Periodontal Medicine - A Window on the Body

Iain L. C. Chapple, John Hamburger

• Publisher: Quintessence Publishing
• Year: 2019
• eBook ISBN: 9781850973072
• Edition: 1
• Topic: Medicine
• Subtopic: Dentistry

Periodontal Medicine is a sub-discipline of Periodontology which deals with non-plaque-induced conditions/lesions of the periodontal tissues, including the periodontal manifestations of systemic diseases and syndromes. It reminds us of the often forgotten and frequently ignored medical aspects of a traditionally surgical discipline. This heavily illustrated text attempts to guide the reader through over 100 conditions using their clinical presentation as the guiding principle to categorization.

Chapter 1

Establishing a Differential Diagnosis for Periodontal Manifestations of Systemic Diseases

Aim

This chapter aims to provide the reader with a step-by-step guide to history-taking, examination and further investigation of non-plaque-induced lesions that arise withithe periodontal tissues, including the free and/or attached gingiva and associated oral mucosa, to help establish a differential diagnosis.

Outcome

Having read this chapter the reader should appreciate the need for a forensic and systematic approach to establish differential diagnoses for oral and medical conditions that manifest within the periodontal and associated tissues.

Terminology

A variety of clinical, procedural and pathological terms and descriptors are used throughout this chapter, and Table 1-1 defines these by category.

Table 1-1 Terminology Used in Periodontal and Oral Medicine/Pathology

Context	Terminology	Definition
Clinical presentation or procedure	Symptom	Something the patient is experiencing or complaining of as a consequence of their condition.
	Sign	Something the clinician detects (visual, tactile or olfactory) that may help inform the diagnosis.
	Biopsy	Acquisition of human cells or tissues to aid diagnosis.
	Incisional biopsy	A biopsy involving partial removal of the lesion. This may be performed when malignancy is suspected and complete excision of the lesion would result in loss of key surgical landmarks.
	Excisional biopsy	A biopsy involving complete removal of the lesion.
	Fine needle biopsy /aspirate	Cells acquired using a fine cutting biopsy needle to obtain diagnostic material from within a lesion whose location or nature is such that surgical management should be delayed until microscopic diagnostic information is available.
	Broad needle biopsy	Tissue acquired using a broad cutting biopsy needle. The purpose is to acquire diagnostic material from within a lesion whose location or nature is such that surgical management should be delayed until microscopic diagnostic information is available. In addition, it is believed that acquisition of small numbers of cells may be of limited/no benefit to the pathologist.
	Swab	Use of a soft material (e.g. cotton pellet) to obtain infective material for culture and subsequent identification and testing (e.g. for antibiotic sensitivity) following culture.
	Smear	Use of a solid/sharp instrument to scrape away cells for microscopic examination.
	Cytology	Examination of individual cells (human or microbial) by microscopy, with or without special stains.
	Differential diagnosis	A list of possible diagnoses, ranked in order of the most likely to the least likely.
	Presumptive (working) diagnosis	A clinical diagnosis made in the absence of confirmatory information from additional clinical investigations and upon which therapy is based.
	Definitive diagnosis	The working and most likely diagnosis upon which therapeutic strategies are based.
Lesions and lesion descriptors	Ulcer	A breach in the epithelium to expose the underlying connective tissue.
	Erosion	Apartial breach in the continuity of an epithelial surface, which does not expose underlying connective tissue.
	Fissure	A narrow crack or slit (usually describes an ulcer shape).
	Vesicle	A small (<0.5cm) fluid filled lesion (not pus)
	Bulla	A larger (>0.5cm) fluid filled swelling (not pus)
	Blister	A fluid filled swelling (not pus)
	Papule	Raised lesion (<1.0cm diameter)
	Macule	Flat lesion (< 1.0cm diameter)
	Nodule	Raised lesion (>1.0cm diameter)
	Pedunculated	Lesion is borne/carried on a stalk/stem
	Sessile	Lesion is borne on a broad/flat base
	Sinus	A hole communicating a body cavity with the external environment
	Sinus tract	An epithelial lined tunnel linking an internal body cavity with the external environment
	Fistula	A communication between two body cavities
	Tumour	A neoplasm is an abnormal mass of tissue, the growth of which is uncoordinated with that of normal tissues, and that persists in the same excessive manner after the cessation of the stimulus which evoked the change
	Granuloma	A well-defined accumulation of modified macrophages (epithelioid cells), surrounded by lymphocytes and often with multinucleated giant cells.
	Epulis	A benign localised swelling of the gingiva usually affecting the interdental papilla
	Cyst	A pathological fluid filled (not pus) cavity.
Pathological terms or descriptors	Atrophic	Thinning of a tissue.
	Hyperplasia	An increase in the size of a tissue due to an increase in the number of its constituent cells.
	Hypertrophy	An increase in the size of a tissue due to an increase in the size of its constituent cells.
	Overgrowth	An increase in the size of a tissue due to an increase in the size and/or number of constituent cells and/or extracellular matrix components.
	Dysplasia	Disturbance in the normal maturation of a tissue.
	Anaplasia	Lack of differentiation of a tissue, characteristic of some tumour cells.
	Acantholysis	Separation of epithelial cells within the stratum spinosum.
	Acanthosis	An increase in thickness of the stratum spinosum.
	Leukoplakia	An adherent white patch or plaque that cannot be characterised clinically or pathologically as any other lesion (WHO).
	Erythroplakia	A bright red velvety plaque that cannot be characterised clinically or pathologically as any other recognisable condition (WHO).
	Hyperkeratosis	Excess deposition/formation of keratin within the stratum corneum of epithelium.
	Oedema	The collection of inflammatory fluid exudate within a tissue or bod...

Table of contents

• Cover
• Title Page
• Copyright Page
• Table of Contents
• Foreword
• Preface
• Acknowledgements
• Chapter 1: Establishing a Differential Diagnosis for Periodontal Manifestations of Systemic Diseases
• Chapter 2: The Role of Clinical Investigations
• Chapter 3: Gingival Colour Changes – Localised
• Chapter 4: Gingival Colour Changes – Generalised
• Chapter 5: Gingival Enlargements – Localised
• Chapter 6: Gingival Enlargements – Generalised
• Chapter 7: Localised Gingival Ulceration
• Chapter 8: Generalised Gingival Ulceration
• Chapter 9: Localised Gingival Recession
• Chapter 10: Generalised Gingival Recession
• Chapter 11: Miscellaneous Lesions