Page 504 - My FlipBook

502 DENTO-ALVEOLAR ABSCESS.

pains dart about the jaw. In the cln-onic cases, large aeeuniulations of
pus may occur and not be detected until the bone is thin and bulged,
emitting a crackling sound upon })res.sure. Extraction of the offending
tooth furnishes an outlet for the pus.
It is usual to attempt the passage of an instrument through the
pulp canals into the antrum and endeavor to preserve the tooth. Such
the wall of the antrum should be perforated.
a drainage is insufficient ;
This little operation is readily done : At a point about one-eighth of an
inch or more above the apices of the roots of the molars an incision is
made through the mucous membrane of the buccal alveolar wall, clear
to the bone a spear-pointed drill, a large one driven rapidly by the
;
engine, is passed instantly through the outer antral wall. The drill
is directed upward and inward. The opening is made sufficiently large
to permit free irrigation. Into the opening thus made the point of a
syringe, perforated to sprinkle, is placed, and the cavity washed out
with 3 per cent, pyrozone which has been diluted one-half and made
faintly alkaline by the addition of sodium dioxid. As pointed out by
Dr. ^y. H. Atkinson many years ago, unless the irrigating fluid be
made faintly alkaline it is irritating. As a stimulant injection to fol-
low, Lugol's solution (liquor iodi compositus, gtt. xx to the ounce) is
excellent. The canal of the tooth is to be thoroughly sterilized and
filled.
In the treatment of other complications, if the case be acute, the im-
mediate extraction of the offending tooth and the free use of antiseptic
mouth-washes will usually effect a cure. In the treatment of chronic
cases, if the focus of infection, the pulp canals, be made antiseptic and
the medicinal agents can be introduced into the abscess tract through-
out, surprising cures may result, as the literature of dentistry testifies.
Abscess upon Temporary Teeth.—Among the most trying classes
of cases with which the dental operator is confronted are those of peri-
cemental disturbance affecting the temporary teeth. The operator is
torn by conflicting emotions : the desire to afford quick relief to the little
sufferers and the hesitancy or dread of inflicting the amount of suffering
necessary to relieve the acute pain. Fortunately the pain is relatively
less than in adults ; the tissues being softer the child escapes the agoniz-
ing pain attending the rapid formation of pus in the apical tissues of the
adult. The swelling, redness, and febrile disturbance are usually greater
in the child than in the adult pus forms more quickly and makes its
;
appearance in the gum sooner. The principle of treatment is the same
as with the adult—evacuation of the pus. The necessary incision may
be made almost painlessly by employing a sharp-pointed bistoury hav-
ing a razor-like edge. The child, reassured by a gentle examination
and firm kindness, is directed to open the mouth and close the eyes,