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ACUTE ABSCESS 235

distal side of the apex of the affected root. In this stage
swelHng of the soft tissues is usually marked.
In other cases, however, the pus, taking easier avenues of
escape, will open to the lingual side, in the roof of the mouth,

into the nasal cavity, the antrum, the inferior dental canal, the
fauces, on the cheek, below the chin, beneath the angle of the
jaw, or at far-distant points. In cases of open cavities, the
pus may find exit by way of the canals, constituting the con-
dition, sometimes erroneously designated as blind abscess.

During the progress of the condition, the bone and over-
lying structures are constantly being broken down, liquefied
and transformed into pus. After perforation has occurred,
the condition remains, if untreated, as a chronic abscess

cavity at the root end, with a sinus leading from it to a fistul-
ous opening at the point of exit. If perforation does not
occur, as occasionally happens, and the case does not receive
treatment, a chronic abscess without fistula is established,
the pus draining through the canals or being absorbed into
the vascular and lymphatic streams, the latter condition

being true blind abscess.

Treatment

The treatment in the main is abortive in character, to

prevent the spread of the infection and the continued forma-
tion of pus. It is divided into (a) local and (b) general or
systemic treatment.
The local treatment may be described as follows:
Under aseptic precautions, open into the pulp chamber,

either through a cavity, old filling, or the lingual, or occlusal
surface of undecayed teeth. As soreness is usually present,
pressure may be somewhat relieved during the necessary drill-

ing, by traction on a ligature tied around the affected tooth,
or the use of a modeling compound splint held in position over