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Chronic Periodontitis: Causes, Symptoms and Treatment

Chronic periodontitis is a slowly progressing inflammation of the tooth-supporting structures that can lead to tooth loss if left untreated. It is one of the most common dental diseases worldwide.

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Things worth knowing about "Chronic Periodontitis"

Chronic periodontitis is a slowly progressing inflammation of the tooth-supporting structures that can lead to tooth loss if left untreated. It is one of the most common dental diseases worldwide.

What is Chronic Periodontitis?

Chronic periodontitis is a widespread, slowly progressing inflammatory disease affecting the periodontium -- the structures that support the teeth. This includes the gums (gingiva), the periodontal ligament, the cementum of the tooth root, and the alveolar bone. If left untreated, it leads to progressive bone loss and ultimately tooth loss. Chronic periodontitis is distinct from aggressive periodontitis, which progresses more rapidly and tends to affect younger individuals.

Causes

The primary cause of chronic periodontitis is the colonization of periodontal pockets by specific bacteria organized in a biofilm known as dental plaque. When plaque is not regularly removed, it hardens into tartar (calculus), which further promotes inflammation.

Key risk factors include:

Poor oral hygiene: Irregular or inadequate brushing and neglect of interdental spaces
Smoking: Smokers have a significantly higher risk and respond less well to treatment
Diabetes mellitus: Poorly controlled blood sugar promotes inflammatory processes throughout the body, including the oral cavity
Genetic predisposition: A family history of periodontitis increases the risk
Immunosuppression: Conditions or medications that weaken the immune system
Chronic stress: Can reduce immune defenses
Hormonal changes: Such as during pregnancy or menopause

Symptoms

Chronic periodontitis often progresses for a long time without significant pain, which is why many people notice it too late. Typical signs include:

Bleeding gums, especially when brushing or flossing
Red, swollen, or tender gums
Gum recession (teeth appear longer than usual)
Deep periodontal pockets (greater than 3 mm)
Loose teeth in advanced stages
Persistent bad breath (halitosis)
Pus coming from the gum line
Changes in tooth alignment or bite

Diagnosis

Diagnosis is made by a dentist or periodontist using several methods:

Periodontal Screening Index (PSI): Routine measurement of pocket depths using a periodontal probe
Dental X-rays: To assess the extent of bone loss around the teeth
Clinical examination: Evaluating bleeding tendency, redness, and swelling of the gums
Microbiological testing: In specific cases to identify the bacterial species involved

Since 2017, an updated international classification system has been used that considers the severity (Grade I to III) and extent (localized or generalized) of the disease.

Treatment

Treatment of chronic periodontitis is carried out in multiple stages, aiming to control inflammation, halt disease progression, and preserve the tooth-supporting structures.

Phase 1: Education and Oral Hygiene

Patients are educated about the disease and instructed on proper oral hygiene techniques. Regular brushing, use of dental floss or interdental brushes, and smoking cessation are critical first steps.

Phase 2: Professional Cleaning and Scaling

The dentist or dental hygienist removes plaque and calculus both above and below the gum line. Scaling and root planing (also called deep cleaning) involves cleaning and smoothing the root surfaces to discourage bacterial reattachment. This procedure is typically performed under local anesthesia.

Phase 3: Antimicrobial Therapy

In certain cases, antibiotics (e.g., metronidazole, amoxicillin) may be used locally or systemically to target persistent bacteria. Antiseptic mouth rinses (e.g., containing chlorhexidine) can support treatment outcomes.

Phase 4: Surgical Treatment

For deep pockets or significant bone loss, surgical interventions may be required, such as flap surgery to improve access to root surfaces, or regenerative periodontal surgery to rebuild lost bone and tissue.

Maintenance Therapy

Regular recall appointments (every 3 to 6 months) with the dentist are essential to maintain treatment success and prevent relapse.

Connection to Systemic Diseases

Chronic periodontitis is not just a local dental issue. Research has shown associations between periodontitis and cardiovascular disease, diabetes mellitus, preterm birth, and rheumatic conditions. Inflammatory mediators from the oral cavity can enter the bloodstream and contribute to systemic inflammation. Maintaining good oral health is therefore important for overall well-being.

References

Tonetti MS, Greenwell H, Kornman KS. Staging and grading of periodontitis: Framework and proposal of a new classification and case definition. Journal of Periodontology. 2018;89(Suppl 1):S159-S172.
World Health Organization (WHO). Oral Health. Fact Sheet. Available at: https://www.who.int/news-room/fact-sheets/detail/oral-health (2023).
Papapanou PN et al. Periodontitis: Consensus report of workgroup 2 of the 2017 World Workshop on the Classification of Periodontal and Peri-Implant Diseases and Conditions. Journal of Periodontology. 2018;89(Suppl 1):S173-S182.

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