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Periodontal Medicine Periodontal Medicine Periodontal Medicine Periodontal Medicine Louis E Rose, DDS, MD Professor of Surgery and Medicine MCP Hahnemann School of Medicine Philadelphia, Pennsylvania and Clinical Professor of Periodontics University of Pennsylvania School of Dental Medicine Philadelphia, Pennsylvania Robert J. Genco, DDS, PhD Distinguished Professor and Chair of Oral Biology State University of New York Buffalo, New York D. Walter Cohen, DDS Chancellor-Emeritus MCP Hahnemann University of Health Sciences Dean- Emeritus University of Pennsylvania School of Dental Medicine Philadelphia, Pennsylvania Brim L. Mealey, DDS, MS Chief of Periodontics Chief of Dental and Professional Services US Air Force Hospital Eglin Air Force Base Fort Walton Beach, Florida 2000 B.C. Decker Inc. Hamilton London Saint Louis B.C. Decker Inc. 4 Hughson Street South PO. Box 620, L.C.D. 1 Hamilton, Ontario L8N 3K7 Tel: 905-522-7017; 1-800-568-7281 Fa: 905-522-7839 e-mail: [email protected] website: http://www.bcdecker.com 0 2000 B.C. Decker Inc. All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without prior writ- ten permission from the publisher. 00 01 / PC/9 8 76 5 432 1 ISBN 1-55009-120-4 SALES AND DISTRIBUTION United States U.K, Europe, Scandinavia, MidLe East B.C. Decker Inc. Harcourt-Brace & Company Ltd. PO. Box 785 24-28 Oval Road Lewiston, NY 14092-0785 London, NWl 7DX Tel: 800-568-728 1 United Kingdom e-mail: [email protected] Tel: 7 1-267-4466 Fa: 7 1-482-229 1 Canada India B.C. Decker Inc. K.M. Varghese Company 4 Hughson Street South Hind Rajasthan Building PO. Box 620, L.C.D. 1 Dadasaheb Phalke Road, Dadar Hamilton, Ontario L8N 3K7 Bombay 400 014 India Tel: 905-522-7017; 800-568-7281 Tel: 91 22 414 6904 Fa: 905-522-7839 Fax: 91 22 414 9074 e-mail: [email protected] e-mail: [email protected] Japan Foreign Rights Ishiyaku Publishers Inc. John Scott & Co. 7-10, Honkomagome I-Chome International Publishers’ Agency Bunkyo-ku, Tokyo 113 PO. Box 878 Japan Kimberton, PA 19442 Tel: 03 5395-7631 Tel: 6 10-827-1640 Fa: 03 5395-7633 Fa: 6 10-827-167 1 Notice: The authors and publisher have made every effort to ensure that the patient care recommended herein, including choice of drugs and drug dosages, is in accord with the accepted standard and practice at the time of publication. However, since research and regulation constantly change clinical standards, the reader is urged to check the product information sheet included in the package of each drug, which includes recommended doses, warnings, and contraindications. This is particularly important with new or infrequently used drugs. Contributors James D. Beck, PhD Michael Glick, DMD Kenan Professor Professor, Department of Oral Medicine Department of Dental Ecology Director, Programs for Medically Complex University of North Carolina at Chapel Hill Patients, University of Pennsylvania Chapel Hill, North Carolina Philadelphia, Pennsylvania Sebastian G. Ciancio, DDS Sara G. Grossi, DDS, MS Professor and Chair, Department of Clinical Director, Periodontal Disease Periodontics and Endodontics Research Center Clinical Professor of Pharmacology, State Department of Oral Biology University of New York at Buffalo School School of Dental Medicine of Dental Medicine State University of New York at Buffalo Buffalo, New York Buffalo, New York D. Wdter Cohen, DDS Car1 W. Haveman, DDS, MS Chancellor-Emeritus, MCP Hahnemann Staff, University Hospital University of Health Sciences Assistant Professor Dean-Emeritus, University of Pennsylvania Department of General Dentistry School of Dental Medicine The University of Texas Health Science Philadelphia, Pennsylvania Center San Antonio, Texas Joel Epstein, DDS, MSD Faculty of Dentistry, University of Palle Holmstrup, PhD, DrOdont British Columbia Professor of Periodontology Department of Oral Medicine, University of Copenhagen University of Washington, Seattle School of Dentistry Department of Dentistry, Department of Periodontology Vancouver General Hospital Copenhagen, Denmark Dentistry, B.C. Cancer Agency Vancouver, Canada Marjorie Jeffcoat, DMD University of Alabama School of Dentistry Robert J. Genco, DDS University of Alabama at Birmingham Distinguished Professor and Chair of Birmingham, Alabama Oral Biology, School of Dental Medicine, State University of New York at Buffalo University Dental Associates Buffalo General Hospital Buffalo, New York Vi Contributors Kenneth S. Kornman, DDS, Ph.D. Louis F. Rose, DDS, MD University of Texas Health Science Center Professor of Surgery and Medicine at San Antonio MCP Hahnemann School of Medicine San Antonio, Texas Clinical Professor of Periodontics Harvard University University of Pennsylvania School of Boston, Massachusetts Dental Medicine Philadelphia, Pennsylvania Brim Medey DDS, MS Chief of Periodontics Terry D. Rees, DDS, MSD Chief of Dental Professional Services Periodontics Department US Air Force Hospital Baylor College of Dentistry Eglin Air Force Base, Florida Dallas, Texas Clinical Assistant Professor Department of Periodontics FrankA. Scannapieco, DMD, PhD University of Texas Health Science Center Department of Oral Biology San Antonio, Texas School of Dental Medicine Associate Professor Robert E. Mecklenburg, DDS, MPH State University of New York at Buffalo Coordinator, Tobacco and Oral Health Buffalo, New York Initiatives, Tobacco Control Research Branch, National Cancer Institute Harold C. Slavkin, DDS Potomac, Maryland Director, National Institute of Dental and Craniofacial Research Laboratory Michael G. Newman, DDS Chief, Craniofacial Developmental Biology University of California School of Dentistry National Institute of Arthritis, Section of Periodontics Musculoskeletal, and Skin Disease Pacific Palisades, California Bethesda, Maryland Steven Offenbacher, DDS Barbara J. Steinberg, DDS Professor and Director Professor of Surgery and Medicine Center for Oral and Systemic Diseases MCP Hahnemann School of Medicine University of Carolina School of Dentistry Clinical Assistant Professor of Oral Medicine Chapel Hill, North Carolina University of Pennsylvania School of Dental Medicine Spencer W. Redding, DDS, MEd Philadelphia, Pennsylvania Staff, University Hospital Professor, Department of General Dentistry Edwin J. Zinman, DDS, JD The University of Texas Health Science Former Lecturer, University of California Center at San Antonio at San Francisco San Antonio, Texas San Francisco, California To my beautihl granddaughter, Cameron Sara, who has brought so much love and joy into my life. To my mother-in-law, Helen Aberbach, whose love and kindness will remain with me for- ever. And to my wife, Claire, and children, Michael, David, and Hedy, whose unconditional love and support have allowed me to pursue my professional dreams. Louis F, Rose To D. Walter Cohen, Henry Goldman, Nicholas Marfino, James English, Fred Karush, and Art Ellison. These mentors instilled in me their intense appreciation for the role of the host in mod- ulating oral diseases, and for the effect of oral disease on the rest of the body. Robert J. Genco To the late Russell Ross, DDS, PhD, one of the most distinguished scientists of the Twentieth Century. D. Walter Cohen To my loving wife Carla, who has supported me in every endeavor and has given me the most beautifd family a man could ever have. I also devote this undertaking to the honor of my mother, Jeanne C. Mealey, who taught me the value of a challenge, who showed through her personal example the gains derived from sacrifice, and who demonstrated that love and devotion overcome all difficulties. Brian L. Mealey Preface Over the past 70 years, a number of astute clinicians in the field of dental medicine have observed and recorded the relationship between periodontopathies and systemic manifestations of disease. The influence of systemic conditions on the oral environment, and especially the periodontium, has long been recognized and supported by scientific evidence. However, an evidence base for the influence of periodontal diseases on overall systemic health has only recently begun to be estab- lished. Fascinating research has eroded the tradition-bound concept that oral infections such as periodontitis are simply local entities whose effects are limited to the oral tissues. While the clini- cal observations of many practitioners have long suggested that periodontal diseases can have widespread systemic effects, only recently has rigorous scientific investigation supported this con- cept. The information in this text has not been collected in this format previously, and one of the goals of the authors is to offer the material to physicians, dentists, and other health-care profes- sionals collaborating in treatment of patients with periodontal disease who may also have systemic involvement. This will allow the practicing clinician to enhance the medical-dental interface when evaluating a patient and will contribute to a continuing dialogue between the dentist and physician. We are hopehl that this information will stimulate new collaborations between physicians and dentists and serve as a basis for hrther studies to help improve the total health of our society. This effort should also prove usehl to medical and dental students as well as those in residency train- ing and post-doctoral studies. Bridging the gap between the dental and medical professions will provide better education, research and patient care. Our purpose is to provide existing evidence
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