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TREATMENT OF CHRONIC ALVEOLAR ABSCESS. 947
should usually be followed by a stimulant tonic ; this should be pre-
scribed on general principles, and will vary with the individual con-
ditions of the patient. If his general health is fairly good, 10 or 15
grains of quinine in divided doses will suffice. If the patient be
ansemie, one of the salts of iron should be added ; and in cases in
which, from the nature of the case, extensive necrosis is thought prob-
able, the treatment should be especially vigorous.
All fomentations or poultices applied to the face should be strictly for-
bidden in acute alveolar abscess, for the reason that they invite an opening
on the face ; and if any softening in this direction is discoverable, the
freest opening and drainage into the mouth should at once be estab-
lished over the affected root, with the view of preventing such a result.
In this matter special care is required in cases of the second form occur-
ring in the lower jaw (Fig. 488).
If the treatment of the acute form fails of its object—the cure of the
abscess—the case soon passes into the chronic form, which will now be
considered.
The TREATMENT of chrouic alveolar abscess presents, in some of its
phases, characteristic differences from the treatment of the acute forms.
There is generally no soreness or any considerable inflammation to con-
tend with. The treatment is therefore more purely local and relates
more especially to the removal of the cause perpetuating the discharge
of pus—indeed, I may say wholly to this ; for if the cause be removed,
the tendency is to a spontaneous cure. Cases are sometimes presented
to the practitioner in which the systemic conditions are so depraved
and recuperative power is so low that an abscess will not heal without,
in addition to local treatment, the use of remedies directed to the im-
provement of the general health.
With reference to local treatment, chronic alveolar abscess is best
divided into five forms, according to the conditions present in the apncal
space
1st. The simple form. In this the tissue of the apical space has not
been so injured as to prevent a ready and spontaneous cure upon the
removal of the fetid contents of the pulp-chamber.
2d. Cases in which injury to the tissue of the apical space has been
so great as to prevent its taking on a healthy action readily, or in which
it has been actually destroyed over a portion of the apical end of the
root.
3d. Cases in which the tissue at the apical end of the root has been
destroyed and serumal calculus has been deposited on the denuded
portion.
4th. Septic abscess.
5th. Cases complicated with necrosis of bone.
The diagnosis of these diiFerent forms is not always easily made, for
the reason that the apical space is not accessible for this purpose without
either considerably enlarging existing openings or making a sufficient
opening artificially ; and if the abscess be of either the first or the second
form—as may be expected in a great majority of cases—this is entirely
unnecessary and may do harm. All that can be gained by an exam-
ination of the apical end of the root is to ascertain if serumal calculus
TREATMENT OF CHRONIC ALVEOLAR ABSCESS. 947
should usually be followed by a stimulant tonic ; this should be pre-
scribed on general principles, and will vary with the individual con-
ditions of the patient. If his general health is fairly good, 10 or 15
grains of quinine in divided doses will suffice. If the patient be
ansemie, one of the salts of iron should be added ; and in cases in
which, from the nature of the case, extensive necrosis is thought prob-
able, the treatment should be especially vigorous.
All fomentations or poultices applied to the face should be strictly for-
bidden in acute alveolar abscess, for the reason that they invite an opening
on the face ; and if any softening in this direction is discoverable, the
freest opening and drainage into the mouth should at once be estab-
lished over the affected root, with the view of preventing such a result.
In this matter special care is required in cases of the second form occur-
ring in the lower jaw (Fig. 488).
If the treatment of the acute form fails of its object—the cure of the
abscess—the case soon passes into the chronic form, which will now be
considered.
The TREATMENT of chrouic alveolar abscess presents, in some of its
phases, characteristic differences from the treatment of the acute forms.
There is generally no soreness or any considerable inflammation to con-
tend with. The treatment is therefore more purely local and relates
more especially to the removal of the cause perpetuating the discharge
of pus—indeed, I may say wholly to this ; for if the cause be removed,
the tendency is to a spontaneous cure. Cases are sometimes presented
to the practitioner in which the systemic conditions are so depraved
and recuperative power is so low that an abscess will not heal without,
in addition to local treatment, the use of remedies directed to the im-
provement of the general health.
With reference to local treatment, chronic alveolar abscess is best
divided into five forms, according to the conditions present in the apncal
space
1st. The simple form. In this the tissue of the apical space has not
been so injured as to prevent a ready and spontaneous cure upon the
removal of the fetid contents of the pulp-chamber.
2d. Cases in which injury to the tissue of the apical space has been
so great as to prevent its taking on a healthy action readily, or in which
it has been actually destroyed over a portion of the apical end of the
root.
3d. Cases in which the tissue at the apical end of the root has been
destroyed and serumal calculus has been deposited on the denuded
portion.
4th. Septic abscess.
5th. Cases complicated with necrosis of bone.
The diagnosis of these diiFerent forms is not always easily made, for
the reason that the apical space is not accessible for this purpose without
either considerably enlarging existing openings or making a sufficient
opening artificially ; and if the abscess be of either the first or the second
form—as may be expected in a great majority of cases—this is entirely
unnecessary and may do harm. All that can be gained by an exam-
ination of the apical end of the root is to ascertain if serumal calculus
