Clinical Attachment Loss
In order to understand clinical attachment loss, it is helpful to know some basics about the anatomy and function of the periodontium. The periodontium is the set of tissues that surround the teeth, supporting them in the bones of the jaw. The four components that make up the periodontium are the gingiva, the periodontal ligament, the cementum, and the alveolar bone. While each of these components functions on their own, they also function together, as a single unit. The gingiva, also known as the gums, are soft tissues that surround the teeth and, when healthy, provide a seal that protects them. The periodontal ligament is a collection of connective tissue fibers that attach the tooth to the alveolar bone, connecting to the tooth’s cementum. The cementum is the calcified substance that covers the roots of each tooth, and the alveolar bone is the ridge of bone that contains the sockets for the teeth. The alveolar bone is the thickened, coronal layer of the jaw bones; the upper jaw bone is called the maxilla, and the lower jaw bone is called the mandible.
Periodontics, also called periodontology, is the field of dentistry that studies the periodontium and the diseases and conditions that affect the periodontium. Periodontists specialize in the diagnosis, treatment, and prevention of diseases of the periodontium. The majority of periodontal diseases are caused by a proliferation of dental plaque and dental calculus, or tartar, on the surfaces of the teeth. These periodontal diseases include gingivitis, a non-destructive periodontal disease, and periodontitis, a destructive periodontal disease. Gingivitis, which is reversible in its early stages, is primarily characterized by inflammation of the gingiva. Periodontitis is not reversible and is characterized primarily by clinical attachment loss. Clinical attachment loss occurs when the collagen fibers of the periodontal ligament detach from the cementum on the root surfaces of teeth, causing the gingiva to migrate toward the roots of the teeth, exposing the roots and eventually causing the affected tooth to loosen, migrate, or fall out. The complex fiber groups of the periodontal ligament support the mechanical loads that are placed on the teeth during eating or when exposed to other outside forces, absorbing this force and protecting the teeth. When the periodontal ligament is compromised, due to the inflammation caused by periodontal disease, it is no longer able to bear these loads and protect the teeth. Because clinical attachment loss causes the gum tissue to loosen and leads to the development of periodontal pockets, which are veritable incubators for bacteria, clinical attachment loss also leads to greater bacterial accumulation and increased severity of periodontitis.
While an accumulation of dental plaque and calculus, in conjunction with the immune response of the host, is the primary cause of periodontal diseases, certain risk factors increase the likelihood of periodontitis developing, and other risk factors can affect its severity. Periodontitis is most significantly affected by oral hygiene but is also affected by age, socioeconomic status, and diet; systemic risks include diabetes and other diseases, as well as the consumption of alcohol and tobacco. While periodontitis is, in its initial stages, characterized by clinical attachment loss, if left untreated, it leads to loss of not only the teeth, but of the alveolar bone that supports the teeth. The most effective way to prevent periodontitis is with a rigorous oral hygiene routine that includes twice-daily brushing along with daily flossing, as well as with regular visits to the dentist for professional cleanings and checkups. Once clinical attachment loss has occurred, the goal is to manage the progression of periodontal disease in the hopes of saving the teeth and maintaining the function of the mouth.