4. Chronic periodontitis, formerly known as adult periodontitis
or chronic adult periodontitis, is the most prevalent form of
It is generally considered to be a slowly progressing disease.
Although chronic periodontitis is most frequently observed
in adults, it can occur in children and adolescents in response
to chronic plaque and calculus accumulation.
5. Chronic periodontitis has been defined as “an
infectious disease resulting in inflammation with in
supporting tissues of the teeth, progressive attachment
loss and bone loss”.
6. Major Clinical & Etiologic
Characteristics of the
1. Microbial plaque formation.
2. Periodontal inflammation.
3. Loss of attachment and alveolar bone.
9. 1. Most prevalent in adults but can occur in
children and adolescents.(age-35+yrs).
2. Supra-gingival and sub-gingival plaque
accumulation (frequently associated with
3. Gingival inflammation
4. Pocket formation
5. Loss of periodontal attachment
6. Occasional suppuration
7. Poor oral hygiene – gingiva is typically may be
slightly to moderately swollen.
10. 1. Color- pale red to magenta
2. Consistency – soft or firm
3. Surface topography – loss
4. Blunted or rolled gingival
5. Flattened or cratered
6. Tooth mobility.
7. Furcation involvement.
8. Spontaneous gingival
9. Pocket depths are variable
and both supra-bony and
intra-bony pockets can be
1. Bleeding gums during brushing or eating.
2. Increasing spacing between teeth as a result of tooth
3. Loose teeth
4. Usually painless, but sometimes localised dull pain
radiating deep into the jaw.
5. Sensitivity to heat, cold, or both due to exposed roots.
6. Food impaction
8. Gingival tenderness or itching.
<30% of the sites assessed in oral cavity demonstrate
attachment loss and bone loss.
>30% of the sites assessed demonstrate attachment loss and
The pattern of bone loss in chronic periodontitis can be vertical
17. Risk Factors For Disease
1. Prior History of Periodontitis
2. Local Factors
3. Systemic Factors
4. Environmental and Behavioural Factors
5. Genetic Factors
18. Systemic Factors
1. Smoking is a major risk factor
3. Conditions associated with compromised immune responses (e.g. HIV)
4. Nutritional defects
6. Medications that cause drug induced gingival overgrowth (e.g. some calcium
channel blockers, phenytoin, cyclosporine).
Genetic factors (as yet poorly defined)
Undoubtedly one of the main and most prevalent, risk
factors for chronic periodontitis, risk calculations
suggesting 40% of the cases of chronic periodontitis may
be attributable to smoking.
It has been estimated that there are 1.1 billlion are
smokers worldwide and 182 million (16.6%) of them live
1. Both the prevalence and severity of
periodontal disease increases with age.
2. Intake of medications.
3. Decreased immune function.
4. Altered nutritional status interaction.
• It is a disease characterised by low bone mass and deterioration of
bone structure that causes bone fragility and increases the risk of
• Both osteoporosis and periodontal diseases are bone resorptive
• Osteoporosis could be a risk factor for the progression of chronic
• A direct association between skeletal and periodontal disease as
measured by loss of inter-proximal alveolar bone in
postmenopausal women has been reported.
22. AIDS epidemics in US suggests HIV
positive patients especially those with
AIDS and low count of T
Lymphocytes(CD4 <200 cells/ml) were
at increased risk of chronic
1. Initial therapy ( scaling and root planing)
2. Antimicrobial therapy – as an adjunct to routine periodontal
3. Improvement in oral hygiene.
4. Instruction, reinforcement, evaluation of plaque control
5. Removal of all the factors contributing to plaque
accumulation, e.g. correction of ill-fitting appliances, over
contoured crowns, overhanging restorations, etc..
25. SURGICAL THERAPY
A variety of surgical treatment modalities may be appropriate in
managing the patient.
1. Pocket elimination procedures.
2. Regenerative therapy :
A. Bone replacement grafts;
B. Guided tissue regeneration;
C. Combined regenerative techniques.
3. Resective therapy :
A. Flaps with or without osseous surgery;
Slight to moderate periodontitis, the prognosis is usually
good provided , the inflammation can be controlled through
good oral hygiene and the removal of local plaque retentive
In patients with more severe disease, as evidenced by
furcation involvements and increasing mobility, or in patients
who are noncompliant with oral hygiene practices, the
prognosis may be downgraded from fair to poor.