SECOND EDITION
Shantipriya Reddy BDS MDS (Periodontia)
Professor Dr Syamala Reddy Dental College and Hospital Bengaluru, Karnataka, India
Jitendar P Vij
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Essentials of Clinical Periodontology and Periodontics
© 2008, 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
9788184481488
Typeset at JPBMP typesetting unit
Printed at Ajanta Offset
4Dedicated to
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
5Acknowledgements
Any book requires the help and assistance of others in order to be completed successfully. In this regard, I would like to extend special thanks to all those who had helped to accomplish this goal. First and foremost I would like to thank my student Dr Deepti Sinha for drawing those excellent diagrams inserted in this book. Special thanks must go to all my colleagues, postgraduate students, (Drs) Jeeth Rai, Keshav, Satish, Shabeer and Anil, Mamatha and Sumaira, who have helped me to prepare the manuscript. I would like to extend my special thanks to Dr Anil Kumar who helped me to collect the photographs used in this book. I am very grateful to Dr Prasad MGS and Dr Sabna Kakarala for being so generous with their clinical photographs which helped to enhance the overall excellence of this edition. Dr Divakaranand and Dr Rudrakshi's helped in typing the manuscript of this edition is greatly appreciated. My heartfelt thanks to Dr Srinivas for helping me in writing the chapter on Oral Malodor. I would also like to thank Dr Ashwath (Smart desq navigators) for helping me with animation photographs of various suturing techniques. The excellent co-operation of the publisher is also greatly acknowledged.
6Preface to the Second Edition
I am extremely happy to present the second edition of Essentials of Clinical Periodontology and Periodontics. Three new chapters including glossary of periodontal terminology has been included in this edition. Chapters on Host Modulation and Oral Malodor are written with same clarity and simplicity, that has been religiously followed in the previous edition. More photographs have been included to make the student understand the subject better.
I thank all the fellow colleagues and students who have supported me with useful suggestions while revising the first edition. I hope to receive the same support and suggestions for the second edition also.
Shantipriya Reddy
7Preface to the First Edition
This 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.
This 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 this 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 this 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 this book will reflect the difficulty of that path. I hope that this 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
8Prolog
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.9
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.
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 to 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 has witnessed significant scientific contributions in the field of periodontics.
JOURNALS OF PERIODONTOLOGY
The various journals of periodontology available are:
- The Journal of Periodontology by Robert. J. Genco.
- Journal of Periodontal Research by Isao Ishikawa, Jorgen Slots, Maurizio Tonetti
- Journal of Clinical Periodontology by Jan Lindhe.
- Periodontology 2000 by Jorgen Slots.
- International Journal of Periodontics and Restorative Dentistry in India by Myron Nevins.
- Journal of Indian Society of Periodontology.