CHAPTER 4.

PYORRHEA AND OTHER DENTAL DISEASES

Pyorrhea, or Riggs disease--more technically known as _pericementoclasia_--is a very pernicious malady, about the pathology of which there is still a great deal to be learned. Enough is already known, however, of the characteristics of pyorrhea to prevent it in the average person, if proper precautions are observed; and to treat it effectively if the patient will heartily cooperate with the dentist, should there be an indication of pyorrhea presenting itself.

This disease is a chronic inflammation located in the membrane covering the roots of the teeth, and in the alveolar process or sockets of the teeth, which produces a gradual and painful dissolution of these structures. It is accompanied by a flow of pus from the alveolus, or socket, resulting, unless the progress of the disease is checked, in the ultimate loss of the teeth.

It is believed to be sometimes due to constitutional causes, such as rheumatism, diabetes, Bright’s disease, gout, mercureal poisoning, anemia, and blood disorders.

A contributing cause is uncleanliness of the mouth, which permits deposits of tartar to accumulate where the teeth join the gums. As a result the gums become irritated and infected by disease--producing germs; the tissues are broken down and pus forms.

A predisposing factor in pyorrhea is believed to be irregular teeth, or malocclusion or improper closing of the teeth. This tends to a mild form of rotation in the process of mastication, and the continued rocking of the teeth contribute to their loosening, which permits the invasion of the gum attachments by destructive micro-organisms.

There is no doubt that hereditary factors are paramount in determining the _character_ of tissue and its susceptibility to, or tendency to resist, certain diseases. This is especially true of the membranes and tissue of the gums and mouth. However, there is equally positive evidence, in the opinion of prominent authorities, that local irritation is a specific cause of pyorrhea.

In this connection, Dr. John Deans Patterson sums up the etiology of the condition as follows: “_Any irritant, of whatever nature, which impairs the integrity and continuity of the gingival gum margin, may cause pyorrhea and without this impairment the condition will not be established._”

Pyorrhea is not restricted to the gums of human beings, but affects as well the teeth of certain domestic animals, notably dogs and cats which share our human habitations.

Dr. Theobold Smith, in his dietetic experiments, while endeavoring to prove that scurvy could be produced by a faulty diet, was the first to produce pyorrhea artificially. He discovered that guinea-pigs fed on a diet of oats, would in three weeks show all the symptoms of scurvy. The dental symptoms were pronounced; the teeth loosened, and the gums became red and swollen, quite as in the case of the pyorrhea patient. Other medical experimenters have also shown the relationship of faulty diet and pyorrhea in animals. It is worthy of note that very few of the animals which received the same diet, but with the addition of orange juice--which is extremely rich in vitamines--displayed the symptoms of scurvy and pyorrhea.

The early symptoms manifest themselves in a tendency of the gums to bleed upon slight provocation, usually while brushing the teeth, or while removing impacted particles of food from between them with a tooth pick.

When the attachments of the soft tissues of the gums to the teeth are destroyed, the teeth become loose and when the disease reaches this stage, there is little that can be done beyond removing them.

TREAT IT EARLY

At the first suspicion of pyorrhea, one should at once put his case in the hands of a dentist, otherwise the disease is apt to become rapidly progressive, and make treatment difficult or ineffective.

At the outset in a case of this kind, the dentist’s treatment lies in thoroughly removing all irritating substances of whatever nature, and polishing the exposed teeth surfaces. The patient, on his part, should give more care and attention than ever to the hygiene of his teeth and mouth, cleaning them several times daily.

It is of paramount importance to keep the teeth and gums clean, and free from all irritating substances.

As there is a definite relation between pyorrhea and the general health, in some cases more noticeable than others, the patient should make every effort to put and keep himself in first-class physical condition. Every endeavor devoted to this end, will be amply repaid, because it will afford the best possible assistance to the specific treatment that the dentist is giving.

There is no dental disease, in fact, in the treatment of which it is so important that the dentist receive the hearty co-operation and support of the patient.

More recent research indicates that malnutrition is a predisposing factor in pyorrhea. Faulty diet, especially in preparing foods so that an insufficient content of mineral salts and vitamines is obtained, seems to play an important role in the genesis of this disease. The experiments with animals, already referred to, lend confirmation to this theory.

Faulty elimination, and toxic absorption from food decomposition in the intestines--a result of chronic constipation--are also believed to be conducive to pyorrhea.

No medicine has ever been suggested which will cure pyorrhea. Medical treatment, if taken, can only be for some other specific disease, or for the general health. There is no medical specific for pyorrhea alveolaris.

RAVAGES OF PYORRHEA

After pyorrhea has definitely manifested itself, the gums recede and shrink, and the tissues surrounding the roots of the teeth deteriorate. Consequently, the attachments of the teeth to the socket in the jaw are loosened.

When the gradual destruction of tissue has reached this point, and the membranes covering the roots of the teeth are gone, there is no chance of ever replacing the tissue destroyed.

As there is always a pus secretion from pyorrhea, this adds to the evil results of the disease, because in masticating food the pus is squeezed from the gums and mixes with the food. Thus, there is a constant supply of poison being swallowed by the pyorrhea patient. This is absorbed into the circulation--or at least carried into the digestive system, ready to assert itself malevolently in the event of low bodily resistance.

Dr. Hunter, the famous English authority already quoted, maintains that pus from the teeth, when swallowed with the food, is a cause of ulcers and other diseases of the stomach and intestines.

Pyorrhea may also cause disturbances in the local regions of the mouth, head and neck. The glands of these parts are particularly susceptible to inflammation. Infections of the nose and throat, diseases of the internal ear, suppuration of the tonsils, and other disorders, are also among the possibilities.

Dr. William H. Porter, Professor Emeritus of Pathology and Clinical Medicine of the New York Post-Graduate Medical School and Hospital, has summed up the treatment of pyorrhea in these words: “Keep the pus flowing, keep the surfaces clean, so that Nature will be enabled, by the germ-resisting action of the white corpuscles, to throw up a barrier, behind which the germs cannot thrive.”

Certain rules with regard to eating, as well as conscientious oral hygiene, will aid in the prevention of pyorrhea. Soft, starchy foods, such as cakes and sweets, and gelatinous concoctions, should not be eaten between meals, nor late at night. When they are eaten at meal-times, they should be followed by foods which act as a cleansor, such as foods of a fibrous nature, and uncooked fruits, the juices of which have a beneficial influence on the teeth and mouth.

When one has a suspicion that the teeth are showing symptoms of pyorrhea, no time should be lost in consulting a dentist. If anything can be done at all, it must be done at the start. After the disease has definitely established itself, the conditions are infinitely more difficult to treat.

Dr. Kurt H. Thoma, of the Harvard University Dental School, mentions the incident of a prominent dentist in the Western part of the country who, when giving a clinic at a dental convention to show the method which made his treatment of pyorrhea so successful, was reproached with the statement that his cases did not present pyorrhea at all. He replied that this criticism was a proof that most dentists either did not recognize the early stages of pyorrhea or else paid no attention to it until the disease was virtually incurable.

It cannot be too strongly emphasized that pyorrhea must be attacked in its incipient stages, if a cure is to be effected. When the gums begin to bleed and show signs of inflammation, then is the time to seek the best professional treatment.

ABSCESSES

There are different types of alveolar abscesses--of which the acute kind, with swelling and pain is best known to the layman.

The most intense pain accompanies the acute alveolar abscess. For this reason, treatment of some kind is usually given. The abscess begins as soon as the infection from the diseased or dead tooth penetrates through the opening at the end of the root.

With the inflammation of the tooth membranes, pus forms and gradually the surrounding bone is destroyed. In a few days the pus burrows a hole toward the surface, accumulating under the gum, and finally obtains an outlet, usually in the mouth, forming a sinus, but sometimes on the outside of the face.

As the early inflammation forces the tooth outward in its socket, whenever the jaws close, the infected tooth is first to come in contact with its opposite tooth, with painful results. Later, the accumulated pus causes a constant pressure, with unremitting deep and throbbing pain. There is an extensive swelling of the face. When a tooth in the upper jaw is abscessed, the swelling extends over the upper part of the face, often partly closing the eye. When in the lower jaw, the swelling may extend down into the neck.

At the peak of the inflammation, there is usually a high fever, preceded by chills. Also, among the usual symptoms are flushing of the face, headache, constipation and highly colored urine. In extremely serious cases, delirium may occur, and in the event of extensive pus absorption, blood-poisoning (_septicemia_) may occur.

Shortly before the abscess breaks the swollen gum takes on a whitish appearance, which is known as the “pointing” of the abscess. With the breaking of the abscess and the discharge of most of the pus, there is a cessation of pain.

The disappearance of the pain and swelling does not imply that the trouble has been eliminated. It means that after a past accumulation of infection an upheaval has taken place, and conditions become temporarily quiet--very similar to the state of a volcano, in its periods of apparent latency--but as long as the seat of the disease remains, there is always the possibility of a recurrence of the acute abscess.

If relief from the more extreme symptoms is afforded by a discharge of pus through the sinus, this may prove detrimental to the general health. It is always a liability to carry around an infection of this kind, and the sooner the case is given thorough-going attention the better.

Never wait for an abscess to run its course, or quiet down on its own account, but at the first hint, seek relief from the dentist, and arrange for prompt removal of the cause of this disturbance. It may be necessary to have an X-Ray taken to obtain a satisfactory diagnosis.

_Blind Abscesses._--The blind abscess--or _dental granuloma_--as it is technically known--is an insidious foe. It causes practically no local disturbances, and this absence of definite symptoms sometimes results in a more unfortunate series of troubles than the intense pain of the acute abscess. The latter gives a warning which is usually headed, while the blind abscess works its mischief painlessly and unobtrusively.

The presence of the blind abscess is often suspected by some constitutional ailment or certain physical or mental symptoms for which no organic basis seem to be in evidence. In any vague disorder of this kind, it is always advisable to have an X-Ray examination of the teeth.

The seat of the infection may be a tooth from which the pulp has been removed. Instead of dissolving a considerable amount of tissue into pus, however,--as in an acute abscess--a blind sac, or _granuloma_, is formed.

A certain amount of bone is eaten away, leaving the sac, and it is this defect in the bone structure which shows as a dark area in the X-Ray picture.

The consequences of blind abscesses, in general disabilities and specific diseases, are many and far-reaching. Some of these results have been referred to in Chapter I, under the caption of Focal Infections.

It may impress one more with the seriousness of alveolar abscesses--both blind and acute--to state that they are in reality infections of the jawbone. If neglected, they may cause serious involvement of the bone structure of the jaw, as well as disease in any part of the body.

IMPACTED AND UNERUPTED TEETH

Civilization hits us pretty hard at times--with all its compensations--and the dental structure is undoubtedly the hardest hit of all. The biologists tell us that one of the penalties of evolutionary progress is a shortening of the jaws. Consequently, there is becoming less room for the teeth and some of them are extremely crowded and are getting smaller, particularly the third molars and lateral incisors.

Worse still, in many instances, certain teeth are sometimes missing altogether. That is, they are not visible. However, in these cases, they are usually lying more or less undeveloped, below the surface of the gums.

These are known as unerupted teeth. The reason they do not erupt is, as aforesaid, because there is not space enough in the jaw for them to take their place alongside their more fortunate fellow teeth. In this submerged state, they become locked or impacted--jammed or crammed down by the adjoining teeth. Often in the case of the third molar, or “wisdom” tooth, it is forced into a horizontal position, instead of the normal upright one, which makes the situation more difficult. Sometimes the bicuspids become impacted.

Residing in this unnatural position in the jaw, impacted teeth are very susceptible to infection, and as their very presence in most instances is not suspected, the trouble caused by the infection remains more or less a mystery.

The presence and position of unerupted, impacted teeth can be determined by an X-Ray picture of the jaw. They cause distressing local symptoms (from pressure on a nerve), such as sharp, throbbing or dull pains, or, in other cases, a vague, obscure sensation of pressure. The trouble is relieved by removing the unwelcome, unaccommodated teeth.

_Cancer of the Month._--Buccal cancer, or cancer of the mouth cavity, is a serious affliction that may result from any sort of chronic irritation or friction in that locality. While the most frequent cause is undoubtedly irritation from excessive smoking, dental causes are also a factor. Of the latter, a broken tooth, hook, diseased root or an ill-fitting plate, may be the seat of the irritation. If one is bothered by any of these irritating stimuli, no time should be lost in going to a dentist to have the offending object eliminated.

According to data obtained by the Metropolitan Life Insurance Company, as a result of a comprehensive survey of the mortality from cancer among its millions of policyholders covering the twelve-year period from 1911 to 1922 inclusive, cancer was the fifth cause of death in numerical importance. Buccal cancer was responsible for 8.9 per cent of all cancer among white males, and 6.9 per cent among colored males. Only one per cent of deaths from cancer among females was due to buccal cavity growths.