Chronic Periodontitis

The American Academy of Periodontology classified types and degrees of periodontitis into seven categories in 1999. Chronic periodontitis is one of the more common diseases of the oral cavity, affecting around 35% of adults in the United States between the ages of 30-90. Chronic periodontitis is characterized by chronic inflammation of the tissues of the periodontium due to an excessive amount of dental plaque. At its onset, periodontitis begins as gingivitis; this can progress into chronic periodontitis and may eventually become aggressive periodontitis if left unaddressed.

Early diagnosis of chronic periodontitis is important in preventing severe and eventually irreversible damage to the tissues of the periodontium, which both protect and support the teeth. Because chronic periodontitis progresses painlessly, however, it can be challenging to diagnose and treat in its early stages. This is one of the key reasons dentists recommend regular dental checkups. When diagnosed early, in its mild to moderate stages, chronic periodontitis can be managed with dental deep cleaning treatments, such as dental scaling and root planing, which mechanically removes plaque and tartar beneath the gum line. Regular, proper home maintenance and periodic periodontal checkups are an integral part of maintaining the benefits of these clinical treatments.

The cumulative outcomes of chronic periodontitis become more apparent with increased age. These outcomes include alveolar bone loss, pocket formation in the gums, and detachment and loss of the teeth. Even in populations that have effective oral hygiene practices, age has been found to relate to the destruction associated with periodontitis. In these populations, the highest rates of periodontal pocketing and resulting attrition of the periodontal structure occur in people between the ages of 50 and 60. Risk factors which increase the prevalence and severity of the progression of chronic periodontitis include smoking and inadequate control of plaque biofilm due to infrequent or technically improper oral hygiene.

While chronic periodontitis usually progresses rather slowly, bursts of rapid progression may also appear. Chronic periodontitis may be associated with such systemic diseases as diabetes or HIV, and it may also be adversely affected by smoking, anxiety, depression, or emotional stress. Smokers may pose particular challenges when diagnosing chronic periodontitis, as the gum tissue of smokers tends to be paler in color and less prone to bleeding, due to the effects of nicotine on the vasculature. Since visual diagnosis and the presence of bleeding on probing are two key markers of chronic periodontitis, it is easy to misdiagnose smokers. However, smokers also present an increase in tartar buildup and visible nicotine staining, and the backs of the teeth may appear receded; these characteristics can support accurate diagnosis.

Chronic periodontitis results from an accumulation of dental plaque that leads to the gradual destruction of bone and soft tissue in the oral cavity. The ecological plaque hypothesis claims that this damage results from a shift in the ratio between beneficial and dangerous bacteria that is found in dental plaque, and it is widely believed that chronic periodontitis is related to variation in microbial patterns. In its early stages, chronic periodontitis may have few or no symptoms, allowing the disease to progress untreated when periodic dental checkups are missed or avoided. Symptoms may include bleeding or redness of the gums, swelling of the gum tissue, bad breath or a bad taste in the mouth, recession of the gums, deepened pockets between the gums and the teeth, loosened teeth, or teeth that shift in position. While not every incidence of gingivitis will progress, all chronic periodontitis was once gingivitis. Controlling gingivitis, marked by inflammation of the gum tissue, is the first step toward preventing chronic periodontitis.