Periscope of Medical and General Science in their Relations to Dentistry. [Volume: 2, Issue: 3, October, 1860, pp. 177-184]

PERISCOPE OF MEDICAL AND GENERAL SCIENCE.

181

liar form of alveolar abscess, or aggravated gum-boil, which appears to
me not to have been noticed by surgical authorities. The dysphagia, salivation, and fever of the first are common to it and to glossitis; the swelling,
however, of the body and edges of the tongue in the latter, the infiltrated
condition of the mucous crest beneath, and the altogether negative evidence afforded by the fauces, when visible, are sufficiently distinctive. If
the surgeon cannot see the interior of the throat, he will be assisted by
the prominence under the finger, and tenderness at the back of the dorsal
aspect of the tongue, and sometimes beneath it, and by the swelling below
the chin. As regards ptyalism, the condition of the gums and the evidence that mercury has not been administered, (when forthcoming,) and
the local tenderness on pressure, are the most decisive. Abscess also,
according to my experience, does not result from mercurial action, while
ulceration is common. The distinction between mercurial and other affections of the mouth, based on an intrinsic character of the saliva, as proposed by Dr. Davidson, may possibly hereafter prove to be available in
inflammation of the tongue. I have more than once verified the absence
of indications of sulpho-cynanogen in the saliva in mercurial ptyalism. It
remains, however, to be shown, that certain diseases do not also cause
suppression of that constituent. I regret that the matter escaped my
recollection at the time the above cases were observed. It is a subject
worthy of the notice of future inquirers.
" The alveolar abscess above noticed, to some extent simulates glossitis.
This affection I have found to depend usually on a carious condition of
the lower dens sapientise, with acute periostitis of its root, more rarely on
inflammation of the gum still covering this tooth at the time when its evolution has made some progress. The first-named affection is very painful. In it, as in glossitis, there is difficulty in opening the mouth and in
protruding the tongue; the mucous crest leading to the sublingual gland
is equally swollen, red, and infiltrated; there is difficulty of swallowing, and
flow of saliva from the mouth, with pain and tenderness about the angle
of the jaw. The diagnostic sign which I have found decisive is, the severe
pain produced by pressure when the finger, by some manoeuvring, is introduced and pressed against the lingual aspect of the jaw at a point corresponding to the fang of the suspected tooth, and to the extremity of the
mylo-hyoid ridge, where a yielding is experienced. The absence of any
material swelling of the body of the tongue, or of tenderness there on
pressure, will further obviate any likelihood of mistake. Having noticed
this affection, I may state that its treatment is equally simple and effective-the opening of the abscess with the point of a bistoury directed
carefully outward and downward, while the subsequent extraction of the
pffending tooth will prevent a recurrence of the mischief. Leeches or
other measures directed to arrest of sublingual inflammation are quite
superfluous. The eruption of the dens sapientite, it may, in passing, be
also observed, is often attended by suppuration between the superincumbent gum and the crown of the tooth; it is a painful affection, and some
times tedious, and not uncommonly mistaken for rheumatic trismus.
" In a late case in which the system refused ptyalism, under mercury in
course of administration for secondary syphilis, the patient, who had absented himself for some days, complaining that his mouth was now very
sore, it was supposed that the mineral had taken effect. I found that he
was laboring under suppurating gums, depending on the cause now described. The rest of the gums were healthy. Such examples enforce the