2. Chronic periodontitis
It is defined as an infectious disease
resulting in inflammation within the
supporting tissues of the teeth,
progressive attachment loss and bone
3. Clinical features.
Presence of supra & subgingival plaque and
Loss of periodontal attachment.
Loss of alveolar bone.
20. In pt’s with poor oral hygiene, the
gingiva shows following features
Pale red to magenta color,
Slight to moderate swelling,
Loss of stippling,
Blunted /rolled gingival margins and
flattened/ cratered papillae.
21. In pt’s with regular home care
Changes associated with color, contour, of the
gingiva may not be visible by inspection,
Thickened & fibrotic gingiva,
Presence of periodontal pockets,
Bleeding on probing with periodontal probing
GCF & suppuration is found in the pocket,
Horizontal & vertical bone loss,
Tooth mobility in advanced cases
22. Clinical diagnosis
Detection of chronic inflammatory changes in
the marginal gingiva,
Presence of periodontal pockets,
Loss of clinical attachment,
Radiographic evidence of bone loss.
23. Differential diagnosis from that of
• Age of the pt,
• Rate of disease progression over time,
• Familial nature of aggressive disease,
• Relative absence of local factors in aggressive
24. Disease distribution
• Chronic periodontitis is considered as a
‘site specific disease’.
• Because clinical signs of the disease
occur on one surface of a tooth ,while
the other surfaces maintain normal
25. Classification of chronic periodontitis
based on disease distribution
A. Localized periodontitis - less than 30% of the
sites assessed in the mouth demonstrate
attachment loss & bone loss.
B. Generalized periodontitis - 30% or more of
the sites assessed in the mouth
demonstrate attachment loss & bone loss.
26. vertical bone loss- attachment & bone loss
on one tooth surface is greater than that on
an adjacent surface & is associated with intra
horizontal bone loss- attachment & bone loss
proceeds at a uniform rate on the majority of
tooth surfaces & is associated with supra
27. Classification chronic periodontitis
based on Disease severity.
1) Mild periodontitis-periodontal destruction
not more than 1-2 mm of clinical
2) Moderate periodontitis-periodontal
destruction not more than 3-4 mm of
clinical attachment loss.
3) Severe periodontitis-periodontal
destruction not more than 5mm or more
of clinical attachment loss.
• Gum bleeding while brushing & eating,
• Occurrence of space between teeth,
• Occasionally pain due to exposed roots which
are sensitive to heat & cold,
• Areas of localized dull pain, sometimes
radiating deep into the jaw,
• Areas of food impaction,
• Gingival itchiness & tenderness
29. Disease progression
It can occur at any age/time but first signs may
be detected during adolescence,
It progress at slow rate & is significant in the
mid 30’s or later,
It does not progress at an equal rate in all
affected sites throughout the mouth,
Lesions of the interproximal areas show rapid
progression along with furcation areas,
ovrhanging margins , sites of malposed teeth
& areas of food impaction.
30. Proposed models of disease
Is assessed by measuring the amount of attachment
loss during a given period of time
I. Continuous model-slow & continuous disease
progression throughout the duration of the
II. Random model/episodic burst model- disease
progression by short bursts of destruction
followed by periods of no destruction.
III. Asynchronous multiple-burst model- disease
progression around affected teeth during defined
periods of life & these bursts of activity are
interspersed with periods of inactivity/remission.
• It increases in prevalence & severity with age.
• Both the genders are equally affected,
• Periodontitis is age associated, not an age
related disease-it is not the age of the
individual that causes the increase in disease
prevalence but rather the length of time that
the periodontal tissues are challenged by
chronic plaque accumulation.
32. Risk factors
Prior history of periodontitis,
-if not successfully treated,
-in pt’s with poor oral hygiene maintenance
-dental plaque with porphyromonus
gingivalis, treponema denticola &
-dental calculus & other predisposing factors
33. • Systemic factors.
- diabetes mellitus.
• Environmental factors-
- emotional stress.
• Genetic factors
- genetic variation or polymorphism in the
genes encoding IL-1 and IL-1β is associated
with more aggressive form of chronic
34. Treatment of chronic periodontitis.
Preliminary phase/ emergency phase
Phase i- periodontal therapy / nonsurgical / etiotrophic
Plaque control & pt education.
Scaling & polishing,
Correction of T.F.O / occlusal therapy,
Antimicrobial therapy-systemic & local,
Minor orthodontic therapy,
Excavation of caries & restoration
correction of restorative & prosthetic irritational factors
Evaluation of response to phase I therapy.
35. Phase ii- periodontal therapy/surgical phase.
Periodontal flap surgery for pockets.
Evaluation of response to phase ii therapy.
Phase iii- periodontal therapy/restorative phase.
Fixed & removable prosthesis
Phase iv- periodontal therapy /maintenance
periodic rechecking for,
-plaque & calculus
-Pockets & inflammation
-Tooth mobility ….,