Chronic Periodontitis: Causes,Signs,Symptoms,and Treatment of Periodontal Inflammation

Periodontitis is the inflammation of periodontium. In simple words, it is the disease which is characterized by inflammation of gums and few other underlying supporting structures of the teeth.

The classic definition of periodontitis is as follows:

“An infectious disease resulting in inflammation within the supporting tissues of the teeth, progressive attachment loss, and bone loss.”

The most common form of periodontitis is chronic periodontitis, which can be categorized as slowly progressing inflammatory disease. BTW there is also the acute form of periodontitis, which is called aggressive periodontitis and a necrotizing form of the disease called necrotizing ulcerative periodontitis.

However, differentiating between the aggressive and the chronic form of this disease is very difficult and most of the times, clinical features are exactly the same.

Below we have given the information about the most common form of this disease, which is chronic periodontitis.

Clinical Signs of Chronic Periodontitis

The earliest and the most obvious signs of periodontitis can be seen in the gingiva or the gums. Below are the most common signs of periodontitis that are seen in patients who haven’t undergone any treatment yet.

  • Most obvious sign in most cases will be the dental plaque and calculus, above and below the gums.
  • Swollen gums are another common finding.
  • Gum bleeding on a slight application of pressure may also be frequently seen.
  • The gingival borders or the edges of the gum line may not be normal.
  • The periodontal pocket formation is also a regular finding in cases of chronic periodontitis.
  • In severe cases, the tooth may be mobile and even change its position, in rare instances.
  • Radiographically, the changes in the other components of the periodontium, such as periodontal ligament and alveolar bone, can be observed.

Are Gingivitis and Periodontitis The Same?

Many people who visit dental clinics feel that both gingivitis and periodontitis are similar diseases because they both have gum problems. But that isn’t true.

Gingivitis isn’t the same as periodontitis. There are some major differences between the diseases, which are as follows.

Gingivitis is the name given to the inflammation of the gingiva or swelling in the gums, without attachment(the attachments that support the tooth) or underlying bone loss. Whereas peridontitis is the inflammation of periodontium, which includes gums as well, with underlying alveolar bone loss.

periodontitis chronic

Chronic Periodontitis in a known Smoker

Gingivitis can be reversed completely if optimum oral hygiene methods are implemented at the right time. But in periodontitis, this isn’t the case. Inflammation can be stopped if the proper measures are taken in periodontitis, but the bone loss and the attachment loss that has already happened can’t be reversed.

Not all the cases of Gingivitis proceed to periodontitis, but all the patients of periodontitis have priorly experienced gingivitis.

Chronic Periodontitis Classification

Based on the Extent of Damage

Based on the extent of damage done to the underlying structure, chronic periodontitis can be classified into the following categories.

Localized Chronic Periodontitis

This affects less than 30% of teeth in your mouth and bone loss/attachment loss is limited to only these teeth.

Generalized Chronic Periodontitis

In this type, the disease has already affected more than 30% of teeth and there may be an extensive bone and attachment loss.

Based on The Degree of Attachment Loss

Here’s a small piece of information about attachment loss, if you need. Attachment loss is nothing but the degradation of the periodontal fibers and the gum tissue that attach the tooth to the bone, for supporting purposes.

  • Mild chronic periodontitis: Has a clinical attachment loss of 1 to 2 mm
  • Moderate chronic: clinical attachment loss of 3 to 4 mm
  • Severe chronic: clinical attachment loss of 5 mm or more

Periodontitis Symptoms: How Do You Know That Your Periodontium is Inflamed?

The best way to control the damage that may be caused by periodontitis is to catch it early. And to do that, you need to know the symptoms of periodontitis properly. Below are the most common symptoms experienced by the people suffering from this periodontal inflammatory disease.

  • Gum bleeding is the first sign of periodontitis in most cases. So if you experience bleeding in gums while chewing, eating or brushing, visit your dentist.
  • There may be an occasional purulent discharge from the gums. This is a type of liquid that usually is discharged from a wound.
  • Receding gums or gingival recession may be present.
  • Sometimes you may notice black triangles between teeth.
  • Tooth sensitivity is commonly experienced by people suffering from periodontitis.
  • Food may frequently get stuck in between teeth, especially in the triangle area between teeth.
  • Bad breath is another common finding in this periodontal inflammatory disease.
  • In advanced cases, you may experience dull pain or pain sensations that radiate towards the head or other parts of the mouth.
  • Finally, in highly advanced cases, you may feel that your teeth are mobile and they have changed their position.

Why Is Chronic Periodontitis Caused? – The Risk Factors

A number of factors can influence the initiation and progression of periodontitis in an individual. The risk factors of periodontitis can be classified into the following categories.

  • Microbiological Factors
  • Local Factors
  • Systemic Factors
  • Immunologic Factors
  • Genetic Factors
  • Environmental Factors
  • Behavioral Factors

Microbiological Factors

Chronic periodontitis is believed to be caused by multispecies infection with a number of different bacteria. Gram-negative organisms readily found in the biofilm and plaque are mainly responsible for causing chronic periodontitis.

The microorganisms like Porphyromonas gingivalis, Tannerella forsythia, and Treponema denticola, otherwise known as the red complex bacteria have been associated with continuing bone loss and attachment loss seen in chronic periodontitis.

Periodontitis Causes

Smoking is a Major Cause of Periodontitis

Local Factors

As you already know, Plaque accumulation and dental biofilm formation are believed to be the primary factors that cause the periodontal inflammatory disease(BTW dental biofilm is an almost colorless sticky bacterial film, which adheres to the surface of the tooth). Therefore any factor that causes the accumulation of plaque in the mouth and doesn’t allow it to be cleaned easily with regular oral hygiene methods, can be considered a cause of periodontitis.

Here are some of the well known local factors that cause periodontitis.

  • Dental calculus is believed to be the most important plaque-retentive factor. That’s because calculus can retain and harbor plaque bacteria on its rough surface as well as inside.
  • Subgingival Caries
  • Overhanging restorations/fillings
  • Anatomical morphology: Some teeth have natural grooves on their surface that facilitate plaque accumulation and restrict plaque removal.
  • Crown margins
  • Deep gingival sulcus areas (the area between the gum and the tooth surface)

Systemic Factors

Chronic periodontitis is a complex disease which isn’t limited to local causes. There are many systemic reasons that can cause this disease.

  • Haim–Munk syndrome
  • Papillon–Lefèvre syndrome
  • Ehlers–Danlos syndrome
  • Kindler syndrome
  • Cohen syndrome

Patients who suffer from diseases that alter the host immune responses in individuals may also show this periodontal disease. AIDS or HIV infection is one such disease.

Other systemic conditions that may cause chronic periodontitis are

  • Osteoporosis
  • Severely unbalanced diet
  • Stress
  • Dermatologic, haematologic, and neoplastic diseases
  • Diabetes Mellitus (Doctors now believe that periodontitis is the sixth common complication of diabetes mellitus)
  • Cardiovascular disorders
  • Stroke
  • Lung disorders

Immunologic Factors

Onset, progression, and severity of this periodontal inflammatory disease depend, on the individual host immune response.

Following immunological factors are associated with chronic periodontitis.

  • Congenital neutropenia
  • Reduced counts in neutrophils
  • Alterations of peripheral monocytes, which relate to reduced reactivity of lymphocytes or enhanced B-cell response.
  • Periodontal ligament cells, gingival fibroblasts, and epithelial cells synthesizing pro-inflammatory mediators.

Genetic Factors

Many genetic disorders are associated with the signs and symptoms of the periodontal inflammatory disease.

Here are some of them:

  • Papillon–Lefèvre syndrome
  • Haim–Munk syndrome
  • Ehlers–Danlos syndrome
  • Down syndrome
  • Kindler syndrome
  • Cohen syndrome
  • Congenital neutropenia

Environmental and Behavioral Factors

Our behaviors, lifestyle and also the environment we live in, greatly influence the onset and progression of chronic periodontitis. Below are some of the important factors, in this category.

  • Smoking – This is a major causative factor of the periodontal inflammation.
  • Tobacco
  • Psychological stress
  • Depression

Treatment for Chronic Periodontitis

As we have mentioned earlier, this disease can’t be completely reversed. However, the inflammation can be stopped and further damage can be prevented. Nowadays there are many treatment options available to repair the damage that has already been done, to a certain extent.

In cases of severe infection and inflammation, the treatment may begin with the administration of topical and/or oral antibiotics.

Oral prophylaxis, dental scaling, and curettage are the first line of treatment. This is done to remove the primary causative agent from the mouth which in most cases is the calculus. Oral prophylaxis and scaling help to reduce the inflammatory signs of the periodontium to a major extent, thereby reducing the number of harmful bacteria in the mouth.

periodontitis treatment

Root planing is a procedure of smoothening the root surfaces of the tooth using special instruments. This is done to remove the inflammatory agents from the surface of the root and prevent the further accumulation of plaque and calculus.

Surgical Treatment for Advanced Cases

Flap Surgery 

Also called the pocket reduction surgery this procedure is carried out to recontour the damaged underlying alveolar bone which is followed by suturing the gingiva (gum) back in its normal place.

The periodontist usually makes an incision on the gum and then lifts it back exposing the root surfaces and the underlying bone. He/she will then do the scaling and root planing procedure followed by bone recontouring.

Soft Tissue Graft 

This is especially useful in case of a gingival recession. It’s also useful when there is a need to increase the thickness of the gingiva. This process involves removing tissue from the donor site and attaching it to the affected site. The donor site usually is the upper roof of the mouth or the palate. In some specific cases, other donor sites from within the mouth may be used.

Bone Grafting 

This procedure is similar to the soft tissue grafting which involves the removal of small bone fragments from the donor site and placing it and reinforcing it on the affected site. Most of the times the donor site is somewhere in your own body. In other cases, donor bone from others may be used. Artificial or synthetic bone material is also used nowadays.

Guided Tissue Regeneration

This procedure involves the elevation of the periosteal flap and curettage followed by the placement of biocompatible fabric. Most commonly used biocompatible agent for this purpose is the polytetrafluoroethylene membrane. This membrane prevents the entry of harmful agents inside and facilitates bone regrowth and attachment regain.

Root Resection

This procedure involves sectioning of the tooth and removing one or two roots that are severely damaged. This is done especially in molars. Whichever root that is retained is then treated endodontically and restored with a crown.

Tunnel Preparation

Involves enlarging the interdental space surgically, especially in lower molars. This is done to facilitate easy access for interdental cleaning devices.

Splints

This process involves increasing the support for the affected tooth by joining it to an adjacent tooth or teeth. This is usually done in teeth with moderate mobility. Splinting is done using orthodontic wires.

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