Periodontitis

Periodontitis is characterised by the loss of bone and tissues that support the teeth (eg periodontal pocket formation, gingival recession)—see Anatomical location of localised odontogenic infections and associated conditions. It is often associated with halitosis and an unpleasant taste in the mouth. In severe periodontitis, the teeth may become loose or drift, allowing spaces to develop between the teeth. Pain is not usually a feature until the late stages of the disease. Assess and record the periodontal status of all patients because approximately 50% of the population have periodontal disease.

Gram-negative anaerobic bacteria are involved with the initiation and progression of periodontitis, with Porphyromonas gingivalis recognised as the key pathogen.

Risk factors for the development and progression of periodontitis include smoking and poorly controlled diabetes.

Periodontitis is classified by its stage (severity of disease and complexity of management) and grade (biological features such as rate of progression). The disease usually presents as chronic and slowly progressing, with brief acute episodes. The amount of plaque, calculus and bleeding usually corresponds with the disease severity.

Rarely patients present with a rapidly progressing form of periodontitis (previously known as aggressive or early-onset periodontitis) characterised by rapid attachment loss and alveolar bone destruction. Unlike the usual presentation, the severity of periodontal destruction does not correlate with the amount of plaque and calculus. This presentation is more common in patients with a family history of the condition. Specialist management of rapidly progressing periodontitis is required.

Periodontitis in children is rare and usually associated with systemic disease (eg leukaemia, type 1 diabetes, cyclic neutropenia)—refer for urgent specialist review.

Successful management of periodontitis requires removal of bacterial deposits, improved patient oral hygiene, control of risk factors and continued follow up. Strategies include:

  • thorough debridement to remove supragingival and subgingival plaque and calculus. Local anaesthetics may be needed
  • polishing, reshaping or replacing defective fillings
  • providing patients with advice on oral hygiene
  • collaborating with the patient’s medical practitioner to modify risk factors (eg smoking, diabetes management)
  • providing regular supportive periodontal care.

For patients with severe periodontitis, specialist referral is usually required. Periodontal surgery may be indicated if the patient has not responded to nonsurgical debridement.

Note: Antibiotic therapy is rarely required for periodontitis.

Antibiotic therapy is rarely required for periodontitis; only consider antibiotic therapy for the following patients, preferably under the care of a periodontist:

  • patients with rapidly progressing periodontitis
  • patients with periodontitis that has not responded to dental treatment
  • immunocompromised patients, including patients with poorly controlled diabetes.