Page 40 - An essay on the diseasesof the jaws, and their treatment

18 AN ESSAY ON THE powerful efforts.of nature require more judicious attention on the part of the surgeon-dentist than in the other, in which the more passive state of the parts, and greater chemical activity of the matter, give a more distinct indication of the power of curative means. In constitutions, however, which are not only suffering from debility, but which are at the same time under the influence of actual disease, or of a general vitiated state of the system ; such as is induced or excited by scrofula, scorbutus, syphilis, the abuse of mercury, or powerful narcotic medicines, &c., the diseases of the jaws most frequently proceed rapidly to their greatest extent and fatal termination. They are, moreover, produced often by the slightest causes ; sometimes one dead tooth or stump is sufficient to give rise to great inflammation and mortification in the bony structure of the jaw, as well as in the membrane lining the cavity, and to hasten the primary disease through all its different grades; while exposure to great cold or heat, an accidental blow, or fall, or any other irritation of a similar kind, acting upon the structures contiguous to parts already symptomatically affected, is quite ade- quate to excite, at every period of the malady, any of the secondary diseases, such as polypi, or oedematous, sarcomatous, and osteo-sar- comatous tumours and excrescences. Indeed, these secondary tumours may sometimes be observed at a period, when the pri- mary affection is so little advanced as entirely to escape surgical observation ; and they may proceed to their greatest extent in a period of one or two years, before the idiopathic disease of the bony maidllary structure has had time to proceed to an advanced stage. In this form, the malady will be most frequently observed among the poorer classes of society, and it is unquestionably the most unfavourable and least manageable kind of maxillary dis- ease; it requires a combined and judicious medical, surgical, and dental management to obtain a desirable result ; for in few in- stances will any separate treatment prove of any permanent benefit. Thus every active general treatment, for instance, without the removal of the local causes of both the primary and secondary local malady, will only aggravate the disease, and hurry it to its malignant state. And thus the surgeon, after the removal of a