PYORRHOEA is a term used to designate any one of a group of diseases (periodontoclasia or pyorrhoea which attack the gums and bone around the teeth. They include ula trophia (recession of the gums), gingivitis (inflammation of the gums), alveolar resorption (wasting of the bony socket), perice mentoclasia (pus pocket formation). Vincent's gingivitis, erro neously called Vincent's angina, also trench mouth, is an acute gingivitis caused by the fusiform bacillus and spirochaete of Vin cent. It is the only type of periodontoclasia which is communi cable. These diseases have a direct sequential relationship, although they do not always occur in the same order. A typical case may begin as recession associated with slight alveolar resorp tion : later it merges into gingivitis with advancing alveolar re sorption; finally it develops a pus pocket (pericementoclasia), due to the detachment of the gum from the root, and still more advanced alveolar resorption. Unless checked by correct treat ment this results in the loss of the tooth.
Knowledge as to the cause of periodontoclasia, while still in complete, has advanced so far that rational treatment is now possible, and, in skilful hands, success is obtainable in nearly all cases. While infection plays a prominent part, the important fac tor is some influence which depresses the resistance of the tissues, thereby making infection possible. a large percentage of cases the important depressant is an inequality of the biting surfaces of the teeth known as traumatic occlusion, resulting in unequal distribution of pressure when the jaws are brought together. De
posits of tartar, long regarded as the important factor, now only share the responsibility. Improper diet is regarded as important in the causation of periodontoclasia. This is apparently due to a failure to develop strong, resistant, supporting tissues for the teeth, because of dietary deficiencies. Af ter the disease has be come established dietary improvement is relatively ineffective.
Treatment includes the following, given in the order of their usual importance: equalizing functional stresses; raising local resistance by massage of the gums ; removal of deposits of tartar, etc.; maintaining cleanliness; and building up general resistance by attention to nutrition. Preventive treatment follows the same lines, with special emphasis on stimulating the blood supply by tooth-brush massage. Orthodontic treatment, by helping to equalize functional stresses, helps in treatment and prevention.
Foci of infection may develop in the later stages of the disease, owing to the absorption of toxic material from the pus-pockets into the circulation. Also when the pocket extends to the end of the root, a typical abscess is produced. Advanced pyorrhoea or periodontal disease may usually be detected in the X-ray film, which registers the resorption of alveolar bone accompanying this disease. (J. 0. McC. ; P. R. S.)