Page 926 - My FlipBook

936 — DISEASES OF THE PERIDENTAL MEMBRANE.

Then we have the condition of blind abscess (Fig. 492), in which there
remains a mass of tissue in the enlarged apical space with which more or
less pus is constantly intermingled. This
Fig. 492. condition of things may continue almost
without change for any length of time,
or the pus may be burrowing through
the tissues without the patient's knowl-
edge. A tooth in this condition is lia-
ble to periodic fits of soreness which will
from time to time attract to it the atten-
tion of the patient. In such a case the
symptoms differ but little from chronic
pericementitis. The contents of the pulp-
chamber are in a state of constant putre-
faction, and the resulting products are
Blind Abscess at the Root of an Upper as constantly being discharged into the
Incisor: «. abscess-cavity iu bone: b,
drill-hole exposing the pulij-chamber apical tissues in a quantity sufficient to
for treatment.
prevent healing. In this chronic form
changes in the enlarged apical space take place very slowly, and usu-
ally are not very marked in their character. It seems evident from the
comparisons I have made from time to time that the absorption of
bone about the apical space is greater in the chronic than in the acute
forms ; therefore I conclude that in the majority of chronic alveo-
lar abscesses the absorption of the bone is slowly progressing, though
this is not necessarily true in all cases. I have seen some chronic
abscesses of long standing in which the absorption of bone was very
slight. In the majority of cases, judging from clinical experience
gained in the treatment of these forms, the tissues of the apical space
do not seem to be very much impaired in their vitality ; for such ab-
scesses heal with the greatest facility when the cause by which they are
maintained—septic matter from the pulp-chamber—is removed. Still,
there is a considerable number in which this is not the case. In some
of these cases the difficulty seems to consist solely in the low state of the
vitality of the tissues ; so that time is required for them to recover tone.
In others there is an actual destruction of the tissues of the apical space,
this proceeding to such an extent that a portion of the apex of the root
is denuded of its tissue. This is always a very grave condition as re-
gards the prospect of recovery. Another complication also is liable to
occur the deposit of senimal calculus on that portion of the root which
has lo.st its covering of tissue. This calculus is evidently derived from
the exuded serum, and not unfrequently is deposited in the form of
crystalline or crystal-like points ; so that when the finger is passed over
it one is strongly impressed with the similarity of the sensation to that
produced by a l)urr. This calculus is an irritant, and is especially so
when in this form, and of course it is impossible that the case can heal
while it remains.
Cases are now and then met with that have taken on a septic condi-
tion and assumed a more aggravated type. In all of the cases before
mentioned the ]mis is of *thc character known as laudable, but in the
septic condition it becomes sanious, or very thin and watery. Now the