merely say that while by the use of these agents I believe I have retarded the progress of the disease, yet I never by their agency in long-established cases succeeded in effecting a permanent cure. In the treatment of the case to which I have alluded, aromatic sulphuric acid was freely employed; it was applied half strength upon pellets of cotton pressed into the sinus or pocket, and allowed to remain for a day. After two or three applications a marked improvement was noticed, particularly in teeth around which the lesion had not attained much depth; in these the suppuration had entirely ceased, but I soon found that any abatement of the patient's efforts in the direction of cleanliness was speedily followed by a return of the discharge. I have stated the belief that the deep sinuses or pockets caused by the death of the peridental membranes greatly add to the difficulty of effecting a cure; I have supposed that it was not possible by any line of treatment to induce a reproduction of this tissue and make it again adhere to the root, -in short, to restore the tooth to its former integrity. Dr. C. G. Davis, in the April (1879) number of the Dental Cosmos,' uses the following language: "I had the satisfaction of seeing the very wide and deep pockets of the teeth first operated upon entirely closed with new tissue, and the teeth themselves quite firmly set-indeed, nearly as fast as the teeth not affected." The inference here is clearly, that both reproduction and reunion were effected; the language, however, might have been more explicit on so important a point. I have occasionally, where the sinus was nearly accessible, as when situated on, the labial surface of a canine tooth, slit the gum constituting the pocket with a delicate curved bistoury to its full extent for the purpose of breaking up the place of lodgment. The same result may be obtained by the frequent use of aromatic sulphuric acid full strength. In reviewing the results of my efforts in the treatment of caries of the peridental tissues, I feel bound to admit that they have not been as positive in cases of long standing as some recent writers have claimed for themselves. Much depends upon the full co-operation of the patient; when we have this we may palliate or retard the progress of the disease, and when taken in time we may effect a cure. There are other forms of gum lesion resulting in loosening and final loss of the teeth which depend upon certain phases of atrophy-or, as it is more frequently termed, "absorption" of the alveolar investments, or of the roots of the teeth themselves. A very remarkable case of atrophy of the roots of all of the teeth in the superior arch came under my notice seven years ago. The patient, a lady, came for advice about a very loose central incisor. I observed a very general ulitis; all the teeth were more or less loose, and there was slight ulceration and much tenderness around the margins of the gums; these were treated by sulphate of zinc, applied with a pencil, and astringent mouth-washes. The ulitic features of the lesion soon subsided under this treatment. It was evident, however, that the disease had been going on for a long time, and that some of the incisor teeth must soon be lost. Within a few days she brought me the central tooth, which had come out while eating. I was surprised to find that the entire root was gone. (Ultimately all the superior teeth were lost. The lower teeth, though still in situ, are infirm, and the same ulitic condition prevails.) The absorption had gone on so uniformly and equally that the root exhibited simply loss of bulk; its shape had not materially changed, but was as gracefully rounded off as as though it had never been of greater length. The pulp-canal, instead of being open and largely exposed, was about of the normal size. I am indebted to Dr. H. Garrett, of Wilmington, Del., for a specimen of another form of atrophy of the roots of teeth; the patient, a very robust gentleman, in the prime of life, had a very loose central incisor, which I here exhibit. I had the good fortune to examine the tooth before extraction; it was simply elongated, loose, and very tender, but all the surrounding teeth were unaffected, and have remained so. It will be observed that the absorption has at one point quite reached the enamel, that it has the appearance of having been fractured, leaving a very uneven surface, but it will also be noticed that as the retrogressive process has gone on the pulpchamber has simply receded, and that the opening through the root is no larger than is often normal. The cause of this lesion seems to be exceedingly obscure: we only know that something has occurred to disturb that physiological balance existing between waste and repair. One of those functions may predominate and go on at the expense of the other, and we may have atrophy or we may have exostosis, as the case may be; thus, if nervous supply is interefered with nutrition is suspended, but, the function of the absorbent vessels being unimpaired, loss of bulk-atrophy -is the result. The treatment of this lesion can only, in the present state of our knowledge of its etiology, be confined to symptoms. Any recognisable exciting cause should be removed, and if accompanied with inflammation or ulceration, these should be subdued as speedily as possible. The first case I have mentioned came to me in its advanced stage, and I could get no history of it; the family physician attributed it in a general way to an adynamic condition incident to numerous closely-succeeding pregnancies. All the cases of this lesion which I have seen were accompanied by ulitic symptoms. Tomes, however, (p. 447, 'System of Dental Surgery'), describes a case in which a number of teeth were lost from this cause, and which was unaccompanied by any indications of the presence of disease either in the gums or alveolar process. Under the head of atrophy we may also class those other causes for the loosening of the teeth the first of which is the gradual recession of the gums and investing tissues without any other signs of disease, differing essentially from the socalled "Riggs's disease," in that there is no discharge, no adhering calculus, no sinus, or pockets, and no ulitic symptoms accompany it; the appearance of the gums is anæmic, expressing feeble vascular action. Individuals suffering from impaired digestion are said to be most liable to it; therapeutic treatment would be ill-directed in a case of this kind, and for such persons the best safeguard would be a life of exercise in the open air with plain nutritious food. There is a somewhat similar form of alveolar absorption, confined, however, usually to the incisor teeth, which resembles in its pathological character the condition just described. It consists of a partial atrophy of the alveolus, the seat of the lesion being confined to the outer plate, which gradually recedes, thus depriving the teeth of much of their support; the result is that change of position and mal-occlusion gradually follows. From observation in a number of these cases I am disposed to regard this as hereditary, and I may mention one case which will serve as an illustration. A lady patient of middle age consulted me about the gradual spreading of the front teeth; they were perfectly sound and well developed, but they were beginning to project so much as to disfigure the patient, and from the extent to which they deviated from the perpendicular line, to be entirely useless for the purpose of incising, in addition to which they were elongating and becoming loose. It was decided to extract, and replace them upon a gold plate. Shortly after this a son of the lady, aged eleven, was brought to me with about the same condition, the teeth projecting and resting in a very unsightly manner upon the lower lip. Very little difficulty was experienced in bringing these teeth to nearly a perpendicular position; a retaining fixture was adjusted, which held them in place for two years; they, however, eventually returned to their former position. The conditions herein considered should not be confounded with loosening of the teeth of very aged persons. In ad vanced life the tissues change; the capillaries become obliterated, constituting a general senile atrophy. To this cause may be attributed that diminution of the alveolus eventuating in loss of the dental organs, and the process seems to be so nearly a physiological one that all treatment is contraindicated.-Dental Cosmos. Mechanical Dentistry. REPLIES TO QUERY. THE following are replies to the query from "O. M. B.” which appeared at p. 245 of our last issue: In reply to "O. M. B.," who asks "the best way of putting new lead into the lid of a vulcaniser," presuming the lid to be a dome-shaped one, "O. M. B." should take it to a blacksmith's forge and place the lid inverted in the centre of the coals, banking them up around it. In another part of the fire have a ladle with the lead, get up a good fire, and heat the lid till nearly red hot, melting the lead in the ladle at the same time. Remove the lid to a vice, fixing it in by the knob on the lid; then, while it is still very hot, pour the lead into the groove. If the lid should not be quite upright the lead, which will remain liquid long enough, will show you when it is so by standing evenly in the groove. When nearly cool remove to the vulcaniser and screw the lid gently down, and the rim will embed itself.G. C. MCADAM, Hereford. In answer to the query of "O. M. B." in the 'British Journal of Dental Science of March 1st, I find the best way is to fix the lid of the vulcaniser in the bench vice, taking care to get it perfectly level, then, after blowing upon it with a Fletcher's blowpipe to make it hot, I pour in the lead from a ladle, but care should be taken that it does not cool too quick, or else, in contracting, the lead sometimes cracks.A. RAYNER, York. |