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INFECTION FROM MOUTH TO MOUTH. 163
lactic measures come into use for the prevention of tuberculosis, in all its
protean forms, antisepsis of the mouth will be given primary importance.
Infection from Mouth to Mouth.
Infection from mouth to mouth through instruments is a difficult
matter to prove by cases, but theoretically there can be no cause for
disputation. The question will always arise, Was the lesion occasioned
by auto-infection or by transmission? The answer can rarely be given
with the assurance desirable. In one instance, at least, in the Avriter's
experience the origin was clearly traceable. This was in a patient of the
better class, presenting for treatment in the clinic of the Dental Depart-
ment of the University of Pennsylvania. Her teeth were remarkable for
structure, regularity, and cleanline-^s gums perfectly healthy. Necrosis
;
of the anterior alveolar plate was threatened when first seen, and
finally resulted in the entire destruction of the alveolar border and all
the anterior upper teeth, but did not involve the maxilla. The history
of the case as given was that a bicuspid had been extracted from the
right superior region by a dentist notorious for his uncleanly habits.
Not long thereafter the patient noticed a serious inflammation. These
symptoms indicated a syphilitic infection, and the family physician was
consulted, who insisted that no history of this disease existed and that
infection must l)c the cause. The patient, through his treatment and
that given locally, recovered, but was forced to wear an artificial sub-
stitute.
Cases of infection through extraction, either by the forceps or after-
infection from the mouth, might be quoted almost indefinitely. Miller
reports case upon case—in fact, the accumulation of these has become
of serious moment ; and yet, in the face of undisputed facts, dentists
will continue to extract teeth frequently without any precautions, or,
at most, relying on simple washing of the instrument. Some German
writers contend that antisepsis after extraction is wholly unnecessary,
as the clot formed is a sufficient protection. This is certainly not true
in all cases. It is not always the fact that a clot is formed, or when
formed that it serves an antiseptic purpose. One of the most serious
cases that has fallen to the writer to treat was that of necrosis of the
superior maxilla involving destruction of the right side, taking in all
the teeth from the third molar to the lateral, the floor of the antrum,
a portion of the nasal bones, and half of the hard palate. This was the
result of the extraction of the third molar by a specialist before the
days of antisepsis; whether it was the result of infection is difficult
to determine. In the opinion of the writer, no extraction should be
attempted until the instruments used have been thoroughly sterilized by
boiling. Before the forceps are applied the parts surrounding the tooth