Page 940 - My FlipBook

950 DISEASES OF THE PERIDENTAL MEMBRANE.

the deposit. After the calcukis has been removed in a satisfactory
manner the case sliould again be left to itself to heal, simply keeping
the parts clean. The prognosis in such cases is always doubtful ; the
greater number of them will recover, but some will be found in which,
no matter what the treatment, there will be no reattachment of the
tissue to the root. This, however, is rare. When we remember that
Hunter boiled teeth for replantation, and yet obtained a union of the
pericementum to the root of the tooth, we should expect such cases to
reform the lost membrane and get Avell.
In the fourth class of abscesses, in which there is a discharge of a
thin, watery, and offensive pus occasionally tinged with blood, con-
nected with a more or less rapid, but marked, destruction of tissue, a
more heroic treatment is required. In these cases there is a condition
not ordinarily found in alveolar abscess. It is not kept up simply by the
escape of septic matter from the pulp-cliamber of the tooth, but is a true
septic abscess, in which the poisonous material is being produced among
the tissues themselves. For a remedial effect on this the strongest anti-
septics are needed. The whole abscess should be injected with either a
95-per-cent. solution of carbolic acid, strong tincture of iodine, or
ethereal solution of iodoform. The injection should be repeated per-
liaps twice within four days. The object in this treatment is to destroy
this septic condition, and thus to convert the abscess into the simpler
form ; and as soon as that is accomplished the severe measures should
be suspended and milder treatment substituted. This class of abscesses
will give the most unsatisfactory results of any that are met with in
practice. There is generally a comparatively great destruction of tis-
sue, and a correspondingly long time is required for the healing pro-
cess. In the mean time, the case will require constant care to keep the
parts in good condition.
Abscesses that are complicated with necrosis of the alveolar process
require special care in their treatment. If this lesion is discovered
early in the case, the parts should be well cared for until by the nat-
ural process of the absorption the necrosed portions are loosened ; they
should then be carefully removed. I have learned by clinical experi-
ence that much of an alveolar process may be destroyed by necrosis
from inflammation without necessarily destroying the hope of saving
the tooth. ]\Iany of those cases that present a very bad appearance
heal with surprising facility with a little care. In Fig. 488 I have
represented a case in which the outer, or buccal, plates of the alveolar
process Avere destroyed from an alveolar abscess, with more than half
; and yet those teeth are in very
of the septum between two of the teeth
good condition to-day, eight years after the occurrence. The sketch was
made at the time the necrosed portions of the bone were removed, and
as nearly as possible represents the actual condition of the case. The
treatment may be very briefly related. Before the pieces of necrosed
bone, were loose enough to be removed the teeth were found to be so
loose that it was thouglit best to wire them together and to their neigh-
Iwrs, to prevent motion. The parts were kept well cleaned by use of
the syringe. As soon as it was practicable the necrosed portions were
removed. Between two of the teeth the septum of necrosed bone passed