Pyorrhea occurs in the absence of inflammation and periodontal pockets. It is a less common disease, develops over years and is seen as the terminal stage of periodontal disease.

The following symptoms apply to this: simultaneous leakage of blood, pus and mobility of the affected tooth (losing its chewing function). Pyorrhea has a greater predisposition for those affected by diabetes, osteoporosis or autoimmune diseases. It is assumed that its cause is not very clear.

It affects both maxillary arches where there is no edema and the teeth appear more mobile. The treatment includes maneuvers to slow down the continuous destructive process of the bones.

Similar to this disease, which mainly affects the support system of a tooth, there is also periodontitis which we deal with on another page.

Similarly to periodontitis, the most important consequences of pyorrhea are:

• Bone resorption;

With this phenomenon we indicate the consequence of the disease itself where the bacteria and their virulence seem to cause a slow and progressive destruction of the alveolar bone and the supporting bone of the affected teeth.

• Gum recessions;

Together with the destruction of the bone, there is also clinical evidence of a receding of the gums called gingival recessions. The level of the gums faithfully follows the bone level of the patient and it may happen that the level of the gums changes from tooth to tooth depending on the bone destruction that has occurred.

• Root exposure;

Once bone resorption and gum recession have occurred, the patient complains that his teeth seem longer and also more sensitive to different thermal stimuli and more. In pyorrhea the exposure of the roots occurs at 360 degrees (which is different in periodontitis).

• Dental mobility;

With progressive bone destruction and loss of the tooth support apparatus, the mobility of the affected element or elements becomes evident. In case of pyorrhea, mobility is now an irreversible process.

• Halatosis.

Bad odor is one of the main symptoms for pyorrhea patients. This symptomatology can cause greater discomfort in patients which, however, disappears when the inflammation is treated.

The method of treatment changes according to the stage of the disease with which the patient presents. In the case of pyorrhea, the solution would be to extract the involved tooth since only in this way can the disease itself cease. To treat this disease it would be good practice to prevent it by carrying out the same methods as the treatment for periodontal disease.

The measures that concern the treatment and slowing down the evolution of pyorrhea are:

• Curettage – deep cleaning of the roots of the teeth;

Root curettage is a therapeutic process carried out with special instruments and its purpose is to remove the subgingival tartar attached to the root. This is to make the surface as smooth as possible so that bacteria do not stick to it, slowing down bone resorption.

• Flap surgery – correction and restoration of periodontal pockets with artificial bone;

Open planing is a surgical procedure that involves opening a flap and removing subgingival tartar in deep periodontal pockets. Artificial bone is subsequently added in the areas where it is deemed necessary to cover the bone defects caused by the disease itself.

• Plasmolifting;

The use of plasma in the dental field has been an innovation in major surgical procedures. The plasma is taken with a blood sample from the patient and then placed in a centrifuge. From there the plasma to be used for surgery is obtained. The plasma itself is used to try to regenerate the gum cells.

• Antibiotic treatment.

This disease is caused and supported by a significant bacterial load. As with all infections, antibiotics present a first line of defense. (It is important to underline that the effect of antibiotic treatment is slower in the case of smoking patients than in non-smoking patients. Its effect in the case of periodontitis is slower)

To try to reduce the consequences of pyorrhea we find (same as periodontitis):

• Teeth splinting;

One of the most effective methods to contain the dental mobility that has occurred is that of splinting the affected teeth. The practice consists of using a metal wire from the inside of the teeth which holds them together making them work as a group. This wire is kept in place for 6-8 months after which the stability of the affected teeth is assessed again.

• Dental crowns and bridges on teeth;

Another solution to reduce the consequence of periodontitis would be to cover the teeth affected by the disease with fixed crowns or bridges, thus improving the aesthetic as well as the functional aspect.

• Gengivoplasty.

Gingivoplasty consists of taking a sample of the patient’s own gums and covering the irregular gingival defect left as a consequence of the periodontitis itself.