Periodontitis

Is literally the discharge of pus in connection with the alveoli, the hollow sockets in the jawbones in which the roots of the teeth are situated. In a healthy jaw, the gum margins are festooned, the triangular spaces between the necks of adjacent teeth being filled up with a projection of gum. The first sign of pyorrhcea is an inflammation of the gum margin where it embraces the neck of the tooth. The gum is reddened, tender in pressure and bleeds readily. To this condition is given the name of marginal gingivitis, and it is to be noted that while every case of periodontitis starts in this way, it does not follow that the gum inflammation will inevitably lead to the destruction of the alveoli which is associated with fully developed pyorrhcea. If treatment is instituted at this stage there is every likelihood of cure or at least the condition is kept in check.

Following on the gingivitis, the inflammation extends deeply to the bone of the alveolus and a pocket or trough is formed in which pus collects. Bone absorption takes place, the sockets become deeper, and in time the teeth loosen in their sockets and fall out. During this process, the affected tissues give rise to an offensive odour in the mouth. On pressure, pus may escape from the gums, which are spongy and bleed freely when the teeth are brushed. Around the necks of the teeth a hard brownish-grey lime deposit is apt to form and this further irritates the sensitive and inflamed gums. It is an interesting point that there appears to be some degree of antagonism between pyorrhcea and dental caries or decay. It is common to see people with teeth perfectly clean and free from caries, and yet with intense periodontitis.

The precise cause of pyorrhcea is unknown. It seems likely that not one, but several factors are at work. Some hold that pyorrhcea is essentially a local disease while others maintain that general factors of health play the predominant part. Among local factors predisposing to pyorrhcea are mouth-breathing and conditions such as narrow jaws, irregularity of the teeth, badly inserted fillings, ill-fitting dentures pressing on the gums. These interfere with the hygiene of the mouth and producing stagnation bring about infection and inflammation of the gums.

Certain investigators hold that it is the excessive consumption of soft starchy food which is the predominant factor. The increase in the average consumption of artificially concentrated carbohydrates within the last four or five decades in civilized countries is enormous and it has certainly coincided with a vast increase in the incidence of periodontitis. Another view, is that periodontitis is associated with an excessively alkaline state of the blood, which leads to the depositing of lime from the blood round the teeth in the form of tartar. Here again, it is largely a matter of diet, for the acid-alkali balance of the blood is largely determined by the nature of the foods we eat.

Treatment

There is a prevalent idea that once periodontitis has set in it is essential for all the teeth to be extracted. This drastic measure will certainly cure the disease but, in a considerable proportion of cases, it is quite unnecessary. Today, conservative treatment is advocated, except in those very severe cases where the general health is affected. For such treatment, it is imperative for the sufferer from periodontitis to co-operate fully with the dentist. It is first necessary to have the scale or tartar thoroughly removed from the teeth. Then the pus pockets must be irrigated with hydrogen peroxide and some antiseptic drug such as iodine introduced to stimulate drainage and to induce a hardening of the soft, tissues. The direct application of penicillin has proved beneficial in some cases. It is possible to avoid wholesale removal of teeth by skillful dentistry. For example, if there is a deep pus socket between two teeth, the extraction of one will allow the gum round the tooth which is left to shrink and so to abolish the pocket. In this way, a policy of judicious extraction of certain teeth will frequently make it possible to retain sufficient teeth to allow of efficient mastication.

Twice daily massage of the gums with glycerine and tannic acid should be performed for two or three weeks and then followed by the use of a common salt solution- a teaspoonful to a glass of water. To perform this massage, a piece of muslin should be wrapped round the forefinger and the gums should be rubbed vigorously, particularly from the gum towards the tooth so as to help in emptying the pockets. The toothbrush should not have too hard bristles and should be used with discretion after every meal, making sure that no food remains are allowed to accumulate between the teeth. Hydrogen peroxide is a most valuable mouth-wash as the bubbles of oxygen mechanically remove the debris which collects around the teeth.

Apart from the local treatment of periodontitis, there is the matter of the general health, and in this connection diet is of paramount importance. All soft sugary starchy foods such as new white bread, cakes, biscuits, chocolates and sweets should be avoided or taken in minimal quantities and followed by the eating of some fresh hard fruit such as an apple or pear. As much fresh vitamin-rich food should be taken as possible. That means wholemeal cereals, plenty of fresh fruit and fibrous green vegetables such as cabbage, lettuce, cress, celery and onions, milk and other fresh daily products; and moderate quantities of animal protein. Such a dietary will help to maintain a high level of general health and will undoubtedly contribute to the natural cure of periodontitis.

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