DHY 137 - Periodontology

1. Describe and be able to identify normal periodontium.

2. Identify subclinical pathological changes that take place within the periodontium during the inflammatory process.

3. Describe various diagnostic techniques used to detect periodontal disease, including evaluating the dentition for furcation involvement, recession and clinical attachment loss. 

4. Describe the following systemic etiologic risk factors of periodontal disease:

a. immunologic defects

b. endocrine dysfunctions

c. nutritional disorders

d. genetically transmitted diseases

e. tobacco and e-cigarette use

f. hematologic disorders

5. After determining a patient’s level of dental knowledge, describe the disease process and evaluate and explain the potential for periodontal /systemic relationships.

6. Compare and contrast clinical and histologic symptoms of and oral changes associated with various gingival and periodontal diseases.

7. Determine and assess patient risk factors such as diabetes, smoking, biofilm and inflammation; Begin analysis of the significant assessment findings to summarize an individual’s periodontal disease risk to 85% accuracy on simulation exercises. 

8. Compare and contrast primary and secondary occlusal trauma, and describe an examination that includes the symptoms of occlusal wear and the degree of mobility on teeth and implants.

9. Explain the rationale and some of the procedures for implementation phase of non-surgical periodontal therapy, including instrumentation and application of antimicrobial agents; describe and recommend appropriate preventive homecare techniques and oral physiotherapy aids for a patient with periodontal bone loss and/or recession. 

10. Describe the provision of on-going re-evaluation during periodontal or dental implant treatment and maintenance appointments; explain the need for periodontal maintenance appointments to lower risk for disease recurrence.

11. Recognize periodontal surgery procedures used to provide secondary and tertiary prevention; describe rationale for various other periodontal surgeries.

12. Explain the management of acute gingival conditions; compare and contrast the symptoms and management of conditions that are viral vs. bacterial in nature.

13. When communicating, use language that is appropriate to the audience. 

14. Make connections between academic learning and GRCC and the knowledge and skills necessary for careers of interest. 
Course Outline:
I. Course Intro and Role of RDH

A. Course Requirements

1. Basic Definitions

2. RDH in General practice

3. RDH in Periodontal office

a) Referring from GRCC clinic (through DDS)

II. Normal Periodontium

A. Normal Clinical Characteristics of Gingival Tissues

1. Structures of supportive apparatus

a) Gingiva

b) Oral epithelium

2. Sulcular epithelium

a) Junctional epithelium

b) Sulcular fluid

c) Lamina propria (gingival connective tissue

4. Blood supply, lymphatics and nerves 

5. Cementum and Sharpey’s fibers

6. Alveolar bone

a. normal bone structure and variations 

b. normal microscopic characteristics

c.alveolar bone structure in constant state of flux

(1) occlusal forces

(2) physiologic drift

(3) disuse atrophy

III. Pathologic Changes during Periodontal Inflammatory Process

A. Inflammatory Cells and their Byproducts

B. Subclinical Changes in Inflammation of Periodontium

C. Clinical Changes

IV. Subclinical and Clinical Changes Associated with Gingivitis

A. Stages

1. Stage I

2. Stage II

3. Stage III

V. Classifications of Gingival Diseases

A. Chronic Gingivitis

B. Acute Gingivitis and Periodontal Abscesses

C. NUG vs. Herpetic Gingivostomatits

D. Gingivitis Associated with Systemic Disease

E. Hyperplasia (medication induced and idiopathic)

F. Desquamative Gingival Changes

G. Hormonally Influenced Gingival Changes

VI. Etiologic Agents and Risk factors for Periodontal Disease

VII. Probable Etiologic Role of Plaque in Periodontal Disease

A. Attached Subgingival Plaque vs. Loosely Attached

B. Inflammatory Cells and their Byproducts

VIII. Chief Complaints/perceived needs and Secondary Etiologic Factors

IX. Etiology of Mouth Odor

X. Periodontal Assessments/Diagnostic Tools and Techniques

     A. Probing: Pocket Depth vs. Clinical Attachment Loss

     B. Furcation Identification

     C. Mobility/Tissue Injury Suggesting Traumatic Occlusion

     D. Periodontal Indices (including AAP classification)

     E. Width of Attached Gingiva (Mucogingival Involvement)

     F. Caries, Open contacts and Iatrogenic Factors as plaque traps

     G. Habits/Tobacco Use and contribution to periodontal bone loss

     H. Developmental Anomalies

     I. Calculus as a plaque trap

XI. Systemic Risk Factors

A. Immunologic Defects

B. Endocrine Dysfunctions

C. Nutritional Disorders

D. Genetically Transmitted Diseases

E. Drug Intake

XII. Occlusion and Periodontal Bone Loss

A. Inflammatory Pathways

B. Physiologic and Traumatic Occlusion

C. Alveolar Bone Affected by Trauma from Occlusion in Periodontal Disease States

D. Primary and Secondary Occlusal Trauma

         E. Identifying Bone Loss, Vertical Defects, and Furcations or Radiographs

F. Normal Alveolar Bone Structure and Function vs. Bone Affected by the Disease

XIII. Periodontal Disease Classifications

A. AAP Categories

B. Assessment Findings and Analysis, Including Patterns of Bone Loss

C. Active Gingivitis vs. Periodontal or Periodontal Maintenance Patients

XIV. Non-Surgical Therapy (NST)

A. Principles of Non-Surgical Periodontal Therapy

B. Implementation Phase of NST, Instrumentation Challenges in Periodontal Patients

C. Introduction to application of Anti-Microbial Agents against perio pathogens

D. Introduction to non-Surgical Preventative Treatment Around a Dental Implant

E. Preventative Dental Hygiene Measures During Non-Surgical Phase of Therapy

F. Post-Op directions for patients undergoing NST

XV. Periodontal Re-Evaluation and Maintenance Therapy

A. Planning and rationale for Periodontal Re-Evaluation and Maintenance. 

B. Parameters for Referral to a Periodontal Specialist

C. Communication and Collaboration with Specialists and other Medical Personnel

XVI. Surgical Techniques

A. Surgery as an Alternative to NST

B. Surgical Procedures used to treat Recession

C. Rationale for Various other Periodontal Surgeries

D. Post-Operative Procedures/Directions

XVII. Periodontal Emergencies

A. Causes and Treatment of Abscesses of the Periodontium

B. Management of Acute Gingival Conditions

On-line discussion board  0-10%

Small Group Work: 30-50%
Mandatory Course Components:
None
Equivalent Courses:
None