Periodontology Diagnosis - Chronic Periodontitis

Chronic periodontitis is one of the seven different categories of periodontitis based on the 1999 classification system from the American Academy of Periodontology. Chronic periodontitis is a disease of the oral cavity which consists of chronic inflammation of the periodontal tissues. The disease is caused by large amounts of dental plaque which accumulates over time. Initially, periodontitis begins as gingivitis and can progress into chronic or subsequent aggressive periodontitis.

It is critical to diagnose chronic periodontitis early in order to prevent severe and irreversible damage. Unfortunately, because chronic periodontitis is relatively painless, most patients do pursue dental treatment until the disease progresses. It is possible to manage mild to moderate chronic periodontitis through the removal of the biofilm and subgingival calculus. It is important to adopt a thorough oral hygiene regimen and attend regular periodontal checkups every three months in order to control the disease.

Chronic periodontitis is prevalent throughout the world. In the United States about 35% of adults who are between 30 and 90 years-old are affected by the disease. The impacts of the alveolar bone loss, attachment loss and formation of pockets becomes more obvious as patients age.

There are numerous different periodontal risk factors which can impact the likelihood, rate, extent and severity of how the disease progresses. Some of the most prominent risk factors include smoking, poor oral hygiene and the failure to control plaque biofilm.

While the disease typically progresses at a slow to moderate rate, patients may have some periods or bursts of rapid progression. Chronic periodontitis can be associated with local predispositions such as tooth-related or iatrogenic factors. The disease may also be modified by or associated with other systemic diseases such as diabetes or HIV. Other factors which can impact the disease include smoking, emotional stress, anxiety and depression. Dental professionals should be careful when they diagnose a patient who smokes with chronic periodontitis because it is possible for smoking to alter some of the examination results. For example, the gingiva in smokers is pale, fibrous and tends to bleed less when probed. It is also more common for patients who smoke to have supragingival calculus along with visible staining from the nicotine. In some cases, the anterior dentition may have recession and the maxillary anterior and palatal surfaces have more negative effects.

In the beginning stages of chronic periodontitis, the disease does not have many symptoms. For most patients, the disease progresses substantially before they seek treatment from a dental professional. Common symptoms of chronic periodontitis include:

• Gum redness or bleeding when brushing the teeth, flossing or eating hard food
• Reoccurring gum swelling
• Halitosis, bad breath or a persistent metallic taste
• Gingival recession, which makes the teeth appear longer
• Formation of deep pockets between the teeth and the gums
• Teeth become loose
• Incisors begin to drift

It is possible for gum inflammation and destruction of the bone to be painless. Some patients assume that there is nothing to be concerned with when they bleeding after brushing their teeth. However, this can be a common early symptom of the progression of chronic periodontitis.

Dental professionals agree that the cessation of smoking and good oral hygiene are critical for an effective treatment and positive outcome. Treatment can also involve both surgical and non-surgical solutions. Initial treatments often include scaling and root planing (SRP). SRP mechanically cleans the periodontal pockets and removes any biofilm which is present.