Progressive Pyorrhea

By  E. C. Lowe, M. B. E., M. B., B.S.

            I have neither time nor intention of entering into the details of the argument with regard to the etiology of pyorrhea alveolaris, concerning which there have been so many opinions expressed in the recent dental literature, beyond saying that, in my experience, I find myself in agreement with Broderick and many others in the opinion that pyorrhea is really a condition depending upon general systemic derangement, as well as upon certain local conditions affecting the gingival tissues particularly, and I also find myself in agreement with those who suggest that the name “pyorrhea” is in many cases a misnomer and is apt to confuse the appreciation of its proper conception. The flow of pus which the name emphasizes is a terminal condition due to secondary infection may not be present in certain cases, and I understand that the International Dental Federation has suggested “Pradentosis” as an alternative.

In many cases of chronic disease pyorrhea is found to exist as part of the clinical complex which may present itself for medical treatment, and one has had the experience of the pyorrheic condition being largely arrested or cleared up as the result of initiating treatment for the more generalized condition of the patient concerned.

The causes of pyorrhea are certainly multiple, and the local condition, as has been pointed out, is probably initiated by some form of marginal gingivitis, the mechanical irritation associated with an alternation in the normal physiology of the gingival tissues, and with tissue status and capillary and lymphatic engorgement. Traumatism, mechanical irritation from defective crowns, tartar or irregularity of the teeth, no doubt all play a part, but the truly septic condition associated with a frank pyorrhea, is probably always secondary, and associated with the production of the deep peridental pockets and alveolar absorption which is usually found under such conditions.

Pyorrhea from the medical point of view is more essentially a condition found associated with the middle decades of life, usually in patients over 30 and under 60, and this is in definite contrast to the usual incidence of caries.

In the type of case in which one finds evidence of pyorrhea in making the pathological examination there is usually evidence of endocrine deficiency, in which the thyroid, adrenals, pancreas deficiency, in which the thyroid, adrenals, pancreas and gonads are more or less implicated, and in this way it is frequently found or less implicated, and in this way it is frequently found associated with menopausal derangement, and in about the same period of life. In those cases in which  frank pyorrhea is present, the removal of the septic condition, either by local treatment, extraction or actual vaccine therapy, may be an essential part of general treatment, but in the yet earlier cases the elimination of toxic and infective conditions, particularly of the bowel, with endocrine reinforcement, has often been associated with a definite improvement or clearing up of the early evidences of an incipient pyorrhea.

There is certainly a great deal of truth in Broderick’s emphasis of the alkalotic state of the patient and the general deficiency of tissue oxidation, associated with a dysfunction of thyroid, adrenal, pituitary and gonad activity. Treatment of such conditions usually involves, apart from endocrine help along the lines suggested, the employment of calcium, contramine and other products of similar type, and my feeling is that incipient and early cases of pyorrhea, when recognized,, should be considered as evidence of the need for some generalized treatment to correct the patient’s endocrine balance, rather than be looked upon as of entirely local importance. –The British Dental Journal, Per The Dental Journal of Australia.