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.
Alveolar Abscess is first indicated by pain of a constant character, which is afterwards aggravated at each pulsation; then swelling about the roots of the affected tooth, which at length becomes defined and prominent, and afterwards points and discharges pus, when the active symptoms subside. The development of alveolar abscess is indicated by such constitutional symptoms as foul tongue, offensive breath, hot skin, thirst and headache, and when the suppuration is considerable, symptomatic fever and rigors.
The characteristic pain of an alveolar abscess is deep-seated and throbbing, and, with the swelling, denotes the formation of pus. A chronic form of alveolar abscess is indicated by a subsidence of the active symptoms, and a continuance of the discharge of small quantities of pus through a fistulous opening opposite the root of the affected tooth, or about its neck. An elastic fluctuating swelling in any part of the face, or for some distance down the neck, may result from abscessed teeth.
Remove all irritants. Give free vent for the escape of the pus. Destroy sac of abscess by therapeutic treatment, or by a surgical operation. Therapeutic treatment: First cleanse the root-canal by injections of chloride of sodium on peroxide of hydrogen, or pyrozone, or peroxide of sodium ; escha-rotics to destroy the sac, such as creasote, carbolic acid, salicylic acid, nitrate of silver, iodine, dilute aromatic sulphuric acid, to which, in chronic cases, add tinct. of capsicum; also antiseptics: bichloride of mercury, chloroform and aristol, also oil of cassia and oil of gaultheria, in combination with carbolic acid, kalium-natrium. Sodium peroxide twenty-five to fifty per cent, solution, or pyrozone twenty-five per cent. ethereal solution, may be employed to secure the thorough sterilization of the dentine of the root, followed by powerful antiseptics, such as Black's 1, 2, 3 mixture; the pulp-cavity may first be washed out with the three per cent. solution of pyrozone by means of a syringe and dried, when the fifty per cent. solution of sodium peroxide is worked into the canals with a fine smooth platinum broach, and a continuation, after drying the cavity, of the application of the sodium peroxide, until the saponifying action ceases. The surgical method consists in gaining access to the sac, by means of a bistoury or small trephine, through the fistulous opening, where such exists, and detaching and breaking up the sac by means of suitable nerve instruments and the application of escharotic agents. Liquid air applied intermittently in the form of spray, has been successfully used as a local anaesthetic in opening abscesses. Dr. Brophy, speaking of cases of alveolar abscess where the disease is in the bone, says: "In such cases if the treatment is simply opening into the tooth for drainage with the expectation that nature will effect a cure, we will be disappointed. In such cases an incision should be made down to the diseased bone, packing it with iodoform gauze, or boracic acid gauze. The next day with a bur cut off the affected portion of the roots of the teeth because they are a source of irritation; then with a bud-bur pass over the bone, and remove the dead portions, and again pack the wound with antiseptic gauze. In a day or two make an examination, and if healthy granulations are beginning, insert a wax plug, which is not permeable like the gauze, to prevent the wound from closing, and the consequent trouble from confined pus."