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522 PYORRHEA ALVEOLARTS.

upon a detailed statement of tlie symptoms or diai>;nostic features of
these various phases of the gouty diathesis ; sufliee it to say that, under
one form or another, tliey are fr(H(uently })resent and associated with
pyorrhea alveolaris. The pathology of ])ericemental iiiliaiinnation from
uratie (lep<^siti()n unfolds itself logically after a cou.sideration of the
diathesis in its constitutional aspects, l^earing in mind the fact that the
alveolo-cemental membrane is a member of the connective-tissue group, it
is not at all sur})rising that it also should become the seat of uratie deposits.
Pathology of the Dental Disease.—Unfortunately the anatomical
relations of the parts and other factors prevent the dental observer from
collecting a complete and connected series of observations as to the exact
pathology of the disease, so that our deductions in this direction are
necessarily confined to a basis of clinical records.
It is a natural inference that the pericementum is the part attacked
because it is a point of minor resistance. The decreasing volume of
pericementum which attends the progress of the disease in these cases
is necessarily followed by a contraction of the caliber of the blood-
vessels. It is not at all improbable that, as a consequence of the general
physical condition, atheromatous changes occur in the pericemental
bloodvessels leading to their occlusion. If it be necessary, as some
pathologists maintain, that a death of cells precede the deposits in
gout, this vascular change will account for the necrosis. The acid re-
action of the necrotic area causes the deposition of urates, which are
insoluble in acids.
The deposit is the source of an irritation which in most cases is
followed by inflammation, leading to inflammatory degeneration and
probably coagulation necrosis of the cellular elements. The alveolar
walls melt down particle by particle, the pericementum disappears, the
diseased area usually becomes infected by pyogenic organisms, and the
process of suppuration is an additional factor leading to the exfoliation
of the teeth. As in necrotic areas of other parts, calcareous deposits
occur, which cover and almost entirely obscure the primary de})osit
of urates.
The condition following upon a deposit at the lateral aspect of a
root, in its pericementum, is shown diagrammatically in Fig. 479. At a
is seen the calculus embraced by a territory of inflammatory corpuscles,
b. The pericementum which has so far escaped destruction is seen at c
and (/, that at d nourished by the anastomosing vessels from the alve-
olar periosteum. At a later period this portion of pericementum be-
comes involved in the degenerative process, and pus escapes at the neck
of the tooth. In other cases the inflammatory degeneration extends
from the deposit to the overlying gum, which is perforated.
It is conceivable that such tissue changes should exist in consequence