Chronic Periodontitis

What is periodontium? 

It involves all supporting structures which is composed of:

• gingiva
• alveolar mucosa
• cementum
• periodontal ligament
• alveolar bone

• Slowly progressive disease 
• It occurs in response to plaque and calculus. 
• It progresses aggressively in patients with
  • diabetes: type I 
  • Smoking habits: more attachment loss and bone loss, more furcation involved, and deeper pockets.
  • Thyroid condition 
  • It can occur in childhood and adolescence also

What is pocket? 

It is pathological deepened cervical gingiva. We can observe that junctional epithelium (attachment of gingival structure) is broken down or detached from coral end. This causes deepened sulcus. Hence, Plaque and calculus are deposited. 

Clinical Features

• Gingival Inflammation is present 
• We can see pocket formation
  • Slight: 1-2mm 
  • Moderate: 3-4 mm 
  • Severe: 5 mm or more 
• Loss of attachment (recession) 
• Presence of inflammatory swelling
• Colour ranges from pale red to magenta 
• Loss of stippling 
• Blunted or rolled gingival margin
• Blunt or flattened interdental papilla 
• All the signs of inflammatory may not always be present 
• May bleed on probing the pocket 
• Increased gingival fluid exudation
• Purulent exudate may be present 
• Signs of inflammatory may be masked because of fibrotic changes
• Horizontal and Vertical bone loss 
• Progressive increase in the mobility of teeth involved due to bone loss

How do you differentiate periodontitis and gingivitis? 

It’s simple, in giginvitis, you can observe no bone loss and mobility whereas, in periodontitis, you can observe mobility, deep pockets and recession.

Differential Diagnosis

• Age of patient 
• Rate of disease progression 
• Familial nature of the aggressive disease
• Can be correlated with the amount of plaque and calculus present 

How to calculate whether chronic periodontitis is generalised or localised based on number of teeth? 

Rules: 

Generalised – when >30% of teeth show attachment loss 

Localised- when <30% of teeth show attachment loss

Let’s consider two type of patents. 

In patient A, the number of teeth is 32. 

We calculate 30% of total teeth, which means 10 teeth are affected by periodontitis. This denotes patient has the generalized condition.

If 7 teeth have recession and pockets, that’s is less than 10. The patient had localized condition. 

In patient B, the total number of teeth is 28

We calculate 30% of 28 teeth, which means 8 teeth are affected. This denotes patient has a generalized condition.

If 6 teeth have recession and pockets, that’s is less than 8. The patient had localized condition. 

Symptoms

• Usually painless due to absence of receptors
• Sometimes, localised dull pain radiating deep into the jaw during brushing 
• Sensitivity to hot and cold or both due to exposure of root dentin. The sensation will be tingling 
• Food lodgement in the areas of bone loss cause discomfort 
• Due to food accumulation, patients feel itchness in the gingiva. They try to remove it using a toothpick. 

Disease Progression

• Slow rate- depends on the post immunity but ageing or disease factors or diabetes play a role in the rate.
• Onset can occur at any time in the presence of calculus and plaque at site-specific surfaces. 
• It is more evident in the mid-30s due to accumulative effect. 
• Some areas progress at a faster rate or slower rate. 
• Faster Rate- due to more accumulation of plaque and short conical roots such as anteriors