This section is from the book "Dental Medicine. A Manual Of Dental Materia Medica And Therapeutics", by Ferdinand J. S. Gorgas. Also available from Amazon: Dental Medicine.
Absorption of Process and Recession of Gum is indicated by a slight increase of redness, some congestion and a shrinkage of the margins of the gums, and may be accompanied with a slight purulent discharge about the neck of the affected tooth. The symptoms resemble those of chronic inflammation of the gums. The progress of the affection is generally slow, and it is often first observed about the necks of the canine teeth. Teeth so affected become more susceptible to impressions of heat, colds, acids, etc., and eventually loose.
To arrest the progress of this affection, first remove all irritants, and cleanse thoroughly, polishing the exposed surfaces. Correct the nature of the fluids of the mouth, if at fault, by constitutional treatment, the use of alkaline lotions, such as lime water, and detergent dentifrices. Such agents as a weak solution of chloride of zinc, to produce healthy granulation, carbolic acid, nitrate of silver, and judicious pressure, may be employed with advantage. A moderately stiff brush and floss silk are useful adjuncts to the treatment.
The term "necrosed" is applied to a tooth when the vitality of its pulp and lining membrane is destroyed, the peridental membrane, however, maintaining a degree of vitality which prevents the tooth from becoming an irritant, so as to insure its loss as an effete organ.
When a necrosed tooth is not productive of injury to the adjacent structures, and there is a probability of rendering it a useful organ, the pulp canal should be thoroughly exposed, cleansed, and irrigated with disinfectants, antiseptics, etc., and then filled, together with the crown cavity, with a suitable material. As necrosed teeth are frequently considerably discolored, on account of the tubuli of the dentine absorbing coloring matter from the dead pulp, such bleaching agents as chloride of lime, chloride of alumina, oxalic acid, chloride of soda, sulphite of soda, combined with boracic acid, cyanide of potassium, tartaric acid in combination with chloride of lime, chloride of zinc, also alum in combination with liq. sodae chlorinatae, may be employed to improve their appearance, also use of nitrous oxide in combination with chloride of sodium, also peroxide of hydrogen, or pyrozone.
Infantile paralysis, or poliomyelitis, is an obscure affection peculiar to a certain season, which has given to it at the hands of some the name of "warm weather spinal disease." It comes on suddenly, but seldom after the age of four years. According to Gowers, of all cases under ten years, three-fifths occur in the first two years of life; and he claims that a considerable number of cases are congenital. There is usually a febrile initial stage followed by the sudden onset of paralysis in one leg or arm. In more than half the cases the lower limbs are affected; of the remainder, the majority represent implications of the arms, notably the deltoid muscles, and legs, or, perhaps, arm and leg, and very seldom the upper extremity alone. The cause of infantile paralysis is generally assigned to teething, cold or damp, injuries to the spine, measles, scarlatina, malarial or other fevers, convulsions or concussion. Dr. Rot, at the Fourth Prussian Congress, declared that heredity is the only etiological factor that has been proven. "The primary cause of the affection must be sought for in the modifications of that part of the fecundated ovum which enters into the formation of the nervous system." During the period of dentition, children are liable to disorders of the cerebrospinal system, and as from such causes we find convulsions the cause of the death of numberless infants seemingly robust, so we see the same cause producing paralysis. There is loss of heat and atrophy in the affected limbs, and the latter may be a feature of the disease dependent upon the morbid changes in the nerve-centres. The atrophy extends to the bony system, the nutrition of which is involved; and it is evident that the atrophic degeneration, if not inherent, is a real sequence of inflammatory process in the spinal cord.
The treatment of infantile paralysis consists in the application of mild galvanic stimulation by the uninterrupted current conveyed through the affected cord out through the nerves of the flabby muscles; the skin may also be stimulated with salt and sulphur baths. In the early stage Dr. Althaus advises the injection of ergotine 1/4 gr., for a child a year old, in order to contract the arterioles of the part to deplete the blood supply. He stimulates the muscles as they become affected with injections of strychnine. Conium and chloral may be used to calm nervous excitement. Dr. Sequin recommends counter-irritation over the spine, bromides and arsenic, while others use cupping, leeches, and iodide of potassium. Brown-Sequard recommended belladonna to control the inflammatory process of the spinal cord. If pain or fever are present, ether spray to the spine, ice, gelsemium, aconite, antipyrine internally. Rubbing, muscle-beating and massage have also been employed as adjuncts.
Prof. Truman's method consists in liberating chlorine from calcium, hydrochlorite, or chloride of lime, in the cavity of decay and pulp canal by a dilute acid. He recommends a fifty per cent. solution of acetic acid, although oxalic, citric or tartaric acid may be used, or indeed any dilute acid to liberate the chlorine. The upper third of the pulp canal should be filled with gutta percha, and the cavity in all cases should be washed out with ammonia or borax, to remove the fatty matter previous to the introduction of the bleaching agent. Labarraque's solution of soda has also been used as a medium from which to liberate the chlorine. Dr. A. W. Harlan uses aluminum chloride in the cavity, from which he liberates the chlorine by means of peroxide of hydrogen. Dr. Edw. C. Kirk's method consists of liberating sulphurous acid, So2, from sodium sulphite, Na2So3 by means of boracic acid. The two substances, in the proportion of 100 grains of sodium sulphite and 70 grains of boracic acid, are desiccated separately, and then intimately ground together in a warm dry mortar. In using this powder, the tooth is carefully dried under the dam, and the powder is packed into the pulp-cavity and cavity until both are full; the reaction which liberates the sulphurous acid is then brought about by moistening the powder in the tooth with a drop of water, and the orifice of the cavity is immediately closed with warm gutta percha; also peroxide of sodium 50 per cent. solution followed by application of a dilute acid, such as sulphuric hydro-chlorine, or trichloracetic, all applied on asbestos fibre; also pyrozone, 5 per cent. and 25 per cent. solutions; also decomposing chloride of magnesia or chloride of tin with peroxide of hydrogen within the tooth. (See Cataphoresis.)
An acute circumscribed inflammatory affection, characterized by an eruption of vesicles of herpes on a red, inflamed basis, the vesicles being disposed in groups and follow the group of the adjacent nerve. The eruption is preceded and accompanied by a very severe neuralgia of the fifth nerve. The period of invasion (three days) is accompanied by a well-defined fever and other general symptoms. The period of eruption begins on the third day, and lasts about three weeks to one month, the pain being persistent. It is probably of an infectious origin, and is due to a neuritis of the affected region which leads to tropic changes.
Merck's Bulletin gives the following.new treatment for herpes zoster:
Extract gelsemium Sodium sulpho-carbolate of each 4 grammes.
Distilled water .......90 grammes. M.
Sig. One teaspoonful every two hours.
At the same time five drops of the tincture of belladonna are administered every two hours until a slight dryness of the pharynx is experienced.
Lead acetate Powdered alum of each 4 grammes.
Distilled water .... 120 grammes. M. Sig. Externally.
Compresses moistened with this solution are applied to the affected parts, and renewed every two hours. It is claimed that the pain disappears within a few hours, and that the disease is considerably shortened by this treatment.