The presence of accumulation of bacteria inside the gum groove produces a progressive detachment of the gum with resorption of the bone, causing the formation of a space, called a periodontal pocket, which further favors the accumulation and growth of bacteria with worsening of the condition. of the tissues. .
Symptoms of pyorrhea
Pyorrhea is an initially asymptomatic disease.
When it begins to manifest itself, in the early stages, it can be observed
- gingivitis: superficial inflammation of the gums that become swollen, red and bleed easily;
- gingival bleeding: this can occur during tooth brushing or chewing or it can be spontaneous, detected in the morning by the presence of blood stains on the pillow;
- bad breath: halitosis, particularly in the more advanced forms, is due to the fermentation of food, produced by certain bacteria.
As pyorrhea worsens, the teeth
- elongate due to receding gums;
- become unstable;
- sometimes they change position.
Chewing also becomes difficult and sometimes painful.
Repeated abscesses may appear in the most serious areas, that is, where the retraction of the gums is deeper (pockets).
Pyorrhea does not cause pain in most cases, except in abscess conditions.
Causes of pyorrhea
Periodontal disease is defined as a multifactorial disease, that is, numerous factors intervene in its appearance:
- bacteria, known as periodontal pathogens, which are the main aetiological agents;
- genetic factors that cause a reduced defense capacity;
- General factors: the most frequently implicated are diabetes and smoking.
Smoking and periodontal disease
There are many studies that show the correlation between smoking and periodontal disease; of smoking
- considerably increases the probability of developing pyorrhea (risk factor);
- significantly reduces response to therapy.
Smoking, in fact, significantly restricts vascularization and has a negative effect on the body’s immune defense response: the ability of cells such as polymorphonucleates to arrive from the bloodstream and act to destroy bacteria (reduction of chemotaxis, production of enzymes and phagocytosis) is profoundly restricted. .
Destruction of gingival tissue also correlates with the duration and amount of smoke to which the tissues have been exposed.
Diabetes and periodontal disease
Pyorrhea also has a special relationship with Diabetes, so much so as to define a bidirectional relationship: those with diabetes are 3 times more likely to develop pyorrhea and those with pyorrhea increase the likelihood of having diabetes or seeing it worsen.
In fact, the inflammatory reaction inherent to periodontal disease (pyorrhea) is altered by elevated blood glucose levels that make gum disease worse.
On the other hand, pyorrhea can affect diabetes due to the large amounts of inflammatory products and bacteria that can enter the circulating blood and reach various organs, including the pancreas, causing inflammatory reactions with worsening of its functions.
Obesity and periodontal disease
The relationship between obesity and periodontitis is also well documented: overweight or obese people are more likely to have periodontitis than people of normal weight.
The biological motivation is mainly that fat cells produce large amounts of proinflammatory cytokines, which elevate the inflammatory state of the subject with worsening periodontal disease.
Similarly, raising the inflammatory state increases insulin resistance, worsening diabetes.
The consequences of pyorrhea if left untreated
Periodontal disease if not treated, therefore, causes tooth loss and participates in the appearance of systemic diseases.
In addition, it is a significant risk factor for:
- cardiovascular diseases;
- premature births in pregnant women;
All of these general conditions can be traced back to the presence of large amounts of proinflammatory molecules that are released into the bloodstream and reach certain target organs.
Diagnosis of periodontal disease
The diagnosis of periodontal disease (pyorrhea) is carried out in a very simple and non-invasive way using a millimetric instrument, the periodontal probe, which slides between the surface of the root and the gum and allows the presence of cracks and the severity of the disease to be evaluated. the same. the lesion to be measured.
Of course, for an evaluation of the morphology of bone destruction, it will be necessary to follow the probe with endoral radiographs.
How is pyorrhea treated?
The first phase of therapy consists of
- remove bacteria (bacterial plaque) and mineral concretions (tartar) above and below the gums;
- provide information on how to improve the quality of oral hygiene;
- implement accurate tobacco control;
- Provide correct dietary and lifestyle suggestions.
After the first sessions of local therapy, which as mentioned consist of oral hygiene instructions, removal of tartar above and below the gum line and superficial portions of the root (cementum) if they are infected, it is returned to Assess the patient for any secondary needs.
This first therapeutic phase, which may represent all that needs to be done, is carried out by the dentist or dental hygienist.
In cases in which this first therapeutic phase does not correspond to the elimination of pockets or the complete resolution of tissue problems, in more serious and more advanced cases, therapy becomes the responsibility of the dentist, who deals mainly with periodontics.
The results of the therapy
The therapy will aim
- restore periodontal health and chewing;
- restore aesthetics to the patient’s smile through specific surgical techniques.
In particular, surgery is used to
- eliminate pockets (resective surgery): this technique aims to eliminate the spaces where bacteria live (pockets), either by surgically resecting them or by moving the gum at its base. Sometimes this also requires bone remodeling;
- Reconstruction of the alveolar bone (guided and induced regenerative surgery): in this case, a set of techniques are used that use various biomaterials, synthetic bone, bovine bone, membranes, growth factors, according to their indications, after the gum to rebuild portions of bone destroyed by the disease;
- reconstruction of the gums (Mucogingival Surgery): in this case, the surgery uses portions of tissue extracted from another area of the mouth or synthetic tissue or heterologous bypass tissue to graft them in the areas where the exposed roots are found. These materials, together with the surgical techniques of gingival detachment that allow their insertion, allow to resolve the majority of gingival recessions and the resulting imperfections.
Prevention of periodontal disease
As already mentioned, pyorrhea causes tooth loss – a long process that begins with gingival inflammation, the progressive mobility of the teeth, their migration, elongation and subsequent fall.
All these stages entail serious discomfort to chewing, but also to phonetics and aesthetics.
Numerous studies highlight the impact of pyorrhea on the social life of the patient, who sees his ability to relate to others very limited because he is often forced not to smile, chews very badly and with discomfort, and frequently has bad breath.
The importance of preventing this disease, which basically consists of proper oral hygiene, is therefore evident.
The toothbrush is the main tool to use for the prevention of gum disease; this should be used correctly two or three times a day.
Proper oral hygiene also includes the use of dental floss or an interdental brush, since a toothbrush cannot reach the interdental surfaces of the teeth.
In addition, the quality of brushing is more important than the frequency: there are numerous “codified” brushing techniques and the most appropriate one should be used for each patient.
Who to contact for pyorrhea prevention
Prevention control is largely entrusted to the dental hygienist, a health professional with a degree in oral hygiene sciences, who can not only intervene to prevent the onset of the disease by controlling the quality of oral hygiene, but also some of the the general factors, in smoking in particular, for which it can suggest appropriate therapeutic strategies aimed at supporting correct lifestyles.