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224: OPERATIVE DENTISTRY
In Chronic Complications of Putrescence Avhere the drainage is
through the pulp canal only, the case may answer to the treat-
ment of the pulp canal. HoAvever other cases will demand special
treatment for the sterilization of the enclosed pocket beyond tlie
foramen. The greatest danger in the treatment of this class is in
suddenly converting them into acute form. This can generally be
avoided by attempting the treatment of the sub-dental conditions
only following complete and absolute sterilization of the communi-
cating canal. That there is a communicating canal in these cases
of so-called ''blind abscesses" is self-evident and this opening per-
mits of treatment without the use of pulp canal drills, a method
which is not advised and a practice Avholly unwarranted, result-
ing, many times, in rendering the case beyond the possil)ilities of
cure.
If the case must have additional drainage it is a case of surgi-
cal procedure and the point of attack should be through the ex-
ternal alveolar wall, a method sometimes resorted to with good re-
sults.
Chronic Alveolar Abscess With Sinus, generally with the opening
on the external alveolar wall, is a complication resulting from a
closed case of i^utrescence of long standing and when not associated
with necrosis or denuded root is not, as a rule, hard to manage.
The Treatment of Chronic Alveolar Abscess is to thoroughly
sterilize the pulp canal, then the fistulous tract. The tract should
be established by forcing hamamelis or cassia water through the
pulp canal and out through the sinus. Follow this with phenol or
aconite and iodine only sufficient to cauterize the entire surface of
the tract thus destroying the fibrous lining, improperly called the
"pyogenic memhrane." Then proceed as with any other case of
putrescence, filling the pulp canal before closure of the sinus has
been effected. Some advise the entire treatment and canal filling
at the first sitting, but it is probable that better results will be ob-
tained if case is allowed a week or ten days between the first
treatment and the canal filling for complete sterilization of the
dentine walls.