Periodontology – Clinical Attachment Loss

Clinical attachment loss (CAL) is a prominent determinate of the presence of periodontal disease. Periodontal disease is a group of inflammatory conditions which impact the tissues surrounding the teeth. In the earliest stage of the disease, the condition is called gingivitis. When a patient has gingivitis, their gums become swollen, red and may also bleed. The more severe form of the condition is called periodontitis. When periodontitis occurs, the gums detach from the tooth, bone loss can occur, and the teeth can become loose or even fall out. Another common side effect of periodontitis is bad breath.

In general, periodontal disease is caused by bacteria in the mouth. This bacteria infects the tissues which surround the teeth. The most common risk factors for periodontal disease include smoking, diabetes, HIV/AIDS, family history of the disease and some types of medication. A dentist is able to diagnosis the condition by inspecting the gum tissue around the teeth both visually and using a special probe. In some cases, x-rays may also be used to evaluate the level of bone loss around the teeth.

Treatment for periodontal disease often involves improved oral hygiene practices and regular visits to the dentist for professional cleanings and exams. A good oral hygiene regimen typically includes brushing the teeth twice each day and flossing. Dental surgery or antibiotics may be suggested as part of the treatment plan for some patients. It is more common for males to be affected with periodontal disease compared to females.

Chronic periodontitis is a disease which can exist in the oral cavity. It represents chronic inflammation of the periodontal tissues from dental plaque accumulation. Periodontitis begins in the form of gingivitis and when left untreated, can progress into chronic or aggressive periodontitis. It is critical to diagnose chronic periodontitis in the early stages in order to prevent severe and even permanent damage. As most patients with chronic periodontitis do not experience pain, patients often do not seek dental treatment in the early phases. With the proper mechanical removal of biofilm and calculus subgingivally, cases of mild to moderate chronic periodontitis can be treated. In order to manage the disease, a thorough oral hygiene routine and regular periodontal checkups every three months are necessary.

Various risk factors can impact the prevalence, rate, extent and severity of the disease. Some of the most vital risk factors include smoking, poor oral hygiene habits and the inability to control plaque biofilm.

Attachment Anatomy

The teeth are connected to the alveolar bone by the periodontal ligament (PDL) fibers. PDL fibers run from the bone to the cementum, which naturally exists on the root surface of teeth. These fibers are also attached to the gingival tissue which covers the alveolar bone by way of an attachment apparatus. Because the attachment is superficial compared to the height of the alveolar bone, it is called the supracrestal attachment apparatus.

The supracrestal attachment apparatus is formed from two layers, the coronal junctional epithelium and the more apical gingival connective tissue fibers. Combined, these two layers form the thickness of the gingival tissue. This particular dimension is referred to as the biologic width.

Periodontal Disease

In most cases, plaque-induced periodontal diseases are classified as destructive or non-destructive. Clinical attachment loss is a sign of destructive and periodontal disease which cannot be reversed. The term clinical attachment loss is often used to describe connective tissue attachment loss.