Chronic PeriodontitisKim RobinsonAsia Hernandezperiodontitis2.jpg0403_Mealey_03_(1).jpg

Periodontitis differs from ginigivitis in that periodontitis displays clinically evident levels of host tissue destruction. This includes bone loss and attachment loss. In chronic periodontitis, this tissue destruction occurs slowly over a length of time and is a result of plaque and calculus present, but can also be modified by diseases, smoking, etc.

Generalized Chronic Periodontitis:

Clinically: Signs of inflammation such as erythematous, edematous attached gingiva with free gingiva being rolled, bulbous, clefted, or erythematous. Pocket depths greater than 1-3 mm that correlate with radiographs, recession, furcations and mobility (depending on how severe the case is). Increased BOP and MBI. Plaque and calculus are present in proportion to the amount of destruction.

Radiographically: Radiographs will correlate with probing depths in terms of bone loss instead of just pseudopockets. There is horizontal and/ or vertical bone loss and possibly furcations present. Lamina dura will be fuzzy or inconsistent depending on how advanced the case is. Calculus may be present radiographically.

Diagnosis: The diagnosis would be clinically evident based on the presence of plaque and calculus which leads to the clinical findings. It would be classified as generalized if the conditions were present on more than 30% of teeth in the mouth. Also, depending on the amounts of bone loss, it is classified as slight (1-2mm bone loss), moderate (3-4 bone loss), or severe (bone loss of 5 mm or more).


Bacterial involvement: The primary initiating factor of chronic periodontitist is plaque accumulation on the tooth and gingival surfaces at the DEJ. Over time, the bacteria associated with the plaque and calculus become more pathogenic (i.e gram negative, mobile, anarobic) and increase in number, Also, the plaque accumulates subgingivally, breaking down the attachment apparatus of the sulcus and the surrounding tissue giving the bacteria access to avelolar bone.


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We're here to destroy your mouth

"Red Complex" bacteria are frequently associated with chronic periodontitist and include: P gingivalis, T.forsynthis and T.denticola.


Localized Chronic Periodontitis:


Clinically and Diagnosis: Periodontitis is considered localized when less than 30% of the sites assessed in the mouth demonstrate attachment loss and bone loss (Carrzanza p.496). Like general chronic periodontitist, localized chronic periodontitis is most associated with an accumulation of certain type of bacteria (specific plaque hypothesis) however, the dental professional should pay extra attention to the specific areas of attachment and bone loss and customize patient education and treatment accordingly. For example, localized attachment loss can be associated with recession due to a frenum pull. The affects of a frenum pull (or short frenum) can often be seen in the mandibular anterior. Over time a frenum pull can cause the gingiva to receed in that area causing localized bone loss. In addition, localized bone loss can occur in areas of the mouth which are difficult for the patient to clean. For example, some care professionals argue that the third molars should be removed if the patient is having difficulty cleaning that area of the mouth causing attachment and bone loss.

Radiographically: Radiographs will correlate with the probing depths in term of bone loss in the the localized areas (less than 30%). There is horizontal and/ or vertical bone loss and possibly furcations present. Lamina dura will be fuzzy or inconsistent depending on how advanced the case is. Calculus may be present radiographically.


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