Perio Diagnosis - Chronic Periodontitis

Chronic periodontitis is one of seven categories of periodontitis according to the 1999 classification system created by the American Academy of Periodontology. Chronic periodontitis is a disease in the oral cavity which is defined by severe inflammation of the periodontal tissues. The cause of the disease is large amounts of dental plaque that is able to accumulate over a period of time. In the initial stage, periodontitis starts as gingivitis and when left untreated, can progress into chronic or subsequent aggressive periodontitis.

In order to prevent severe and irreversible damage, it is imperative to diagnose and treat chronic periodontitis early. Because chronic periodontitis results in virtually no pain, most patients do not seek dental treatment until the disease has progressed. Mild to moderate chronic periodontitis can be managed by removing the biofilm and subgingival calculus. It is also important to maintain an effective oral hygiene regimen in addition to attending regular periodontal checkups to manage the disease.

In the United States, nearly 35% of adults between the age of 30 and 90 are affected by chronic periodontitis. The side effects including the alveolar bone loss, attachment loss and the formation of pockets is more obvious as the patient ages.

Various periodontal risk factors exist which effect the likelihood, rate, extent and severity of the progression of the disease. Some of the greatest risk factors include poor oral hygiene, smoking and failing to control plaque biofilm.

Under normal circumstances, the disease progresses at a slow to moderate rate. However, patients can experience periods or bursts of rapid progression. Chronic periodontitis can be associated with local predispositions which include tooth-related or iatrogenic factors. In addition, the disease can be modified by or associated with other systemic diseases including diabetes or HIV. Other components which can impact the disease include smoking, emotional stress, depression and anxiety. Dental professionals should use caution when diagnosing patients who smoke with chronic periodontitis as it is possible for smoking to alter some results of the examination. As an example, in patients who smoke, the gingiva is pale, fibrous and tends to bleed less as a result of probing. Patients who smoke also more commonly have supragingival calculus along with visible staining as a result of the nicotine. The anterior dentition may have recession and the maxillary anterior and palatal surfaces may have more negative effects.

Signs & Symptoms

In the early stages of chronic periodontitis, the disease has very few symptoms. In most cases, the disease will progress significantly before patients seek professional dental treatment. The following is a summary of common symptoms of chronic periodontitis:

  • Deep pocket formation between the teeth and the gums
  • Drifting incisors
  • Frequent swelling of the gums
  • Gingival recession, making the teeth appear longer
  • Halitosis, bad breath or a metallic taste in the mouth
  • Loose teeth
  • Redness or bleeding of the gums during routine use such as brushing, flossing or eating

In some cases, the gum inflammation and bone destruction is painless. Patients may even assume that bleeding after brushing their teeth is perfectly normal and nothing concerning. Unfortunately, these are common early symptoms of chronic periodontitis.

Treatment of chronic periodontitis can involve both surgical and non-surgical therapy. In many cases, the initial treatment which is often effective is called scaling and root planing (SRP). SRP is used to mechanically debride the depths of the periodontal pocket and disrupt the biofilm which is present. This process is completed with the use of a powered ultrasonic or sonic scaler in addition to unpowered hand instruments. It is vital for patients to undergo a review of treatment to ensure it is effective within 8–12 weeks. Quitting smoking and good oral hygiene are both crucial in effective treatment and successful patient outcomes.