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474 THE TREATMENT AND FILLING OF ROOT CANALS.
tice to pennit the vent \uAv drilled ;it the lu'ck of a tooth to remain
open for the escape of the gases of decomposition, consequently tlie
cases were in a constant state of sepsis. The practice is ol)solete and
is to be unqualifiedly condemned.
In cases where the inflammatory action runs liiuh, the tooth is ex-
tremely tender, much extruded, and loose, the gum over the tooth be-
comes livid, the pulse increases, there is some, and it may be marked,
febrile action, the tongue is coated and the breath oifensive. Energetic
measures are necessary to avert necrotic action in the apical tissues.
In this, as indeed in all cases without exception, the promptness and
thoroughness of relief depends primarily upon the thoroughness with
which the exciting cause of the inflammation is removed, i. e. the septic
contents of the pulp chamber. In any case where direct access may be
had to the canals, and this is very frequently the case, every eifort short
of that producing great suffering to the patient should be employed to
wash away and broach away the putrescent material, using, where ne-
cessary, sulfuric acid to enter the canals, powerful antiseptics always
preceding the broach. Lysol is an excellent medicament in this con-
nection, and campho-phenique another. The canal is syringed freely
and repeatedly with 3 per cent, pyrozone, which should also be used as
an antiseptic mouth-wash. Local bloodletting, as advised by Dr. G. V.
Black,' is frequently an effective means for securing relief. Make a
deep cut in the gum, clear to the process, the incision to be about one-
quarter inch from the margin of the gum and encircling the neck of the
tooth ; this will tend toward unloading the engorged vessels of the apical
region. Dry cups over the face and to the neck, and always hot mus-
tard foot-baths, are valuable adjuncts.
Should the inflammatory disturbance run high, and a full, bounding
pulse, coated tongue, marked fever, constipation, headache, and other
febrile symptoms appear, attempts should still ])e made to abort the
inflammatory action. After as thorough a cleansing of canals and anti-
septic washing as possible under the circumstances, local bloodletting
as described and advised by Dr. Litch '" is efficient, by means of Swedish
leeches, washing the gum, touching it with sugar, then applying the
leech, which should ])e first j^laced in a test-tube, the mouth of the tube
then being placed over the gum when the leech is gorged, it drops back
;
into the tube. The mouth is then rinsed with warm water, to continue
the bleeding. Quinin in doses never less than gr. vj is given in the hope
of limiting the exudation into the inflamed area. As one of the best and
most effective means of derivation is the induction of watery alvine dis-
charges, the patient may be directed to take a saline cathartic or a rectal
^ American System of Dentistry, vol. i. p. 927.
2 Ibid., vol. i. p. 928.