Chronic Periodontitis

In 1999, The American Academy of Periodontology classified seven categories of periodontitis, or gum disease. Though these classifications have been modified, the seven initial classifications continue to provide a guideline for many periodontists. Chronic periodontitis is one of these initial seven classifications and is a common disease that is characterized by chronic inflammation of the tissues inside the oral cavity, specifically the tissues of the periodontium. It is estimated that around 35% of adults in the United States have chronic periodontitis, the likelihood of which increases with age. This chronic inflammation is generally caused by the unchecked proliferation of excessive amounts of dental plaque. Early diagnosis of chronic periodontitis is a vital part of the disease’s maintenance and can prevent irreversible damage from befalling the structures and tissues that protect and support the teeth. However, because periodontitis generally progresses painlessly, people may be unlikely to seek dental care; this is one of the more salient reasons that periodic professional dental checkups and cleanings are strongly recommended. Periodontitis can be diagnosed easily at a dental checkup, and subgingival plaque and tartar can be removed, slowing or even preventing gum disease.

Chronic periodontitis is characterized by the formation of pockets between the gum tissue and the teeth, the gradual separation of the teeth from the gums and loosening of the teeth in the bones, and, eventually, loss of the bone that supports the teeth. In its earliest stages, when only gingival recession is present, gum disease can be reversed. Once more destructive periodontal pockets are present, the disease can be slowed and managed but cannot be reversed. While aging contributes to the likelihood of periodontitis developing, other significant risk factors for chronic periodontitis are lack of oral hygiene and smoking. Chronic periodontitis may also be associated with certain systemic diseases, and it may be exacerbated by such factors as emotional stress and anxiety. The disease usually progresses slowly, though some patients may experience “bursts of destruction” in which the disease progresses more rapidly.

Gum diseases are initiated by a host response in the oral cavity, in which the tissues of the periodontium become inflamed in response to an imbalance in the types of bacterial plaque in the mouth, and to an excess of dangerous bacteria. This gradually leads to destruction of the bone and connective tissue of the periodontium. While this is often painless, it can be characterized by certain symptoms, including redness and bleeding from the gums, especially while brushing or flossing; persistent swelling of the gum tissues; pocket formation between the gums and teeth; bad breath; and, eventually, loosening and possible loss of the teeth. Bleeding and redness may also characterize gingivitis, which is reversible when addressed early on. If left inadequately addressed, however, gingivitis frequently progresses to chronic periodontitis. Dentists can diagnose periodontitis and determine its severity by assessing the depth of periodontal pockets; noting the presence of clinical attachment loss and bleeding on probing; indexing the quantity of plaque present in the oral cavity; noting any suppuration, furcation, or mobility; and reviewing x-rays of the oral cavity. Treatment depends on the severity of the disease, though the basic periodontal treatment consists of mechanical removal of subgingival and supragingival plaque and tartar, followed by the application of a topical antibiotic to discourage further bacterial proliferation.