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Sites with periodontitis exhibit clinical signs of gingival inflammation and loss of connective tissue attachment. Connective tissue attachment loss refers to the pathological detachment of collagen fibers from cemental surface with the concomitant apical migration of the junctional or pocket epithelium onto the root surface. [2]
Ultimately, tooth loss may occur if the condition is not halted. It is termed localized when less than 30% of sites around teeth are involved, and generalised when more than 30% are involved. clinical attachment loss can be used to determine the severity of the condition, where 1–2mm is slight, 3–4mm is moderate and more than 5mm is severe. [5]
Although it cannot cause periodontium damage in itself, [19] bruxism is known to be able to worsen attachment loss and tooth mobility if periodontal disease is already present. [20] Moreover, the severity of tooth mobility caused by bruxism also varies depending on the teeth grinding pattern and intensity of bruxism. [ 21 ]
If there is attachment loss, and no other systemic condition, then the diagnosis will be periodontitis. Using the periodontal six/four point chart, if more than 30% of sites are involved then a diagnosis of generalised disease is given. If less than 30% of sites are involved, then the type of periodontitis is localized.
1: Total loss of attachment (clinical attachment loss, CAL) is the sum of 2: Gingival recession, and 3: Probing depth. Gingival recession, also known as gum recession and receding gums, is the exposure in the roots of the teeth caused by a loss of gum tissue and/or retraction of the gingival margin from the crown of the teeth. [1]
These numbers, often referred to as probe measurements, can be assigned to the depth of the gingival sulcus, the location and depth of root furcations, the size and length of oral pathology, the loss of periodontal fiber, the clinical attachment loss (CAL), alveolar bone loss, and help in assessing and determining a periodontal disease ...
1: Total loss of attachment (clinical attachment loss, CAL) is the sum of 2: Gingival recession, and 3: Probing depth. As the original sulcular depth increases and the apical migration of the junctional epithelium has simultaneously occurred, the pocket is now lined by pocket epithelium (PE) instead of junctional epithelium (JE). [3]
The "severity" of disease refers to the amount of periodontal ligament fibers that have been lost, termed "clinical attachment loss". According to the 1999 classification, the severity of chronic periodontitis is graded as follows: [67] Slight: 1–2 mm (0.039–0.079 in) of attachment loss; Moderate: 3–4 mm (0.12–0.16 in) of attachment loss