Page 495 - My FlipBook

TREATMENT. 493

A sharp curved bistoury is held as a pen, its point directed always
toward the bone, and is passed boldly down to the bone immediately
over the apex of the root.
Inflammatory symptoms, as a rule, subside promptly as soon as exit
is afforded the pus. As soon as the tooth may be operated upon, its
canals are to be treated as virulently and deeply infected centres, opened
freely and sterilized with the utmost thoroughness. The usual and
satisfactory method of accomplishing this is by means of a 50 per cent,
solution of sodium dioxid ; after which a stout syringe filled with 3
per cent, pyrozone is to have its contents driven forcibly through the
abscess tract, the application to be repeated until the peroxid comes
aw^ay clear. A few drops of campho-phenique or Dr. Black's 1, 2, 3
mixture are placed in the pulp canal by means of Flagg's dressing
pliers. This may be drawn into the abscess sac along
Fig. 470.
its tract, emerging at the fistulous opening, by a little
device of Dr. T. M. Hunter.' One of the rubber cups
used for finishing fillings and cleaning teeth is to have
its tool opening filled with gutta-percha, the concavity
of the cup moistened and pressed flat against the gum,
covering the fistula ; removing the pressure from the
centre of the cup but keeping its edges closely in con-
tact with the gum, a suction is created drawing the
medicament through the abscess tract. The writer has
used these cups, but mounted on a No. 300 mandrel
(Fig. 470), for this purpose for several years ; indeed
the discovery that Dr. Hunter had employed and ad-
vised it as a means of emptying abscess cavities was a
gratifying surprise, as he states that they serve this
purpose admirably.
The sterilized canals are now to be thoroughly filled with cotton twists
or gilling twine which has been moistened with the last-named antisep-
tic, or 5 per cent, formalin, the crown cavity sealed, and the case dis-
missed. In twenty-four hours, only a slight serous exudate should be
pressed from the fistula. In a week the abscess cavity should be
healed. In that time a permanent canal filling may be inserted, but it
is wiser to defer the filling of the crown cavity for some time—that is,
if it is to be filled with cohesive gold.
In case of acute abscess where marked inflammatory symptoms with
involvement of neighboring parts persists after the evacuation of the
pus, the gum overlying the tooth being purplish and tumid, the tooth
very loose, and no diminution of the attendant fever, neighboring
structures in addition to the tooth are in danger, and the latter should
^ Dental Cosmos, vol. xxxiv. p. 82.