Page 475 - My FlipBook

CASES IN WHICH PERICEMENTITIS IS PRESEXT. 473

the aim is to get rid, first, of the causes of the iuflammation ; second^
when necessary to treat the inflammation itself. In entering the canals
of such teeth—and of course they should be opened and cleansed as
—
quickly and as thoroughly as possible " The tooth should receive
lateral support against the pressure of the burs used in excavating ; if
the cavity be approximal the tip of a finger is placed against the face
of the tooth on the opposite side to the bur. Should the direction
of entrance be in a perpendicular line a ligature of linen twine having
long ends may be tied tightly about the neck of the tooth, and traction
exerted as a counter-pressure." '
If the conditions i)erniit, the cleansing and sterilizing are to be well
done at once. Should the tooth be too tender to permit the usual
manipulations, the gross mass is removed by treatment with sodium
dioxid solution or by syringing with meditrina and stirring with
broaches ; then a pellet of cotton saturated with lysol, a strongly alka-
line and penetrating cresol, is placed against the putrescent mass ; the
gum is painted with iodin at a little distance from the site of the inflam-
mation. When quiet is secured, the cleansing and sterilization of the
canals should be thoroughly done ; and a dressing of a sedative anti-
septic introduced. Campho-pheuique or cinnamon oil answers well in
this particular.
In more pronounced cases the tenderness, extrusion, and looseness
of the tooth are more marked ; in case the tooth should contain a filling
beneath which a pulp has died—and this is a common history of such
cases—the release of the imprisoned mephitic gases is imperative. Ex-
ercising counter-pressure, a very sharp and small spear-pointed drill is
passed into the pulp chamber ; it may be necessary in cases of extreme
soreness to effect this entrance at the neck of the tooth as the shortest
path. After a few minutes the opening is syringed out with meditrina,
and a blister is applied over the gum at a distance from the tooth, about
two teeth posterior to it. The patient is directed to immediately take
a hot mustard foot-bath, and to use frequently a 3 per cent, solution of
pyrozone or other strong antiseptic solution as a mouth-Avash. When
the tooth is much extruded and is kept irritated by striking upon the
occluding tooth, it is advisable to place a cap over the tooth jiosterior
to the one affected. A cap may be readily made in a few minutes, by
taking an impression in moldine or in plaster of the tooth to be capped,
pouring a small die of fusible metal ; drive this into a block of soft
lead, and then swage a piece of silver or German silver. No. 26, to fit
the die. This cap, covering the occlusal face and about half the walls
of the tooth, is attached by means of zinc phosphate, thus securing
surgical rest for the affected tooth. It Avas at one time a general prac-
' J. Foster Flagg's Lectures.