Causes, symptoms and remedies of pyorrhoea

By Cristiano Antonino On Nov 6, 2022

Periodontal disease, commonly called pyorrhoea, is a bacterial disease that, due to the body’s inflammatory response, leads to the progressive resorption of the alveolar bone, the bone that keeps the teeth working, with retraction of the gums and serious aesthetic and chewing problems

The presence of bacteria accumulating inside the gum groove produces a progressive detachment of the gum with resorption of the bone causing the formation of a space, called the periodontal pocket, which further favours the accumulation and growth of bacteria with worsening of the condition of the tissues.

Symptoms of pyorrhoea

Pyorrhoea is a disease that is initially asymptomatic.

When it begins to manifest itself, in the early stages, one can observe

gingivitis: superficial inflammation of the gums that become swollen, reddened and bleed easily;
gingival bleeding: this may occur during tooth brushing or chewing or may 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 fermentation of food, produced by certain bacteria.

As pyorrhoea worsens, the teeth

become elongated due to retraction of the gums;
become unstable;
sometimes change their position.

Chewing also becomes difficult and sometimes painful.

Repeated abscesses may appear in the areas of greatest severity, i.e., where gum receding is deepest (pockets).

Pyorrhoea does not cause pain in most cases, except in abscess conditions.

Causes of pyorrhoea

Periodontal disease is defined as a multifactorial disease, i.e. numerous factors are involved in its occurrence:

bacteria, known as periodontal pathogens, which are the primary aetiological agents;
genetic factors causing reduced defence capacity;
general factors: the most frequently involved are diabetes and smoking.

Smoking and Periodontal Disease

There are many studies showing the correlation between smoking and periodontal disease; smoking

greatly increases the probability of developing pyorrhoea (risk factor);
significantly reduces the response to therapy.

Smoking, in fact, significantly restricts vascularisation and has a negative effect on the body’s immune defence response: the ability of cells such as polymorphonucleates to arrive from the bloodstream and act to destroy bacteria (reduction in chemotaxis, enzyme production and phagocytosis) is profoundly restricted.

Gingival tissue destruction also correlates with the duration and amount of smoking to which tissues have been exposed.

Diabetes and Periodontal Disease

Pyorrhoea also has a special relationship with Diabetes, so much so as to define a bidirectional relationship: those who suffer from diabetes have a 3 times greater risk of becoming ill with pyorrhoea and those who have pyorrhoea increase the likelihood of having diabetes or seeing it worsen.

In fact, the inflammatory reaction inherent in periodontal disease (pyorrhoea) is altered by elevated blood glucose levels causing gum disease to worsen.

On the other hand, pyorrhoea can affect diabetes due to the large quantities of inflammation 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: obese or overweight individuals are more likely to have periodontitis than normal-weight people.

The biological motivation is mainly that fat cells produce large quantities of pro-inflammatory cytokines, which raise the inflammatory state of the subject with worsening periodontal disease.

In the same way, raising the inflammatory state increases insulin resistance, worsening diabetes.

The consequences of pyorrhoea if left untreated

Periodontal disease if left untreated, therefore, causes tooth loss and participates in the onset of systemic diseases.

In addition, it is a significant risk factor for:

cardiovascular diseases;
pre-term births in pregnant women;
diabetes.

All these general conditions can be traced back to the presence of large quantities of pro-inflammatory molecules that are released into the bloodstream reaching certain target organs.

Diagnosis of periodontal disease

The diagnosis of periodontal disease (pyorrhoea) is made very simply and non-invasively using a millimetric instrument, the periodontal probe, which is slid between the surface of the root and the gum and allows the presence of indentations to be assessed and the severity of the lesion to be measured.

Of course, for an evaluation of the morphology of the bone destruction, it will be necessary to follow the probe with endoral radiographs.

How pyorrhoea is treated

The first phase of therapy consists of

removing bacteria (bacterial plaque) and mineral concretions (tartar) above and below the gums;
providing information on how to improve the quality of oral hygiene;
implement precise tobacco control;
provide correct dietary and lifestyle suggestions.

Following the first local therapy sessions, which as mentioned consist of oral hygiene instructions, removal of tartar above and below the gumline and superficial portions of the root (cementum) if infected, the patient is re-evaluated 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 the therapy becomes the responsibility of the dentist, who deals mainly with periodontology.

The results of therapy

Therapy will aim to

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 their base. Sometimes this also requires bone remodelling;
reconstructing the alveolar bone (guided and induced regenerative surgery): in this case, a set of techniques using various biomaterials, synthetic bone, bovine bone, membranes, growth factors, are used according to their indications, after the gingiva has been dislodged to reconstruct portions of bone destroyed by the disease;
reconstructing the gums (Mucogingival Surgery): in this case, surgery uses portions of tissue taken from another area of the mouth or synthetic tissue or tissue of heterologous derivation to graft them into areas where the roots are uncovered. These materials, together with the surgical techniques of gingival detachment that allow their insertion, make it possible to resolve the majority of gingival retractions and the resulting imperfections.

Prevention of Periodontal Disease

As already mentioned, pyorrhoea causes tooth loss: a long process that begins with gingival inflammation, progressive mobility of teeth, their migration, elongation and then falling out.

All these stages lead to serious discomfort to chewing, but also to phonetics and aesthetics.

Numerous studies emphasise the impact of pyorrhoea on the social life of the patient, who sees his or her ability to relate to others very limited because he or she is often forced not to smile, chews very badly and with discomfort and frequently has bad breath.

The importance of the prevention of this disease, which essentially consists of correct oral hygiene, is therefore obvious.

The toothbrush is the main tool to be used for the prevention of gum disease; this should be used correctly two to three times a day.

Proper oral hygiene also includes the use of dental floss or an interdental brush, as 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 one most suitable for the individual patient should be used.

Who to contact for the prevention of pyorrhoea

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 general factors, in particular smoking, for which he or she can suggest appropriate therapeutic strategies aimed at supporting correct lifestyles.

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