2. Necrosis is an affection which is characterized by blackness of the tooth and loose ness in its socket. It may be caused by violence, accompanied with destruction of the nutrient vessels, or by inflammation of the pulp. If the tooth gives trouble, it must be extracted. Necrosis of the teeth is quite distinct from the very destructive necrosis of the dental alveolar processes and of the jaws generally, which results from the poisonous action of phosphorus fumes, or from the very similar affection which sometimes follows the eruptive fevers. For an account of the singular and terrible disease from which artisans employed in making •lucifer-matches suffer, in consequence of their inhaling the fumes of phosphorus (probably in the form of phosphorous acid), which was first noticed in 1839, we may refer to a review of Von Bibra and Geist's exhaustive treatise (in German) on the subject in the British and Foreign. Review for April,. 1848; and to an article ou "Phosphorus Workers" in the fifth report of the medical officer of health. Reference is also made to the disease in the article PHOSPHORUS in this work. The necrosis and exfoliation of the alveolar processes and portions of the jaws in children, consequent upon the eruptive.fevers, is accompanied by the shedding of the teeth; and according to Mr. Salter, surgeon-dentist to Guy's hospital, who was the first to describe its true nature, is essentially the same as the necrosis in phosphorus and, like it, is the result of the local application of a specific poison, gen erated within the indiVidual, to the vascular parts of the teeth. For a description of this remarkable disease, and of the treatment to be adopted, we must refer to Mr. Salter's article on "Exanthematous Jaw-necrosis," in Holmes's System of Surgery.
3. Alveolar abscess may be defined as a suppuration around the fang or fangs of a tooth, usually carious, accompanied by absorption of the bony walls of the alveolar process, and enlargement of the little sac of pus or matter, which gradually makes its way to the surface, "either along a canal by the side of the fang of the tooth opening at the edge of the gum, or through the gum itself at a point corresponding to the end of the root (or roots) of the tooth implicated. When, however, the fangs are unusually long, or the reflection of the mucous membrane from the gum to the cheek or lip is very superficial, this same discharge may burrow still more outwardly, and find its exit upon. the surface of the face."—Salter, op. cit., p. 2. When the discharge bursts, as it most commonly does, through the gum, the alveolar abscess is reduced to its simplest form, and is known as a When the discharge takes place in the region of the cheek or chin, the true nature of the case may easily be mistaken by a careless surgeon, who might refer the symptoms to hone-disease. The cause of this affection is either caries or necrosis. In its earliest stage the disease may be cut short by the extraction of the affected tooth, or even by the removal of the stopping, if the tooth is a stopped tooth. If it is desirable to save (for appearance's sake or otherwise) a threatened tooth, the gum should be freely leeched, and hot fomentations applied to the swollen part of the face. and the system should be briskly purged. As soon as matter can be detected it should be allowed to escape by a puncture made through the gum—an operation which is fol lowed by immediate relief, and by rapid subsidence of the swelling, although pus con tinues to be discharged for a considerable time. Indeed, the disease seldom ceases altogether till the offending tooth is removed. When the abscess shows symptoms of pointing on the face, the tooth must be at once extracted, and more serious surgical interference will probably be necessary.
4. Toothache is not so much a disease as a symptom of various morbid states of the affected part, which, for convenience, may be classed under this single heading. " Toothache," says Dr. Wood, " offers every possible variety in degree, character, and duration. The pain runs through all the grades which intervene between a slight sensa tion of uneasiness and unsupportable agony. It may be dull, aching, heavy, sharp, pungent, throbbing, grinding, or lancinating. It may be continued or paroxysmal, remittent or intermittent, and regular or irregular in its recurrence. It may come in flashes, and as suddenly disappear; or may continue a long time with little variation."' —Practice of Medicine, 4th ed. vol. i. p. 512. According to the various conditions which give rise to it, toothache may be divided into: (a.) Inflammatory toothache, which is. almost always dependent upon caries. The inflammation may be seated in the pulp of the tooth, in the nerve-twig entering the pulp-cavity, or in the periosteum investing its roots, and reflected over the interior of the alveolar cavity. There is generally some external swelling after the pain has continued for some time, and it occasionally extends. to the salivary glands. The tooth is at the same time very tender, and any force applied to it aggravates the pain, which is also increased by hot and cold liquids taken into the mouth. When, as in the great majority of these cases, the pain is associated with caries, the best treatment is as follows: " Let the patient have a dose of calomel and colocynth; confine him to spoon diet; let him wash out the mouth with a solution of carbonate of soda in tepid water; let the gum around the tooth, and between it and its neighbors, if tumid and tender, be deeply scarified with a fine lancet; then let the cavity be filled loosely with a little bit of cotton-wool, dipped into the solution of tannin and mastic (for which the formula has been already given); and if the toothache be• curable at all, this plan, with a little patience, will be almost sure to succeed. If the pain is very violent, half a grain of powdered acetate of morphia may be taken up with the cotton imbued with the tannin, which should be warmed before it is put into the cavity. As soon as the pain is relieved, the tooth, if of use, should be stopped with gold or amalgam; or if of no use, it should be extracted. It may be added that most of the violent, burning, empirical nostrums, such as creosote, oil of thyme, etc., although they may be of service when introduced in small quantity by a skillful hand into the carious tooth at the right time, can do nothing hut mischief when employed indiscrim inately, as they are by the vulgar."—Druitt's Surgeon's Vade-mecum, 8th ed. p. 458. (b.) :Neuralgic toothache may occur either in sound or in carious teeth. It may be recog nized by its occurrence in paroxysms at more or less regular intervals, and by its being attended with little or no swelling of the external parts. It is very common in the months of pregnancy, and in persons of a general neuralgic tendency, and is often excited by changes in the weather. The treatment is the same as for neuralgia generally. After the bowels have been freely opened,.chalybeates and quinine must be given in large doses, and frictions with vcrntria or tincture of aconite (both of which are energetic poisons) may be carefully applied to the gum. (c.) Rheumatic and gouty toothache may occur in sound or in carious teeth in rheumatic or gouty persons. The constitutional treatment applicable to these diseases must be tried, together with the local applications already noticed.