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476 THE TREATMENT AND FILLING OF ROOT CANALS.
gr. vj doses of potassium iodid are to he adniiuistercd every three hours.
Should there be eviileuce of detachment of the periosteum, evidenced by
boggy swelling, a bistoury is to be passed boldly to the bone, making a
laro-c and free incision.

Treatment of Chronic Pericementitis.
The most usual form of chronic apical pericementitis is that associ-
ated with pus formation. It will be discussed in the succeeding chapter
under the head of Chronic Apical Abscess.
A not inconsiderable number of cases may be seen in which pus
formation is not evident and yet a chronic inflammation is present in
the tissues of the apical region. If the pulp chamber be open the
cause is evident, and its treatment has been described. A not inconsid-
erable number of cases are due to mal-occlusion. This point is to be
carefully observed, for it frequently affects teeth containing vital pulps
and free from caries. The tooth is slightly loose and sore to pressure^
Examination reveals aljnormal occlusion, either too severe or in the
wrong direction. Should the tooth contain a tilling, it usually gives a
normal response to applications of heat and cold ; examining the filling
a spot is seen marking excessive occlusion ; in both cases grinding off
the redundant tooth structure or filling and applying a counter-irritant
over the apex subdues the inflammation. Its exciting cause being
removed, it subsides.
A class of cases is occasionally met with in which there is evidence
of sluggish and persistent inflammation al)out the apices of pulpless-
teeth which have been filled ; acute inflammatory disturbance of a
severe grade occurs but seldom. The most common cause of this con-
tinued inflammation is probably the decomposition of a minute filament
of pulp tissue which has not been removed from a canal ; or, again,,
well-cleansed canals which have not been filled to the apex. Such
cases are those of mild sepsis : perfect restoration to health is only pos-
sible by re-cleansing, sterilizing and perfectly filling the canals. These
teeth are always more or less hypersensitive even though it be unnoticed,
and therefore are not of a full measure of service until cured.
Other cases in which there is reasonable assurance of perfect steril-
ization and complete filling exhibit vascular sluggishness over the apex
of the root. Continued and repeated massage is beneficial,^ the disorder
being apparently due to paralysis of vessel walls and not to septic
causes. The tonus of the vessels may be improved by application of
the galvanic current. This principle has wide application in general
medicine and surgery.
It is to be remembered that when the tissues about the apex of a
^ Dr. W. F. Relifuss, International Dental Journal, vol. xi. p. 581.