Page 55 - An essay on the diseasesof the jaws, and their treatment

DISEASES OF THE JAWS. 3$ a of parts, occasions what may at first be regarded as a secondary affection of the osseous structure of the jaws and their lining mem- branes, which at length take on a state of idiopathic inflammation, that sooner or later ends in suppuration. In some instances the disease assumes a more acute form, and is accompanied by considerable tumefaction of the soft parts, occasi- onally forming a considerable abscess, the matter of which is ultimately discharged, and the malady then assumes a chronic character.* In the latter state, the disease may proceed in a very gra- dual manner for several years, during which it now and then changes from the chronic to the acute state, accompanied by inconsiderable pain, and giving little warning to the patient, or even to the attending surgeon, of the dangerous extent to which it has advanced. The matter being constantly, partly absorbed and partly discharged, either through the sockets of the dead roots or teeth, or through some small perforations in the external structure of the alveoli, and then carried oif with the saliva, the malady, while it causes a considerable destruction of the parts affected, for the most part maintains Its chronic state, and proceeds without changing much its external appearance, except as may regard the occasionally increased swelling of the gimas and cheeks. The removal of the tumefaction in the soft parts, which generally fol- lows the more convenient discharge of the matter, greatly adds to the deceptive character of the disease, f • This more active inflammation, however, sometimes does not subside till the vitality of the part of the maxilla more immediately involved is destroyed, and a sequestrum of bone produced, which must be removed by exfoliation. The fre- quency of the occurrence of necrosis, independently of external injury, in the jaws, compared with other bones, is very remarkable, and quite unaccountable, except as arising from causes connected with the diseases or irregularities of the teeth. Indeed, it has been remarked that this species of necrosis seldom takes place after the age of thirtj' but in the jaw-bones. t From the structure of the upper jaw-bone, and the extensive cavity which it contains, a ready lodgement is afforded for the matter which is formed, and thus there results, in addition to the infiltration and tumefaction that attend the dis- ease in other parts, the compUcation of engorgement of the maxillary sinus— circumstance demanding particular attention, as being sometimes one of the most distressing symptoms of the complaint. The natural vent by which the matter escapes from the anti-um, is generally a sinus situated by the side ofone of the small grinders, or in the anterior wall of the antrum. Expansion of the cavity is by D