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Essentials of Clinical Periodontology and Periodontics
Shantipriya Reddy
PART I: THE NORMAL PERIODONTIUM
CHAPTER 1:
Anatomy and Development of the Structures of Periodontium
INTRODUCTION
EXTERNAL ANATOMIC FEATURES
DEVELOPMENT OF PERIODONTIUM
Early Development of Cementum
Later Development of Cementum
Development of Junctional Epithelium (Fig. 1.8)
REVIEW QUESTIONS
CHAPTER 2:
Biology of Periodontal Tissues
INTRODUCTION
THE GINGIVA
Macroscopic Features
Marginal Gingiva or Free Gingiva or Unattached Gingiva
Gingival Sulcus
Attached Gingiva
Interdental Gingiva
Microscopic Features
Morphologic Characteristics of the Different Areas of Gingival Epithelium
Epithelium-Connective Tissue Interface
Supra-alveolar Connective Tissue
Blood Supply, Lymphatics and Nerves
PERIODONTAL LIGAMENT
Definition
Structure
Cellular Composition
Characteristics of a Synthetic Cell
Resorptive Cells
Extracellular Components
Development of Principal Fibers of Periodontal Ligament (Fig. 2.15)
Structures Present in the Connective Tissue
Functions of Periodontal Ligament
Physical Function
Formative and Remodeling Function
Nutritional and Sensory Function
Clinical Considerations
Orthodontic Tooth Movement
ALVEOLAR BONE
Definition
Parts of Alveolar Bone (Fig. 2.17)
Composition of Alveolar Bone
Cellular Components
Osseous Topography
Fenestrations and Dehiscences (Fig. 2.18)
Periosteum and Endosteum
Remodeling and Resorption
Blood Supply to the Bone
Clinical Considerations
CEMENTUM
Definition
Classification
Functions
Composition
Thickness of Cementum
Cementoenamel Junction (Fig. 2.20)
Cemental Resorption and Repair
REVIEW QUESTIONS
The Gingiva
Tooth-supporting Structures
Periodontal Ligament
Alveolar Bone
Cementum
CHAPTER 3:
Periodontal Structures in Aging Humans
GENERAL EFFECTS OF AGING
Skin
Bone
AGE CHANGES IN THE PERIODONTIUM (FIG. 3.1)
Gingiva and other Areas of the Oral Mucosa
Periodontal Ligament and Age Changes in the Periodontium
Changes in the Alveolar Bone and Cementum
Bacterial Plaque and Immune Response (Fig. 3.2)
EFFECTS OF AGING ON THE PROGRESSION OF PERIODONTAL DISEASES
EFFECTS OF TREATMENT ON THE AGING INDIVIDUALS
REVIEW QUESTIONS
PART II: CLASSIFICATION AND EPIDEMIOLOGY OF PERIODONTAL DISEASES
CHAPTER 4:
Classification Systems of Periodontal Diseases
NEED FOR CLASSIFICATION
CURRENT CLASSIFICATION SYSTEMS OF PERIODONTAL DISEASES
World Workshop in Clinical Periodontics (1988)
Gingivitis
Periodontitis
World Workshop in Clinical Periodontics (1989)
Genco (1990)
Ranney (1993)
Gingivitis
Periodontitis
European Workshop in Periodontology (1993)
Classification of Periodontal Disease and Condition
Gingival Disease (Table 4.1)
Chronic Periodontitis (Table 4.2)
Aggressive Periodontitis
Periodontitis as a Manifestation of Systemic Diseases
Necrotizing Periodontal Diseases
Abscesses of the Periodontium
Periodontitis Associated with Endodontic Lesions
Developmental or Acquired Deformities and Conditions
CHAPTER 5:
Epidemiology of Gingival and Periodontal Diseases
EPIDEMIOLOGY
Definition
Types of Epidemiologic Research
Descriptive Studies
Longitudinal Studies
Cross-sectional Studies
Analytical Studies
Experimental Epidemiology
Aims of Epidemiology
INDEX
Definition
Purposes and Uses of an Index
For Individual Patients
In Research
In Community Health
Characteristics of an Index
Indices Used to Assess the following Periodontal Problems
Indices Used to Assess Gingival Inflammation
Indices Used to Measure Periodontal Destruction
Indices Used to Measure Plaque Accumulation
Indices Used to Measure Calculus
Indices Used to Assess Treatment Needs
INDICES USED TO ASSESS GINGIVAL INFLAMMATION
Papillary Marginal Attachment (PMA) Index by Schour and Massler (1944)
Gingivitis Component of the Periodontal Disease
Gingival Index by Loe H and Sillness J (1963)
Method
Indices of Gingival Bleeding
Sulcular Bleeding Index by Mühlemann and Son (1971)
Papillary Bleeding Index by Mühlemann HR (1977)
Bleeding Points Index by Lennox and Kopczy K
Interdental Bleeding Index by Caton and Polson
Gingival Bleeding Index by Ainamo and Bay
INDICES USED TO MEASURE PERIODONTAL DESTRUCTION
Russell's Periodontal Index by Russell AL (1956)
Uses
Periodontal Disease Index by Sigurd P Ramfjord (1959)
Scoring Criteria
Extent and Severity Index by Carlos and Coworkers
Radiographic Approaches to Measure Bone Loss
Gingival Bone Count Index by Dunning and Leach
The Periodontitis Severity Index by Adams and Nystrom
INDICES USED TO MEASURE PLAQUE ACCUMULATION
Plaque Component of Periodontal Disease Index by Ramfjord
Uses
Simplified Oral Hygiene Index by Greene and Vermillion (1964)
Scoring Criteria for DI-S
Scoring Criteria for CI-S
Method
Turesky-Gilmore-Glickman Modification of the Quigley Hein Plaque Index (1970)
Scoring Criteria
Plaque Index by Sillness and Loe (1964)
Method
Scoring Criteria
Modified Navy Plaque Index
Advantage
Procedure
Tooth Mobility Indices
Miller's Index (1938)
Glickman's Index (1972)
Patient Hygiene Performance Index (PHP) by Podshadley and Hadley
Advantages
Selection of Teeth and Surfaces
Suggested Nominal Scale
Plaque Weight
Plaque-free Score by Grant, Stern and Everett
Purpose
Selection of Teeth and Surfaces
Procedure
Papillary Bleeding on Probing
Calculations
Plaque Control Record by O'Leary
Interpretations
INDICES USED TO MEASURE CALCULUS
Calculus Component of the Simplified Oral Hygiene Index by Greene and Vermillion—Discussed in Plaque Index
Calculus Component of the Periodontal Disease Index by Ramfjord
Advantages
Procedure
Probe Method of Calculus Assessment by Volpe and Associates
Advantages and Disadvantages
Purpose
Method
Calculus Surface Index by Ennever and Coworkers
Objective
Scoring Criteria
Marginal Line Calculus Index by Mühlemann and Villa
Purpose
INDICES USED TO ASSESS TREATMENT NEEDS
Gingival Periodontal Index
Objective
Specific Criteria
Community Periodontal Index of Treatment Needs by Ainamo and Associates
Procedure
Criteria
Advantages
Disadvantages
Periodontal Treatment Need System by Bellini HT
PART III: ETIOPATHOGENESIS
CHAPTER 6:
Periodontal Microbiology (Dental Plaque)
DEFINITION
Dental Plaque
Plaque
Biofilms
DENTAL PLAQUE AS A BIOFILM
TYPES OF DENTAL PLAQUE
Supragingival Plaque (Fig. 6.1)
Subgingival Plaque (Figs 6.2 and 6.3)
Tooth-associated Subgingival Plaque
Epithelium-associated Subgingival Plaque
Connective Tissue-associated Plaque
COMPOSITION OF DENTAL PLAQUE
FORMATION/DEVELOPMENT OF DENTAL PLAQUE
Bacterial Adherence
Bacterial Attachment via Electrostatic Interactions
Bacterial Attachment via Hydrophobic Interactions
Bacterial Attachment via Specific Lectin-like Substances (Fig. 6.6)
Growth and Accumulation of Bacteria
STRUCTURAL AND MICROSCOPIC PROPERTIES OF PLAQUE
Supragingival Plaque
CLINICAL SIGNIFICANCE OF PLAQUE
Subgingival Plaque
MICROBIAL SPECIFICITY OF PERIODONTAL DISEASES
Specific Plaque Hypothesis
WHAT MAKES PLAQUE PATHOGENIC?
MICROORGANISMS ASSOCIATED WITH PERIODONTAL DISEASES
Bacteria Associated with Periodontal Health and Disease
Health
Chronic Gingivitis
Gram-negative Organisms
Pregnancy-associated Gingivitis
Acute Necrotizing Ulcerative Gingivitis
Adult Periodontitis
Viruses
Localized Juvenile Periodontitis
Generalized Juvenile Periodontitis
Refractory Periodontitis
Abscesses of the Periodontium
REVIEW QUESTIONS
CHAPTER 7:
Calculus and other Etiological Factors
CALCULUS
Definition
Types
Supragingival Calculus
Subgingival Calculus
Structure
Composition
Differences between Supragingival and Subgingival Calculus
Attachment to the Tooth Surface
Formation of Calculus
Theories of Calculus Formation
Pathogenic Potential of Calculus in Periodontal Diseases
OTHER CONTRIBUTING ETIOLOGICAL FACTORS INCLUDING FOOD IMPACTION
Iatrogenic Factors
Faulty Restorations
Periodontal Problems Associated with Orthodontic Therapy
Food Impaction
Unreplaced Missing Teeth
Malocclusion (Figs 7.9 and 7.10A and B)
Habits
REVIEW QUESTIONS
Calculus
Other Contributing Etiological Factors including Food Impaction
CHAPTER 8:
Host Response: Basic Concepts
INTRODUCTION
ROLE OF SALIVA IN THE HOST DEFENCE
GINGIVAL EPITHELIUM
GINGIVAL CREVICULAR FLUID
COMPLEMENT (FIG. 8.1)
Classical Pathway
Alternative Pathway
THE INFLAMMATORY CELL RESPONSE
Neutrophils
Functions of Neutrophils
Neutrophil Disorders Associated with Periodontal Diseases
Periodontal Diseases Associated with Neutrophil Disorders
Functions of Macrophages in the Gingiva, Crevice and Pocket
IMMUNOLOGICAL MECHANISMS (FIG. 8.9)
Type I: Anaphylactic Reactions
Mechanisms of Anaphylactic Hypersensitivity
Type II: Cytotoxic Reactions
Type III: Immune Complex or Arthus Reactions
Type IV: Cell-mediated or Delayed Hypersensitivity
IMMUNOLOGY OF PERIODONTAL DISEASE (FIG. 8.11)
REVIEW QUESTIONS
CHAPTER 9:
Trauma from Occlusion
PHYSIOLOGIC ADAPTIVE CAPACITY OF THE PERIODONTIUM TO OCCLUSAL FORCES
TRAUMA FROM OCCLUSION (TFO)
Definition and Terminology
Types
Signs and Symptoms
Clinical Signs and Symptoms
Histologic Changes
Stage 1: Injury
Stage 2: Repair
Stage 3: Adaptive Remodeling of the Periodontium
Other Properties
Effect of Insufficient Occlusal Force
Reversibility of Traumatic Lesion
Effect of Increased Occlusal Forces on Pulp
ROLE OF THE TRAUMA FROM OCCLUSION IN THE PROGRESSION OF PERIODONTAL DISEASE
PATHOLOGIC TOOTH MIGRATION
Pathogenesis
The Health and Normal Height of the Periodontium
Changes in the Forces Exerted on the Teeth
OTHER CAUSES
REVIEW QUESTIONS
CHAPTER 10:
Role of Systemic Diseases in the Etiology of Periodontal Diseases
INTRODUCTION
DIETARY AND NUTRITIONAL ASPECTS OF PERIODONTAL DISEASE
The Consistency of Diet
Protein Deficiency and Periodontal Disease
Vitamins and Periodontal Disease
Vitamin C
Clinical Manifestations
Histopathological Features
Possible Etiologic Relationships between Ascorbic Acid and Periodontal Disease
Periodontal Features of Scurvy
Vitamin D Deficiency
Vitamin E
Vitamin A
Vitamin B-Complex
EFFECTS OF HEMATOLOGICAL DISORDERS ON PERIODONTIUM
White Blood Cell Disorders
Neutropenias
Cyclic Neutropenia
Chronic Benign Neutropenia of Childhood
Benign Familial Neutropenia
Chronic Idiopathic Neutropenia
Leukemia
Periodontal Manifestations
Treatment Plan for Leukemic Patients
Thrombocytopenic Purpura
Treatment
Disorders of WBC Function
Chédiak-Higashi Syndrome
Lazy Leukocyte Syndrome
Chronic Granulomatous Disease
Red Blood Cell Disorders
Aplastic Anemia
Fanconi's Anemia
Sickle Cell Anemia
Acatalasia
METABOLIC AND ENDOCRINE DISORDERS
Diabetes Mellitus and Periodontal Disease
Pathogenesis
Treatment
Guidelines
Thyroid Gland
Treatment
Pituitary Gland
Parathyroid Glands
Gonads
Gingivitis in Puberty (Fig. 10.5)
Gingival Changes Associated with Menstrual Cycle
Gingival Diseases in Pregnancy (Fig. 10.6)
Clinical Features
Menopausal Gingivostomatitis
CARDIOVASCULAR DISEASES
Arteriosclerosis
Congenital Heart Disease
ANTIBODY DEFICIENCY DISORDERS
Acquired Immunodeficiency Syndrome
Clinical Manifestations
OTHER SYSTEMIC DISEASES
Bismuth Intoxication
Lead Intoxication
Mercury Intoxication
Other Chemicals
PSYCHOSOMATIC DISORDERS
REVIEW QUESTIONS
CHAPTER 11:
Oral Malodor
INTRODUCTION
CLASSIFICATION OF HALITOSIS
Genuine Halitosis
Pseudohalitosis
Halitophobia
ETIOLOGY
Causes for Physiologic Halitosis
Causes for Pathologic Halitosis
Systemic and Extraoral Factors
DIAGNOSIS OF HALITOSIS
TREATMENT AND MANAGEMENT OF ORAL MALODOR
SUMMARY
REVIEW QUESTIONS
CHAPTER 12:
Pathogenesis of Periodontal Diseases
INTRODUCTION
ROLE OF BACTERIAL INVASION
ROLE OF EXOTOXINS
ROLE OF CELL CONSTITUENTS
ROLE OF ENZYMES
EVASION OF HOST RESPONSES (TABLES 12.1 TO 12.5)
THE HOST DERIVED BONE RESORBING AGENTS
Cytokines
Other Inflammatory Mediators
ROLE OF CYTOKINES
REVIEW QUESTIONS
CHAPTER 13:
Periodontal Medicine
INTRODUCTION
ERA OF FOCAL INFECTION
PERIODONTAL DISEASE AND CORONARY HEART DISEASE/ATHEROSCLEROSIS
EFFECT OF PERIODONTAL INFECTION
Ischemic Heart Diseases
Thrombogenesis
Atherosclerosis (Fig. 13.2)
Periodontal Infection and Stroke
PERIODONTAL DISEASE AND DIABETES MELLITUS
ROLE OF PERIODONTITIS IN PREGNANCY OUTCOME
PERIODONTAL DISEASE AND CHRONIC OBSTRUCTIVE PULMONARY DISEASE
PERIODONTAL DISEASE AND ACUTE RESPIRATORY INFECTION
PERIODONTAL MEDICINE IN CLINICAL PRACTICE
REVIEW QUESTION
CHAPTER 14:
Smoking and Periodontal Diseases
EFFECT OF SMOKING ON THE PREVALENCE AND SEVERITY OF PERIODONTAL DISEASE
EFFECT OF SMOKING ON THE ETIOLOGY AND PATHOGENESIS OF PERIODONTAL DISEASE
Microbiology
Immunology
Physiology
EFFECT OF SMOKING ON THE RESPONSE TO PERIODONTAL THERAPY
EFFECT OF SMOKING CESSATION
REVIEW QUESTION
CHAPTER 15:
Host Modulation in Periodontal Therapy
INTRODUCTION
Specific Aspects of Disease Pathogenesis as Potential Targets for Host Modulation
REGULATION OF IMMUNE AND INFLAMMATORY RESPONSES
EXCESSIVE PRODUCTION OF MATRIX METALLOPROTEINASES (MMPs)
Role of MMPs in Human Periodontal Diseases
PRODUCTION OF ARACHIDONIC ACID METABOLITES
REGULATION OF BONE METABOLISM
REVIEW QUESTION
PART IV PERIODONTAL PATHOLOGY: SECTION 1: GINGIVAL DISEASES
CHAPTER 16:
Defence Mechanisms of the Gingiva
DEFENCE MECHANISMS
Nonspecific Protective Mechanisms
Bacterial Balance
Surface Integrity
Surface Fluid and Enzymes
Phagocytosis
The Inflammatory Reaction
Specific Protective Mechanism
SULCULAR FLUID
Anatomy of Gingival Crevice or Sulcus
Significance of Gingival Sulcus and Fluid
Significance of Gingival Vasculature and Crevicular Fluid (Fig. 16.1)
Permeability of Sulcular and Junctional Epithelium
Methods of Collection
Absorbing Paper Strips
Evaluation of Amount of Fluid Collected
Sampling by Means of Micropipettes (Fig. 16.3)
Gingival Washings
Other Methods
Composition of Gingival Crevicular Fluid (GCF) (Table 16.2)
Clinical Significance
General Health and Gingival Fluid
Drugs in Gingival Fluid
Influence of Mechanical Stimuli
Periodontal Therapy and Gingival Fluid
REVIEW QUESTIONS
CHAPTER 17:
Gingival Inflammation
INTRODUCTION
STAGE I GINGIVITIS: THE INITIAL LESION (FIG. 17.2)
STAGE II GINGIVITIS: THE EARLY LESION (FIG. 17.3)
STAGE III GINGIVITIS: THE ESTABLISHED LESION
STAGE IV GINGIVITIS: THE ADVANCED LESION
Progression from Health to Periodontitis
CHAPTER 18:
Clinical Features of Gingivitis
TYPES OF GINGIVITIS
Depending on the Course and Duration
Depending on the Distribution
CLINICAL FINDINGS
Gingival Bleeding on Probing (Fig. 18.5)
Significance of Gingival Bleeding on Probing
Etiological Factors Responsible for Gingival Bleeding on Probing
Microscopic Changes Associated with Gingival Bleeding on Probing
Color Changes in the Gingiva
Changes in the Consistency of Gingiva
Changes in the Size of the Gingiva
Surface Texture
Changes in the Position of Gingiva
Definition
Types
Classification of Gingival Recession
Etiology of Gingival Recession (Figs 18.7 to 18.11)
Clinical Significance of Gingival Recession
Changes in Gingival Contour
REVIEW QUESTION
CHAPTER 19:
Gingival Enlargement
INTRODUCTION
CLASSIFICATION
INFLAMMATORY ENLARGEMENT (Table 19.1)
Acute Inflammatory Enlargement (Table 19.2)
Signs and Symptoms
Etiology
Histopathology
Treatment of Gingival Abscess
Chronic Inflammatory Enlargement (Fig. 19.1)
Localized/Generalized
Discrete/Tumor-like
Histopathology
Etiology
In mouth breathers:
Treatment
NONINFLAMMATORY GINGIVAL ENLARGEMENT (FIBROTIC GINGIVAL ENLARGEMENT) (Table 19.3)
Phenytoin-induced Gingival Hyperplasia (Fig. 19.2)
Clinical Features
Histopathology
Pathogenesis
Treatment of Drug-associated Gingival Enlargement
First Step
Second Step
Idiopathic Gingival Fibromatosis (Fig. 19.4)
Clinical Features
Histopathology
Etiology
Combined Enlargement
Treatment
ENLARGEMENT ASSOCIATED WITH SYSTEMIC DISEASES OR CONDITIONS (Table 19.4)
Conditioned Enlargement
Enlargement in Pregnancy
Marginal Enlargement
Tumor-like Gingival Enlargement or Pregnancy Tumor
Histopathology
Treatment
Enlargement in Puberty (Fig. 19.5)
Clinical Features
Histopathology
Treatment
Vitamin C Deficiency
Clinical Features
Histopathology
Plasma Cell Gingivitis
Nonspecific Conditioned Enlargement (Granuloma Pyogenicum) (Figs 19.6 and 19.7)
Clinical Features
Histopathology
Treatment
Systemic Disease Causing Gingival Enlargement
Leukemia
In Chronic Leukemia
Granulomatous Diseases (Table 19.5)
Wegener's Granulomatosis
Sarcoidosis
NEOPLASTIC ENLARGEMENT (GINGIVAL TUMOR)
Benign Tumors of the Gingiva (Table 19.6)
Malignant Tumors of the Gingiva (Table 19.7)
FALSE ENLARGEMENT (FIG. 19.9)
Underlying Osseous Lesions
Underlying Dental Tissues
REVIEW QUESTION
CHAPTER 20:
Acute Gingival Infections
CLASSIFICATION OF VARIOUS ACUTE GINGIVAL LESIONS
According to Manson
NECROTIZING ULCERATIVE GINGIVITIS (NUG)
Terminology
Clinical Features (Fig. 20.1)
Intraoral Signs and Symptoms
Oral Symptoms
Extraoral Signs and Symptoms
Clinical Course
Etiology
Role of Bacteria
Local Predisposing Factors
Systemic Predisposing Factors
Histopathology
Relationship of Bacteria to the Characteristic Lesions
Diagnosis
Treatment
Treatment for Non-ambulatory Patients
Treatment for Ambulatory Patients
Further Treatment Considerations
ACUTE HERPETIC GINGIVOSTOMATITIS (AHG) (FIGS 20.2 AND 20.3)
Clinical Features
Primary Gingivostomatitis
Oral Symptoms
Extraoral and Systemic Signs and Symptoms
Recrudescent Oral HSV Infection
Etiology
Histopathology
Diagnosis
Differential Diagnosis
Treatment
Recurrent Aphthous Stomatitis (RAS)
Etiology
Treatment
PERICORONITIS (FIG. 20.5)
Definition
Types
Clinical Features
Signs and Symptoms
Acute Pericoronitis
Complications
Treatment (Figs 20.6A to E)
First Visit
REVIEW QUESTIONS
CHAPTER 21:
Periodontal Diseases in Children and Young Adolescents
INTRODUCTION
ANATOMIC CONSIDERATIONS IN CHILDREN
Changes in Gingiva
Cementum
Periodontal Ligament
Alveolar Bone
HISTOPATHOLOGY OF GINGIVITIS IN CHILDREN
MICROBIOLOGY OF PERIODONTAL DISEASES IN CHILDREN
CLASSIFICATION OF PERIODONTAL DISEASES IN CHILDREN
Gingival Lesions
Periodontal Lesions
Early Onset Periodontitis
PERIODONTITIS ASSOCIATED WITH SYSTEMIC DISEASE
Gingival Lesions
Acute Herpetic Gingivostomatitis
Clinical Features
Acute Necrotizing Ulcerative Gingivitis (NUG)
Candidiasis: Acute Candidiasis (Moniliasis, Thrush)
Chronic Candidiasis
Chronic Marginal Gingivitis
Etiology
Factitious Gingivitis (Gingivitis Artefacta)
Localized Gingival Recession
Types of Periodontitis
Prepubertal Periodontitis
Localized Prepubertal Periodontitis
Generalized Prepubertal Periodontitis
Juvenile Periodontitis
Clinical features of localized juvenile periodontitis (LJP)
Periodontitis Associated with Syndromes
Papillon-Lefévre Syndrome
Ehlers-Danlos Syndrome
Down's Syndrome (Mongolism, trisomy 21)
CHAPTER 22:
Desquamative Gingivitis
INTRODUCTION
CLASSIFICATION
CLINICAL FEATURES
HISTOPATHOLOGY
DIAGNOSIS
THERAPY
DISEASES CLINICALLY PRESENTING AS DESQUAMATIVE GINGIVITIS
LICHEN PLANUS
Clinical Features
Oral Lesions
Gingival Lesions
Histopathology
Differential Diagnosis
Treatment (Fig. 22.4) and Prognosis
CICATRICIAL PEMPHIGOID
Clinical Features
Histopathology
Differential Diagnosis
Treatment and Prognosis
BULLOUS PEMPHIGOID
Clinical Features
Histopathology
Treatment
LINEAR IgA DISEASE
Oral Lesions
Histopathology
Differential Diagnosis
Treatment
DERMATITIS HERPETIFORMIS
Clinical Features
Histopathology
Treatment
PEMPHIGUS VULGARIS
Clinical Features
Histopathology
Differential Diagnosis
Treatment
DRUG REACTION OR ERUPTIONS
DISEASES CLINICALLY PRESENTING AS DESQUAMATIVE GINGIVITIS
REVIEW QUESTION
SECTION 2: PERIODONTAL DISEASES
CHAPTER 23:
The Periodontal Pocket
INTRODUCTION
DEFINITION
CLASSIFICATION (FIG. 23.1)
CLINICAL FEATURES
Signs
Symptoms
PATHOGENESIS (Figs 23.2A to G)
Summary of Pathogenesis
First Event
Second Event
HISTOPATHOLOGY
Changes in the Soft Tissue Wall
Microtopography of the Gingival Wall of the Pocket
Periodontal Pocket as a Healing Lesion
Pocket Contents
Changes in the Root Surface Wall
Periodontal Disease Activity
Relation of Loss of Attachment and Bone Loss to Pocket Depth (Fig. 23.4)
PERIODONTAL CYST
Determination of Pocket Depth
TREATMENT OF PERIODONTAL POCKET
REVIEW QUESTION
CHAPTER 24:
Bone Loss and Patterns of Bone Destruction
INTRODUCTION
NORMAL ANATOMY OF ALVEOLAR BONE (FIG. 24.1)
MECHANISM OF BONE FORMATION AND BONE DESTRUCTION
Local Factors
Role of Chronic Gingival Inflammation
Bone Destruction Caused by Trauma from Occlusion Alone
Systemic Factors
Pharmacological Agents and Bone Resorption
Radius of Action
Rate of Bone Loss
Periods of Destruction
FACTORS DETERMINING BONE MORPHOLOGY IN PERIODONTAL DISEASE
Normal Variation in Alveolar Bone
BONE DESTRUCTION PATTERNS IN PERIODONTAL DISEASE
Horizontal Bone Loss
Vertical or Angular Defects (Figs 24.3 and 24.4)
Osseous Craters (Fig. 24.5)
Bulbous Bony Contours (Fig. 24.6)
Reversed Architecture
Ledges
Furcation Involvements (Fig. 24.7)
PREVALENCE AND DISTRIBUTION OF BONE DEFECTS IN MODERATE ADULT PERIODONTITIS
REVIEW QUESTION
CHAPTER 25:
Chronic Periodontitis
INTRODUCTION
DEFINITION
DIAGNOSTIC CRITERIA FOR CHRONIC PERIODONTITIS (FIGS 25.1 AND 25.2)
Clinical Features
Microbiological Features
Radiographic Features (Fig. 25.3)
TYPES
Disease Distribution
Disease Severity
Slight (Mild) Periodontitis
Moderate Periodontitis
Severe Periodontitis
NATURE OF DISEASE PROGRESSION
RISK FACTORS FOR DISEASE
GENERAL CONCEPT FOR ETIOLOGY OF CHRONIC PERIODONTITIS
REVIEW QUESTION
CHAPTER 26:
Aggressive Periodontitis
INTRODUCTION
LOCALIZED AGGRESSIVE PERIODONTITIS/LOCALIZED JUVENILE PERIODONTITIS
Historical Background
Clinical Features
Age and Sex Distribution
Distribution of Lesions
Clinical Findings (Figs 26.1 and 26.2)
Radiographic Findings (Figs 26.3 and 26.4)
Histopathology/Microscopic Features
Bacteriology
Immunology
Treatment
Current Approach to Therapy
GENERALIZED AGGRESSIVE PERIODONTITIS
Clinical Characteristics
Radiographic Findings
Risk Factors for Aggressive Forms of Periodontitis
Microbiologic Factors
Immunologic Factors
Genetic Factors
Environmental Factors
CHAPTER 27:
Necrotizing Ulcerative Periodontitis, Refractory Periodontitis and Periodontitis as a Manifestation of Systemic Disease
NECROTIZING ULCERATIVE PERIODONTITIS (NUP)
Non-AIDS Type Necrotizing Ulcerative Periodontitis
Clinical Features
AIDS-Associated Ulcerative Periodontitis
REFRACTORY PERIODONTITIS
Etiology
Risk Factors Responsible for Refractory Cases
Clinical Features
Treatment
PERIODONTITIS AS A MANIFESTATION OF SYSTEMIC DISEASE
Papillon-Lefévre Syndrome (Fig. 27.1)
Chédiak-Higashi Syndrome (CH Syndrome)
Down's Syndrome (Mongolism, Trisomy 21)
Hypophosphatasia
Neutropenia
Leukocyte Adhesion Deficiency
REVIEW QUESTION
CHAPTER 28:
AIDS and the Periodontium
HIV OPPORTUNISTIC INFECTIONS
CLASSIFICATION OF PERIODONTAL DISE- ASES ASSOCIATED WITH HIV INFECTION
Linear Gingivitis
Necrotizing Ulcerative Gingivitis (NUG)
Necrotizing Ulcerative Periodontitis (Figs 28.1 and 28.2)
Necrotizing Stomatitis
CDC Surveillance Care Classification (1993)
MOST COMMON ORAL AND PERIODONTAL MANIFESTATIONS OF HIV INFECTION
MANAGEMENT
TREATMENT OF LINEAR GINGIVAL ERYTHEMA AND NECROTIZING ULCERATIVE GINGIVITIS
Treatment of Necrotizing Ulcerative Periodontitis
Treatment of Necrotizing Stomatitis
REVIEW QUESTION
CHAPTER 29:
Diagnosis of Periodontal Diseases
PERIODONTAL DIAGNOSIS
PRINCIPLES OF DIAGNOSIS
CLINICAL DIAGNOSIS
Key Stages of Periodontal Diagnosis
Clinical Diagnosis with Detailed Case History Recording
CASE HISTORY PROFORMA
Chief Complaint
Oral Hygiene Methods
Clinical Examination
Extraoral
Intraoral
Gingival Status
Special Investigations
Surgical Assessment
Other Investigations
Diagnosis
Prognosis
Treatment Plan
Preliminary Phase/Emergency Phase
CHAPTER 30:
Determination of Prognosis
DEFINITION OF PROGNOSIS
DETERMINATION OF PROGNOSIS
Factors for Determination of Prognosis (Fig. 30.1)
Overall Clinical Factors
Systemic/Environmental Factors
Local Factors
Prosthetic/Restorative Factors
OVERALL VERSUS INDIVIDUAL TOOTH PROGNOSIS
Overall Prognosis
Individual Tooth Prognosis
Factors Influencing the Individual Tooth Prognosis
RELATIONSHIP BETWEEN DIAGNOSIS AND PROGNOSIS
Prognosis for Patients with Gingival Disease
Dental Plaque-induced Gingival Disease
Nonplaque-induced Gingival Lesion
Prognosis for Patients with Periodontitis
Periodontitis as a Manifestation of Systemic Disease
Necrotizing Periodontal Disease
RE-EVALUATION OF PROGNOSIS AFTER PHASE I THERAPY
REVIEW QUESTION
CHAPTER 31:
Related Risk Factors Associated with Periodontal Diseases
DEFINITION
RISK FACTORS FOR PERIODONTAL DISEASE
RISK DETERMINANTS/BACKGROUND CHARACTERISTICS FOR PERIODONTAL DISEASE
RISK INDICATORS FOR PERIODONTAL DISEASE
RISK MARKERS/PREDICTORS
CLINICAL RISK ASSESSMENT FOR PERIODONTAL DISEASE
Demographic Data
Age
Gender
Socioeconomic Status
Medical History
Dental History
Clinical Examination
REVIEW QUESTIONS
CHAPTER 32:
Various Aids including Advanced Diagnostic Techniques
AIDS USED IN CLINICAL DIAGNOSIS
Periodontal Probes
Uses of Probes
Types of Conventional Periodontal Probes (Fig. 32.1)
Limitations of Conventional Probes
Limitations of all Automated Controlled Force Probes
Periodontal Screening and Recording (PSR)
AIDS USED IN RADIOGRAPHIC DIAGNOSIS
Orthopantamograph (OPG)
Xeroradiography
Advanced Radiographic Techniques
Iodine-125 Absorptiometry
Photodensitometric Analysis
Digital Radiography
Substraction Radiography
Digital Substraction Radiography
Computer Assisted Densitometric Image Analysis (CADIA)
Computerized Tomography
Nuclear Medicine Bone Scan
AIDS IN MICROBIOLOGICAL DIAGNOSIS
Microbiology and Disease Progression
Identification of Bacteria
Different kinds of media
Different Culture Techniques
Speciation Techniques
METHODS/AIDS IN IMMUNOLOGICAL DIAGNOSIS
Immunofluorescence
Direct Immunofluorescence (Fig. 32.3)
Indirect Immunofluorescence (Fig. 32.4)
Latex Agglutination (Fig. 32.5)
Enzyme-linked Immunosorbent Assay (ELISA) (Fig. 32.6)
Flow Cytometry
BIOCHEMICAL DIAGNOSIS
Prostaglandins
Collagenase
OTHER DIAGNOSTIC AIDS
N-benzoyl-DL-arginine 2-naphthylamide (BANA)
Filter Separation Enzyme Immunoassay (FSEIA)
Polymerase Chain Reaction (PCR)
History
DNA Hybridization
Mechanism of Action of PCR
Advantages
CHAPTER 33:
Treatment Plan
INTRODUCTION
SEQUENCE OF THERAPEUTIC PROCEDURES
Preliminary Phase or Emergency Phase
Phase I Therapy (Etiotropic Phase)
Evaluation of Response to Phase I
Phase II Therapy (Surgical Phase)
Phase III Therapy (Restorative Phase)
Phase IV Therapy (Maintenance Phase)
PREFERRED SEQUENCE OF PERIODONTAL THERAPY
CHAPTER 34:
Rationale for Periodontal Treatment
OBJECTIVES OF PERIODONTAL THERAPY
FACTORS WHICH AFFECT HEALING
Local Factors
Systemic Factors
HEALING AFTER PERIODONTAL THERAPY (FIGS 34.1 AND 34.2)
REVIEW QUESTION
CHAPTER 35:
Periodontal Instrumentarium
PERIODONTAL INSTRUMENTS
Classification of Periodontal Instruments
Diagnostic Instruments
Scaling, Root Planing, and Curettage Instruments
The Periodontal Endoscope
Cleansing and Polishing Instruments
Surgical Instruments
Periodontal Probes
Types of Periodontal Probes
Explorers
Scaling and Curettage Instruments (Figs 35.5 to 35.8)
Extended Shank Curettes or After Five Curettes
Ultrasonic and Sonic Instruments (Fig. 35.12)
Dental Endoscope
Cleansing and Polishing Instruments
Surgical Instruments (Fig. 35.13)
SECTION 2(A): NONSURGICAL THERAPY
CHAPTER 36:
Principles of Periodontal Instrumentation including Scaling and Root Planing
INTRODUCTION
ACCESSIBILITY (POSITIONING OF PATIENT AND OPERATOR)
Neutral Seated Position for the Clinician
Patient's Position
VISIBILITY, ILLUMINATION AND RETRACTION (FIGS 36.1A AND B)
Dental Mirror
Various Types of Mirror Surfaces
Various Uses of a Dental Mirror
CONDITION OF INSTRUMENTS (SHARPNESS)
Advantages of Sharpness
MAINTAINING A CLEAN FIELD
INSTRUMENT STABILIZATION
Instrument Grasp (Figs 36.2 and 36.3)
Finger Rest
Standard Intraoral Finger Rest
Advanced Intraoral Finger Rests
INSTRUMENT ACTIVATION
Adaptation
Angulation (Fig. 36.5)
Lateral Pressure
Strokes (Fig. 36.6)
Stroke Direction
PRINCIPLES OF SCALING AND ROOT PLANING
Scaling
Root Planing
Principles of Curettes
Supragingival Scaling Technique
Subgingival Scaling and Root Planing Technique
ULTRASONIC INSTRUMENTS
Equipment and Armamentarium for Ultrasonic and Sonic Instrumentation
Advantages of Ultrasonic and Sonic Instruments
AEROSOL PRODUCTION
REVIEW QUESTION
CHAPTER 37:
Plaque Control
DEFINITION OF PLAQUE CONTROL
GOALS OF PLAQUE CONTROL MEASURES
RATIONALE
BASIC APPROACHES FOR PLAQUE CONTROL
MECHANICAL PLAQUE CONTROL
Toothbrushes (Fig. 37.1)
BRUSHING TECHNIQUES
Powered Toothbrushes (Figs 37.5A and B)
Interdental Cleaning Aids (Fig. 37.6)
Other Aids
CHEMICAL PLAQUE CONTROL
Ideal Properties of a Mouthwash
Classification of Antimicrobial Agents
Chemicals Used for Supragingival Plaque Control [Addy's classification]
Bisbiguanides (Chlorhexidine)
REVIEW QUESTION
SECTION 2(B): SURGICAL THERAPY
CHAPTER 38:
Principles of Periodontal Surgery
INDICATIONS OF PERIODONTAL SURGERY
CONTRAINDICATIONS OF PERIODONTAL SURGERY
GENERAL PRINCIPLES OF SURGERY
PREPARATION OF THE PATIENT
General Conditions that are Common to all Procedures
Premedication
Sedation and Anesthesia
Tissue Management
Suturing
Suturing Techniques (Figs 38.1 to 38.8)
Interrupted Suture
Continuous Suture
Periodontal Dressing
Advantages of Periodontal Packs/Dressings
Preparation and Application of Periodontal Dressing (Figs 38.9 to 38.11)
Instructions for the Patient after Surgery
COMPLICATIONS DURING SURGERY
Complications during the First Postoperative Week
HOSPITAL PERIODONTAL SURGERY
REVIEW QUESTIONS
CHAPTER 39:
Gingival Curettage
DEFINITION
TYPES
RATIONALE
INDICATIONS
PROCEDURE
Basic Technique
Other Techniques
Excisional New Attachment Procedure (ENAP) (Fig. 39.3)
Ultrasonic Curettage
Caustic Drugs
HEALING AFTER SCALING AND CURETTAGE
CLINICAL APPEARANCE AFTER SCALING AND CURETTAGE (FIGS 39.4A AND B)
REVIEW QUESTION
CHAPTER 40:
Gingivectomy
INTRODUCTION
DEFINITIONS
PREREQUISITES
INDICATIONS
CONTRAINDICATIONS
TYPES OF GINGIVECTOMY
Surgical Gingivectomy (Figs 40.1 to 40.4)
Technique
Surgical Procedure
Procedure for Gingivoplasty
Healing after Surgical Gingivectomy
Electrosurgery (Surgical Diathermy)
Gingivectomy by Electrosurgery
Advantage
Disadvantages
Indications
Technique
Healing after Electrosurgery
Laser Gingivectomy
Gingivectomy by Chemosurgery
Disadvantages
REVIEW QUESTIONS
CHAPTER 41:
Periodontal Flap
INTRODUCTION
INDICATIONS/OBJECTIVES OF FLAP SURGERY
DEFINITION
CLASSIFICATION
According to the Placement of Flap after Surgery
According to Design of the Flap/Management of the Papilla
INCISIONS
Horizontal Incisions (Figs 41.6A and B)
Crevicular Incision
Vertical Incision (Figs 41.7A and B)
Papilla Preservation Flap (Figs 41.8 to 41.10)
FLAP TECHNIQUES FOR POCKET THERAPY
Modified Widman Flap (Figs 41.11 to 41.13)
Undisplaced Flap (Figs 41.14 to 41.16)
Palatal Flap (Figs 41.17 and 41.18)
Variations in the Techniques
Apically-displaced Flap
Distal Molar Surgery
HEALING AFTER FLAP SURGERY
HEALING AFTER FULL THICKNESS FLAP
REVIEW QUESTIONS
CHAPTER 42:
Osseous Surgery
DEFINITION
RATIONALE
TERMINOLOGY
TYPES OF OSSEOUS SURGERY
RESECTIVE OSSEOUS SURGERY
Indications
Contraindications
Examination Prior to Surgery
Methods
TECHNIQUE
Vertical Grooving
Radicular Blending
Flattening of the Interproximal Bone
Gradualizing Marginal Bone
Healing after Surgery
RECONSTRUCTIVE OSSEOUS SURGERY
Evaluation of New Attachment and Bone Regeneration
Clinical Methods
Radiographic Methods
Surgical Re-entry
Histological Methods
Nongraft-associated New Attachment
Removal of Junctional and Pocket Epithelium
Prevention of Epithelial Migration
Guided Tissue Regeneration (GTR)
Clot Stabilization, Wound Protection and Space Creation
Preparation of the Root Surface (Root Biomodification) (Fig. 42.8)
Graft-associated New Attachment
Terminology
Ideal Requirements of a Bone Graft Material
REVIEW QUESTIONS
CHAPTER 43:
Mucogingival Surgery
DEFINITION
MUCOGINGIVAL PROBLEMS
OBJECTIVES, INDICATIONS AND CONTRAINDICATIONS OF MUCOGINGIVAL SURGERY
Objectives
Indications
Contraindications
TECHNIQUES TO INCREASE THE WIDTH OF ATTACHED GINGIVA
Gingival Extension Operation
Free Soft Tissue Autograft
Advantages
Disadvantages
Procedure
The Classic Technique (Figs 43.1A to H and 43.2A to H)
Variant techniques
Accordion technique (Figs 43.3A to F)
Strip technique (Fig. 43.4)
Connective tissue technique
Combination techniques
Healing of the graft (Figs 43.5A and B)
Apically-Displaced Flap (Fig. 43.6)
Procedure
Other Techniques for Widening the Zone of Attached Gingiva
Fenestration Operation/Periosteal Separation
Vestibular Extension Operation
Procedures for Root Coverage
Conventional procedures
First Technique
Second Technique
Free Gingival Autograft
Subepithelial Connective Tissue Graft (Figs 43.15A to F)
Procuring the Graft from the Donor Site
GUIDED TISSUE REGENERATION TECHNIQUE FOR ROOT COVERAGE
Indications
Modifications
OPERATIONS FOR REMOVAL OF FRENA
Indications
Techniques for the Removal of the Frenum (Figs 43.22A to I)
REVIEW QUESTIONS
PART V: TREATMENT OF PERIODONTAL DISEASES
CHAPTER 44:
Furcation Involvement and its Management
DEFINITION
ETIOLOGY
Primary Etiologic Factor
Anatomic Considerations (Fig. 44.1)
Tooth
Bone
Gingiva
CLASSIFICATION
CLINICAL FEATURES
Clinically
Microscopically
PROGNOSIS
TREATMENT
Traditional Treatment Procedures
Reconstructive and Regenerative Treatment Procedures
Definition of Root Resection, Hemisection and Root Separation (Figs 44.6 to 44.8)
INDICATIONS AND CONTRAINDICATIONS FOR ROOT RESECTION AND SEPARATION
Indications
Contraindications
REVIEW QUESTIONS
CHAPTER 45:
Pulpoperiodontal Problems
INTRODUCTION
PATHWAYS OF COMMUNICATION BETWEEN PULP AND PERIODONTIUM (FIG. 45.1)
EFFECTS OF PULPAL DISEASE ON THE PERIODONTIUM
EFFECTS OF PERIODONTITIS ON THE DENTAL PULP
ENDOPERIOLESIONS
Classification
Microbiological Findings
Diagnosis and Treatment
Treatment
REVIEW QUESTIONS
CHAPTER 46:
Splints in Periodontal Therapy
DEFINITION
Harmful Aspects
Beneficial Aspects
OBJECTIVES OF SPLINTING
CLASSIFICATION OF SPLINTS
According to the Period of Stabilization
According to the Type of Material
According to the Location on the Tooth
Intracoronal
Extracoronal
VARIOUS COMMONLY USED SPLINTS
PRINCIPLES OF SPLINTING
INDICATIONS AND CONTRAINDICATIONS OF SPLINTING
Indications
Contraindications
ADVANTAGES
DISADVANTAGES
REVIEW QUESTIONS
CHAPTER 47:
Dental Implants: Periodontal Considerations
INTRODUCTION
TERMINOLOGY
HISTORICAL BACKGROUND
The Ancient Era (Before 1000 AD)
The Medieval Era (1000 to 1799 AD)
The Foundation Era (1800 to 1910 AD)
The Modern Era (1910 to 1978 AD)
The Contemporary Era (1978 Till Date)
BIOLOGICAL CONSIDERATIONS OF IMPLANTS
Soft Tissue Implant Interface
Bone Implant Interface
Fibro-osseous Integration
Osseointegration
Bioactive Integration
BIOMATERIALS USED FOR IMPLANTS
Metals and Alloys
Inert Ceramics
Calcium Phosphate Ceramics
Bioactive and Biodegradable Ceramics
Polymers
CLASSIFICATION OF IMPLANTS
Based on the Shape and Form
Based on Surface Characteristics
CLASSIFICATION OF IMPLANT SYSTEMS
TREATMENT PLANNING
Clinical Assessment
The Absolute Requirements for Treating Implant Patients
Indications for Implant Therapy
Absolute Contraindications for Implant Treatment
Intraoral Contraindications
Radiographs
Other Radiographic Procedures Employed
Surgical Procedures
One-stage: Endosseous Implant Surgery
Two-stage: Endosseous Implant Surgery
HEALING FOLLOWING IMPLANT SURGERY
Different Phases of Healing
Osseous Healing—Early Phase
Osseous Healing—Late Stage
PERI-IMPLANT COMPLICATIONS
PERI-IMPLANT DISEASES
Types of Peri-implant Diseases
Clinical Features
Diagnosis
Probing
Radiographs
Microbial Monitoring
Management and Maintenance
Management
Maintenance
Oral Hygiene Aids
REVIEW QUESTIONS
CHAPTER 48:
Maintenance Phase (Supportive Periodontal Treatment)
IMPORTANCE OF MAINTENANCE PHASE
RATIONALE FOR SUPPORTIVE PERIODONTAL THERAPY
CAUSES FOR RECURRENCE OF PERIODONTAL DISEASE
GOALS OF SUPPORTIVE PERIODONTAL TREATMENT
OBJECTIVES OF MAINTENANCE PHASE
PARTS OF MAINTENANCE PHASE
Part–I: Examination (Approximate Time –7 Min)
Part–II: Treatment (Approximate Time – 35 Min)
Part–III: Schedule Next Procedure
Sequence of Maintenance Visits
DETERMINATION OF MAINTENANCE RECALL INTERVALS
Procedures to be Performed at Recall
Management of Particular Type of Recall Patients
REVIEW QUESTIONS
CHAPTER 49:
Occlusal Evaluation and Therapy in the Management of Periodontal Disease
TERMINOLOGY
CLINICAL EVALUATION OF OCCLUSION
Temporomandibular Disorders (TMDs)
Screening Examination
Intraoral Evaluation of Occlusion
MANAGEMENT OF TRAUMA FROM OCCLUSION
POSSIBLE REQUIREMENTS FOR OCCLUSAL STABILITY
OCCLUSAL THERAPY
CHAPTER 50:
The Role of Orthodontics as an Adjunct to Periodontal Therapy
INTRODUCTION
RATIONALE FOR ORTHODONTIC TREATMENT IN PERIODONTAL THERAPY
Reducing Plaque Retention
Improving Gingival and Osseous Form
Facilitating Prosthetic Replacements
Improving Esthetics
USE OF ORTHODONTICS AS AN ADJUNCT TO OVERALL TREATMENT
INDICATIONS AND CONTRAINDICATIONS OF ORTHODONTIC THERAPY
Indications
Contraindications
TIMING OF ORTHODONTIC PROCEDURES IN PERIODONTAL TREATMENT
IATROGENIC EFFECTS ASSOCIATED WITH ORTHODONTIC TREATMENT
Root Resorption
Effects of Orthodontic Bands on the Periodontium
MICROBIOLOGY AROUND ORTHODONTIC BANDS
Effects of Orthodontics on Dentition with Normal Height of Attachment Apparatus
Dentition with Reduced Height of Attachment Apparatus
Response of the Periodontal Ligament to Orthodontic Forces (Fig. 50.2)
REVIEW QUESTION
CHAPTER 51:
Periodontal-Restorative Inter-relationship
INTRODUCTION
MARGINS OF THE RESTORATIONS
RULES FOR MARGIN PLACEMENT
RESTORATIVE MARGINS ENCROACHING ON THE BIOLOGIC WIDTH (FIG. 51.1)
METHODS TO CORRECT BIOLOGICAL WIDTH VIOLATION
CROWN CONTOUR
HYPERSENSITIVITY TO DENTAL MATERIALS
PROXIMAL CONTACT AND EMBRASURE
PONTIC DESIGN
REVIEW QUESTIONS
CHAPTER 52:
Drugs Used in Periodontal Therapy
INTRODUCTION
CLASSIFICATION OF VARIOUS DRUGS USED IN PERIODONTAL THERAPY
Depending on Antimicrobial Efficacy and Substantivity
Chemicals used for Supragingival Plaque Control
Phenols
Quaternary Ammonium Compound
ANTIBIOTICS USED IN PERIODONTAL THERAPY
Systemic Administration of Antibiotics
Advantages of Systemic Medication
Local Administration of Antibiotics
Advantages of Local Drug Administration
Tetracyclines
Antibacterial Actions
Adverse Effects of Tetracyclines
Significant Drug Interactions Involving Tetracyclines
Contraindications for the Use of Tetracyclines
Specific Agents and their Dosage
Metronidazole
Penicillins
Dosage
NON-STEROIDAL ANTI-INFLAMMATORY DRUGS (NSAIDs)
Actions of Flurbiprofen
Mechanism of Action of NSAID (Fig. 52.1)
LOCAL DRUG DELIVERY SYSTEMS
LOCAL ADMINISTRATION OF ANTIBIOTICS AND ANTIMICROBIAL AGENTS (FIG. 52.2)
Vehicles for Local Delivery
Slow-release Devices/Controlled-Release Delivery Systems
Classification of Controlled-Release Local Delivery Systems
Methods of Delivery of Chemotherapeutic Agents
Keyes Technique
Root Biomodification
Home Irrigation Devices
Professional Subgingival Irrigation
CURRENTLY AVAILABLE LOCAL DRUG DELIVERY SYSTEMS IN PERIODONTAL THERAPY
Frequently used Local Antimicrobials with Dosage Specification
CONCLUSION
REVIEW QUESTIONS
CHAPTER 53:
Questionnaire for Clinical Case Discussion
QUESTIONS
QUESTIONS RELATED TO PERIODONTAL INSTRUMENTS AND TREATMENT
QUESTIONS AND ANSWERS
ADVANCES IN ROOT PLANING INSTRUMENTS
Glossary
INDEX
TOC
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