The American Academy of Periodontology classified seven categories of periodontitis in 1999; one of these categories is chronic periodontitis. Chronic periodontitis is manifested by chronic inflammation of the tissues of the periodontium inside the oral cavity, including the gums and teeth and their supporting bones and ligaments, and is caused by a copious buildup of dental plaque. Periodontitis first manifests as gingivitis before progressing into chronic periodontitis. Aggressive periodontitis results when chronic periodontitis is untreated and the disease is allowed to progress.
Chronic periodontitis is common in adults around the world. It is estimated that about 35% of adults in the US are affected, and the effects of chronic periodontitis become more prevalent as people age. The primary effects of chronic periodontitis are bone loss, the formation of pockets between the gums and teeth, and the loss of attachment, or loosening, of the teeth. Risk factors for chronic periodontitis include smoking and inadequate oral hygiene. Other predisposing factors that may contribute to chronic periodontitis are certain systemic diseases, emotional stress, and overall mental and physical health. While chronic periodontitis generally progresses relatively slowly, it may be characterized by periodic bursts of rapid destruction.
Early diagnosis of chronic periodontitis is the best way to prevent its irreversible progression. If allowed to progress, chronic periodontitis can lead to irreparable damage to the structures that support and protect the teeth. Because chronic periodontitis is painless in its initial stages, however, diagnosis can pose challenges; people may not seek dental care in the absence of symptoms. When diagnosed and treated in its earlier stages, chronic periodontitis can be treated by subgingival removal of plaque and tartar. This mechanical removal can only be safely and effectively done in a clinical setting, by a dental professional. After the plaque and tartar are removed, patients must maintain diligent oral hygiene practices, including regular return visits for periodontal checkups, lest the plaque and tartar build up once again.
When symptoms of chronic periodontitis do appear, they may include bleeding or redness of the gums that arises while brushing the teeth, flossing, or biting hard or crunchy foods; recurring swelling of the gums; persistent bad breath; recession of the gums; and the formation of deep pockets between the gums and teeth. In later stages, the teeth may loosen and drift in the mouth. By the time many symptoms appear, the disease may have already progressed significantly; for this reason, regular dental checkups are instrumental in the early diagnosis of all gingivitis and chronic periodontitis, and periodic dental checkups allow dentists to track the progression of the disease. When periodontitis is suspected, a dental professional can assess the progression of the disease with basic periodontal screening procedures and can use these procedures to determine the appropriate treatment plan. Smoking cessation and improved oral hygiene are the two most commonly agreed upon treatment approaches for chronic periodontitis, which also include either non-surgical or surgical therapies to mechanically remove subgingival plaque and tartar. Scaling and root planing and mechanical debridement are the two most common and effective approaches for removing the plaque and tartar below the gumline, which is the first step toward encouraging healing of chronic periodontitis. Other treatments include full-mouth disinfection, open flap debridement, tissue regeneration procedures, and antibiotic or antimicrobial treatments.