TOOTHACHE.
The pain is usually due to caries, the result of bacterial activity which involves the dentine or causes acute inflammation of the pulp; it may also arise from periostitis or suppuration of the alveolar bone, or the impaction of a wisdom tooth.
The first step is to exclude neuralgia by an examination of the seat of pain, and next to determine the nature of the dental lesion. The carious cavity should be gently cleared Of all debris and dried with a small mop of absorbent wool on the point of a fine probe, after which it should be thoroughly disinfected by Oil of Clove, and plugged with an impervious gutta-percha or mastic filling should the pain be slight. Usually it will be necessary to avoid impervious plugging and resort to pledgets of wool moistened with the clove oil, creosote or carbolic acid; these must be frequently changed till all pain has been removed, after which the cavity may be permanently filled with metallic stopping.
The same treatment should be followed when the pulp has become inflamed, but the gentlest packing of the cavity with oil of clove pledgets rimy for the moment increase the pain, and in order to prevent frequent changing of the wool it is advisable to roof over the cavern by inserting a ]dug soaked in strong alcoholic solution of mastic, which need not be removed for 1 2 to 24 hours. One of the best routine local anaesthetics for relieving the pain of an inflamed pulp-cavity is a mixture of Carbolic Acid and Collodion. This obliterates sensibility, and seals up the chamber if applied carefully upon cotton-wool. Cocaine may be combined with the Acid.
It . Collodil 13.P. 5iij.
cid i Carbolic?' (Crest.) 5iij.
Cocaime llydrochlor. gr. x. Misce.
Fiat solidi°. Signa.—"..1 small portion to be applied upon cotton-wool 10 the dried-out pulp-cavity of the painful tooth." The pulp-cavity may he packed with drugs in the dry state. Thus Cocaine, Chloral, Butyl-Chloral, Camphor, Menthol, Morphine, Opium, Antipyrine or Exalgin may he placed in the hollow, and kept in position by a little cotton-wool loosely packed upon the top.
In adults, where there is very severe pain originating in the living pulp of a carious tooth, the most satisfactory method will be to remove any stoppings, if such exist, or to gently remove any carious dentine till thc pulp-cavity is well exposed, and then by a minute quantity of powdered White Arsenic left to situ by a plug of cotton-wool the vitality of th( pulp will he entirely destroyed. Chloride of Zinc and Nitric Acid or solid Nitrate of Silver may be used in the same way.
Tomes points out that for the relief of pain a dead tooth should he left quite open, and a live tooth sealed closely up. This is seen where the pair results from pus in the pulp-cavity. No relief can be expected till the pulp. cavity is opened up and the matter evacuated, and further tension pre. vented by leaving a way for free exit.
Abscesses in the alveoli should he evacuated by a free incision of the periosteum, and when severe pain is caused by septic absorption from f. dead pulp, the only remedy which affords any immediate relief is ex. traction of the dead tooth. I f the pain he not very severe, however relief may be obtained by injecting pure Carbolic Acid through the dew pulp flown into the hollow fangs or root canal, and sometimes by drillinf the alveolar process, at the root of the tooth, pus may be evacuated am the incisor or bicuspid saved after disinfecting from above.
The popular remedies for external application are of little use, and au plan of rubbing Aconite, Belladonna or Chloroform along the gums doe: more harm than good. ('hewing of Pellitory Root sometimes relieve: the pain depending upon congestion of the fangs or of the periosteum The antineuralgic remedies internally are also not to be relied upon a: long as the local conditions remain unattended to.
It is hardly necessary to insist upon the importance of saving the tooth Extraction should only be resorted to when the disease in the tooth substance is too extensive to permit of the hope of a solid stopping being inserted after the subsidence of the acute symptoms or when the tooth cannot be thoroughly disinfected or rendered totally aseptic.
It is almost impossible to exaggerate the importance of the treatment of dental caries, as so much harm is done by the absorption of pus and microbes from the cavities of suppurating teeth. Dyspepsia, ear disease, tuberculosis, adenitis, ulcerative endocarditis, pernicious aniemia and many other serious forms of general infection arise from the microbes or their toxins being absorbed. Turner insists upon the importance of sacrificing every temporary tooth and the first permanent molars rather than leaving a child with painful or foul teeth in its mouth.
The prevention of dental caries is a very important matter. and the treatment may be summed up in absolute cleanliness of the mouth and the avoidance of continuous indulgence in sweetmeats and excessive use of starchy foods. The use of bakers' bread made from refined white flour is believed to be a prolific cause of dental caries. The writer advises patients who have suffered from loss of a tooth by caries to once a day place a little oil of cloves on the point of a wooden tooth-pick inserted between each tooth after cleansing the mouth. This operation can be accomplished inside one minute, and the mouth remains aseptic fur the day.
Extraction may be the only means of giving relief where the pain is caused by the impaction of a wisdom tooth. If possible, the wisdom tooth itself should be removed, as it is generally much less valuable than the molar in front of it, but this latter may have to be sacrificed if the wisdom tooth cannot be brought within the grasp of the forceps.