Pyorrhea

Pyorrhea: A Short Survey of Some Suggested Name
By JOHN BOYES, L.R.C.P.
As a profession we are agreed that the same pyorrhea is most unsuitable. At the same time we are agreed that nothing has yet been suggested which can suitably replace it. We have not found a name, but neither have we found the cause, nor the cure. Not that names, causes and cures have not been suggested. They are, in fact, legion. That, then, is to difficulty form the point of view of nomenclature. Determine the cause and the name will soon follow.
The condition which is known to all as pyorrhea has been described in dental literature since the eighteenth century. The list of names, descriptions and classifications, which has been suggested since that time is surely as large or larger than any similar list for a single disease. Yearly new names are suggested. Some differ very slightly from those previously suggested and discarded; others are entirely new. It does not matter, however, they all have their following for a time and then gradually pass into oblivion on ly to be revived again by someone referring to the literature on paradontol disease. meanwhile, pyorrhea continues to be used and to have criticism hurled at it.
It is most convenient to consider this long list of names in groups. The first contains the early references to the disease starting with Fauchard’s mention of “False Scurvy.” That was in 1746. Jourdain followed in 1778 with a description of “Conjoint Suppuration of the Alveoli and Gingivae.” In the same year Hunter wrote about the “wasting of the sockets of the teeth and alveolar process.” Twenty-six years later Fox thought that the conditions was one of “Gradual absorption of the alveolar process.” The absorption was held by Koechker who, writing in 1826, refers to the “Absorption of the gums and sockets of the teeth.” Three years previously, 1823, pyorrhea was first suggested. In that year Joiruc gave the condition the name “Pyorrhea interlveolo-dentaire.” It is interesting to not that Oudet in 1835, mentioned that the origin of the disease was in the periodontal membrane. In 1853 Harris made his contribution of “Chronic inflammation of the gums and tumefaction of the gums attended by recession of their margins from the teeth.” Some fourteen years later, in 1876, Riggs, after whom the disease was successfully named for many years, called it a suppurative inflammation of the gums and absorption of the gums and alveolar process. With this the first group ends.
The first and most obvious point about this list is that Fauchard was the only person to give the disease a name, all the others giving a clinical description. The constant reference to the body disappearance is noteworthy. Some place as the most important sign. The suppurative element is not forgotten and is given prominence by some observers. Perhaps another point of interest is the non-reference to the accumulation of tartar. Had this been referred to there would have been in this group a complete survey of all the possibilities of names that future years were to utilize to the fullest extent.
The remaining groups will be considered differently. Instead of the chronological order adopted above the names will be put into a pathological and tissue grouping. In the one to be considered next the gingiva is the main tissue pathologically involved; calcific gingivitis, interstitial gingivitis; infectious arthrodental gingivitis; expulsive gingivitis; phagedenic gingivitis; gingival ulceration; chronic gingivitis.
The attitude, towards the etiology, of those who have suggested the above names is clear. They would suggest that pericemental and bony infection are secondary to, and the result of, a progressive gingivitis. But, of course, even some of those who agree with the possibility of the disease starting in the gum margin feel a slight hesitancy in agreeing that it should be labelled gingivitis. Also, (as can be seen) there is a difference of opinion as to the type and description of the gingivitis. Some would emphasize its progressive character, others the shedding of the teeth; whilst among the remainder, one would stress the association of calculus, another the pus formation and so on. All of which, in a way, are common signs and symptoms but not single one can be said to have precedence over another in all the clinical varieties of the disease that are found. Of course, gingivitis is not acceptable as a name to those who maintain a different cause. So the next group deals with those names connected with the pericemental infection: Phagedenic pericementitis; chronic suppurative percementitis; calcific pericemntitis; interstitial pericementitis; alveolo-dental pericemntits; gouty pericementitis; ptyalogenic calcific pericementitis; pyo-destructuve pericementitis; symptomatic alveolar arthritis; expulsive periodontitis; chronic marginal suppurative pericementitis; suppurative peridentitis; gangrenous peridentitis; chronic general periodontitis; periodontia; chronic marginal suppurative osteo-pericementitis.
Accuracy in Names is Important
Perhaps confusion is apt to arise in the correct interpretation of this group. There is always the possibility that instead of confining the name to mean the pericemental ligament, the real meaning includes all the structures adjacent to the tooth. Confusion in regard to a scientific name is undesirable at any time. As with gingivitis the etiological beliefs of the investigator take a prominent part, and whatever has been said of gingivitis can be repeated for this group. In taking notice of some of the suggestions advanced perhaps the fact is worth repeating, that several names suggested in this group are identical with some in the last excepting for the substitution of pericementitis or periodontitis. More emphasis on the suppurative condition appears in this group than the last. Again the attempt to include tartar as an integral part of the disease is worthy of attention, and other small points can be noted here and there. Unfortunately in this group there is not a suggestion suitable to everyone. The next, takes the alveolar involvement as the important feature of the disease: Alveolitis; osteo-periostite alveol-dentaire; dento alveolitis; alveolar blenorrhea; caries alveolaris; infectious alveolitis; caries alveolitis specificsseu pyorrhea; atrophia alveolaris precoxet osteoporosis; alveolitis calcophagia seucalci; chronic alveolitis; alveolitis calculosa; chronic alveolar osteomyelitis; ligamentous pyogenic alveolar atrophy; alvelitis chronica atrophicans; atrophia alveolaris idiopathica osteitis alveolaris.
Bone Involvement to be Considered
The importance of bone involvement cannot be overlooked or denied and as previously stated it impressed the early observers. What has been said about the etiological outlook when dealing with gingivitis and periodontitis can again be repeated about alveolitis. Once more some of the terms have names suggestive of the other tissues involved while others emphasize one or other of the clinical signs, especially, of course, the disappearance of bone. Thus this group, as with the other two, has not managed to suggest a term for universal acceptance.
The remainder of the list is included in the miscellaneous group which follows: –
Periodontoclasia (varieties: (1) Suppurative, (2) Non-Suppurative, (3) Alveoloclasia, (4) Cementoclasis); Rigg’s disease; Fuachard’s disease; dental alveolar pyorrhea; senile osteomyelitis; dirt pyorrhea; paradontal pyorrhea; pyorrhea (simplex et complex); syphilitic loculosis; stomatitis pyorrhea; perialgitis; pyorrhea (supra-alveolaris et intra-alveolaris); paradentitis; paradontitis; paradentosis.
The way out of calling the disease after a man is, as would have been expected, evident, but of course, as usual, at least two names are put forward and so even here unanimity is not to be found. Even pyorrhea, the term which is so universally used, has different words prefixing it. Thus there is an element of confusion creeps in even when it is used.
As a result of this short survey it would appear perhaps that, at the present state of our knowledge, the ideal name should have several characteristics.
It should not emphasize too much one particular tissue. It should therefore include the three main structures involved. It should convey the type of pathological change taking place. It should not be too long or unwieldy to use. After much thought and with the above suggestions consideration of the following term might be found adaptable to the disease and prove universally acceptable despite the differences of opinion regarding the various aspects of the disease.
Parodontitis G.P.A.
The suggestion advanced is “Parodontitis G.P.A.” Parodontitis is used ratherthan peridontitis because of the confusion associated with the interpretation of the latter. It is intended, therefore, to convey the literal meaning of all the structures around the tooth, the ermination “itis” conveying the meaning of an inflammatory change of these structures. The letters G.P.A. are contractions for gingival, pericementi et alveoli, so emphasizing the three main tissues involved. The name, therefore, is “An inflammation of the surrounding tissues of the tooth, especially of the gingiva of the pericementum and of the alveolar process.” Perhaps it may be argued that the letters are only a repetition and not worthy of inclusion and that the name becomes one of those already turned down. The letter, however, convey a little more than just appears.
Their order is of importance. If the G is placed first it means that the user maintains that the gingival theory of etiology is the correct one. If P is first then the disease is primarily of pericemental origin, and if A is first then the bony involvement is the important condition. Thus emphasis is given to a particular tissue, but not to the ocmplete exclusion of the other two. Thus the disease is Parodontitis G.P.A. Parodontitis P.G.A, or Parodontitis A.G.P. This, under the circumstances, is surely an advantage rather than a disadvantage. Let it be noticed that the order of the letters only is altered. No letter are added or taken away. The order of the letters used accordingly banishes any doubt as to the exact meaning implied by a lecturer or writer at the very outset of his remarks.
A classification can also be used for the disease with the term; Parodontitis G.P.A. classification. The classification is based entirely on clinical signs and not on histo-pathological evidence.
Three Stages
FIRST STAGE. –Parodontitis G.
The gum margin is the first tissue clinically to become involved. When this early stage is seen there is no obvious clinical involvement of the pericemental ligament of the alveolar process.

SECOND STAGE. –Parodontitis G.P.
In the second stage there is involvement of the pericemental ligament, and as soon as clinical signs of its involvement appear in the inflammatory process the P is placed in the name.
THIRD STAGE. –Parodontitis (G.P.A. or A.G.P.).
When bony involvement becomes clinically evident then the disease is fully developed, and it matters not whether the order is G.P.A., P.G.A., or A.G.P, only of course it must agree with the order originally used in naming the disease. If it is desired to denote the presence of pus in a particular case, then “suppurative” can prefix the term.
In case of doubt an example may be given to show its intended use. In a patient suffering from the disease, there is a definite gingival involvement and the gingival trough is deeper than normal, in other words there is destruction of the circular ligament of the pericemental ligament and the teeth are tender on percussion. Apart from this there is no obvious bone involvement, i. e. no marked exposure of the cementum of the teeth, no slackness of the teeth, etc. The patient is therefore suffering from parodontitis G.P.A. and at the stage of parodontitis G.P. Again let it be repeated, this is a classification based only on clinical signs and symptoms, and not one based on patho-histological evidence.
That this suggestion has faults, the writer is aware, but surely it has certain advantages over those names already suggested. If this suggestion is like the rest, unsuccessful, it is the hope of the writer that some term will soon be discovered to end the chaos and confusion which meantime exists.
The British Dental Journal.