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CASES IN WHICH PERICEMENTITIS IS PRESENT. 475
injection of half an ounce of pure glycerin. If the pulse remain full and
bounding, and headache persist, tr. aconiti or tr. veratri viridis is to
be used as an arterial sedative, gtt. j of the tr. aconiti rad., or gtt. ij of
the tr. veratri viridis, repeated every hour, until the pulse slows and
lessens in volume and tension. At bedtime, if the inflammation be not
markedly lessened, a sedative diaphoretic is administered, Dover's pow-
ing the latter he or she is to be well wrapped in hot blankets and tiie
feet and leos immersed in a hot mustard foot-bath. Tlie followino-
morning a saline cathartic—magnesise sulph. 5ss— is given in a goblet
of water. These directions (substantially those given by Dr. Litch,
ibid.), may be followed with gratifying results in many cases ; even
when the inflammation is not aborted, its violence is almost invariably
lessened.
Should the inflammation remain at its height for more than twenty-
four hours, it is almost certain that pus has formed, and the indication
is to give it exit. A spear-pointed bistoury is thrust through the gum
over the apex of the aifected root with such decided force as to pene-
trate the process if possible. In the event of not accomplishing this
«nd, the point of a spear-head drill revolving very rapidly is passed
through the process to the apical region. Although this operation may
be performed very quickly it may be necessary to administer nitrous
oxid to quiet the patient and render the drilling painless. Anesthesia
may be secured by means of the injection of a drop of a 15 per cent,
solution of cocain. Dr. Black has described a painless method of effect-
ing an entrance to the apical region.^ A napkin is placed about the
parts, the gum dried and touched at the point of election with a drop of
95 per cent, solution of carbolic acid (trichloracetic acid full strength
may be used). The necrosed membrane is scraped away by means of a
€oarsely serrated plugger until sensation is felt, when another dn^p of
ticid is applied, and the scratching is resumed until the bone is laid
bare ; a sharp chisel is then used to open the apical region. Xo blood
should be drawn during the o})eration except at the last step.
The case in its present stage belongs to and is described in the suc-
<^eeding cha])ter, upon Alveolar Abscess. In any case presenting in
which there is reason to believe the patient is the victim of syphilis
and alveolar periostitis is an occasional accompaniment of tertiary syphi-
^
lis —the use of large doses of potassium iodid is imperatively indicated.
Unless decided measures are taken to abort such cases—and the usual
antiphlogistic measures are of little avail—dangerous involvement of
the general periosteum may occur, leading to necrosis. Not less than
' American Sytitem of Dentistry, vol. i. p. 928.
^ See case— Heath, Injuries and Duieanes of the Jaws, 3d edition.
CASES IN WHICH PERICEMENTITIS IS PRESENT. 475
injection of half an ounce of pure glycerin. If the pulse remain full and
bounding, and headache persist, tr. aconiti or tr. veratri viridis is to
be used as an arterial sedative, gtt. j of the tr. aconiti rad., or gtt. ij of
the tr. veratri viridis, repeated every hour, until the pulse slows and
lessens in volume and tension. At bedtime, if the inflammation be not
markedly lessened, a sedative diaphoretic is administered, Dover's pow-
feet and leos immersed in a hot mustard foot-bath. Tlie followino-
morning a saline cathartic—magnesise sulph. 5ss— is given in a goblet
of water. These directions (substantially those given by Dr. Litch,
ibid.), may be followed with gratifying results in many cases ; even
when the inflammation is not aborted, its violence is almost invariably
lessened.
Should the inflammation remain at its height for more than twenty-
four hours, it is almost certain that pus has formed, and the indication
is to give it exit. A spear-pointed bistoury is thrust through the gum
over the apex of the aifected root with such decided force as to pene-
trate the process if possible. In the event of not accomplishing this
«nd, the point of a spear-head drill revolving very rapidly is passed
through the process to the apical region. Although this operation may
be performed very quickly it may be necessary to administer nitrous
oxid to quiet the patient and render the drilling painless. Anesthesia
may be secured by means of the injection of a drop of a 15 per cent,
solution of cocain. Dr. Black has described a painless method of effect-
ing an entrance to the apical region.^ A napkin is placed about the
parts, the gum dried and touched at the point of election with a drop of
95 per cent, solution of carbolic acid (trichloracetic acid full strength
may be used). The necrosed membrane is scraped away by means of a
€oarsely serrated plugger until sensation is felt, when another dn^p of
ticid is applied, and the scratching is resumed until the bone is laid
bare ; a sharp chisel is then used to open the apical region. Xo blood
should be drawn during the o})eration except at the last step.
The case in its present stage belongs to and is described in the suc-
<^eeding cha])ter, upon Alveolar Abscess. In any case presenting in
which there is reason to believe the patient is the victim of syphilis
and alveolar periostitis is an occasional accompaniment of tertiary syphi-
^
lis —the use of large doses of potassium iodid is imperatively indicated.
Unless decided measures are taken to abort such cases—and the usual
antiphlogistic measures are of little avail—dangerous involvement of
the general periosteum may occur, leading to necrosis. Not less than
' American Sytitem of Dentistry, vol. i. p. 928.
^ See case— Heath, Injuries and Duieanes of the Jaws, 3d edition.
