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Of Complicated Caries, or Caries accompanied by Disease
in the Lining Membrane of the Tooth*

When either external or internal caries has penetrated the
bony structure as far as the natural cavity of the tooth, the
lining membrane becomes inflamed and diseased. In this
state the disease may be called complicated caries, as the
tooth is affected not only by the caries of the bony structure,
but also by inflammation of the lining membrane.
Instead of being resisted in its progress by the healthy ac-
tion of this membrane, the caries is now aggravated by its dis-
eased state ; and this caries by its greater extent, becomes
a greater exciting cause of inflammation in the nerve. The
tooth being thus subjected to the influence of these two dis-
tinct diseases, which are rapidly advancing to their final
crisis, viz. suppuration of the internal membrane, now soon
loses its vitality.
For a just understanding and a judicious treatment of
complicated caries, this disease requires to be minutely ob-
served during its progress in every stage, and its different
causes and effects, as well as symptoms and appearances
very perfectly understood. In this state the disease differs
somewhat in appearance from simple caries ; the tooth so
affected has generally an opaque appearance all over the sur-
face of the enamel. This however is not easily distinguish-
ed, except by the very experienced dentist.
When the disease in its first stage h; s penetrated into the
interior, and destroyed the vitality of the bony structure, the
osseous parts although dead retain their hard and dry state
for a long time. Although the lining membrane is then slight-

Koecker, pages 236 to 239.
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