Periodontology Diagnosis - Chronic Periodontitis

Chronic periodontitis is a prevalent disease found in the oral cavity. It consists of chronic inflammation of the periodontal tissues due to the accumulation of dental plaque. Periodontitis starts as gingivitis and can progress onto chronic and aggressive periodontitis. It is important to diagnose chronic periodontitis in its early stages in order to prevent severe and irreversible damage to the tooth. Because chronic periodontitis is painless as the disease progresses, it’s not common for patients to seek dental treatment in the early stages. Mild to moderate chronic periodontitis is manageable with the proper mechanical removal of the biofilm and calculus subgingivally. Thorough and effective oral hygiene and regular periodontal checkups every three months are critical for managing the disease.

Chronic periodontitis is prevalent in the adult and senior population worldwide. In the United States, the disease affects about 35% of adults between the ages of 30–90 years-old. The cumulative effects of the alveolar bone loss, attachment loss and formation of pockets is more obvious as patient’s age. Age is related to increased periodontal destruction. In patients who practice good oral hygiene at home and maintain regular check-ups, the prevalence of periodontal destruction increases with age. The highest rate is reported as occurring between the age of 50 and 60.

There are numerous risk factors which can affect the prevalence, rate, extent and severity of the progression of the disease. Some of the most important risk factors include smoking, poor oral hygiene and the inability to control plaque biofilm.

The disease typically progresses in a slow to moderate rate, however, the patient may have some periods of rapid progression. Chronic periodontitis can be also associated with factors which are local predisposing. The disease can also be modified by and be associated with some systemic diseases including diabetes and HIV. It can also be modified by outside factors beyond systemic diseases like smoking and emotional stress, anxiety or depression. In patients who smoker, the gingiva are pale, fibrous and are less likely to bleed when probed. This is because of the effect of nicotine on the vasculature. As a result, there is a slower response which explains why incorrect data can be gained from examinations.

Signs and symptoms

Chronic periodontitis has few symptoms in the early stages. For many individuals, the disease has substantially progressed before they seek treatment. Symptoms can include the following:

• Redness or bleeding in the gums when brushing teeth, using dental floss or biting into hard food.
• Reoccurring gum swelling
• Halitosis or chronic bad breath. A metallic taste in the mouth
• Gingival recession, which gives the appearance of lengthened teeth. This can also be caused by using too much pressure when brushing or when using a stiff tooth brush
• Deep pockets between the teeth and the gums
• Loose teeth, in later stages of the disease
• Drifting of the incisors

Gingival inflammation and bone destruction often don’t result in pain. Patients often assume that bleeding after cleaning their teeth is normal. Though this can be a symptom of progressing chronic periodontitis.

Dentists agree that by quitting smoking and good oral hygiene are critical for effective treatment and successful outcomes for patients. Treatment usually involves a combination of non-surgical and surgical therapy. The first treatment that is typically used is called scaling and root planing (SRP).