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Volume 4 • Number 1 • December 1999

Consensus Report: Chronic Periodontitis

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

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