CHRONIC PERIODONTITIS

DR. NAEL ALMASRI

PERIODONTIST
 PERIODONTITIS

Definition
It is inflammatory disease of supporting tissues of teeth caused by
group of specific micro-organisms resulting in progressive
destruction of periodontal ligament and alveolar bone

1- Gingival inflammation
2- Apical migration of epithelial attachment( loss of attachment )
3- Irreversible destruction of gingival connective tissue , PDL ,
Bone , cementum

Attachment loss clinically :

Deep pockets
Recession
Furcation involvement
 PATHOGENESIS OF PERIODONTITIS
Gingivitis is always a component/ precede onset of periodontitis, or
it could remain stable for years and never progress to periodontitis.

Bacterial biofilm will induce gingivitis but the degree of host

response/susceptibility will determine whether or not chronic periodontitis
will develop
 Multi factorial disease

1- -Changes of bacterial composition of plaque

2- Changes of host response

3- Environmental and behavior factors can influence
plaque and host response
4- Genetic susceptibility
RISK FACTORS OF THE DISEASE
Local Factors
Anatomical
Cervical enamel projections
Enamel pearls
Root grooves and concavities
Furcation
Root trunk length
Crowding of the teeth
Frenum pull
Iatrogenic Factors
I- SYSTEMIC RISK FACTORS
II- ENVIRONMENTAL AND BEHAVIORAL
FACTORS

Smoking
Medication
Diabetes and hormonal changes(pregnancy , oral
contraceptive)
HIV infection
Osteoporosis
Familial and genetic risk factors
Psychological factors
 CHRONIC PERIODONTITIS
The most commonly occurring form of periodontitis

Chronic periodontitis previously called adult periodontitis

“Chronic” periodontitis refers to progression of the disease

over time without treatment and does not suggest that the
disease is “untreatable
OVERALL FEATURES OF CHRONIC PERIODONTITIS

1- Chronic periodontitis is prevalent in adults

>35 but may occur in children and adolescent
Can also be seen in adolescents and even in the primary dentition f
children
Increased prevalence with age
(Age associated disease not age related(

2- Evident plaque and local factor :

amount of plaque biofilm accumulation, local contributing risk factors

3- The composition of the biofilm may vary between

subjects and sites
Red complex, gram – anaerobic bacteria
 OVERALL FEATURES OF CHRONIC PERIODONTITIS

4- Rate of destruction is slow to moderate in general ,

BUT period of rapid destruction may occur

The progression of chronic periodontitis in most individuals and at most

disease sites is a continuous process.

5- Chronic Periodontitis can be modified by:

- Smoking

- Emotional Stress

- Systemic Diseases (diabetes)

6- Genetic factors may play some role (family history)

SYMPTOMS OF CHRONIC PERIODONTITIS

Usually painless

- Deep dull pain

(not always)
- Sensitivity to cold or hot

Bleeding

Spacing between teeth

Loosening teeth

Food impaction

Esthetic
 CLINICAL SIGNS AND SYMPTOMS OF CHRONIC
PERIODONTITIS

Gingival inflammation & Bleeding on probing

-Gingival tissue may appear bright red , red or purplish
also may appears swollen, rolled at gingival margins with
blunted or flattened papillae depend of severity and activity of
disease
Loss or flattened interdental papilla
 Poor oral hygiene
Accumulation of supragingival and subgingival Plaque
and calculus
 Periodontitis with
Gingival enlargement

Suppuration

Increased flow of gingival

Crevicular fluid or suppuration
(pus) from periodontal pockets is
common
 ATTACHMENT LOSS

Deep periodontal pockets Furcation involvement

16
 ATTACHMENT LOSS

Gingival recession

Localized or generalized
Increased teeth mobility Drifting and spacing of teeth
 Bone resorption
Dental Radiographs of patients with generalized chronic
periodontitis usually reveal horizontal patterns of alveolar bone
loss

vertical bone loss usually in localized periodontitis

where local factor present
Chronic Periodontitis is : a site-specific disease
(site predilection)
Chronic periodontitis does not progress at an equal rate in all
affected sites throughout the mouth
 Gingivitis periodontitis
Etiology mainly gram positive aerobic mainly gram negative anaerobic

Plaque and calculus +++ +++

Gingival inflammation ++++ +++

Supporting tissue loss _ +++

PDL. bone , cementum
Attachment level No apical migration of the junctional +++
-epithelium Loss of attachment
Bone level Normal level of bone Bone loss (vertical , horizontal )
Bleeding on probing +++ +++
Gingival enlargement -/+ -/+

Mobility -- -- --- -/+

Pocket Gingival pocket (pseudo-pocket ) Suprabony , infrabony True
periodontal pockets
Prognosis Excellent Depend on type and severity
Recession - +++
Furcation - +++
Treatment Scaling + polishing Scaling + root planning
Reversible Irreversible
 DISEASE DISTRIBUTION
Localized or generalized inflammation
< 30% of examined sites possess attachment loss and bone loss

Generalized inflammation

Generalized: if > 30% of examined sites possess attachment

loss and bone loss
 DISEASE SEVERITY

Based on attachment loss

Slight (mild): 1-2 mm of clinical attachment loss has occurred

Moderate : 3-4 mm of clinical attachment loss has occurred

Severe : 5 mm or more clinical attachment loss has occurred

 Goals of periodontal treatment
Resolve periodontal inflammation
Arresting disease progression and destruction of soft
tissue & bone
Restoring tissue destroyed by disease
Preventing recurrence of disease

Esthetic Function
Gingival contour Eliminate pain , reduce teeth mobility
position, color Prevent tooth loss
symmetry Establish optimal occlusal function
 TREATING CHRONIC PERIODONTITIS

Chronic periodontitis respond well to nonsurgical treatment

Clinical signs of inflammation are completely reversible;

bleeding on probing disappear but destruction, on the other

hand, are is irreversible
Non surgical periodontal therapy
Phase I therapy
OHI
Individualized instruction, reinforcement, and evaluation of the
patient's self-care skills to control plaque

Periodontal instrumentation of tooth surfaces

Scaling and root planning

Correction of local plaque retentive factors

Controlling systemic and environmental factors

(such as: uncontrolled or poorly controlled diabetes, systemic diseases,

or certain systemic medications)

Smoking
 Antimicrobial agents may be used as an adjunct to initial
therapy

Systemic antibiotics should not be used in the treatment of Chronic

Periodontitis patients without mechanical debridement

Biofilms are resistant to the to the action of antimicrobial agents

Systemic antibiotics should not be routinely used in the treatment of Chronic

Periodontitis patients in mild to moderate periodontitis
Thank you