Course : Periodontology
- Course Number
- DNHY 3023
- Section Number
- Spring 2021
- Centennial Hall, 103-A
- Jill Young
- Days & Times
- Final Exam Day/Time
CLASS SESSION 1 Course Introduction
OBJECTIVES: Given the reading assignment, lecture and class discussion upon completion of this class session
the student should be able to: (1 hr.)
Handouts from Patient Assessment Tutorials
1. Define communication and describe the communication process.
2. Describe the two major forms of communication and give examples of each.
3. Discuss techniques that promote effective communication.
4. Understand the role of effective communication in the provision of quality dental care.
5. Discuss techniques that promote effective communication.
6. Describe how ineffective communication hinders the provision of quality dental care.
CLASS SESSION 2 Documentation
OBJECTIVES: Given the reading assignment, lecture and class discussion upon completion of this class session
the student should be able to: (1 Â½ hrs)
N-G Chap 34- pg 634-648
1. Discuss the foundations of tort law and how it applies to the profession of dentistry.
2. Define the term liability as it applies to provision of periodontal care.
3. Identify situations in the dental office that trigger liability for dental hygienists.
4. Define the terms intentional torts and negligence and give examples of each.
5. In the clinical setting thoroughly document all periodontal treatment including treatment options,
cancellations, patient noncompliance, refusal of treatment, and follow-up telephone calls.
6. List six currently accepted insurance codes pertaining to periodontal instrumentation explaining
what procedures each code includes.
CLASS SESSION 2 Tooth Supporting Structures
OBJECTIVES: Given the prerequisite courses (Head, Neck and Dental Anatomy, Dental Hygiene I, and Histology), reading assignments, lecture and class discussion upon completion of this class session the student should be able to: (1 Â½ hrs)
N-G Chapter 1
1. Describe the function that each tissue serves in the periodontium, including the gingiva, periodontal ligament, cementum, and alveolar bone.
2. Describe and identify the following anatomical areas of the gingiva: free gingiva, gingival sulcus, interdental gingiva, attached gingiva, and mucogingival junction.
3. Discuss color variations of normal gingival.
4. List the branches of the trigeminal nerve and their intervention to the periodontium
5. List the vessels of the vascular supply to the periodontium
6. Explain the function of the lymphatic system & its relationship to the periodontium
7. List the lymph nodes of the head & neck and their primary areas of drainage in relation to the periodontium
N-G Chapter 2
8. Define the term epithelial tissue and describe its function in the body.
9. List and define the layers that comprise the stratified squamous epithelium of the skin.
10. Compare the epithelium of the oral cavity to that in other areas of the body
11. Define keratin and describe its function in the epithelium; List the keratinized and not-keratinized areas of the
12. Define the term cell junction and describe its function in the epithelial tissues.
13. Compare and contrast the terms Desmosome and Hemidesmosome.
14. Describe the epithelium- connective tissue interface found in most tissues of the body, such as the interface between the epithelium and connective tissues of the skin.
15. Describe the function of connective tissue in the body.
16. List and recognize the histologic features of periodontal health.
17. List and define the layers that comprise the stratified squamous epithelium of the gingiva.
18. Identify the three anatomical areas of the gingival epithelium on an unlabeled drawing of the anatomical areas of the gingival epithelium.
19. Define and describe the location and function in the gingival epithelium of:
a. Oral epithelium
b. Sulcular epithelium
c. Junctional epithelium
20. State which of the anatomical areas of the gingival epithelium have an uneven, wavy epithelium-connective tissue
interface in health and which have a smooth junction in health.
21. State the level of keratinization present in each of the three anatomical areas of the gingival epithelium (keratinized, non-keratinized, or parakeratinized).
22. Identify the enamel, gingival connective tissue, junctional epithelium, internal basal lamina, external basal lamina,
epithelial cells, Desmosomes, and Hemidesmosomes on an unlabeled drawing depicting the microscopic anatomy of the junctional epithelium and surrounding tissues.
23. Describe the function of the gingival connective tissue.
24. Define the term supragingival fiber bundles and describe their function in the periodontium.
25. Define the term periodontal ligament and describe its function in the periodontium.
26. Identify the principle fiber groups of the periodontal ligament on an unlabeled drawing.
27. Define the term Sharpey fibers.
28. Define the term cementum and describe its function in the periodontium
29. State the three relationships that the cementum may have in relation to the enamel at the cemento- enamel junction.
30. Define the term alveolar bone and describe its function in the periodontium
CLASS SESSION 3 Progression & Classification of Periodontal Diseases/ conditions/ Cause
N-G Chap 3, 4, & 5
OBJECTIVES: Given the prerequisite course Dental Hygiene, reading assignments, lecture and class discussion upon completion of this unit of study the student should be able to: (2 hrs)
1. Define the term pathogenesis.
2. Define the term periodontal disease and contrast it with the term periodontitis.
3. Differentiate between the two types of periodontal disease: gingivitis and periodontitis.
4. Compare and contrast clinical features of healthy and inflamed gingival tissues (gingivitis) in regards to:
a. Color c. Consistency e. Margin height
b. Contour d. Texture f. Bleeding
5. Differentiate between and identify examples of bulbous, blunted and cratered papilla.
6. Differentiate between the gingival pocket and the periodontal pocket.
7. Discuss the bodyâs inflammatory response to periodontal disease including the (a) classic systems of
inflammation and (b) clinical terms utilized for description.
8. Explain the difference between acute and chronic inflammation and identify examples of various levels of
9. Discuss what is meant by the extent and distribution of inflammation of the gingival tissues:
localized vs. generalized and papillary, marginal or diffuse
10. Describe the position of the crest of the alveolar bone in gingivitis.
11. Describe the position of the junctional epithelium in health, gingivitis, and periodontitis.
12. Describe the epithelial-connective tissue junction in health, gingivitis and periodontitis.
13. Explain why there is a band of intact transseptal fibers even in the presence of severe bone loss.
14. Describe the progressive destruction of alveolar bone loss that occurs in periodontitis.
15. Compare and contrast horizontal and vertical bone loss.
16. Describe the pathway of inflammation that occurs in:
a. Horizontal bone loss
b. Vertical bone loss
17. Define the terms prevalence and incidence
18. Explain the historical views of periodontal disease progression
19. List the primary and secondary periodontal pathogens.
20. Explain the distribution of these pathogens in regard to the different stages of periodontal disease.
21. Discuss the transmission of periodontal disease between family members.
22. Describe the difference in location and variance of microorganisms in the sub-gingival plaque.
23. List, describe, and differentiate the various periodontal diseases according to the 1999 classification
system established by the Academy of Periodontology
24. Define and contrast the terms gingival disease, periodontal disease, and periodontitis.
25. Define and contrast the terms plaque-induced gingival diseases and non-plaque-induced gingival lesions.
26. Define and contrast the terms chronic periodontitis and aggressive periodontitis.
27. Define epidemiology
28. Define the terms prevalence and incidence
29. Explain the historical views of periodontal disease progression
30. List the primary and secondary periodontal pathogens.
31. Explain the distribution of these pathogens in regard to the different stages of periodontal disease.
32. Discuss the transmission of periodontal disease between family members.
33. Describe the difference in location and variance of microorganisms in the sub-gingival plaque.
CLASS SESSION 4 & 5 Clinical Assessment & Radiographic Analysis
N-G Chap 6, 19 & 20
OBJECTIVES: Given the prerequisite course Dental Hygiene I, reading assignments, lecture and class discussion upon completion of this class session the student should be able to: (2 Â½ hrs)
1. Describe the legal responsibility for complete and accurate periodontal assessment and documentation
of the findings.
2. Define the terms:
a. Treatment Outcome
c. Baseline Data
3. Discuss the following as they relate to gingival/periodontal health:
a. Bleeding on gentle probing (BOP)
c. Clinical attachment loss
4. Differentiate between the classifications of tooth mobility and chart correctly
5. Differentiate between the classifications of furcations and chart correctly
6. Locate the level of free gingival margin and mucogingival junction on slides and describe the significance of the
clinical attachment level.
7. Explain how to calculate the width of the attached gingiva.
8. Discuss the relationship that exist between the gingival margin and the CEJ
9. Differentiate between a periodontal screening examination and comprehensive periodontal assessment.
10. Describe the procedure for the PSR screening exam including:
a. Type of probe
b. Criteria for PSR codes
c. Information recorded
d. Forms utilized
e. Instrumentation technique
11. Identify periodontal structures as seen on radiographs
12. Describe the benefits of radiographs for periodontal evaluations.
13. Describe the limitations of radiographs in detecting periodontal disease.
14. List and differentiate between infra-bony pocket defects
CLASS SESSION 6 EXAM #1
CLASS SESSIONS 7 & 8 Etiology & Risks of Periodontal Diseases
N-G Chap 12 & 16 (3 hrs)
Chap 12 Oral Bio-films and Periodontal Infections
1. Describe the features and structure of dental plaque bio-film.
2. Name the three bacteria designated by the World Workshop in Periodontology as periodontal pathogens.
3. Identify bacteria associated with health, gingival diseases, and periodontitis.
4. Describe how the numbers of bacteria vary from health to disease in the periodontium.
5. Explain the significance of the extracellular slime layer to a bacterial microcolony.
6. Explain the purpose of the fluid channels in a biofilm
7. Define coaggregation and explain its significance in bacterial colonization of the tooth surface.
8. Explain why systemic antibiotics and antimicrobial agents are not effective in eliminating dental plaque biofilm
9. State the most effective ways to control dental plaque biofilm.
10. Explain why frequent periodontal instrumentation is vital in the control of dental plaque biofilm.
11. Given a drawing of the subgingival plaque biofilm, label the zones of bacterial attachment.
12. Differentiate between bacterial virulence factors; peptide proteins, exotoxins, and bacterial enzymes
Chap 16 Local Contributing Factors
13. Describe the composition, type and mechanism of attachment of dental calculus
14. Explain how local factors can increase plaque bio-film pathogenicity and cause direct damage to the
15. Discuss what is meant by âbiologic widthâ and the need to maintain itsâ integrity
16. Explain the following as they pertain to periodontal disease:
a. Functional occlusal versus parafunctional occlusal forces
b. Clenching and bruxism
c. Lateral occlusal forces
d. Occlusal adjustment
CLASS SESSION 9 Immunity & Inflammation host response
n-g chap 13 & 14 (1 Â½ hrs)
Chap 13: Basic Concepts of Immunity & Inflammation
1. Briefly describe the purpose and function of the human immune system.
2. List and describe the components of the immune system as presented in your textbook.
3. Discuss the role of each of the following cells in the immune system.
b. Polymorphonuclear Leukocytes
1. B Lymphocytes
g. T - Lymphocytes
4. Define and explain the activities of the Complement System
5. Define the process and the actions of leukocyte migration and phagocytosis which are necessary in
6. List the five classic symptoms of acute inflammation.
7. Give a detailed description of chronic inflammation and the chronic inflammatory process.
8. Name and explain the effects of the inflammatory biochemical mediators on the tissues of the
Chapter 14: Host Immune Response to Periodontal Pathogens
9. List the sequence of events in the host response including:
a. Sub-gingival gingivitis
b. Plaque over growth- acute inflammation
c. Sub-gingival plaque phase
d. Tissue destruction phase
10. List the inflammatory biochemical mediators the body releases as a response to periodontal disease.
a. Source of the mediator
b. Function of the mediator
c. Local effects on tissue
CLASS SESSIONS 10 & 11 Systemic Factors Associated With Periodontal Disease
N-G Chapter 15, 32 & 33 (2 Â½ hrs)
1. Explain the statement âperiodontitis as a manifestation of systemic diseaseâ.
2. Identify why the systemic problems listed below may increase an individualâs risk for periodontitis
a. Diabetes Mellitus
c. Acquired Immunodeficiency Syndrome
e. Hormonal Variations
3. For each of the major systemic risk factors listed in item #2 discuss the:
a. Effects on the periodontium
b. Guidelines and possible responses to periodontal therapy
4. Describe the connection between hematological disorders and periodontitis
a. Acquired Neutropenia
5. Discuss the connection between periodontitis and:
b. Down Syndrome
c. Leukocyte Adhesion Deficiency Syndromes
d. Papillon-Lefevre Syndrome
e. Chediak-Higashi Syndrome
6. Explain how the following systemic diseases are influenced by periodontitis
a. Coronary heart disease
c. Myocardial infarction
e. Cerebrovascular accident
f. Diabetes mellitus
g. Per-term/low birth-weight infants
h. Hospital acquired pneumonia
CLASS SESSION 12 Smoking & Periodontal Disease/etiology & risk factors
n-g chap 18 & 11 (1 Â½ hrs)
N-G CHAP 18
1. Discuss the impact of tobacco products on the periodontium.
2. Explain the progression of periodontal disease in smokers
3. Describe and identify changes to the oral tissues and periodontium seen commonly in smokers
4. Explain why tobacco cessation counseling is a valuable part of patient care in the dental setting.
N-G CHAP 11
1. Define the term biologic equilibrium and discuss factors that can disrupt the balance between health
and disease in the periodontium
2. Define and give examples of the term âcontributing risk factorsâ.
3. In the clinical setting for a patient with periodontitis explain to your clinical instructor the factors
that may have contributed to your patientâs disease.
CLASS SESSION 13 Nutrition & Periodontal Disease
N-G CHAP 17 (1 Â½ hrs)
1. Explain the possible relationship between Vitamin D and calcium deficiency and periodontal disease.
2. List some oral symptoms that can be seen in chronic or sever vitamin C deficiency.
3. Define scurvy
4. Explain the term ascorbic acid-deficiency gingivitis.
5. List several nutrient deficiencies that may increase the risk for periodontal disease.
6. Name two dietary factors that may increase the risk for periodontal disease in addition to specific
7. Name three general functions of nutrients in maintaining periodontal health.
8. Explain how nutritional counseling might be accomplished with a patient.
9. Explain how the following can build a healthy periodontium and/or can modify the severity and extent of
a. Refined carbohydrates
d Omega-3 polyunsaturated fatty acids.
CLASS SESSION 14 EXAM #2
CLASS SESSION 14 Periodontitis & Other Periodontal Conditions
N-G Chap 7, 8 & 9 (2 hrs)
1. Name and define the three major categories of periodontitis.
2. Recognize and describe clinical and radiographic features of chronic periodontitis.
3. Define the term clinical attachment loss.
4. In the clinical setting explain to your patient the signs and symptoms of chronic periodontal disease.
5. In a clinical setting for a patient with chronic periodontitis, describe to your clinical instructor the clinical signs of
disease present in the patientâs mouth.
6. List systemic factors that may be contributing factors to periodontitis.
7. Differentiate between recurrent and refractory forms of periodontitis
9. Discuss the general clinical and radiographic characteristics of chronic and aggressive periodontitis.
10. Discuss the differences between ideal and reasonable treatment goals for aggressive periodontitis.
11. Given the clinical and radiographic features for a patient with a history of aggressive periodontitis, determine
if the disease is localized or generalized aggressive periodontitis.
12. Define necrotizing periodontal diseases.
13. Describe the tissue destruction that occurs in necrotizing periodontal diseases.
14 List and describe the clinical signs of necrotizing ulcerative gingivitis and the microorganisms associated
with the disease.
15. List and describe the clinical signs of necrotizing ulcerative periodontitis and the microorganisms
associated with the disease
16. Define secondary occlusal trauma and explain how it can lead to rapid bone loss.
CLASS SESSIONS 15, & 16 DECISION MAKING & TREATMENT PLANNING RELATED TO
NON-SURGICAL PERIO THERAPY (N-S PERIO TRT)
N-G Chap 21, 10, 22, & 29 / Wilkins Chap 19 (4 Â½ hrs)
N-G Chap 21
1. Define the term best practice.
2. Summarize how the explosion of knowledge is impacting practitioners and patients.
3. Identify the three components of evidence-based decision making.
4. Define a systematic review.
5. Discuss the benefits and limitations of experience.
6. Describe the role of the patient in the evidence-based model.
7. List locations for accessing systematic reviews.
8. Explain the difference between a peer-reviewed journal and trade magazine.
9. State desired three outcomes from attending continuing education courses.
10. Formulate a question using the PICO process.
N-G Chap 10
1. List the three fundamental diagnostic questions used when assigning a periodontal diagnosis.
2. Explain how to arrive at appropriate answers to each of the fundamental diagnostic questions.
3. Explain the difference between the terms signs of a disease and symptoms of a disease.
4. Explain the term silent disease.
5. Describe the elements of a well written diagnosis for periodontitis.
6. List the phases of treatment.
7. Explain the term informed consent.
8. List guidelines for obtaining informed consent.
N-G Chap 22
1. Explain the term non-surgical (N-S Perio TRT) periodontal treatment.
2. Describe the indicators for N-S Perio TRT.
3. Describe the phases related to treatment sequencing.
4. Discuss the goals of N-S Perio TRT.
5. Differentiate between the terms scaling, root planing, periodontal debridement and deplaquing
6. Describe the stages of healing and the appearance of the tissues after N-S Perio TRT.
7. Develop treatment plans including referrals, re-evaluation appointments and maintenance schedule
8. Analyze patient cases to determine the most appropriate Recare schedule( 4-6 week Re-Eval, 2-4-6 month
Recare) and give rationale for selection.
9. Discuss dentinal hypersensitivity: precipitating factors, fundamental origin, and strategies for managing.
10. Explain current American Academy of Periodontology recommendations for deciding which patients should be
managed by a periodontist.
N-G Chap 29
1. Describe the primary difference between how hygienists often approach patient education and the motivational
2. Identify the three elements of the motivational interviewing philosophy and the four general principles.
3. Give examples of specific motivational interviewing methods and how they are used to enhance patient motivation
CLASS SESSION 17 Patientâs Role in Nonsurgical Periodontal Therapy
N-G Chap 23 and Lasers (3 hrs)
1. Discuss the concept of self-care and the roles of the patient and provider.
2. State the benefits of power toothbrushes.
3. Give examples of oral conditions that might prompt a dental hygienist to recommend a power toothbrush.
4. State the rationale for tongue cleaning.
5. Explain why interdental care is of special importance for a patient with periodontitis.
6. Define the term gingival embrasure space and explain its importance in selecting effective interdental aids.
7. Define the term root concavity and explain its importance in selecting effective interdental aids.
8. In a classroom or lab setting, explain the criteria for selection and correctly demonstrate the use of a power
toothbrush and all of the aids presented in this chapter.
9. Know laser classifications.
10. Define Nominal Ocular Hazard Distance.
11. Discuss Maximum Permissible Exposure.
12. Explain requirements for Laser Safety warning sign and eye wear.
13. Define proper PPE.
14. Describe the role of a laser in dental hygiene.
15. Discuss other uses of a laser in the dental office.
CLASS SESSION 18 EXAM # 3
CLASS SESSION 19 CHEMOTHERAPY FOR THE CONTROL OF PERIO DISEASE
Supra- and Subgingival Irrigation/ Chemical Agents
N-G Chapter 24 (45 min)
1. Discuss the oral health benefits from using a dental water jet.
2. Identify the types of patients who would benefit from using a dental water jet.
3. Compare the use of the dental water jet to traditional dental floss.
4. Distinguish the depth of the delivery between the dental water jet, a toothbrush, dental floss, and other
5. Name the types of agents that can be used in a dental water jet.
6. Instruct patients in the use of the dental water jet including how to use the standard irrigation tip,
subgingival tip, and orthodontic tip.
7. Summarize research findings that relate to using professional irrigation to deliver chemicals to periodontal pockets.
N-G Chapter 25 (45 min)
1. Compare the advantages and disadvantages of the various types of drug delivery systems
a. Systemic Delivery
b. Topical Delivery
d. Mouth rinses
2. Describe the expected outcomes of the treatment modalities in item #4
CLASS SESSIONS 20, 21 & 22 PERIODONTAL SURGICAL CONCEPTS & VIDEOS/Implants
N-G Chapter 27, 26 & 31 (7 Â½ hrs)
1. List the objectives for periodontal surgery
2. Explain the term relative contraindications for periodontal surgery.
3. Define the terms
c. New attachment
4. Explain the difference between healing by primary intentions and healing by secondary intention.
5. Explain the term elevation of a flap.
6. Explain two methods for classification of periodontal flaps.
7. Describe two types of incisions used during periodontal flaps.
8. Describe the healing following flap for access and open flap debridement.
9. Describe the typical outcomes for apically positioned flap with osseous surgery.
10. Define the terms:
a. Ostectomy d. Osteoconductive g. Xenograft
b. Osteoplasty e. Autograft h. Alloplast
c. osteoinductive f. Allograft
11. Name the two types of materials available for bone replacement grafts.
12. Explain why a barrier material is used during guided tissue regeneration.
13. List two types of crown lengthening surgery.
14. List some disadvantages of Gingivectomy.
15. Describe the technique for a gingival curettage.
16. Explain what is meant by biological enhancement of periodontal surgical outcomes.
17. List the different types of suture materials and the sizes generally utilized in periodontal surgery
18. Explain the term interrupted interdental sutures
19. Explain the guidelines for suture removal
20. Describe the use of periodontal dressing
21. Discuss the general guidelines for the management of periodontal dressing
22. Explain the topics that should be covered in postsurgical instructions.
23. List steps in a typical postsurgical visit.
CLASS SESSION 23 MAINTENANCE FOR THE IMPLANT PATIENT
N-G Chap 31 (1 Â½ hrs)
1. Define the term Implantology
2 Define and identify the components of the dental implant system
3. List and compare the periodontium interface of a natural tooth vs. a dental implant
4. Describe causative factors for implant rejection or failure
a. Peri-implant mucositis
c. Biomechanical forces
5. Describe the characteristics of
a. Healthy implant site
b. Diseased implant site
6. Define the role of the dental hygienist in implant maintenance
7. Describe maintenance procedures following implant placement
8. Design a patient education program related to implant therapy that includes, but not limited to, informed consent, duration of care, oral health maintenance (periodic probing, radiographs, and removal of superstructures) and the clientâs responsibilities in implant maintenance
CLASS SESSION 24 MAINTENANCE FOR THE PERIO PATIENT
N-G Chap 30 (1 Â½ hrs)
1. Define and give three objectives of periodontal maintenance
2. Describe how periodontal maintenance relates to other phases of periodontal treatment.
3. List the usual procedures performed during a periodontal maintenance appointment.
4. Explain how specific needs of the patient relate to periodontal maintenance.
5. Describe the guidelines for determining whether the general practice office or the periodontal office should provide perio maintenance for a particular patient.
6. List the clinical signs of re-occurrence of periodontitis
7. List the reasons for re-occurrence of periodontitis
8. Explain what is meant by compliant patient and noncompliant patient.
9. List reasons for noncompliance with perio maintenance recommendations
10. List strategies that can be used to improve patient compliance.
11. Explain the term root caries
12. List recommendations for use of fluorides in the prevention of root caries.
13. Given a selected case history devise a perio maintenance program including the aspects of patient compliance
CLASS SESSION 25 & 26 PERIODONTAL EMERGENCIES
N-G Chap 28 (1 Â½ hrs)
1. Give the definition of periodontal abscess
2. List and describe the three types of abscesses of the periodontium
3. Name possible causes of abscesses of the periodontium
4. Compare and contrast the abscess of the periodontium and the endodontic abscess.
5. Outline the typical treatment steps of a gingival or periodontal abscess
6. Describe Pericoronitis and the treatment normally prescribed
7. Define necrotizing periodontal gingivitis (NUG)
8. List the causative factors and describe the clinical characteristics of NUG
9. List the typical treatment steps for a patient with NUG
10. Define necrotizing ulcerative periodontitis (NUP)
11. Define primary herpetic gingivostomatitis (PHG)
12. Describe the general characteristics of PHG including the causative factor
13. Describe the clinical signs of PHG
14. Describe the typical treatment in management of PHG
CLASS SESSION 27 FINAL EXAM (2ND SEMESTER FINAL EXAM)
COURSE EVALUATION:Dental Hygiene Department Grading Scale
Homework (10) 10%
Exams (4) 35%
Final Exam 40%
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