Non-Surgical Control of Periodontal Diseases Paul A. Levi, Jr. • Robert J. Rudy Y. Natalie Jeong • Daniel K. Coleman Non-Surgical Control of Periodontal Diseases A Comprehensive Handbook Paul A. Levi, Jr. Y. Natalie Jeong Department of Periodontology Department of Periodontology Tufts University School Tufts University School of Dental Medicine of Dental Medicine Boston, MA Boston, MA USA USA Robert J. Rudy Daniel K. Coleman Department of Periodontology Department of Periodontology Tufts University School Tufts University School of Dental Medicine of Dental Medicine Boston, MA Boston , MA USA USA ISBN 978-3-662-46622-3 ISBN 978-3-662-46623-0 (eBook) DOI 10.1007/978-3-662-46623-0 Library of Congress Control Number: 2015949120 Springer Heidelberg New York Dordrecht London © Springer-Verlag Berlin Heidelberg 2016 This work is subject to copyright. All rights are reserved by the Publisher, whether the whole or part of the material is concerned, specifi cally the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfi lms or in any other physical way, and transmission or information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed. The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication does not imply, even in the absence of a specifi c statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use. The publisher, the authors and the editors are safe to assume that the advice and information in this book are believed to be true and accurate at the date of publication. Neither the publisher nor the authors or the editors give a warranty, express or implied, with respect to the material contained herein or for any errors or omissions that may have been made. Printed on acid-free paper Springer-Verlag GmbH Berlin Heidelberg is part of Springer Science+Business Media (www.springer.com) This book is dedicated to the memory of Dr. Irving Glickman “…It is only in the past quarter century that the dental curriculum has undergone a major change insofar as periodontics is concerned. Only recently has the status of periodontics been changed from that of a peripheral subject tacked on somewhere in the third and fourth year, a position in which it could not impress the student attitude regarding the importance of periodontal health in the total dental care which should be provided by general practitioners. It gradually has become a major clinical discipline stressing the philosophy that the periodontal care of the American public is primarily the responsibility of the general practitioner and that restorative dentistry without necessary periodontal care is not an oral health service… The concept of what constitutes the practice of dentistry must change. Dentistry’s mission under its franchise must be clearly defi ned as primarily the preservation of the health of the natural structures through the prevention of disease and deformities, and secondarily the repair of destroyed tissue the replacement of lost parts and the correction of developmental anomalies.” Irving Glickman. Preventive periodontics: a blueprint for the periodontal health of the American public. J Periodontol. 1967;(38):361. Purp ose The purpose of this book is to share information that is of great value and practical use to general dentists, dental students, dental hygiene students, dental assistants, dental assisting students and postgraduate periodontal resi- dents. Two of the authors have had the very good fortune, early in their pro- fessional careers, of coming under the pedagogical infl uence of Dr. Irving Glickman. The other two authors, graduates of Tufts University School of Dental Medicine, were infl uenced by the Glickman philosophy of dental edu- cation, which today still strives to remain a strong component of the curricu- lum at Tufts. Dr. Glickman was Research Professor of Oral Pathology and Professor and Chairman of the Department of Periodontology at Tufts University School of Dental Medicine in Boston, Massachusetts. During four decades of active teaching and research (1940s–1970s), Dr. Glickman pioneered the teaching of a rigorous curriculum in periodontics, for all pre- and postdoc- toral students. The rigorous nature of the program was necessary, he felt, to ensure that future general dentists were thoroughly prepared and motivated to serve the periodontal needs of all patients regardless of whether they prac- ticed in a private offi ce setting, a hospital or military setting, or a community health center. As Dr. Glickman so often said, “There is no such thing as a ‘periodontal patient,’ as all patients with natural teeth have a periodontium.” Many of the ideas presented in this book can fi nd their source in the numerous original writings of Dr. Glickman. Dr. Glickman was particularly concerned with fostering among his stu- dents a deep appreciation for the following ideas: (a) The importance of preventative dentistry measures in the daily practice of general dentistry (b) The importance of diagnosing periodontal diseases in the incipient stages, by examining the periodontal tissues with an uncompromising attention to detail (c) The importance of being capable of treating periodontal disease by providing nonsurgical therapy in the daily practice of general dentistry vii viii Purpose (d) The importance of supportive therapy in the long-term maintenance of periodontal health once disease is eliminated (e) The importance of understanding clinical phenomena in terms of under- lying microscopic tissue changes (f) The importance of working intelligently and with confi dence as a co- therapist, when the nature of the case suggests referral to the periodontal specialist Dr. Glickman’s teaching legacy endures to this day because, at its core, it addresses the most crucial dental needs of the public—namely, the attainment and preservation of oral and dental health. The authors are grateful for his public health vision and for all the arduous work he shouldered in bringing his vision to reality. The intent of this book is to continue the Glickman phi- losophy—a philosophy that at its heart embraces the idea that family dentists are responsible for the early diagnosis and appropriate treatment of the com- mon periodontal diseases that affl ict the public at large. Only through comprehensive training and familiarity with the detailed information presented in this handbook will dental clinicians and hygienists be prepared to meet their responsibility in providing an excellent standard of dental care to their patients. The hard-won achievement of oral health can also be counted upon to foster improved general health—certainly another of the crucial needs that must be addressed and to which the public is entitled. Other students of Dr. Glickman have undertaken the challenging task of authoring textbooks in the fi elds of periodontology and oral pathology; taken together, the works of Drs. Jerome B. Smulow, Gerald Skhlar, Fali S. Mehta, Esther M. Wilkins, Edward Cohen, and Noshir Mehta, along with the present publication, represent a rich legacy to one of the truly great dental educators of the twentieth century—Dr. Irving Glickman. Acknowledgments We gratefully thank the following individuals for their major contributions to this book. Their efforts and expertise have greatly assisted the authors in cre- ating a handbook, which can be utilized by the readers to provide valuable information in a concise and yet comprehensive manner. Stephen P. Comstock – Fourth-year dental student at Tufts University School of Dental Medicine, medical and dental textbook illustrator – All text- book illustrations Nevin Zablotsky, D.M.D. – Periodontist and authority in smoking cessa- tion, speaker for the American Dental Association, and teacher of smoking cessation for medical and dental students at Nova Southeastern University – Wrote Section 7.2 on smoking cessation Lorenzo Mordini, D.D.S. – Periodontist, fellow at Tufts University School of Dental Medicine, clinical photographer – Contribution of clinical photographs Julia Zhogina, R.D.H. – Practicing dental hygienist, professional photographer – Dental product pictures Additionally we thank our spouses, Patty Levi and Shannon Coleman and our friends and relatives who supported us and provided us with excellent feedback throughout the process of writing this book. ix About the Authors Dr. Robert J. Rudy earned his D.M.D. from Tufts University in 1970. After serving as a captain in the USAF, from 1970 to 1972, he earned a Certifi cate in Periodontology from the University of Washington, in Seattle, in 1975. Returning to Boston and the Tufts School of Dental Medicine, Dr. Rudy became a Clinical Instructor in the Department of Periodontology. Ten years later he became an Associate Clinical Professor. From 1995-2014, Dr. Rudy served as Director of Pre- doctoral Periodontology. Additionally, he maintained a private practice, in Brookline and Newton Centre, Massachusetts, from 1975-2015. Dr. Y. Natalie Jeong is an Assistant Professor in the Department of Periodontology at Tufts University School of Dental Medicine. She earned her D.M.D. and her Certifi cate in Periodontology from Tufts University. She is a Diplomate and a Board Examiner of the American Board of Periodontology. She is a Director of Lincoln Dental Study Club and main- tains a private practice limited to Periodontics and Implant surgery in Lincoln, Massachusetts. About the Authors xi Dr. Paul A. Levi, Jr. is an Associate Clinical Professor in the Department of Periodontology at Tufts University School of Dental Medicine, Visiting Professor at Universitat Internacional de Catalunya in Barcelona, Spain, and a Clinical Instructor at the Harvard University School of Dental Medicine. He earned a B.S. at St. Lawrence University in Canton, NY, and his D.M.D. and Certifi cate in Periodontology from Tufts University. He is a Diplomate and a Director of the American Board of Periodontology. Additionally, he main- tains a private practice limited to Periodontics and Implant surgery in Burlington, VT.