Periodontitis often develops as a progression of gingivitis to the point that loss of supporting bone has begun because of destruction of alveolar bone. Tooth mobility, bleeding gingivae, and increased spaces between the teeth are common but are not necessarily signs of advanced disease. In some cases purulent exudate is present. Periodontal infection tends to localize to intraoral soft tissue but can spread to adjacent sites. The two main forms of periodontitis are chronic and aggressive periodontitis (Table 2).
Chronic periodontitis (replaced adult periodontitis) occurs mostly in adults, but can be also seen in younger individuals. Destruction is consistent with the amount of plaque present
TABLE 2 Outline of the 1999 Classification of Periodontal Disease
1. Gingival disease
Dental plaque-induced Non-plaque-induced
2. Chronic periodontitis3'11
Generalized (>30% of sites involved)
3. Aggressive periodontitis0
a Can be further classified on basis of extent and severity. b Chronic periodontitis replaced adult periodontitis.
° Aggressive periodontitis replaced early onset, destructive and juvenile periodontitis. Source: From Ref. 38.
and other local factors (i.e., anatomic and other factors that retain plaque next to a tooth such as overhanging restorations, open contacts and palato-radicular grooves); subgingival calculus is also commonly found. The disease progresses slowly but there may be bursts of destruction. Local factors, systemic diseases and extrinsic factors such as smoking can modify the rate of disease progression. Chronic periodontitis has been further classified as localized or generalized depending on whether < 30% or > 30% of sites are involved. Severity is based on the amount of clinical attachment loss (CAL) and is designated as slight (1-2 mm CAL), moderate (3-4 mm CAL), or severe (>5 mm CAL).
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