An Essay on Causes of Inflammation of the Periosteum of the Teeth. [Volume: 2, Issue: 10, May, 1861, pp. 541-547]

CAUSES OF INFLAMMATION OF THE PERIOSTEUM OF THE TEETH. 543

bone denuded. In the highest stage of the affection, the alveolar process
of the lower maxilla, with its greenish-gray looking alveoli, is laid bare;
the alveolar process of the upper maxilla presents the same appearance;
the hard palate, in its whole extent, is deprived of its covering, and the
roof of the palate seems to belong to a dried skull; at the same time pus
escapes from all the margins of the necrosed parts.
Nearly in all cases, fistulous passages are observed, which penetrate the
soft parts in different places; their number and the amount of their discharge depend upon the greater or less quantity of pus produced at
the diseased bone. If the destruction has its seat in the lower maxilla,
the fistulous openings are generally found at the lower margin; if in
the upper maxilla, in the region of the antrum. In cases, however,
where the duration of the disease is longer, the pus often spreads to a
greater extent; it makes its way to the region of the temporal bone, and
escapes from the ear; fistulous passages penetrate the pars squamosa, or
the matter gravitates into the mastoid process; it even travels as far as
the nape of the neck. When the lower jaw is the seat of the destructive
process, fistulous openings are formed at the neck, and if the matter
descends still further, it may make its appearance on the anterior surface
of the thorax.
If the course of the disease is acute in the beginning, the swelling
attains considerable size, suppuration is established, and the destruction
of the bone commenced within a few weeks from the time that the
affection of the periosteum of a tooth first manifested itself by violent
pain. During the more inflammatory stage, symptoms of constitutional
suffering are not wanting; there is fever, loss of appetite, and constipation; the face assumes a yellowish color; the secretion of the saliva is
increased the more the greater the inflammation, and the more quiet
the mouth is kept on account of the pain; the quantity of saliva is, however, not as great as it appears. The symptoms disappear, and the affection assumes a more chronic course; it exists for years, the pain increasing or decreasing according as the inflammatory action preceding
the necrosis is extended, or increasing as the formed matter finds outlet with more or less difficulty. If the suppuration is considerable,
digestion is frequently impaired in consequence of the matter being
swallowed; vomiting often takes place in the morning in consequence of
pus having been swallowed during sleep. The constitution finally succumbs
under symptoms of consumption.
The disease is, however, not always attended with the distinct signs of
inflammatory action, but may establish itself under hardly perceptible
symptoms; the affection of the dental periosteum, with which it commences, manifests itself more by swelling than by pain. The tooth becomes
loose, but is not lifted out of the alveolus by a greatly hyperplastic odontoperiosteum; the swelling commences gradually at the alveolar process,