Periodontal medicine is described in this text as a subdiscipline of periodontics that deals with non–plaque-induced conditions/lesions of periodontal tissues, including the periodontal manifestations of systemic diseases and syndromes. This text reconfirms the medical aspects of a traditionally surgical discipline and illustrates over 100 conditions categorized by clinical presentation.

ISBN: 1-85097-079-3
978-1-85097-079-8 , 9781850970798

250 pp; 262 illus

Contents
1. Establishing a Differential Diagnosis for Periodontal Manifestations of Systemic Diseases
2. The Role for Special Investigations
3. Gingival Colour Changes - Localised Colour Changes
4. Gingival Colour Changes - Generalised Colour Changes
5. Gingival Enlargements - Localised Swellings
6. Gingival Enlargements - Generalised Swellings
7. Gingival Ulceration - Localised
8. Gingival Ulceration - Generalised
9. Gingival Recession - Localised
10. Gingival Recession - Generalised
11. Miscellaneous Lesions

Preface

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-birthweight 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 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 patient’s 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 without their natural visual grouping.

Outcomes of Reading This Text

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 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 which non-periodontal sites may be affected by the presenting condition and what to look for at those sites.
• Return to the verbal enquiry and identify relevant follow-up questions that may further clarify the findings of the clinical examination and refocus the history.
• Understand when certain additional clinical investigations are indicated, which are appropriate and how to perform these.
• Be able to interpret the findings of routine clinical investigations (eg, 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 routine treatment 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.

Iain L Chapple and John Hamburger

© 2006