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We do not know exactly what role any of the different microorganisms found in the gingival crevice play relative to disease there. Probably it is a very complex process. However it is clear that for the purpose of preventing initiation of the lesions of this disease and preventing further progress of lesions that have already been established, effective measures must be applied to prevent or minimize the growth and accumulation of bacterial material on the tooth at the entrance to, and within, the gingival crevice, which cause the disease (Figures 10, 11, 12).

Food material retained at the entrance to the gingival crevices and between the teeth, and packed into the crevices, promotes growth of bacteria there and increases inflammation of the tissues against which it rests. If food and bacterial material that has accumulated at and within the gingival crevices during the day is effectively removed at night before retiring, there follows a period of many hours during which there is greatly lessened bacterial growth. Rapid subsidence of inflammation occurs. Therefore to effectively prevent the initiation and further progress of periodontoclasia lesions the teeth must be cleaned at and within the gingival crevices every night before retiring. Nothing else will suffice.

Diagnosis Of Early Stage Periodontoclasia

The periodontoclasia lesion begins at the entrance to and just within the gingival crevice, principally the interproximal crevices, the distal and mesial crevices about teeth where there is no approximating tooth and the crevices at the buccal, labial and lingual embrasures. At first the lesion is only microscopic in extent. Even then there are a few (often only microscopic quantities) pus cells passing through the inflamed inner surface of the free gingiva. These tend to accumulate just within the crevice and at the entrance to it. Material removed from within the crevice by proper technic, stained and examined shows some to many pus cells. There are no pus cells within uninflamed healthy gingival crevices. Therefore, the presence of pus in material from the gingival crevice is diagnostic of inflammation there. Likewise the absence of pus cells means absence of inflammation and absence of periodontoclasia.

Microscopic examination for pus is a very simple procedure. Material must be properly taken from the gingival crevice, spread upon a microscope slide and stained with some one of the many appropriate stains for such specimens. The material must be delicately scraped from within the crevice with an appropriate small instrument. Although some of the instruments usually used by dentists for other purposes may be used, the best results can be obtained with an explorer and scraper which the author first made from a D. C., R & L, Premierlite explorer (Figure 13). The blade is ground to a width of .55 mm. and suitably shaped for entrance and manipulation within the gingival crevices especially the interproximal crevices. A cross section of the blade is half disc shaped. With it one can obtain small amounts of material from the inflamed surface of the gum within the crevice and from the very bottom of the space, where the disease is progressing. Success depends upon correct technic in collecting and preparing material for examination rather than upon collecting large amounts improperly.

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