Page 973 - My FlipBook

TREATMENT OF PHAGEDENIC PERICEMENTITIS. 983

surface with a solution of gutta-percha in chloroform ; this completely
seals up the wound and prevents it from becoming septic, in addition to
the protection to the granulations. This, if desired, may also be used to
seal up the gingival margins after operations through the gingival aper-
ture, by first drying the parts thoroughly and packing the gutta-percha
around the necks of the teeth. In order to render it more secure in its
jDOsition, a wire or thread may be used to first secure to the teeth a
small piece of undissolved gutta-percha, to which the solution may be
added. This means of sealing the gingival margins would be very val-
uable if tiie gutta-percha would cling to the gums with more tenacity,
but it will generally hold for two days if well applied. Some effort in
this direction has been made in the way of the construction of plates to
fit over the parts, but such an apparatus is likely to do more harm by
the collection of irritating agents under it than good by preventing fric-
tion. The requirement of such an appliance is that it shall hermetically
seal the parts. After these operative procedures the further treatment
is to be conducted as recommended for the simpler cases that are treated
without other surgical interference than the thorough cleaning of the
necks and roots of the affected teeth.
Many cases of this disease will be met with in which operative
procedures further than the thorough cleaning of the necks and de-
nuded portions of the roots of the teeth are entirely unnecessary. If
there are no thickened or roughened margins to interfere with the con-
tact of the parts, in many cases the medicinal treatment may be begun
at once, even when considerable portions of the alveolar wall have been
lost.
Some of the cases will present no calculus whatever to be removed,,
but even in these the roots should be well cleaned, for a close examina-
tion will show them to be coated with an apparent gummy material which,
clings quite closely and tenaciously to the root and should generally be
loosened with an instrument. This is usually composed of micro-organ-
isms and a kind of inspissated mucus or pus. The cavity or pocket
should now be thoroughly washed with peroxide of hydrogen, for the
removal of all debris. This and all subsequent washings may be done
with peroxide of hydrogen in M'hicli a grain of the bichloride of mercury
to the ounce has been dissolved. This combination has become quite a
favorite in my hands for the beginning of the treatment, on account of
its very fine antiseptic qualities. This washing should be done with the
Farrar's syringe, or other instrument possessing its advantages.
In most cases we may go directly forward with antiseptic stimulant
remedies presently to be described, but in some of the more acute forms
tlie gums and soft tissues will occasionally be found much congested
and turgid with blood. In such cases, after thoroughly cleaning the^
parts and washing with the peroxide of hydrogen and bichloride of"
mercury, it is well to begin the treatment with the application of a 30-
per-cent. solution of chloride of zinc; this should be applied deep down
in the pockets. After one or two applications of this remedy others of
a different character should take its place, for its principal use is that of
aa astringent for the reduction of the calibre of the blood-vessels, which
have become abnormally large. This remedy, however, possesses another