Clinical Manifestations
CLASSIC SIGNS: Bleeding on probing (BOP); increased probing depths (>3mm pathological); clinical attachment loss (CAL = distance from CEJ to pocket base); alveolar bone loss on radiographs; gingival recession.
ADVANCED SIGNS: Tooth mobility (grades I–III); furcation involvement; suppuration from pockets; halitosis; drifting and flaring of anterior teeth. SMOKER PITFALL: nicotine causes vasoconstriction — smokers have reduced BOP and erythema despite severe disease. Probing depths and radiographic bone loss are the key parameters in smokers.
SYSTEMIC ASSOCIATIONS: Bidirectional with diabetes (treating periodontitis improves HbA1c by ~0.4%); associated with cardiovascular disease (P. gingivalis found in atherosclerotic plaques); preterm low birth weight; COPD exacerbations.