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DENTO-ALVEOLAR ABSCESS.
494 —
be extracted. An early and free incision will freqnently avert this con-
dition and necessity for extraction.
Shonld the case when first seen exliibit marked evidences of involve-
ment of the tissues of the face, a threatening of the abscess toward
pointing on the face, prompt and active measures are necessary. As a
rule in these cases the ]iornicioiis domestic practice of applying ponltices
to the face has been followcMl, and in consequence the tissues of the
cheek are distended and softened, lessening the suffering but inducing
the flow of ])us along the line of softening. Compresses wet with lead-
water and laudanum

I^. Plumbi subacet., 3J ;
Tr. opii, s} ;
Aqu:e, Oj.—M.
should be laid upon the face, and an incision made at the line of junc-
tion of the cheek with the gum, down to the bone over the ai)ex of
the root. As a rule, in these cases the pus has found its way into the
tissues of the cheek, but drains through the incision ; a cut must always
be made away from, not toward the cheek, to avoid cutting the facial
artery or any of its branches. Opening upon the face may be averted
by this means, even when the pus is beneath the skin. The danger of
inclusion of the duct of Steno should be borne in mind should the case
be one of abscess upon an upper molar, and energetic measures pursued
to prevent the establishment of that annoying trouble, salivary fistula.
When fluctuation of the inflammatory tumor u]ion the face becomes
evident, indicating that an external opening must be made, it is prefer-
able that it be made with a sharp knife and not by sup])uration. Scars
left by abscesses discharging spontaneously are irregular and disfiguring,
those following clean incision are but a line. A curved bistoury is used
to transfix the summit of the swelling, the knife is then carried outward,
making an incision about an inch long. In this as in all cases of abscess
where pus is detected the indication is to give it immediate exit.
It occasionally occurs that abscess may be found upon the lateral
aspect of a tooth containing a vital pulp. The tooth is free from
caries, and is perfectly translucent. The most usual situations of these
abscesses are upon the labial faces of the anterior teeth and the buccal
faces of the molars, between the gingival margin, which may be intact,
and the apex of the root. As a rule the evacuation of the pus and
dressing with antiseptics causes a speedy disappearance of the abscess.
Left to themselves they discharge as a rule at the gum margin. They
are a frequent associate of the condition graphically described by Dr.
G. V. Black as phagedenic pericementitis. Believers in the gouty
origin of this disorder note their occurrence in gouty patients.^ In
1 Typical cases are recorded in Proc. Academy of Stomatology of Plilladelphia, 1S95.