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KINGSAUD UNIVERSITY
College of Dentistry Department of Periodontics and Community
Dentistry
313 PCS
CLINICAL PERIODONTOLOGY I
COURSE DIRECTOR : Dr. Hamdan Algamdi
COURSE COORDINATOR : Dr. Nawaf Al-Hamoudi
Academic Year
1436/1437 H (2015/2016 G)
2
Reviewed and Updated by
PCS Department Courses Review and Update Committee
- Prof. Nahid Ashri Chairperson
- Prof. Nadir Babay Member
- Dr. Salwa Al Sadhan Member
- Dr. Amel Darwish Member
- Dr. Reem Al Kattan Member
- Dr. Mansour Al Askar Member
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COURSE TITLE: CLINICAL PERIODONTOLOGY I COURSE CODE: PCS 313 CREDIT HOURS: 4 hours (1 hour- Lecture & 3 hours -Clinic) PREREQUISITES: None INTRODUCTION: Gingivalandperiodontaldiseasesarecommonpathologicalconditionsthatcontinuetoaffectthesupportingstructuresofthedentitionindifferentpartsoftheworld.TheClinicalPeriodontologyI course runsover one year. It reviews and expands the student’s knowledgeof thebiologyofhealthyperiodontium;introducesthestudenttothecurrentclassificationofperiodontaldiseases;and provides the fundamental knowledge of the etiology, microbiology, and diagnosis ofperiodontal diseases. Basic information will be integrated with necessary clinical skills tosystematicallyevaluateanddiagnoseallcurrentlyrecognizedformsofperiodontaldiseases,andformulateacomprehensivetreatmentplan.Thisincludestheabilitytorecognizethelesscommonforms of gingivitis and periodontitis and those systemic conditions that may influence theinitiation,progression,ortreatmentofperiodontaldiseases. COURSE DESCRIPTION:
Thiscourseconsistsofdidactic,pre‐clinicalandclinicalcomponents.Itcoversthefollowing:
1. Periodontiuminhealth.2. Etiology,pathogenesis,andclassificationofperiodontaldiseases.3. Systematic examination, diagnosis, treatment planning and management of patients with
non‐advancedperiodontaldiseases.4. Principlesandtechniquesofpreventionandtherapyofperiodontaldiseases.5. Re‐evaluationofthepatientresponsetothegivenperiodontaltreatment.6. Periodontal instrumentation, including the proper use and handling of the periodontal
instruments.
COURSE OBJECTIVES:
Attheendofthiscoursethestudentshouldbeableto:1. Present a complete patient record, including the history and comprehensive clinical and
radiographicexaminationoftheperiodontiumaswellasotheroraltissues.2. Develop the appropriate diagnosis, identify prognosis and formulate a multidisciplinary
treatmentplanofperiodontaldiseases.3. Mastertheabilitytomotivateandcustomizeahome‐basedplaquecontrolregimeforeach
individualpatient.4. Becomecompetentintheprevention,assessmentandmanagementofperiodontaldiseases.5. Distinguish between healthy and diseased periodontium based on the knowledge of the
biology of the periodontal structures and the pathological mechanisms of periodontaldiseases.
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6. Demonstrate the ability to identify the presence of local irritants and the competencynecessarytoeliminatethem.
7. Useandhandlevariousperiodontalinstrumentseffectively. COURSE REQUIREMENTS:
Studentsmustsatisfactorilycompletethefollowingminimumrequirements:
Finishatleastthree(3)clinicalcases:
• Two case with gingivitis including slight/moderate amount of calculus and/orsystemicfactors.
Onecasewithgeneralizedperiodontitisincludingslight/moderateamountofsubgingivalcalculusand/orsystemicfactors
Onegingivitisorslightperiodontitisre‐evaluationcasefromthestudentsselftreatedpatients
COURSE PROTOCOL: ScreeningofclinicalcasesbytheCOURSE DIRECTOR ismandatory. ApprovaloftheCOURSE DIRECTOR todismissortransferpatientsismandatory. SIGNING AND APPROVING of the treatmentplanby your supervisor ismandatorybefore
startingthetreatmentprocedures Studentsareexpectedtoperformsatisfactorily inbothDidacticandClinicalcomponentsof
thecourse The Clinical Evaluation Formwill be strictly followed for each clinical procedure, and the
instructormustsigneachstepduringthesession. Allreportoftheassignedpatientsshouldbekeptwiththestudent. Thestudentshouldmaintaindisciplinewithregardstoattendingtheclinicsessionsontime. Thestudentsareexpectedtomaintainagoodrelationshipwithhis/herpatients,colleagues
andinstructoralike. The student must always observe cleanliness and neatness in appearance and wear their
properclinicalgowns,ID,headcoverandgogglesduringtheclinicalsession;otherwisetheywillnotbeallowedtoperformtheirclinicalprocedures.
It is the responsibility of the student to complete the patient's permanent file, indicatingclearly thename, university number and signature of the students. A temporary file is notacceptable.
Attheendofeachclinicalsessionthestudentshouldobtainthesignatureoftheinstructor. Thepatient'sfile,withoutthesignatureoftheassignedinstructor,shallbeconsideredasan
incompleteclinicalprocedure,andwillaffectyourdailygrade. In a situation where the patient is unable to attend the clinic, the instructor should
immediatelybenotified. Studentsshouldattendtheclinicsessiondespitetheabsenceoftheirpatients.
Eachstudentmustfulfilltheminimumtreatmentrequirementsofthecourse(3patients). The quality of treatment for each clinical step providedwill be of primary concern in the
assignmentofthefinalgrade. Regularity, punctuality & adherence to college didactic & clinical regulation in treating
patientsmustbestrictlyobservedandwillbegraded. Your instructor will continually monitor your clinical skills, behavior and patient
management. Allpatientsunderthestudent'scarewillundergoroutineevaluation. Scalingandrootplaningwillbeevaluatedonaquadrantorsextantbasis.
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TheSTUDENTisresponsibletoassurethathis/herclinicalworkisregularlyevaluated. TheclinicalmarkwillbeseverelyaffectediftheStudentwillshow: Poormanagementofthecase Repeatedignorancetogiveninstructions Unacceptablebehaviorwithpatientsand/orclinicalinstructors.
Studentwhofailstofinishtheclinicalworkduringtheallottedclinicaltimepersessionwillreceiveazeromark.AnotherZero(0)willcanceltheclinicalrequirementforthatcasewiththestudentcontinuingtotreattheclinicalcase.
Allperformedclinicalproceduresshouldberecordedinthepatient'sfile. It is the Student responsibility to prepare the clinic before starting the treatment.
Radiographs,treatmentplan,salineandsharpenedinstrumentshouldalwaysbeavailableintheclinic.
Attendancetothelecturesandtheclinicismandatory.Being10minuteslatetothelectureor15minutes late to theclinical sessionwillbeconsideredasabsenceaffecting thestudent'sevaluation.
KingSaudUniversityrulesandregulationsstipulate thatmissing25%of the lectureor theclinicalsessionswilldeprivethestudentfromsettinginthefinalexam.
It is the students responsibility to coordinate with the Booking Area for patientsappointments
Studentwho does not fulfill the all the above‐mentioned itemswill have their final gradenegativelyaffected
MEASUREMENT AND EVALUATION: Finalmarkwillbecalculatedasfollows:
A. CONTINOUSYEARLYEVALUATION (60%)
1. Clinicalevaluation 25%2. Mid‐YearClinicalexamination(I) 10%3. Mid‐Yearexamination 15%4. Punctuality/quizzes 10%
B. FINALEXAMINATION (40%)
1. Writtenexamination 25%2. FinalClinicalexamination(II) 15%
________ TOTAL 100% The finalwritten examination includes all coursematerials presented during the year.Dailyclinical evaluation will be in the categories of preparation, professionalism, knowledge andmanagementofthepatients.Note:Failure tomeet the professional and ethical responsibilities towards the patientswillaffectthestudent’sgrade.ROUTINE EVALUATION MARKS: This evaluation measures the quality of the work performed by the student during themanagement of his/her periodontal patients. Marks will be calculated using the point systemdependingonthecaseselectionandtheprocedure:
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Gingivitiscase 1pointoutof15 Slightperiodontitiscase 1.5pointsoutof15 Moderateperiodontitiscase 3pointsoutof15 Severeperiodontitiscase 3pointsoutof15 Re‐evaluationafterinitialtherapyofacase 3pointsoutof15 Recallofafinishedcasetreatedbystudent 2pointsoutof15 Periodontalsurgery/implantcasereport 1.5pointsoutof15
REQUIREMENT MARKS:
A clinical treated casewill not be considered in the requirement until it has a passinggradeof60%.
Anygradebelow60%willonlybecountedintheroutineevaluation. Accordinglyeachrequirementcasewillbecalculatedinaccordancewiththeirtypeasthe
following:Example:Studenttreatsaslightperiodontitiscase(examination,diagnosis,treatmentplanand initial therapy, scalingandrootplaning)and thecalculatedaverageof thecase fromstudentevaluationformis80%thenthepointforthiscaseis:
(80x1.5)100=1.2outof1.5points REQUIRED TEXT: 1. Carranza'sClinicalPeriodontology,12thedition,MichaelG.Newman,HenryTakei,Perry
R.Klokkevold,andFerminA.Carranza(editors),SaundersElsevier,2011.
2. Color Atlas of Dental Medicine 1, Periodontology, 3rd ed. Herbert F. Wolf, Edith M.Rateitschak‐Pluss,KlausH.Rateitschak,ThiemeInc.,2005.
Periodontal examination and evaluation forms: The forms, lecturesandtheclinicalmanualrequiredfor thiscoursecanbedownloadedfromthewebsite: http://faculty.ksu.edu.sa/nalshibani/default.aspx
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Course Director, Course Coordinator and Participating Faculty Contact Information:
NAME EMAIL
Dr.Montaser Qutub [email protected]
Dr.Khalid Alhmdan [email protected]
Dr.Sameer Mokeem [email protected]
Dr.Hamad Alzoman [email protected]
Dr.Fahad Alshehri [email protected]
Dr.Mohammed Alsarhan [email protected]
Dr.Mohammed Alsaif [email protected]
Dr.Hamdan Algamdi [email protected] Director
Dr.Nawaf Al-Hamoudi [email protected] Coordinator
Dr.Mansour Alaskar [email protected] Dept. Chairman
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313 PCS
CLINICAL EVALUATION GUIDELINES
GRADE CLINICAL PROCEDURES Students will be evaluated for the following:
Attitude
Professionalism
Cleanness of the field
Organization
Availability of the charting and dental radiographs
Scaling and root planning
90-100
No injury to the gingival tissue
No roughness left
Good knowledge
Complete removal of sub- & supra-gingival calculus
80-89
No injury to the gingival tissue
Localized roughness left
Complete removal of sub- & supra-gingival calculus
70-79
Some injury to the gingival tissue
Unable to detect localized areas of sub-gingival calculus
Multiple areas with root roughness left
60-69 Obvious injury to the gingival tissue
Multiple areas with sub- & supra-gingival calculus
<60 (Fail)
Remarkable injury to the gingival tissue
Unable to detect huge amount of sub- & supra-gingival
calculus
Does not deserve to pass (unsafe)
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CLASSIFICATION OF PERIODONTAL DISEASES (AAP 1999)
GINGIVAL DISEASE
Plaque induced gingival disease
I-A1 Gingivitis associated with plaque only
I-A2 Gingival disease modified by systemic factors e.g. puberty, diabetes
I-A3 Gingival disease modified by medication e.g. phenytoin
I-A4 Gingival disease modified by malnutrition e.g. vitamin C deficiency
Non-plaque induced gingival disease
I-B1 Gingival disease of specific bacterial origin e.g. syphilis
I-B2 Gingival disease of specific viral origin e.g. herpes infection
I-B3 Gingival disease of fungal origin e.g. candidiasis
I-B4 Gingival disease of genetic origin e.g. hereditary fibromatosis
I-B5 Traumatic lesion of the gingival i.e. chemical, physical, thermal
I-B6 Foreign body reaction of the gingival
PERIODONTITIS
Chronic Periodontitis
II-A1 Slight 1-2mm clinical attachment loss
Generalized >30% of sites involved
Localized <30% of sites involved
II-A2 Moderate 3-4mm clinical attachment loss
II-A3 Severe
5mm or more clinical attachment loss
Aggressive Periodontitis II-B Absence of large amount of
plaque and calculus
Generalized >30% of sites involved
Localized <30% of sites involved
Periodontitis as manifestation of systemic disease
II-C Such as periodontitis in acquired neutropenia or leukemia
NECROTIZING PERIODONTAL DISEASE III-A Necrotizing ulcerative gingivitis III-B Necrotizing ulcerative periodontitis
ABSCESSES OF PERIODONTIUM IV-A Gingival abscess IV-B Periodontal abscess IV-C Pericoronal abscess
PERIODONTITIS ASSOCIATED WITH ENDODONTIC LESIONS
V-A Endo-perio lesion V-B Perio-endo lesion V-C Combined lesion
DEVELOPMENTAL OR ACQUIRED DEFORMATIES AND CONDITIONS
VI-A Localized tooth-related factors that predispose to plaque induced gingival diseases or periodontitis.
VI-B Mucogingival deformities and conditions around teeth
VI-C Mucogingival deformities and conditions around
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edentulous ridges
VI-D Occlusal trauma
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PROGNOSIS CLASSIFICATION
McGuire & Nunn, 1996
GOOD
Control of the etiologic factors and adequate periodontal support as measured clinically and radiographically to ensure the tooth would be
relatively easy to maintain by the patient and clinician assuming proper maintenance
FAIR
Approximately 25% attachment loss as measured clinically and radiographically and/or class I furcation involvement. The location and depth of the furcation would allow proper maintenance with good patient compliance.
POOR
50% attachment loss and/or class II furcations. The location and depth of the furcations would allow proper maintenance, but with difficulty.
QUESTIONABLE
>50% attachment loss resulting in a poor crown/root ratio. Poor root form, class II furcations not easily accessible to maintenance care, or class III furcations. ≥2+ mobility. Significant root proximity.
HOPELESS Inadequate attachment to maintain the tooth in health, comfort, and function. Extraction is suggested.
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STUDENT'S PROGRESS 313 PCS
FIRST SEMESTER
STUDENT'S PROGRESS
313 PCS SECOND SEMESTER
Date Requirement Complete In Progress Needed
Date Requirement Complete In Progress Needed
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DEPARTMENT OF PERIODONTICS AND COMMUNITY DENTISTRY
DIVISION OF PERIODONTICS 313 PCS
Clinical Evaluation Form
Patient’s Name ______________________ Patient’s File No: ____________________
Case Diagnosis:
Severity of local factor: slight - moderate – severe Extent of local factor:localized - generalized
Faculty Signature: ___________________
FacultySignature:________________________ TOTALGRADE:
TOTALPOINTS:
PROCEDURE GRADE FACULTY
SIGNATURE Part I – Initial Examination
1. Chief complaint, oral history, medical history 2. Extra- and intra- oral examination
Part II- Clinical Examination 1. Periodontal charting 2. Radiographic interpretation 3. Oral and periodontal diagnosis
Part III –Treatment Plan 1. Motivation, OHI, periodontal treatment plan 2. Other dental treatment specialties needed 3. Initial surgical treatment plan 4. Overall and individual tooth prognosis
Part IV – Therapy 1. Motivation and oral hygiene performance 2. Gross scaling and polishing 3. Scaling and root planning
a. QuadrantI b. QuadrantII c. QuadrantIII d. QuadrantIV
4. Availability of the charting and x-ray 5. Cleanness and instruments sharpening 6. Attitude 7. Professionalism 8. Organization 9. Surgical Procedure Quadrant Teeth
Part V – Re-evaluation
1. Plaque, bleeding indices and re-evaluation findings
2. Definitive treatment plan
Part VI – Recall and maintenance
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PATIENT NUMBER
CLINICAL DIAGNOSIS SEVERITY LOCAL
FACTORS
REQ/ADDIT CLINICAL EVALUATION AVREAGE
POINTS
1
2
3
4
5
6
7
8
9
10
11
12
13
Total
Additional Points
Student's Performance
15
LECTURE SCHEDULE
313 PCS 2015-2016
FIRST SEMESTER
DATE LECTURE CLINIC LECTURER25/8/2015 24/8/2015
Course introduction
Introduction to clinical session, course forms and requirements (lecture room)
Dr. AlshibaniDr. Alghamdi
1/9/2015 31/8/2015
Classification of diseases & conditions affecting the periodontium (Chapter 3)
Demonstration on the clinical forms Dr. Alshibani Dr. Alghamdi
8/9/2015 7/9/2015
Periodontal anatomy (gingiva & periodontal ligament) (Chapter 1) Demonstration on the clinical forms Prof. Awartani
Dr. Alhamdan
15/9/2015 14/9/2015
Periodontal anatomy (cementum & alveolar bone) (Chapter 1)
Demonstration on chair position/ students probing each other
Prof. Awartani Dr. alhamdan
Hajj Break
29/9/2015 5/10/2015
Periodontal microbiology (Chapter 8) Faculty case Dr. Alotaibi
Dr. alzoman
6/10/2015 12/10/2015
Non‐surgicalperiodontaltherapyI:Mechanical&chemicalplaquecontrol(Chapter45)
ReviewofOralHygieneinstruction,patientmotivation
Dr. Alomar Dr. alhomodi
13/10/2015 19/10/2015
Non‐surgicalperiodontaltherapyII:Scaling&rootplaning(Chapter46)
Introduction to periodontal instruments
Dr. Alhazimi Dr. Alshehri
20/10/2015 26/10/2015
Non‐surgicalperiodontaltherapyIII:Sonic&ultrasonicinstrumentation&irrigation(Chapter47)
Student case (start) Dr. Nath Dr. Alshehri
27/11/2015 2/11/2015
Periodontal case presentation Student case (continue) Dr Alsinidi
Dr.Alghamdi
3/11/2015 9/11/2015
Treatment plan seminar (tentative). Only at GUC Extra week ONLY GUC
Dr. Alshibani Only GUC
10/11/2015 16/11/2015
Role of dental calculus & other local predisposing factors (Chapter 7)
Student case (continue) Dr. Basudan Dr.Alhomodi
17/11/2015 23/11/2015
Periodontal pocket & patterns of bone destruction (Chapter 20 & 21) Student case (continue)
Dr. AlshibaniDr. Alqutub
24/11/2015 30/11/2015
Clinical features of gingivitis & chronic periodontitis (Chapter 15 & 23)
Student case (continue) Dr. Alomar Dr. alqutub
8/12/2015 7/12/2015
Clinical diagnosis (Chapter 29) Student case (continue) Dr. Alahmari
Dr. Alshehri
16
15/12/2015 14/12/2015 Course review Student case (continue)
Dr. Alshibani Dr. Alghamdi
Student case (continue)
20/12/2015
Midterm Written and 1st Clinical Examination
LECTURE SCHEDULE
313 PCS 2015-2016
SECOND SEMESTER
DATE LECTURE CLINIC LECTURER 19/1/201618/1/2016
Epidemiology of Periodontal Disease (Chapter 4) Patients Dr.Ajlan
Dr.Alhomodi26/1/201625/1/2016
Periodontal pathogenesis (Chapter 5) Patients Dr.Alotaibi
Dr.Alghamdi
2/2/20161/2/2016
Host response: basic concepts (Chapter 9)
Patients Dr.ShaheenDr.Alghamdi
9/2/20168/2/2016
Radiographicaidsinthediagnosisofperiodontaldisease(Chapter31)
Patients Dr.AlhazimiDr.Alhomodi
16/2/201615/2/2016
Prognosis&rationaleforperiodontaltreatment(Chapters33&34)
Patients Dr.zawawiDr.Alqutub
23/2/201622/2/2016
Periodontaltreatmentplan(Chapter35) Patients Dr.Alsinidi
Dr.Alhomodi
1/3/201629/2/2016
Reevaluation&periodontalmaintenance(Chapters33,34,35&handout)
Patients Dr.MerdadDr.Alzoman
8/3/20167/3/2016
Periodontalmanagementofmedicallycompromisedpatients(Chapter37)
Patients Prof.AwarataniDr.Alghamdi
Mid-Term Break
22/3/201621/3/2016
Periodontalemergencies´conditions(Chapters41,42&handout)
PatientsDr.AlharbiDr.Alrasheed
29/3/201628/3/2016
Periodontaldiseasesinchildren(Chapter18) Patients Dr.Merdad
Dr.AlShehri
5/4/20164/4/2016
Systemicdiseases&periodontitis(I)(Chapters11&12) Patients Dr.Zawawi
Dr.Alhamdan
12/4/201611/4/2016
Systemicdiseases&periodontitis(II)(Chapters11&12) Patients Dr.Nath
Dr.Alhamdan
19/4/201618/4/2016
Aggressiveperiodontitis‐diagnosis&treatment(Chapter25&40) Patients Dr.Alharbi
Dr.Alghamdi
26/4/201625/4/2016 Gingivalenlargement(Chapter16) Patients Dr.Alahmari
Dr.Alhomodi
3/5/202/5/20
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FINAL
WRITTEN EXAMINATION
