PYORRHEA ALVEOLARIS.
In all advanced cases it is useless to attempt the saving of the tooth, which should be extracted; this, moreover, will give freer admittance of remedial agents to the neighbouring sockets which are beginning to be invaded by the microbes.
The involved tooth must be stripped for its entire length of its tartar and a strong antiseptic, as concentrated Carbolic Acid solution or Tincture of Iodine in minute quantity, should be applied to its surface on a little cotton-wool on the point of a fine probe; this will work its way between the diseased gum and the tooth. The most absolute cleanliness is essential, and one of the best cleansers is a little lemon-juice brushed with cotton wool or lint over the swollen gum at its junction with the tooth. Peroxide of hydrogen is much recommended, but the writer has recently obtained better results by the application with a soft damp toothbrush of Perborate of Sodium in powder; this gives off free hydrogen peroxide, and the result ing borax solution is also a good cleanser of the mouth.
Where pockets exist these must be reached by whatever antiseptic is employed by injecting it with a fine syringe, and free drainage should be provided. It will often be necessary to excise the tag of gum tissue with the scalpel so as to obliterate the pocket. Whittles claims that the disease is curable by the application of Protargol in glycerin on the electrode of a primary interrupted current. All local treatment is, however, highly unsatisfactory in most cases, and some authorities strongly advocate Vaccine treatment. The vaccine, according to Goadby, should be pre pared from whatever microbe to which the patient's blood exhibits an abnormal opsonic index. The casual microbe has not yet been demon strated. Kolle claims the discovery of a specific spirochxte, and he states marked improvement follows a single intravenous injection of Neosalvarsan, while two doses of o'3 grm. cured the disease in ten days
in several cases.
Preventive treatment affords the only hope of successfully dealing with all septic conditions of the mouth, and as the importance of oral sepsis is becoming more clearly recognised as a factor in many grave blood and stomach diseases, systematic and patient cleansing of the teeth, gums and mouth will alone prevent the advent of dental caries and of pyorrhoea.
PYO-SALPINX—see under Pelvic Inflammation. RANULA.
A free incision should be made under cocaine through the bluish mucous covering of the cyst, and its walls as far as possible dissected out. Often a considerable portion of the sac cannot be removed, in which case the wall which is left should be scraped, dried and swabbed with a I in 12 solution of Chloride of Zinc, strong Tincture of Iodine or pure Carbolic Acid, after which the cavity must be firmly packed with lodoform gauze and per mitted to granulate from the bottom.
cysts bulging into the floor of the' mouth are best treated by a free dissection carried out through the skin of the neck below the chin, and this route is sometimes selected for the removal of large sublingual ran ulie.
When a ranula is met with in its very early stage it may be success fully dealt with by snipping out with a scissors a small window-like piece of mucous membrane, including cyst wall, swabbing the interior with dry wool, and leaving in for a day a plug soaked in equal parts Weak Tincture and Strong Tincture of Iodine, after which the cavity may be allowed to heal up naturally without further packing.
A minute seton of horsehair is often sufficient to secure the withering up of a small ranula.