[Footnote: Abstract from a paper lately read before the Southern Dental
Association, Baltimore, Md.]
By Dr. J. M. RIGGS, of Hartford, Conn.
A gentleman, a physician, aged thirty-two years, strong and vigorous,
with no lack of nerve-energy, calls to have his teeth attended to, with
the disease in the first stage throughout the mouth. Upon examination,
he observes upon the gum of one of the lower cuspids a dark purplish
ring encircling the neck, from one-sixty-fourth to one sixteenth of an
inch in depth; the tooth _in situ_ is white and clean. With the aid of
the mouth and hand mirror he shows the condition to the patient, and,
taking up an excavator, endeavors to pass it down between the tooth
and gum, on the labial surface. After it gets down a little way the
instrument meets with an obstruction, over which, calling the patient's
attention to the fact, he carefully guides the instrument until it drops
down on the tooth-substance beyond it; then, turning the instrument and
pressing it upward, he breaks off a portion of the concretion; which
proves to be what is ordinarily called lime-salts, or tartar. That is
the cause of the purple ring on the gum, which is merely the outward
manifestation of the disease. Take it off thoroughly, polish the surface
of the tooth, and in three days' time the gum will show a perfectly
healthy color. The condition described is the first stage of the
disease, and the treatment given is all that is required for a cure of
the case at this time. But take the same man and let him go for ten
years without the simple operation detailed. The disease spreads,
and causes inflammation of the process, and, finally, its
absorption--sometimes on the labial surface for one half or two-thirds
the length of the tooth. It runs its course, the tartar accumulating,
all the time following up the line of attack. At the end of ten years
what has become of the line of tartar? Sometimes it will be found
extending clear around the tooth. Sometimes it will not be found at all;
it has done its work--the tooth is loose, but the concretion is gone, in
whole or in part. In this case the patient wants the tooth out, but,
he asks, what has become of the tartar? The answer is that the natural
acids found in the oral cavity have dissolved it, and it has passed into
the stomach or out of the mouth in the saliva. But the tooth is so loose
that it is a torment to the man; it lies in its socket, entirely loose,
almost ready to drop over. It hurts so that he cannot bear the pain. The
tooth is taken out. There is no tartar on it, or very little; there is
a little speck near the point that looks like a foreign body; but the
point of the tooth--the apex--is as sharp as a needle. After the
disease has done its work of separating the tooth from its socket, the
destroying agent begins to absorb the tooth at the point, irregularly,
causing the sharpness described. Now, because no tartar is found upon
the tooth, does that argue that it has never been there? Not at all;
the loosened tooth shows simply that it has been there and has been
absorbed. The speaker has never seen a tooth in that condition on the
point of which he could not show patches or specks; we may not see the
tartar, but it certainly once existed there, and has accomplished its
work.
Now suppose we find a patient with all the teeth loosened; he has
neuralgia pains in the face, for which medicine seems to furnish no
remedy; he has also catarrh, and the malar and nasal bones are all
affected. In the third and fourth stages a low inflammatory action
pervades all the bones of the face, accompanied by neuralgic pains,
extending to the brain itself. In such a case the disease of the teeth
intensifies the catarrh. A medical man called upon him for treatment for
pyorrhea alveolaris; the patient was also afflicted with catarrh. He
cured the pyorrhea alveolaris, and cured the catarrh, too, at the same
time.
Another case.--A lady called in great distress. Nearly all her teeth
were affected, and the discharge was most offensive and abundant; if she
lay on her side in bed, the pillow would be covered with large splotches
of the discharge in the morning; if she lay on her back, the mass was
swallowed, and the result was that the whole alimentary canal was
demoralized by the pus, blood, and vitiated secretions. When she arose
she wanted no breakfast, only two or three cups of strong coffee and
some crackers. She was nearly blind, could only see a great light, and
was totally unable to see to read. He told her that the trouble with her
sight was caused by the diseased condition of the teeth; that unless
that was remedied, she might live three months, but she would die
suddenly. He treated three or four teeth at a time at each sitting. This
consumed three weeks. The teeth became firm, her appetite returned,
her sight was restored, and she was able to walk a mile or two without
disturbance. He was called to Brooklyn, where they had a live society,
and an infirmary for the treatment of dental diseases, at which members
of the society were delegated to attend from day to day. He was invited
to give a clinic upon pyorrhea alveolaris, and he told them of this
patient, whom he showed to some fifteen members. The woman was
apparently in fair health. It was not loss of nerve-energy which started
the disease in this case, but the disease caused the loss of appetite
and the vitiated condition of the whole alimentary canal. Her physician
would have sent this woman to the grave, not recognizing the disease and
its management.
He maintains that it is not lack of nervous energy that causes this
disease, but the disease will lead to loss of nerve-energy. That small
purple ring on the gum of the cuspid in the case first mentioned would
eventually have led to the loss of the whole set, if left to work its
way unopposed. He had tried in these remarks to controvert the old
ideas, and to present the cause of the disease and its treatment as he
sees it. You may see it differently; if so, give us your information, in
order that we may correct our views, if wrong.
One gentleman says he finds it is only those who are strong and vigorous
who have this disease. The speaker finds some cases of this kind; he
also finds consumptives who have not a trace of it, but he would take
the strongest man in the room and cause a beautiful case of pyorrhea
alveolaris in his mouth in three weeks, with a fine cotton thread tied
around one of the lower front teeth at the line of the gum. The thread
will work its way under the gum, and the gum will become inflamed;
it will work its way down between the gum and the tooth, and in the
meantime the flour and the particles of food will also work down under
the loose gum, finding a rallying-point on the thread; the mass will
become impregnated with lime-salts, and will then begin to harden, and
in a very short time you will have an excellent example of the disease
under discussion. Patients suffering from salivation fall an easy prey
to this disease, due to the action of the drug on the glands and the
hard and soft tissues of the mouth, the gums in such cases affording a
ready pocket under their edges for the deposits.
When you find a tooth with the characteristic concretion of tartar upon
it, the first principle of surgery demands that you clean that tooth
thoroughly. Go down beyond the line of the disease, go around the tooth
thoroughly, and break up the diseased tissue, and apply tincture of
myrrh, and in three days you will notice a marked improvement for the
better, and if the patient takes proper care of the teeth the disease
will not return. Practitioners should watch the teeth of the young
people under their care, and see that the mouth is kept scrupulously
clean and healthy.
In reply to a question, Dr. Riggs stated that whenever absorption goes
on irregularly, unless the inflammatory action is extreme, it will
sometimes absorb one or two bone-cells, and then skip one or two, and
these last, being isolated, naturally die, or become necrosed to
some extent. In treating this disease you must break up the line of
disintegrated tissue. You must, as it were, transfer your eyesight to
the end of the instrument, so that when you strike dead bone you will
know it. Live bone will feel smooth and greasy.
It requires some years of experience to treat this disease properly,
because you have not your eyesight to aid you, but must depend
absolutely upon the sense of touch. With experience, however, you
will learn to give a great deal of relief in one of the most annoying
conditions to which the teeth are subject. The reason the profession
are not familiar with the treatment of this disease is, they fail to
recognize it until it reaches its third or fourth stage, and then
they treat it by depletion and therapeutic remedies. Some treat it by
stippling in acids underneath the gum, thinking thereby to dissolve away
not only the tartar, but the necrosed bone. Another writer takes off
patches of the diseased tissue, and another a strip of the gum, from
wisdom-tooth to wisdom-tooth. This treatment he could only characterize
as simply barbarous. The treatment of this disease is purely surgical.
Any therapeutic treatment is to alleviate the pain and soreness
immediately after the operation.
Dr. W. N. Morrison, St. Louis, referring to the method of treating
pyorrhea alveolaris described by Dr. Riggs, said he cheerfully bore
testimony to the importance of loosening the scales of tartar, and
teaching patients the value of cleanness of the mouth. In his experience
he had found that all instruments will occasionally fail to dislodge the
deposit. In such cases he used as an assistant a little ring of para gum
about an eighth of an inch wide. This was sprung on the tooth at the
edge of the gum. If this is done and the ring allowed to remain a few
hours, you will see an entirely new revelation, and you will readily be
able to get at the tooth to clean it. He had found it advisable to give
patients practical showing how the brush should be used.
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