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526 PYORRHEA ALVEOLARIS.
tooth or two or more teotli in widely separated regions of the mouth
;
the exudation and discharge of pus ah)ng but one side of the root,
the increase of the flow of pus from llic interior of the alveolus under
])i'essure ; the usually limited amount of cahnc deposition as contrasted
with the ])tval(\Q:enic form ; the destruction of the pericemental nu'm-
brane and the denudation of the cementum ; the absorj>tion of the
alveolar process; the loosening and exfoliation of the teeth indurated
in structure and changed in physical apjK-arancc are the main charac-
teristics of the disorder; all these features taken in their totality so
individualize this disease that there shoidd be no difficulty in identi-
fving it.
In the pfi/((/of/aiic form almost the ojiposite conditions })rcvail. As
a general rule there is no evidence that there is any constitutional diath-
esis of which it might be an expression. The age at which it presents
itself extends from the eighteenth year, sometimes earlier, to any period
in later years, varying in its virulence with the varying systemic condi-
tions and food habits of the individual. The ])resence of a calcic depo-
sition around the neck of the tooth is often most abundant; the primary
gingivitis occasioned by the ])resence of this mechanical irritant is not
confined to one tooth nor to isolated regions of the mouth ; the subse-
quent extension (where neglected) and infiltration of this deposit into
and beneath the pericemental membrane ; the localization of the sup-
puration in the early stages around the margin of the gums ; the de-
layed loosening of the teeth, the infrequent loss of the teeth and the
susceptibility to successful treatment upon the removal of the salivary
deposit : these features taken together fully characterize this disease and
render its identification easy.
Contrasting these different inflammatory states of the pericemental
membrane from their inception to their termination, it becomes evident
that distinct yet closely allied diseases are here very frequently confused
and associated.
Causation.—If we take as our point of departure the postulate that
hematogenic calcic pyorrhea alveolaris is but a special manifestation of
the gouty diathesis, we should expect to find in its causation the same
predisposing and exciting agencies operative as in the production of all
other manifestations of the general diathesis.
Predisposing Causes.— 1. Heredity.—Among the predisposing
causes may be mentioned heredity, which may be regarded as one of
the most important factors concerned in its development. The writer
feels justified in asserting, after a careful investigation into the fiimily
history of a large number of pyorrhea patients that fully 90 per cent,
inunifest an hereditary tendency to this disorder, parents and grand-par-
526 PYORRHEA ALVEOLARIS.
tooth or two or more teotli in widely separated regions of the mouth
;
the exudation and discharge of pus ah)ng but one side of the root,
])i'essure ; the usually limited amount of cahnc deposition as contrasted
with the ])tval(\Q:enic form ; the destruction of the pericemental nu'm-
brane and the denudation of the cementum ; the absorj>tion of the
alveolar process; the loosening and exfoliation of the teeth indurated
in structure and changed in physical apjK-arancc are the main charac-
teristics of the disorder; all these features taken in their totality so
individualize this disease that there shoidd be no difficulty in identi-
fving it.
In the pfi/((/of/aiic form almost the ojiposite conditions })rcvail. As
a general rule there is no evidence that there is any constitutional diath-
esis of which it might be an expression. The age at which it presents
itself extends from the eighteenth year, sometimes earlier, to any period
in later years, varying in its virulence with the varying systemic condi-
tions and food habits of the individual. The ])resence of a calcic depo-
sition around the neck of the tooth is often most abundant; the primary
gingivitis occasioned by the ])resence of this mechanical irritant is not
confined to one tooth nor to isolated regions of the mouth ; the subse-
quent extension (where neglected) and infiltration of this deposit into
and beneath the pericemental membrane ; the localization of the sup-
puration in the early stages around the margin of the gums ; the de-
layed loosening of the teeth, the infrequent loss of the teeth and the
susceptibility to successful treatment upon the removal of the salivary
deposit : these features taken together fully characterize this disease and
render its identification easy.
Contrasting these different inflammatory states of the pericemental
membrane from their inception to their termination, it becomes evident
that distinct yet closely allied diseases are here very frequently confused
and associated.
Causation.—If we take as our point of departure the postulate that
hematogenic calcic pyorrhea alveolaris is but a special manifestation of
the gouty diathesis, we should expect to find in its causation the same
predisposing and exciting agencies operative as in the production of all
other manifestations of the general diathesis.
Predisposing Causes.— 1. Heredity.—Among the predisposing
causes may be mentioned heredity, which may be regarded as one of
the most important factors concerned in its development. The writer
feels justified in asserting, after a careful investigation into the fiimily
history of a large number of pyorrhea patients that fully 90 per cent,
inunifest an hereditary tendency to this disorder, parents and grand-par-
