ALVEOLAR ABSCESS. A TREATISE 
ON 
Alveolar Abscess, 
BY 
W. I-I. SHADOAN, D. D. S. 
LOUISVLLLE, KT. 
CINCINNATI: 
WRIGHTSON & CO., PRINTERS, 167 WALNUT ST. 
1868. A. TREATISE 
0 N 
ALVEOLAR ABSCESS, 
DR. W. H. SHADOAN. 
Alveoli.—Semi-circular canals or grooves into which the 
teeth are set. Their size and shape are determined by the 
teeth that occupy them. 
Abscess.—From Abscedo, I depart or separate from, loss 
of substance, a gathering or rising, a collection of pus in a 
cavity, the result of a morbid process or action in the parts. 
The French have various distinctive terms for abscess, as 
Ab’ces chaudaign sondain, is one which follows violent in- 
flammation ; Ab’ces froid chronique scrofulux, cold, chronic 
or scrofulous abscess, one which is the result of chronic or 
scrofulous inflammation; Ab’ces par congestione, diasthese- 
que, symptomatic abscess, one which occurs in a part, at a 
distance from the inflammation by which it is occasioned. 
“ Some writers are of opinion that pus is formed by the ar- 
terial system, and is deposited by way of excretion in the 
inflamed parts; others, that it is formed by the destruction 
of the solid parts.” It seems to be a degeneration of the 
liquor sanguinis and exudation corpuscles. “ In Alveolar 
Abscess we have the whole range of structure involved, from 
unpronounced amorphous, mucus mass, or chaotic materials 
in the juices of the flesh, from which arise and by which are 4 
nourished the neural and muscular fibrillae, the vascular 
and osseous, no less than the glandular and dermal tissue. 
If then all these must be involved in destruction, just in the 
ratio of the size of the sac, in every case of matured alveo- 
lar abscess, is it not of some moment to us to be able to de- 
tect the order of its inception and progress from its first be- 
ginning to its most unmistakable presence ? Where then is 
the point of departure from normal activity ? Is it in the 
juices of the flesh? Or is it in the granular living contents 
of the cells ? Or may it not have its inception, in a refusal 
on the part of the formed material of the cell wall, to afford 
free transit into and out of the parenchyma of the cell to 
the pubulum, or juices upon Avhich it subsists ? Although 
it may be clear to him who has investigated this subject, 
that all departures from healthy action take their origin in 
the neural sea, or juices of the flesh; yet it is difficult to 
prove this to the uninitiated mind short of laborious and te- 
dious detail of untrient activities. The oneness of this sea 
throughout the whole range of the body within the outer 
pellicle or skin, whether that body be large or small, com- 
posed of one organ or many divisions, their sustenance from 
this elemental mass, renders the whole body or any part of 
it, subject to change in accordance with the extent of the 
application and the force of the disturbing agent.” * 
There is very little difference between alveolar abscess 
and abscesses in general; the former has its origin within 
the alveolar border, while the latter may have their origin 
on the outer surface of the osseous system and in the soft 
parts. 
Abscess is the most common affection to which the alveo- 
lus is subject. “ Its effects are always exceedingly perni- 
cious,” f not only to the sockets of the teeth thus affected, 
but to the gums, and very often the health is largely affected 
thereby. When severe inflammation of the lining membrane 
* Prof. Atkinson on Alveolar Abscess, 
t Harris’ Principles and Practice of Dental Science. 5 
of the tooth or the alveolus is produced, causing the death 
of one or more cells which suppurate and form a pocket, there 
is an effusion of coagulable lymph, which will harden and 
form a sac, which attaches itself to the tooth or alveolus at 
the point of inflammation. This may be averted even after 
the sac is partially formed, by interrupting or cutting off the 
poisonous food or supply which feeds the disease. The cells 
forming the walls of the nucleated abscess having the least 
power of resistence, give way first, and determine the direc- 
tion of the abscess. Cold abscess may readily be detected 
by its appearance, which is recognized by the parts being en- 
larged, of a soft or spongy appearance, with very little ten- 
derness and slight constitutional disturbance. It progresses 
slowly, and is found in persons of low vitality and of a 
scrofulous temperament The warm variety is almost the 
exact opposite of the cold, the parts swell, are red, and very 
tender to the touch. There is a great variety ranging from 
cold to warm; some will be intermediate, while others will 
approximate the one or the other extreme. 
In evacuations of the cold or chronic variety the pus will 
be found thick and poorly defined, with very little traces of 
blood, laying close to the surface, showing a slow develop- 
ment and little variety. It is not so with the warm, the pus 
is more fluid, with traces of blood, and on evacuation will be 
found coming from the middle, while red blood will be dis- 
charged from the surface cut or walls of the tumor. The 
last occur in persons of sound constitution, are rapid, and of 
easy cure, if not complicated with other diseases, while the 
cold is, as before stated, slow and stubborn, requiring skillful 
treatment, or in other words, very tedious of cure, often re- 
quiring the best skill, and in some cases, resisting curative 
effort altogether. 
DIAGNOSIS. 
The correctness of the diagnosis will depend somewhat 
upon three things, (viz:) Acuteness of perception, the stage 
of the affection, and the characteristics of the patient. In 6 
its earlier stages, in some peculiar constitutions, diagnosis is 
very difficult. But to the close observer and the thoroughly 
conversant it is not so, especially with the acute variety. 
The presence of abscess may, by some, be detected while yet 
in its primative or cell state, and in such a case cure is 
almost certain. The following may be considered some of 
the unmistakable signs of abscess : In the earlier stages 
redness of the gums, extreme tenderness of the tooth to the 
touch, swelling of the gums, &c. At a later period the 
symptoms become more prominent. Elongation and loosen- 
ing of the tooth, an increased size of the gum over the point 
affected, a great rush (apparently) of blood to the part on 
taking a recumbent position ; increase of pain in the parts, 
a fistulous opening through the gums, cheek, jaw, or at any 
other point where the pus may be conveyed by the aid of a 
suture or other channel, susceptible of being traversed by 
pus. These are the most prominent signs of alveolar abscess, 
and may be regarded as reliable. The cause and duration 
of the disease will depend upon the constitutional health of 
the patient, of the susceptibility to abscess, the stage of the 
disease when the treatment is commenced, and the kind of 
treatment adopted. 
The warm variety is the most rapid in its course, and the 
cold is the slowest; the intermediate, in temperature, will 
vary between the two classes above named in duration. The 
general health always strongly influencing either variety or 
class of abscess. 
CAUSES. 
The causes of alveolar abscess are very numerous. A lack 
of power, on the part of the system, to take up and appro- 
priate the nutritious food contained in the juices. The pre- 
sence of irritating matter, dead nerve membrane, dead roots 
of teeth, mechanical violence, sudden and repeated transi- 
tions of temperature, and any other cause that produce acute 
inflammation. Irritating matter may be secreted at the 
point of the root of a tooth in which the nerve is dead, and 7 
as long as the canal of the root or roots is kept open there 
may be no injurious effects, but as soon as the avenues of es- 
cape are closed, by any means whatever, the escape of the 
matter is checked, and as the secretion is still kept up it will 
soon form, in such quantities, as to produce pressure on the 
lining membrane of the socket, and a high state of inflam- 
mation and congestion is set up. It is not always the case 
that a dead tooth has a decaying nerve, in some cases the 
nerve is entirely gone, yet a secretion may exist at the 
apicial foramin, which, if not allowed to escape, will produce 
the same effect that a dead pulp will. It is one of the most 
difficult points in pathology to ascertain just how much in- 
flammation will be tolerated. If the recuperative powers be 
equal to the inflammatory conditions, one will poise the 
other, and as one predominates so will be the result. 
In some cases there will be evil resulting from the slightest 
disease, while at other times it will take almost death itself 
in the parts to produce any change whatever. This is often 
manifested in other things; sometimes men die from slight 
scratches, and at other times they may be torn almost to 
pieces and yet live. I remember, during the late rebellion 
having seen a man who had received thirteen wounds, either 
of which seemed sufficient to have killed him; yet he wholly 
recovered. I allude to this only to show how much the 
system is capable of resisting at some times as compared 
with other times. We are all aware that the system can 
not endure as much at one time as it can at another. 
This depends somewhat upon the condition of the mind. 
An abscess is often produced by the simple operation of 
filling a tooth at an improper time, for instance, when the 
system is in a reduced condition, or when there is inflamma- 
tion in the parts or any other unhealthy condition, that contri- 
butes to the formation of alveolar abscess. To attempt a 
clear and concise description of all the circumstances that 
tend to produce, or contribute to the formation of abscess 
would be a tedious as well as unprofitable undertaking; the 8 
above refers mainly to roots of teeth and teeth in which 
there is no nerve membrane. The next class of causes that 
claim our attention are those in which the nerve membrane 
is yet remaining. A tooth may be slightly decayed, enough 
so to expose the pulp, and the irritation thereof from contact 
with the air, from chemical action or otherwise, may be 
sufficient to produce inflammation in the membrane, and this, 
if not relieved by topical applications, usually results in the 
death of the pulp. The power of recupuration in the pulp 
of a tooth is very low at best, and when inflamed from con- 
tact with the air and fluids of the mouth, death is almost sure 
to follow. The engorgement may be relieved by stimulants 
or by drawing the blood from this point to some other, thus 
permitting the part to recover. This may be done by the 
use of leeches, counter-irritants, activity of body or mind, or 
both, or any other act that will change the current of blood 
to some other point. It takes very little irritation in some 
persons, and especially at certain times to produce inflamma- 
tion at the apex of the roots of teeth sufficient to cause an 
abscess, and the conditions mentioned above seem peculiarly 
to favor this result. There are other cases where the nerve 
of a tooth is not exposed, but the decay approaches very 
closely, the cavity is cleansed and filled, and the thermal 
changes in the filling, together with the close proximity of 
the same to the pulp, will cause irritation and inflammation; 
and as the tissue is encased in a firm and unyielding cham- 
ber the only egress is through the foramin of the root, and 
whether the cavity is filled or not an abscess may form. 
After a tooth is filled the nerve often dies from inflamma- 
tion produced by the operation. Abscesses may be formed 
and exist for a long time without being apparent, and in 
persons of good health, have existed and been cured by 
nature alone. I have seen cases where there had been 
abscess and no external signs of lesion, and the persons 
themselves had no knowledge of its existence, clearly show- 
ing to my mind that an abscess may exist and be radi- 9 
cally cured by nature alone. The next among the causes 
that we shall mention is mechanical violence; this, like 
many other causes, has its peculiarities. Mechanical vio- 
lence may be in any direction that will bruise the perios- 
teum of the tooth. But the most favorable is the lateral. 
You may force a tooth in the socket with such violence 
that it will bruise or otherwise wound the membrane, and 
cause inflammation. It may first be in the form of pe- 
riostitis, but if the inflammation is not allayed a plasma will 
be wept out and matter formed; but as before stated the 
most favorable kind of violence for the production of abscess 
is the lateral. Strike a tooth on either side and not only 
bruise the investing membrane, but the nerve itself is liable 
to be injured, either of which will cause thickening of the 
membrane and produce the same result. An alveolar abscess 
is sometimes caused by simple inflammation of the perioste- 
um, this is often the result of sudden transitions of tempera- 
ture. These are some of the exciting causes, there are 
others that might be named, but for the present we will omit 
them. There are general or constitutional causes which con- 
tribute largely to the formation of abscess. Persons of a 
manifest inflammatory diathesis or those in which there is 
considerable local inflammation from some local exciting 
cause. Those of a manifest strumous diathesis and persons 
living in miasmatic districts are more likely to be attacked 
than those of a healthy condition. 
HOW THEY ARE PRODUCED. 
It will be well to state that the same laws govern alveolar 
abscess that govern abscesses in general. The healthy ac- 
tion of a single cell, or a number, may be disturbed by a 
faulty, or diseased supply of nutritious matter, or by me- 
chanical violence, wounding or entirely obliterating them, 
either of which will deprive the cell or cells of their pure 
pabulum or food, and death is the result. When periosteal in- 
flammation takes place, whether it be at the apex of the root 10 
or any other point, and continues until suppuration ensues, 
the periosteum at that point thickens, and as the matter ac- 
cumulates, the periosteum is distended, and begins to press 
against the walls of the alveolus, and the consequence is, that 
the walls at the point affording the least resistance, are ab- 
sorbed until there is an opening formed for the escape of the 
matter. 
“ Let us take, for instance, a case of common phlegmonous 
abscess, and trace it from its origin to its culmination. The 
inception depends upon the poisoning of pabulum, or mucus 
mass, by the accumulation of innutritious or effete matter, 
which disturbs the nutrient action of one or more cells, by 
depriving them of their pure pabulum or healthy liquid food. 
These salts and gasses being held in solution, have a tenden- 
cy to diffuse themselves in every direction throughout the 
free juices of the flesh, and this predominance of chemical 
affinities disturbs the equipois of the currental movement de- 
nominated vitality, and is destructive in the exact proportion 
of its predominance.”, The healthy parts are constantly 
making an effort to stay the further advance of the abscess 
and to some extent limits the size of the sac. The process 
of the formation is by breaking down cell after cell, until the 
whole surrounding structure is destroyed; this may be .slight 
or extended, owing to the poisonous condition of the juices, 
and the state of the health of the patient. There seems to 
be no settled theory among authors, just how, or by what 
modus operandi abscesses are formed. Some writers assert 
that the sac is formed by the distention of the periosteum, 
while others say that it is formed by the hardening of co- 
agulable lymph, which is effused at that point. If the latter 
be true, then it is certain that the periosteum is destroyed by 
a sort of chemico-vital process so far as the pressure of the 
sac extends; then if the theory of the formation of the sac, 
by the distention of the periosteum be true, that membrane 
is changed somewhat in character; the healthy periosteum 
being a white fibrinous substance capable of powerful resis- 
tance, &c., while the sac of an abscess is of a different 11 
character, inasmuch as it is much more highly organized, and 
is capable of greater resistance than healthy tissue. 
Prof. Harris says that “ whenever there is intense orsevere 
inflammation at the root, or in the alveolus infusion of coagu- 
lable lymph takes place, which hardening attaches itself to 
the tooth, and ultimately a sac is formed. This, as suppura- 
tion takes place distends and presses against the alveolus 
through which an opening is formed for the escape of the 
matter.” 
The character of abscesses is exceedingly variable owing 
to the constitutional peculiarities and susceptibilities, the con- 
dition of the parts immediately concerned, and to the cause 
producing it. There are exceptions however to all rules, but 
this is the general rule. Persons of a scrofulous tempera- 
ment are more liable, as before stated, and an abscess in per- 
sons of this temperament takes the chronic form almost im- 
mediately; while those of good constitutions will recover 
with little or no treatment at all. When a part capable of 
suppuration is subjected to inflammation of the required in- 
tensity some of the small vessels give way and blood is 
effused into the surrounding parts; simultaneously with this 
rupture, or nearly so, the arteries begin to throw out a pe- 
culiar plastic matter, called coagulable lymph, this is capable 
of becoming organized and being thrown around the diseased 
parts, and between them and those which are healthy, it forms 
a barrier to the infiltration of extravasated fluids. 
“By some strange process to us altogether inscrutable, 
the walls of lymph become vascular, and capable of perform- 
ing the vital functions of secretion and absorption and by 
them the pus is furnished. As this secretion proceeds the 
previous contents of the abscess including the effused blood, 
are gradually absorbed, and fresh pus is deposited in their 
stead, so that if the tumor be opened at an early stage the 
pus will be more or less mixed with blood ; but if the open- 
ing be delayed the cavity will be found to contain only pure 
pus.”* 
♦Bond’s Dental Medicine. 12 
WHERE SITUATED. 
The point of attack is usually at the apex of the roots, but 
not always. In the superior teeth, abscess attacks the inci- 
sors sometimes on the side, some distance below the point, 
and especially on the buccal surface, in the bicuspids there is 
little difference from the incisors and canine teeth. In the 
molars the point of attack is frequently in the bifurcations of 
the roots, sometimes occupying the entire space, if at the 
apex of the root, the palatine or lingual is most likely to be 
affected, or in other cases, the anterior buccal root. The 
same will apply to the inferior teeth as to the superior, ex- 
cept in the single-root teeth. They are rarely attacked ex- 
cept at the apex of the root. The inferior molars are attacked 
usually, at the point of the roots, but sometimes between 
them, at or near the bifurcation ; as to which of the roots is 
most liable, there is really no difference. If the cause is from 
mechanical violence, it will be at the point where the greatest 
injury is produced. Abscesses in childrens’ teeth are pro- 
duced more frequently by mechanical violence, than, proba- 
bly, any other cause, and in the four anterior superior teeth 
than any others. The third molars and especially the in- 
ferior are more liable to the ravages of this disease than any 
other class of teeth; they are liable to be attacked at all 
points; probably not in every tooth, but there is no point 
but is liable to attack at some time or other. The tempo- 
rary teeth are more liable to the disease than the permanent, 
and should be more carefully treated, from the fact that the 
parts about are more susceptible to injury than the adult 
teeth and jaws. The superior incisors will be found more 
liable than the canine teeth, and the ten anterior inferior teeth 
less liable than any other class. 
POINTS OF ESCAPE. 
There are, perhaps, as many points of escape of the pus 
of abscesses as there are different points of attack. As a 13 
general rule, the pus will find an opening through the most 
yielding part involved. If an incisor is affected, it is usually 
at the apex of the root; especially if it is an inferior tooth ; 
but here we will remark that the six anterior inferior teeth, 
are rarely ever affected with abscess. Should such be the 
case it will be at the apex of the root. Not so with the su- 
perior incisors; they may be affected very often, and at 
various points. If abscess be produced from a dead or de- 
caying nerve it will be at the apex of the root, and the open- 
ing will be at that point, but not always, though usually 
through the external wall of the alveolus. If the tooth thus 
affected be a central incisor, the opening may take a central 
or anterior course; in that event, when the pus reaches the 
suture, it will take its course along that suture, and find an 
escape at the posterior border of the hard palate. There 
are cases on record, where the pus passed over the floor of 
the nasal cavity, and was discharged at the soft palate. Such 
cases, however, are seldom met with. The cases most usually 
met with, are those that discharge through the anterior wall 
of the alveolar process, at the apex of the root. There is 
very little difference in points of attack, as well as of dis- 
charge, in any of the ten anterior teeth. They having sin- 
gle roots, except occasionally the first bicuspid which are 
sometimes double. If a molar of the superior maxilla be the 
Seat of an abscess, it may be at the point of the roots, at the 
bifurcation, or on one side of the root; if at the apex of the 
palatine root, the pus will usually be discharged through the 
process at the point of the root, or it may traverse the alveo- 
lus for some distance before it is discharged; the most usual 
is at the point opposite the apex. Abscesses of the buccal 
roots discharge their contents through the outer wall and 
usually at the nearest point. If the anterior buccal root has 
an abscess at the apex, it is sometimes the case that the dis- 
charge is into the maxillary sinus. When this is the case the 
treatment is complicated. The discharge from a third molar 
may be an inch or two from the seat of the disease, owing to 14 
its situation. There have been cases where the discharge was 
on the angle of the jaw, or on the side of the neck, and one 
or two cases where the pus escaped on the back part of the 
shoulder. A case of this kind was described to me, by an 
old and experienced Dentist some time since. In the inferior 
third molars, the discharge may be on the inner side of the 
jaw, or at the lower edge, and is sometimes mistaken for 
scrofula, especially if the patient be of a scrofulous diathe- 
sis. The discharge from the first and second inferior molars 
is always or nearly so at the point of attack. 
Before dismissing this part of the subject I will mention a 
few cases met with in my own practice : 
First case.—A little boy about eight years of age — of a 
manifest scrofulous diathesis, was brought to my office for 
consultation. On examination I found large abscesses (or an 
abscess,) situated at the roots of the first and second left 
superior temporary molars, ulcerated at the roots and dis- 
charging the pus over the posterior angle of the malar bone, 
just under the canthus of the eye. I inserted the probang, 
and could distinctly feel the permanent teeth. 
Second case. — A lady had an abscess at the apex of the 
root of the left superior lateral incisor, it discharged pus at 
the apex ; in a few days she called to have it further treated 
as it seemed somewhat indolent. After giving it such treat- 
ment as I considered necessary she asked me to look at the 
opposite side of her mouth, where, to my astonishment, I 
found a lump as large as a hazel nut, which, on being opened, 
was found to contain pus ; a further examination showed 
that the latter proceeded from the left side of the mouth. 
Here were two points of discharge from one abscess, one at 
the point of the root affected, and the other at a point be- 
tween the right lateral and cuspidatus, a distance of at least 
one inch from the first. Another feature in this case is, that 
the whole face swelled, and beneath the right angle of the 
inferior jaw was swollen more than any other part. At one 
time I had fears that suppuration might possibly take place 15 
at that point. The cause of so much swelling and inflamma- 
tion was, I think, the malarious condition of the system. I 
have failed to say that the external opening may be through 
the gum and into the mouth, or it may be through the cheek 
and skin, making its appearance on the face, and if it he a 
lower tooth the pus may be discharged through the jaw 
avoiding the mouth altogether. A very remarkable case of 
fistulous opening through the inferior maxillary is reported 
by Mr. Bell, and on account of the singularity of it, I give 
his report, believing that it will be of benefit to some 
who have not seen it. This had resulted from an abscess 
in the socket of a dens sapientise of the inferior maxilla. 
The discharge had been kept up for two years previous to 
the time that the case was submitted to Mr. Bell for treat- 
ment. “At this time a funnel-shaped depression existed in 
the skin, which could be seen to the depth of nearly three- 
quarters of an inch, and a small probe could be passed through 
it into the sac of the abscess underneath the root of the 
tooth. The abscess had now remained open for nearly two 
years, during the latter of which the parts had been in the 
state I have described them. I removed the tooth, and as I 
had anticipated, no further secretion of pus took place, but 
so perfectly had the communication been established, that 
when the gum healed, it left, by its contraction, a fistulous 
opening, through which a portion of any fluid received into 
the mouth passed readily to the outside of the cheek, and I 
could, with care, introduce a fine probe completely through 
the passage. So free, in fact, was the communication that 
some of the hairs of the whiskers, with which the external 
portion of the depression was filled, grew through the exter- 
nal opening and appeared in the mouth.” 
PUS. 
Pus, under all circumstances, is nearly the same, and all 
chemists give to it the same chemical constituents. Pus, of 
a good or healthy quality, is of a creamy appearance, of a 16 
yellowish white color, inodorous, and opaque. Alcohol and 
heat coagulate it. In an analysis, by Schuilque it was found 
to contain albumen and water, a particular extractive sub- 
stance, and a small quantity of soda, phosphate of lime, and 
other salts. “ Normal pus consists essentially of two dis- 
tinct parts : pus corpuscles, or pus globules, and a colorless, 
aqueous fluid liquor puris, in which the corpuscles are sus- 
pended.” A variety of globules or corpuscles are described 
by other chemists, but the above is sufficient for our pur- 
pose, hence we will not occupy space in describing them. 
Unhealthy pus, the kind usually found in abscesses of an 
ichorus character, is very irritating to the parts effected, and 
as long as that condition exists the parts will remain in a 
diseased condition. It is of a thin dark appearance, and is 
irritating. 
“Although it is true that such pus as is called healthy in- 
dicates a convalescent state of an ulcer or abscess, the infer- 
ence to be drawn from its appearance attaches exclusively to 
the parts which secrete it, while it may herald the abate- 
ment of local inflammation, it may, at the same time, give 
clear evidence of a state of disease incompatible with integ- 
rity of organs, or with life itself. Suppuration of the eye, 
liver, or of the lungs would be a very serious matter, however 
healthy the pus might be.” * 
Some writers have considered suppuration a curative pro- 
cess, and have regarded the pus a valuable covering for the 
granulations or new growth of flesh, and so it is in some 
cases, but there are many exceptions. 
Some parts of the body have a much greater disposition 
to form pus when inflamed than others. The cellular tissue, 
skin, and mucous membrane are very prone to suppurate, 
while the fibrous tissues manifest no disposition to it. 
“ Pus is modified, by the nature of the part where it is 
formed, by the constitution of the individual, by various ac- 
cidents occuring in the process of its formation, and by cer- 
* Macartney on Inflammation. 17 
tain obscure laws which control the phenomena of these 
affections, which are called specific. It will also present 
different appearances, as it may be mixed with other fluids, 
as blood, saliva, bronchial mucus, etc.” f 
“ When pus is irritating it is not so to the surface which 
secretes it, but to the adjoining healthy structure over which 
it flows. 
“ Pus is heavier than water, and this quality assists us in 
distinguishing it from mucus. 
“ Mr. Hunter is of opinion that it is coagulable in muriate 
of ammonia, which peculiarity distinguished it from mucus 
and all other natural secretions, but this test was disputed. 
“From the fact that hard and inflammatory tumors, in the 
course of inflammation become soft and yielding, and filled 
with pus, it was naturally supposed that the original solid 
parts were converted into this fluid, it is now wTell ascertained 
that such is not the case, but that pus is secreted by the 
arteries.” | 
TREATMENT. 
By treatment is meant all means employed for the cure of 
disease. The treatment of abscess may be divided into 
three classes, Preventive, Therapeutic, and Surgical. The 
preventive may embrace all means employed, and in order 
to be the better understood and to avoid confusion, we will 
arrange our classes of treatment, commencing with 
PREVENTIVE. 
In this class of treatment we often have to resort to gen- 
eral as well as local means. An abscess may, in some in- 
stances, be prevented by antiphlogistic treatment, such as 
saline cathartics, leeching the gums, and anything of a cool- 
ing nature, either constitutionally or locally applied. There 
are so many different remedies for different cases that it 
is impossible to give a single remedy that will suit all. 
f Macartney on Inflammation. 
X Bond’s Dental Medicine. 18 
Where we wish to prevent the formation of an abscess the 
first and most important thing to be done is to remove the 
exciting cause. If the pulp be dead in a tooth, its re- 
moval will, in many cases, prevent the formation of an 
abscess or the removal of any foreign body, such, for in- 
stance, as the roots of dead teeth, or any thing that proves 
an exciting cause. Sometimes the application of a counter- 
irritant to the gums, when the use of leeches is impracticable. 
The gums may be scarified and bathed in warm water to 
promote bleeding which will, usually, prove beneficial. Paint- 
ing the gums well with compound tinct. of iodine is also at- 
tended with good results. I have also found great relief in the 
application of croton oil to the gums ; a saturated solution 
of creosote and iodine as a local application is invaluable in 
many cases. For the last year or two I have been using, 
with great satisfaction, “ Mercurim vivus,” (third tritura- 
tion,) which, for acute periosteal inflammation, in many 
cases has no rival, except where the system is very suscep- 
tible to impressions of mercurial agents, then it should not 
be used. If the case is found to be too obstinate to yield to 
the preventives used, the only course left for us is to use 
palliatives until the sac is formed and then adopt the kind 
of treatment indicated. 
“ Pressure will limit the outwTard wave whenever applied 
upon a purely healthy portion of structure, and define the 
size of an abscess by turning back the wave of nutrient ac- 
tivity in the deteriorated part upon itself, preserving the 
outward sea from threatened disturbance.” Vigorous or 
active exercise, both bodily and mental, have a powerful 
influence on incipient abscess, and sometimes cure entirely. 
Why, or how this is done may not be very well understood, 
nevertheless it is true, and may be accounted for by the in- 
viting away of the nerve force and current of blood 
and literally starving the abscess. When therapeutic 
agents are used the principle of their action is very much 
the same as that of pressure in arresting the wave of poi- 19 
sonous nutrition, and in like manner they abate or greatly re- 
duce the size of the sac. 
THERAPEUTIC TREATMENT 
Of the remedial agents for the cure of alveolar abscess 
we will mention creosote, nitrate of silver, chloride of zinc, 
chlorate of potassa, iodine, iodide of potassium, bromine, and 
brom.de of potassium, etc. 
CREOSOTE-. 
Creosote was discovered by Reichenbach, of Blenkso, in 
1830; it is procured by the dry distillation of various vege- 
table as well as animal substances, but is officinally described 
to be obtained from wood tar. It is a colorless, oily liquid, 
of a peculiar, disagreeable and penetrating odor, resembling 
that of wood smoke, and has a burning, acrid taste which is 
perceived throughout the whole extent of the buccal, nasal, 
and pharyngeal mucous membrane. Its specific gravity at 
68° F. is 1.037. It boils at 397° F., and is frozen at 17° F. 
It burns with difficulty in the air, emitting large volumes of 
smoke. It coagulates albumen but exerts no action upon 
fibrin. Owing to these facts, and its strong antiseptic pro- 
perties, it is considered one of the best therapeutic agents 
in the cure of all ulcerative affections. This substance is 
more peculiarly adapted to the treatment of alveolar abscess 
than any other known agent. “ Creosote is an active caus- 
tic. Its escharotic power is due to its affinity for albumen, 
which is so strong as to take the latter from living tissue 
and thus destroy vitality to the extent of the combination. 
Its compound with albumen is white, hence the extent of its 
escharotic action is readily observed.” In addition to its 
strong affinity for albumen with which it rapidly forms a 
permanent insoluble compound, it possesses the valuable 
property of arresting and preventing the decomposition of 
animal matter, which renders it preferable to any other 
agent that has hitherto been introduced fur the treatment 20 
of abscess. “ Its great penetrating power enables it to per- 
vade every part of the cavity and diffuse itself over the en- 
tire surface of the sac, thus effectually securing the desired 
result.” It is also one of the most energetic stimulants. 
The mode of applying creosote is usually by injection. In 
some cases, however, where the fistulous opening is large it 
may be applied by saturating a pledget of cotton or lint and 
forcing it into the cavity formed by the abscess. The most 
successful means of applying creosote is by injection. I 
find this most readily done by the use of a syringe when 
the liquid is to be inserted through the fistulous opening, 
but if the root of the tooth is well opened then the pulp 
cavity may be filled with gutta percha or Hill’s stopping, 
through which drill a hole for the insertion of the point of 
the syringe which will greatly facilitate the operation. 
Another manner of injecting an abscess is preferable to the 
above, inasmuch as it is less complicated and will allow a 
much more thorough operation than with the syringe espe- 
cially if the foramen be small. This is accomplished by 
shaping a broach of a piece of pivot or any hard wood, such 
as straight grained hickory, barb the point, around which 
roll loosely some cotton, this dip into the creosote and use 
as a piston, dipping it into the creosote every few seconds 
and forcing it into the sac until the patient complains of 
pain. If there be a fistulous opening through the gums the 
creosote can, in nearly all cases, be forced through the tooth, 
sac, and gum. This is indicated by the surface around the 
fistulous opening turning white, and is an indication that 
the process has been carried far enough for that time. If 
the operation has been thoroughly performed, the creosote 
having pervaded every particle of the sac, there is little 
doubt that a cure will be effected, other things being favora- 
ble. I find, in many cases, a cure may be effected in healthy 
patients with a single application of the creosote. In most 
cases all can be accomplished with creosote that can be with 
other agents, I seldom use anything else for that purpose. 21 
Were it not necessary in a paper like this to give all the 
remedies used I would let the above suffice, but to meet the 
views of all, other remedies will be given. 
NITRATE OF SILVER. 
Although this remedy is but little used, it is occasionally 
employed and is deserving a place in the catalogue of reme- 
dies,, a consideration of its merits will not be regarded out 
of place. 
Nitrate of silver is a white salt having an intensely me- 
tallic, bitter taste, it is usually prepared in the form of hard, 
brittle sticks, at first it is white but becomes gray, and after- 
ward more or less dark under the influence of the air. It 
was once thought that the light caused this substance to turn 
dark, but this is shown to be erroneous. The turning dark is 
caused by organic matter or sulphuretted hydrogen contained 
in the air. Silver coin will be affected in the same way. Its 
affinity for animal matter is evinced by its forming definite 
compounds with albumen and fibrin. Nitrate of silver is 
soluble in its own weight of water and in four parts of 
alcohol, its solution stains the skin an indelible black color ; 
when exposed to heat it fuses at 426°, and at 600° undergoes 
decomposition with evolutions of oxygen and nitrous acid. 
Nitrate of silver is employed as a vesicant, stimulant, and 
escharotic, either dissolved in water or in the solid state. It 
may be used in abscess for two purposes, one to break up the 
sac, the other to heal the ulcer, and when employed for the 
latter should be applied in solution of about two or three 
grains to the fluid ounee of water; a drachm of the salts to 
an ounce of water forms an escharotic, and may be injected 
into the sac of an abscess. I usually prefer the solid nitrate 
to the solution. 1 find the best and most convenient mode 
of applying the nitrate in the solid state is by pulverizing 
the crystals as finely as possible, and by means of a small 
slightly tapering silver tube they may be carried into the 
sac with little difficulty. There is another way of introduc- 22 
ing the nitrate that may be well to mention j take a small 
stick of the salts, about the size of the lead in a common 
pencil, and upon it form a covering of melted engraver’s 
wax, this done, trim off a portion of the wax at the point 
and insert it rapidly, not allowing time for the substance to 
dissolve and stick to the flesh. This method is not so suc- 
cessful or satisfactory as the other. The injecting of the 
solution may be conducted in the same way as that of 
creosote. 
CHLORIDE OF ZINC. 
As this remedy is seldom used I shall not enter into a 
detailed account of its administration and uses. The chief 
employment of the chloride of zinc has externally as 
an escharotic, applied to schirrhus and cancerous affections 
and to ulcers of an anomalous and intractable character., 
When thus used it acts not only by destroying the diseased 
structure but by exciting a new and healthy action in the 
surrounding parts. It may be applied in the same manner 
as nitrate of silver. The greatest benefit resulting from the 
use of chloride of zinc is in the reproduction of alveolar 
process, where it has no rival. The chloride should not be 
used oftener than once a day for one or two days. Then, 
if the application has been thorough, there is no further use 
for this agent. 
IODTNE AND ITS TINCTURES. 
Iodine is an elementary non-metalic substance having some 
resemblance to chlorine. It was discovered in 181.', by a 
soda manufacturer of Paris. Sometime after this its thera- 
peutic properties were discovered, since which, it has gradu- 
ally come into general use, so that at the present time it is 
universally a standard remedy. It is found chiefly to exist 
in the kelp of sea weeds, in the animal, and mineral king- 
dom. It is also found as an iodide of sodium in several min- 
eral springs of the United States, and in some minerals in, 23 
other parts of the country. As a therapeutic agent, iodine is 
used as an absorbent—it excites absorption in the alveolus, 
and in erysipelatious affections. In glandular enlargements 
and malignant growths, its use is more beneficial than most 
other stimulants, in bronchocele and other affections of the 
throat, and thyroid glands iodine is considered invaluable. 
As the Dentist is not expected to treat such diseases the fur- 
ther consideration of the agent in this connection will be dis- 
continued. It has only been thus spoken of to show its effi- 
cacy in such cases. 
* Iodine is less used by the Dentist than the tincture ; as an 
internal remedy it is seldom used, the iodide of potassa be- 
ing considered far superior. Iodine may be useful in the lo- 
cal treatment of chronic inflammation or induration of the sali- 
vary glands, in dental periostitis, in alveolar abscess, in some 
morbid states of the antrum, in thickening of the mucus 
membrane, in tumors of the mouth, and in absorption of the 
gums and alveolar processes. The officinal tincture will an- 
swer very well for periostitis, thickening of the membrane, 
and sometimes for abscess. For chronic catarrh, or inflama- 
tion of the lining membrane of the antrum, the compound 
tincture very much diluted is a good injection. For destroy- 
ing the sac in alveolar abscess, a solution of iodine and creo- 
sote is a sovereign agent, and when not too concentrated, the 
same is an admirable application to the margins of the gums 
and alveolar processes, after the removal of all irritating and 
dead substances; but care must be taken that it is not applied 
too frequently. It is an escharotic, and as a general rule 
it is well to let the slough separate before a second applica- 
tion. To use externally I prefer a colorless solution of io- 
dine, prepared by combining equal quantities of compound 
tincture of iodine and pure aqua ammonia. As combination 
takes place, the mixture becomes transparent and will not 
then color the skin. I do not think of any condition which 
will require the Dentist to prescribe iodine internally. When 
its constitutional action is indicated as in scrofulous or syphi- 24 
litic diseases of the mouth more benefit will be derived from 
the use of iodide of potassium.1 
IODIDE OF POTASSIUM. 
Omitting its history, we will pass immediately to its physio- 
logical effects and uses. 
o 
“Locally, this salt is an irritant, but is not near so ener- 
getic in its action as free iodine On this account it may be 
given internally, in larger doses and for a longer period? 
than iodine. Indeed, iodine can be introduced into the sys- 
tem much faster by the use of the iodide, than when given 
uncombined. A solution of albumen, fibrin, or gelatin, is 
not obviously changed by the addition of this salt, and as 
these are the most abundant organic constituents of the 
body, Ave may infer that the chemical action of iodide on the 
living tissue is but slight. To obtain a clear view of the ac- 
tion of this salt, as a remedial agent, it is necessary to bear 
in mind its peculiar properties. It is very soluble, and is, 
therefore, readily absorbed. It passes rapidly into the circu- 
lation, and may be detected in all the tissues and secretions. 
It is composed of two elements, both of which are character- 
ized by strong affinities for other substances, and for some of 
them stronger than that by which they are held together. 
If the salt is decomposed, the potassium takes oxygen and 
becomes potash, which is a general solvent of the animal tis- 
sues. At the same time the iodine is set free, and is thus 
able to exert its affinities. And as all chemical agents are 
peculiarly active in the nascent condition, the iodine and pot- 
ash are both more energetic than if carried in their free 
state, to the point of action. Each one, as it were, holds the 
other quiet till the proper point is reached, and then lets it 
go, to accomplish its work. Each element by neutralizing 
the other prevents its local, irritant action, and each is libera- 
ted, atom by atom, in obedience to stronger affinities, each 
1. Watt’s Dental Materia Medica. 25 
particle being promptly saturated, by the gratification of the 
affinity, which liberates it. And this explains how it is that 
such large doses of this salt, can be taken for a long time, 
without local, or constitutional disturbance. The affinities of 
iodine and potassa are sufficient to account for all the phe- 
nomena, observed in the remedial action of the salt. Highly 
soluble compounds, are the natural results, and these are 
naturally carried out by the various excretories. Let us sup- 
pose that the iodide is administered for the arrest or removal 
of morbid growths, or to relieve tertiary syphilis. The latter 
is often spoken of as a disease of the bones. But that 
expression convey the whole truth ? Is there not a disease 
of the formative fluids from which bony tissue is deposited ? 
Now, if these morbid particles are arrested, by the affinities 
of the elements of the salt, held in solution, and carried out 
through the various secretions, it is evident they will not fur- 
ther build up the morbid development. And as the particles 
of morbid structure, like those of normal tissues, perfornt 
their functions and pass away, unless new ones are furnished 
in their places, the abnormal solid is carried off little by lit- 
tle. The diseased growth is literally starved to death, and 
carried out by the scavengers of the system. It is this ac- 
tion of the remedy which has induced some writers to call it 
a resolvent, or liquefacient. In some of the above remarks, 
I have sacrificed technicality, to a desire to be understood by 
beginners, and those wThose opportunities have not been such 
as they desired. They are not written for the critic, though 
of course, he may use his pleasure in regard to them. It 
should be given in solution, and usually, immediately after 
eating. It may be taken in sweetened water, or almost any 
way the patient may fancy. The average dose is from 4 to 
10 grains. Many use much larger doses, but I have 
found it best to do so. For an adult, I frequently prescribe 
a solution of a drachm of the salt to an ounce of water, and 
direct the patient to take a teaspoonful three times a day.*’ 
1. Watt’s Dental Materia Medica. 26 
BROMINE. 
Dromine is a volatile liquid of a dark red color, when 
viewed in substance. Its taste is very caustic, and its smell 
very disagreeable, somewhat resembling chlorine. It evapo- 
rates rapidly, and is sparingly soluble in water, more so in 
alcohol, and still more in ether. It is valuable for its bleach- 
ing properties, and may be used for bleaching teeth, not so 
well, however, as chlorine, or chlorate of zinc. Bromine is 
intermediate in its effects between iodine and chlorine. It 
stimulates the sympathetic system, promotes absorption, and 
is supposed to be more energetic than iodine or bromide of 
mercury. It is recommended where iodine has been tried, 
and does not act with sufficient energy, or has lost its effi- 
cacy by habit. I am of opinion that bromine, like iodine, 
is not as efficacious as bromide of potassium. In case the pa- 
tient has any syphilitic taint, bromine and bromide of potassi- 
um may advantageously be used. They may be used constitu- 
tionally or locally, either or both if thought best, for local 
treatment, make a saturated solution of bromide of potas- 
sium, then add 40 drops of bromine to each ounce of the so- 
lution, and apply to the effected part, always cleansing the 
part well before making the application. Apply this remedy 
in the same manner as creosote. For internal treatment take 
of bromide of potassium lG, distilled water 13, misce, and 
add bromine 16. Take a teaspoonful three times a day, one 
hour before or after each meal. This treatment is only to be 
used in cases of syphilitic taint. 
When local treatment is applied through the canal, it 
should first be cleansed of all impurities, such as nerve mem- 
brane, or any foreign substance contained therein, and the 
root opened freely to allow a free use of the injection. In 
case the discharge be fetid, a solution of chloride of sodium 
should be injected into the cavity, to correct this condition. 
After this, an injection of any of the above agents, may be 27 
used to break down the sac. The directions for the use of 
which see Creosote. 
Here let me remark, that the young and inexperienced 
may be easily deceived in their cure. Either of the local 
remedies used will soon impart a very healthy appearance, 
and often cause the external opening to heal almost imme- 
diately, causing the operator to think he has cured the dis- 
ease, when really he has hardly checked it. It is frequently 
the case that the therapeutic treatment alone will not affect 
a cure, but surgical aid is required. In the treatment of ab- 
scess in the inferior Maxilla, there are serious difficulties, 
which are not met with in the superior. One is, the situation 
being at the bottom, instead of at the top of the socket, the 
secretions rest on the diseased parts, while in the superior it 
is drained off. The presence of this matter is a serious ob- 
stacle in the treatment of abscess unless it can be drained off 
and kept free. Again, the size and shape of the jaw, is such 
that an opening through the gums can not be well made’ 
Therapeutic treatment, in cases of this kind, is not very effi- 
cient unless it be vigorous. The treatment of abscess in the 
inferior jaw is not generally so successful as that of the su- 
perior. 
SURGICAL TREATMENT. 
The surgical treatment of alveolar abscess is very short 
and simple. That most commonly resorted to, viz: extrac- 
tion, is generally successful. There are cases, however, in 
which it is desirable to avoid the extraction of the tooth, but, 
there are a great many teeth thus affected that are utterly 
useless and should be removed; for the irritation which they 
cause to the surrounding parts, to say nothing of the abscess, 
is sufficient cause for their removal. Old roots of teeth, and 
teeth that have lost their antagonists are nearly always a 
source of irritation, and when that is the case they should b© 
removed. It sometimes happens that an abscess at the roo$ 28 
of a tooth, will burrow into the alveolar process, making 
the cavity containing the abscess larger a short distance be- 
yond the root than at the socket. In such a case the sac will 
nearly always be retained in the alveclus after the tooth or 
root is removed; the abscess now acts independent of the 
cause which produced it, and the extraction of the tooth will 
rarely effect a cure, and an operation for the removal of the 
abscess will be necessary. 
When the tooth is a valuable one and should be retained, 
either for ornament or service, and therapeutic treatment 
does not accomplish the desired result, it may be aided by 
the trephine, drill or chisel; with either of these instruments 
an opening may be made through the alveolus opposite the 
point of the root of the affected tooth, then, with a suitable 
instrument cut away or separate the sac from the root. 
In some cases of alveolar abscess the alveolus is largely 
affected, and in such a diseased condition that it will not heal 
without first cleansing the parts ; this may be done by chisel- 
ing or scraping off all dead particles of bone in and about the 
cavity, for as long as anything of the kind remains, the chan- 
ces of success are greatly diminished. Care should be taken 
in all cases, that unnecessary pain is not inflicted. I have 
met and treated cases of abscess, where the outer wall of the 
alveolus was so largely affected as to present a honey-comb 
appearance; the only speedy and successful treatment in such 
a case, would be a breaking down of the diseased wall, and 
the removal of every particle of diseased bone. Again, in 
addition to the above, the root of the tooth may be in such a 
diseased condition, that the removal of the diseased portion 
of its substance will be necessary to a cure. All diseased 
bone and tooth substance being removed, a proper therapeu- 
tic treatment, and a vigorous constitution, will soon affect a 
cure. Compresses are necessary to stay the tide of nutri- 
tious food to the abscess, together with all other means that 
assist in the abatement of the disease. 29 
To sum up the whole treatment, in a few words, the for- 
ceps and the chisel are the most effective instruments, and 
will generally be found successful. In the incipient stage of 
an abscess, if it be at a point where the outer wall of the al- 
veolus is thin, and easily cut through, the knife may be used 
to advantage, by cutting through the process to the abscess, 
which will greatly facilitate the escape of the pus, and in this 
way a cure is sometimes effected. Scarifying the gums, and 
thoroughly opening down to the sac with the knife is often 
successful. These are the surgical means usually employed, 
and are so plain that the time, and manner need not be mis- 
understood. 
EVIL RESULTS. 
We wish now to call attention to some of the evil results 
of alveolar abscess. I desire to call attention first to chil- 
dren’s teeth. In these the greatest evil and most to be dreaded 
is necrosis which may take place, and extend to the sockets of 
the permanent teeth, causing exfoliation of their walls, as well 
as those of the temporal'}'’ teeth. This is of the utmost impor- 
tance, as by the destruction of the alveolus the permanent 
teeth are also very often lost. There have been several cases 
where the disease occasioned by an abscess caused exfolia- 
tion of the sockets of two or three teeth. It is frequently 
the case where the first or second superior molars are effec- 
ted, their roots being situated immediately beneath the floor 
of the antrum, and as the roots very closely approximate, 
and sometimes even penetrate it, an abscess of these teeth 
often produces a disease in this cavity, that is very trouble- 
some, and may result in Hydatides of the antrum. They are 
often very hard to cure, and in some cases are never cured. 
This is a very serious form of disease, superinduced by 
abscess. We find about as extensive, and alarming troubles 
arising from an abscess of the inferior third molars, as in any 
other of the mouth. Some of the reasons for this are, first, 30 
the difficulty of diagnosing the disease. We find physicians, 
as a general rule, liable to be misled, and even Dentists are 
not always free from being deceived, in consequence of the 
opening for the escape of the pus, being at a considerable 
distance from the seat of the disease, the patient is often 
treated for a different disease entirely. Such has been, is 
now, and will continue to be the case, for those who are called 
in such cases treat their patients for months, and even years, 
without knowing what is the real cause of the disease, while, 
in the meantime, the abscess is still progressing, and as the 
tooth is situated so closely to the fauces, and soft parts, they 
Will soon become largely inflamed, and if the tooth is very 
much decayed, the evil is increased by the amount of irrita* 
tion produced by the ragged edges of the tooth, and thus ex- 
tending to the lungs, may, so seriously effect the lungs 
as to finally produce Phthisis Pulmonalis. Again, the 
amount of swelling and inflammation in the mastoid muscles 
may be such as to render them useless, for the time 
being, and if the disease continues for any considera- 
ble length of time the muscles become ridged, and finally 
the jaws can not be used with that freedom they should 
be. 
Exfoliation of the alveolus is another of the evils of alveo- 
lar abscess. This was mentioned above, but only in connec- 
tion with children’s teeth. I now recur to it mainly for the 
purpose of giving it a more extended notice, and relate a 
case or two to show how far this disease will be carried when 
all things are favorable. When the inflammation is extreme or 
very great it may produce necrosis, and exfoliation. In an 
old work published by “Fox & Harris on the Human 
Teeth,” two or three cases are recorded, in two of which, three 
teeth, and in the third, all of the anterior teeth were lost by 
the suppurative process, produced by an abscess. 
It is unnecessary to mention other cases to prove the 
evils of the disease in question, any one will admit that those already mentioned are quite sufficient to show the importance 
of timely attention. With regard to the treatment of ab- 
scess there is yet very much to be learned; in fact very lit- 
tle as compared to what is required is yet thoroughly under- 
stood. Yet, enough is known to prove conclusively that very 
many cases may and can be cured. But the progressive 
practitioner will not rest contented with what is known on the 
subject.