For some countries in African meningitis belt, vaccinations prior to entry are not required, but highly recommended. : 21–24

References
Further reading
Conterno LO, Silva Filho CR, Rüggeberg JU, Heath PT (2006). Conterno LO (ed.). "Conjugate vaccines for preventing meningococcal C meningitis and septicaemia". Cochrane Database Syst Rev. 3 (3): CD001834. doi:10.1002/14651858.CD001834.pub2. PMID 16855979. Patel M, Lee CK (2005). Patel M (ed.). "Polysaccharide vaccines for preventing serogroup A meningococcal meningitis". Cochrane Database Syst Rev (1): CD001093. doi:10.1002/14651858.CD001093.pub2. PMID 15674874. External links
"Meningococcal ACWY Vaccine Information Statement". U.S. Centers for Disease Control and Prevention (CDC). 10 August 2021. "Meningococcal B Vaccine Information Statement". U.S. Centers for Disease Control and Prevention (CDC). 17 August 2021. "Meningococcal (Groups A, C, Y and W-135) Polysaccharide Diphtheria Toxoid Conjugate Vaccine". U.S. Food and Drug Administration (FDA). 17 April 2019. "Meningococcal Polysaccharide Vaccine, Groups A, C, Y and W-135 Combined". U.S. Food and Drug Administration (FDA). 25 April 2019. "Menveo". U.S. Food and Drug Administration (FDA). 28 July 2020. "Bexsero". U.S. Food and Drug Administration (FDA). 18 November 2019. "Trumenba". U.S. Food and Drug Administration (FDA). 18 November 2019. "Meningococcal Vaccine". Drug Information Portal. U.S. National Library of Medicine. Meningococcal Vaccines at the US National Library of Medicine Medical Subject Headings (MeSH)
apples) (though this may occur even in gingivitis, where there is no attachment loss)
Gum swelling that reoccurs
Halitosis, or bad breath, and a persistent metallic taste in the mouth
Gingival recession, resulting in apparent lengthening of teeth. (This may also be caused by heavy-handed brushing or with a stiff tooth brush.) Deep pockets between the teeth and the gums (pockets are sites where the attachment has been gradually destroyed by collagen-destroying enzymes, known as collagenases)
Loose teeth, in the later stages (though this may occur for other reasons as well)
Drifting of incisorsGingival inflammation and bone destruction are often painless. Patients sometimes assume that painless bleeding after teeth cleaning is insignificant, although this may be a symptom of progressing chronic periodontitis in that patient. Subgingival calculus is a frequent finding as well as supragingival calculus due to the bacteria migrating apically and the combined effect of the host response system of the body. Diagnosis
1999 classification
Chronic periodontitis is one of the seven destructive periodontal diseases as listed in the 1999 classification. Not every case of gingivitis will progress onto chronic periodontitis, but all chronic perodontitis results from gingivitis. Therefore it is important to control the first step; gingival inflammation. A difficulty which arises with diagnosing chronic periodontitis patients is due to the slow and painless progression of the disease. The most effective and timely diagnosis would be during the mild to moderate stage. However, usually when presenting complaints do arise the effects of mobility and alveolar bone loss have become severe.