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168 DENTAL MEDICINE.

Epithelioma of the gum is in the form of a ragged ulceration,
often the result of irritation from diseased teeth ; the pain and
inconvenience at first slight; a tending of the ulceration to
spread towards the tongue and cheek, with induration of the base
of the ulcer.
Treatment.—Removal as soon as its nature is manifest. In
slight or doubtful cases the application of the strongest nitric
acid, the acid nitrate of mercury, or the actual cautery, to bring
about a healthy cicatrization. If the disease has involved the
alveolus, as is evident by the swelling of the gum and the loose-
ness of the teeth, a free removal of the bone is necessary.
Hypertrophy of the Gums is indicated by an increase of their
sui)stance to such a degree as to cause them to overhang and
cover the greater portion of the crowns of the teeth ; tendency to
hemorrhage ; gums dark and livid ; fetor of breath ; increased
flow of saliva.
Treatment.—Remove all dead teeth and salivary calculus. Re-
move the morbid growth by a horizontal incision through the
diseased structure to the crowns of the teeth, and freely scarify
the gums by passing a lancet between the teeth to the process,
and repeat this operation at intervals of four or five days, if
necessary. Use detergent and astringent and antiseptic lotions
and mouth-washes, and occasionally a weak solution of nitrate of
silver. Phenate of soda is efficacious as a lotion, it is also antiseptic.
Diet non-irritating, and all excess and intemperance avoided.
The teeth should be kept perfectly clean. Trichloracetic acid to
dissolve calculus.
Alveolar Pyorrhoea^ or Riggs' Disease^ is indicated at first by an
uneasy sensation ; then inflammation of margins of gums ; loose-
ness of the gums about the teeth, which form pus-pockets; and
necrosis of edges of alveolar process ; a tendency to hemorrhage
;
inflammation extending deeper into gums; small sulci filled with
pus; looseness of the teeth and change of positions ; disagreeable
taste ; peculiar fetor of breath ; dark livid color of gums, with
thick margins, and often extreme sensitiveness to touch ; in some
cases the gums are denuded of their epithelium, with a polished
appearance, in others, with a pimpled surface; the teeth, at