You are on page 1of 8

CHAPTER 31 Chronic Periodontitis

M. John Novak and Karen F. Novak Periodintitis kronis dahulunya dikenal sebagai periodontitis dewasa atau periodontitis kronis dewasa merupakan penyakit yang sudah umum dari periodontitis. Chronic periodontitis, formerly known as adult periodontitis or chronic adult periodontitis, is the most prevalent form of periodontitis. It is generally considered to be a slowly progressing disease. However, in the presence of systemic or environmental factors that may modify the host response to plaque accumulation, such as diabetes, smoking, or stress, disease progression may become more aggressive. Although chronic periodontitis is most frequently observed in adults, it can occur in children and adolescents in response to chronic plaque and calculus accumulation. This observation underlies the recent name change from adult periodontitis, which suggests that chronic, plaque -induced periodontitis is only observed in adults, to a more universal description of chronic periodontitis, which can occur at any age (see Chapter 7). Chronic periodontitis has beeed as an infectious disease resulting in inflammation within the supporting tissues of the teeth, progressive attachment loss, and bone loss.2 This definition outlines the major clinical and etiologic characteristics of the disease: (1) microbial plaque formation, (2) periodontal inflammation, and (3) loss of attachment and alveolar bone. Periodontal pocket formation is usually a sequela of the disease process unless gingival recession accompanies attachment loss, in which case pocket depths may remain shallow, even in the presence of ongoing attachment loss and bone loss.

CLINICAL FEATURES General Characteristics


Characteristic clinical findings in patients with untreated chronic periodontitis may include supragingival and subgingival plaque accumulation (frequently associated with calculus formation), gingival inflammation, pocket formation, loss of periodontal attachment, loss of alveolar bone, and occasional suppuration (Figure 31-1). In patients with poor oral hygiene, the gingiva typically may be slightly to moderately swollen and exhibits alterations in color ranging from pale red to magenta. Loss of gingival stippling and changes in the surface topography may include blunted or rolled gingival margins and flattened or cratered papillae. In many patients, especially those who perform regular home care measures, the changes in color,

contour, and consistency frequently associated with gingival inflammation may not be visible on inspection, and inflammation may be detected only as bleeding of the gingiva in response to examination of the periodontal pocket with a periodontal probe (Figures 31-2, A, and 31-3, A). Gingival bleeding, either spontaneous or in response to probing, is common, and inflammationrelated exudates of crevicular fluid and suppuration from the pocket also may be found. In some cases, probably as a result of long-standing, low-grade inflammation, thickened, fibrotic marginal tissues may obscure the underlying inflammatory changes. Pocket depths are variable, and both horizontal and vertical bone loss can be found. Tooth mobility often appears in advanced cases with extensive attachment loss and bone loss. Clinical features of chronic periodontitis in 45-year-old patient with poor oral home care and no previous dental treatment. Abundant plaque and calculus are associated with redness, swelling, and edema of the gingival margin. Gingival recession is evident, resulting from loss of attachment and alveolar bone. Spontaneous bleeding is present, and there is visible exudate of gingival crevicular fluid. Gingival stippling has been lost Chronic periodontitis can be clinically diagnosed by the detection of chronic inflammatory changes in the marginal gingiva, presence of periodontal pockets, and loss of clinical attachment. It is diagnosed radiographically by evidence of bone loss. These findings may be similar to those seen inaggressive disease. A differential diagnosis is based on the age of the patient, rate of disease progression over time, familial nature of aggressive disease, and relative absence of local factors in aggressive disease compared with the presence of abundant plaque and calculus in chronic

periodontitis.

Disease Severity
The severity of destruction of the periodontium that occurs as a result of chronic periodontitis is generally considered a function of time. With increasing age, attachment loss and bone loss become more prevalent and more severe because of an accumulation of destruction (see Chapter 8). Disease severity may be described as being slight (mild), moderate, or severe (see Chapter 7). These terms may be used to describe the disease severity of the entire mouth or part of the mouth (e.g., quadrant, sextant) or the disease status of an individual tooth, as follows. Slight (mild) periodontitis: Periodontal destruction is generally considered slight when no more than 1 to 2 mm of clinical attachment loss has occurred. Moderate periodontitis: Periodontal destruction is generally considered moderate when 3 to 4 mm

of clinical attachment loss has occurred. Severe periodontitis: Periodontal destruction is considered severe when 5 mm or more of clinical attachment loss has occurred.

Symptoms
Patients may first become aware that they have chronic periodontitis when they notice that their gums bleed when brushing or eating; that spacesoccur between their teeth as a result of tooth movement; or that teeth havebecome loose. Because chronic periodontitis is usually painless, however, patients may be totally unaware that they have the disease and may beless likely to seek treatment and accept treatment recommendations. In addition, a negative response to questions such as, Are you in pain? is not sufficient to eliminate suspicion of period ontitis. Occasionally, pain may be present in the absence of caries caused by exposed roots that are sensitive to heat, cold, or both. Areas of localized dull pain, sometimes radiating deep into the jaw, have been associated with periodontitis. The presence of areas of food impaction may add to the patients discomfort. Gingival tenderness or itchiness may also be found.

Add Although chronic periodontitis requires an infection to initiate the host response and subsequent inflammatory reaction, the specific bacteria causing the infection in an individual are unknown. Several different microorganisms apparently are capable of initiating the host response, and a certain combination of species is probably required to overwhelm the host and initiate tissue loss (attachment loss and bone loss). This provides the basis for periodontal therapy in which periodic monitoring, removal of plaque, and management of risk factors are aimed at keeping the hostbacteria relationship tipped in favor of the host response and control of the disease process. Chronic periodontitis is generally slowly progressive, with some patients having increased susceptibility to bone loss and pocketing. Some patients who have a genetic profile that accentuates interleukin-1 production have a 2.9-times increased risk of tooth loss, and if these patients are also smokers, their risk increases to 7.7 times. Diabetes is another factor that often leads to severe and extensive periodontal destruction. Also, a specific group of microorganisms is seen in the subgingival biofilm of patients with ongoing bone loss associated with chronic periodontitis, including Porphyromonas gingivalis, Tannerella forsythia, and Treponema denticola. The identification and characterization of these other and pathogenic microorganisms and their association with attachment and bone loss have led to the specific plaque hypothesis for the development of chronic periodontitis. This hypothesis implies that although a general increase occurs in the proportion of gram-negative micro-organisms in the subgingival plaque in periodontitis, it is the presence of increased proportions of members of the red complex, and perhaps other microorganisms, that precipitates attachment and bone loss. The mechanisms by which this occurs have not been clearly delineated, but these bacteria may impart a local effect on the cells of the inflammatory response and the cells and tissues of the host, resulting in a local, site-specific disease process. The interactions between pathogenic bacteria and the host and their potential effects on disease progression are discussed in detail in Chapter 13.

Radiopaque horizontal line across the roots. This line demarcates the portion of the root where the labial or lingual bony plate has been partially or completely destroyed from the remaining bone-supported portion (Figure 36-26).

You might also like