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500 DENTO-ALVEOLAR ABSCESS.

.sumahly due to a putroscent ])iil|>. In a day or two a discharge of
})us may he noted about tlie neck of the tooth. Sueli teeth when
extracted exhibit an unmistakable abscess sac in the pericementum at
the bifurcation of the roots. Wliether the pyogenic organisms have
traversed the dentin in the bottom of the pulp chamber and the
cementum beneath, and thus inaugurated the suppurative j)rocess, is
undetermined ; it may be, however, that waste products from this
source following the channel named may have saturated the cementum
with noxious material and caused the inflanniiation, or the organisms may
have found entrance at the gum margin. The diagnosis of such a con-
dition is most uncertain before pus finds exit at the gum margin. Such
a case is to be treated by sodium dioxid, full strength, ])lac(>d in the
floor of the cavity, frequently washed away and renewed until the base
of the pulp chamber is bleached white. The abscess cavity is syringed
out with pyrozone.
Another variety of abscess should receive mention : that occurring
about lower third molars, affecting the gum tissues partially enclosing
the emerging crown. The gum overlying and surrounding the erupting
tooth becomes reddened, tumid, and exquisitely sensitive ; if the inflam-
mation be not aborted by timely incision and antiseptic washes, pus may
form, and the gum acquire an ulcerous appearance. The treatment is
free incision, dividing the swollen gum, and syringing with 3 per cent,
pyrozone. If there be ulcerous surfaces they are to be touched with 50
per cent, solution of trichloracetic acid.
Occasionally the muscles of mastication may become aifected by the
inflammatory process, and inability to open the jaws result. Such cases
are not uncommon when the eruption of the tooth is delayed by lack of
room between the ramus of the jaw and the second molar. The extrac-
tion of this latter tooth may be required before relief is secured.

Complications of Alveolar Abscess.

The complications of alveolar abscess are due in acute cases to the
involvement of other tissues than those commonly affected in the course
of abscess formation and discharge. They depend in great part upon
peculiarities of the anatomical relations existing between teeth and their
surroundings, and, as anatomical variations are not uncommon in these
parts, aberrations of disease process may be found with unwelcome fre-
quency. An examination of some of Dr. Cryer's sections ^ will exhibit
in one case the root of a lower second bicuspid penetrating the passage-
way for the inferior dental vessels and nerves. It is quite possible that
an abscess upon such a tooth discharging about the fibrous sheaths of
^ Proc. of American Dental Association, 1895.