Pericementitis, or Periodontitis, or Infammation of the Peridental Membrane is indicated by a sense of uneasiness and fullness, which is at first relieved by pressure, but, after active inflammation is established, pressure on the affected tooth causes intense pain, of a dull, heavy, annoying character. The tooth is also protruded, to a slight degree, from the alveolus, and also somewhat loosened, owing to the thickening of the investing membrane; and the inflammation, which is at first manifested by a red line near the margin of the gum, becomes general over the entire root, sometimes involving the neighboring gum, and even the palate and cheek, and symptoms of febrile disturbance. In extreme cases the temperature may rise to 1050 F., and subsequently septicemia, or pyemia and death may ensue. If not arrested, a suppurative condition, alveolar abscess, ensues. A modification of the symptoms just enumerated, the tooth being tender to pressure, more or less raised in its cavity, and surrounded by a reddened and swollen gum, with a varying amount of pain, and the discharge of pus from around the neck of tooth, or from a fistulous opening in the gum, and such symptoms continuing for a long time, indicate the chronic form of an advanced state of periodontitis, which often results from systemic influences. The common cause of severe cases of pericementitis is the entrance of pyogenic organisms from the pulp-canals of teeth into the tissues of the apical space and into the lymphatics.

Treatment

Remove all irritants; apply counter-irritants, such as equal parts of tinct. iodine, tinct. aconite, tincture of canabis indica, and compound tincture of benzoin; or cantharidal collodion; or iodine and creasote, or carbolic acid; or capsicum in form of tincture, or in small bags of the powder to surface of gum over root of affected tooth. Depletion by the lancet, leeches or cups. Hypodermic injection of morphine, or tinct. of opium. Application of spray of rhigolene or absolute ether until gum is blanched. To relieve pain, a solution of equal parts of tinct. aconite, tinct. of opium, and chloroform; or lead water and tinct. opium. Disinfecting the root canals, after the removal of a decomposed or dead pulp, by means of disinfectants and antiseptics, viz.: peroxide of hydrogen, or pyrozone, in three, or five per cent. solutions or fifty per cent. solution of peroxide of sodium, used alternately; also, by the cataphoric current with solutions possessing the requisite conductivity, such as a saturated solution of iodide of potassium to which is added about one fifth its quantity of a mixture of equal parts of the tinctures of iodine and aconite. Constitutional treatment: Saline cathartics; bromide of potassium, gr, xxv, combined with gtt. v of tinct. veratrum, every four hours; or bromide of potassium alone, in doses of gr. xxv or xxx; or hot water applications to face and neck, and calcium sulphide in 1/10 gr. pill until eight have been taken in two hours, then one every half-hour for two hours; or, drachm doses of fluid extract of gelsemium, minims x, waterTreatment 320 every fifteen minutes until four doses have been taken, then every half-hour for two hours. Sulphate of quinine gr. viij combined with sulphate of morphia gr. 1/8 and patient placed in bed with the head elevated. If pulse is full and throbbing, tincture of aconite ten drops in one ounce of water, and teaspoonful doses given every hour until the pulse becomes normal. If the inflammatory symptoms are not relieved in five hours, the feet are to be placed in hot water, and then wrapped in blankets, and x gr. of Dover's powder in hot lemonade given until free diaphoresis occurs. The tooth protected from irritation during treatment, by a cap over adjoining teeth. The removal of the extremity of the root of a tooth affected with chronic periodontitis by means of a trepan, has also been suggested.