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.
General blood-letting is now rarely employed in the treatment of inflammation; but the local abstraction of blood by means of leeches, cups, scarification, incisions, and other means, is of great service in reducing vascular action, and lessening inflammatory symptoms. The efficiency of local depletion in relieving hyperaemia is very evident by the cessation of pain caused by strangulation and tension. Periodontitis and acute gingivitis furnish examples. Leeches should never be applied to a part where it would be difficult to arrest the hemorrhage which may follow their use; their application is also contra-indicated in the case of children, who cannot bear the loss of considerable blood with impunity.
Incisions are made for the purpose of relieving tension and pain, evacuating pus, or the escape of dead material, for tension aggravates the inflammation and the retention of pus in an abscess prolongs the pain, and also adds to the destruction of parts by the formation of gangrenous patches. Superficial incisions will relieve the tension of the skin and mucous membrane, and also evacuate the pus of an abscess when it is near the surface.
Deeper incisions are necessary when the pus is at a greater distance from the surface, and there is considerable tension. Incisions are also often judicious as a prevention of suppuration and ulceration ; also in cases where the presence of pus is suspected, but there is no apparent fluctuation. In making deep incisions, care is necessary to avoid wounding arteries and nerves; hence the director should precede the use of the knife. In acute abscesses the incisions should be made at an early stage, and of such a size as will permit of the free evacuation of the pus, and in the most depending position, to insure its easy discharge. Hence, as soon as fluctuation is detected in an acute abscess, the incision for the escape of the pus should be made ; while in the case of a chronic or cold abscess, the incision may be delayed, or a puncture with a trocar substituted for it, which may at once be closed.
Drainage (or Irrigation) is employed for the purpose of giving outlet for any matters liable to collect in a wound or abscess which may act as obstacles to the process of repair. Teeth affected with abscess are often relieved and retained by an opening made into the pulp canal or into the abscess sac, sufficiently free to relieve the tension and drain off the accumulated pus ; also in the case of abscess of the antrum, where an opening made through the alveolar cavity of one of the roots of a posterior tooth is kept open by means of a canula, to relieve the tension and permit the pus to escape as it accumulates, and also to afford an easy entrance for the injection of antiseptic and stimulating agents in the treatment of such cases. Drainage can also be made through soft tissues, such as the gum, etc., by strands of floss silk, hemp thread, and horse hair, dipped in a carbolic acid solution before they are inserted into the opening connected with the sac; also by means of caoutchouc tubing.
Counter Irritation, "counter irritants," or "derivatives," are also employed in the treatment of inflammation, for the purpose of inducing an afflux of blood from the locality of the inflammation to another point in close proximity, thus relieving the vessels of the affected part. Such counter-excitement in the case of the oral mucous membrane, is induced by blistering applications, stimulants, escharotics, etc., which excite a new action in a part more or less remote from the focus of inflammation.
Cantharidal collodion, tincture of iodine, either alone or in combination with aconite, or with creasote, or with carbolic acid, nitrate of silver, nitric acid, and the actual cautery, may be named as the most common counter-irritants for application to the oral mucous membrane in the case of deep-seated inflammation and pulpitis, and are mainly useful in the early stage of the acute form, and in the chronic form.
Antiseptic and Germicide Mouth Washes and Lotions, such as tincture of myrrh, chlorate of potassa, solutions of carbolic acid, listerine, permanganate of potash, nitrate of silver, sulphate of copper, sulphate of zinc, lead water, tincture of opium, aqueous solution of pyrozone, bichloride of mercury I to 500, 1 to 1,000, 1 to 2,000, 1 to 4,000. Carbolic acid 1 to 20, 1 to 40. Formalin 1 to 2,000. Iodoform, creolin, peroxide of hydrogen, chloride of zinc, boric acid, sulpho-carbolate of zinc (which is less irritating and more potent than the chloride of zinc), etc., are employed with benefit in inflammations and ulcerations of the oral mucous membrane.
When putrefaction is present in the inflamed part, chlorinous washes are serviceable for deodorizing purposes, and also to prevent the entrance of putrid matter into the circulation. The object of cauterizing an inflamed part is to break the continuity of the morbid process.
Anesthetics, such as chloroform, ether, etc., when employed in the treatment of inflammation, exercise an influence as preventives, and also render lax tissues which become very rigid, and enable reductions to be made, as well as temporarilv mitigating the pain; fracture and dislocation of the jaw are examples.
When inflammation has devitalized parts, the treatment varies in respect to the nature of such parts. Dead, soft tissues are to be so treated that the putrid matter is prevented from entering the circulation, by the application of antiseptic agents, and by maintaining thorough sterilization; hence, antiseptics which possess the power of destroying micro-organisms without the danger of destroying the vitality of the tissues, are considered to be the most active agents of this class. When the hard tissues are devitalized, such as bone, for example, although the living bone becomes separate from the dead portion as effectually as a living soft part from its slough, yet it is necessary to liberate the bony sequestrum from the overlying texture which may confine it; hence the removal of dead bone is necessary as soon as the line of demarcation is formed, the time for which may vary from a period of less than three weeks in the case of small sequestra, to more than two months, where the entire bone is involved. Also in cases where the extremity of a part consisting of soft and hard tissues, for example, the alveolar process and tissues over it, become gangrenous, it is best, in most instances, to remove the dead tissues by amputation; and such an operation may also become necessary in cases of long-continued exhaustive suppuration. Many forms of inflammation have their special remedies, such as mercurial inflammation of the mouth, when chlorate of potash is indicated; periodontitis, when tincture of iodine and tincture of aconite, or creasote, or carbolic acid, in combination with the iodine, or iodine, aconite, canabis indica, and benzoin in combination, etc., are indicated; gingivitis, where stimulating and antiseptic washes and lotions of tincture of myrrh, biborate of soda, boric acid, carbolic acid solutions and combinations, etc., are indicated. The spray of liquid air is useful in aborting periodontitis, alveolar abscess, also in advanced stages of abscess after incision, in all inflammatory and ulcerated conditions of the oral mucous membrane, etc. (See Liquid Air.)