numerical Results

287 Medications
287 Anti-Infectious Supportive Therapy—Antibiotics in Periodontitis Therapy
288 Decision-Making Criteria—When to Use Antibiotics?
290 Antibiotics—Bacterial Sensitivity and Resistance
291 Systemic Versus Local (Topical) Antimicrobial Therapy
292 Local (Topical) Antimicrobial Therapy—“Controlled Release Drugs” (CRD)
294 Host Response/Reaction—Modulating Substances

295 Phase 2 Therapy—Corrective Phase: Summary—
Periodontal and Mucogingival Surgery
296 Purposes and Goals of Periodontal Surgery
297 Patient Selection
298 Factors that Influence the Treatment Result
299 Methods of Periodontal Surgery and their Indications
300 Principles of Various Treatment Modalities—Advantages and Disadvantages
302 Pre-operative Treatment—Post-operative Care

303 Furcation Involvement—Furcation Treatment
304 Therapeutic Possibilities for Various Cases
306 Furcation Involvement—Classifications
307 Furcation Involvement, F2, in the Maxilla—Furcationplasty

309 Phase 3 Therapy
Periodontal Maintenance Therapy—Recall
310 Recall in the Dental Practice—Recall Effect
311 Recall—Continuous Risk Management
312 The “Recall Hour”—Practical Periodontal Maintenance Therapy
314 Dental Hygienist and Dentist—The “Preventive Team”
314 Auxiliary Personnel and Treatment Needs
315 Failures—Lack of Periodontal Maintenance Therapy
316 Negative Results of Therapy
318 Hypersensitive Dentin

319 Dental Implants—Implant Therapy
320 Determinative Diagnostic Criteria
321 Therapeutic Concepts—Therapeutic Results
322 Recall—Management of Implant Problems

323 Geriatric Periodontology?
The Periodontium in the Elderly
326 Age-related Changes—Influence Upon Treatment Planning
327 Classification of Periodontal Diseases

327 Most Recent Re-Classification of Periodontal Diseases (1999)
332 Acknowledgments for Figures

333 References

334 Index