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THE CURRICULUM

 

 

 

“All art is either imitation or revolution"

                                                                

 
     
 

COURSE TITLE: BIOFILMS

COURSE DESCRIPTION
     The most recent research on the study of biofilms has yielded both the most comprehensive and disturbing evidence to date on microbials. Biofilms have been demonstrated not only to adapt, but to flourish under the most adverse conditions medical science and the human body can exert on them. We are currently challenged with many chronic and infectious diseases which defy both diagnosis and treatment. Anti-microbials, detergents, germicides, ozone, etc, may reduce their numbers but have proven to be unable to eradicate them. In fact, utilization of such agents only renders the biofilm more tenacious and un-tenable.
     An in-depth structural and functional analysis will be conducted as will biofilm specific concepts such as: ‘climax community’, ‘signal compounds’, “Quorum sensing’, ‘pathogenic potentiation’, ‘elective detachment’, nutrient potentiation (can certain nutrients be detrimental to the host?) and ‘Anaerobic Tendency’ (particularly in a totally aerobic environment).
     Further, microbial succession and virulence progression are detailed with particular emphasis on the creation of ‘stealth’ and ‘super’ pathogens. These micro-organisms are cultured and protected within biofilms and possess the capability of both evading and destroying the immune system. This lecture is significant for both dental and medical biofilms.

COURSE OBJECTIVES
1. Understand how biofilm structural characteristics give rise to its unique functional capabilities.
2. Understand how biofilms can evade and destroy the human immune system giving rise to generalized symptoms, infectious and chronic disease.
3. Review current diagnostic systems and show how biofilms are difficult to culture or identify as being an integral part of most disease processes.
4. Trace the use of traditional and alternative procedures which have not only proven powerless, but may have inadvertently given use to ‘stealth’ and ‘super’ pathogen creation.

COURSE TITLE: PERIODONTAL MEDICINE I

DESCRIPTION OF COURSE CONTENT: A comprehensive, evidence-based, periodontal course with emphasis on biofilms, systemic interactions, and periodontal regeneration

EDUCATIONAL OBJECTIVES:
     1. Develop a broad understanding of biofilms with focus on local disease, systemic dissemination and subsequent systemic disease.
     2. Understand impact on biofilms from dental treatment including prostheses, root canals and implants.
     3. Perform a comprehensive assessment of a patient’s periodontal condition and be able to determine etiology, diagnosis, prognosis and a periodontal risk assessment.
     4. Understand how a patient’s systemic status can impact the periodontium, the diagnosis and risk assessment.

TEACHING METHOD AND CDE HOURS
     Lecture Methodology with questions and answers, and case studies to ensure a high level of understanding, clinical application and practice integration. (16 Lecture Hours)

LEVEL OF SKILL, KNOWLEDGE AND EXPERIENCE
     Participants are required to be licensed dentists and hygienists; have a basic knowledge of periodontology and have some form of a soft tissue program in their practice.

PART I: BIOFILM SCIENCE

  1. THE ‘NEW SCIENCE’
    1. Dental Focal Infection Evidence
    2. Classical vs. Opportunistic Infections
    3. Acute vs. Chronic Inflammation
  2. THE CONCEPT OF BIOFILMS
    1. A Reassessment of ‘Plaque’
    2. Basic Characteristics
    3. Structural Analysis
    4. Functional Analysis
  3. BIOFILMS AND THE INITIATION OF LOCALIZED DISEASE
    1. Conditions Giving Rise To Pathogen Proliferation
    2. Periodontal Tissue Breakdown: Microbiological and Molecular Mechanisms
    3. Immune System Dysfunction: TH-1 Chronic Inflammatory Disease
    4. Etiological Factors In Local Disease
  4. BIOFILMS  IN ORAL-SYSTEMIC INTERACTIONS
    1. Mechanisms of Metastasis
    2. Metastatic Infection
    3. Metastatic Inflammation
    4. Metastatic Injury
  5. ORAL-SYSTEMIC DISEASE
    1. Cardiovascular Disease
    2. Acute Events: MI and CVA
    3. Diabetes
    4. Pulmonary Disease
    5. Obstetric Disease
  6. BIOFILMS AND DENTAL UNIT WATERLINES
    1. Waterline Dynamics
    2. Analysis
    3. Isolates
    4. Outbreaks
    5. Regulatory Recommendations
  7. BIOFILMS AND DENTAL TREATMENT INTERACTIONS
    1. Prostheses
    2. Implants
    3. Root Canals and Implant-RCT Interactions
    4. Osseous Biofilms

PART II: CLINCAL DIAGNOSIS OF BIOFILMS AND PERIODONTAL DISEASE

  1. The Comprehensive Systemic Intake (The “CSI”)
    1. Systemic Assessment
    2. Past Dental History and Review of Systems
    3. Etiological Assessment
  2. The Comprehensive Periodontal Assessment (The “CPA”)
    1. Periodontal Probing
    2. Gingival and Mucogingival Assessment
    3. Furcation Assessment
    4. Mobility and Trauma from Occlusion Assessment
    5. Pocket Activity and Bleeding Upon Probing
  3. Diagnostic Parameters
    1. Plaque Induced Gingivitis and Local, Systemic, Medicament and Malnutrition Modifiers
    2. Non-Plaque Induced Gingivitis: Specific Bacterial, Viral (including AIDS), Fungal and Systemic Interactions
    3. Chronic Periodontitis
    4. Aggressive Periodontitis
    5. Systemic and Necrotizing Periodontitis
    6. The Periodontal Abscess and Perio-Endo Lesions
    7. Developmental and Trauma from Occlusion
  4. Prognostic Parameters
    1. Individual Teeth Prognosis
    2. Case Prognosis
  5. Periodontal Risk Assessment (simplified)
    1. Basic Risk Categories
    2. Risk Modifiers
    3. Calculation
  6. Case Studies: Application
    1. Completing the Comprehensive Systemic Intake
    2. Completing the Comprehensive Periodontal Assessment
    3. Determining the Diagnosis
    4. Determining the Prognosis
    5. Determining the Periodontal Risk Assessment
  7. Integration: Periodontal Practice Management
    1. Periodontal Flowcharts
    2. Forms, Coding and Documentation
    3. Scope of Practice
    4. Informed Consent

COURSE TITLE: PERIODONTAL MEDICINE II

DESCRIPTION OF COURSE CONTENT: Part II of a comprehensive, evidence-based, periodontal course with emphasis on biofilms, systemic interactions and periodontal regeneration.

EDUCATIONAL OBJECTIVES:
     1. Understand the science and clinical application of current periodontal treatment.
     2. Understand new concepts in periodontal therapy and the potential for regeneration. Emphasis is focused on adding new treatment modalities to enhance periodontal outcomes.
     3. Develop a comprehensive periodontal treatment plan approach based upon one’s risk assessment.
     4. Integrate a predictable method of periodontal diagnosis and a regenerative-based treatment plan.

TEACHING METHODS AND CDE HOURS
     Lecture Methodology with extensive questions and answers to ensure a high level of understanding, clinical application and practice integration (16 Lecture hours)

PRE-REQUISITES
     Level I is strongly advised and is considered essential to understanding and applying the regenerative concepts introduced in Level II.

PART I: CURRENT CONCEPTS IN PERIODONTAL TREATMENT

  1. Goals of Periodontal Therapy
  2. Clinical Decision Making Based Upon Microbiological Research
  3. Supra-Gingival Scaling (Studies)
    1. Effect on 3mm pockets
    2. Effect on 4-5mm pockets
    3. Effect on 6mm plus pockets
    4. Conclusions
  4. Scaling and Root Planing (Studies)
    1. Effect On Sub-Gingival Biofilm
    2. Short-term Benefits
    3. Long-term Benefits
    4. Conclusions
  5. Periodontal Surgery
    1. Mucogingival Surgery
    2. Osseous Surgery
    3. Guided Tissue Regeneration and Hard Tissue Grafting
    4. Soft Tissue Grafting/ Cosmetic Periodontics
  6. Implants and Periodontal Considerations
    1. Anterior Placement and the Maintenance of Gingival Architecture
    2. Posterior Placement: Ridge Assessment, The Mandibular Nerve and Maxillary Sinus

PART II: NEW CONCEPTS IN PERIODONTAL THERAPY

  1. “GUIDED TISSUE REGENERATION”
    1. Antagonistic Strain Therapy
    2. Early Colonizer Therapy
    3. Conclusions
  2. PERIODONTAL VACCINATION
    1. rogA DNA (sIgA) Vaccine
    2. rogA DNA (IgG) Vaccine
  3. HOST MODIFICATION STUDIES
    1. Mechanisms of Host Modification
    2. Van Dyke: Initial Study
    3. Van Dyke: Follow-up Study
    4. Results and Conclusions
  4. PERIODONTAL “TISSUE ENGINEERING”
    1. Growth and Differentiation Factors
    2. Platelet Derived Growth Factor
    3. Transforming Growth Factor Beta and Bone Morphogenetic Proteins
    4. Gene Therapy To Target Periodontal Tissue Growth Factors
    5. Stem Cell Considerations
  5. LASER THERAPY
    1. Research and Clinical Findings
    2. Implementation of Laser Therapy
    3. Case Studies

PART III: PERIODONTAL TREATMENT PLANNING AND TREATMENT

  1. Gingival Preventive Services (“GPS”) Overview
    1. Level of Care
    2. Periodicity
    3. Risk Assessment-Based Services
  2. Gingival Preventive Services (“GPS”)
    1. Assessment “A”
    2. Assessment “B”/ Radiographic Considerations
    3. Assessment “C”
  3. Scaling and Root Planing
    1. Diagnosis and Treatment Planning
    2. Re-evaluation of Results
    3. Periodontal Maintenance
  4. Periodontal Maintenance Services (PMS)
    1. Assessment A,B and C
    2. Assessment “D” (Pathogen Testing)
    3. Metastatic Risk
    4. Systemic Risk
  5. Periodontal Surgery
    1. Surgical Intervention
    2. Re-assessment
    3. Maintenance Determination

PART IV: APPLICATION AND INTEGRATION

    1. Case Studies Requiring Root Planing and Maintenance
    2. Case Studies Requiring Periodontal Surgery and Maintenance
    3. Treatment Plans Integrating Current and New Treatment Concepts
    4. Forms, Coding and Documentation
    5. Scope of Practice

COURSE TITLE: SYSTEMIC DENTISTRY

COURSE DESCRIPTION:

The concept of systemic dentistry, that oral disease can have systemic consequences, is explored in a greater context.  Can systemic disease, particularly nutritional deficiency or toxicity, affect the health and healing of oral tissues?  The course will examine the systemic etiology of caries, pulpal and periodontal disease.

OBJECTIVES:

  1. Review oral-systemic disease from the concept of the dental focal infection theory.
  2. Review the mechanism of oral-systemic metastasis
  3. Explore the possible pathway for the systemic etiology of caries, pulpal and periodontitis.

COURSE TITLE:  FUNCTIONAL DENTISTRY

COURSE DESCRIPTION:

Functional Dentistry explores the proper function and the effect of stress on the dental tissues with regard to occlusion, neuro-muscular (NM) and TMJ Dysfunction.  The course is oriented in a clinical fashion to permit a quick and proper diagnosis.  Treatment, similarly, is presented from using the diagnosis to determine proper and predictable therapy.

OBJECTIVES:

  1. Understand how occlusal concepts such as centric relation, anterior guidance, vertical dimension and neutral zone, relate to NM and TM Dysfunction.
  2. Understand the etiology, pathogenesis and treatment of neuro-muscular dysfunction.
  3. Understand intra-articular TMJ staging and methods of splint delivery and adjustments.

TEACHING METHODS AND CE CREDITS

Lecture with Examination, Diagnosis and Treatment Format.  The CE credit for Systemic and Functional Dentistry is 13 credits.  The Lecture is open to all dentists.

 

Courses are held in New Jersey (NJ), New York (NY), Arizona (AZ), Chicago, Illinois (IL), Florida (FL) and California (CA)