What are the other Names for this Condition? (Also known as/Synonyms)

• Adult Periodontitis
• Adult-Onset Periodontitis
• Chronic Periodontal Disease

What is Chronic Periodontitis? (Definition/Background Information)

• Chronic Periodontitis is a severe and infectious form of gum disease that affects the teeth, gums, and surrounding tissues of the oral cavity. This chronic inflammatory process can cause damage to the gums and tissues, which in turn leads to deterioration of teeth structures and teeth loss
• It is characterised specifically by receding gum lines, loss of attachment of teeth, and jawbone destruction. The term “chronic” is chiefly applied, since periodontitis has progressed over time in the absence of any specific treatment
• Chronic Periodontitis is the most common form of periodontitis and is frequently observed as a slowly-progressing condition in adults. Hence, the condition is also referred to as Adult-Onset Periodontitis. When young and old children are affected occasionally by Chronic Periodontitis, at times, it can be a rapidly-progressing condition
• The risk factors that could predispose an individual to Chronic Periodontitis include inadequately treating early gum diseases, smoking, reduced immunity, diabetes, and the use of certain medication
• A dental professional may be able to diagnose the infection and weakened gums during a dental examination. Some imaging techniques may be used to ascertain the damage extent to the teeth, gums, surrounding tissue, and jaw bones
• The treatment plan for Chronic Periodontitis may involve oral cleaning, removal of plaque, to administration of medication for bacterial infection. Surgery may be necessary in some individuals. The prognosis of the condition depends upon its severity

Who gets Chronic Periodontitis? (Age and Sex Distribution)

• Chronic Periodontitis is generally seen among adults, usually above age 45 years. However, it can also develop in children, adolescents, and teens
• It can affect both males and females, though this form of gum disease is more prevalent among males (men)
• Currently, no studies report the condition to be more prevalent among a particular racial or ethnic group

What are the Risk Factors for Chronic Periodontitis? (Predisposing Factors)

The risk factors associated with Chronic Periodontitis may include:

• Smoking and tobacco use: Heavy and chronic tobacco use increases the risk of developing periodontitis to a great extent
• Generally, the older the age, the greater is the risk
• A positive family history of periodontal disease
• Early form of gum disease or gingivitis, which is left untreated
• Changes in hormonal levels due to various health conditions
• Individuals with poorly-controlled diabetes
• Poor oral habits: This facilitates bacterial growth in the mouth thereby increasing the risk for developing periodontitis
• Weakened immune system: Individuals affected by diseases, such as HIV or AIDS, which decrease one’s immunity are at an increased risk
• Individuals with cancer
• Certain diseases and disorders such as heart diseases and rheumatoid arthritis
• Certain medications can increase the risk for periodontitis
• Some individuals can have abnormal teeth structure that may place them at a higher risk for gum disease. This feature may run in certain families
• Genetic susceptibility: Some individuals are more genetically predisposed and have a higher risk of developing severe forms of gum disease

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases one’s chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Chronic Periodontitis? (Etiology)

The main cause of Chronic Periodontitis is longstanding and severe infection of the gum, teeth, and surrounding tissue.

• This leads to plaque buildup on the affected teeth (or tooth). When this plaque is left on teeth for extended periods of time, it hardens, and (usually gram-negative) bacteria in the mouth start to release toxins that damage the gums
• Over time as the plaque builds up, pockets form between the teeth and gums that lead to deeper infection of the gums. Eventually, this infection spreads to the ligaments and bone in the mouth causing degradation of these structures resulting in periodontitis

What are the Signs and Symptoms of Chronic Periodontitis?

The signs and symptoms associated with Chronic Periodontitis may be mild, moderate, or severe, and may include:

• Swollen, painful gums that appear pale red, even purple/magenta
• Tender gums, itching sensation
• The pain may be dull and involving the jaw too
• Gums have receded such that teeth appear bigger (or longer)
• Abnormal teeth with gaps in between them; having loose teeth (attachment loss)
• Presence of deep pockets
• Severe tissue destruction and bone loss may be present
• Increased tooth sensitivity, since the roots may be exposed
• Pus buildup between the teeth and gums
• Bleeding during brushing or flossing
• Abnormal taste in the mouth
• Bad breath

In most cases, Chronic Periodontitis is localized to a few pockets of the oral cavity, and it does not involve the entire mouth. Also, in adults, the condition may progress slowly; whereas among the younger population, periods of rapid progression may be observed.

How is Chronic Periodontitis Diagnosed?

The diagnostic tests for Chronic Periodontitis may involve the following:

• An oral specialist (dentist) will examine the symptoms and perform a physical exam on the mouth
• The specialist will look for plaque and tartar buildup and check how tender and how easily the gums bleed
• A thorough analysis of the individual’s medical history
• X-rays of the jaw, head, and neck area can be taken to detect the extent of teeth and bony involvement, which is caused by the inflammation
• An MRI scan or CT scan of the head and neck region can be used to detect the extent of the damage to the jaw, head, and neck

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of Chronic Periodontitis?

The possible complications associated with Chronic Periodontitis include:

• Severe emotional stress from cosmetic concerns
• Permanent and irreversible injury to the dental cavity and supporting structures
• Loss of teeth
• In individuals with osteoporosis, such as in post-menopausal women, the condition may get aggravated
• Increased susceptibility to other heart and lung related conditions
• Recurrence of the condition

How is Chronic Periodontitis Treated?

The main goal of treatment for Chronic Periodontitis is to avoid further damage to the teeth structure. Therapy may include conservative measures including proper oral hygiene, stopping smoking, professional cleaning and removing plaque, and addressing any factor (such as misaligned tooth or improperly placed prosthetic dental device) that causes retention of plaque.

• Scaling and polishing: Oral cleansing treatment by the dental professional and removal of plaque may be necessary. However, moderate to severe cases may require a dental sealant to level the surface of teeth and avoid further plaque buildup
• Root surface debridement procedure - removal of food debris using abrasion
• Administering systemic antibiotics: Medications, such as amoxicillin and metronidazole, may be recommended to combat any bacterial infection. Doxycycline may be prescribed for those with penicillin allergy
• Full mouth disinfection is part of the treatment undertaken for Chronic Periodontitis: In addition to scaling and cleaning of affected soft tissue, gum and root surfaces, an antiseptic agent (such as chlorhexidine) is used to disinfect the region
• Use of laser therapy and photodynamic therapy for disinfection and elimination of bacteria
• Periodontal surgery: Typically, for localized destruction and poor response to therapy, invasive procedures may be necessary
  • An open flap debridement procedure or pocket reduction surgery may be performed
  • If necessary, regenerative surgical procedures, such as bone and/or tissue grafting, may be used to correct destruction of periodontal tissue and bone

Regular visits for dental health checkups and maintaining good oral hygiene, such as brushing and flossing after each meal, are generally recommended.

How can Chronic Periodontitis be Prevented?

Currently, the best approach to prevent the development of Chronic Periodontitis is to maintain good oral hygiene and treating gum disease early.

• Create an awareness of the importance of oral health in children, from an early age
• Good oral hygiene can be achieved by brushing the teeth twice daily and by flossing at least once a day
• Studies indicate that flossing before brushing is beneficial and recommended. Flossing loosens food particles in the teeth, making it easier to remove them with brushing
• Using recommended oral rinses and antiseptic mouthwashes
• Stopping smoking or chewing tobacco and substance abuse
• Parents and caregivers are asked to periodically  check the mouth of children for detecting any early signs of gum disease or other dental health issues
• Controlling diabetes through lifestyle changes
• Have a well-balanced diet with lots of fruits and vegetables, to avoid any nutritional imbalances
• Avoidance of sweets, sugary or carbonated drinks
• Use a mouth guard, if the child has a habit of grinding teeth (especially at night)
• Be physically active and exercise regularly to remain healthy and stress-free; meditation and yoga may be beneficial
• Early and prompt treatment of mild gum disease or any dental health conditions can help prevent periodontitis (the advanced stage of gum disease)

Undertake regular visits to a dental health professional for a proper dental check-up and to prevent any tooth-related issues early.

What is the Prognosis of Chronic Periodontitis? (Outcomes/Resolutions)

The prognosis of Chronic Periodontitis is dependent upon the severity of the signs and symptoms and associated complications, if any.

• Individuals with mild conditions have better prognosis than those with severe symptoms and complications. Typically, the prognosis may be assessed on a case-by-case basis
• However, in most cases, irreversible damage of gums and teeth-supporting structures may have taken place. But, the progression of the condition can be arrested with adequate treatment
• Following a good oral hygiene regimen after treatment can help prevent recurrences

Additional and relevant useful information for Chronic Periodontitis:

• In order to prevent periodontitis, gum disease needs to be treated in the early stages

Please visit our Dental Health Center for more physician-approved health information:

https://www.dovemed.com/healthy-living/dental-health/