-º-º-º-º-º-º-º-º-º-º-º-º-º: ****** *. 5. º --sº-sº-º-º-º-º-º-º-º-º-º-º-º: --~~~~~~~~~~…~~~~~~ } | | | ºss. sº § *ſ*y*y*?<، ، ، ، ، ، ، *、。gael ¿¿ e ¡ ¿ º gaeae， *********** ， |?，，,% z）=xy， ž， š， ž， s. • • •。 ºsſ， ºverae? 、ſºſ ∞ √∞ ey√∞ . . . . . . ., ， , ，ſ ********~***********®£ 2«.！!！ ******º-º- }ț¢&& ！！*șae&#*******- ſae;¿ſk, ·2. ≡|- ：t.،·--~~ №s… × × × × ×§ 8º.§§§§§§§: &（3）×， ÷）.*********、、。§§§§¶√∞i√∞'，§§ -►~~--~•，，.…… -.-.-.-.-.-.4， zºs.x， y= <！--***=ri s ſºrºrº. --º- ************** “ .، ، ،ſ rºxºrºſºº :*********************** ..s.º.º.º.e. *º. 3A&º * ***ś t *& \\ # , ſ *~&#}ºs. §§§ \, *Aſs & `"Anson, wº: P R C P E R T Y O F ſº f; / £º § 3. yº /1f. f, / ; º %; § º & ſº 2^ ////// if ºff 4/ {#/f § K * ºw &# Ağ. ºf *; A ~ ////% ſtº gºev. * // WWW tºº.7 º * B-5## 32: --~~~-º-º: \s SE=S X. FIG. 45. FIG. 46. FIG. 45.-This shows the retainer in wax with the sprue inserted ready to be in- vested for casting. FIG. 46.—This shows the completed appliance set on the model. DIRECTIONS FOR MAKING. A modeling compound impression is taken of the cutting edge and upper lingual third of the teeth to be included in the appliance. From this impression a model is made with a good investment material. It is best to let it set over night, when the modeling compound can be removed by using dry heat. Care should be exercised so as not to chip the margins of the investment teeth. On this model the retainer can be made in wax just as it is desired when completed. The model is trimmed so it will enter a casting flask, the sprue inserted and it is ready for investing (Fig. 45). After casting, it is finished and Set in the usual manner. (Fig. 46.) Great care must be exercised in making this solution, for if any of the hydrofluoric acid is left free, its action would produce serious results. Head recommends making the application to a pyorrheal pocket with a rubber syringe having a platinum point or with a drop appli- cator. The claim is made that it will dissolve the deposit without any deleterious effect on the soft tissues. At this time varying reports are given, for and against the use of the remedy. The author again desires to emphasize the precautions to be observed in obtaining a solution of ammonium hydrogen fluorid free from uncombined hydro- fluoric acid, for a burn from this acid is at best a stubborn condition to treat, especially in the mouth where there is always danger of a mixed infection. PYORREHEA. ALVEOLARIS. 365 The raising of the opsonic index has been suggested as a means of combating the disease, as has also the use of a specific vaccine (Hecker). The efficacy of these methods have not been sufficiently demonstrated to merit a discussion in a work on “practical thera- peutics” at this time. It is to be hoped the true cause of pyorrhea alveolaris will Soon be discovered, when the medicinal treatment can be instituted along more rational lines or, what would be better, to inaugurate such prophylactic measures that the disease might be prevented. In our present state of knowledge it must be stated that too much dependence should not be placed upon drugs, for at this time there is no known specific for the cure of the disease. Where the loss of tissues has been extensive and the teeth are so loose as to interfere with their usefulness in mastication, the correct treatment necessarily includes the making of mechanical appliances for their support. 3. Mechanical Treatment.—The importance of what the # : à s Wi. S. E 2: *:: FIG. 47.-This shows loosened lower anterior teeth, temporarily wired with a 26 gauge platinoiridium wire, to hold the teeth during the scaling process, after which a permanent retainer, as illustrated in Figs. 45 and 46, was adjusted. author has chosen to call the mechanical treatment of the disease under consideration has previously been emphasized. The detailed descriptions of the method of making the various mechanical appli- ances is not properly included in a work of this character. The proper appliance for holding loose teeth in the jaw will naturally suggest itself to the ingenious dentist. They consist of a combination of inlays, crowns and bridges, the so-called splints, and various retainers. For the benefit of the beginner a splint suggested by Dr. C. L. Hine, of . Tuscola, Ill., for loose teeth, which need not be devitalized, is illustrated and briefly described in Figs. 45, 46 and 47. On the following pages the reader will find Figs. 48 to 60, inclusive, with descriptions which were furnished the author by Dr. Lee K. Stewart, of Chicago, and explain fully his method of treating the conditions under consideration from . the mechanical view point. |PRACTICAL IDENTAL THERAPEUTICS. ~）; • ONır) ├─º• � ºr：§2Ë [++ �Çd§ £OĢĒ`№È\\ º&\r)=#№ſſº �Ēģ} ĀŅOEğ , !CDĖ№ĒŠá ſ };}，{**}\\\\Y\\xu!=*§！=$??！！•' ſaeſ ）ſ！�№ſ ſ ( ） wė，ĚŘ |}OĒģ% ºf\, ：{"ſ.º'，\\§,•b）kº »ºſae)}~~~~* : ''，�••• • • • •}} • ț¢&\}\}\\}\\}\\CD¿„^2 §}}}įș\\\Ē<%@%%,• º.• •#.*•<<2//////// Ģ''}}%}\\！<！:<ź ~~~~-O ur) FIG ſae|| }¡¡¡¡¡¡± {{{ſ}}%¿?'ſ}=ș\ſ|\|\● Š， Ē-et? 、)（（\|| ſºſiſi ſº IG. 48 -º-º: ºw .50s, (ſ F | ſ |'s ſú // %ų ſº {{!! „Źź\} Ņ� §§·§●· ·! ~, \s*）（\'*)/， //\\&€！%}|->> IG. 49 B. | FIG. 51 B ~--- t { ~" * ~ F 54 FIG. FIG PYORRHEA ALVEOLARIS. #: . S. | : # --> -ź. § r: sº sº * == \X " | *Í. | #- E-3 ę º :- \ \ i É. ºr - .#zº +=. =? º: ºt l,§;- Ž/ S. *§. º § __ ––– – - FIG. 60. FIG. 48.-‘‘A” and “B”. Loose Teeth from which the pulps have been removed, the canals filled, prepared for insertion of soft platinum wire and ready for the wax pattern or modeling compound impression. FIG. 49.—“A” and “B”. One or more teeth with soft platinum wire in position. The exposed end is barbed to hold either in the wax pattern or the impression material. The operator may prepare the wax model for casting directly upon the tooth, or upon the models. FIG. 50-% A* and “B”. Modeling compound impressions of one or more teeth. FIG. 51.-‘‘A”, “B” and “C”. Models of one or more teeth made from impressions, waxed and ready for investing for casting. Notice the pin has been placed to direct the flow of gold by rather than at the model. Models made of equal parts of plaster and silica. FIG. 52 —Double wax model made directly upon the teeth and ready for investment. FIG. 53.−Method of investing. FIG. 54.—Two castings in position and ready for the impression. Notice the exposed end of soft platinum wire has not been cut off. Do not attempt to assemble more than two at one time, and take the impression of the parts ready to be united either with a small piece of modeling compound or just a little plaster. Fill the impression with ordinary soldering investment, separate and solder. FIG. 55.—Two castings soldered. Continue in this manner, making single, double or larger castings, either from models or by carving the wax upon the natural tooth. FIG. 56.—Finished case with pins well barbed. Do not cut barbs opposite each other and remember the exposed ends of soft platinum wire are not cut off until case is ready for the final polishing. No gold should be noticeable in the patient’s mouth. The larger barbs will prevent a tooth that has been shortened from dropping below the others. FIG. 57.-A case with loss of the lateral incisor. FIG. 58.-Retaining appliances replacing lost incisor. Many cases present where one or more teeth have been lost and the others very loose. This appliance will support the loose ones and replace the lost ones. . FIG. 59.—Labial view. FIG. 6o.—Lingual view. This method can be used in any place in the mouth to support loose teeth and to carry bridged ones. Where it is desirable to retain the pulps, use one or two short soft platinum pins in each tooth and prepare nearly parallel pits as far away from the pulp as possible. Before placing the appliance, barb the pins well and undercut the cavities. (L. K. Stewart.) 368 PRACTICAL IDENTAL THERAPEUTICS. CLASS III. In considering the therapeutics of this class of cases from the dental viewpoint it can be stated that the treatment is both local and general. I. Local Treatment.—The local treatment involves practically the same surgery, drugs and remedies, and mechanical appliances as in the preceding classes, modified only to meet the conditions as found. To be effective and permanent the treatment by the dentist must be done conjointly with the general treatment by the physician in charge. 2. General Treatment.—Whenever the local condition in the mouth seems to be aggravated, if not caused by some of the systemic diseases elsewhere mentioned, it is the plain duty of the dentist to refer the patient to their family physician for the general treatment. In fact, it is almost useless to undertake the local treatment unless measures are simultaneously instituted for the correction of the sys- temic disease; but when the physician and dentist work together in harmony, it is surprising what great relief can be given the patient by the proper local treatment, for the mouth in many instances is in a hideous condition. In conclusion, I desire to state that it is a pleasure to work for pyorrheal patients. In many instances they have been informed that nothing could be done, and that they must soon lose their teeth; therefore, in most cases, they appreciate fully your every effort. NEURALGIA. GENERAL CONSIDERATIONS. Neuralgia may be defined as a severe paroxysmal pain in the area of distribution of a nerve, or along its course; and, according to Barrett, true neuralgic pain is principally confined to the afferent or sensory nerves but it may be of a reflex character and hence have its origin in the efferent or motor nerves. It is not a disease in itself, but is rather a manifestation of a disease or perverted function; therefore the con- ditions which may cause neuralgia are many and varied; and, for con- venience in study, they may be classified as follows: I. General Diseases. I. Those Which Lower Vital Resistance.—This class includes anemia, or other diseases which interfere with such vital functions of the body as the circulation, respiration, secretion, digestion, assimilation and elimination. 2. Those Which Produce Foreign or Abnormal Substances in the Blood.—This includes syphilis, gout, rheumatism, diabetes, nephritis, malaria, chronic pyemas, metallic poisoning, etc. II. Local Diseases. I. Those Which Cause Reflex Peripheral Irritation.—In this class is included diseases of the teeth, eyes, ears, stomach, uterus, and ovaries. 2. Those Which Produce Pressure.—This includes various tumors, and especially such abnormal growths as occur within bony canals through which nerve-trunks pass. 3. Chronic Inflammation of the Nerve-sheath or of the Nerve Itself—This includes neuritis, or actual diseased conditions of the Iner Ve. III. Certain Intractable Cases. This class includes a large number of cases of neuralgia for which no cause can be found. - The neuralgias which generally come under the observation of the dental practitioner are chiefly tho e manifested in the area of distribu- tion or along the course of the fifth cranial nerve, and are accordingly called facial, trifacial and trigeminal neuralgia. 24 369 37o PRACTICAL IDENTAL THERAPEUTICS. FACIAL NEURALGIA. There are many local conditions in and about the teeth which cause facial neuralgia. Chief among which are: I. Pulpitis. - . Pulp nodules, partially calcified pulps, and secondary dentin. . Pericementitis. º . Cementosis. Deposits on the roots of teeth. Infections about the roots of teeth. Exposed dentin and cementum. Impacted teeth. . Faulty occlusion. THERAPEUTICS. The first essential in the treatment of neuralgia due to diseases of the teeth is to ascertain the cause and remove or correct it, if possible. As Harlan says, “the dentist should consider no time lost in an en- deavor to find the cause of facial neuralgia.” It is essential here, as in all treatment cases, to make a correct diagnosis. In most cases the symptoms are of the subjective variety and a correct diagnosis is often difficult to make. It is necessary oftentimes to take into consideration the diseases outlined in the classification on the preceding page; and it is also well to remember that women are especially prone to neuralgia. during the period of the so-called “change of life.” Fortunately, how- ever, by means of skiography many of the conditions mentioned as being productive of facial neuralgia may be positively diagnosed. Illustrations of several of these conditions are found on the following page in Figs. 61, 62, 63, 64, 65, 66, 67 and 68. Dr. J. N. Crouse, of Chicago, reports an interesting case in his practice which occurred before skiography was known (see Figs. 69, 70, 71 and 72). The author desires to emphasize the importance of ascertaining, if at all possible, the cause of the neuralgia, for upon this depends largely the method of applying our therapeutics. With the cause known, the treatment is of two kinds—medicinal and surgical. I. Medicinal Treatment.—The medicinal treatment of facial neuralgia may be subdivided into local and general. I. Local Treatment.—There are many drugs and remedies which act favorably upon the sensory nerve-endings, and are therefore efficacious in the local medicinal treatment of this disorder. The author’s dental liniment mentioned in connection with non- NEURALGLA. 3 7 I FIG. 61.-This skiagraph, taken by Ream, shows an impacted lower third molar, frequently the cause of facial neuralgia. FIG. 62. FIG. 63. FIG. 64. FIG. 65. FIGS. 62, 63.64 and 65.-These all show cementosed roots, the cause of facial neuralgia. FIG. 66. IIc. 67. FIG. 68. FIG. 66.-This shows a lower third molar coalesced to and between the roots of the lower second molar. FIG. 67-This shows a pulp nodule nearly one-quarter of an inch long which fits the canal as perfectly as a pea fits the pod. The tooth for years had carried an ill-ad- º shell crown, which had been placed without devitalization and the proper trimming of the root. FIG. 68–This shows various size pulp nodules. 372 PRACTICAL DENTAL THERAPEUTICs. Septic pericementitis (p. 298) will often give excellent results, or any of the following remedies may be prescribed: T}—Mentholis, gr. XXX (2.ogm.) Alcoholis, - Etheris, ââ f3vi (24.o. c.c.) Chloroformi, q. s. ad. fšiij (90.0 c.c.)—M. Sig.—Apply by vigorous rubbing or massage over the area of distribution of the affected nerve, or along its course. B—Camphorae (gum), 5ij (8.ogm.) Tincturae aconiti, f5.j (30.o c.c.) Linimenti Saponis, q. s. ad. fšiij (90.o c.c.)—M. Sig.—Use as above. W. H. Truman suggests the following: T-Camphorae (gum), 5j (4.ogm.) Etheris, f5ij (8.0 c.c.) Alcoholis, f5; (30.o c.c.) Chloroformi, q. S. ad. fšiij (90.0 c.c.)—M. Sig.—Use as above. The various liniments here given have practically the same thera- peutic effect—that of a sedative upon the peripheral sensory nerves. In cases where the pain comes from pericementitis or from a developing abscess associated with the upper anterior teeth, it may be stopped in many instances like magic by spraying the posterior nares with alcohol and water, as suggested by Keefe (see p. 310). - Electricity is often of great value. Marshall suggests applying the positive pole of a galvanic battery to the painful spot, when a current of from one to three milliamperes is applied from two to five minutes. 2. General Treatment.—The general medicinal treatment in- volves the administration of drugs systemically. If certain drugs are indicated for the correction of some systemic derangement which is causing reflexly the facial neuralgia, as, for instance, iron compounds in anemia, quinin in malaria, mercury and iodids in syphilis, etc., they had better be prescribed by the family physician. Here again is a con- dition wherein the best results in the treatment of which are only obtained by both the family dentist and physician working in harmony. Cases have been authentically reported where physicians had treated patients systemically for neuralgia for months without effect, when ultimately the case was cured instantly by the dentist in relieving some local condition about the teeth. While, on the other hand, den- tists have been known to keep patients suffering for months in an NEURALGIA. 373 endeavor to locate the cause about the mouth, when ultimately the correction of some systemic trouble cured the local neuralgia. While patients should be referred to the family physician for the general treatment of constitutional diseases, it is not only the privilege but the plain duty of dentists to prescribe internal drugs for the relief of pain while the cause of the neuralgia is being searched for and re- moved. It is true that this involves a knowledge of drugs and their uses, but surely this is not too much to expect of the trained dental practitioner of to-day. The classes of drugs indicated for the control FIG. 69. FIG. 7o. FIG. 71. FIG. 72. The above figures are illustrations of perfectly sound teeth which were extracted from one mouth. The symptoms were different from those of any other case with which I have had to deal. When the patient first presented, in the middle of the night, he was suffering such severe paroxysms of pain that during one of the attacks he dropped to the floor almost senseless. The attacks were of short duration, but several occurred before I could learn what the trouble was. Directly after one of these spells, by tapping the teeth on the side where the pain was most severe, I found slight sensitiveness, particularly was this so of the first upper bicuspid, although the pain radiated all over the head. I attempted to drill into this tooth and found the canal obliterated, so I extracted it (Fig. 69). Notice also the cemen- tosed root. The history of the other teeth (Figs. 70, 71 and 72) is similar, except I was able to locate the trouble with less difficulty after the first experience, then, too, the disease had not progressed quite so far before the teeth were extracted. I lost track of the patient and do not know whether he had further trouble or not. (J. N. Crouse). of pain are the hypnotics or general anodynes or analgesics. Several prescriptions are here given. The practitioner can select the one which best seems to suit the case at hand. B—Pulveris acetanilidi comp., gr. xx (1.3 gm.) Fiat chartula No. iv. Sig.—Take one powder every hour until two or three are taken; if not relieved after two or three hours, take the remaining One Or two. In cases of neuralgia of rheumatic origin phenacetin may be com- bined with salophen and codein sulphate to control the pain. A prescription follows: 374 -- PRACTICAL DENTAL THERAPEUTICS. B—Phenacetini, Salophen, ââ gr. xx (1.3 gm.) Codeinae sulphatis, gr. j (o. off gm.)—M. Fiat chartula No. iv. Sig.—Take one powder every two hours. When the neuralgia is associated with nervous headache the following prescription may be given: B—Caffeinae citratis, gr. xij (o.8 gm.) Phenacetini, 5ss (2.0 gm.)—M. Fiat chartula No. v.j. Sig.—Take one powder every two hours until relieved. Occasionally patients do not like to take a powder, preferring a liquid preparation. In these cases we can prescribe antipyrin in Solu- tion with an aqueous vehicle, for, unlike acetanilid and phenacetin, this drug is soluble in water. Sometimes it is advisable to combine the coal-tar analgesics with a bromid, a prescription for such a combination is here given: B—Antipyrini, 5Ss (2.0 gm.) Sodii bromidi, 5j (4.ogm.) Glycerini, fåss (15.0 c.c.) Aquae cinnamomi, q. s. ad. fšij (6o.o. c.c.)—M. Sig.—Take a dessertspoonful three times a day, and oftener if conditions necessitate. Sometimes the coal-tar analgesics fail to produce the desired effect, in which case there is always one drug that can be relied upon to control the pain, and that is morphin. This drug is truly indicated for the control of pain from whatever source and may be given here in I/8 gr. (O.Oo3 gm.) dose, but under no conditions should a prescription be written for the drug. Many patients are in the habit of keeping a copy of the prescription, and when the remedy works well in a certain case they often get the prescription refilled for themselves or friends on the least provocation. In the case of morphin this might innocently lead to the “habit.” Tablets containing the usual dose (1/8 gr. —o.oo& gm.) may be kept on hand, and, if necessary, two such tablets may be given by the stomach within one-half hour, and then the patient can take one tablet home—never more than one, if two have been given at the office, which can be taken in the course of one hour, if not relieved. - When the patient is unable to sleep, chloral hydrate or butyl- chloral hydrate may be prescribed. The fifth nerve is supposed to be NEURALGIA. 375 especially sensitive to the influence of butyl-chloral hydrate. A pre- Scription follows: B–Butyl-chloralis hydratis, 5j (4.ogm.) Fiat capsula No. xij. Sig.—Take one capsule every three hours until four are taken. In cases where a tonic is indicated, as in anemia, the official syrup or glycerite of iron, quinin, and Strychnin phosphate may be given. A prescription for the syrup follows: B—Syrupus Ferri, Quininae et Strych- ninae phosphatis, f5iij (90.o c.c.) Sig.—Take a teaspoonful in water before meals. Where the neuralgia is of malarial origin, quinin is indicated. An excellent prescription follows: *R–Quininae Valerianatis, gr. xviij (I.2 gm.) Extracti Hyoscyami, gr. iv (o. 25 gm.) Extracti Cinchonae, gr. viij (o. 5 gm.)—M. Fiat capsula No. xij. Sig.—Take one capsule before meals and on retiring. It will be noticed that only a few doses have been prescribed in any of the above prescriptions. This precaution has been taken be- cause some of these patients suffer untold agony; in fact, they may be considered temporarily demented, and no matter how specific your verbal and written directions have been, they may ignore your direc- tions entirely and take one dose after another on the general principle that “if a little is good, more is better,” until they have taken such a quantity as may result in an overdose. Therefore, it is well for den- tists especially to be careful in this respect. II. Surgical Treatment.—The surgical treatment often involves major surgery, for a discussion of which see works on Oral Surgery. TIC DOULOUREUX. The discussion of facial neuraliga would indeed be incomplete without at least brief mention of tic douloureux, so named by Trous- seau, a Frenchman. The condition frequently results from chronic ir- ritation of the fifth cranial nerve. The pain is very acute, and occurs in distinct paroxysms, gradually increasing in severity, until it reaches a climax, when it quickly subsides. The attack may occur at any time and is provoked by speech, laughing, talking, the movement of a muscle, etc., and even slight noise or a light touch, as placing the hat on * Taken from the Dental Cosmos. 376 PRACTICAL IDENTAL THERAPEUTICS. the head, may cause a paroxysm. The patient lives in constant dread of an attack. * - There is no condition which elicits greater sympathy than this, for the experienced physician or surgeon realizes that little can be done either medicinally or surgically. Materia medica has been exhausted in search of a cure, and surgery affords only temporary relief. Patrick, Moyer, and others report favorably upon the use here of castor oil. The drug is first pushed to almost catharsis, then checking the dose, but still keeping up the administration of the drug. Ultimately the patient can take large quantities of castor oil without the cathartic effect. Stekoulis, Schapiro, Bennett, Murphy, and others have injected osmic acid into the substance of the affected nerve and report en- couraging results. Deep injections of alcohol in the region of the orbit of the affected nerve for the relief of facial neuralgia has been recently suggested. Patrick, Moorehead, Potts, and others report favorably on the method. . The needle generally employed is one adopted by Levy and Bandonin, which is graduated in centimeters up to five. The alcohol should be about 75 per cent., and should contain a very Small amount of cocain hydrochlorid. The success of the operation will be indicated by a slight anesthesia over the parts supplied by the nerve. Upon the slightest return of the pain the operation should be repeated, after which relief for some months, and even two years or more, may be expected. The formula used by Patrick is here given: B—Cocainae hydrochloridi, gr. j (o oé4 gr) Chloroformi, m. x (o.61 c.c.) Alcoholis, f5iij (12 occ.) Aquae, distillatae, q. s. ad. föss (15.0 c.c.)—M. Sig.—Use as directed above. On the whole, it may be stated that the therapeutics of tic doulou– reux is discouraging to all concerned. Hirt sums up the conditions very properly when he says: “Numerous are the means at our com- mand for combating tic douloureux, and quite as numerous are the patients who, after hundreds of unsuccessful trials, have given up in despair all medicines and all physicians.” The condition has not been thus briefly discussed here because of the likelihood of dentists being called upon to treat it, but rather because they are often called in consultation on the case to aid in mak- ing a correct diagnosis. DISEASES OF THE SOFT TISSUES OF THE MOUTH NOT DIRECTLY ASSOCIATED WITH THE TEETH. GENERAL CONSIDERATIONS. In this general group will be considered the diseases of the soft tissues of the mouth other than those directly associated with the teeth. The etiology and pathology of these diseases will be considered somewhat more fully than has been done with the diseases of the hard tissues of the mouth and associated structures, for the reason that dentists, as a rule, are not so familiar with the etiology and pathology of the diseases under consideration here, and therefore find it more difficult to differentiate between some of these conditions and to make a correct diagnosis—upon which the successful therapeutics is based. The mouth is a hot-bed for many kinds of bacteria, and is therefore a fruitful field for diseases of almost every description. CANKER SORES. Canker sores are true ulcers and are among the more common pathologic conditions of the soft tissues of the mouth. They are sup- posed to have their origin primarily in the mouth, yet Pusey and others believe them to arise from trophic disturbances. The author has observed that women are peculiarly susceptible to this condition during the menstrual period. Some women have canker sores nearly every time they menstruate. They seem to be associated also with gastro-intestinal disturbances. They always appear suddenly and are very persistent unless given suitable treatment. Gilmer states “that they most commonly occur at the duplica- ture of the mucosa of the clicek and the gums, though they are Occa- sionally seen on the ſloor of the mouth and on the edges and under the surfaces of the tongue. They vary in size from that of a grain of wheat to that of a small-sized bean. Their depth varies, but they can never be considered superſicial. Their margins are rather well-defined, but not so markedly as are chancrous ulcers of similar tissues, neither are they so irregular as are lupus ulcers of the mouth. The mucosa * Dental Review, Vol XXIII, p. 496. 377 37 8 - PRACTICAL DICNTAL THERAPEUTICS. for a quarter to a half-inch from the ulcer is of a deep red color. The base of the ulcer is overlaid with a grayish-white necrotic covering, not unlike that found in syphilitic ulcers in the mouth. When this coating is removed, a granulating surface is exposed, which, while extremely sensitive to the touch, bleeds but slightly, if at all. These ulcers are so distinctive in their appearance that they can hardly be mistaken for any other lesion.” - Therapeutics.-The treatment of canker sores is purely local, and the sooner it is instituted the less persistent the ulcer will be. The necrotic tissue may be carefully removed by scraping, or cleansed with hydrogen dioxid, after which the raw surface should be dried and cauterized. They generally yield nicely to one application of silver nitrate. For this purpose a Io per cent. Solution may be used; a 20 per cent. Solution of argyrol may also be employed. The ulcer being acutely sensitive, it is sometimes better to use 95 per cent. phenol as the cauter. izing agent. The analgesic effect thus produced is often of value. The mouth should be kept clean, when the ulcers usually heal with- out further treatment. HERPES LABIALIS. Herpes labialis, also called cold Sores.or fever sores, have a similar origin to canker sores. They are of a herpetic nature, and differ in appearance from the latter principally on account of location and tissues involved. They occur frequently when the patient is suffering from colds or during convalescence from fevers, hence the name. Of these Gilmer says: “herpes of the lips (herpes labialis) and occasionally of the gums, (herpes gingivalis) sometimes follow dental operations and cause uneasiness on the part of patient, who often attributes this condi- tion to infection from unclean armamentarium used by the dentist, when, in truth, the patient is of a herpetic diathesis, and under such circumstances a slight irritation only, in such locations, being sufficient to excite the condition.” . Therapeutics.-The treatment of cold sores consists in cleaning the part with such agents as hydrogen dioxid or alcohol, then drying and making an application of oil of cloves or spirit of camphor. Either of these latters agents are just sufficiently irritating to produce stimulation of the cells and promote healing. If the cold-sore is large and liable to crack and bleed by moving the lips, it can be kept Soft and pliable by frequently applying euroform paste, or immobilization may be had by applying collodion. In the latter instance the part should be dusted with boric acid before coating with collodion. SYPHILIS. It is important that every dentist be familiar with the characteris- tic symptoms of this disease; for acquired extragenital syphilis is primarily manifested in and about the soft tissues of the mouth in what is known as the initial leison or hard chancre, which, as a rule, develops in from three to six weeks after infection. The chancre may occur in various locations—on the lips, tips of the tongue, and the pharynx—and is characteristic of what is known as primary symptoms. PRIMARY SYPHILIS. The infection here is produced by direct contact of the syphi- litic virus with an abraded surface. According to Logan, the principal means of conveying the infection extragenitally is through the act of kissing, drinking from a broken utensil, the use of a pipe or handkerchief that has been contaminated with the virus, or from physicians' or dentists’ instruments or fingers that have had the infected secretions from the mouth of a previous patient dried upon them. In the locations found in the mouth, chancre is usually single, though it may be multiple. It may appear first as a papule, the superficial cells of which finally ulcerate, with necrosis of the central area quickly following, when a copious and highly infectious discharge comes from the crater-like opening that is forming on the tissues involved. The ulceration occurs in from four to ten days after full development of the chancre, until which time the patient, as a rule, experiences very little pain or discomfort. Syphilis is a more common disease than is generally supposed, and inasmuch as the characteristic symptoms of the most infectious stage of the disease occur primarily in the mouth, dentists should be ever watchful and guard against the infection of themselves and other patients. Whenever the skin on the hand or finger of the dentist is broken, or the mucous membrane of the patient’s lip, gum, or cheek is punctured by an instrument, cauterization of the part should at once be done. * Therapeutics.—The treatment of the primary symptoms is unimportant. In fact, unless a positive diagnosis can be made, and it * Dental Review, Vol. XXII, p. 8oo. 379 38o - PRACTICAL IDENTAL THERAPEUTICS. is often difficult to be certain of the clinical diagnosis at this stage of the disease, the treatment had better be deferred until the diagnosis is established by the manifestations of the secondary symptoms. Syphilis is now known to be a germ disease, and the only positive means of Con- firming the diagnosis of the clinical symptoms in this stage is the microscope by which the Tryponemata pallidum (spirocheta pallida) may be discovered. These appear as fine, closely coiled spirals, 6 to 15 microns long, feebly motile. They are most abundant in the margins of the lesions, and are practically constantin chancre and mucous patches. Old chancres and those treated by local antiseptics may easily fail to show the organisms (White and Martin). Long" says that “positive knowledge upon this point is so important, in view of the question of marriage, of prolonged treatment, and of personal care in spreading of infection, that the matter of a few weeks treatment may be properly disregarded, particularly as it is believed that nothing is lost, in the efficacy of treatment, by the delay.” Oral hygiene, of course, should not be neglected. A new remedy has recently been discovered which promises to be a specific for syphilis. It is commercially called “606.” The remedy, as yet, has not been employed sufficiently long to deter- mine the ultimate results of its use. SECONDARY SYPHILIS. The manifestations of what is known as the secondary symptoms do not begin to appear until from four to six weeks after the develop- ment of the hard chancre. If no treatment has been instituted, eruptions on the skin usually mark the beginning of this stage, and according to L. Blake Baldwin, eruptions are frequently found on the oral mucous membrane quite similar to those upon the skin. These eruptions are accompanied by fever, sometimes preceded by it. Simultaneous with the eruptions and fever characteristic mucous patches occur, and may be located on any part of the mucosa of the mouth, regardless of whether the disease originates primarily or secondarily in the mouth. The presence of mucous patches is a positive sign of syphilis. They differ from canker sores in that they have more clearly defined margins and are not so painful to the touch, and the immediate area is not of such a deep red color (Gilmer). The mucous patches are exceedingly infectious, and due caution should be observed not to carry the infection from one patient to another. Therapeutics.-Inasmuch as secondary syphilis is manifested in 1 “Dental Materia Medica and Therapeutics,” p. 206. SYPHILIS. 381 the mouth and leaves its indelible effects upon the gums, jaws, and ad- jacent structures, mercury is the one drug indicated in its treatment, for this drug has a selective influence upon these structures. In fact, mercury is a specific for the secondary symptoms, though its action, as yet, rests purely upon an empirical basis. It is not even known whether the action of the drug here is due to specific toxicity for the syphilitic virus or whether it is simply due to its general effects upon metabolism. The former, according to Sollmann, seems to be the case. Mercury is not only palliative, but curative in this stage—congenital as well as acquired—whilst its administration is worse than useless in the first and third stages. The systemic treatment, of course, should be relegated to the family physician. Long" very properly emphasizes a word of caution here. He says: “It may fall to the dentist to discover a case of syphilis, by mouth symptoms, where it had not been suspected, but he must be exceedingly cautious about discussing this finding with the patient. He is dealing with a matter for which he has not been con- sulted, and in any suspicious acts or words of his lie the possibilities of much unpleasantness. If the patient be an innocent wife, a statement of his discovery might produce domestic discord. While she would have a most serious grievance, entitling her to our pity, a revelation could only add to her unhappiness. A suggestion to her to see her family physician for certain general conditions that you find evidence of, would be the proper course; and even this advice must be given tactfully, without arousing suspicion as to the probabilities in the case, for, after all, a mistaken diagnosis is possible.” The preparations of mercury most frequently prescribed in syphilis are mercury with chalk, and compounds like bichlorid, bin- iodid, and protiodid. The ointments are used by inunction. None of these preparations should be pushed to the extent of producing ptyalism or salivation. 4. An accurate and positive diagnosis of syphilis should always be made before instituting the mercurial treatment, otherwise disastrous results are almost certain to follow. In a recent case of a little girl seven years old, of doubtful syphilitic history, coming under the ob- servation of the author, a sequestrum was removed which contained the erupted first permanent molar and the crowns of the nonerupted first and second bicuspids. The case terminated fatally. Syphilographers have learned from sad experience that mercury can be pushed much farther without producing ptyalism, if the mouth * “Dental Materia Medica and Therapeutics,” p. 206. 382 PRACTICAL IDENTAL THERAPEUTICS. has first received a thorough prophylactic treatment. This includes the removal of all local irritants, such as hard and soft deposits, over- hanging fillings, ill-fitting crowns, and bridges. In fact it is only when the mouth and teeth are clean that the symptoms of ptyalism are valuable as an index that the System is taking all the mercury it can absorb without producing marked toxic effects. If the teeth are not clean and the mucous membrane healthy, it is best to wait until the mouth receives proper attention before attempting to find the minimum toxic dose of the drug. On this point, White and Martin, state that: “the teeth should be put in perfect order by a competent dentist, and should be kept scrupulously clean throughout the entire course of treat- ment by cleansing washes, astringent and mildly antiseptic powders (or pastes), and careful removal of particles of food by means of tooth- picks and dental floss immediately after eating. Upon the health of the mucous membrane of the mouth depends, to a great extent, the ability of the patient to take an efficient quantity of mercury without causing salivation.” - Dentists in the past have hesitated to work for patients who were known to have the specific disease on account of the danger of self- infection, and thinking it necessary to subsequently discard all instru- ments used. Logan” says: “These syphilitic individuals can be cared for with impunity if the operator protects his hands with rubber gloves and then scrubs all the instruments employed and boils them for fifteen minutes. If this plan is pursued, there is no need of such absurd action as is often recommended—that all such instruments should never be used again, but thrown away.” TERTIARY SYPHILIS. This condition may be prevented if proper treatment has been previously inaugurated. In cases not so treated the tertiary symptoms usually occur in from one-half to two years after infection. Gumma mark the third stage of syphilis and first appear as hard bodies or nodes occurring mostly under the skin, although they may occur under the mucosa of the mouth. They gradually increase in size, become more superficial, with a tendency to break down and ulcerate. When they occur in the region of the hard palate, the underlying bone fre- quently becomes involved and extensive necrosis of the palate and nasal bones follow. Gilmer” states that subperiosteal gumma are especially destructive to bone, and reports having seen cases in which * “Genito-Urinary and Venereal Diseases,” Ninth Faition, p. 1008. * Dental Review, Vol. XXII, p. 813. - ° Dental Review, Vol. XXIII, p. 498. SYPHILIS. 383 the soft palate also was completely destroyed from ulceration of gumma in that locality. Authorities differ in regard to whether the lesions of tertiary syphilis are infectious. They are probably but slightly So, if at all; however, it is well here also to guard against spreading possible infection. Therapeutics.—The one drug indicated in the treatment of tertiary syphilis is the great alterative, potassium iodid. In this stage of the disease the efficacy of potassium iodid is equal to that of mercury in the secondary stage, and may be considered a specific. The systemic treatment should be relegated again to the family physician. The initial dose of the drug should be small, and the amount gradually in- creased until improvement follows or symptoms of iodism appear. For permanent results it is necessary to continue the antisyphilitic treatment from six months to a year or more. The question of whether syphilis can be cured or not has been a debatable one in the past, but its cure is no longer questioned by ex- perienced syphilographers. Yet it may be safely stated that few cases are ever permanently cured, for Only a small percentage of patients will continue the treatment sufficiently long, after they feel perfectly well, to effect a permanent cure. . It should be remembered that syphilis stamps its indelible effects upon the individual thus afflicted in almost every case, and that any subsequent infection, like in alveolar abscess or pyorrhea alveolaris, is likely to extensively involve the osseous structures, and yield to the ordinary treatment with difficulty. The author has previously re- ferred to a case of extensive necrosis following slight trauma after the re- moval of a pulp, by pressure anesthesia, where every due precaution was taken to maintain asepsis in performing the operation (see Fig. 12, p. 319.) In conclusion here I desire to again emphasize the fact that every dentist should so school himself in this dreadful disease that he may be able to at once recognize its various manifestations. When in doubt about a lesion in the mouth, it is always better for dentists to as- sume that it is specific in character, and take every due precaution against infecting themselves or their patients. MERCURIAL STOMATITIS. Mercurial stomatitis is a condition of the mouth frequently follow- ing the administrations of mercury and its compounds for the treatment of syphilis and other conditions. The characteristic symptoms, known as ptyalism, and the treatment of the condition have been fully Con- sidered under Mercury (see p. 184). 384 PRACTICAL IDENTAL THERAPEUTICS. TUBERCULOSIS. This dreaded disease is known as the “great white plague,” and is occasionally seen on the mucosa of the mouth. Gilmer' reports having seen three cases, one of the tongue, one of the Sublingual Sali- vary gland, and one an extensive involvement, including a part of the lips, the mucosa of the cheek, the soft palate, the tongue, and a portion of the pharynx. The microscope will aid in definitely determining tubercular lesions in the mouth, as well as in other parts of the body. The dentist may first discover the lesion and aid in making the diagno- sis; but the treatment had better be done by the general medical practi- tioner or specialist, for the cases are rare and no definite local treatment has thus far been permanently established. It may be stated, however, that various forms of light have been used in many cases with favorable results in tubercular and similar affections. Where there is bone in- volvement Beck reports surprising results from the injection of bismuth paste. In this connection it may be remembered that Cook, Moorehead, and others have reported cases where the tubercle bacilli have entered the system through the canals of pulpless teeth and pyorrheal pockets, involving the glands in the neighboring region. LEUCOPLAKIA BUCCALIS. This is a disease of the mouth and tongue, the etiology of which is as yet unknown. A large percentage of the cases of leucoplakia buccalis give a previous history of syphilis. It is, therefore, suspected that the latter disease has a causative relation to leucoplakia, though no definite evidence in this respect has been produced. Gilmer, who has seen a large number of cases, is of this opinion. He says: “Many cases of leucoplakia buccalis have come under my observation, and, with few exceptions, I was able to elicit a history of syphilis.” The disease manifests itself upon the buccal mucosa, portions of the gums and the dorsum and edges of the tongue, and other places. There appears, sharply outlined, whitish or silver-colored points, streaks, bands, or patches of irregular shape, either flattened or slightly elevated above the level of the general mucosa. Ordinarily they simply present a roughened surface without much discomfort. They occur almost exclusively in the mouths of men who are excessive smokers. The con- dition, however, should not be mistaken for that which is frequently Seen in the mouth of excessive Smokers, especially pipe Smokers, where * Dental Review, Vol. XXIII, p. 499. * Dental Review, Vol. XXIII, p. 5oo. SYPHILIS. - 385 there is a whitening of extensive areas of the tongue or hard palate or both, Gilmer" says “that the epithelium of the smoker's tongue is of a brownish-white, while in leucoplakia the patches are of a clear white color.” Leucoplakia patches are very characteristic, no other condition of the mouth presents the same clinical picture. The affection is painless, and may be overlooked by the patient unless it becomes com- plicated with cancer. It has been observed that carcinoma frequently has its beginning in the site of an old leucoplakia patch. Since this is true, an early diagnosis should be made, and the proper treatment in- stituted by the family physician. In cases of known syphilis the antisyphilitic treatment would be indicated. The general tendency of dentists in conditions of this kind is to use cauterants, such as silver nitrate. In the treatment of leucoplakia this should be avoided as it only tends to aggravate the disease. ACTINOMYCOSIS. This disease is common among the lower animals, especially cattle, and is known as lumpy-jaw. The disease affects the lower jaw and cervical glands, and cases in the human being have been reported by Brophy, Bevan, Zederbaum, and others. It is produced by the ray- fungus, and the microscope affords a positive means of diagnosis. The treatment of the disease had better be carried on by the medical specialist, as it is so rare in the human being that dentists but seldom see the condition. The use of copper sulphate in this disease has been previously considered (see p. 76). ACUTE ULCEROUS GINGIVITIS. Acute ulcerous gingivitis is a comparatively rare disease. The author, however, has seen a number of cases in the mouths of children coming to the college infirmary for treatment from the so-called “slum districts” of Chicago. This may have been a coincidence, but I have never observed the typical disease in well-kept mouths. It may be regarded as a filth disease. Gilmer" well describes it as follows: “The disease attacks simultaneously the gum margins on their buccal or labial aspect about two, three, or possibly four teeth, at the same time. The ulcers come suddenly, quickly destroying the gingivae down to the alveolar process, but seemingly not invading it, exposing the roots of the teeth to this extent. The margins of the ulcers are everted crater-like, somewhat like chancrous ulcers. The base of the * Dental Review, Vol. XXIII, p. 5oo. * Dental Review, Vol. XXIII, p. 5or. 25 386 PRACTICAL IDENTAL THERAPEUTICS. ulcers is overlaid with a grayish-white covering. When this covering is removed, the granulating surface bleeds freely. The lymphatics related to the area become enlarged, and, unlike chancrous lymphatic enlargements, are tender. It is also unlike chancre in that the ulcers are nearly always multiple and exceedingly painful to touch. Saliva- tion is much increased, with frequent drooling, the breath is fetid, and owing to the absorption of toxic elements, there is a slight rise in tem- perature. The contiguous lingual gingiva become reddened, but do not participate in the ulceration. The condition has been mistaken for syphilis.” - - Therapeutics.-The ordinary local remedies used for somewhat similar conditions are of little value here unless systemic treatment is simultaneously instituted. Calomel is the drug to give internally. A prescription for which follows: B—Hydrargyri chloridi mitis, gr. ii (o. I3 gm.) Sodii bicarbonatis, 5j (4.ogm.)—M. Fiat chartula No. xx. . Sig.—Take one powder every two or three hours. The local treatment consists in cleansing the ulcer with such agents as hydrogen dioxid, drying the part and applying a roper cent. Solution of silver nitrate or a 20 per cent. Solution of argyrol. If the ulceration is checked, complete restoration of the gum tissue by granulation follows. Mouth hygiene should, of course, be instituted and strenu- ously carried out. - GONORREHEA. According to Burchard-Inglis, undoubted cases of oral infection by the specific germ of gonorrhea (gonococcus) have occurred. The author has seen at least one such case. The mucosa of the cheeks, gums, tongue, and even of the hard and soft palate may undergo intense suppuration. Mouth hygiene and the systemic treatment of the constitutional trouble cures the case. There are a variety of tumors and other diseases which manifest themselves in the mouth, involving both the soft and osseous structures, for the diagnosis and treatment of which see works on Oral Pathology and Surgery. The more common of the diseases of the soft tissues of the mouth and their treatment have been thus briefly considered here with the hope of stimulating a greater interest in this phase of mouth diseases. DENTAL STERILIZATION. GENERAL CONSIDERATIONS. Throughout this work the author has endeavored to emphasize the importance of dental sterilization. The methods and means of steriliz- ing tooth-structure and the field of operation have been fully discussed in the description of the various operations which are performed in and about the mouth; but while the importance of having the instruments sterile has been repeatedly mentioned, the means of sterilizing the same has not been previously discussed. The importance of personal cleanliness on the part of the dentist and of his office armamen- tarium is of course understood and need not be considered here. A principle in surgery is to avoid the presence of germs. This means that the instruments used must be sterile, as well as the field of operation and the operator’s hands. The same principle holds true in dental as well as in general surgery. There are many practical devices on the market for the sterilization of instruments. By practical here we take into consideration the con- venience and the expense. Any apparatus for this purpose must be convenient to use and no reasonable amount of expense should deter dentists from accomplishing this end. It is to be regretted that many of our most potent disinfectants, such as formaldehyd, mercuric chlorid, etc., while excellent for the sterilization of the hands and the site of operation, cannot be used for the sterilization of metal instruments, on account of the agent acting upon the metal. - A Method for Sterilizing Instruments.-In late years the author relies largely upon moist heat. The method used is here given: The instruments are first brushed with a stiff brush to remove whatever débris may be present, after which they are immersed in boiling water for about two minutes; they are then transferred to a Io per cent. Solution of formalin, to which solution about 5 per cent. of borax has been added. After being in this solution for about two minutes, they are again rinsed in the boiling water, carefully dried, and placed in their proper places in the cabinet. In cases of questionable specific infection, the instruments should be boiled for at least fifteen minutes. Sodium carbonate or borax should be added to the water to prevent rusting of the instruments. 387 388 PRACTICAL DENTAL THERAPEUTICS. If the instruments are thoroughly dried they can be kept from tarnishing and rusting to a marked degree by having calcium chlorid in the cabinet near the instrument tray. The agent should be in a small glass container without a top. Calcium chlorid is highly deliquescent and readily absorbs the moisture in the air. It should be replenished every few days or whenever it has completely liquefied. This pre- caution is of special value during the damp days of summer-time when the instruments are more liable to rust. - IND EX. ABSCESS, alveolar, 308, 312 acute, 3 o'S question of extraction in, 3 II treatment of, 3 o& chronic, 3 I 2 treatment of, without sinus, 312 treatment of, with sinus, 314, I 5 comflºtions, 3 I 3, 3 I 7 surgical treatment of, 323 in deciduous teeth, treatment of, 330 pericemental, 33 I Absorbent cotton, 18 Abstracts, 14 Acacia, I 13 Acetanilid, 137 poisoning and treatment, 137 Acetozone, 85 Acetphenetidin, I 38 Acid, Organic, 5 acetic, 92 glacial, 92 benzoic, 41 boric, 4o gallic, 7o hydrochloric, 91 hydrofluoric, 99 treatment of poisoning, 99 lactic, 93 monochloracetic, 93 nitric, 90 nitrohydrochloric, 91 Oxalic, 86 phenolsulphonic, 89 phosphoric, 177 salicylic, 42 sulphuric, 89 aromatic, 89 sulphurous, 88 tannic, 68 trichloracetic, 93 Aconite, IcG poisoning by, Ioé treatment of, Io? Actinomycosis, 385 Action, physiologic, 2 of salt solutions, 204 Active principle of drugs, 4 Actual cautery, 99 Acute intoxication by alcohol, I 58 Acute ulcerous gingivitis, 385 Adenphrin, 73 Administration of drugs, 19 Adrenalin, 73 chlorid in pressure anesthesia, - objections to, 284 Age, modifying drug action, 26 Alcohol, I 56 - oisoning and treatment, I 58 Alkaloids, 4 artificial, 5 Allspice, 227 Aloes, I 99 Alphozone, 86 Alteratives, 28, 171 Althea, II 5 Alum, 74 Ammonia, 16o poisoning and treatment, I 60 Ammonium bromid, 145 carbonate, I 61 chlorid, 22.2 Amyl nitrite, 163 poisoning and treatment, I 64 Amylum, I Io - Analgesics, 28, I 18 Anesthetics, 28, I 18 local, I 18 general, I31 Anesthetization of pulps, 276 Anise, 227 Anodynes, 28, I 18 Antacids, 27, 34 Antagonism of drugs, 258 Antagonists, 28 Anthelmintics, 28 Antifebrin, 137 Antimony and potassium tartrate, 22 I Antipyretics, 28, 136 Antipyrin, 136 Antiseptics, 28, 38 solution of, 4o, 253, 359 Antispasmodics, 29 Antrum of Highmore, 344 diseases of, 344 involvement from abscessed teeth, 323 treatment of, 346 Apomorphin, 2 I 9 Apothecaries' weight and measure, 24 o Approximate fluid measures, 24 I Aquae, 8 Aqua regia, 91 Argentum, 8o Argyrol, 82 Aristol, 52 Arnica, 57 389 39C INDEX. Arsenical paste, 286 fiber, 286 Arsenic trioxid, 94, 190 poisoning by, 94 local, 95, 293 systemic, 95 treatment of, 95, 96 Arsenum, I 90 Artificial respiration, 124 Sylvester's method, 124 Aspirin, 44 Astringents, 29, 67 Atropin, 166 poisoning and treatment, I 66 Avoirdupois weight, 240 BANDAGES, I9 plaster-of-Paris, 19 Bark, 7 Beck's paste, 8o Belladonna, 165 Betanaphthol, 55 - Bismuth subnitrate, 8o Black pepper, 22.5 Black's 1–2–3, 47 Blaud's pills, I 74 Bleachers, 29, 83 Bleaching teeth, 336 with sodium dioxid, 33.9 with 25 per cent. dioxid, 342 Blue ointment, 183 vitriol, 76 Bone involvement, from abscesses, 3 I 9, 32 o Borax, 36, 4 I Borism, 4o Bromids, 144 Brucin, I 54 Buds, 7 Butyl-chloral hydrate, 142 AFFEIN, 161 citrate, I 61 Calcium carbonate, 34 chlorid, 79 hydroxid, solution of, 35 hypophosphite, 179 phosphate precipitated, I 78 sulphid, crude, I 93 Calendula, 56 Calomel, 186 Calx sulphurata, 193 Calyx, 7 Camphor, Io'7 Camphors, 5 Cane-sugar, 231 Canker sores, 377 treatment of, 378 Cannabis indica, 152 Cantharides, Io 5 poisoning and treatment, Io 5 Capping the pulp, 27 I Capsicum, IoI plaster, Io.2 Caraway, 227 Carbohydrates, 4 hydrogen Carbon, 56 Cardamom, 226 Cardiac stimulants, I 54 Carminatives, 29, 2 24 Carron oil, 35 Cascara Sagrada, IQ7 Castile soap, 37 Castor oil, 200 Cataphoresis, 24, 236, 264, 285 Cathartics, 29, 196 Caustic potash, 98 soda, 98 pyrozone, 85 Caustics, 31, 88 * in treatment of hypersensitive dentin, 264 Cereates, 17 Chalk, 34 Charcoal, animal and wood, 56 Chinosol, 66 Chloral, 141 Chloretone, 13 o Chlorin, 86 Chlorinated lime, 87 soda, solution of, 87 Chloroform, I 34 indications and contraindications, I 35 Chloropercha, I 16 Chromic trioxid, 96 Chronic alcoholism, I 58 Cinchona, I 39 Cinchonism, I 4o Cinnamic aldehyd, 46 Coca, I 2 o Cocain, I 2 I history of, 122 hydrochlorid, I 2 I habit, I 2 5 points, 278 oisoning and treatment, 1 2 3 cod-Hº oil, 18O Codein, I.47 Cold, 233 in treatment of hypersensitive dentin, 2.63 sores, treatment of, 378 Collodion, I I 5 Collodions, Io Colycynth, 2 og Complications of pulp removal, 289 in treating putrescent pulps, 3o4 of alveolar abscesses, 3 I 3, 3 I 7 Compressed air, 234 Confections, I 5 Copper oxid, 76 sulphate, 76. Corolla, 7 Coriander, 228 Corm, 6 Corrosive sublimate, 1.87 Cosmolin, II 2 Cotton, absorbent, 18 Counterirritants, 31, Ioo Cream of tartar, 2 I 2 Creosote, 62 Cresol, 61 INDEX. 39 I Croton oil, 2 o'S Cumulative effect, 25 DEADLY NIGHTSHADE, 1.65 Decoctions, I 2 Demulcents, 3o, Io& Dental liniment, Io'7, 298 sterilization, 3.87 Dentifrices, 3o, 252 Denuded root-end, 31 7 Deodorants, 3o, 38 Devitalization of pulps, 285 Dialysed iron, 174, 288 Diaphoretics, 3o, 2 I 7 Digestants, 194 Digitalis, I 62 poisoning and treatment, I 63 Discolored teeth, 336 Disinfectants, 3 o, 38 Dispensatory, 3 Disposing of pus in abscess cavity, 3 I 5 Dissolution, definition of, 3 Diuretics, 3o, 2 II Dobell’s solution, 253 Donovan’s solution, I 90 Dosage, modifying drug action, 25 Dover's powder, I47, 22 o Drastics, 29, 196 Dressings, antiseptic, I 9 Drugs, administration of, 20 definition of, I derivation of, 4 Dry gangrene, 3 o'S ECHAROLTA, I 92 Echinacea, I 92 Effect, physiologic, 2 therapeutic, 2 Effervescent salts, I 5 Electricity, 236 Elixirs, Io Emetics, 3o, 218 Emollients, 31, 88 Emulsions, II Encystment of root, 31 9 Epidermic method of administering drugs, 23 Epsom salt, 2 of - Equivalents of apothecaries' in metric weights and measures, 244 Ergot, 7 I Escharotics, 31, 88 in treatment of hypersensitive dentin, 264 Essential oils, 5 w group of, as antiseptics, 45 Ether, 132 contraindication, I 33 Spray, I 2 o Ethyl alcohol, I 56 bromid, 135 chlorid, I 19 Eucain, 129 alpha, I 29 beta, I29 hydrochlorid, 129 IEucalyptol, 48 compound, 49, 294 Eucapercha compound, II 6 Eugenol, 47 Euroform paste, 54 Europhen, 53 Exceptional casesof pulp exposure, 27 I Excision of root, 326, 362 Expectorants, 31, 22 I Exposed pulps, treatment of, 27 o Extensive caries or necrosis, from abscesses, 32 o Extracts, 14 FATS, 5 Fennel, 228 Ferric chlorid, 173 hydroxid, I 75 with magnesia, I 75 Ferrous carbonate, I 74 hypophosphite, I 75 iodid, I 75 sulphate, I 72 subsulphate, I 73 Ferrum, 171 Fig, 198 Filling root canals, 333 large canals, 334 Small canals, 334 Fixed oils and fats, 5 Flavoring agents, 228 Flaxseed, I I I Flower, 7 Fluid extracts, I 3 Fomentations, 18 Foods, 32 Formaldehyd, 63 Formalin, 63 Formocresol, 64 prescription for, 3o 3 Formol, 63 Fowler's solution, 190 Foxglove, 162 Fruit, 7 Fuller's earth, I 17 GAMBQGE, 2 og Gangrene of pulp, dry, 3 o'S Gastric stimulants, I 67 Gauzes, I 9 Gelsemium, I 69 General anodynes or analgesics in treatment of hypersensitive dentin, 268 Gentian, 167 Germicides, 3o, 38 Ginger, 225 Glauber's salt, 2 oé Glonoin, I 65 Glucosids, 5 Glycerin, Io9 Glycerites, Io Glycyrrhiza, I 14 Gold and sodium chlorid, 194 Golden Seal, 72 Gonorrheal stomatitis, 386 Green vitriol, I 72 Gregory's powder, 202 Guaiacol, 62 Gum arabic, I 13 392 INDEX. Gums, 5 Gutta-percha, I 16 ABIT, modifying drug action, 24 Hamamelis, 7 I Heat, 67, IoI, 232 in treatment of hypersensitive dentin, 262 Hematics, 32, 171 Hematoxylon, 71 Hemophilia, 79 Hemorrhage after pulp removal, 284 control of, 281 Hemostatics, 33, 67 Henbane, I 51 Herb, 6 Herpes labialis, 378 Honey, 198 Honeys, Io Hydragogues, 29, 196 Hydrastis, 72 Hydrate of magnesia, 37 Hydrated chloral, 141 Hydrogen dioxid, 64, 85 25 per cent. Solution of, 65, 85, 342 Hygienic remedies, 2 Hyoscyamus, I 51 Hypersensitivedentin,treatmentof,261 Hypodermic method, 2 o factors to be remembered, 2 I Syringe, 22 technic of injection, 22 where indicated, 2 I ICE, I 2 O Idiosyncrasy, 25 Imponderable remedies, 2 Incompatibility, 256 Indian hemp, 152 Indications for removing pulps in pyorrhea alveolaris, 360 Infusions, 12 Inhalation of drugs, 24 Intravenous method of administering drugs, 23 Inunction, 23 Iodids, 182 ammonium, 182 potassium, 181 Sodium, 182 strontium, 182 Iodin, 51 Iodism, 53, 182 Iodoform, 52 Iodol, 52 Ipecac, 22 o Iron, 17 I by hydrogen, 174 compounds of, 172 carbonate, 174 chlorid, 173 hyposphosphite, 175 iodid, 175 sulphate, 172 subsulphate, 173 Irritants, 31, Ioo Isotonic solution, 204 hyper, 2 o 5 hypo, 2 o 5 JABQRANDI, 217 Jalap, 209 Juice, 7 KAQLIN, II 7 Kelene, I I 9 Krameria, 7o Kresamin, 67 LABARRAQUE's solution, 87 Lanolin, II 2 Laudanum, I47 Laughing gas, I 3 I Lavender, 23 o Laxatives, 29, 196 Lead acetate, 75 poisoning by, 75 Leaves, 7 Lemon, 228 Leucoplakia buccalis, 384 Liber, 7 Licorice root, I I4 Light, 234 in treatment of hypersensitive dentin, 263 Light magnesia, 37 Lime water, 3.5 Liniments, II for dentists’ use, Io 7, 254 Linseed, I I I Liquor antisepticus, 4o, 253, 359 Liquors, 8 Lithium benzoate, 216 carbonate, 2 I 5 citrate, 2 16 Local anesthetic solution, 278 anodynes or local anesthetics in treatment of hypersensi- tive dentin, 265 Logan-Buckley set of scalers, 354 description of uses, 355 Logwood, 7 I Lozenges, I 5 Lugol's solution, 181 prescription for, 299 Lunar caustic, 81 Lysol, 61 MAQ#. 225 Magnesium citrate, 207 hydrate, 37 Oxid, 37 sulphate, 2 of Malt, 195 Malted liquors, I 57 Mandrake, 2 Io Manna, 198 Marshmallow, II 5 Massage, 237 Masses, I 6 Materia medica, definition of, I May apple, 2 Io Mechanical remedies, 2 Medical Latin, 2.5o Medicated dressings, 19 gauzes, I Q Medicines, definition of, I classification of, 27 Menthol, 5o INDEX. 393 Mercurol, 189 Mercury, 183 compounds of, 185 mercuric chlorid, 67, 187 mercurous chlorid, I86 iodid (red), 188 iodid (yellow), 189 mercury biniodid, 188 protiodid, 189 objections to use in the mouth by homeopathic physicians, 185 treatment of poisoning by, 184 Mercurial stomatitis, 383 Methods of bleaching teeth, 338 Metric system, 241 Metrology, 23.9 Milk of magnesia, 37 Miscellaneous compounds, 6 Mixtures, I I Monsel's solution, 173 salt, I 73 Morphin, 147 Mouth, administering drugs by, 20 washes, 253 Mucilages, I I - Mustard, black, Io.2 white, Io.2 Mydriatic, 3 I Myotics, 32 Myrrh, 57 Myrtol, 223 NARCOTICS, 32, I46 National formulary, N. F., 4 Neuralgia, 369 facial, 37 o treatment of, 370 tic douloureux, 375 treatment of, 376 Neurocain, I 28 Neutral principles, 5 Nicotin, I 53 Nitroglycerin, 165 Nitrous oxid, 13 I Normal saline solution, 1.69 Nosophen, 53 Novocain hydrochlorid, 129 Nutmeg, 225 Nux vomica, 154 poisoning and treatment, I 55 OIL of cajuput, 46 of cinnamon, 46 of cloves, 47 of eucalyptus, 48 of morrhuae (cod-liver), 180 of myrtle, 223 of peppermint, 49 of thyme, 5o of tigli (croton), 208 of turpentine, Io 3 olive, I I I ricini (castor), 2 oo Oils, fixed, 5 - volatile, 5 Ointments, 17 Oleates, Io Oleoresins, 14 Opium, 146 - conditions modifying action of, I48 . contraindications, I 5o poisoning and treatment, I49 Orange, 229 Organic acids, 5 Orthoform, 13 o Osmic acid, 97 Osmium tetroxid, 97 Ovary, 7 Oxidizing agents, 83 Oxygen, 58 Ozone, 58 PANCREATIN, I95 Papain, 196 - Papers, 18 Paraffin, I 13 Parts of a prescription, 247 of plants used for drugs, 6 Paraform, 63 Paraformaldehyd, 63 Paraldehyd, 143 Paregoric, Io 7, 147 Pathologic conditions modifying drug action, 26 Pearson’s solution, 190 Pepper, black, 225 Pepsin, I 94 Percentage in solutions, 244 Pericarp, 7 Pericementitis, nonseptic, 295 causes of, 295 treatment of, 297 Septic, 2.95, 3 o'8 treatment of, 3 o'8. Peruvian bark, I 39 Petroleum, I I 2 liquid, I 12 Pharmaceutic preparations, 7 Pharmacodynamics, definition of, I Pharmacologic remedies, 2 Pharmacology, definition of, I Pharmacopeia, U. S., 3 Pharmacy, definition of, 3 Phenacetin, 138 Phenol, 58 compound, 51 poisoning and treatnent, 59 Phenyl salicylate, 43 Phosphorus, 176 poisoning and treatment, 176 Physical agents in the treatment of hypersensitive dentin, 262 Physiologic action, 2 effect, 2 Pills, 16 Blaud's, 174 compound cathartic, 186 compound vegetable, 2 Io Pilocarpus, 2 17 Pistils, 7 Plaster-of-Paris bandages, 19 Plasters, 18 Podophyllum, 2 Io 394 - - INDEX. Poison, definition of, 3 Pollen, 7 Potassium acetate, 213 and sodium, 97 tartrate, 2 o'7 bicarbonate, 212 bitartrate, 2 I 2 bromid, I44 Carbonate, 2 I 2 chlorate, 214 citrate, 2 I 2 dichromate, 97 hydroxid, 98 treatment of poisoning by, 99 iodid, 181 - flitrate, 2 I 5 permanganate, 66 Powders, I 5 • Practical prescriptions, examples of, - 2 52 - Precipitated calcium phosphate, 178 carbonate, 34 - Preparations, pharmaceutic, 7 Prescription-writing, 246 Pressure anesthesia, 276 Products of pulp decomposition, 3 or Prophylactic remedies, 2 Protargol, 83 Protectives, Io9 Prune, 198 Prunus virginiana, 168 Ptyalism, 184 Pulp calcification, 29 I capping, 27 I decomposition, 3 or nodules, 29 I removal, 275 - - anesthetization method, 276 devitalization method, 285 Purgatives, 29, 196 Putrescent pulps, 3 oo treatment of, 3 oz in deciduous teeth, 33 o Pyorrhea alveolaris, 349 description of class I, 349 of class II, 35o of class III, 351 treatment of class I, 353 of class II, 360 of class III, 368 Pyrozone, caustic, 85 UICKSILVER, 183 Quinin, 139 Salts of, I 39 RADIUM, 236 Rectum, administration by, 24 Reduced iron, 174 Reducing agents, 87 Refrigerant counterirritant, prescrip- tion for, 299 Remedies, definition of, 2 hygienic, 2 imponderable, 2 mechanical, 2 prophylactic, 2 Remedies, specific, 2 Removing the pulp, 275 in deciduous teeth, 292 Resins, 5, 13, I4 . . . Resolution, definition of, 3 Resorbed or roughened root, 3 I 9 Resorcin, 55 Respiratory stimulants, I 65 Restorative stimulants, I 69 Restoratives, 32, I 7 I Retainers for loose teeth, 364, 366, 367 . Rhatany, 7o Rhigolene spray, I2O Rhizome, 6 Rochelle salt, 2 o'7 Röntgen ray, 235 Root, 6 Root-canal fillings, 333 Rose, 23 o SACCHARIN, 23 I Salol, 43 Salophen, 44 Saltpeter, 21 5 Salt solutions, action of, 204 Sarsaparilla, I 91 Sassafras, II 5, 227 Schreier's paste, 98 for putrescent pulps, 3o 6 Scopola, I 51. Scopolamin, I 52 Secondary dentin, 29 I Sedatives, 32 Seed, 7 Seidlitz powder, 207 Senna, 2 oo Sensitive dentin, treatment of, 261 Sepals, 7 Septic pulps, 3o 5 Sialogogues, 32, 223 Silver, 8o nitrate, 81 vitellin, 82 Slippery elm, I I 5 Soap, 37 Soapstone, I I 7 Sodium and potassium, 97 tartrate, 2 o'7 lbicarbonate, 35 borate, 36 bromid, 145 dioxid, 83, 339 hydroxid, 98 treatment of poisoning by, 99 phosphate, 206 salicylate, 45 sulphate, 206 Solutions, 8 of ammonium acetate, 2 I 8 Somnifacients, 3 I, I4o Spearmint, 2.26 Specific disease, 2 remedy, 2 Spirits, 9 of mindererus, 2 18 . of niter, sweet, 2 18 f - INDEX. 395 Spirits of nitroglycerin, 1.65 of nitrous ether, 218 Splints, I 9, 364, 366, 367 Squill, 222 Stamens, 7 Starch, I Io Stem, 6 - Sterilization of instruments, 387 Stigma, 7 Stimulants, 33, I 54 Stipes, 6 Stomatitis, mercurial, 183, 383 gonorrheal, 386 Strychnin, I 54 poisoning and treatment, I 55 Style, 7 Styptics, 33, 67 Sublamin, 189 Suction, 237 Sudorifics, 3o Sugar, and sugar of milk, 231 of lead, 75 Suggestion, 238 Sulphonal, I42 Sulphur, 2 oz Suppositories, I 7 Suprarenal extract, 73 Suprarenalin, 73 Sweet oil, I I I Sylvester's method of artificial respi- ration, I 24 Syphilis, 2, 184, 379 primary, 379 secondary, 185, 38o tertiary, 182, 382 Syrups, 9 TABLETs, I 6 Talc, I 17 Tamarind, 197 Tannin, 68 Tartar emetic, 22 I Technic of applying arsenical prepa- rations, 287 of capping pulps, 272 of injecting local anesthetics, 22 Tepid water, as an emetic, 22 I Terebene, IoA. Therapeutic effect, 2 Therapeutics, definition of, I empirical, I rational, I Thermometric scale, 233 Thymocamphen, 51 Thymol, 51 iodid, 52 Thymophen, 51 Thyroid extract, 74 Tinctures, 12 Tobacco, I 53 Tolerance, 25 Tonics, 32, 17 I Tooth powders, 253 paste, 359 Toxicology, definition of, 3 Tragacanth, I 13 Tricresol, 61 Trional, I43 Troches, 15 Tropococain hydrochlorid, 128 Troy weight, 24o Tuber, 6 - Tuberculosis of the mouth, 384 Tully's powder, 148 Turpentine, Io 3 ULMUS, II 5 Urotropin, 64 VALERIAN, I 7o Vallet’s mass, 174 Vanilla, 229 Vaselin, I 12 liquid, I I 2 Vinegars, 12 Volatile oils, 5 group of, as antiseptics, 45 WATERS, 8 White arsenic, 94 White vitriol, 76 Witch-hazel; 71 Wild cherry, 168 Wine measure, 24o Wines, I 2 Wood, 7 Wool fat, I 12 X-RAY, 225 YELLOW jasmine, I 69 ZINC chlorid, 78 iodid, 78 oxid, 78 phenolsulphonate, 77 sulphocarbolate, 77 sulphate, 76 Ź;&& ！¿¿.* ، -}›‹‹‹‹șwę ·¿&&#§§§§§§- #¿。。、、、、、、、 --*******@****¿??¿ §§-.š***¿£&** -saevae- §§ ¿¿.*¿¿.*¿ș***** ¿??¿ $¢ §§§§§ 、、、、、、、、、、、、、-- ; ::::::::::::::：::::::::::: ****\，{*&#***********----|- §§§§§§§§§§§§。 ¿ -*******.- ----*№ſº:* $ſ;**********§§&&ț¢，»ș*r*r************* §§§§ ******șºr ¿ -§§§ ſaeșža;±±-x*| ��***********ț¢， №ž* §§# ķīš §§