Essentials of Clinical Periodontology and Periodontics Shantipriya Reddy
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1Essentials of Clinical Periodontology and Periodontics2
3Essentials of Clinical Periodontology and Periodontics
THIRD EDITION
Shantipriya Reddy BDS MDS (Periodontia) Professor and Head Department of Periodontics Dr Syamala Reddy Dental College and Hospital Bengaluru, Karnataka, India
4Published by
Jitendar P Vij
Jaypee Brothers Medical Publishers (P) Ltd
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Essentials of Clinical Periodontology and Periodontics
© 2011, Shantipriya Reddy
All rights reserved. No part of this publication should be reproduced, stored in a retrieval system, or transmitted in any form or by any means: electronic, mechanical, photocopying, recording, or otherwise, without the prior written permission of the author and the publisher.
First Edition: 2006
Second Edition: 2008
Third Edition: 2011
9789350250372
Typeset at JPBMP typesetting unit
Printed at
5To
My late grandfather, who had believed in my abilities, it is because of whom I chose this profession
My grandmother, for her constant support
My father and mother, for always being there
My uncle for his continuous encouragement
My husband for his unique mentorship
My daughter and son for being so understanding
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7PREFACE TO THE THIRD EDITION
I am extremely happy to present the third edition of Essentials of Clinical Periodontology and Periodontics. In planning the third edition, a firm commitment has been made to provide a thorough and complete text. An attempt has been made to revise and update all the chapters. The highlight of the edition is introduction of KNOW MORE section which contains latest additional information pertaining to each chapter.
Conscious attempt has been made not to disturb the clarity and simplicity of the main text which had gained immense popularity amongst the students. The edition also provides an add on, Manual of Clinical Periodontics which will guide the students in recording case history and performing clinical examination so as to arrive at a proper diagnosis and treatment planning. Also, special emphasis was given to instrumentation which will instruct the students in their clinical work. While describing all these, we have not only mentioned what steps are to be followed but also how to carry out these steps with the help of various illustrations and photographs.
I am grateful to all my colleagues and students who have helped me with their valuable suggestions, which in turn enabled me to write the edition in a more understandable fashion. I hope this book will help the students and practitioners in understanding periodontics in a simplified manner.
Shantipriya Reddy
8PREFACE TO THE FIRST EDITION
The basic text when conceived in the year 2003 has been written in an attempt to make our understanding of periodontal disease accessible to the undergraduate students, general practitioners and dental hygienists. The Essentials of Clinical Periodontology and Periodontics is a learning textbook intended to serve the needs of several groups of dental care professionals and is written with credibility and readability maintained at every level. Undergraduate students especially will find it useful in integrating the concepts they have been taught in a more elaborate way. Clarity and simplicity in language has been my objective while writing this book. The organization of the chapters and the key points with review questions at the end of every chapter serve as a programmed-guide for the reader.
The text can be of help for the academicians to re-think the modes of presenting information and also as a model to test whether the students have grasped the concepts they have been taught and are able to use them in a practical manner.
All the efforts have been made to make the text as accurate as possible and the information provided in the text was in accordance with the standards accepted at the time of publication. In order to attain these goals, suggestions as well as critiques from many students and clinicians have been received and utilized.
Much of the style in the textbook is compact with adequate bibliographies. The reader is advised to use them to gain greater depth of knowledge. The way of periodontist is hard and the book will reflect the difficulty of that path. I hope that the textbook will fulfill all the requirements and expectations of the students and practitioners as this is a special branch of our profession. The field of periodontics remains a work in progress.
Shantipriya Reddy
9ACKNOWLEDGMENTS
Any book requires the help and assistance of others in order to be completed successfully. First and foremost, I would like to thank Dr Deepti Sinha for drawing the excellent diagrams inserted in the book. Special thanks must go to all my colleagues Dr Prasad MGS, Dr Amudha D and Dr Jaya for their contribution in writing Manual of Clinical Periodontics. I owe a deep sense of gratitude to all my postgraduate students (Dr Ravi Kumar Jirali, Dr Chaitali Agrawal, Dr Soumya Kambali, Dr Shweta Kumari, Dr Nirjhar Bhowmik, Dr Hrishikesh Asutkar) who have helped me relentlessly, while writing the edition. I would like to extend my special thanks to Dr Jeeth Rai, Dr Satish, Dr Keshav, Dr Shabeer, Dr Anilkumar for being so generous in helping me to collect the clinical photographs used in various editions.
My heartfelt thanks to Dr Srinivas K for writing the chapters Desquamative Gingivitis and Oral Malodor in the edition. I am also very grateful to Dr Deepak Daryani for providing me with some of the excellent photographs published in the edition. I would also like to thank Dr Ashwath (Smart design navigator) for helping me with animation photographs of various suturing techniques. The excellent cooperation of the publisher is also greatly acknowledged.
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11PROLOG  
HISTORICAL BACKGROUND OF PERIODONTOLOGY
Various forms of gingival and periodontal diseases have affected the human race since the dawn of history. In the earlier historical records, almost all the writings have information regarding the diseases affecting oral cavity and majority of it is about periodontal diseases.
 
Early Civilizations
Summerians of 3,000 BC first practiced oral hygiene. Babylonians and Assyrians, who also have suffered from periodontal diseases, have treated themselves using gingival massage combined with various herbal medications. Research on embalmed bodies of the ancient Egyptians pointed out that periodontal disease was the most common of all the diseases. Medical writings of the time Ebers Papyrus had many references to gingival diseases and also contain various prescriptions for strengthening the teeth and gums.
The medical works of ancient India, Susruta Samhita and Charaka Samhita describe severe periodontal disease with loose teeth and purulent discharge from the gingiva and the treatment advised was to use a stick that is bitter for cleaning teeth.
Periodontal disease was also discussed in Ancient Chinese books. The oldest book written in 2,500 BC describes various conditions affecting oral cavity. Gingival inflammation, periodontal abscesses and gingival ulcerations are described in detail. They were among the earliest people to use the toothbrush to clean the teeth.
 
Middle Ages
The systematic therapeutic approach was not developed until the middle ages. This was a period of golden age of Arabic science and medicine. Avicenna and Albucasis made a refined, novel approach to surgical work. Albucasis had a clear understanding of calculus as etiology of periodontal disease and described the technique of removing it. He had also developed a set of scalers for removing calculus. He also wrote in detail on other treatment procedures like extraction of teeth, splinting loose teeth with gold wire, etc.
 
18th Century
Modern dentistry was developed in 18th century. Pierre Fauchard in 1678 who is rightly considered as Father of Modern Dentistry designed periodontal instruments and described the technique in detail. His book The Surgeon Dentist published in 1728 presented all aspects of dental practice (i.e. restorative dentistry, prosthodontics, oral surgery, periodontics and orthodontics). Fauchard wrote in that, confections and sweets destroy the teeth by sticking to the surfaces producing an acid. John Hunter (1728–93) known as an anatomist, surgeon and pathologist of 18th century wrote a book entitled The Natural History of the Human Teeth describing the anatomy of the teeth and their supporting structures with clear illustrations.
Thomas Berdmore (1740–85) known as Dentist to His Majesty published the Treatise in the disorders and deformities of the teeth and gums. He not only offered detailed descriptions of instrumentation but also stressed on prevention.
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19th Century
A German born dentist, Leonard Korecker in his paper Philadelphia Journal of Medicine and Physical Sciences mentioned the need for oral hygiene by the patient, to be performed in the morning and after every meal using an astringent powder and a toothbrush.
Levi Spear Parmly was considered the Father of Oral Hygiene and the Inventor of Dental Floss. The name Pyorrhea Alveolaris was used to describe periodontal disease. John W Riggs was the first individual to limit his practice to periodontics and was considered the first specialist in this field. Periodontitis was known as Riggs disease. Several major developments took place in the second half of the 19th century starting the era called modern medicine.
The first was the discovery of anesthesia and second scientific breakthrough was made by Louis Pasteur who established the Germ Theory of Disease. The third scientific finding was the discovery of radiographs by Wilhelm Roentgen.
Also the late 19th century has witnessed a proper understanding of the pathogenesis of periodontal disease based on histopathologic studies. GV Black in 1899 gave the term gelatinous microbic plaque and described its relationship to caries. Xenophon recognized ANUG in 4th century BC Salomon Robicsek developed a surgical technique called gingivectomy.
 
20th Century
Early 20th century witnessed major changes in the treatment of periodontal disease. Gottlieb published extensive microscopic studies of periodontal diseases in humans. It was realized that, removal of calculus and other deposits was not enough. In addition, removal of periodontal pockets was necessary to control the disease.
Leonard Widman and Newman described flap surgery for the removal of periodontal pockets. Removal of bone was considered essential at that time.
After World War II, the focus was on periodontal research and this led to a better understanding of the pathological, microbiological and immunological aspects of periodontal disease.
The first workshop in periodontology was conducted in 1951. It was realized at that time, scientific methods should be introduced in the periodontal research. Subsequent workshops conducted in periodontics have witnessed significant scientific contributions in the field of periodontics.
 
JOURNALS OF PERIODONTOLOGY
The various journals of periodontology available are: