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ALVEOLAR ABSCESS. 929
Alveolar Abscess.—Alveolar abscess results from inflammation having
its seat in the apical space proceeding to the formation of pus ; there-
fore the location of alveolar abscess is always in its inception the apical
space, no matter where it may afterward extend. If this be not the
case, it is not alveolar abscess even though it be an al^scess within the
alveolus of a tooth. This term has been employed from time immemo-
rial to designate this special form of abscess, and it should be strictly
confined to this one form, so that all may know exactly what is meant.
If an abscess occurs on the side of a root of a tooth as the result of
injury, and be not the effect of the death of the pulp of the tooth, it is
properly a traumatic alveolar abscess. If such an abscess occurs from
any of the diseases that attack the sides of the root of the tooth and it
is thought well to designate it as alveolar, the word should in all cases
be accompanied by an adjective expressing the fact. This is necessary
to accuracy.
Alveolar abscess, then, is in all cases a result of apical pericementitis.
If the case is not seen until the formation of pus has begun, or if the
means employed for subduing the inflammation have proved ineffectual,
all the symptoms will show an aggravation. The gums over the
aflected tooth will become deej^ly congested, and perhaps actually
from a fluidounce to a fluidounce and a half of blood may readily be abstracted from
each leech-bite, in addition to the amount originally drawn. "When leeches are not
obtainable, the method of scarification of the gum recommended in the text should be
ibllowed. Leeching not only ])ossesses the great advantage of being an entirely pain-
less method of abstracting blood, but secures a greater outflow than that obtainable
from a simple incision. It should always be practised before any local medication is
attempted, as the pi'esence of any foreign substance upon the gum interferes with the
biting of the leech, if it does not entirely prevent it.
'2d. After the removal of the leeches give a full dose—from 6 to 10 grains— of
quinine. This somewhat reduces the temperature and the force of the circulation, and
possibly tends to retard the inflannnatorv process by arresting the migration of the
leucocytes through the walls of the congested capillaries, although in the ordinary
medicinal dose this may be considered doubtful.
3d. Following the quinine, give one drop of tincture of aconite- root evei\v hour until
bedtime. For safety, place the recpiired number of drops (and no more) in a small bottle,
carefully instructing the patient as to dosage. Ten or twelve drops are usually sufficient
for tiie required number of hours, and this amount, even if taken at once by an adult,
would not prove fatal. P^rom such small doses no very marked effect upon the force or
frequency of the circulation can be expected, but they will at least liolcl the inflamma-
tion in ciieck and prevent an increased pulse-rate. Larger closes of aconite should not be
given unless the patient can be kept constantly under observation and the eflect of each
dose noted—a precaution which the exigences of dental practice usually make imprac-
ticable. Under proiter safeguards a reduction below the normal of from five to ten beats
per minute in tiie i)ulse-rate is desirable and safely attainable.
4th. At bedtime give a full dose (10 grains) of Dover's powder. This is to be taken
in conjunction witii a liberal amoimt of hot lemonade, the feet to be previously Mell
soaked in hot water, and the patient, when in bed, well covered, to promote sweating.
This treatment is a most effective feature in general medication in tiiis class of cases.
The opium eases pain, cjuiets nervous irritation, lowers the circulation, and in conjunc-
tion with ipecacuanha promotes diaphoresis, thus diverting to the cutaneous surface
perverted blood-currents, draining the congested vessels of their contents, and dimin-
ishing the force and frequency of the circuhitory impact upon the inflamed area.
5th. T/(e/o//oM'mf/wioramr/ give a brisk saline cathartic. If given during the previous
day, its operation is likely to take the patient out of bed at night, and thus to interfere
with the action of the Dover powder.
6th. Quinine, aconite, and oijium to be continued (according to indications) until
inflammation subsides, on the one hand, or the abscess has formed and discharged,
on the other. (See Treatment of Alveolar Abscess.) Ed.
Vol. I.—59
ALVEOLAR ABSCESS. 929
Alveolar Abscess.—Alveolar abscess results from inflammation having
its seat in the apical space proceeding to the formation of pus ; there-
fore the location of alveolar abscess is always in its inception the apical
space, no matter where it may afterward extend. If this be not the
case, it is not alveolar abscess even though it be an al^scess within the
alveolus of a tooth. This term has been employed from time immemo-
rial to designate this special form of abscess, and it should be strictly
confined to this one form, so that all may know exactly what is meant.
If an abscess occurs on the side of a root of a tooth as the result of
injury, and be not the effect of the death of the pulp of the tooth, it is
properly a traumatic alveolar abscess. If such an abscess occurs from
any of the diseases that attack the sides of the root of the tooth and it
is thought well to designate it as alveolar, the word should in all cases
be accompanied by an adjective expressing the fact. This is necessary
to accuracy.
Alveolar abscess, then, is in all cases a result of apical pericementitis.
If the case is not seen until the formation of pus has begun, or if the
means employed for subduing the inflammation have proved ineffectual,
all the symptoms will show an aggravation. The gums over the
aflected tooth will become deej^ly congested, and perhaps actually
from a fluidounce to a fluidounce and a half of blood may readily be abstracted from
each leech-bite, in addition to the amount originally drawn. "When leeches are not
obtainable, the method of scarification of the gum recommended in the text should be
ibllowed. Leeching not only ])ossesses the great advantage of being an entirely pain-
less method of abstracting blood, but secures a greater outflow than that obtainable
from a simple incision. It should always be practised before any local medication is
attempted, as the pi'esence of any foreign substance upon the gum interferes with the
biting of the leech, if it does not entirely prevent it.
'2d. After the removal of the leeches give a full dose—from 6 to 10 grains— of
quinine. This somewhat reduces the temperature and the force of the circulation, and
possibly tends to retard the inflannnatorv process by arresting the migration of the
leucocytes through the walls of the congested capillaries, although in the ordinary
medicinal dose this may be considered doubtful.
3d. Following the quinine, give one drop of tincture of aconite- root evei\v hour until
bedtime. For safety, place the recpiired number of drops (and no more) in a small bottle,
carefully instructing the patient as to dosage. Ten or twelve drops are usually sufficient
for tiie required number of hours, and this amount, even if taken at once by an adult,
would not prove fatal. P^rom such small doses no very marked effect upon the force or
frequency of the circulation can be expected, but they will at least liolcl the inflamma-
tion in ciieck and prevent an increased pulse-rate. Larger closes of aconite should not be
given unless the patient can be kept constantly under observation and the eflect of each
dose noted—a precaution which the exigences of dental practice usually make imprac-
ticable. Under proiter safeguards a reduction below the normal of from five to ten beats
per minute in tiie i)ulse-rate is desirable and safely attainable.
4th. At bedtime give a full dose (10 grains) of Dover's powder. This is to be taken
in conjunction witii a liberal amoimt of hot lemonade, the feet to be previously Mell
soaked in hot water, and the patient, when in bed, well covered, to promote sweating.
This treatment is a most effective feature in general medication in tiiis class of cases.
The opium eases pain, cjuiets nervous irritation, lowers the circulation, and in conjunc-
tion with ipecacuanha promotes diaphoresis, thus diverting to the cutaneous surface
perverted blood-currents, draining the congested vessels of their contents, and dimin-
ishing the force and frequency of the circuhitory impact upon the inflamed area.
5th. T/(e/o//oM'mf/wioramr/ give a brisk saline cathartic. If given during the previous
day, its operation is likely to take the patient out of bed at night, and thus to interfere
with the action of the Dover powder.
6th. Quinine, aconite, and oijium to be continued (according to indications) until
inflammation subsides, on the one hand, or the abscess has formed and discharged,
on the other. (See Treatment of Alveolar Abscess.) Ed.
Vol. I.—59
