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POINTS OF ATTACK IN SOFT TISSUES OF THE MOUTH. 333

Analogous circumstances are noticed in other parasitic diseases
of the oral and pharyngeal cavities.
According to this conception, pyorrhoea alveolaris is not caused
by any specific bacterium, which occurs in every case (like the
tubercle-bacillus in tuberculosis), but various bacteria may par-
ticipate in it, just as in suppurative processes not only one but
generally various species have been found. Besides, as far as we
know, there is no bacterium which, inoculated under the gums,
is able to provoke the disease in healthy persons.
The pronounced tendency of pyorrhoea alveolaris to recur after
it has been apparently healed may be explained by the fact that
we are seldom able to determine with certainty the predisposing
cause, or, having found it, to remove it. 'New infections of the
wound continually take place from the mouth.
The prognosis is always unfavorable ; in the fi'ont teeth, how-
ever, a marked improvement, if not a complete cure, may be
effected. Even in far-advanced cases I have seen the suppura-
tion totally subside after appropriate treatment, and only reappear
months after at circumscribed points. I have therefore generally
found an after-treatment necessary at intervals of from four to
six months, and have in very many cases succeeded in at least
retarding the progress of the disease for years, and in restoring
the affected teeth, which had been painful and loose, to their
former condition of usefulness.
The chance of preserving the molars is exceedingly small.
The local treatment consists in a thorough cleansing of the
roots of the teeth, which in all cases anyways advanced can be
performed only after making an incision in the gums over and
parallel to each root, and extending at least to the line of demar-
cation between the healthy and diseased tissue. K, then , a tampon
of cotton is placed in the incision, the flaps of gums will be pressed
apart, and in a few hours the root plainly exposed to ^dew. The
mechanical cleansing may be followed by an application of nitric
acid (2 to 4 per cent, solution). Finally, astringents, and par-
ticularly antiseptics, are to be used. The patient must pay the
strictest attention to his moutlj, and when there are pockets be-
tween gums and roots, syringe them with an antiseptic solution
after everv meal.