Dissertation on Periodontia

By  D. P. Mowry,  D. D. S., L.D.S.

Montreal, Canada

            As a rule I do not like generalizations. It often happens that, in making a statement, the hearer receives a concept which differs materially from that which the speaker intended to convey by the use of the words he employed. This need not be the case in the sciences, because their development has been made possible by exact vocabularies. This is true of histology. Therefore I do not need to preface the next paragraph by any such premise as “it would appear”, or “it is commonly accepted”.

The dentist should be familiar with the tissue structure which he treats daily. The cell is the unit of life and the odontoblast of the pulp, the cementoblast of the cementum, the osteoblast and osteoclast of bone, the connective tissue, all of the peridental membrane and the gingival tissue, and last, but not least, the epithelial cell of the stratified squamous epithelium of the gums should be as intimate and exact in the mind of the dentist as his choice of a forcep for the extraction of a particular tooth.

With this preamble I present the questions and answers of a round-table discussion of periodontia at the Eleventh Annual Greater New York December Meeting.

Question No. 1. –Does traumatic occlusion, once relieved, recur? If so, why?

Answer: Yes and no. By its very name it implies an injury. Normally there is a harmony between the fibers holding a tooth in the alveolar socket. When this harmony is altered, the healthy fibers tend and, in fact, do draw the tooth into a new position which may or may not be a new position of trauma in function. Relief of traumatic occlusion does not remove the cause of the breakdown of supporting tissues in any individual case. It is the treatment of symptoms –necessary but not fundamental. There is of course a recognition of the physiological movement of the teeth occlusally and mesially.

Question No. 2 –How do you desensetize the very sensitive cervical areas of teeth which require sealing?

Answer: Personally, I attempt to locate the cause of sensitiveness such as trauma, caries, etc. Where it is the reflection of some general condition. I use a local anesthetic either topical (chloroform, senthesin, nupercain, topanol, etc.), or, in secere cases, infiltration or block anaesthesia. The application of paraformaldehyde powder in cement and covered over with a layer of cement to protect mucous tissues will often relieve if allowed to remain for a week.

Question No. 3 –is diet an important factor in the treatment of periodontal disease?

Answer: Yes, but its choice should be in the lands of a competent physician.

Question No. 4 –Can periodontal disease be prevented? If so, what is the ideal program for its prevention?

Answer: Very probably. Program calls for discovery of etiology.

Awaiting the solution of the common factor, the following should be of value:

(a)             Establish a nation-wide program of eugenics to be taught high school and college students with a view to improving hereditary factors.

(b)            Insist on all occasion that there is no equivalent substitute for mother’s milk.

(c)             Permanent campaign showing need for exercise of teeth and through them the supporting tissues by mean of rough natural foods.

(d)            Prophylactic odontotomy.

(e)             Co-operation with orthodontists.

(f)              Continue and intensify oral hygiene propaganda.

(g)             Co-operate with physicians. Investigate the value of a diet composed of 80% alkalin forming foods and 20@ acid forming foods.

(h)            Investigate the wisdom of reducing cusps or opening bite after age 30, wherever there is evidence that lateral stress is exceeding physiological tolerance..

Question No. 5 –How do you explain the rapid deposition of calculus within a few days after its thorough removal?

Answer: I do not think there is as yet a scientific explanation. It would appear that there is an excess of calcium salts in the blood stream and salivary glands were being utilized as excretory organs.

Question No. 6 –What part doe therapeutics play in the treatment of periodontal disease?

Answer: A very great assistance but, in the vast majority of cases, it is quite inadequate without thorough local periodontal treatment. In any case, I repeat that therapeutic treatment should be conducted by the physician. I think we are all aware of the complications of mercury, bismuth, lead, arsenic, etc.

Question No. 7-What systemic conditions, or diseases, predispose to periodontoclasia?

Answer: Diseases of the digestive system, diseases of the ductless glands, rickets, pellagra, scurvy, leukemia, syphilis, or, in fact, any disease that severely alters the body fluids. The dental anatomy is very susceptible to circulatory disturbances.

Question No. 8-How valid are the objections to the grinding of teeth to secure a balanced occlusion?

Answer: In some cases it is probably better to eradicate lateral stress by filling in the sulci or by means of a splint. naturally, if the dentin is very sensitive, further grinding is contraindicated. Every case should be treated o its own merits. I do not think that we can generalize on this question.

Question No. 9 –Is tooth replacement an important factor in the prevention of periodontal disease?

Answer: An important but no an imperative factor. Again, we cannot generalize.

Question No. 10 –When is sub-gingival curetage and when so-called “surgical treatment” incated?

Answer: Whenever the final result is a gingival crevice of more than 2 mm., “surgical treatment” is may be attempted. For esthetic reasons one is often justified in putting off “surgical treatment” in the anterior region as long as possible.

Question No. 11 –Does the average general dental practitioner evaluate the importance of proper diagnosis of incipient periodontoclasia?

Answer: I do not think do.

Question No. 12 –Can a standardized technique for the treatment of periodontoclasia be established?

Answer: With sufficient classification to allow for variation of individual cases, yes.

Question No. 13 –What are the chances for a cure in the case of the indifferent patient where all pathosis has been effectively removed and no periodic prophylactic after-care has been followed?

Answer: There are poor chances for a cure, but the teeth may be “prolonged”. A cure may be defined as a restoration to health. In this sense a temporary cure is quite possible.

Question No. 14 –Should proliferative (hypertropic) tissue be exercised? If not, why?

Answer: Yes.

Question No. 15 –Is the use of the toothbrush important factor in maintaining a healthy condition of the gingiva?

Answer: Yes.

In conclusion, let me suggest that research to date would indicate that the etiology of periodontoclasi (phyorrhea) is in the realm of the body metabolism. With rare exceptions, the treatment of this disease consists in the treatment of aggravating local irritations –physical, chemical an bacteriological. Many cases are seen with severe local stresses and inflammatory conditions without the development of pyorrhea. Similar cases are observed with much less local abnormalities but with the complication of acute and chronic gingival and alveolar lesions. The reduction of local irritations may bring the stress within the region of the individual physiological tolerance of the tissues and the maintenance of the relationship results in a cure.

It would be appear to be the duty of the general dental practitioner to adjust the relationship of the teeth and provide adequate dental hygiene such that even a patient with relatively poor general health would have a dental environment adequate for the conduct of life.

The Dental Journal of Australia.