Guide to Periodontal Treatment Solutions for General Dentistry (eBook)

Tobias K. Boehm, Sam Chui (Autoren)

eBook Download: EPUB

2020 | 1. Auflage
255 Seiten
Georg Thieme Verlag KG
9781638535300 (ISBN)

Infos

<p><strong><em>A unique how-to guide for dental trainees on the practical application of periodontal treatment</em></strong></p> <p><cite>Guide to Periodontal Treatment Solutions for General Dentistry</cite> by Tobias Boehm and Sam Chui is a concise textbook on periodontics geared towards dental students, residents, and early-career general dentists. Each chapter includes cases and evidence-based practice exercises that illustrate key concepts and enable application of these concepts through independent study or non-lecture based teaching methods. The book is arranged in a logical sequence mirroring the manner in which patients present with periodontal disease, from the initial exam to state-of-the-art treatments.</p> <p>The opening chapters cover gingivitis and disease basics, data collection, epidemiology, classification systems, and diagnosis. Subsequent chapters encompass a wide array of nonsurgical and surgical approaches for treating issues such as gum pockets, furcation, gingival recession, mucogingival defects, and tooth mobility, as well as when to refer patients. The latest methods for controlling gingival inflammation are discussed, including scaling and root planing, systemic and local antimicrobial therapy, antiseptics, lasers, and photodynamic therapy.</p> <p><strong>Key Features</strong></p> <ul> <li>Case studies, review questions and explanations, coupled with diagrams and illustrations, enhance understanding and knowledge retention</li> <li>Nine chapters feature key points of periodontal treatment, with detailed step-by-step instructions on how to approach clinical problems</li> <li>Prognostic tools and risk assessments for predicting tooth longevity with discussion of various tooth replacement options</li> </ul> <p>This is an essential resource that guides dental students, residents and early career stage dentists through the fundamental aspects of periodontal treatment. The book also provides an excellent classroom tool for dental school instructors.</p> <p>This book includes complimentary access to a digital copy on <a href='https://medone.thieme.com/'>https://medone.thieme.com.</a></p>

Textauszug

1 Background: Periodontal Disease Mechanisms and Wound Healinga

Abstract

Periodontal diseases are one of the most common diseases in adults. Signs of mild periodontal inflammation are usually present in adults, and 10 to 60% of middle-aged adults have severe enough periodontal disease that requires treatment.

For diagnosis, it is helpful to understand the appearance of healthy periodontal tissues. This chapter begins with a description of periodontal health and reviews the contribution of microbes and immune system to the cellular changes that lead to the signs and symptoms of periodontal diseases. This is followed by reviews of periodontal wound healing and tooth development, and their influences on periodontal disease and treatment.

Keywords: structure, microbes, cells, development

1.1 Learning Objectives

•Recognize normal anatomy of healthy periodontal tissue.

•Describe the contribution of microbes to the periodontal disease process.

•Describe cellular and molecular events that lead to clinical signs and symptoms of periodontal disease.

•Describe how periodontal tissue recovers from injury caused by bacteria or tissue trauma.

•Describe how tooth development influences periodontal disease and treatment.

1.2 Case

A 25-year old healthy female dental student is seen for a peri-odontal exam as part of a clinical peer-to-peer exercise. See ►Fig. 1.1 for clinical presentation and ►Fig. 1.2 for radiographic presentation. She is currently satisfied with her dental condition, but had minor restorative treatment in the past and receives routine preventive dental care. She brushes and flosses regularly at least twice a day. These are the findings:

•Soft tissue exam: No pathology other than the presence of small lingual tori.

•Tooth condition: Small occlusal and interproximal amalgam restorations, and a slightly chipped maxillary incisor.

•Periodontal measurements: Probing depths less than 5 mm, no bleeding on probing, no clinical attachment loss, furca-tion involvement, tooth mobility, and gingival recession. The gingiva is coral pink with patches of light pink on the maxilla, firmly attached to underlying hard tissue and stippled. The gingival margin follows the contours of the teeth in a scalloped fashion, and no plaque or calculus is present.

Fig. 1.1 Clinical presentation for case.

Fig. 1.2 Radiographic series for case.

What can be learned from this case?

This dental student displays a good example of periodontal health. The description of the gingiva matches characteristics of periodontal health. Periodontal health is most commonly seen in young, healthy adults who receive frequent preventive care and practice effective oral hygiene.

1.3 Periodontal Health

1.3.1 Characteristics of Healthy versus Diseased Periodontal Tissues

As seen in the previous case, periodontal health means absence of signs and symptoms of periodontal disease. No signs of inflammation are present in any area of the gingiva (see ►Fig. 1.1), and all gingival landmarks are easily visible and in normal proportion to each other. Landmarks and areas of gingiva and mucosa are named as shown in ►Fig. 1.3.

The case illustrates what periodontal health looks like, and clinical data matches many elements of periodontal health as shown in ►Table 1.1.

Most patients' periodontal disease experience will fall somewhere on a spectrum of periodontal disease between perfect periodontal health and severe disease, matching all characteristics listed in ►Table 1.1. The challenge for a clinician is to decide whether a patient has sufficient signs and symptoms of the disease to warrant treatment.

1.3.2 Healthy, but Reduced Periodontium

The case described in this chapter demonstrates a healthy peri-odontium in an individual who likely never experienced severe periodontal disease, as the tissues are intact with no evidence of gingival recession, attachment loss, and bone loss. It is possible to achieve periodontal health after periodontal therapy, but here the tissues may show signs of past disease activity. This state is called “healthy, but reduced periodontium,” and has the following characteristics:

Fig. 1.3 (a) Oblique facial view of gingiva in patient seen in the preceding case with the different gingival landmarks and areas labeled. (b) Diagram of gingival landmarks. Healthy gingiva usually contains patches of stippling in the attached gingiva zone. (c) Diagram of a cross-section of healthy gingiva and periodontium attaching up to the cemento-enamel junction (CEJ). E = epithelium, CT = connective tissue. (d) Atraumatic extraction of a periodontally involved tooth reveals a depression in the interdental papilla called a “col,” which forms around wide interproximal contact points. Periodontal disease also produced the rough, pebbly epithelial surface that lined the extracted tooth. This is the sulcular epithelium that normally adapts tightly to the tooth surface inside the periodontal sulcus.

•Low probing depths.

•Little (< 10% of sites) or no bleeding on probing.

•Clinical attachment levels greater than zero/presence of radiographic bone loss.

•Gingival recession may be present.

•Tooth mobility may be present.

•Often, has a history of past periodontal treatment.

•Likely needs continued periodontal preventive care to prevent disease recurrence.

“Periodontal health” can also be achieved in edentulous areas of the jaw as there is no tooth-soft tissue interface where peri-odontal disease can develop. Here, the residual gingiva, away from any teeth, will appear healthy and there is no disease activity other than slow ridge resorption from lack of use.

1.4 Anatomy, Histology, and Clinical Relevance

The anatomy and histology of periodontal tissues are important for diagnosis and disease development as shown here.

1.4.1 Relationship between Clinical Landmarks and Tissue Histology

Gingival landmarks are related to unique histologic features of each gingival area (see ►Fig. 1.3):

•Marginal gingiva or free gingiva consists of keratinized stratified squamous epithelium resting on a small area of connective tissue apical to it. There is no fiber attachment to the underlying tooth. This makes the free gingiva flexible, and allows the insertion of a periodontal probe. Since this area is closest to the tooth surface, this area will display the earliest signs of periodontal inflammation. In healthy tissues, the marginal groove usually corresponds to the level of the periodontal sulcus.

•Attached gingiva consists of a thick layer of stratified squamous keratinized epithelium that usually lack residual cell nuclei in the most superficial layer (orthokeratinized). On the hard palate, and occasionally in gingiva, the superficial layer may retain greatly reduced cell nuclei (parakeratinized). The epithelium is firmly attached to underlying dense connective tissue with interlocking tissue fingers (rete pegs), and the underlying dense connective tissue is firmly attached to the periosteum of alveolar bone and teeth through gingival fibers. In a thin biotype, the gingiva is thin, translucent, relatively smooth, and has long and thin, friable dental papillae. In a thick biotype, the gingiva is very thick and heavily stippled with a dense, fibrous connective tissue core, and has short, stubby interdental papillae.

•Palatal gingiva is similar to the attached gingiva found on facial surfaces, but may also contain minor salivary glands and islands of adipose tissue, loose connective tissue, nerves and blood vessels, in addition to dense connective tissue. The epithelium and dense connective tissue of the hard palate also tend to be thicker and denser than their facial gingiva counterpart, which makes the palatal gingiva lighter in color than facial gingiva, and makes it more difficult to reflect palatal gingiva during surgery.

•Mucosa is a soft, flexible tissue that covers most of the oral cavity and allows jaw, lip, and tongue movement. It consists of a relatively thin nonkeratinized squamous stratified epithelium that has shallow rete pegs and rests on a deep bed of loose connective tissue. Clinically, since the epithelium is thinner and so it is more transparent. This tissue appears darker than gingiva and contains numerous small surface blood vessels that are clearly visible.

•Interdental papilla consists of smooth, keratinized-stratified squamous epithelium, and dense connective tissue near the interproximal alveolar bone. For anterior teeth, the interdental papilla usually is pyramid-shaped, whereas, for posterior teeth, it is saddle-shaped around the contact point. The depression around the contact point is called a col (see ►Fig. 1.4). Periodontal disease usually starts interproximally, and this tissue usually suffers the worst destruction during periodontal disease.

•Sulcular...

Produkt-Details

• Erscheint lt. Verlag: 7.10.2020
• Verlagsort: Stuttgart
• Sprache: englisch
• Themenwelt: Medizin / Pharmazie ► Gesundheitsfachberufe
• Themenwelt: Medizin / Pharmazie ► Studium
• Themenwelt: Medizin / Pharmazie ► Zahnmedizin
• Schlagworte: dentistry • Furcation • gingival inflammation • Gingival Recession • Gingivitis • gum pockets • Periodontal • Periodontal Disease • Periodontics • Periodontitis • tooth longevity • Tooth mobility • Treatment
• ISBN-13: 9781638535300 / 9781638535300