CHRONIC PERIODONTITIS

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KAVIN N T
INDEX:
INTRODUCTION
ETIOLOGY
RISK FACTORS
DISEASE DISTRIBUTION
CLINICAL FEATURES
PROGRESSION OF DISEASE
DISEASE SEVERITY
RADIOGRAPHIC FEATURES
CLINICAL DIAGNOSIS
TREATEMENT
INTRODUCTION
Chronic periodontitis was previously known as adult
periodontitis or progressive periodontitis
It has been defined as “an infectious disease resulting
in inflammation within the supporting tissues of the
teeth, progressive attachment loss and bone loss”.
ETIOLOGY
Causative organisms of chronic periodontitis are;
Porphyromonas gingivalis
Prevotella intermedia
Capnocytophaga
Eikenella corrodens
Campylobacter rectus
Aggregatibacter actinomycetemcomitans
RISK FACTORS OF THE
DISEASE
LOCAL FACTORS :
Plaque and calculus accumulation,
subgingival restorations, crowded teeth
SYSTAMIC FACTORS :
Diseases such as diabetes
ENVIRONMENTAL AND BEHAVIORAL FACTORS
Smoking, stress
GENETIC FACTORS:
Family history
DISEASE DISTRIBUTION
LOCALIZED PERIODONTITIS :
When less than 30 percent of the site
assessed in the oral cavity demonstrate attachment loss
and bone loss

GENERALIZED PERIONTITIS:
When more than 30 percent of the sites
assessed in the oral cavity demonstrate attachment loss
and bone loss
CLINICAL FEATURES
Accumulation of supragingival and subgingival plaque
and calculus formation.
Gingival inflammation.
Attachment loss either by recession or pocket formation.
Inflammatory swelling.
Changing in color from pale red to purplish red.
Loss of stippling.
Tooth mobility is seen in advanced cases.
Rounded gingival margin and flattened interdental
papilla.
SYMPTOMS
Painless

Sensitivity to hot and cold

Localized areas of food cause discomfort

Impaction areas of food cause discomfort

PROGRESSION OF THE DISEASE
Rate of disease progression is usually slow but may be
modified by systemic , environmental ,behavioral
factors
However because of its slow rate of progression chronic
periodontitis usually becomes clinically significant in
the mid 30s or later
Several models have been proposed to describe the rate
of disease progression.
Continuous paradigm.
Random burst theory.
Asynchronous multiple
Continuous paradigm implies slow, continuous and
progressive destruction of periodontium.
Random burst theory proposes that the progression of
disease occurs at short periods of active destruction
which are followed by periods of remission that occur
with respect to time and site in an individual.
Asynchronous multiple burst model the tissue
destruction occurs at a definite period of time in ones
life, then it passes into a state of remission as in
juvenile periodontitos.
DISEASE SEVERITY
DESCRIBED BY THE AMOUNT OF
ATTACHEMENT LOSS:

Slight(mild) one to 2mm CAL

Moderate 3-4mm CAL

Severe 5mm or more CAL

RADIOGRAPHIC FEATURES
Pattern of bone loss observed in chronic periodontitis
may be vertical or horizontal.
When attachment loss and bone loss on one tooth
surface is greater thane that on an adjacent surface is
referred to as vertical bone loss
 when attachment loss and bone loss occur at a
uniform rate on majority of tooth surface is called
horizontal bone loss
CLINICAL DIAGNOSIS

Clinical attachment loss

Radiographs
TREATMENT
oral hygiene instructions

Scaling and root planing

Pocket therapy