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Periodontology Research Paper: Chronic Periodontitis

Maria Campos Sanchez

Indian Hills Community College

Author Note

This paper was prepared for DHY 208 Periodontology taught by Jody Williams, RDH, MA
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Abstract

Chronic periodontitis is one of the periodontal diseases that patients will underestimate and

neglect. The cyclic process of the disease and the influence of the host response are some

important features when assessing a patient. Categorizing the stage of the chronic periodontitis

will help in the management of the disease. The dental hygiene care plan needs a systematic

approach and clearly express goals, interventions, and outcomes. An interprofessional approach

among dentists, dental hygienists, periodontists, and physicians is the best standard of care for

each patient.

Keywords: Chronic periodontitis, etiology of chronic periodontitis, categories of

periodontitis, Dental Hygiene non-surgical therapy.

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Periodontology Research Paper: Chronic Periodontitis

Chronic periodontitis is an infectious disease resulting in inflammation within the supporting

tissues of the teeth, progressive attachment loss, and bone loss.

General characteristics

Signs that will help differentiate gingivitis from periodontitis are pocket formation,

attachment loss, and bone loss. Although other characteristics commonly seen in dental Plaque-

related periodontal diseases are also observed in chronic periodontitis (e.g. supragingival and

subgingival plaque and calculus, gingival swelling, redness, bleeding on probing, among others).

Characteristics such as root furcation involvement, increased tooth mobility, change in tooth

position, and tooth loss are present in advanced stages of periodontitis (Newman et al., 2015).

Measurements of periodontal pocket depth should consider the location of marginal gingiva

since its inflammation would increase and alter the recording. Bone loss is site-specific and may

occur on one surface of a tooth, while the rest remains normal (Newman et al., 2015).

Classification

There are different ways to categorize chronic periodontitis. Considering the extent if more

than 30% of teeth are involved, it is referred to as generalized. On the other hand, if less than

30% of teeth are involved then it is called localized (Perry et al.,2015; World Workshop on the

Classification of Periodontal and Peri-Implant Diseases, 2017).

Periodontitis is also categorized by assigning types (see Table 1) or assigning stages (World

Workshop on the Classification of Periodontal and Peri-Implant Diseases, 2017). Specific values

of clinical attachment loss, radiographic bone loss, and pocket depth are three of the major

characteristics to determine the stage of periodontitis (see Table 2).

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Etiology.

The major clinical and etiologic characteristics of the disease include microbial biofilm

formation, periodontal inflammation, attachment loss, and alveolar bone loss (Newman et al.,

2015).

The formation of calculus and calculus itself is not the cause of the disease, it is more a

result of plaque accumulation. Other retentive local factors that contribute to chronic

periodontitis are crown margins and restoration overhangs. Anatomic variances from normal,

such as grooves and pathologic consequences (e.g. furcation involvement, deep pockets,

subgingival caries) are important local factors (Newman et al, 2020).

Types of bacteria involved

Subgingival plaque biofilm is composed of different species, predominantly anaerobic

gram-negative. The red complex bacteria, including Porphyromonas gingivalis, Tannerella

forsythus, and Treponema denticolum, are associated with late-stage subgingival plaque

development and with progressive periodontitis (Hughes, 2015), the orange-complex bacteria

contribute to the disease but are less virulent. The orange-complex bacteria include P.intermedia,

F.nucleatum, Campylobacter species, Eubacterium nodatum, Peptostreptococcus micros, and

others (Perry et al.,2014).

At present, the ecological plaque hypothesis is more accepted. This hypothesis states that

the establishment of complex stable ecosystems is what produces the disease (Hughes, 2015).
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Host Response

Most of the signs of the chronic periodontitis are a result of the inflammatory host

response towards bacteria; the body is fighting against an infection that doesn’t resolve because

the etiological factors remain. The body’s main action is to activate plasma cells, T-lymphocytes,

and macrophages as soldiers. The pocket epithelium responds by increasing rete pegs and

microulcerations which will result in bleeding. The balance of osteoclasts and osteoblasts is

altered, hence the bone loss.

Neutrophiles, the first responders to inflammation, are also responsible for a chain of

chemicals that will contribute to the effects on the tissues; these are part of the innate and

acquired immune mechanisms such as cytokine production ( IL 10, TGF β, IL1, IL6, IL7, and

TNF). Antibodies play important roles in the opsonization of bacteria for neutrophil targeting,

neutralization of bacterial binding, and virulence factors (Hughes, 2017).

Systemic conditions that aggravate chronic periodontitis.

Periodontitis is associated with systemic disorders such as Haim-Munk syndrome,

Papillon Lefevre syndrome, Ehlers-Danlos syndrome, Kindler syndrome, and Cohen syndrome.

HIV/AIDS will also aggravate the host response to periodontitis. Osteoporosis, severe

unbalanced diet, stress, dermatologic, hematologic, and neoplastic factors influence the process

of disease (Newman et al., 2020).

Diabetes mellitus is one of the major conditions associated with periodontitis.

Uncontrolled diabetes shows increased average pocket depth and more clinical attachment loss in

comparison to the controlled diabetes patient. However, the progression of severe periodontitis is

not different between patients with good glycemic control and nondiabetic patients. The

inflammatory response may be related to glycation end products and cytokines, which will
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promote increased inflammatory response and increased apoptosis of fibroblasts and osteoblasts.

Systematic therapy of chronic periodontitis leads to a short-term reduction of glycated

hemoglobin (HbA1c). This will decrease the risk of myocardial infarction, microvascular

complications among others (Newman et al, 2020).

Treatment of Chronic periodontitis: Patient’s Goals, Interventions and Outcomes

After the assessment of the data recorded, periodontal therapy can be planned and

implemented. Interprofessional collaboration is highly recommended for cases where systemic

conditions influence the outcome of the treatment. And periodontists will provide appropriate

care for severe or more advanced chronic periodontitis.

When writing Dental Hygiene Care plan, it is important to establish the problem

statement because it will help formulate the goal of treatment. The interventions are activities

and procedures that will help achieve the goals. A dental hygienist usually will perform scaling,

root planing, periodontal debridement, and prophylaxis. Based on the needs of the patient,

systemic pharmacotherapy or local delivery systems of antibiotics can be an adjunct in the

treatment. The outcome stated should be measurable and based on the goal already established.

The rationale for maintenance is based on the cyclic process of the disease. Long-term plaque

control and debridement of soft and hard deposits are necessary to control the disease. (Bowen

and Pieren, 2020).

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References

Bowen, D. and Pieren J. (2020). Darby and Walsh Dental Hygiene. Theory and Practice.

Missouri: Elsevier

Hughes, F. Periodontium and Periodontal Disease (2015) Stem Cell Biology and Tissue

Engineering .Stem Cell Biology and Tissue Engineering in Dental Sciences pp 433-444.

Retrieved from https://www.sciencedirect.com/topics/medicine-and-dentistry/chronic-

periodontitis

Newman, M., Essex, G.,Laughter, L.,and Elangovan S. (2020) Newman and Carranza’s Clinical

Periodontology for the Dental Hygienist - E-Book) Retrieved from

https://books.google.com/books?

id=btfYDwAAQBAJ&dq=calculus+and+chronic+periodontitis&source=gbs_navlinks_s

Newman, M., Takei, H., Klokkevold, P., Carranza, F. (2015) Carranza's Clinical Periodontology -

E-Book: Expert Consult: Online Retreieved from https://books.google.com/books?

id=CDKPBAAAQBAJ&pg=PA652&dq=chronic+periodontitis&hl=es-

419&sa=X&ved=0ahUKEwjJ7s3-

6ZbpAhWCB80KHVKQBwY4ChDoAQguMAE#v=onepage&q=chronic

%20periodontitis&f=false

Perry, D., Beemsterboer, P., and Essex, G. ( 2014) Periodontology for the Dental Hygienist. 4th

Edition. Missouri:Elsevier.

World Workshop on the classification of Periodontal and Periimplant Diseases and

conditions( 2017) Staging and Grading periodontitis.Retrieved from

https://www.perio.org/sites/default/files/files/Staging%20and%20Grading%20Periodontitis.pdf
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Tables

Table 1

Type Classification System

Case Type
I Gingivitis
II Slight Chronic Periodontitis
III Moderate Chronic Periodontitis or Aggressive Periodontitis
IV Advanced Chronic Periodontitis or Aggressive Periodontitis
V Refractory Chronic Periodontitis or Aggressive Periodontitis

Note: This system was adopted by the American Academy of Periodontology before 1999

(Perry, Beemsterboer and Essex, 2014)

Table 2

Classification System of Periodontitis 2017

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Note: This system was adopted by the American Academy of Periodontology since 2017 (World

Workshop on the classification of Periodontal and Periimplant Diseases and conditions, 2017)