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486 DENTO A L VEOLA R ABSCESS.

from the bone over a certain area. Shonld these cases not obtain (|nick
relief by evacnation of the pns, necrosis of the dennded bone may occur
(Fig. 409). lieattachment of the periosteum may take place even after
extensive separation, provided the pus be evacuated early.

Fig. 469.

Necrosis of the buccal plate of the alveolar process from alveolar abscess (Black).
Cachectic conditions exert a strong modifying influence upon the
course and termination of alveolar abscess. In strumous or debilitated
persons the disease tends to invade neighboring structures, whose resist-
ance is lessened. This is well illustrated by a case of obstinate maxil-
lary caries which destroyed the entire process of one side, the begin-
ning of the disease being apical pericementitis of a lower bicuspid.
The carious process became chronic soon after the extraction of the
offending tooth, and persisted until the death of the patient from
tuberculosis.
Alveolar abscess occurring in syphilitic patients is prone to involve
the deep structures, and more or less necrosis is not an uncommon
sequel.
Clinical History of Chronic Alveolar Abscess.
After the subsidence of the symptoms attendant upon the formation
and discharge of acute abscess, there is rarely a spontaneous healing or
filling of the abscess cavity and tract with healthy granulation tissue
;
the development of organisms in the abscess cavity and pulp canal con-
tinues and produces a continuance of the suppurative process, forming a
chronic abscess.
In other cases abscess may have developed without marked inflam-
matory symptoms, and yet a prolonged and obstinate pus formation
occurs in the tissues of the apical region, the pus finding exit through
the pulp canal, constituting what is known as blind abscess, one of the
most common of the chronic types.
Many of the cases which open upon the face are of the chronic
variety ; during the development of the abscess and its discharge there