Clinical Attachment Loss

The periodontal disease known as periodontitis is characterized primarily by a condition called clinical attachment loss. To understand clinical attachment loss, it’s helpful to understand the basic anatomy of the periodontium. The periodontium is the set of specialized tissues that support and surround the teeth, and it includes the gingiva, or gum tissue; the cementum, which is the mineral coating of the roots of the teeth; the alveolar bone that supports the teeth; and the periodontal ligament fibers that attach the cementum to the gingival tissue. The gingival tissue is attached to the alveolar bone, coating the height of its surface and affixed to the bone by ligaments that are called the supracrestal attachment apparatus. This supracrestal attachment apparatus is made up of the separate strata of the coronal junctional epithelium and the connective tissue fibers of the gingiva; these tissues are layered together over the alveolar bone.

Clinical attachment loss is specific to destructive periodontal diseases and indicates irreversible damage to the periodontium. It is caused by periodontitis, and it is specifically characterized by the relocation of the junctional epithelium, which shifts from a coronal position to an apical position, or a position that is proximal to the root of the tooth. Other indicators of clinical attachment loss include the pathological destruction of the gingival fibers and the fibers of the periodontal ligament, and dissolution and resorption of the alveolar bone that surrounds the teeth.

In its earlier stage, inflammation of the gum tissues is known as gingivitis. If not treated, gingivitis often progresses to periodontitis. Gingivitis is primarily caused by a buildup of the bacteria in plaque. Plaque naturally forms on the teeth, and all plaque contains bacteria; with proper oral hygiene, which includes twice-daily brushing and daily flossing combined with regular professional cleanings and checkups, the accumulation of plaque can be minimized and gingivitis can be prevented. Even when gingivitis is present, it can often be reversed with effective removal of accumulated plaque and dental calculus, as it is characterized primarily by inflammation and irritation and not by destruction. When gum disease advances to periodontitis, pockets form as the tissues of the gum pull away from the teeth, and these small pockets are prone to collecting a proliferation of debris and becoming infected. This causes the immune system to produce inflammation, as a defense mechanism against bacteria, below the gumline, which leads, in turn, to clinical attachment loss. Clinical attachment loss creates increasingly deep periodontal pockets, which become more difficult to clean and which lead to the destruction of more gum and bone tissue, eventually leading to loss of the teeth. Gum disease is a significant contributing factor for tooth loss in adults. While periodontitis, characterized by clinical attachment loss, is irreversible, it can be treated and managed. The ideal goal of periodontal treatment is to save the teeth; even when the teeth have already been damaged beyond repair, however, treatment can consist of restoration of the bone and gum tissue and the placement of dental prostheses that allow the wearer to chew, speak, and smile as if they had a mouth full of their own healthy, natural teeth.