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528 PYORRHEA ALVKOLARIS.

with calcium salts derived from the blood. This morbific matciial, plav-
iuiSi' the part of foreign bodies, irritates and excites the membrane to
infiammatorv activity and all its attendant symptoms. But even ad-
mittini;- this depositiou, there must be some ])redisposition on the part
of the membrane Avhich makes it specially liable to such deposition.
This, it is believed, is in harmony Avith gouty deposition in all other
tissues of the body ; it is to be found in im])aired nutrition and lowered
vitality in consequence of mechanical strain from an overcrowding of
the dental arch, contusions or injuries consequent upon the usual and
aj)parently unavoidable dental manipulations, such as wedging and
malleting, and similar procedures. It may be from the unskilful em-
ployment of toothpicks, toothbrushes, etc.—though these latter are rare
as compared with other acts and conditions which may impair the nor-
mal nutritional condition of the pericemental membrane. On numer-
ous occasions where the predisposition existed, pyorrhea has devel-
oped immediately foUoM'ing operations upon one or more teeth. Prof.
Armand Depres ^ attributes considerable importance to the overcroAvded
condition of the dental arch as a predisposing cause in the develop-
ment of pyorrhea.
Treatment.—The treatment of gouty pericementitis resolves itself
into both local and constitutional.
The local treatment is to be directed toward removal of the deposit
and the control and the suppression of the inflammation and its con-
comitants, and has been already described at p. 511 in connection with
the study of ptyalogenic calcic pericementitis.
Constitutional Treatment.—Whatever the predisposing cause may be,
the immediate or exciting cause must ever be borne in mind. This, it
is believed, to a certain extent at least is found in all of those mechani-
cal agencies, so well known to the dentist, which impair or lower the
nutritional level of the pericementum, thus rendering it liable, under
certain systemic conditions, to a deposition of uratic salts. The ques-
tion has been raised as to why the membrane of one or more teeth
widely separated or occupying positions on opposite sides of the mouth,
either simultaneously or successively becomes the seat of inflammation
when there is no continuity of structure. The answer to this must be
found in the fact that impaired nutrition and lowered vitality in such
structures are due in the majority of instances to mechanical injury of
these. Malocclusion may be noted as a fruitful cause. It is certainly
within the experience of many observant dentists that pyorrhea has not
infrequently developed around a tooth after it has been subjected to the
necessary mechanical manipulations incident to tooth protection and
tooth preservation.
^ Legons de Clinique chirurgicale, p. 9-656.