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DENTAL MEDICINE. —
14:4
Necrosis of the jaws may be either partial or complete
partial when it is confined to the aveolar process, complete when
the entire thickness of the bone is affected. The causes are the
same as those of periostitis, such as injuries, eruptive fevers,
syphilis, periodontitis, scorbutus, mercurial, phosphorus, and
arsenical poisoning, and ulceration of the soft tissues. The
svmptoms of necrosis are in the beginning the same as those of
periostitis or periodontitis, and after the disease is established, the
pus escapes by the side of the loosened teeth and the gums be-
come detached from the bone, and pus finds an outlet from be-
tween them. In necrosis of the lower jaw the pus frequently
penetrates the tissues covering the bone and points upon the under
at other times the pus may follow the inter-
surface of the jaw ;
muscular connective tissue of the neck, and point as low down
as the clavicle or breast. The necrosis may also extend to bones
of the face and head. The necrosed portion of bone becomes a
foreign body which the surrounding tissues endeavor to extrude,
or to wall off and surround, owing to the presence of granula-
tion tissue, which gradually perforates the surrounding bone at
places of least resistance, the result being the formation of one
or more sinuses, through which the dead portion can be with-
drawn with little trouble. Separation finally takes place between
the living and dead portions of the bone. While this is taking
place, a quantity of new bone, especially in the case of necrosis
of the lower jaw, is forming around the sequestrum ; the new
osseous tissue is called the " involucrum," which it is necessary
to at least partially remove before the sequestrum can be with-
drawn.
Treatment.—The treatment of necrosis of bone consists in the
removal of the dead portion (sequestrum), and the restoration of
the parts to a condition favoring regeneration. The removal
of the sequestrum or dead portion is accomplished with bone-
forceps and chisels, and all the lining material of the cavities
which the fragments have occupied should be scraped away with
a sharp spoon. The cavities are then packed with iodoform
gauze soaked in a mixture of balsam of Peru, containing ten per
cent, of guiacol. Before the sequestrum or dead fragments