Volume 4 Number 1 December 1999

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Consensus Report: Chronic Periodontitis
It may affect a variable number of teeth and it has
variable rates of progression.
Chronic periodontitis is initiated and sustained by
bacterial plaque, but host defense mechanisms play an
integral role in its pathogenesis. The progressive nature
of the disease can only be confirmed by repeated
examinations. It is reasonable to assume that the dis-
ease will progress further if treatment is not provided.
Chronic periodontitis can be further characterized
by extent and severity. Extent is the number of sites
involved and can be described as localized or gen-
eralized. As a general guide, extent can be charac-
terized as localized if 30% of the sites are affected
and generalized if >30% of the sites are affected.
Severity can be described for the entire dentition or
for individual teeth and sites. As a general guide,
severity can be categorized on the basis of the
amount of clinical attachment loss (CAL) as follows:
Slight = 1 to 2 mm CAL, Moderate = 3 to 4 mm CAL,
and Severe = 5 mm CAL.
The group acknowledged that in clinical practice,
there are recurrent and refractory (non-responsive)
cases of periodontitis. However, the group did not
believe that there is enough evidence to place these
cases in their own disease categories since any type
of periodontitis can recur and a small percentage of
cases can be non-responsive to therapy. The group
concluded that recurrent periodontitis represents a
return of periodontitis and is not a separate disease
entity. For a variety of identiable and non-identiable
reasons, not all cases of periodontitis have a successful
treatment outcome. Such cases can be referred to as
refractory periodontitis but do not necessarily constitute
a separate disease entity. More research is needed to
identify the reasons for the failure to respond to treatment.
Since conditions or factors that modify the gingiva
in gingivitis (see Gingival Diseases, pages 7-31) also
modify the gingiva in periodontitis, they were not con-
sidered in this section of the classication.
GROUP MEMBERS
Jan Lindhe, Group Leader Denis Kinane
Richard Ranney, Chair Max Listgarten
Ira Lamster, Secretary Harald Le
Allan Charles Robert Schoor
Chong-Pyoung Chung Gregory Seymour
Thomas Flemmig Martha Somerman
The group accepted the review paper written prior to
the workshop. After considerable discussion, the group
recommended that the term adult periodontitis be
discarded since this form of periodontal disease can
occur over a wide range of ages and can be found in
both the primary and secondary dentition. Although the
disease is the most commonly occurring form of peri-
odontitis affecting adults, it can also be found in chil-
dren and adolescents. The term Chronic Periodonti-
tis was eventually agreed upon by the workshop
participants since it is less restrictive than the age-
dependent designation of adult periodontitis.
The group agreed upon the following simple clas-
sication for this most common form of periodontitis:
II. Chronic Periodontitis
A. Localized
B. Generalized
Some of the clinical features and characteristics of
Chronic Periodontitis are:
Most prevalent in adults, but can occur in children
and adolescents;
Amount of destruction is consistent with the pres-
ence of local factors;
Subgingival calculus is a frequent nding;
Associated with a variable microbial pattern;
Slow to moderate rate of progression, but may have
periods of rapid progression;
Can be further classied on the basis of extent and
severity;
Can be associated with local predisposing factors
(e.g., tooth-related or iatrogenic factors);
May be modied by and/or associated with systemic
diseases (e.g., diabetes mellitus, HIV infection);
Can be modied by factors other than systemic dis-
ease such as cigarette smoking and emotional stress.
The following working definition and features of
Chronic Periodontitis were developed by the group:
Chronic Periodontitis. An infectious disease result-
ing in inflammation within the supporting tissues of
the teeth, progressive attachment, and bone loss. It is
characterized by pocket formation and/or gingival
recession. It is recognized as the most frequently occur-
ring form of periodontitis. Its onset may be at any age,
but is most commonly detected in adults. The preva-
lence and severity of the disease increases with age.
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