Chapple Iain L. C. - Periodontal Medicine - A Window on the Body: QuintEssentials of Dental Practice Vol. 43/44

Quintessentials of Dental Practice 43/44
Periodontology 5/6

Quintessence Publishing Co. Ltd.

British Library Cataloguing-in Publication Data

Chapple, Iain L. (Iain Leslie)
Periodontal medecine; a window on the body. - (Quintessentials of dental practice; 43/44. Periodontology; 5 )
1. Periodontics
I. Title II. Hamburger, John
617.632

ISBN: 1850973075

Copyright 2006 Quintessence Publishing Co. Ltd., London

All rights reserved. This book or any part thereof may not be reproduced, stored in a retrieval system, or transmitted inany form or by any means, electronic, mechanical, photocopying, or otherwise, without the written permission of the publisher.

ISBN 1-85097-307-5

This text is dedicated to my second daughter, Natasha Sophie Chapple, born 17th August 2004

Iain L C Chapple

Periodontal Medicine is an intriguing title for the latest addition to the rapidly expanding, widely acclaimed Quintessentials in Dental Practice series. Building on differential diagnoses for periodontal manifestations of systemic diseases and the role of relevant special investigations, this compact text of immediate practical relevance provides a unique consideration of gingival colour changes, enlargements, ulcerations and recession, not to forget a concluding miscellany of other gingival lesions.

This book is novel and therefore another pleasing first for the timely Quintessentials in Dental Practice series. In common with all the other volumes in the Series, Periodontal Medicine can be read and easily digested over a matter of a few hours. This time will be well spent, with a lasting legacy of enhanced insight and understanding of conditions of the periodontium. Once read, this book should not be put on a shelf to gather dust. In contrast, it should become a well-used aide-memoire to keep to hand in everyday clinical practice. Excellent clinical pictures generously illustrate the carefully crafted text, making this attractive volume another jewel in the Quintessentials crown. The authors are to be congratulated on the special qualities of this book.

Nairn Wilson
Editor-in-Chief

Periodontal Medicine is a term used for different purposes in different parts of the world. In North America, it relates to the study of the dynamic relationship between periodontal diseases and systemic conditions, such as cardiovascular and cerebrovascular disease, pre-term labour and low-birth-weight babies, diabetes mellitus, osteoporosis and disorders of the respiratory tract. Such studies investigate the peripheral impacts of periodontal inflammation on systemic health and also the influence of systemic diseases on the progression of chronic periodontitis, such as type 2 diabetes mellitus, where evidence exists for a bi-directional relationship with periodontitis. However, in the UK and parts of Europe periodontal medicine is a term used to describe the periodontal (and gingival) manifestations of medical conditions. This includes their investigation, diagnosis and therapeutic management and how management of the oral condition integrates with the patients medical management as part of a holistic approach within defined care pathways. My own periodontal practice (ILC) relies heavily upon close working relationships with medical and surgical colleagues and joint patient management with bi-directional feedback, discussion and decision-making. In order of frequency, joint care is provided with Oral Medicine, Dermatology, Genito-Urinary Medicine, Cardiology, Clinical Immunology, Paediatric Medicine, Nephrology, Haematology, Gastroenterology, Geriatric Medicine, Ear/Nose/Throat and Maxillofacial Surgery.

This text therefore aims to provide the reader with an illustrated approach to managing the oral consequences of systemic diseases that present within and around the periodontal tissues. We have used the clinical appearance of the lesions as the starting point for discussion so that practitioners can follow a logical step-wise approach to differential and definitive diagnosis and subsequent management, either themselves, or through referral for secondary care. Some lesions are extremely common and others rare, and therefore each chapter tabulates the lesions that fall within its boundaries at the beginning of the chapter, but only discusses in detail the more common conditions. The final chapter discusses the less common non-plaque-induced conditions outwith their natural visual grouping.

This text will not deal with plaque-induced periodontal conditions, but will focus on non-plaque-induced lesions and their management. It is hoped that having read this text the reader will be able to:

• Recognise the broader scope of clinical periodontology and the importance of medical management in addition to the traditional surgical focus of the discipline.

• Recognise the importance of close liaison with colleagues in oral medicine and pathology.

• Take a systematic approach to medical history-taking that extends routine questions into certain relevant areas of enquiry that involve the body in general.

• Examine oral lesions systematically and use the findings of specific features of the lesion and associated signs and symptoms, to start formulating differential diagnoses.

• Identify non-periodontal sites that may be affected by the presenting condition and what features to note at those sites.

• Return to the verbal enquiry and identify relevant follow-up questions that may further clarify the findings of the clinical examination re-focus the history.

• Understand when additional clinical investigations are indicated, which are appropriate and how to perform them.

• Be able to interpret the findings of routine clinical investigations (e.g. blood test results) and develop a sense of the potential implications for the patient.

• Advise the patient about the aetiology of non-plaque-induced periodontal lesions.

• Identify the need to refer for advice or treatment by dental or medical specialists.

• Understand how the routine treatment he or she provides may impact, either positively or negatively, upon the condition.

• Identify a range of therapeutic options for the patient and understand the need for regular review and re-appraisal of the condition as appropriate.

Iain L C Chapple
John Hamburger

Iain Chapple wishes to thank his wife Liz and daughters Jessica and Natasha for their unconditional support and forbearance during the preparation of this book.

John Hamburger would like to thank his wife Ros and daughter Rachel for all their support and understanding during the preparation of this book.

The authors would also like to thank their colleagues within Periodontology and Oral Medicine. In particular Mrs Lorraine Williams and her staff who have approached the changes of the last 10-years so positively with enthusiasm, vigour and open minds. In addition, we are most grateful to our colleagues across a diverse range of medical specialties who offered their valued advice generously during the multidisciplinary management of our more complex patients.