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TREATMENT. 495
these cases the abscess is attended by more or less destruction of the
pericementum. Cases may be seen in which the abscess involves the
tissues near the apex of the root, the pulp being vital ; its death, how-
ever, will doubtless result from the invasion.
Acute apical abscess may discharge at the margin of the gum, follow-
ing the pericementum. These cases are to be treated as abscess with
fistula. In some cases subsequent to the treatment of the abscess there
appears to be a restoration of the pericementum lost in the formation of
the fistula. In others a permanent loss of tissue results. This mode
of discharge is common about dead roots which have been in the jaw
crownless for a long period ; a resorption of alveolar process has
occurred and the root is retained by fibrous tissue. The treatment in
these cases is that accorded any and all roots which may not be made
serviceable—extraction
Treatment of Chronic Abscess.—For purposes of treatment,
chronic abscesses are divided into two classes : those discharging through
the pulp canal, wdiat are known as blind abscesses ; second, those dis-
charging upon the gum, at the neck of the tooth or in fact at anv point,
through a fistula.
The usual condition existent with the blind abscess, is a cavitv
which may have any volume, its diameters, however, rarely exceeding
three-eighths of an inch ; this cavity is bounded upon all sides by a
fibrous capsule, analogous to the indurated surroundings of an ulcer; the
wall represented l:>y the cementum of the affected tooth mav be devoid
of fibrous tissue, the pericementum being necrotic. The pulp chamber
is the centre of infection the abscess cavity is the habitat of l^acteria,
;
which cause the peptonization of the inflammatory exudate from the
wall of circumvallation, and destroy the exudation corpuscles, thus
producing a continued pus formation. The observation and statement
of Dr. Black have been quoted above, wherein he states that gravity
largely determines the direction pursued by the pus in chronic abscess.
This tendency will be found to exist with the blind varietv also.
The tendency of long-continued pus formation about the roots of the
upper teeth will be to progress along the pericementum, resulting in a
molecular necrosis of that structure from the apex downward. The
condition is represented in Fig. 471. The extent to which the apex of
the root projects into a cavity increases with the progress of the necrotic
process.
In the lower teeth, the influence of gravity carries the suppurative
process away from the apex of the root, the abscess cavity increasing
downward (Fig. 472).
If the case be seen shortly after the subsidence of the inflammatory
attack which may have ushered in the suppurative process, the cavity
TREATMENT. 495
these cases the abscess is attended by more or less destruction of the
pericementum. Cases may be seen in which the abscess involves the
tissues near the apex of the root, the pulp being vital ; its death, how-
ever, will doubtless result from the invasion.
Acute apical abscess may discharge at the margin of the gum, follow-
ing the pericementum. These cases are to be treated as abscess with
fistula. In some cases subsequent to the treatment of the abscess there
appears to be a restoration of the pericementum lost in the formation of
the fistula. In others a permanent loss of tissue results. This mode
of discharge is common about dead roots which have been in the jaw
crownless for a long period ; a resorption of alveolar process has
occurred and the root is retained by fibrous tissue. The treatment in
these cases is that accorded any and all roots which may not be made
serviceable—extraction
Treatment of Chronic Abscess.—For purposes of treatment,
chronic abscesses are divided into two classes : those discharging through
the pulp canal, wdiat are known as blind abscesses ; second, those dis-
charging upon the gum, at the neck of the tooth or in fact at anv point,
through a fistula.
The usual condition existent with the blind abscess, is a cavitv
which may have any volume, its diameters, however, rarely exceeding
three-eighths of an inch ; this cavity is bounded upon all sides by a
fibrous capsule, analogous to the indurated surroundings of an ulcer; the
wall represented l:>y the cementum of the affected tooth mav be devoid
of fibrous tissue, the pericementum being necrotic. The pulp chamber
is the centre of infection the abscess cavity is the habitat of l^acteria,
;
which cause the peptonization of the inflammatory exudate from the
wall of circumvallation, and destroy the exudation corpuscles, thus
producing a continued pus formation. The observation and statement
of Dr. Black have been quoted above, wherein he states that gravity
largely determines the direction pursued by the pus in chronic abscess.
This tendency will be found to exist with the blind varietv also.
The tendency of long-continued pus formation about the roots of the
upper teeth will be to progress along the pericementum, resulting in a
molecular necrosis of that structure from the apex downward. The
condition is represented in Fig. 471. The extent to which the apex of
the root projects into a cavity increases with the progress of the necrotic
process.
In the lower teeth, the influence of gravity carries the suppurative
process away from the apex of the root, the abscess cavity increasing
downward (Fig. 472).
If the case be seen shortly after the subsidence of the inflammatory
attack which may have ushered in the suppurative process, the cavity
