Course Name: Periodontology Course Department: Dental ...DHY 184 Clinical Dental Hygiene I . Textbook(s) Required: Nield-Gehrig, Foundations of Periodontics for the Dental Hygienist,

Course Name: Periodontology Instructor Name: Jodi Major BS RDH Course Number: DHY 209 Course Department: Dental Hygiene/ STEMM Course Term: Spring 2020 Last Revised by Department: 10-13-19 Total Semester Hour(s) Credit: 3 Total Contact Hours per Semester: Lecture: 30 hours Lab: 0 Clinical: 0 Internship/Practicum: 0

Catalog Description: This course covers the initiation, development, pathogenesis, mechanism, etiology and process of periodontal disease is fundamental to the clinical hygienist. Periodontology provides an in-depth study of the pathogenesis of periodontal disease. It presents the microscopic oral anatomy of the periodontium, plaque-induced and non-plaque induced diseases and the American Academy of Periodontology (AAP) classification of periodontal diseases, clinical characteristics, histopathology, and etiology of periodontal diseases. Special emphasis centers on the role of the immune system and host response to bacteria in the initiation and progression of periodontal disease, including the risk factors associated with periodontal disease.

Pre-requisites and/or Co-requisites: BIO 186 Microbiology with lab

DHY 184 Clinical Dental Hygiene I

Textbook(s) Required: Nield-Gehrig, Foundations of Periodontics for the Dental Hygienist, 4th edition, 2016, Lippincott Williams & Wilkins ISBN 978-1-4511-9415-9

Access Code: No Required Materials: textbook, syllabus, scantrons, folders for papers and projects, and index cards Suggested Materials: Binder, folder Course Fees: None

Institutional Outcomes: Critical Thinking: The ability to dissect a multitude of incoming information, sorting the pertinent from the irrelevant, in order to analyze, evaluate, synthesize, or apply the information to a defendable conclusion. Effective Communication: Information, thoughts, feelings, attitudes, or beliefs transferred either verbally or nonverbally through a medium in which the intended meaning is clearly and correctly understood by the recipient with the expectation of feedback. Personal Responsibility: Initiative to consistently meet or exceed stated expectations over time.

Department Outcomes: • To promote excellence in instruction and create a safe and nurturing

learning environment that facilitates student learning and improves client care through research, guided self-study, online activities and varied clinical instructional opportunities.

• To comprehensively prepare students for entry level dental hygiene with core knowledge of dental hygiene sciences, critical thinking skills and clinical skills for individualized delivery of preventative education and oral health care to diverse populations.

• To provide effective education in dental hygiene to produce graduates competent to practice within the profession’s ethical and legal framework pertinent to the role of a dental hygienist and who participates in community service and lifelong learning through professional development.

• To provide transferable education to allow graduates to continue their education in dental hygiene related fields.

Program Outcomes: At the completion of the program the student will:

• Function safely in clinical areas as a dental hygienist utilizing critical thinking and their knowledge base.

• Become a competent health care provider who performs as an integral member of the dental team rendering oral health care to clients utilizing basic communication skills to meet individual’s needs.

• Develop a personal practice philosophy that reflects sensitivity and cultural understanding to their client’s individual needs.

• Demonstrate professional manners, attitudes and behaviors. • Assume leadership roles in the promotion of preventative health to meet

the needs of the changing needs of the community. • Develop mutually beneficial collaborations with the local community, allied

health, dental and dental hygiene professional and serve as a dental health resource for community groups.

• Practice self-assessment and personal responsibility.

• Utilize critical thinking skills when assessing, planning, implementing and evaluating comprehensive dental hygiene care and programs.

• Recognize the value and need for lifelong learning. • Uphold the ethics of the dental hygiene profession.

Student Learning Outcomes:

• Discuss the development of pellicle, plaque and calculus including its microbial make-up at different points of maturation.

• Describe periodontics as the diagnosis, treatment and prevention of pathologic conditions affecting the supporting and surrounding tissues of teeth: the gingiva, periodontal ligament, alveolar bone and cementum.

• Correctly identify the clinical, histological, radiological features and function of the normal periodontium.

• Describe classical and opportunistic infection and how they relate to plaque-induced periodontal disease and list, describe and differentiate various periodontal diseases.

• Describe the epidemiologic concerns in periodontology and the importance of various indices in the identification of periodontal disease.

• Discuss the relationship between systematic factors and periodontal disease and the implications to periodontal treatment.

• Identify the educational and clinical services necessary for the presentation and treatment of periodontal diseases with complete understanding of the rationale, indications and contraindications for nonsurgical therapy.

• Identify and utilize advanced terminology of Periodontology. • Describe the basic principles of periodontal surgery. • Discuss wound healing and dressing after non-surgical and surgical therapies. • Discuss dental implants and the related periodontal implications. • List and describe in detail the most common periodontal surgery procedures. • Discus periodontal emergencies and develop treatment plans. • Demonstrate decision-making principles in Periodontics. • Correlate information from basic dental hygiene courses to data in case studies.

Objectives:

Objectives

Chapter 1 1-1 Identify the tissues of the

periodontium on an unlabeled drawing depicting the periodontium in cross section

1-2 Describe the function that each tissue serves in the periodontium, including the gingiva, periodontal ligament, cementum, and alveolar bone

1-3 In a clinical setting or on a color photograph, identify the following anatomical areas of the gingiva in the oral cavity: free gingiva, gingival sulcus, interdental gingiva, and attached gingiva

1-4 In a clinical setting or on a color photograph, identify the following boundaries of the gingiva: gingival margin, free gingival groove, and mucogingival junction

1-5 In a clinical setting, identify the free gingiva on an anterior tooth by inserting a periodontal probe to the base of the sulcus

1-6 In a clinical setting, contrast the coral pink tissue of the attached gingiva with the darker, shiny tissue of the alveolar mucosa 1-7 In the clinical setting, use

compressed air to detect the presence or absence of stippling of the attached gingiva

1-8 Identify the alveolar process (alveolar bone) on a human skull

1-9 Describe the position and contours of the alveolar crest of the bone in health

1-10 Describe the nerve and blood supply to the periodontium

1-11 Explain the role of the lymphatic system in the health of the periodontium

Contents

Periodontium: The Tooth-Supporting Structures Tissues of the Periodontium

• Gingiva • Periodontal Ligament • Root Cementum • Alveolar Bone

Nerve Supply, Blood Supply, and Lymphatic System Focus on patients

Learning Activities/Assessment

• Foundations of Perio: • Read Chapter 1 • Define key terms • Focus on patient:

◦ Case 1 – 3

Objectives

Chapter 2 2-1 Describe the histology of the tissues and the

function that each serves in the human body 2-2 List and define the layers that comprise the

stratified squamous epithelium of the skin 2-3 Define keratin and describe its function in the

epithelium 2-4 Describe the composition and function of the

connective tissue 2-5 Describe the epithelium–connective tissue

interface found in most tissues of the body, such as the interface between the epithelium and connective tissues of the skin

2-6 Define the term cell junction and describe its function in the epithelial tissues

2-7 Compare and contrast the terms desmosome and hemidesmosome

2-8 Identify the three anatomical areas of the gingival epithelium on an unlabeled drawing depicting the microscopic anatomy of the gingival epithelium

2-9 Describe the location and function of the following regions of the gingival epithelium: oral epithelium, sulcular epithelium, and junctional epithelium

2-10 State the level of keratinization present in each of the three anatomical areas of the gingival epithelium (keratinized, nonkeratinized,or parakeratinized)

2-11 State which of the anatomical areas of the gingival epithelium have an uneven, wavy epithelium--connective tissue interface in health and which have a smooth junction in health

2-12 Identify the enamel, gingival connective tissue, junctional epithelium, internal basal lamina, external basal lamina, epithelial cells, desmosomes, and hemidesmosomes on an unlabeled drawing depicting the microscopic anatomy of the junctional epithelium and surrounding tissues

2-13 Define and describe the function of the supragingival fiber bundles and the periodontal ligament in the periodontium

2-14 Identify the principle fiber groups of the periodontal ligament on an unlabeled drawing

2-15 Define the terms cementum and Sharpey fibers and describe their function in the periodontium

2-16 State the three relationships that the cementum may have in relation to the enamel at the cementoenamel junction

2-17 Define the term alveolar bone and describe its function in the periodontium

Contents

Microscopic Anatomy of the Periodontium: Histology of the Body's Tissues

• microscopic anatomy of a tissue

• microscopic anatomy of epithelial tissue

• microscopic anatomy of connective tissue

• epithelial-connective tissue interface

• epithelial cell junctions

Histology of the Gingiva • microscopic anatomy of

gingival epithelium • why the teeth need a

junctional epithelium • attachment of the cells of

the junctional epithelium • microscopic anatomy of

gingival connective tissue

Histology of the Root Cementum and Alveolar Bone

• microscopic anatomy of Cementum

• microscopic anatomy of Alveolar Bone

Focus on Patients


• Foundations of Perio: • Read Chapter 2 • Define key terms • Focus on patients: Case 1–3

Objectives

Chapter 3 3-1 Define the term disease progression. 3-2 Define the term periodontal disease and

contrast it with the term periodontitis. 3-3 Describe and contrast the (1) position of

the junctional epithelium, (2) characteristics of the epithelial--connective tissue junction, and (3) position of the crest of the alveolar bone in health, gingivitis, and periodontitis.

3-4 Explain why there is a band of intact transseptal fibers even in the presence of severe bone loss.

3-5 Describe the progressive destruction of alveolar bone loss that occurs in periodontitis.

3-6 Describe the pathway of inflammation that occurs in horizontal bone loss and contrast it with the pathway of inflammation that occurs in vertical bone loss.

3-7 Contrast the characteristics of gingival and periodontal pockets

3-8 For patients in the clinical setting, identify visible clinical signs of health and periodontal disease for your clinic instructor.

3-9 For a patient with periodontal disease, measure the probing depth of the sulci or pockets on the facial aspect of one sextant of the mouth. Using the information gathered visually and with the periodontal probe, explain whether this patient’s disease is gingivitis or periodontitis.

3-10 Given a drawing of a periodontal pocket, determine whether the pocket illustrated is a suprabony or infrabony pocket.

3-11 Describe variables associated with periodontal disease that an epidemiologist might include in a research study.

3-12 Define prevalence and incidence as measurements of disease within a population.

3-13 Describe how clinical dental hygiene practice can be affected by epidemiological research.

Contents

Overview of Diseases of the Periodontium The Periodontium in Health and Diseases

• 3 Basic States of the Periodontium

• Periodontium in Health • Gingivitis-Reversible Tissue

Damage • Periodontitis-Permanent

Tissue Destruction Pathogenesis of Bone Destruction

• Changes in Alveolar Bone Height in Disease

• Patterns of Bone Loss in Periodontitis

Periodontal Pockets

• Characteristics of Periodontal Pockets

• Pocket Formation Theories of Disease Progression Epidemiology of the Diseases of the Periodontium Focus on Patients


• Foundations of Perio: • Read Chapter 3 • Define key terms • Focus on patients: Case 1-4 • List the commonly used

Periodontal Indices

Objectives

Chapter 4 4-1 Name the two major

categories of periodontal disease.

4-2 Define and contrast the terms gingival disease, periodontal disease, and periodontitis.

4-3 Explain the historical background of the periodontal classification systems.

4-4 Explain the importance of a classification system for periodontal disease.

4-5 List, describe, and differentiate the various periodontal diseases according to the current classification system established by the American Academy of Periodontology.

Contents

Classification of Periodontal Diseases and Peri-Implant Diseases and Conditions Disease Classifications Systems -The 2017 AAP/EFP Classification of Periodontal and Peri-Implant Diseases The 2017 Classification of Periodontal and Peri-Implant Diseases and Conditions -Health, Gingivitis, and Gingival Diseases/Conditions -Forms of Periodontitis -Other Conditions Affecting the Periodontium -Peri-Implant Diseases and Conditions -Comparison of the 2017 and 1999 Classification Systems Focus on Patients


• Foundations of Perio: • Read Chapter 4 • Define key terms • Break out activity • Focus on patient: case 1-3

Objectives

Chapter 5 5-1 Describe characteristics

of the gingiva in health. 5-2 List clinical signs of

gingival inflammation. 5-3 Compare and contrast

clinical features of healthy and inflamed gingival tissue.

5-4 Explain the difference in color between acute and chronic inflammation.

5-5 Differentiate between bulbous, blunted, and cratered papilla.

5-6 Write a description of gingival inflammation that includes descriptors of duration, extent, and distribution of inflammation.

Contents

Clinical Features of the Gingival Clinical Features of Healthy Gingiva

• Tissue color and contour in health

• Tissue consistency and texture in health

• Position of gingival margin in health

• Absence of bleeding in health

Clinical Features of Gingival Inflammation

• Characteristics of gingivitis • Tissue consistency and

texture in gingivitis • Position of margin in

gingivitis • Presence of bleeding in

gingivitis Extent and Distribution of Inflammation

• Gingival inflammation Focus on Patients


• Foundations of Perio: • Read Chapter 5 • Define key terms • Focus on patient: case 1-2

Objectives

Chapter 6 6-1 Define periodontal health and be

able to describe the clinical features that are consistent with signs of periodontal health.

6-2 List the two major subdivision of gingival disease as established by the American Academy of Periodontology and the European Federation of Periodontology.

6-3 Compare/Contrast the etiologic factors associated with dental biofilm-induced gingivitis and non-plaque-induced gingival diseases.

6-4 List the conditions that are classified under the non-plaque-induced gingival diseases category.

6-5 Describe the differences between and intact periodontium and a reduced periodontium.

6-6 Differentiate papillary gingivitis, marginal gingivitis, and diffuse gingivitis.

6-7 Describe the clinical signs of inflammation characteristic of moderate plaque-induced gingivitis.

6-8 Describe how systemic factors can modify the host response to plaque biofilm and lead to gingival inflammation.

Contents

Diseases of the Gingival Periodontal Health Dental Plaque-Induced Gingival Diseases • Classification of plaque-induced

Gingivitis and modifying Factors • Plaque-Induced Gingivitis • Modifying Factors of

Plaque-Induced Gingivitis • Drug-Influenced Gingival

Enlargements Non-Plaque-Induced Gingival Diseases

• Description of Selected Disease Disorders

• Description of Selected Inflammatory and Immune Conditions and Lesions

Focus on Patients


• Foundations of Perio: • Read Chapter 6 • Focus on patient: Case 1-4 • Ethical Dilemma

Objectives

Chapter 7 7-1 In a clinical setting for a patient with periodontitis, describe to your clinical instructor the clinical signs of disease present in the patient’s mouth. 7-2 Define the term clinical attachment loss and explain its significance in the periodontal disease process. 7-3 In the clinical setting, explain to your patient the warning signs of periodontal disease. 7-4 Recognize and describe clinical and radiographic features of periodontitis. 7-5 Describe the change or advancement-disease progression- typically seen in periodontitis. 7-6 Explain how disease severity and complexity of management play a role in determining staging of periodontitis. 7-7 List the primary criteria used to determine the grade of periodontitis. 7-8 Define the meaning of the descriptors recurrent and refractory as they pertain to periodontitis.

Contents

Periodontitis Periodontitis

• Definition of Periodontitis • Characteristics of

Periodontitis • Extent and Progression of

Periodontitis • Therapeutic Endpoints and

Goals • Recurrent and Refractory

Forms of Periodontitis

Periodontitis • The Periodontitis Case

Definition System • Examples of Periodontitis

Case Staging and Grading Focus on Patients

• Clinical Patient Care • Ethical Dilemma


• Foundations of Perio: • Read Chapter 7 • Define Key Terms • Focus on Patients:

Chapter 7 case 1-4. Ethical Dilemma 1-3

Objectives

Chapter 8 8-1 Describe the clinical presentation

of necrotizing periodontal diseases.

8-2 Compare and contrast the tissue destruction that occurs in necrotizing gingivitis and necrotizing periodontitis.

8.3 Compare and contrast the tissue destruction in periodontitis with the seen in necrotizing periodontitis.

8-4 Explain the Miller and Cairo classification systems used to classify gingival recession.

8-5 Name several local factors, such as tooth-related or prosthesis-related factors, that may contribute to the initiation and progression of periodontitis.

Contents

Other Conditions Affecting the Periodontium Necrotizing Periodontal Diseases Mucogingival Deformities and Conditions Around Teeth Tooth and Prosthesis-Related Predisposing Factors Focus on Patients

• Clinical Patient Care


• Foundations of Perio: • Read Chapter 8 • Define Key Terms • Focus on Patients:

Chapter 8 case 1

Objectives

Chapter 9 9-1 Describe the components

of a typical dental implant and restoration.

9-2 Compare and contrast the periodontium of a natural tooth with the peri-implant tissues that surround a dental implant.

9-3 Define and distinguish the key differences between peri-implant health, peri-implant mucositis, and peri-implantitis.

9-4 Define the terms osseointegration and biomechanical forces as they apply to dental implants.

9-5 Compare and contrast the terms peri-implant mucositis and peri- implantitis. 9-6 Discuss the special considerations for periodontal instrumentation of a dental implant. 9-7 Describe an appropriate

maintenance interval for a patient with dental implants.

9-8 In the clinical setting, select appropriate self-care aids for a patient with dental implants.

Contents

Peri-Implant Health and Diseases Anatomy of the Dental Implant and Surrounding Peri-Implant Tissues Peri-implant Health, Diseases, and Conditions Recognition of Peri-Implant Diseases Clinical Monitoring of Peri-Implant Health and Diseases Clinical Guidelines for Maintenance of Patients with Dental Implants Focus on Patients

• Clinical


• Foundations of Perio: • Read Chapter 9 • Define key terms • Focus on patient: case 1-4

Objectives Chapter 10 10-1 List the three fundamental

diagnostic questions used when assigning a periodontal diagnosis.

10-2 List the two fundamental diagnostic questions used when assigning a peri-implant diagnosis.

10-3 Explain how to arrive at appropriate answers to each of the fundamental diagnostic questions.

10-4 Explain the difference between the terms “signs” of a disease versus “symptoms” of a disease.

10-5 List several overt and hidden signs of periodontal inflammation.

10-6 Define the term silent disease.

10-7 Describe what is meant by the term clinical attachment loss.

10-8 Describe the elements of a well-written diagnosis for periodontitis.

10-9 List the phases of treatment. 10-10 Explain why a patient’s diagnosis and treatment plan may require modifications at a later point.

Contents Clinical Decision-Making for Periodontal Care Guidelines for Arriving at a Periodontal Diagnosis Guidelines for Periodontal Treatment Sequencing The Need for Ongoing Decision-Making Focus on Patients



• Foundations of Perio: • Read Chapter 10 • Define Key terms • Focus on Patient: case 1-4

Objectives Chapter 11 11-1 Define shared decision-making. 11-2 Explain key steps for engaging in shared decision-making. 11-3 Describe how patient decision aids facilitate shared decision-making. 11-4 Describe the importance of informed consent to successful periodontal care. 11-5 List the guidelines for obtaining informed consent. 11-6 Describe two formats for documenting informed consent.

Contents Shared Decision-Making for Periodontal Care Shared Decision-Making A Model for Shared Decision-Making in Periodontal Care

• The SHARE Approach: Essential Steps of Shared Decision-Making

Decision Aid for Periodontal Patients Guidelines Related to Consent for Periodontal Treatment Focus on Patients

• Ethical Scenarios


• Foundations of Perio: • Read Chapter 11 • Define Key Terms • Ethical Scenarios case 1-2

Objectives

Chapter 12 12-1 Define and give examples Of the term “risk factors”. 12-2 Define the term biologic

equilibrium and discuss factors that can disrupt the balance between health and disease in the periodontium.

12-3 Discuss the importance of a periodontal risk assessment in periodontal treatment planning.

12-4 In a clinical setting-for a patient in your care with periodontitis, explain to your clinical instructor the factors that may have contributed to your patient’s disease.

Contents

Etiologic Factors: Risk for Periodontal Disease What is Oral Health Risk factors for Periodontal Disease

• Local Risk Factors • Systemic Risk Factors • Tobacco Use • Medications • Other Risk Factors

Balance Between Periodontal Health and Disease Periodontal Risk Assessment Focus on Patients

• Evidence in Action • Ethical Dilemma • Clinical Patient Care


• Foundations of Perio: • Read Chapter 12 • Define Key Terms • Evidence on Action • Ethical Dilemma • Clinical Patient Care

Objectives

Chapter 13 13-1 Explain the difference in the cell

membrane of a gram-positive versus a gram-negative bacterium.

13-2 Define the term biofilm and explain the advantages to a bacterium of living in a biofilm.

13-3 Describe the life cycle of a biofilm. 13-4 Explain the significance of the

extracellular slime layer and fluid channels to a biofilm.

13-5 Define coaggregation and explain its significance in bacterial colonization of the tooth surface

13-6 Define quorum sensing and explain its significance in coordination and regulating microbial behavior and growth.

13-7 Explain why systemic antibiotics and antimicrobial agents are not effective in eliminating dental plaque biofilms.

13-8 State the most effective ways to control dental plaque biofilms

13-9 Name several reasons why newer microbe detection method have brought Socransky’s microbial complexes and the Specific Plaque Hypothesis model into question.

13-10 Discuss the evolution of hypotheses to explain the role of bacteria in periodontal disease and how current hypotheses are distinct from the Nonspecific Plaque Hypothesis and the Specific Plaque Hypothesis.

13-11 Discuss the hypothesis that plaque biofilm is necessary but not sufficient for periodontal destruction to the cause destruction of the tissues of the periodontium and the implications for the treatment of individuals with periodontitis.

Contents

ORAL BIOFILMS Microbial Biofilms

• Characteristics of bacteria • Microbial communities • Oral Biofilms • Oral Biofilms: Symbiosis

Versus Dysbiosis • Species Capable of

Colonizing the Mouth The Structure and Colonization of Oral Biofilms

• Stages of Polymicrobial Biofilm Formation

• Bacterial Colonization and Succession of Oral Biofilms

• Bacterial Attachment Zones The Role of Bacteria in Periodontal Disease

• Changing evidence for the role of bacteria

• Historical Perspectives on the Role of Bacteria

• Contemporary Perspectives on the Role of Bacteria

Focus on Patients

• Clinical Patient Care • Evidence in Action


• Foundations of Perio: • Read Chapter 13 • Define Key Terms • Focus on patient: Case 1-2 • Evidence in Action

Objectives

Chapter 14 14-1 Define the term immune

system and name its function. 14-2 Describe the role of

polymorphonuclear leukocytes, macrophages, B lymphocytes, and T lymphocytes in the immune system.

14-3 Contrast the terms macrophage and monocyte

14-4 Describe the three ways that antibodies participate in the host defense.

14-5 Define complement system and explain its principle functions in the immune response.

14-6 Describe the steps in the process of phagocytosis.

14-7 Give an example of a type of injury or infection that would result in inflammation in an individual’s arm. Describe and contrast the symptoms of inflammation that the individual would experience due to acute inflammation versus chronic inflammation.

14-8 Define the term inflammatory mediator and give several examples of inflammatory mediators of importance in periodontitis.

Contents

BASIC CONCEPTS OF IMMUNITY AND INFLAMMATION The Body’s Defense Systemic

• Introduction to the immune system

• Components of the immune system

• Cells of the immune system • The complement system

Leukocyte Migration, Chemotaxis, and Phagocytosis The Inflammatory Process

• Major events in the inflammatory response

• Two stages of inflammation Focus on Patients

• Evidence in Action


• Foundations of Perio: • Read Chapter 14 • Define key terms • focus on patients: case 1-2

Objectives

Chapter 15 15-1 Define the term host

response and name its primary function.

15-2 Name the factors than can enhance the microbial challenge to the periodontium.

15-3 Define the term biochemical mediator and name three types of mediators.

15-4 Describe the role of Ecytokines in the pathogenesis of periodontitis.

15-5 Describe the role of prostaglandins in the pathogenesis of periodontitis.

15-6 Describe the effect of MMPs on periodontal tissues.

15-7 Explain the phases of the bone remodeling cycle.

15-8 Explain the significance of a balanced OPG-to-RANKL ratio.

15-9 Describe the link between periodontitis and RANKL-mediated bone resorption.

15-10 For each of the histologic stages of gingivitis and periodontitis listed below name one change in the host immune response likely to be encountered:

• Bacterial Accumulation • Early Gingivitis • Established Gingivitis • Periodontitis

Contents

HOST IMMUNE RESPONSE TO PLAGUE BIOFILM The Host Response in Periodontal Disease

• Factors enhancing the microbial challenge

• Factors affecting the host immune response

• Inflammation: A Protective Host Response That Can Turn Harmful

• Inflammatory Biochemical Mediators of the Host Response

• Current Theory of Pathogenesis

Histologic Stages in the Development of Periodontal Disease The Impact of Host Response on Bone Homeostasis Focus on Patients

• Clinical Patient Care • Evidence in Action • Ethical Dilemma


• Foundations of Perio: • Read Chapter 15 • Define key terms • Focus on Patient: Case 1-2 • Evidence in action • Ethical Dilemma

Objectives

Chapter 16 16-1 Name several systemic

diseases/conditions that may modify the host response to periodontal pathogens.

16-2 Engage other health professionals-appropriate to the specific care situation-in shared patient-centered problem-solving.

16-3 Place the interests of patients at the center of interprofessional health care delivery.

16-4 Recognize the importance of educating patients about the relationship between oral health and systemic diseases, states, or conditions (such as the link between diabetes mellitus and periodontitis).

16-5 Discuss the potential implications of these systemic diseases on the periodontium:

uncontrolled diabetes, leukemia, and acquired immunodeficiency syndrome.

16-6 Describe the significance of the AGE-RAGE interactions and its role in amplifying periodontal inflammation.

16-7 Discuss how hormone alterations may affect the periodontium.

16-8 Define the term osteoporosis and discuss the link between skeletal osteoporosis and alveolar bone loss in the jaw.

16-9 Discuss the implications of Down syndrome on the periodontium.

16-10 Name three medications that can cause gingival enlargement.

16-11 For a patient in your care with periodontitis that is amplified by a systemic condition, explain to your clinical instructor the risk factors that may have contributed to the severity of your patient’s periodontitis.

Contents

SYSTEMIC RISK FACTORS THAT AMPLIFY SUSCEPTIBILITY TO PERIODONTAL DISEASE Systemic Conditions as Risk Factors for Periodontitis

• Diabetes mellitus • Stress • Hormonal Fluctuations

During Puberty, Pregnancy, and Menopause

• Metabolic Syndrome • HIV/AIDS • Neutropenia • Down Syndrome • Leukemia

Systemic Medications with Periodontal Side Effects Focus on Patients



• Foundations of Perio: • Read Chapter 16 • Define key terms • Focus on patient: Case 1-2 • Evidence in action • Ethical dilemma

Objectives

Chapter 34

34-1 Contrast the terms “association” and “cause” between a given factor (A) and a systemic disease (B).

34-2 Educate patients at risk for cardiovascular diseases about the possible impact of periodontal infection on cardiovascular health and encourage oral disease prevention and treatment services.

34-3 Educate pregnant women and those planning pregnancy regarding the possible impact of periodontal infection on pregnancy outcomes and encourage preventive oral care and treatment services.

34-4 Educate patients with diabetes about the probable bi-directional association between periodontal disease and diabetes; encourage oral disease prevention and treatment services.

34-5 Educate family members and caregivers about the association between periodontal disease and pneumonia in health-compromised seniors in hospitals and long-term care.

34-6 Establish collaborative relationships with other healthcare providers to insure the highest standard of care for periodontal patients with systemic diseases and conditions.

Contents

Impact of Periodontitis on Systemic Health Linking Periodontitis to Systemic Diseases Systemic Conditions Associated with Periodontitis

• Atherosclerotic Cardiovascular Disease

• Adverse Pregnancy Outcomes

• Diabetes Mellitus • Potential Associations with

Other Systemic Conditions Focus on Patients



• Foundations of Perio: • Read Chapter 34 • Define key terms • Clinical Patient Care

case 1-2 • Evidence in action

Objectives

Chapter 17 17-1 Describe local factors that

contribute to the retention and accumulation of microbial plaque biofilm.

17-2 Explain what distinguishes a local contributing factor from a systemic contributing factor.

17-3 Identify and differentiate the location, composition, modes of attachment, mechanisms of mineralization, and pathologic potential of supra- and subgingival calculus deposits.

17-4 Describe local contributing factors that can lead to direct damage to the periodontium.

17-5 Explain the role of trauma from occlusion as a possible contributing factor in periodontal disease.

Contents

LOCAL FACTORS CONTRIBUTING TO PERIODONTAL DISEASE Introduction to Local Contributing Factors Local Factors That Can Increase Biofilm Retention Dental Restorations as Local Factors Local Factors That Cause Direct Damage Focus on Patients




case 1-2 • Evidence in action

Objectives

Chapter 18 18-1 Discuss the link between

obesity and periodontal disease.

18-2 Discuss the role of polymorphonuclear leukocytes in the production of ROS in response to plaque biofilm.

18-3 Discuss how antioxidants may influence periodontal disease onset and progression.

18-4 Describe the proposed roles of micronutrients and macronutrients in periodontal disease.

18-5 List some oral symptoms associated with ascorbic acid-deficiency gingivitis.

18-6 Explain the role of dental healthcare providers in addressing obesity and nutrition in the management of periodontal disease.

Contents

NUTRITION, INFLAMMATION, AND PERIODONTAL DISEASE Association Between Obesity and Periodontal Disease Micronutrients, Antioxidants, and Periodontal Diseases Macronutrients and Periodontal Disease Focus on Patients




case 1-2 • Ethical dilemma • Break out activity

Objectives

Chapter 19 19-1 Discuss the implications

of smoking/ the use of tobacco products on periodontal health status.

19-2 Discuss the implications of smoking on the host response to periodontal disease. 19-3 Discuss the effects of

smoking on periodontal treatment outcomes.

19-4 Discuss current theories as to why smokers have more periodontal disease than nonsmokers.

19-5 Explain why tobacco cessation counseling is a valuable part of patient care in the dental setting.

19-6 Value the importance of providing tobacco cessation counseling as a routine part of periodontal treatment.

Contents

TOBACCO, SMOKING, AND PERIODONTAL DISEASE Tobacco as a Risk Factor for Periodontal Disease

• Epidemiology of tobacco in Periodontal Patients

• Smoking and Periodontitis Mechanisms of Smoking-Mediated Periodontal Disease

• Effects of smoking on Periodontium

• Effects of smoking on Periodontal Therapy

Smoking and Peri-Implant Disease

• The impact of smoking om dental implants

Tobacco Cessation for the Periodontal Patient

• Effects of Tobacco Cessation on the Periodontium

• Tobacco Cessation Counseling in Periodontal Therapy

• A User-Friendly Model for Counseling the Periodontal Patient

Focus on Patients

• Clinical Patient Care • Clinical Evidence in Action:

Clinical Relevance


• Foundations of Perio: • Read Chapter 19 • Define key terms • Clinical Patient Care: case 1 • Clinical Evidence in Action

Objectives

Chapter 20 20-1 List the components of a

comprehensive periodontal assessment.

20-2 Describe how to evaluate each component of a comprehensive periodontal assessment.

20-3 Explain how to calculate the width of attached gingiva.

20-4 Explain how to calculate clinical attachment level given several different clinical scenarios.

20-5 Compare and contrast a periodontal screening examination and a comprehensive periodontal assessment.

20-6 Given a clinical scenario, calculate and document the clinical attachment levels for a patient with periodontitis.

Contents

CLINICAL PERIODONTAL ASSESSMENT Overview of the Periodontal Assessment Process The Comprehensive Periodontal Assessment

• Components of the Comprehensive Periodontal Assessment

• Components of the Comprehensive Assessment that Require Calculations

Periodontal Screening Examinations Supplemental Diagnostic Tests Focus on Patients



• Foundations of Perio: • Read Chapter 20 • Define key terms • Clinical Patient Care:

case 1-3 • Ethical dilemma

Objectives

Chapter 21

21-1 Describe dental radiographic characteristics of the healthy periodontium.

21-2 Describe early dental radiographic evidence of periodontal disease.

21-3 Name some techniques that can be employed with periodontal patients to obtain good quality dental radiographs.

21-4 Explain the basic principles of the vertical bitewing technique.

21-5 Describe the limitations of dental radiographs that all clinicians should keep in mind when viewing radiographs.

21-6 Explain the difference between vertical and horizontal alveolar bone loss as seen in dental radiographs.

21-7 Given a selection of sample dental radiographs, apply the information from this chapter when analyzing those radiographs.

Contents

RADIOGRAPHIC ANALYSIS OF THE PERIODONTIUM Radiographic Appearance of the Periodontium

• Radiolucent Versus Radiopaque Structures

• Radiographic Features of Parts of the Periodontium

Use of Radiographic Images for Periodontal Evaluation

• Review of Some Basic Techniques for Obtaining Good Radiographs

• Limitations of Dental Radiographs during Periodontal Evaluations

• Benefits of Dental Radiographs During Periodontal Evaluation

• Beyond Conventional Dental Radiography

Focus of Patients




case 1-3 • Ethical dilemma • Break out activity

Objectives

Chapter 22 22-1 Summarize how the

explosion of knowledge is impacting practitioners and patients.

22-2 Identify the three components of evidence-based decision making.

22-3 Discuss the benefits and limitations of experience.

22-4 Describe the role of the patient in the evidence-based model.

22-5 List locations for accessing systematic reviews.

22-6 Explain the difference between a peer-reviewed journal and trade magazine.

22-7 State three desired outcomes from attending continuing education courses.

22-8 Formulate a question using the PICO process.

Contents

BEST PRACTICES FOR PERIODONTAL CARE What is Best Practice? Role of Evidence-Based Decision Making in Best Practice Finding Clinically Relevant Information

• Clinical Case Example Lifelong Learning Skills for Best Practice Focus on Patients



• Foundations of Perio: • Read Chapter 22 • Define key terms • Clinical Patient Case:

case 1-3 Evidence in Action

• Ethical dilemma

Objectives

Chapter 24 24-1 Explain the term and

name four goals for nonsurgical therapy.

24-2 Explain the role of interdisciplinary collaborative care in nonsurgical periodontal therapy.

24-3 Write a typical plan for nonsurgical therapy for (1) a patient with dental biofilm-induced gingivitis and (2) a patient with generalized stage I, grade A periodontitis.

24-4 Describe the type of healing to be expected following successful instrumentation of root surfaces.

24-5 Explain strategies for managing dentinal hypersensitivity during nonsurgical therapy.

24-6 Explain why reevaluation is an important step during nonsurgical therapy.

24-7 List steps in an appointment for reevaluation of the results of nonsurgical therapy.

24-8 Describe the rationale and list the indications for referring a patient to a periodontist.

Contents

NONSURGICAL PERIODONTAL THERAPY Overview of Nonsurgical Periodontal Therapy

• Understanding Nonsurgical Periodontal Therapy

• Goals of Nonsurgical Periodontal Therapy

• Types of Procedures Included in Nonsurgical Therapy

• Nonsurgical Therapy Related to the Periodontal Diagnosis

• Typical Treatment Plans for Nonsurgical Periodontal Therapy

Mechanical Nonsurgical Therapy

• Overview of Instrumentation in Nonsurgical Therapy

• End point for Instrumentation During Nonsurgical Therapy

• Dentinal Hypersensitivity Associated with Nonsurgical Therapy

Decisions Following Nonsurgical Therapy

• The Re-evaluation Appointment

• The Relationship of Nonsurgical Re-evaluation to Other Steps in Treatment

• The Relationship between Nonsurgical and Surgical Therapy

• Recognizing the Need for Referral to a Periodontitis

Focus on Patients




case 1-7 • Ethical dilemma

Objectives

Chapter 29 29-1 List objectives for periodontal surgery. 29-2 Explain the term relative

contraindications for periodontal surgery.

29-3 Define the terms repair, reattachment, new attachment, and regeneration.

29-4 Explain the difference between healing by primary intention and healing by secondary intention.

29-5 Explain the term elevation of a flap. 29-6 Explain two methods for classification

of periodontal flaps. 29-7 Describe two types of incisions used

during periodontal flaps. 29-8 Describe healing following flap for

access and open flap debridement. 29-9 Describe the typical outcomes for

apically positioned flap with osseous surgery.

29-10 Define the terms ostectomy and osteoplasty.

29-11 Define the terms osteoinductive and osteoconductive.

29-12 Explain the terms autograft, allograft, xenograft, and alloplast.

29-13 Name two types of materials available for bone replacement grafts.

29-14 Explain why a barrier material is used during guided tissue regeneration.

29-15 Explain the term periodontal plastic surgery.

29-16 List two types of crown lengthening surgery.

29-17 List some disadvantages of gingivectomy.

29-18 Describe the technique for gingival curettage.

29-19 Explain what is meant by biological enhancement of periodontal surgical outcomes.

29-20 Name two broad categories of materials used for suturing periodontal wounds.

29-21 Explain the term interrupted interdental suture.

29-22 List general guidelines for suture removal. 29-23 Describe the technique for periodontal dressing placement. 29-24 List general guidelines for periodontal

dressing management. 29-25 Explain the important topics that should

be covered in postsurgical instructions. 29-26 List steps in a typical postsurgical visit.

Contents

PERIODONTAL SURGICAL CONCEPTS FOR THE DENTAL HYGIENIST Introduction to Periodontal Surgery

• Evolution of Concepts related to Periodontal Surgery

• Indications and Contraindications for Periodontal Surgery

• Possible Outcomes for Periodontal Surgery

• Terminology used to Describe Healing after Periodontal Surgery

Understanding the Periodontal Flap Descriptions of Common Types of Periodontal Surgery Biological Enhancement of Surgical Outcomes Patient Management Following Periodontal Surgery

• Use of Sutures in Periodontal Surgical Wounds

• Use of Periodontal Dressing • Postsurgical Instructions

and Follow-Up Visits Focus on Patients


• Foundations of Perio: • Read Chapter 29 • Define key terms • Focus on patient: case 1-4 • Video

Objectives

Chapter 30 30-1 Name and describe the

three types of abscesses of the periodontium.

30-2 List the possible causes of abscesses of the periodontium.

30-3 Compare and contrast the abscess of the periodontium and the endodontic abscess.

30-4 Outline the typical treatment steps for a gingival abscess and a periodontal abscess.

30-5 Describe the clinical situation that can result in a pericoronal abscess.

30-6 Outline the typical treatment for a pericoronal abscess (pericoronitis).

30-7 Describe the characteristics of necrotizing ulcerative gingivitis.

30-8 Outline the typical treatment steps for necrotizing ulcerative gingivitis.

30-9 Describe the symptoms of primary herpetic gingivostomatitis.

Contents

ACUTE PERIODONTAL CONDITIONS Introduction to Acute Periodontal Conditions Abscesses of the Periodontium Necrotizing Periodontal Diseases Primary Herpetic Gingivostomatitis Focus on Patients




case 1-2 • Evidence in action • Ethical dilemma

Objectives Chapter 31 31-1 Describe the normal clinical appearance of the periodontal anatomy surrounding the primary dentition and be able to explain how these features differ from the clinical appearance of the periodontium surrounding the permanent dentition. 31-2 Describe the normal radiographic appearance of the periodontal anatomy surrounding the primary dentition and be able to explain how these features differ from the normal radiographic appearance found around the permanent dentition. 31-3 Explain the difference between a “cold sore” and a “canker sore” and be able to describe treatment strategies for each condition. 31-4 Explain the importance of education pediatric patients and their caretakers about the relationship between periodontal health and oral development. 31-5 Describe the potential implications of untreated periodontal disease in the pediatric patient. 31-6 Describe the common types of acute periodontal conditions that are seen in the pediatric population. 31-7 Recognize the common forms of periodontal diseases that affect the pediatric patient and be able to detail the treatment regimens to manage each of these conditions.

Contents Periodontal Disease in the Pediatric Population Periodontal Anatomy of the Primary Dentition Gingival Diseases in Pediatric Patients

• Eruption Gingivitis and Pericoronal Abscess

• Plaque-Induced Gingival Disease

• Gingival Diseases Modified by Medications

Common Types of Periodontitis in Pediatric Patients

• Periodontitis • More Aggressive Forms of

Periodontitis • Necrotizing Periodontal

Disease

Common Acute Periodontal Conditions in Pediatric Patients

• Herpes Virus Infections and Aphthous Ulcers

Focus on Patients



• Foundations of Perio: • Read Chapter 31 • Define key terms • Focus on Patient: case 1-2

Objectives

Chapter 33 33-1 List three objectives of periodontal

maintenance. 33-2 Describe how periodontal

maintenance relates to other phases of periodontal treatment.

33-3 List the typical steps performed during an appointment for periodontal maintenance.

33-4 Explain the term baseline data. 33-5 Describe guidelines for

determining whether the general practice office or the periodontal office should provide periodontal maintenance.

33-6 Describe how to establish an appropriate interval between maintenance appointments.

33-7 Define the term recurrence of periodontitis.

33-8 List clinical signs of recurrence of periodontitis.

33-9 List reasons for recurrence of periodontitis.

33-10 Define the term compliance. 33-11 Explain the role compliance plays

in maintaining periodontal health and stability.

33-12 List reasons for noncompliance with periodontal maintenance recommendations.

33-13 Explain some strategies that can be used to improve patient compliance.

33-14 Explain the term root caries and list recommendations for use of fluorides in the prevention of root caries.

Contents

MAINTENANCE FOR THE PERIODONTAL PATIENT Introduction to Periodontal Maintenance Planning Periodontal Maintenance Periodontal Disease Recurrence Patient Compliance with Periodontal Maintenance Root Caries as a Complication During Maintenance Focus on Patients




case 1-3

College Procedures: All college-wide procedures are located in the Iowa Central Community College Student Handbook.

Assessments: Please note that assessments are subject to change.

Assignments & Vocabulary Terms 10% Quizzes 15%

Examination #1 25% Examination #2 25% Comprehensive Final 25% Total 100%

Non-discrimination Statement: It is the policy of Iowa Central Community College not to discriminate on the basis of race, color, national origin, sex, disability, age (employment), sexual orientation, gender identity, creed, religion, and actual or potential parental, family or marital status in its programs, activities, or employment practices as required by the Iowa Code §§ 216.6 and 216.9, Titles VI and VII of the Civil Rights Act of 1964 (42 U.S.C. §§ 2000d and 2000e), the Equal Pay Act of 1973 (29 U.S.C. § 206, et seq.), Title IX (Educational Amendments, 20 U.S.C. §§ 1681 – 1688), Section 504 (Rehabilitation Act of 1973, 29 U.S.C. § 794), Age Discrimination Act of 1975 (34 CFR Part 110), and Title II of the Americans with Disabilities Act (42 U.S.C. § 12101, et seq.). If you have questions or complaints related to compliance with this policy, please contact Kim Whitmore, Director of Human Resources, phone number 515-574-1138, [email protected]; or the Director of the Office for Civil Rights, U.S. Department of Education, Citigroup Center, 500 W. Madison, Suite 1475, Chicago, IL 60661, phone number 312-730-1560, fax 312-730-1576.

Disability/Accommodation Services:

If you have a request for an accommodation based on the impact of a disability, it is Iowa Central’s policy that you contact the Academic Assistance & Accommodations Coordinator to discuss your specific needs and to provide supporting information and documentation, so we may determine appropriate accommodations. The office for accommodations is located in the Academic Resource Center, and it can be reached by calling 515-574-1045. For online information about accommodations, please go to www.iowacentral.edu/accommodations.

http://www.iowacentral.edu/accommodations

Bias-Free Classroom Statement: Periodontology maintains high standards of respect in regard to individual beliefs and values when selecting classroom materials including textbooks, project activities, power points, videos, presentations, and classroom discussions. It is our belief that all people have the right to obtain an education within our department/program courses free of bias, with full respect demonstrated to all who enroll in the courses of this department/program. External Accreditation: The program in dental hygiene is accredited by the Commission on Dental Accreditation (CODA). The Commission is a specialized accrediting body recognized by the United States Department of Education.

Documents

Course Name: Periodontology Course Department: Dental ...DHY 184 Clinical Dental Hygiene I . Textbook(s) Required: Nield-Gehrig, Foundations of Periodontics for the Dental Hygienist,