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Liability Statement
This textbook endeavors to present an evidence-based discussion of periodontology based on information from recent research. Periodontology, however, is a rapidly changing science. The authors, editors, and publisher have made every effort to confirm the accuracy of the information presented and to describe generally accepted practices at the time of publication. However, as new information becomes available, changes in treatment may become necessary. The reader is encouraged to keep up with dental and medical research through the many peer-reviewed journals available to verify information found here and to determine the best treatment for each individual patient. The authors, contributors, editors, and publisher are not responsible for errors or omissions or for any consequences from application of the information in this book and make no warranty, express or implied, with respect to the contents of this publication.
Contributors
Kimberly S. Bray, RDH, MS
Professor, Division of Dental Hygiene
University of Missouri—Kansas City School of Dentistry
Kansas City, Missouri
Delwyn Catley, PhD
Professor and Associate Director, Center for Children’s Healthy Lifestyles and Nutrition
Children’s Mercy Kansas City
University of Missouri—Kansas City
Kansas City, Missouri
Teresa Butler Duncan, RDH, BS, MDH
Assistant Professor
Department of Dental Hygiene
School of Dentistry
The University of Mississippi Medical Center
Jackson, Mississippi
Pinar Emecen-Huja, DDS, PhD
Division of Periodontics
Department of Stomatology
College of Dental Medicine
Medical University of Carolina
Charleston, South Carolina
South Florida State College
Avon Park, Florida
Dianne Glasscoe Watterson, RDH, MBA
Chief Executive Officer
Watterson Speaking/Consulting LLC
Lexington, North Carolina
Karen Williams, RDH, MS, PhD
Department of Biomedical and Health Informatics
University of Missouri
Kansas City, Missouri
Kansas City School of Medicine
be accepted worldwide.
The aforementioned chapters highlight many key aspects of the new classification system. Additionally, the chapters review the case definitions and diagnostic criteria for each category of periodontal and peri-implant disease and condition.
Chapter 11: Shared Decision-Making for Periodontal Care
Shared decision-making is a collaborative process that recognizes a patient’s right to make decisions about his or her care once fully informed about the options. Periodontal treatment is always based upon the best available scientific evidence, but many times there will be more than a single course of treatment that could benefit an individual patient.
Shared decision-making is a process in which clinicians and patients work together to make treatment decisions that are best for the patient.
Chapter 23: Iatrosedation: Easing and Managing Pediatric Patient Fears
Fear of dentistry is a worldwide health problem of considerable significance. In the United States it is estimated that 20 million people avoid the dental care because of fear.
The use of drugs is the traditional modality used to help the fearful patient. It must be recognized, however, that pharmacosedation does not reduce or eliminate fear. Treatment of the fear syndrome requires a different technique, one with which the fear is eliminated or significantly reduced by means of a relearning process.
Iatrosedation is defined as: the act of making calm by the clinician’s behavior. Behavior, in this sense, includes a broad spectrum of verbal and non-verbal communication techniques.
Chapter 31: Periodontal Disease in the Pediatric Population: an important new chapter that presents content on periodontal disease in pediatric patients. This chapter elaborates on the significance of pediatric oral
Chapter 38 (an online chapter) provides radiographs for six cases. These cases are intended to give students the opportunity to develop their critical thinking skills in analyzing and interpreting radiographs as it pertains to the hard tissues of the periodontium in health and disease.
Glossary. The glossary provides quick access to common periodontal terminology.
Online Resources
Chapter 38: Patient Cases: Radiographic Analysis
Instructor Resources
PowerPoint presentations for each chapter
Lesson plans
Test Bank
Image bank
Discussion topics and learning exercises
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Student Resources
Animation: Anatomy of Periodontium in Disease
Foundations of Periodontics for the Dental Hygienist, Enhanced Fifth Edition strives to present the complex subject of periodontics in a reader-friendly manner. The authors greatly appreciate the comments and suggestions from educators and students about previous editions of this book. It is our sincere hope that this textbook will help students and practitioners alike to acquire knowledge that will serve as a foundation for the prevention and management of periodontal diseases.
Jill S. Gehrig, RDH, MA
Donald E. Willmann, DDS, MS Daniel Shin, DDS, MSD
Acknowledgments
It is a great pleasure to acknowledge the following individuals whose assistance was indispensable to this Enhanced Fifth Edition: Charles D. Whitehead and Holly R. Fischer, MFA, the highly skilled medical illustrators, who created all the wonderful illustrations for the book.
Kevin Dietz, a colleague and friend for his vision and guidance for all editions of this book.
And with great thanks to our wonderful publishing team without whose expertise and support this book would not have been possible: Jonathan Joyce, John Larkin, and Jennifer Clements. Jill S. Gehrig, RDH, MA
Donald E. Willmann, DDS, MS
Daniel Shin, DDS, MSD
Contents
Contributors
Preface for Course Instructors
Acknowledgments
PART 1: 1
THE PERIODONTIUM IN HEALTH
Periodontium: The Tooth-Supporting Structures
Jill Gehrig, Daniel Shin and Donald Willmann
Tissues of the Periodontium
Nerve Supply, Blood Supply, and Lymphatic System
Focus on Patients
2
Microscopic Anatomy of the Periodontium
Jill Gehrig, Daniel Shin and Donald Willmann
Histology of the Body’s Tissues
Histology of the Gingiva
Histology of Root Cementum and Alveolar Bone
Focus on Patients
PART 2:
DISEASES AFFECTING THE PERIODONTIUM
4 3 5
Overview of Diseases of the Periodontium
Jill Gehrig, Daniel Shin, Donald Willmann and Sharon Logue
The Periodontium in Health and Disease
Pathogenesis of Bone Destruction
Periodontal Pockets
Theories of Disease Progression
Epidemiology of the Diseases of the Periodontium
Focus on Patients
Classification of Periodontal and Peri-Implant Diseases and Conditions
Jill Gehrig, Daniel Shin and Donald Willmann
Disease Classification Systems
The 2017 Classification of Periodontal and Peri-Implant Diseases and Conditions
Focus on Patients
Clinical Features of the Gingiva
Rebecca Sroda
Clinical Features of Healthy Gingiva
Clinical Features of Gingival Inflammation
Extent and Distribution of Inflammation
Focus on Patients
14 15
Jill Gehrig, Daniel Shin and Donald Willmann; Ethical Dilemma by Robin Matloff
What Is Oral Health?
Risk Factors for Periodontal Disease
Balance Between Periodontal Health and Disease
Periodontal Risk Assessment
Focus on Patients
Oral Biofilms
Jill Gehrig, Daniel Shin and Donald Willmann
Microbial Biofilms
The Structure and Colonization of Oral Biofilms
The Role of Bacteria in Periodontal Disease
Focus on Patients
Basic Concepts of Immunity and Inflammation
Jill Gehrig, Daniel Shin and Donald Willmann
The Body’s Defense System
Leukocyte Migration, Chemotaxis, and Phagocytosis
The Inflammatory Process
Focus on Patients
Host Immune Response to Plaque Biofilm
Craig S. Miller, Pinar Emecen-Huja, Jill Gehrig, Daniel Shin; Ethical Dilemma by Robin Matloff
The Host Response in Periodontal Disease
Histologic Stages in the Development of Periodontal Disease
The Impact of Host Response on Bone Homeostasis
Focus on Patients
Systemic Risk Factors That Amplify Susceptibility to Periodontal Disease
Jill Gehrig, Daniel Shin and Donald Willmann; Ethical Dilemma by Robin Matloff
Systemic Conditions as Risk Factors for Periodontitis
Systemic Medications With Periodontal Side Effects
Focus on Patients
Local
Factors Contributing to Periodontal Disease
Jill Gehrig, Daniel Shin and Donald Willmann
Introduction to Local Contributing Factors
Local Factors That Increase Biofilm Retention
Dental Restorations as Local Factors
Local Factors That Cause Direct Damage
Focus on Patients
Nutrition, Inflammation, and Periodontal Disease
Robert Schifferle; Ethical Dilemma by Robin Matloff
Association Between Obesity and Periodontal Disease
Micronutrients, Antioxidants, and Periodontal Disease
Macronutrients and Periodontal Disease
Focus on Patients
Tobacco, Smoking, and Periodontal Disease
Patient’s Role in Nonsurgical Periodontal Therapy
Carol Jahn; Ethical Dilemma by Robin Matloff
Patient Self-Care in Nonsurgical Therapy
Self-Care Challenges for Patients With Periodontitis
Tongue Cleaning as an Adjunct
Focus on Patients
Supragingival and Subgingival Irrigation
Carol Jahn; Ethical Dilemma by Robin Matloff
Patient-Applied Home Irrigation
Professional Subgingival Irrigation
Focus on Patients
Chemical Agents in Periodontal Care
Yusuke Hamada and Daniel Shin; Ethical Dilemma by Robin Matloff
Introduction to Chemical Agents in Biofilm Control
Use of Systemic Antibiotics to Control Biofilm
Use of Topically Delivered Chemical Agents
Educating Patients on the Use of Unconventional Dental Products/Remedies
Focus on Patients
Host Modulation Therapy
Yusuke Hamada; Ethical Dilemma by Robin Matloff
Introduction to Host Modulation Therapy
Potential Host Modulating Therapies in Periodontal
Jill Gehrig, Daniel Shin and Donald Willmann
Linking Periodontitis With Systemic Disease
Systemic Conditions Associated With Periodontitis
Focus on Patients
OTHER ASPECTS OF THE MANAGEMENT OF PATIENTS WITH PERIODONTAL DISEASES
Documentation and Insurance Reporting of Periodontal Care
Dianne Glasscoe Watterson; Ethical Dilemma by Robin Matloff
Legal Issues in the Provision and Documentation of Care
Documentation of Periodontal Care
Computer-Based Patient Records
Insurance Codes for Periodontal Treatment
Focus on Patients
Future Directions for Management of Periodontal Patients
Vanchit John
Contemporary and Evolving Diagnostic Technology
Periodontal Disease/Systemic Disease Connections
Research in Dental Implantology
Treatment Modalities in Periodontal Care