1. Chronic periodontitis
Definition : it is an infectious disease result in
inflammation with in the supporting tissues of
the teeth ,progressive attachment loss and bone
loss .
It was known as adult periodontitis ,but now it is
chronic periodontitis and can occur in children
2. • It is generally slowly progressive disease ,but in
presence of local envirnomental factors or
systemic disease it may become more aggressive.
• These factors are :
a) Systemic e.g. diabetes mellitus ,stress and HIV
b) Environmental e.g. smoking
3. c. Local factors include :
tooth anatomy
Root curvature
Improper restoration
Appliances .
Chronic periodontitis is known to be the main
cause of tooth loss through out life .
4. • Etiology : mainly plaque
• Classification : chronic periodontitis is
classified according to
1) Distribution : into
a) Localized periodontitis when the sites affected
with attachment loss and bone loss are ≤30% .
b) Generalized when sites affected are ≥30%
5. 2) According to severity into :
a) Mild : amount of CAL is 1-2mm
b) Moderate CAL is 3-4mm
c) Severe CAL is ≥5mm .
• Chronic periodontitis is considered to be site-
specific disease i.e. the clinical signs of the
disease are believed to be caused by the direct
6. Site –specific effects of the sub gingival plaque
accumulation .as a result of this site –specific
effect pocketing , attachment loss , bone loss
may occur on one surface of the tooth while
other surface maintained normal attachment
level .
7. • Clinical features : the charactristic clinical
finding in patient with untreated chronic
periodontitis include :
1. Supra and sub gingival plaque accumulation (
frequently associated with calculus
formation) .
2. Gingival inflammation
8. 3. Pocket formation
4. Loss of the periodontal attachment
5. Loss of alveolar bone
6. Occusionally suppuration .
7. tooth mobility often appears in advanced
cases with extensive attachment loss and bone
loss .
9. • In patient with poor oral hygiene , the gingivae may
typically be :
a) Slight to moderately swollen .
b) Color alternation ranging from pale red to megenta
red
c) Loss of stippling
d) Surface topography is changed to be blunt or rolled
marginal gingivae and flattened or cratered papillae
10. In may patient especially who performed regular
home care these changes in gingival color
,countour , and consistency are not visibly
inspected and frequently associated with
gingival inflammation which is detected only
as bleeding of the gingivae in response to
examination of the periodontal pocket with a
periodontal probe .
11. • In some cases probably as a result of long –
standing inflammatory disease the gingival
margin becomes thickened and fibrotic and
may obscure the underlying inflammatory
changes .
• Both horizontal and vertical bone loss may be
found .
12. • Vertical bone loss in chronic periodontitis is
seen when the attachment loss and bone loss
on one tooth surface is greater than on the
adjacent surface , while the horizontal one is
seen when attachment loss and bone loss
proceeds at a uniformity on majority of the
tooth surfaces .
13. • Diagnosis : can be detected by :
a) Clinical examination : in which there are
inflammatory changes on the marginal
gingivae , presence of periodontal pocket and
loss of clinical attachment .
b) Radiographically : by evidence of bone loss
These finding are similar to those in aggressive
14. Periodontitis . The differential diagnosis is based
on the following :
i. Age of the patient
ii. Rate of the disease progression
iii. Familial nature of aggressive disease
iv. Relative absence of local factors in
aggressive periodontitis compared to chronic
periodontitis
15. Symptoms :
1. patient first become awared they have
chronic periodontitis when their gum bleed
when brushing or eating .
2. Spaces between teeth as their teeth started
to move and become loose
3. Pain in absence of caries because of root
exposure that are sensitive to heat, cold ,or
both .
16. 4. Localized area of dull pain sometime radiating
deep into jaw.
5. Localized area of food impaction may lead to
patient discomfort
6. Gingival tenderness or itching may also be
found.
17. • Risk factors: include the following :
1) Prior history to periodontitis : patient
previously affected by chronic periodontitis
are at greater risk to develop more attachment
loss .
2) Local factors : include plaque and plaque
retentive factors .
18. Gram –ve bacteriae in sub gingival plaque are
considered to be the more pathogenic factor in
initiation of chronic periodontitis mainly
which is called the red complex
microorganism such as p.gingivalis ,
Tannerrlle forsythia and treponemae denticola .
Plaque retentive factors mainly calculus .
19. 3) Systemic factors :both type 1 and 2 diabete
mellitus increase rate of disease progression .
4) Environmental and behavioral factors :
somking has been shown to increase disease
severity and extend by affecting host response
and also the response to therapy . In addition to
smoking ,emotional stress also affect the
disease severity and extend
20. 5) Genetic factors : recent data has shown that a
genetic variation or polymorphism in the gene
encoding interlukin IL-1α and IL-1β is
associated with increase susceptibility to a
more aggressive form of chronic periodontitis .
