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POINTS OF ATTACK IN SOFT TISSUES OF THE MOUTH. 323

laris. In the ease of a lame boy, nine and a half years old, with
remarkably advanced dentition, I found the left inferior iirst
bicuspid so loose that it could be pushed back and forth with the
fingers, the alveolns discharging pus profnsely under pressure.
The superior incisors of a girl four years old were extremely
loose ; the gums had receded, were very red, suppurating, in
short exhibited all symptoms of pyorrhoea alveolaris.
Its etiology is a very much debated question, and at present
Some
the greatest difterences of opinion prevail concerning it.
(including Riggs, who first accurately described the disease and
whose name it often bears) regard it as an altogether local affec-
tion, and consequently advise local treatment only. It cannot be
denied that a careful cleansing of the teeth, the removal of accn-
mulations of tartar, etc., may have a beneficial effect in the earlier
stages of the disease, although those doubtless go too far who
maintain that all cases may be permanently healed by this means.
We are never sure that a relapse will not occur ; severe cases
may be kept within bounds, but not healed ; a restoration of the
lost portion of the gums is, however, out of the question.
Others, on the contrary, define pyorrhoea alveolaris as a gen-
Xewland Pedley ^^^ writes, " The inferences that follow from the
points I have enumerated lead to the assumption that pyorrhoea
alveolaris is essentially of constitutional origin. In man and in
lower animals it is found connected with wasting diseases and
depressed conditions of the system. The local exciting cause
may be very trivial in nature.
" The weight of evidence tends to place pyorrhoea alveolaris
in the category of bone-diseases. The exposed position of the
alveolar margin and its intimate relation Avith organs of such
feeble vascularity as the teeth go far to explain why it is this
portion of the alveolus that is first affected, and also the usual
arrest of the disease by the removal of the teeth. It is not a
necessary concomitant of tabes dorsalis."
Bland Sutton^ indorses the views of Pedley : " The disease
is undoubtedly of constitutional origin, but also requires local
treatment." He has repeatedly observed the disease in rheuma-
toid arthritis, mollities ossium, etc.