Carranza's Clinical Periodontology (Expert Consult Title: Online + Print)

Cover Title Page Copyright Page Editors Contributors Contributors to the Adaptation Edition About the Authors About the Adaptation Editors Preface to the South Asia Edition Preface to the 12th Edition Acknowledgments to the South Asia Edition Acknowledgments to the 12th Edition Contents Part 1 - Biologic Basis of Periodontology Section I - Normal Periodontium 1 - Gingiva Definition and Scope of Periodontology Oral Mucosa Gingiva Clinical Features Marginal Gingiva Gingival Sulcus Attached Gingiva Interdental Gingiva Microscopic Features Gingival Epithelium General Aspects of Gingival Epithelium Biology Structural and Metabolic Characteristics of Different Areas of Gingival Epithelium Oral (Outer) Epithelium Sulcular Epithelium Junctional Epithelium Development of Gingival Sulcus Renewal of Gingival Epithelium Cuticular Structures on the Tooth Gingival Fluid (Sulcular Fluid) Gingival Connective Tissue Gingival Fibers Cellular Elements Repair of Gingival Connective Tissue Blood Supply, Lymphatics, and Nerves Correlation of Clinical and Microscopic Features Color Physiologic Pigmentation (Melanin) Size Contour Shape Consistency Surface Texture Position Continuous Tooth Eruption Suggested Readings References 2 - Tooth Supporting Structures Development of the Attachment ­Apparatus Periodontal Ligament Development of the Periodontal Ligament Periodontal Fibers Cellular Elements Ground Substance Functions of Periodontal Ligament Physical Functions Resistance to Impact of Occlusal Forces (Shock Absorption) Transmission of Occlusal Forces to Bone Formative and Remodeling Function Nutritional and Sensory Functions Regulation of Periodontal Ligament Width Cementum Development of Cementum Permeability of Cementum Cementoenamel Junction Cementodentinal Junction Thickness of Cementum Cementum Resorption and Repair Ankylosis Exposure of Cementum to the Oral Environment Alveolar Process Composition of Alveolar Bone Cells and Intercellular Matrix Socket Wall Bone Marrow Periosteum and Endosteum Interdental Septum Osseous Topography Fenestration and Dehiscence Remodeling of Alveolar Bone Clinical Considerations Physiologic Migration of the Teeth External Forces and the Periodontium Vascularization of the Supporting Structures Suggested Readings 3 - Defense Mechanisms of the Gingiva Sulcular Fluid Methods of Collection Permeability of Junctional and Sulcular Epithelia Amount Composition Cellular Elements Electrolytes Organic Compounds Cellular and Humoral Activity in Gingival Crevicular Fluid Clinical Significance Circadian Periodicity Sex Hormones Mechanical Stimulation Smoking Periodontal Therapy Drugs in Gingival Crevicular Fluid Leukocytes in the Dentogingival Area Saliva Antibacterial Factors Salivary Antibodies Enzymes Salivary Buffers and Coagulation Factors Leukocytes Role in Periodontal Pathology Suggested Readings References 4 - Aging and the Periodontium Classification of Elderly Population The “Elderly” Segment of the Population Effects of Aging on the Periodontium Gingival Epithelium Gingival Connective Tissue Periodontal Ligament Cementum Alveolar Bone Tooth–Periodontium Relationship Bacterial Plaque Immune and Inflammatory Responses Effects of Aging on the Progression of Periodontal Diseases Aging and the Response to Treatment of the Periodontium Suggested Readings References Section II - Classification and Epidemiologyof Periodontal Disease 5 - Classification of Diseases and Conditions Affecting the Periodontium Gingival Diseases Dental Plaque-Induced Gingival Diseases Gingivitis Associated with Dental Plaque Only Gingival Diseases Modified by Systemic Factors Gingival Diseases Modified by Medications Gingival Diseases Modified by Malnutrition Nonplaque-Induced Gingival Lesions Gingival Diseases of Specific Bacterial Origin Gingival Diseases of Viral Origin Gingival Diseases of Fungal Origin Gingival Diseases of Genetic Origin Gingival Manifestations of Systemic Conditions Traumatic Lesions Foreign-Body Reactions Periodontitis Chronic Periodontitis Aggressive Periodontitis Periodontitis as a Manifestation of Systemic Disease Bisphosphonate-Related Osteonecrosis of the Jaw Necrotizing Periodontal Diseases Abscesses of the Periodontium Periodontitis Associated With Endodontic Lesions Endodontic–Periodontal Lesions Periodontal–Endodontic Lesions Combined Lesions Developmental or Acquired Deformities and Conditions Localized Tooth-Related Factors That Modify or Predispose Individuals to Plaque-Induced Gingival Diseases or Periodontitis Tooth Anatomic Factors Dental Restorations and Appliances Root Fractures Cervical Root Resorption and Cemental Tears Mucogingival Deformities and Conditions Around the Teeth Mucogingival Deformities and Conditions of the Edentulous Ridges Occlusal Trauma Suggested Readings References 6 - Epidemiology of Gingival and Periodontal Disease Indices Used to Study Periodontal Problems Indices Used to Assess Gingival Inflammation Papillary-Marginal-Attachment Index Periodontal Index Gingivitis Component of the Periodontal Disease Index Gingival Index (Loe and Silness) Indices of Gingival Bleeding Gingival Index Used by the National Institute of Dental Research Indices Used to Measure Periodontal Destruction Gingival Sulcus Measurement Component of the PDI Extent and Severity Index Radiographic Approaches to Measuring Bone Loss Indices Used to Measure Plaque Accumulation Plaque Component of the PDI Simplified Oral Hygiene Index Turesky–Gilmore–Glickman Modification of the Quigley–Hein Plaque Index Plaque Index Other Plaque Indices PHP Index Indices Used to Measure Calculus Calculus Component of the Simplified Oral Hygiene Index Calculus Component of the Periodontal Disease Index Probe Method of Calculus Assessment Calculus Surface Index Marginal Line Calculus Index Calculus Index Used by NIDR Indices Used to Assess Treatment Needs GPI Periodontal Treatment Need System Community Periodontal Index of Treatment Needs Community Periodontal Index Selection of Teeth Loss of Attachment Suggested Readings References Section III - Etiology of Periodontal Disease 7 - Periodontal Pathogenesis Inflammatory Responses in the Periodontium Microbial Virulence Factors Lipopolysaccharide Bacterial Enzymes and Noxious Products Microbial Invasion Fimbriae Bacterial Deoxyribonucleic Acid and Extracellular Deoxyribonucleic Acid Host-Derived Inflammatory Mediators Cytokines Antiinflammatory Cytokines Prostaglandins Matrix Metalloproteinases Linking Pathogenesis to Clinical Signs of Disease Alveolar Bone Resorption Resolution of Inflammation Immune Responses in Periodontal Pathogenesis Cells of Immunity and Inflammation Innate Immunity Saliva Epithelial Tissues Gingival Crevicular Fluid Pathogen Recognition and Activation of Cellular Innate Responses Neutrophil Function Adaptive Immunity Antigen-Presenting Cells T Cells B Cells Antibodies Complement Systems Concept of Host Susceptibility Suggested Readings 8 - Biofilm and Periodontal Microbiology Ecosystems of the Oral cavity Bacteria and Their Biofilm Mode of Living Dental Plaque Biofilm Structure of a Mature Dental Plaque Biofilm Formation of Dental Plaque Biofilm Formation of the Pellicle Initial Adhesion/Attachment of Bacteria Secondary Colonization and Plaque Maturation Factors That Affect Supragingival Dental Plaque Formation Topography of Supragingival Plaque Surface Microroughness Individual Variables That Influence Plaque Formation Variation Within the Dentition Impact of Gingival Inflammation and Saliva Metabolism of Dental Plaque Bacteria Communication Between Biofilm Bacteria Biofilms and Antimicrobial Resistance Bacterial Transmission and Translocation Microbiologic Specificity of Periodontal Diseases Nonspecific Plaque Hypothesis Specific Plaque Hypothesis Criteria for the Identification of Periodontopathogens Ecological Plaque Hypothesis Microorganisms associated with Periodontal Health and Disease Periodontal Health Gingivitis Chronic Periodontitis Localized Aggressive Periodontitis Generalized Aggressive Periodontitis Necrotizing Periodontal Diseases Abscesses of the Periodontium Periimplantitis Virulence Factors of Periodontopathogens Future Advances in Periodontal Microbiology Suggested Readings 9 - Microbial Interactions with the Host in Periodontal Diseases Bacterial Colonization and Survival in the Periodontal Region Host Tissue Invasion Bacterial Evasion of Host Defense Mechanisms Microbial Mechanisms of Host Tissue Damage Tissue Destruction–Promoting Factors 10 - The Role of Dental Calculus and Other Predisposing Factors Calculus Supragingival and Subgingival Calculus Prevalence Composition Inorganic Content Organic Content Attachment to the Tooth Surface Formation Theories Regarding the Mineralization of Calculus Role of Microorganisms in the Mineralization of Calculus Etiologic Significance Materia Alba, Food Debris, and Dental Stains Other Predisposing Factors Iatrogenic Factors Margins of Restorations Retained Cement/Periimplantitis Contours/Open Contacts Materials Design of Removable Partial Dentures Restorative Dentistry Procedures Malocclusion Periodontal Complications Associated with Orthodontic Therapy Plaque Retention and Composition Gingival Trauma and Alveolar Bone Height Tissue Response to Orthodontic Forces Extraction of Impacted Third Molars Habits and Self-Inflicted Injuries Trauma Associated with Oral Jewelry Toothbrush Trauma Chemical Irritation Smokeless Tobacco Radiation Therapy Genetic Susceptibility to Periodontal Disease Genetic Study Designs Inherited Variation and Risk of Periodontitis Periodontitis in Genetic Syndromes Nonsyndromic Aggressive and Chronic Periodontitis Suggested Readings 11 - Smoking and Periodontal Disease The Smoking Epidemic Effects of Smoking on the Prevalence and Severity of Periodontal Diseases Gingivitis Periodontitis Effects of Smoking on the Etiology and Pathogenesis of Periodontal Disease Microbiology Immune–Inflammatory Responses Physiology Effects of Smoking on Response to Periodontal Therapy Nonsurgical Therapy Surgical Therapy and Implants Maintenance Therapy Effects of Smoking Cessation on Periodontal Treatment Outcomes Suggested Readings 12 - Influence of Systemic Conditions Endocrine Disorders and Hormonal Changes Diabetes Mellitus Oral Manifestations Bacterial Pathogens Polymorphonuclear Leukocyte Function Altered Collagen Metabolism Female Sex Hormones Puberty Menstruation Pregnancy Hormonal Contraceptives Menopause Hyperparathyroidism Hematologic Disorders and Immune Deficiencies Leukocyte (Neutrophil) Disorders Neutropenia Agranulocytosis Leukemia The Periodontium in Leukemic Patients Leukemic Infiltration Bleeding Oral Ulceration and Infection Anemia Thrombocytopenia Genetic Disorders Chédiak–Higashi Syndrome Lazy Leukocyte Syndrome Leukocyte Adhesion Deficiency Papillon–Lefèvre Syndrome Down Syndrome Stress and Psychosomatic Disorders Psychosocial Stress, Depression, and Coping Stress-Induced Immunosuppression Influence of Stress on Periodontal Therapy Outcomes Psychiatric Influence of Self-Inflicted Injury Nutritional Influences Fat-Soluble Vitamin Deficiency Vitamin A Deficiency Vitamin D Deficiency Vitamin E Deficiency Water-Soluble Vitamin Deficiency B-Complex Deficiency Vitamin C (Ascorbic Acid) Deficiency Possible Etiologic Factors Protein Deficiency Medications Bisphosphonates Bisphosphonates and Periodontal Bone Loss Corticosteroids Other Systemic Conditions Osteoporosis Congenital Heart Disease Tetralogy of Fallot Eisenmenger Syndrome Hypophosphatasia Metal Intoxication Bismuth Intoxication Lead Intoxication Mercury Intoxication Other Chemicals Suggested Readings Section IV - Periodontal Pathology 13 - Gingival Inflammation Stage I Gingival Inflammation: The Initial Lesion Stage II Gingival Inflammation: The Early Lesion Stage III Gingival Inflammation: The Established Lesion Stage IV Gingival Inflammation: The Advanced Lesion Suggested Readings References 14 - Clinical Features of Gingivitis Course and Duration Description Clinical Findings Gingival Bleeding on Probing Gingival Bleeding Caused by Local Factors Chronic and Recurrent Bleeding Acute Bleeding Gingival Bleeding Associated with Systemic Changes Color Changes in the Gingiva Color Changes with Gingivitis Metallic Pigmentation Color Changes Associated with Systemic Factors Changes in the Consistency of the Gingiva Calcified Masses in the Gingiva Toothbrushing Changes in the Surface Texture of the Gingiva Changes in the Position of the Gingiva Traumatic Lesions Gingival Recession Positions of the Gingiva Clinical Significance Changes in Gingival Contour Suggested Readings References 15 - Gingival Enlargement Inflammatory Enlargement Chronic Inflammatory Enlargement Clinical Features Histopathology Etiology Gingival Changes Associated with Mouth Breathing Acute Inflammatory Enlargement Gingival Abscess Periodontal Abscess Drug-Induced Gingival Enlargement General Information Clinical Features Histopathology Anticonvulsants Immunosuppressants Calcium-Channel Blockers Idiopathic Gingival Enlargement General Information Clinical Features Histopathology Etiology Enlargements Associated with Systemic Diseases or Conditions Conditioned Enlargements Enlargement in Pregnancy Marginal Enlargement Tumor like Gingival Enlargement Histopathology Enlargement in Puberty Histopathology Enlargement in Vitamin C Deficiency Histopathology Plasma Cell Gingivitis Histopathology Nonspecific Conditioned Enlargement (Pyogenic Granuloma) Systemic Diseases that Cause Gingival Enlargement Leukemia Clinical Features Histopathology Granulomatous Diseases Wegener Granulomatosis Histopathology Sarcoidosis Histopathology Neoplastic Enlargement (Gingival Tumors) Benign Tumors of the Gingiva Fibroma Histopathology Papilloma Histopathology Peripheral Giant-Cell Granuloma Histopathology Central Giant-Cell Granuloma Leukoplakia Histopathology Gingival Cyst Histopathology Other Benign Masses Malignant Tumors of the Gingiva Carcinoma Malignant Melanoma Sarcoma Metastasis False Enlargement Underlying Osseous Lesions Underlying Dental Tissues Suggested Readings References 16 - Acute Gingival Infections Necrotizing Ulcerative Gingivitis Historical Background Clinical Features History Oral Signs Oral Symptoms Extraoral and Systemic Signs and Symptoms Clinical Course Histopathology Relation of Bacteria to the Necrotizing Ulcerative Gingivitis Lesion Diagnosis Differential Diagnosis Etiology Role of Bacteria Role of the Host Response Local Predisposing Factors Systemic Predisposing Factors Nutritional Deficiency Debilitating Disease Psychosomatic Factors Epidemiology and Prevalence Communicability Primary Herpetic Gingivostomatitis Clinical Features Oral Signs Oral Symptoms Extraoral and Systemic Signs and Symptoms History Histopathology Diagnosis Differential Diagnosis Communicability Pericoronitis Clinical Features Complications Suggested Reading References 17 - Desquamative Gingivitis Desquamative Gingivitis Definition Classification Dermatoses Endocrinal Imbalance Chronic Infections Idiopathic Drug Reactions (Lichenoid Reactions) Others (Conditions Which Mimic Desquamative Gingivitis) Clinical Features of Desquamative Gingivitis Mild Form Moderate Form Severe Form Management Clinical History Clinical Examination Biopsy Microscopic Examination Immunofluorescence Supportive Measures in the Management of Desquamative Gingivitis Medications Used in Desquamative Gingivitis Alternative Treatment Suggested Readings 18 - The Periodontal Pocket Classification Clinical Features Signs Symptoms Pathogenesis Histopathology Soft-Tissue Wall Bacterial Invasion Mechanisms of Tissue Destruction Microtopography of the Gingival Wall Periodontal Pockets as Healing Lesions Pocket Contents Significance of Pus Formation Root Surface Walls Structural Changes Chemical Changes Cytotoxic Changes Surface Morphology of Tooth Wall Periodontal Disease Activity Site Specificity Pulp Changes Associated With Periodontal Pockets Relationship of Attachment Loss and Bone Loss to Pocket Depth Area Between Base of Pocket and Alveolar Bone Relationship of Pocket to Bone Lateral Periodontal Cyst Suggested Readings References 19 - Abscesses of the Periodontium Gingival Abscess Histopathology Etiology Pericoronal Abscess Periodontal (Lateral) Abscess Classification According to Location According to Onset or Course of Lesion Depending on Number Etiology Pathogenesis and Histopathology Diagnosis Differential Diagnosis Suggested Readings 20 - Bone Loss and Patterns of Bone Destruction Bone Destruction Caused by the Extension of Gingival Inflammation Histopathology Radius of Action Rate of Bone Loss Periods of Destruction Mechanisms of Bone Destruction Bone Formation in Periodontal Disease Bone Destruction Caused by Trauma from Occlusion Bone Destruction Caused by Systemic Disorders Factors Determining Bone Morphology in Periodontal Disease Normal Variation in Alveolar Bone Exostoses Trauma From Occlusion Buttressing Bone Formation Food Impaction Aggressive Periodontitis Bone Destruction Patterns in Periodontal Disease Horizontal Bone Loss Bone Deformities (Osseous Defects) Vertical or Angular Defects Osseous Craters Bulbous Bone Contours Reversed Architecture Ledges Furcation Involvement Suggested Readings References 21 - Periodontal Response to External Forces Adaptive Capacity of the Periodontium to Occlusal Forces Trauma From Occlusion Acute and Chronic Trauma Primary and Secondary Trauma From Occlusion Stages of Tissue Response to Increased Occlusal Forces Stage I: Injury Stage II: Repair Stage III: Adaptive Remodeling of the Periodontium Effects of Insufficient Occlusal Force Reversibility of Traumatic Lesions Effects of Excessive Occlusal Forces on Dental Pulp Influence of Trauma From Occlusion on the Progression of Marginal Periodontitis Clinical and Radiographic Signs of Trauma From Occlusion Alone Pathologic Tooth Migration Pathogenesis Weakened Periodontal Support Changes in the Forces Exerted on the Teeth Unreplaced Missing Teeth Failure to Replace First Molars Other Causes Suggested Readings References 22 - Chronic Periodontitis and Necrotizing Ulcerative Periodontitis Chronic Periodontitis Clinical Features General Characteristics Disease Distribution Disease Severity Symptoms Disease Progression Prevalence Risk Factors for Disease Microbiological Aspects Local Factors Systemic Factors Immunologic Factors Genetic Factors Environmental and Behavioral Factors References Necrotizing Ulcerative Periodontitis Clinical Features Microscopic Findings Etiology of Necrotizing Ulcerative Periodontitis Microbial Flora Immunocompromised Status Psychologic Stress Malnutrition Conclusions Suggested Readings Chronic Periodontitis Necrotizing Ulcerative Periodontitis References 23 - Aggressive Periodontitis Historical Background Classification and Clinical Characteristics Features Subgroups Generalized Aggressive Periodontitis Prevalence and Distribution by Age and Gender Radiographic findings: Localized Aggressive Periodontitis Prevalence and Distribution by Age and Gender Radiographic findings Current Understanding Pathobiology and Risk Factors Microbiology Specific Bacteria in Localized Aggressive Periodontitis Host Response to Bacterial Challenge Host Response Specific to Aggressive Periodontitis Abnormalities in Localized Aggressive Periodontitis Genetics: Family Studies Genetics: Polymorphisms Environmental Factors That Affect Susceptibility Diagnosis Assessment of Clinical Presentation Suggested Readings References 24 - Pathology and Management of Periodontal Problems in Patients With Human Immunodeficiency Virus Infection Pathogenesis Classification and Staging Testing for Human Immunodeficiency Virus Infection Centers for Disease Control and Prevention Surveillance Case Classification Antiretroviral Therapy Highly Active Antiretroviral Therapy Oral and Periodontal Manifestations of Human Immunodeficiency Virus Infection Oral Candidiasis Oral Hairy Leukoplakia Kaposi’s Sarcoma and Other Malignancies Non-Hodgkin’s Lymphoma Bacillary (Epithelioid) Angiomatosis Oral Hyperpigmentation Atypical Ulcers Salivary Gland Disorders and Xerostomia Dental Treatment Complications Gingival and Periodontal Diseases Linear Gingival Erythema Necrotizing Ulcerative Gingivitis Necrotizing Ulcerative Periodontitis Necrotizing Ulcerative Stomatitis Chronic Periodontitis Periodontal Treatment Protocol Health Status Infection Control Measures Goals of Therapy Maintenance Therapy Suggested Readings References 25 - Impact of Periodontal Infection on Systemic Health Focal Infection Theory Revisited Evidence-Based Clinical Practice Subgingival Environment as a Reservoir for Bacteria Periodontal Disease and Mortality Periodontal Disease and Coronary Heart Disease/Atherosclerosis Effect of Periodontal Infection Systemic Infections Thrombogenesis Atherosclerosis Role of Periodontal Disease in Myocardial or Cerebral Infarction Periodontal Disease and Stroke Periodontal Disease and Diabetes Mellitus Periodontal Infection Associated with Glycemic Control in Diabetes Periodontal Disease and Pregnancy Outcome Role of Periodontitis Periodontal Disease and Chronic Obstructive Pulmonary Disease Periodontal Disease and Acute Respiratory Infections Role of Periodontal Disease in Erectile Dysfunction Periodontal Medicine in Clinical Practice Patient education regarding Periodontal Disease and Systemic Health Suggested Reading Part 2 - Clinical Periodontics Section I - Diagnosis, Prognosis and Treatment Plan 26 - Clinical Diagnosis Overall Appraisal of the Patient Chief Complaint Medical History Casts Clinical Photographs Extraoral Examination Examination of the Lymph Nodes Intraoral examination Oral Hygiene Oral Malodor Examination of the Teeth and Implants Wasting Diseases of the Teeth Dental Stains Hypersensitivity Proximal Contact Relations Tooth Mobility Trauma from Occlusion Pathologic Migration of the Teeth Sensitivity to Percussion Dentition with the Jaws Closed Functional Occlusal Relationships Examination of the Periodontium Plaque and Calculus Gingiva Use of Clinical Indices in Dental Practice Periodontal Pockets Signs and Symptoms Detection of Pockets Pocket Probing Probing Technique Level of Attachment and Pocket Depth Determining the Level of Attachment Bleeding on Probing When to Probe Probing Around Implants Automatic and Electronic Periodontal Probing Probing Force Probe Angulation Determination of Disease Activity Amount of Attached Gingiva Degree of Gingival Recession Alveolar Bone Loss Palpation Suppuration Periodontal Abscess Periodontal Abscess and Gingival Abscess Periodontal Abscess and Periapical Abscess Intraoral Radiographic Survey Laboratory Aids to Clinical Diagnosis Histopathologic examination Radiographic Aids in the Diagnosis of Periodontal Disease Normal Interdental Bone Radiographic Techniques Bone Destruction in Periodontal Disease Bone Loss Amount Distribution Pattern of Bone Destruction Radiographic Appearance of Periodontal Disease Periodontitis Interdental Craters Furcation Involvement Periodontal Abscess Clinical Probing Localized Aggressive Periodontitis Trauma from Occlusion Digital Intraoral Radiography Conclusion Advanced Diagnostic Techniques Conventional Routine Diagnostic Methods Status of Current Conventional Diagnostic Methods The Positives The Negatives Requirements of Newer Diagnostic Methods Periodontal Probing Ultrasonography in Periodontics Gingival Temperature Advances in Radiographic Assessment Digital Radiography Subtraction Radiography Computer-Assisted Densitometric Image Analysis System Advances in Microbiologic Analysis Bacterial Culturing Direct Microscopy Immunodiagnostic Methods Enzymatic Methods Diagnostic Assays Based on Molecular Biology Techniques Nucleic Acid Probes Checkerboard DNA–DNA Hybridization Technology Polymerase Chain Reaction Advances in Characterizing the Host Response Source of Samples Inflammatory Mediators and Products Host-Derived Enzymes Tissue-Breakdown Products Conclusion Suggested Readings 27 - Clinical Risk Assessment Definitions Risk Factors for Periodontal Disease Tobacco Smoking Diabetes Pathogenic Bacteria and Microbial Tooth Deposits Risk Determinants/Background Characteristics for Periodontal Disease Genetic Factors Age Gender Socioeconomic Status Stress Risk Indicators for Periodontal Disease HIV/AIDS Osteoporosis Infrequent Dental Visits Risk Markers/Predictors for Periodontal Disease Previous History of Periodontal Disease Bleeding on Probing Clinical Risk Assessment for Periodontal Disease Conclusions Suggested Readings 28 - Determination of Prognosis Definitions Types of Prognosis Overall Versus Individual Tooth Prognosis Factors in Determination of Overall Prognosis Type of Disease Prognosis for Patients With Gingival Disease Dental Plaque–Induced Gingival Diseases Gingivitis Associated With Dental Plaque Only Plaque-Induced Gingival Diseases Modified by Systemic Factors Plaque-Induced Gingival Diseases Modified by Medications Gingival Diseases Modified by Malnutrition Nonplaque-Induced Gingival Lesions Prognosis for Patients With Periodontitis Chronic Periodontitis Aggressive Periodontitis Periodontitis as Manifestation of Systemic Diseases Necrotizing Periodontal Diseases Age of the Patient Rate of Disease Progression Height of the Remaining Bone Systemic Background Genetic Factors Smoking Stress Number of Remaining Teeth and Their Distribution Patient Compliance and Cooperation Factors in Determination of Prognosis of Individual Teeth Tooth Mobility Anatomical Factors Level of Clinical Attachment Type of Bone Defect Subgingival Restorations Caries, Nonvital Teeth, and Root Resorption Teeth Adjacent to Edentulous Areas Strategic Importance of the Tooth Plaque Control Reevaluation of Prognosis After Phase I Therapy Suggested Readings 29 - Rationale for Periodontal Treatment and Treatment Plan What Does Periodontal Therapy Accomplish? Local Therapy Systemic Therapy Factors That Affect Healing Local Factors Systemic Factors Healing After Periodontal Therapy Regeneration Repair New Attachment Periodontal Reconstruction The Treatment Plan Master Plan for Total Treatment Extracting or Preserving a Tooth Sequence of Therapeutic Procedures Explaining Treatment Plan to the Patient Suggested Readings Section II - Management of Patients with Periodontal Diseases 30 - Periodontal Treatment of Medically Compromised Patients Cardiovascular Diseases Hypertension Ischemic Heart Diseases and Other Cardiovascular Disorders Principles of Periodontal Management Congestive Cardiac Failure Cardiac Pacemakers and Implantable Cardioverter-Defibrillators Infective Endocarditis Cerebrovascular Accident Endocrine Disorders Diabetes Tests for Diabetes and Metabolic Control Guidelines for Managing a Diabetic Patient in the Dental Office Thyroid and Parathyroid Disorders Adrenal Insufficiency Hemorrhagic Disorders Coagulation Disorders Anticoagulant Medications Antiplatelet Medications Thrombocytopenic Purpuras Nonthrombocytopenic Purpuras Blood Dyscrasias Leukemia Agranulocytosis Renal Diseases Liver Diseases Hepatitis Pulmonary Diseases Medications and Cancer Therapies Bisphosphonates Anticoagulant/Antiplatelet Therapy Corticosteroids Immunosuppression and Chemotherapy Radiation Therapy Pregnancy Infectious Diseases Tuberculosis Hepatitis Suggested Readings 31 - Treatment of Aggressive and Atypical Forms of Periodontitis Aggressive Periodontitis Therapeutic Modalities Conventional Periodontal Therapy Surgical Resective Therapy Regenerative Therapy Antimicrobial Therapy Microbial Testing Local Delivery Full-Mouth Disinfection Host Modulation Treatment Planning and Restorative Considerations Use of Dental Implants Clinical Consideration Periodontal Maintenance Periodontitis Refractory to Treatment Necrotizing Ulcerative Periodontitis Suggested Readings References Section III - Diagnosis and Treatment of Periodontal Emergencies 32 - Treatment of Acute Gingival Disease Necrotizing Ulcerative Gingivitis First Visit Instructions to the Patient Second Visit Third Visit Gingival Changes With Healing Additional Treatment Considerations Contouring of Gingiva as Adjunctive Procedure Role of Drugs Persistent or Recurrent Cases Acute Pericoronitis Acute Herpetic Gingivostomatitis Suggested Readings References 33 - Treatment of Periodontal Abscess Specific Treatment Approaches Acute Abscess Drainage Through Periodontal Pocket Drainage Through External Incision Chronic Abscess Gingival Abscess Pericoronal Abscess Suggested Readings References Section IV - Nonsurgical Treatment 34 - Phase I Periodontal Therapy Rationale Treatment Sessions Sequence of Procedures Step 1: Plaque-Biofilm Control Instruction Step 2. Removal of Supragingival and Subgingival Plaque Biofilm and Calculus Step 3. Recontouring Defective Restorations and Crowns Step 4. Management of Carious Lesions Step 5. Tissue Reevaluation Results Healing Decision to Refer for Specialist Treatment Conclusion Suggested Readings References 35 - Plaque Biofilm Control The Tooth Brush Toothbrush Design Powered Toothbrushes Dentifrices Caries prevention Anticalculus Whitening Agents Antibacterial Action Antihypersensitivity Other Dentifrice Ingredients Humectants Binders Buffers Flavors/Sweeteners Surfactants Colors/Visuals Toothbrushing Methods Bass Technique Brushing With Powered Toothbrushes Recommendations Interdental Cleaning Aids Dental Floss Technique Recommendations Interdental Cleaning Devices Interdental Brushes Technique Wooden or Rubber Tips Technique Recommendations Gingival Massage Oral Irrigation Home/Self-Applied Irrigation Mechanism of Action of Irrigation Safety Clinical Outcomes of Irrigation Individuals with Special Considerations Conclusions Caries Control Recommendations Chemical Plaque Biofilm Control With Oral Rinses Disclosing Agents Patient Motivation and Education Motivation for Effective Plaque Biofilm Control Education and Scoring Systems Plaque Biofilm Control Record (O’Leary Index) Bleeding Points Inde