Page 350 - My FlipBook

322 THE MICRO-ORGANISMS OF THE HUMAN MOUTH. ;

The first stage of the disease presents hut little characteristic
it manifests itself only as a slight redness of the gums at the
neck of the tooth, which cannot be distinguished from a simple
gingivitis marginalis, such as is often caused by tartar. In the
majority of cases tartar is actually present. The disease at this
stage occasions but little or no inconvenience, and is therefore
generally overlooked.
Soon, however, distinct and characteristic symptoms appear;
the connection between the gums and the root is destroyed by
the suppuration of the pericementum, the gums appear more or
less sw^ollen or j^ufted up, dark red or bluish red in color, and
but loosely surround the neck of the tooth. Pressure upon the
loose gums causes a slight discharge of pus. As the process ad-
vances, the margin of the alveolar process becomes involved and
gradually broken down.* The gums either become hypertro-
phied and pufly^ or gradually recede, exposing a large portion of
the root. A loosening of the teeth is now noticeable, whicli when
neglected generally increases until they drop out of their own
accord or become so troublesome as to make removal necessary.
The interval of time between the first appearance of the
disease and the falling out of the affected tooth varies. I
observed a case in which (according to the statement of the
patient) three wrecks after the commencement of the loosening
of the teeth all the superior incisors were irrevocably lost; two
fell out spontaneously, the others had to be removed. In other
cases, how^ever, the disease becomes chronic and many years
elapse before it comes to an end. After the loss of the teeth,
the phenomena completely disappear.
Pyorrhoea alveolaris usually attacks adults, by no means, how^-
ever, exclusively, as many maintain. Some months ago I had
an opportunity of studying several pronounced cases of pyorrhoea
alveolaris in children of from four to twelve vears of ao-e.
By the kindness of Dr. Cass, director of the asylum for
rhachitic and scrofulous children at Middelkerk, Belgium, I
received permission to examine the mouths of over one hundred
patients, and discovered several typical cases of pyorrhoea alveo-

* By many the bone is regarded as the seat of the primary infection.