This course is intended to provide the dental clinician with an overview of the etiology, classification and treatment of periodontal disease. Topics discussed include the risk factors and etiology of periodontal disease, non-surgical periodontal therapy, adjunctive therapies and the role of the dental team. The target audience for this course is dental clinicians.

Abrasion of teeth involves an abnormal mechanical process that results in enamel, dentin and cementum being worn away over time. Susceptibility to abrasion is increased in the presence of erosion of the surface of the tooth, which results in softening of the tooth structure. Professional dental care is aimed at preventing disease and restoring oral health for patients with oral disease. The appropriate use of professional and home use oral care products is required to achieve these objectives. Careful selection of polishing techniques is required by the dental clinician to ensure optimized stain removal, polishing and preservation of surface integrity, and the oral care regimen recommended to patients for home care must also consider the risk of abrasion.

Dentinal hypersensitivity has been referred to as one of the most painful and chronic dental conditions, with a reported prevalence of between 4% and 57% in the general population and a higher prevalence in periodontal patients. It may also occur as a result of, or during, dental treatment. Clinicians must screen for dentinal hypersensitivity and diagnose by exclusion, determine appropriate treatment, and provide treatment and preventive recommendations. Consideration should also be given to treating dentinal hypersensitivity associated with dental treatment. Traditional treatments have included adhesive resins, fluoride varnishes, HEMA,iontophoresis, gingival grafts and desensitizing dentifrices. Other technologies include the use of bioglass particles,ACP, as well as 8% arginine and calcium carbonate paste.

Periodontal disease is progressive and episodic in nature, with tissue destruction resulting from the host response to bacterial antigens and irritants. Risk factors encompass systemic influences, external influences, intrinsic factors and local factors. An individual patient’s responsiveness to treatment also depends on the host response and the presence of risk factors. Adjunctive systemic and/or local therapy can positively impact periodontal therapy. Considerations in determining which to select include clinical preference and efficacy.

Twenty-six million people in the United States are living with chronic kidney disease (CKD). As the baby boomer generation continues to mature, medical procedures extending life improve,and with pharmacology advances, this number will increase. With an increased number of patients living with CKD seeking dental treatment, will the dental healthcare provider be prepared to provide treatment to patients living with renal disease-induced anemia, and with secondary hyperparathyroidism and its effects on bone metabolism and the cardiovascular system? Many providers are familiar with providing palliative treatment for xerostomia, but how do you recommend palliative treatment for someone who is on strict fluid and dietary restrictions, such as patients living with end stage renal disease? Diabetes and hypertension are the two greatest causes of kidney disease. Dental providers should be knowledgeable about the different stages of renal disease and different treatments associated with this condition, and be prepared to address oral complications of renal disease. The dental healthcare provider must become more familiar with the impact of periodontal disease on renal disease, specific medical challenges and become proficient in collaborating with medical healthcare providers to provide dental treatment to these patients.

The prevention of periodontal disease is a key factor in oral health. It has also become evident that periodontal health is associated with systemic health. Nonsurgical scaling and root planing is the standard of care for periodontitis. Supragingival plaque removal influences the bacterial environment in pockets up to 3 mm in depth, while subgingival scaling and root planing is essential in pockets 4 mm or more with attachment loss to remove and reduce the levels of periodontal bacteria. The thorough removal of both supragingival and subgingival deposits is important to remove niches for microbes, prevent inflammation, and prevent future growth of a mature subgingival biofilm. Ultrasonic scaling offers practical and practicebuilding advantages over manual scaling. Consideration of the advantages, safety and technique-sensitivity of method of scaling is required in selecting one. Given the oral-systemic link, periodontal treatment is important to help systemic health and the patient’s quality of life.