Running Head: CHRONIC PERIODONTITIS

Chronic Periodontitis
Jennifer Linder
Indian Hills Community College
CHRONIC PERIODONTITIS

Chronic Periodontitis
Chronic periodontitis is the most common form of periodontal disease, so it is what a
dental hygienist will see the most of throughout their career. Since it is the most common, it is
important for dental hygienists to have a deep understanding of the disease, its causes, and how
to treat it. The terms periodontitis and periodontal disease are often used in place of “chronic
periodontitis.”
Chronic periodontitis affects over 20% of the United States population. It in most
prevalent in adults, usually gets noticed around age 35, but can begin at any age and can appear
in children or adolescents. It slowly progresses throughout life if it is not recognized and treated.
In the United States, it is found more commonly in men than in women, which can be related to
the fact that women seek dental care more regularly than men. It can appear as localized or
generalized within the mouth. Progression of attachment loss is intermittent in episodic bursts
until the teeth are lost.
Chronic periodontitis is characterized by horizontal bone loss and is directly related to the
accumulation of plaque biofilm and calculus on the surfaces of the teeth. The amount of
destruction is found to be consistent with the amount of plaque biofilm and calculus present
within the oral cavity. It is considered a multibacterial disease, consisting of high levels of gram-
negative anaerobic bacteria and spirochetes. Specific bacteria are not attached to the diagnosis of
chronic periodontitis. One of the primary pathogens, and the most common one found, is
Porphyromonas gingivalis, a red complex bacteria. Tannerella forsynthensis, Treponema
denticola, Prevotella and Fusobacterium species, and Actinomyces actinomycetemcomitans are
other pathogens commonly found in chronic periodontitis cases. Presence of specific pathogens
are not a diagnostic basis to rely on. Clinical rather than bacteriologic diagnosis is the primary
method of diagnosing chronic periodontitis. Determining attachment loss through probing of the
periodontal pockets and radiographs is the basis of diagnosing chronic periodontitis.
Systemic disease and abnormalities in the host defense are not associated with the
formation of chronic periodontitis, but can modify the disease. Factors such as stress and tobacco
use can cause chronic periodontitis to have a period of rapid progression. Host response may
include inflammation and bleeding of the gingiva.
Treatment of chronic periodontitis is dependent on each patient’s condition and
individual needs. Patients with slight or moderate periodontitis can be treated within a general
CHRONIC PERIODONTITIS

dental practice with non-surgical periodontal therapy, but patients with advanced cases may need
surgical periodontal therapy from a periodontist in a periodontal specialty practice. Patients may
need to be referred to a periodontist for a deeper evaluation and diagnosis prior to receiving any
treatment. Once bone level is lost, it cannot be reversed. Treatment is focused on stopping further
progression of attachment loss. In order to stop the progression of chronic periodontitis, the
plaque biofilm and calculus must be removed and prevented from reforming. Non-surgical
periodontal therapy, also known as SRP (scaling and root planing), is a deep cleaning of the oral
cavity. Dental hygienists use ultrasonic scalers, hand scalers, and specialized root curettes to
remove plaque biofilm and calculus from the crown and root surfaces of the teeth. The amount of
work required to thoroughly debride the teeth and periodontal pockets requires multiple
appointments. Depending on the degree of severity, the appointments will be divided into 2, 4, or
6 appointments where the dental hygienist performs the non-surgical periodontal therapy in
either halves, quadrants, or sextants of the mouth. It is detrimental to the patient’s outcome to
fully explain the risks and benefits associated with receiving or denying nonsurgical periodontal
therapy. Some patients may be hesitant to accept care because of finances or the amount of
appointments required. They will also need re-care appointments every 3 months.
Patient education on home care is detrimental to the cessation of their chronic
periodontitis and prevention of further attachment loss. Patients must understand the proper
toothbrushing technique to remove plaque biofilm from all surfaces of the teeth. Patients must
understand the need for plaque biofilm removal 2 times a day. They must also understand the
importance of cleaning the interproximal spaces. If the patient does not prevent future buildup of
plaque biofilm and calculus, the disease will continue progressing.
Before starting the treatment process, the hygienist should explain the treatment plan to
the patient and receive informed consent. If the patient does not understand the importance of
their cooperation and agree to be compliant throughout the treatment course, the treatment plan
should not be started, because if it is not adequately followed, chronic periodontitis will continue
to progress for the patient.