Perio Other - Clinical Attachment Loss

Clinical attachment (CAL) is a sign of destructive and potentially irreversible periodontal disease. Periodontal or gum disease is a set of inflammatory conditions impacting the tissues surrounding the teeth. In the early stages of periodontal disease, the condition is called gingivitis. Gingivitis causes the gums to become swollen, red and may even result in bleeding. In a more severe form, the condition is called periodontitis. This occurs when the gums detach from the tooth. There can also be bone loss, and in some cases, the teeth become loose or fall out. A bad odor of the breath may also be a symptom of periodontitis.

In general, periodontal disease occurs when bacteria in the mouth infects the tissue surrounding the teeth. Risk factors for periodontal disease can include smoking, diabetes, HIV/AIDS, patients with a family history and some types of medication. The disease is diagnosed through an inspection of the gum tissue around the teeth. The inspection is usually both visual and conducted with a probe. X-rays may also be used to evaluate the amount and severity of bone loss around the teeth.

Periodontal disease treatment often involves the practice of good oral hygiene and regular visits to the dentist for an examination and professional teeth cleaning. A thorough oral hygiene regimen typically includes brushing the teeth twice each day and daily flossing. In more severe cases, surgery or antibiotics may be required. In 2015, an estimated 538 million people were affected with periodontal disease throughout the world. In the United States specifically, nearly half of people over 30 years old are impacted. About 70% of adults over the age of 65 have the condition. It is more common for males to be affected by the disease than females.

Chronic periodontitis is a disease in the oral cavity and involves the chronic inflammation of the periodontal tissues. This occurs from the accumulation of dental plaque. Periodontitis begins as gingivitis and when left untreated, can progress into chronic or aggressive periodontitis. It is critical to make an early diagnosis of chronic periodontitis to prevent severe or irreversible damage. Due to chronic periodontitis being painless with the progression of the disease, patients often do not seek dental care in the early stages. Mild to moderate forms of chronic periodontitis are manageable with the proper removal of the biofilm and calculus subgingivally. Thorough oral hygiene and regular periodontal checkups every few months are vital in the management of the disease.

Numerous risk factors can impact the prevalence, progression, extent and severity of the disease. Some of the greatest risk factors for the disease include smoking, poor oral hygiene and the failure to control the buildup of plaque.

Attachment Anatomy

Through the periodontal ligament (PDL) fibers, the teeth are attached to the surrounding and supporting alveolar bone. The PDL fibers run from the bone to the cementum, which naturally exists on the tooth’s root surface. The fibers are also attached to the gingival tissue covering the alveolar bone through an attachment apparatus. It is called the supracrestal attachment apparatus because the attachment exists superficial to the height of the alveolar bone,

The supracrestal attachment apparatus is comprised of two layers including the coronal junctional epithelium and the more apical gingival connective tissue fibers. Together, these layers form the gingival tissue thickness, a dimension which is called the biologic width.

Periodontal disease

Periodontal diseases caused by plaque are typically classified as being either destructive or non-destructive. Clinical attachment loss is a sign of destructive periodontal disease which is often irreversible. The term clinical attachment loss is used almost exclusively to describe to connective tissue attachment loss.

Areas with periodontitis can exhibit clinical signs of gingival inflammation and also experience the loss of connective tissue attachment. Connective tissue attachment loss describes the pathological detachment of collagen fibers from the cemental surface with the concomitant apical migration of the pocket epithelium to the surface of the root.