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CHAPTER IX

INFECTIONS OF THE PERI-APICAL TISSUES

ACUTE ALVEOLAR ABSCESS—CHRONIC ALVEOLAR
ABSCESS—ORAL FOCI OF INFECTION—CHRONIC

ABSCESS WITHOUT SINUS—CHRONIC ABSCESS
WITH SINUS

Acute Alveolo-Dental Abscess

The causes of this condition are the entrance of pus-
forming germs and the escape of the gases and intermediate
products from a putrescent pulp into the tissues of the apical

space. Lack of aseptic precautions in treating canals, and
imperfectly treated and filled canals are also frequent causa-
tive agents. An abscess on an adjoining tooth, or infection
from a pyorrhea pocket may also extend by way of the cir-
culation, or by continuity of tissue, and produce the condition.

As a result of infection, the periapical tissues become sub-
ject, first, to arterial hyperaemia, leading into venous hyper-
aemia and later inflammation of an acute type. Following
the inflammatory stage, the tissues of the apical space are
broken down and liquefied into pus, through the action of the
suppurative and putrefactive germs present. This consti-

tutes the first or initial stage. In the second or perforative
stage the increasing pus formation takes the line of least
resistance, and bores its way, in the majority of cases, through
the alveolar plate of bone on the labial or buccal aspect of the

affected root and into the overlying soft tissues. In the third
stage the advancing pus perforates the soft tissues, making an
opening about one-third of an inch below and slightly to the
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