Parameters of Care Summary - Chronic Periodontitis
With Advanced Loss of Periodontal Support
Chronic Periodontitis: Inflammation of the gingiva extending into the adjacent attachment apparatus; characterized by loss of clinical attachment due to destruction of the periodontal ligament and loss of the adjacent supporting bone.
- This is the most common form of periodontal disease in adults.
- It can occur over a wide age range.
- It can occur in primary and secondary dentition.
- It usually has slow to moderate rates of progression, but may have periods of rapid progression.
Clinical signs and symptoms that may be present:
- Gingival bleeding upon probing
- Loss of greater than one-third of supporting periodontal tissues
- Furcation involvements exceeding class I (incipient)
- Probing depths greater than 6mm with clinical attachment loss greater than 4mm
- Radiographic evidence of bone loss
- Increased tooth mobility
This disease may be further classified as:
- Localized, involving one area of a tooth's attachment
- Generalized, involving several or all teeth
- Alter or eliminate the microbial etiology and contributing risk factors;
- Arresting progression of the disease;
- Preserving dentition in a state of health, comfort, and function;
- Prevention of periodontitis recurrence;
- Regeneration of periodontal attachment apparatus in select cases.
Consider these items in treating chronic periodontitis with slight to moderate loss of periodontal support:
- Systemic health
- Therapeutic preferences
- Patient's ability to control plaque
- Clinician's ability to remove subgingival deposits
- Restorative and prosthetic demands
- Presence and treatment of teeth with more advanced chronic periodontitis
- Address systemic risk factors.
- Diabetes, smoking, certain periodontal bacteria, aging, gender, genetic predisposition, systemic diseases and conditions, stress, nutrition, pregnancy, HIV infection, substance abuse, medications.
- Patient's plaque control instruction, reinforcement, and evaluation.
- Supra- and subgingival scaling and root planing.
- Antimicrobial agents or devices.
- Subgingival microbial samples, and possibly antibiotic sensitivity testing, may be done.
- Eliminate or control local contributing factors.
- Removal or reshaping of restorative overhangs or overcontoured crowns;
- Correction of ill-fitting prosthetic appliances;
- Restore carious lesions;
- Tooth movement;
- Restore open contacts that have resulted in food impaction;
- Treat occlusal trauma;
- Extract hopeless teeth.
- Reevaluation of initial therapy; compare with initial documentation.
- Consider next step.
- Defer or decline appropriate treatment to control the disease.
- Periodontal maintenance.
- Periodontal surgery.
- In certain cases, because of severity and extent of disease, age and health of patient, treatment that is not intended to attain optimal results may be indicated.
- Initial therapy may become the end point.
- This should include timely periodontal maintenance.
- Gingival augmentation therapy
- Regenerative therapy
- Bone replacement grafts
- Guided tissue regeneration
- Combine regenerative techniques
- Resective therapy
- Flaps with or without osseous surgery
- Root resective therapy
- Refinement therapy
- Treatment of residual risk factors
- Problem focused surgical therapy
- Periodontal maintenance
- Significant reduction of clinical signs of gingival inflammation;
- Reduction of probing depths;
- Stabilization or gain of clinical attachment;
- Radiographic resolution of osseous lesions;
- Progress toward occlusal stability;
- Reduction of clinically detectable plaque to a level compatible with gingival health.
- Inflammation of gingival tissues;
- Persistent or increasing probing depths;
- Lack of stability of clinical attachment;
- Persistent clinically detectable plaque levels not compatible with gingival health.
- A patient may simultaneously have areas of health and chronic periodontitis with slight, moderate, and advanced destruction.
- Not all patients or sites will respond equally or acceptably.
- Additional therapy may be warranted on a site specific basis.
Source: Journal of Periodontology, Volume 71 Number 5, May 2000 (Supplement)
Parameters are available for download from the AAP web site.