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492 DENTO-ALVEOLAR ABSCESS.

hytl and its great penetrating power place it among the most satisfactory
agents in the dental pharmacopoeia. For the treatment of root canals
with apical pericementitis a wisp of cotton moistened with a 5 per
cent, solution of formalin (the 40 per cent, solution of the gas in
water) and sealed in the canal will in a few hours completely sterilize it,
so that usually the canal may be permanently closed within twenty-four
hours. Rarely, a second dressing is required. Stronger solutions of
formalin are irritating and should be avoided, as they may cause
necrosis if used beyond the strength stated, or even in that strength
if used in too large quantity or too frequently.
Should the effort to enter the apical region through the canal fail, and
pus be present, an entrance should be eifected through the gum. At a
point on the gum immediately overlying the apex of the affected root,
a pointed bistoury is quickly thrust down to the bone, the bleeding is
encouraged by the use of hot water for several minutes, when a pellet
of cotton which has been dipped into 95 per cent, carbolic acid is laid
against the periosteum at the bottom of the cut. In a few seconds a
spear drill driven by the engine is passed through the bone into the
tissues of the a])ical region. Any bleeding which may occur is encour-
a^ed as above mentioned. For washing; the incisions and the abscess
in such cases there is no agent more acceptable than a 20 })er cent, solu-
tion of phenol sodique, it being both sedative and antiseptic. A thread
of floss silk dipped in carbolic acid is passed into the fistula to the seat
of abscess, its projecting edge lying upon the gum ; this will prevent too
rapid a healing of the fistula. The case now resembles an abscess with
a fistulous opening, the next variety of acute alveolar abscess ; the treat-
ment for both is the same.
Treatment of Abscess with Fistula.—Cases of acute alveolar
abscess discharging through a fistulous opening are either seen when
the pus has perforated the bone and is making its exit through the soft
tissues, or in cases where the inflammatory symptoms run high, the
usual methods of aborting the inflammation having failed, pus forms
and the abscess discharges rapidly, it may be within thirty-six hours,,
The use of pepper plasters and like devices to induce pointing of an
abscess are irrational ; they render no service which cannot be per-
formed better and more expeditiously by an incision made down to
the bone by means of a sharp bistoury. In all cases of acute apical
pericementitis where the swelling of the gum is marked, an early and
deep incision is useful and advisable. If pus be already formed and
if the pus have not yet per-
the abscess pointing, escape is afforded it ;
forated the periosteum that structure receives early relief from a condi-
tion which might threaten it. The greater the swelling the more
imperative is the necessity for this incision, which must be freely made.