Page 913 - My FlipBook

CONDITIONS OF ABSORPTION. 923

Now, by the application of the facts here presented we can know the
conditions under which the roots of the permanent teeth are absorbed.
There must in each instance be a mild form of irritation that will
keep up local excitement of a particular kind. In the physiological
processes this excitation is probably furnished by the nervous system.
In the pathological processes of absorption the excitation is undoubtedly
furnished by some local irritant which acts more or less continuously.
What this irritant may be must be determined for each case inde-
pendently. In many of the cases of absorption it will be found
extremely difficult to determine the exact cause of the excitation, but in
all cases that have come under my observation the tissues in the imme-
diate neighborhood of the destructive process have been found hypersemic
and presenting the macroscopic appearance of granulation-tissue.
In many cases that present themselves to the practitioner it will be
very difficult to assign a cause for this chronic irritation. One of the
most frequent causes in my experience has been the protrusion of
root-fillings beyond the apical foramen into the tissues of the apical
space, where they keep up a very low degree of ii'ritation. I have
seen many cases in which this was the only cause that I was able to
assign for the difficulty. These cases have nearly all been those in
which I have myself filled the roots with gold. But since the filling
of root-canals with gutta-percha has come in vogue I have met Avith
a few cases in which the protrusion of that substance seemed to have
acted as a cause. It is plain, however, that these materials will not
invariably produce this result; for I have seen cases where the root-
filling had extended into the tissues, and so remained for years without
evil consequences.
Some of the cases that have come before me have seemed to arise from
some cause entirely hidden. In one very remarkable case eight teeth of
the upper jaw had lost their roots by absorption. Three of the eight had
root-fillings that I had introduced fourteen years before ; in the other
five the pulps were alive. The process seemed to have been about the
same in those with living pulps as in those in which the pulps were
dead. The woman had become very intemperate and excessively fat.
A number of cases have come to my notice in which this absorption
has occurred on the roots of teeth otherwise healthy.^
The absorptive process in these cases is usually very irregular. It
may attack the root at any point and remove its substance in the most
irregular manner, or the root may be removed almost as are the roots
of the temporary teeth. Irregularity of absorption is, however, the
rule. This affection presents no symptoms by which it can be recog-
nized before it becomes manifest by the loosening of the crown of the
tooth. It is not amenable to treatment.
Apical Pericementitis, or Pericementitis foJJoicing the Death of the
Dental Pulp.—This, together with its resultant, alveolar abscess, is

^ Since writing the above I have met with a case in which all of the posterior root
and the floor of the pulp-chamber of a lower molar has disappeared by absorption.
The tooth had a large contour-filling occupying the posterior half of the crown, which
I placed there ten years ago, after capping the pulp. The pulp was alive, as I found by
drilling into the pulp-chamber.