Page 66 - An essay on the diseasesof the jaws, and their treatment

44 • AN ESSAY ON^ THE Whereas, a perfect removal of these causes, followed by the greatest cleanliness of the mouth, will frequently effect a cure without any * further operation. * Dr. Harris of Baltimore, who is one of tlie editors of the " American Journal of Dental Science," and author of the " Principles and Practice of Dental Surgery," in his " Dissertation on the Diseases of the Maxillary Sinus," furnishes an excel- lent illustration of the truth of this remark, in the history of one of the cases treated by him, A youog lady consulted Dr. Harris on account of a painful throbbing tumour on the cheek, over the first right molar tooth, which had commenced eighteen months previously. She had several decayed teeth on the affected side. After examining the state of the cheek. Dr. Harris ordered four leeches to the painful part, to be followed by an anodyne fomentation and a pedi- luvium at bed-time. On the day following the pain in the cheek was relieved, but more minute inspection showed that the gums were spongy and inflamed, and the first right molar sensitive to the touch. On the second day a discharge of matter took place from the nose, proving that the maxillary sinus was in a state of engorgement. The first superior right molar was now extracted, for the pur- pose of evacuating the antrum, and its removal permitted the escape of a quan- tity of bloody pus. " I urged upon the patient," says Dr. Harris, " the importance of having several other decayed teeth removed, though not as necessary to the cure of the affection, to which she had been subject, but she would not submit to the operation." During thirteen weeks Dr. H. persisted in the ordinary treatment by perforation of the antrum and injections, without the smallest benefit. Thrice the opening in the alveolus was allowed to close, and as often it had to be re-opened, on account of the accumulation of matter. At last measures were adopted to remove the exciting cause. " Suspecting," says Dr. H., " that the diseased condition of the teeth, gums, and alveolar processes beneath the cavity exerted a morbid influence upon it, I, a second time, urged the removal of the first bicuspis, and the second and third molaris, which were all so much decayed as to render their restoration out of the question." The result was a perfect cure.— (" American Journal of Dental Science," vol. iii., p. 106.) Here is trifling truly! Dr. Harris, after three months of painful and injurious delay, discovers that the removal of the decayed teeth in the immediate neighbourhood of the affected part was necessary to the cure of the disease ! I have no doubt but that by that time the patient herself liad also made the discovery. Even Mr. Thomas Bell, whose authority is deservedly so great among his pro- fessional brethren, appears to consider the extraction of the teeth and stumps, which are the local exciting cause of the disease^ as an unimportant part of the treatment. According to this author, tlie treatment consists of— 1st, the eva- cuation of the antrum by the introduction of a trocar. 2nd, the correction of the diseased condition of its lining membrane by the injection of various stimulants. 3rd, the removal of caries bone—the product of the disease.— (" Anat. Phys. and Diseases of the Teeth," p. 261.) In all Mr. Bell's cases decayed teeth were the cause of the disease. He does not hesitate to state that the affection under consideration almost invariably proceeds from that cause, but in the treatment of the cases he records, the removal of all dead teeth and roots was only put in practice after a long course of ineffec- tual treatment. The necessity of this measure is also entirely overlooked by him in stating the indications to be fulfilled by the treatment ; and the cures which took place imder his care are attributed to the perforation and injec-