JAWS, DISEASES OF.
Alveolar Abscess. or "Gum-boil." A gum-boil usually begins in the socket of a carious tooth. It is generally , quite superficial. and gives rise to but few external signs, but occasionally, espe cially when dne to a disorder at the root of a tooth, the active manifestations are accompanied by severe throbbing pain, considerable swelling of the cheek of the corresponding side, and with protrusion of the tooth from thickening of the peri dental tissues. When the lateral incisors are involved, the abscess may spread pos teriorly between the layers of the hard palate, or anteriorly in the direction of the nose, opening into the latter. When the molars are involved, it may penetrate the tissnes of the face, thus leaving a sinus or scar. _Necrosis and pymmia have occurred in rare instances as complica tions. .
The process in the bone in alveolar py orrlicea is one of osteitis rarefaciens. It does not develop primarily in the bone, but subsequently, commencing as a. purulent inflammation of the gums, which gradually extends to the bone and produces the pathological condition. The osteoporotic fortn of atrophy of the alveolar processes leading to complete loosening of the teeth, so far nude scribed, has been up to the present looked upon as alveolar pyorrlicea with out suppuration or deposit of tartar. It ou account of this form that Baume and others erroneously maintained that pyorrheca alveolaris may commence primarily in the bone in the absence of any inflammation of the gums. The osteoporotie form of atrophy of the alveolar process presents a very favor able soil for the development of pyor rhica alveolaris. Various pathological conditions of a constitutional eharacter, as scrofula, rachitis. syphilis, tubercu losis, aente eruptive fevers-. typhus, ma laria, diabetes mellitus. tabes dorsalis, rheumatism, gout, chronic eatarrh of the stomach, amemia, ehlorosis, unsani tary dwelling, insuflicient nourishment, repeated pregnancy, and other debilitat ing diseases lead to general atrophy of the soft parts of the organism as well as the skeleton and particularly the al veoli. These debilitating eonditions ere ate in the bone a favorable soil tor the development of pyorrhcea, alveolar's, particularly in the form of osteoporotie atrophy. The lack of proper nygienic
attention to thc teeth during. the above mentioned constitutional diseases lead.s to a deposit of tartar, and suppurative inflammation of the gums. which ex tends to the bone-forming alveolar pyor rhcea. In the mild forms of pyorritcea, when only the parts of the alveoli which do • not contain bone-marrow are at tacked, more attention to the teeth, re moval of the tartar, washing with some disinfecting and astringent solution, and correction of the diet are sufficient to effect a cure. In more advanced cases the above treatment is inadequate, and scraping the affected bone with a sharp spoon is the only radical and rapid method of treatment. In th: presence of constitutional diseases it is essential to employ in addition to the local also general treatment. In view of prophy lactic and hygienic measures for the pre vention of the disease, chewing of solid food, such as a hard crust of bread, is advisable as a means of gymnastics tending to improve the nutrition of the alveoli and strengthening the gums and teeth. .N. N. Znamensky (Med. Oboz renije, vol. lvii, No. 6, 1902; Phila. lied. Jour., Oet. 11, 1902).
Treatment. — The old-fashioned lin seed-meal poultice is worse than useless; it tends to encourage the inflammatory process and to involve the cheek. Hot water as hot as can be borne held in the mouth is far better. Painting the gums with a 10-per-cent. solution of cocaine is sometimes temporarily effective in mild cases. Free leeching or lancing can be resorted to if the abscess progresses. Leeches should always be applied through leech-glasses, and not wrapped in a nap kin, as often done. If these measures do not suffice the patient should consult a dentist.
Epulis.
Although applied to various neoplasms of the gums, the term "epulis" is only applicable to a growth of the alveolar process and tooth-sockets. Two varieties of epulis are recognized: the simple, or benign; and the nialignant.