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GOUTY PERICEMENTITIS. 523

of injuries sustained during ordinary dental manipulations, the careless
use of the teeth in biting unyielding substances, or even in the unwise
use of toothpicks, brushes, etc. This supposition granted—and of its
truth there appears to be much evidence, for the disease not unfrequeutly

Fig. 479.

Hematogenic calcic pericementitis (Burchard).
develops after the operation of wedging, malleting, etc.— it is reasonable
to believe that during the transudation of lymph through the lym})h
channels of the membrane, cementum, and dentin freighted with uratic
salts, deposition and crystallization would readily take place in tlie
dento-alveolar articulation as in other localities of the body. Not
unfrequeutly has the writer recognized pus-exuding pockets resulting
solelv from wedwin^ or lono'-continued malleting, and these in teeth that
previously to the oj^eration were as free from any appearance of either
of these conditions as a normal tooth could be, yet an idiosyncrasy
or predisposition existed—the exciting cause only being needed to
develop it.
With this deposit and accumulations between two unyielding bony
surfaces and the pressure on the tissue elements in consequence, these
salts will act as specific irritants and engender the well-known ])he-
nomena — pain, congestion, swelling, exudation, impaired nutrition,
tissue disorganization, the formation of pus, an osteomyelitis resulting
in the absorption of the alveolar process, and finally the exfoliation
of the teeth characteristic of pyorrhea alveolaris. The most general
seat for the deposition of tliese salts is toward the apex of the root,
where the texture of the alveolo-cemental membrane is less firm and
compact, and more bulky.