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.
Chemical analysis demonstrates the presence of iron in the blood, the gastric juice, chyle, lymph, bile, milk, urine and the pigment of the eye; and, although metallic iron is inert, yet, when it reaches the stomach, it is dissolved by the acids, and thus acquires molecular activity. By its oxidation in the stomach hydrogen is set free, which in its nascent state unites with sulphur, forming sulphuretted hydrogen.
The salts of iron act through and upon the blood, improving its quality and increasing its quantity, and hence they are termed "hematinic." These salts of iron are absorbed into the system, and are detected in the blood, urine, etc., and under their use the appetite increases, the digestion is improved, the pulse increases in frequency and fulness, the health becomes better, and there is an increase in flesh and an improvement in color; hence they are "restoratives." As these salts of iron in large doses cause nausea and vomiting, being irritant poisons, and even small doses, when administered for a long period, exhaust the gastric glands by over-stimulation, their use is contra-indicated in a plethoric condition, especially when accompanied with a hemorrhagic tendency, or when there is an atheromatous state of the cerebral vessels. Certain of these salts, such as the sulphates, the chlorides, and the nitrates, possess a high degree of astringency, and when taken internally produce constipation. Brought in contact with the blood, they coagulate it, and solidify the albuminous elements of the tissues, being powerful "hemostatics."
Without great care is exercised in the internal administration of iron, owing to the acidity and astringent property of many of these preparations, injury results to the teeth, upon which they act with great energy. The tincture of the chloride and the sulphate, as shown by the experiments of Dr. Smith, of Edinburgh, Scotland, are more corrosive than the wine of iron, and even more injurious than the compounds of iron with the vegetable acids. The use of an alkaline gargle of carbonate of soda, or prepared chalk, or solution of ammonia, before and after the taking of the iron preparation into the mouth, and the subsequent employment of an antacid dentifrice, will obviate the injurious effects of these salts of iron upon the teeth. While the carbonate of iron in the form of pill, nor the reduced iron, are injurious to the teeth by direct action, yet eructations of hydrogen compounds produced by their ingestion may injure the teeth.
The use of a tube carried well back in the mouth and the iron preparation well diluted, should be preceded and followed by the alkaline solution. The preparation known as dialysed iron - Ferrum Dialysatum - which is iron in the colloid state, made by the process of diffusion, is odorless, without the styptic taste of the other preparations, and does not discolor the teeth, being free from irritant action; neither does it cause constipation, and hence it is the best form in which to administer iron. The dose of dialysed iron is to
Iron is an efficient tonic, and promotes the appetite and the digestion; hence it is employed in anemia, chlorosis, combined with quinine in chronic malarial affections, syphilitic cachexia, acute rheumatism, erysipelas, diphtheria, scrofula, rickets, neuralgia depending on anemia, epilepsy in weak, anemic subjects, fatty degeneration of the heart, passive forms of hemorrhage due to anemia, albuminuria, etc., etc. Externally, the styptic preparations of iron are employed to arrest hemorrhage - hemorrhage from leech bites, hemorrhage following the extraction of teeth, hemorrhage resulting from wounds and surgical operations, etc., etc.
[For doses of the various preparations of iron, see " Table of Doses."]
Chloride of Iron - Ferri Chloridum - Perchloride of iron. Formula, Fe2Cl6, is obtained by heating iron wire with hydrochloric acid, and afterward converting the ferrous chloride thus formed into ferric chloride by heating it with hydrochloric and nitric acids. It is in the form of crystalline masses of an orange yellow color, inodorous and of a strong styptic taste. It is deliquescent and readily soluble in water, alcohol and ether. It is used internally in the form of a tincture - Tinctura Ferri Chloridi.
Externally the chloride of iron is employed as a styptic and as an astringent, for the latter purpose being in the form of solutions of various strength.
In dental practice the chloride of iron is used internally for the treatment of neuralgia when it is attended with anemia; also externally, for the arrest of alveolar hemorrhage, although the preference is given to the solution or powder of the subsulphate. The chloride of iron may be used in the semi-deliquesced or crystallized form, or in solution - Liquor Ferri Perchloridi - which is preferred by some to the crystallized. To bleeding surfaces it is applied in the proportion of 3ss to 3vj to the ounce of water. One part of the chloride gradually added to six parts of collodion, in the form of a yellowish-red, limpid liquid, makes a valuable styptic. Chloride of iron is also useful as an application to fungous tumors.
Reduced Iron - Ferrum Reductum - is metallic iron in the form of a fine powder, obtained by the reduction of ferric oxide by hydrogen. Dose. - Gr. j to gr. v.
Solution of Subsulphate of Iron - Liquor Ferri Subsulpbatis - Mon-sel's Solution - Formula: 2 Fe2O3(So4)3 - is composed of sulphate of iron, 3xij; sulphuric acid, 3j, and gr. xxx; nitric acid, gr. ccclx. It is of a syrupy consistence and a ruby red or dark brown color, no odor or acrid taste, but possesses powerful astringent properties. When employed for the arrest of alveolar hemorrhage from tooth-extraction it is liable to cause sloughing of the bleeding tissues, and if used it should be in weak solution, and carefully watched.
Pulvis Ferri Subsulpbatis - Mon-sel's Powder - is in the form of a yellow powder, and possesses the same astringent and other properties as the solution, and is applied as a styptic in alveolar hemorrhage with much greater convenience than the liquid form.
Monsel's solution and powder act topically as powerful astringents and mild caustics, and are considered to be among the best styptics in use. These styptics combine with albumen and form a pale yellow compound, and on this property depends their chemical action on the tissues of the body. Internally administered, they act like the sulphate of iron, their remote effect being tonic and hemostatic. In small doses they exert an astringent effect on the gastro-intestinal mucous membrane, diminishing the quantity of fluids secreted or exhaled; hence their continued use will cause constipation.
Monsel's preparations of iron are principally used externally for hemorrhage from bleeding vessels. When employed internally it is for the arrest of hemorrhage from remote organs.
The solution and powder of the subsul-phate of iron are used internally for hemorrhage from the stomach and bowels. Externally, for hemorrhage, varicose ulcers, etc., etc.
Of the solution of subsulphate of iron, gtt. v to gtt. x, twice a day in some bitter infusion. Of the powdered subsulphate of iron the dose is gr. v to gr. xv. The solution is also given in small doses with the sulphate of magnesia, and as an artificial chalybeate purging water.
In dental practice, Monsel's solution and powder are principally employed for arresting hemorrhage following the extraction of teeth, hemorrhage from leech bites, and also from other causes, such as wounds of the gums and mucous membrane, in the treatment of ulcers of the mouth; and the solution, diluted with water, forms a serviceable application for abraded and inflammed mucous surfaces.
Dialysed iron is suggested as a local application for soreness of teeth following devitalization by arsenious acid, and removal of pulp, the root canal also packed with cotton, moistened with the iron preparation. It is an antidote for arsenious acid, and is locally applied after the removal of arsenical devitalizing mixtures, with good effects.
After carefully cleansing the bleeding cavity as thoroughly as possible, the styptic should be applied on a pellet of cotton, or, in case the powdered subsulphate of iron is employed, on a pellet of cotton previously dipped in sandarach varnish, to which the powder will adhere, and inserted over the mouth of the bleeding vessel at the apex of the alveolar cavity. Cotton should then be inserted over the styptic preparation, and the alveolar cavity be thoroughly filled up. If necessary, a compress, made from a cork, or softened modeling composition, should be applied over the cotton filling the cavity and held in place by the opposing teeth, when the mouth is closed.
For Hemorrhage from Extraction of Teeth.
Liq. ferri persulph.,
Sodium chlor............aa partes aequales. M.
Apply on cotton to bleeding cavity and secure by covering with a roll of cotton cloth.
For Hemorrhage after Lancing Gums of Children.
Dr. J. \Y. White.
Where oozing of blood persists in spite of local treatment:
Tinct. ferri chloridi.............
Acid. acetic dil..............
Liq. ammonii acet..............
Ext. ergot. fld................
Aquae q.s. ad................
A teaspoonful every 3 hours for a child 6 months old.