Clinical definition of periodontitis Periodontitis is a chronic multifactorial inflammatory disease associated with dysbiotic plaque biofilms and characterised by the progressive destruction of the tooth-supporting apparatus. Periodontitis is characterised by inflammation that results in the loss of periodontal attachment. While the formation of bacterial biofilm initiates gingival inflammation, the disease of periodontitis is characterised by three factors: • The loss of periodontal-tissue support, manifested through clinical attachment loss (CAL) and radiographically assessed alveolar bone loss; • The presence of periodontal pocketing; • Gingival bleeding. Current evidence supports multifactorial disease influences – including smoking – on multiple immunoinflammatory responses. This makes dysbiotic microbiome changes more likely for some patients than for others and may well influence the severity of disease for such individuals.
A periodontitis classification system should include three components:
• Identification of a patient as a periodontitis case; • Identification of the specific type of periodontitis;
• Description of the clinical presentation and other elements that affect clinical management, prognosis, and potentially broader influences on both oral and systemic health. In the context of clinical care, a periodontitis case is defined when loss of periodontal-tissue support through inflammation is the primary feature. Clinical attachment loss (CAL) is calculated by a circumferential assessment of the erupted dentition with a standardised periodontal probe with reference to the cemento- enamel junction (CEJ).
A patient is a periodontitis case when:
• Interdental CAL is detectable at ≥2 non-adjacent teeth, or • Buccal/oral CAL of ≥3mm with pocketing of >3mm is detectable at ≥2 teeth, and • The observed CAL cannot be ascribed to non-periodontal causes such as: 1. Gingival recession of traumatic origin; 2. Dental caries extending in the cervical area of the tooth; 3. The presence of CAL on the distal aspect of a second molar and associated with malposition or extraction of a third molar; 4. An endodontic lesion draining through the marginal periodontium; 5. The occurrence of a vertical root fracture. Measuring CAL Given the measurement error of CAL with a standard periodontal probe, a degree of misclassification of the initial stage of periodontitis is inevitable and this affects diagnostic accuracy. It is recognized that “detectable” interdental attachment loss
Periodontitis
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Guidance for clinicians
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