Course Outlines

Microbiology of Dental Plaque

Course Outline:

1. Dental Plaque
   1. Composition - organic
   2. Composition - inorganic
   3. Classification
   4. Experimental gingivitis
   5. Plaque development - dental pellicle
   6. Plaque development - primary colonizers
   7. Plaque development - secondary colonizers
   8. Plaque development - tertiary colonizers
   9. Microbial shifts associated with plaque development
   10. Microbial shifts associated with periodontal disease development
   11. Selected plaque species of importance in periodontal diseases
2. Dental Plaque: Relationship of Dental Diseases
   1. Historical perspective: Kock's Postulates
   2. Specific plaque hypothesis
   3. Socransky's criteria for periodontal pathogens
   4. Socransky's criteria for Porphyromonas gingivalis
   5. Socransky's criteria for Actinobacillus actinomycetemcomitans
   6. Other periodontal pathogens
   7. The non-specific nature of current therapeutics
3. Dental Plaque: Recent Reclassification of Periodontal Microorganisms
   1. Comments in reclassification of periodontal microorganisms
   2. List of recent reclassifications

Periodontal Disease Recognition: A Review Course for Dental Hygienists

Course Objectives

1. Identify the patient's periodontal status
2. Review current systems of classifications and identification of periodontal diseases

Periodontal Status

1. Assessment of Clinical findings
   1. Full mouth probing will provide the following data necessary to assess the patient's periodontal status.
      • Baseline data
      • Attachment Loss
      • Bleeding upon probing
      • Documentation
      • Communication
      • Education
   2. Recession
   3. Furcations
      • Grade I, Grade II, Grade III, Grade IV
   4. Mobility
      • Class I, Class II, Class III
   5. Mucogingival Involvement
2. Assessment of Radiographic Findings
   Radiographic interpretation includes the following areas:
   1. Type of bone loss
      Horizontal and Vertical.
   2. Level of bone loss
      Severity of bone loss/attachment loss. Compare to clinical findings.
   3. Crown to root ratio
      Dependent on severity of bone loss. Used to assess the prognosis of the tooth.
   4. PDL
   5. Furcations
      Identification of furcation invasion areas and compare to radiographic findings
   6. Other dental pathology

   Classifications of Periodontal Disease

3. ADA Classifications
   Determined by the severity of bone loss.
   • Case Type I -- Gingivitis
   • Case Type II -- Early Periodontitis
   • Case Type III -- Moderate Periodontitis
   • Case Type IV-- Advanced Periodontitis
4. AAP Diagnosis
   Determined by the etiology/microflora of the disease.
   Categories for Gingivitis:
   1. Plaque-associated gingivitis
   2. Chronic gingivitis
   3. Steroid hormone-induced gingival inflammation
   4. Medication-induced overgrowth
   5. Acute Necrotizing Ulcerative Gingivitis
   6. Experimental Gingivitis
   
   Subdivisions of Periodontitis:
   1. Plaque Associated Adult Periodontitis -- Case will be illustrated
   2. Early-Onset Periodontitis
      Pre-pubertal -- Case will be illustrated
   3. Rapidly Progressive -- Case will be illustrated
   4. Periodontitis associated with a systemic disease -- Case will be illustrated
   5. Refractory Periodontitis
   6. Necrotizing Ulcerative Periodontitis -- Case will be illustrated

   Upon completion of data gathering. The clinician will be able to make a thorough assessment of the patient's periodontal status. The dentist and hygienist will work together to establish the appropriate treatment plan, expected dental hygiene therapy outcomes, or need for referral.

Periodontal Flap Surgery for Maxillary Posterior Segments

Course Outline:

This is a continuing education course which demonstrates a periodontal flap surgery in the maxillary molar and premolar areas. This tutorial includes both slides and written material.

1. Informed consent
2. Patient Preparation
3. A statement regarding the need for initial periodontal therapy including scaling, root planing and oral hygiene instruction
4. Surgical Instrument Tray is reviewed in detail which includes both the instrument names and the specific location on the tray.

1. Anesthesia techniques reviewed and demonstrated with slides.
2. Preoperative exam.
3. Periapical radiographs reviewed
4. Initial incisions
5. Flap reflection
6. Debridment of soft tissue and root surfaces
7. Osseous surgery
8. Suturing techniques
9. Surgical dressing
10. Post operative instructions
11. One week post operative appointment

Use of Oral Analgesic Drugs Following Periodontal Surgery

Course Outline:

This is a continuing education course which reviews four different analgesics drugs for use after periodontal surgery. There are also three referenced abstracts included.

1. The four drugs reviewed are:
   1. Ibuprofen
   2. Acetaminophen
   3. Diflunisal
   4. Naproxen
2. Each drug is reviewed separately with the following categories discussed:
   1. Generic Name
   2. Commercial Products
   3. Structure
   4. Mode of Action
   5. Periodontal Indications
   6. Dosage
   7. Side Effects
   8. Contraindication
   9. Precautions
   10. Drug Interactions
   11. How Prescribed

Infection Control and OSHA in the Dental Environment

Course Outline:

1. General Information
   1. Introduction
   2. Dental Item Classification
   3. Private Dental Practice Oversight Program
   4. Personnel Training
   5. Record of Staff Hepatitis Vaccine
2. Universal Precautions
   1. Discussion
   2. Immunization and HIV Testing
   3. Medical History Review
   4. Protective Attire and Barrier Techniques
   5. Preparation of the Dental Treatment Room (DTR)
   6. Treatment
   7. Disinfecting the DTR between patients
   8. Securing the DTR at the End of the Day
   9. Housekeeping
3. Handwashing
   1. Introduction
   2. Hand Washing Agents
   3. Hand Washing Equipment and Soap Dispensers
   4. Hand Washing Guidelines
   5. Hand Washing Techniques
4. Sterilization
   1. Introduction
   2. Physical Design
   3. The Sterilization Process
   4. Examples of Critical Category Items Requiring Sterilization
   5. Sterilization Monitoring
   6. Shelf-Life of Sterilized Items
   7. Wrapping and Sterilizer Compatibility
   8. Sterilization Packaging Materials
   9. Biological Monitor and Sterilizer Compatibility
   10. SOP: Sterilization Monitors
   11. Guide to Chemical Agents for Disinfection and Sterilization
5. Disinfection
   1. Introduction
   2. Levels of Disinfection
   3. Factors Influencing Germicidal Procedures
   4. General Categories of Liquid Chemical Agents
   5. Examples of Semi-Critical Category Items Requiring
   6. Chemical Disinfection 5-2
   7. Examples of Noncritical Category Items Requiring Chemical
6. Oral Radiology
   1. Introduction
   2. Hand Washing
   3. Film Positioning Devices
   4. Panoramic Unit Bite Blocks
   5. Intraoral Film Packets
   6. Darkroom
   7. Automatic Film Processor with Daylight Loader
   8. X-Ray Chair
   9. X-Ray Tubehead and Controls
7. Dental Laboratory
   1. Introduction
   2. Barrier Control
   3. Dental Treatment Room (DTR) Infection Control
   4. Laboratory Infection Control
   5. Casts and Miscellaneous Laboratory Items
   6. Daily Disinfection
   7. Weekly Disinfection
8. Needle Sticks/Sharps Injury Or Mucus Membrane Contact
   1. Purpose
   2. Background
   3. Prevention
   4. Reporting
   5. Action
   6. Incident Report Form
   7. Treatment Protocol Algorithm Summary
9. Waste Management
   1. Waste Classification
   2. Infectious Waste Bags and Sharps Containers
   3. Disposal of Infectious (Biohazardous) Waste
   4. Disposal of Non-infectious (Medical-solid) Waste

Reconstructive Osseous Surgery

Course Outline:

1. Definition of reconstructive osseous surgery in periodontics
2. Objectives of periodontal surgery
3. Indications for periodontal regeneration
   1. Type of defects
   2. Anatomical considerations
   3. Furcations
4. Treatment modalities
   1. Graft Materials: Autografts, Allografts, Xenografts, Alloplastic Materials
      1. Patient selection
      2. Defect selection
         1. Classification of defects
      3. Surgical technique
         1. Preparation for procedure
         2. Procurement and preparation of graft
         3. Placement of graft
         4. Periodontal dressing
         5. Antibiotic Therapy
      4. Postoperative management
      5. Supportive Periodontal Therapy/Maintenance Phase
      6. Histologic observations
      7. Predictability
      8. Possibilities and Complications
   2. Non-Graft Materials
   1. Guided-tissue regeneration
   2. Placement
   3. Surgical protocol
   4. Evaluating results
5. Reconstructive Osseous Surgery vs. Resective Osseous Surgery

Recording the Periodontal Exam: A Program for Dental Assistants

Course Outline:

1. Objectives of Periodontal Charting
   1. Detection
   2. Recording
2. Medical and Dental Findings
   1. Medical History
   2. Dental Exam
3. III. Six cycles of data collecting
   1. Missing Teeth & Tooth Mobility
   2. Pocket Depths
   3. Furcations
   4. Mucogingival Problems
   5. Assessing Contact Points
   6. Radiographic Interpretation
4. Set of examination instruments
5. Cycle One: Missing Teeth & Tooth Mobility
   1. Identifying and recording missing teeth
      
   2. Assessing and recording tooth mobility
      
6. Cycle Two: Pocket Depth
   1. Illustration and recording of pocket depths
   2. Assessing and recording bleeding and suppuration
   3. Identifying and recording recession areas
   4. Recording gingival overgrowth
7. Cycle Three: Furcations
   1. Instrument used for assessing furcation areas
   2. Severity of furcations
   3. Classification of furcations
8. Cycle Four: Mucogingival Problems
   1. Tension test
   2. Roll technique
   3. Recording mucogingival problems
9. Cycle Five: Assessing Contact Points
   1. Assessing and recording open contacts
10. Cycle Six: Radiographic Interpretation
    1. Comparison of data
    2. Record new findings
11. Conclusion

Oral Malodor: A Periodontal Perspective

Course Outline:

1. Etiology of Oral Malodor
   1. Volatile Sulfur Compounds (VSCs)
   2. Nonsulfur-containing Compounds
   3. Gram-negative microorganisms
2. Relationship of Periodontal Disease to Oral Malodor
   1. Association Between Chronic Periodontitis and Mouth Odor
   2. Periodontal Pathogens
   3. Relationship Between Oral Malodor and BANA Hydrolysis
   4. Implication Between VSCs and Periodontal Disease
3. Diagnosis of Oral Malodor
   1. Methods Used to Detect and Diagnose Oral Malodor
      1. Subjective Measurements
      2. Objective Instrumental Analysis
      3. Indirect Methods
4. Treatment of Oral Malodor
   1. Oral Malodor Diagnosis and Treatment Algorithm
      1. Screening Examination
      2. Determine Primary Source
      3. Complete Oral Examination
      4. Oral Hygiene Instructions
      5. Periodontal Therapy
      6. Periodontal Re-evaluation

Periodontal Immunology

Course Outline:

1. The Immune System Involvement in the Pathogenesis of Periodontal Disease
   1. Histology: Temporal Sequence
      1. Early Lesion
      2. Established Lesion
      3. Advanced Lesion
   2. Histology: Spatial Considerations
   3. A Paradigm for Pathogenesis Opportunistic Infection
      1. Specific Interactions - the specific plaque hypothesis
      2. Natural History
   4. Perspective
   5. Conflicting Opinions to the Paradigm
2. Complement and Periodontal Disease
   1. Gingival Crevice and Gingival Crevicular Fluid (GCF)
3. Neutrophils and Periodontal Diseases
   1. Primary Neutrophil Defects
   2. Severe Periodontal Diseases Associate with Subtle Neutrophil Defects
   3. Early Onset Periodontitis (EOP) - Localized Juvenile Periodontitis (LJP)
   4. Early Onset Periodontitis (EOP) - Generalized Juvenile Periodontitis (GJP), Rapidly Progressing Adult Periodontitis (RAP)
   5. Rapidly Progressing Adult Periodontitis (RAP)
   6. Refractory Periodontitis
   7. Neutrophil Defects May be Acquired
   8. Experimental Evidence Neutrophils Protect the Periodontium
   9. Crevicular Neutrophils
4. Lymphocytes-Monocytes and the Chronic Phase of Periodontal Diseases
   1. The Role of Lymphocytes and Monocytes in Periodontal Protection
   2. Decreased Activity of Lymphocytes and Monocytes and Periodontal Disease
   3. Systemic Lymphocyte Activity and Periodontal Diseases
   4. Local Lymphocyte Activity and Periodontal Disease
   5. Other Lymphocytes: NK Cells
   6. Gingival Mononuclear Cell (GMC)/Monocyte Activity
   7. Antiinflammatory Effects and Healing Orchestrated by Chronic Inflammatory Cells
   8. Bone Healing
   9. MHC Genetics and Periodontal Diseases
   10. Summary and Final Caveat

The Role of Phagocytes and Neutrophils in Periodontal Disease

Course Outline:

1. Description of Neutrophils
2. Maturation and Fate of Phagocytes
   1. Azurophil Granules
   2. Specific Granules
   3. Interaction of neutrophils with chronic immune cells
3. Neutrophil Activities
4. Neutrophil Adherence to Tissues
   1. Selectin-dependent Phase
   2. Integrin-dependent Phase
5. Selectins
6. Leukocyte B2 Integrins
7. Neutrophil Rolling
   1. L-selectin
   2. Sialomucin CD34
8. Inflammation of Vascular Endothelium
   1. P-selectin
   2. E-selectin
   3. Leukocyte adhesion deficiency, type 2 (LAD-2)
9. Leukocyte Diapedesis
   1. Interendothelial Cell-Junction Diapedesis
10. Shedding of L-selectin
    1. Interleukin-8 (IL-8)
    2. Platelet Activating Factor (PAF)
11. Up-Regulation of Leukocyte B2 Integrins
    1. Mac-1
    2. LFA-1
12. Reversible Binding - LFA-1
13. Leukocyte Adhesion Deficiency, type 1 (LAD-1)
14. Interendothelial Transmigration
    1. Indentation
15. Hunting Targets by Leukocytes
    1. Chemotaxis
    2. Chemokinesis
    3. Random Migration
16. Chemotaxins for Neutrophils
17. Chemotaxin Receptors
    1. G-protein Coupled Receptor
    2. Formylmethionyl Peptide Receptor
    3. Complement Receptors
    4. Fc Receptors
18. Neutrophil Migration: Into Other Tissues
19. Delivery Systems
    1. Phagocytosis
    2. Secretion
    3. Apoptosis/Cytolysis
    4. Respiratory Burst
20. Phagocytosis
    1. Opsonization
21. Neutrophil Killing of Targets: Antimicrobial Systems
    1. Localization of Antimicrobial Substances of Neutrophils
       1. Oxidative and Nonoxidative Mechanisms
    2. Specific Granules
    3. NADPH Oxidase System
    4. Myeloperoxidase (MPO)
    5. Intraphagolysosomal Secretion
    6. Extracellular Secretion
    7. Cytolysis and Apoptosis
22. Nonoxidative Antimicrobial Mechanisms
    1. Defensins
    2. Bactericidal/Permeability Increasing Protein (BPI)
    3. Neutral Serine Protease (NSP) Family
    4. hCAP-18
    5. Lactoferrin
    6. Lysozyme
23. Oxidative Antimicrobial Mechanisms
    1. Respiratory Burst
24. The NADPH Oxidase System
    1. G Proteins
    2. GDP-dissociation Inhibitor (GDI)
    3. Cytochrome b
25. Reduced Oxygen Metabolites
    1. Superoxide Anion
    2. Hydrogen Peroxide
    3. Hydroxyl Radical
    4. Water
    5. Singlet Oxygen
26. Myeloperoxidase and ³Bleach²
    1. Interaction with Hydrogen Peroxide and Halide
    2. Hypochlorous Acid
27. Digestion
28. Elaboration of Eicosanoids
    1. Phospolipase A2
    2. Lipoxygenase Pathway
    3. Cyclooxygenase Pathway

Role of Biomechanics in Periodontal Therapy

Course Outline:

1. Stress and Load Determination
   1. Introduction
   2. Principles of Stress Analysis
      1. Theoretical Techniques
         1. Mathematical Analysis
         2. Finite Element Analysis
      2. Experimental Techniques
      1. Strain Gages
      2. Holography
      3. Photoelasticity
   3. Photoelasticity
      1. Advantages
      2. Disadvantages
      3. Modeling Concepts
      4. Photoelastic observations
      5. Application of Photoelastic Principles
         1. Two-dimensional Technique
         2. Three-dimensional Technique
         3. Quasi-three-dimensional Technique
         4. Combined Technique Applications
      6. Photoelasticity as a Predictor

Case One

Course Outline:

This case involves a step by step detailed description the following periodontal procedures:

• Crown Lengthening
• Osseous Surgery
• Implant

The Case includes the following:

1. Patient Profile
2. Chief Complaint
3. Medical History
4. Family History
5. Social History
6. Dental History
7. Clinical Examination
   1. Extraoral
   2. Intraoral
   3. Dental
   4. Occlusal
   5. TMJ
   6. PeriodontalExamination
8. Radiographic Examination
9. Prognosis
10. Treatment Plan
    1. Preparatory
    2. Surgical
    3. Restorative
    4. Maintenance Phase Outlines

Case Two

Course Outline:

This case involves an extraction and ridge augmentation surgery for the maxillary anterior sextant. It also has a second stage ridge augmentation procedure.

The maxillary right sextant was treated with pocket reduction osseous surgery and a bone graft.

A second stage surgery included a free connective tissue graft and reentry to bone graft site.

The upper left quadrant required a Strip Gingival Graft.

The Case includes the following:

1. Patient Profile
2. Chief Complaint
3. Medical History
4. Family History
5. Social History
6. Dental History
7. Clinical Examination
   1. Extraoral
   2. Intraoral
   3. Dental
   4. Occlusal
   5. TMJ
   6. Periodontal Examination
8. Radiographic Examination
9. Prognosis
10. Treatment Plan
    1. Preparatory
    2. Surgical
    3. Restorative
    4. Maintenance Phase Outlines

The surgical phases are reviewed in detail with slides and includes:

• Presurgical chemotherapeutic regimen
  Upper frontal sextant:
  1. Surgical Extraction
  2. Post-operative course
  3. Membrane removal
• Secondary surgical procedure: Ridge Augmentation
  Upper Right Sextant:
  1. Surgical analysis
  2. Surgical Plan
  3. Post-operative course

Frequent Oral Diseases in HIV Positive and AIDS Patients

Classification of the Most Common Oral Manifestations of AIDS

1. Bacterial Infections
   1. Gingivo-Periodontal Disease
      1. Linear gingival erythema (LGE)
      2. Necrotizing ulcerative periodontitis (NUP)
      3. Necrotizing stomatitis (NS)
   2. Other Locations

2. Fungal Infections
   1. Candidiasis
      1. Pseudomembranous
      2. Hyperplastic
      3. Erythematous
      4. Angular cheilitis
   2. Other Fungi

3. Viral Infections
   1. Epstein-Barr Virus
      1. Hairy Leukoplakia
   2. Herpes Simplex Virus
      1. Primary herpetic gingivo-stomatitis
      2. Recurrent herpetic infection
   3. Variacella-Zoster Virus
      1. Herpes zoster
   4. Human Pailloma Virus
      1. Condyloma accuminatum
      2. Multifocal epithelial hyperplasia
   5. Cytomegalovirus

4. Neoplasms
   1. Kaposi's sarcoma
   2. Lymphoma
   3. Other neoplasms

5. Other Oral Lesions
   1. Major aphtous ulcers
   2. Minor aphtous ulcers
   3. Salivary gland enlargement

6. Some Perioral Skin Lesions