TOOTHACHE: Its Forms, Diagnosis, and Treatment for Relief.
The sharp, paroxysmal, shooting pain which is caused by the application of cold, heat, sweets or sours, or by biting some substances into a cavity, is due to a live pulp, and the treatment is quite simple. Clean out the cavity as well as possible, then saturate a small pellet of cotton with oil of cloves, or one drop of carbolic acid, or a solution of cocaine hydrochlorate and clove oil. Place this in the cavity and add another pellet of cotton to prevent the solution from being washed out by saliva. Relief should be immediate, but if not, reapply within a few minutes.
The dull, throbbing pain, with swelling of the face and a sensation of elongation of the tooth, is caused by either a putrescent pulp or an imperfect root canal filling. There is infection; therefore, the first thing to do is to remove the pus.
Dental Treatment.—If there is a large cavity in the tooth, try to enter the root canals and remove the putrescent matter. If the face is badly swollen, make a digital examination, and over the root of the affected tooth you will find a spot about the center of the swelling where it seems to be spongy, appearing to hold the impress of the finger. Take a clean, sharp, cycle-shaped lancet, place on the spot, holding the patient’s head firm with your other arm for fear of his moving. Press the lancet firmly and directly through to the bone, then draw it out with a pulling motion so as to make a cut about an eighth of an inch or more. If this has been done properly, a creamy flow of pus should follow the lancet. Place the fingers on either side of the incision and massage toward incision. To relieve the pain, give hot foot-baths, cold applications to face (never hot), and some other sedative internally, such as remedies given for a headache. When a tooth is sore to percussion, so that the food cannot be masticated, but is without pain when left at rest, if there is no pain over the root of the tooth, it is best to give the tooth a rest, and apply counterirritants over the roots of the adjacent teeth.
This condition is called apical pericementitis, an inflammation of the layer of bone about the fangs of teeth. For relief, give hot foot-baths and pain remedies, as in abscessed tooth. A dead pulp in a tooth will form gas and cause the sensation of elongation and soreness. If the putrefaction is not removed, an abscess will result. At first there will be no soreness to pressure over the root, but on application of heat, such as drinking hot coffee, there will be pain, while cold water will temporarily remove it.
Dental Treatment.—Open the chamber and remove the putrescent pulp, being careful not to go beyond the apical foramen. Use a barbed broach, then wash out with peroxide of hydrogen on a thread of absorbent cotton wrapped smoothly about the broach. Do not push the instrument up into the canal very far for fear of sending some putrescent matter beyond the tooth. Then withdraw the broach and apply oil of cloves or carbolic acid, leaving the canal open and clean for the gas to escape. Hot foot-baths and headache remedies will relieve the pain.
Gum-boils are abscessed teeth, and may be deep-rooted or very superficial. The treatment is the same as given above. Hot applications are very often prescribed, but as an infection will always follow the line of least resistance, it can be readily understood why such a treatment should not be given. The abscess may gather in the cheek, necessitating lancing, which will leave a scar. Cold cloths will allay the infection and simplify the treatment to the gums alone. Teeth are withdrawn, leaving unsightly cavities, which could be avoided by a more deliberate treatment. Treat the abscess of the tooth the same as an abscess in any other part of the body, thereby saving the root of the tooth, if not the entire portion, which can be crowned and give a permanent good tooth.
Mastication is the most important part of the digestive system, and mastication cannot be done without good teeth. Therefore, it behooves everyone to preserve his own teeth and to give this benefit to others who may not have had dental treatment. There are dentists who will extract a tooth upon the patient’s request, and it is best to seek the most progressive and modern dental doctors for the preservation of the teeth to prevent the untimely loss of a tooth, which means also many times a preventive against other ailments affecting the digestive tract. A good dentist should be consulted at least once a year, although the teeth may appear sound and in good condition.
ERUPTION OF THE DECIDUOUS
OR MILK-TEETH.
| Lower central | incisors, | 6 to 9 | months. | ||
| Upper | “ | 8 “ 10 | “ | ||
| Lower lateral | “ | 15 “ 21 | “ |  | also first molars. |
| Canines, | “ | 16 “ 20 | “ | ||
| Second molars, | “ | 20 “ 24 | “ | ||
Eruption of the deciduous teeth
(Frühwald and Westcott).
Twenty teeth in all: eight incisors, four on each jaw; four canines, two on each jaw; eight molars, four on each jaw.
| Permanent teeth: | ||
|---|---|---|
| First molars coming back of baby molars, | 6 | years. |
| Centrals, | 7 | “ |
| Laterals, | 8 | “ |
| First bicuspid, | 9 | “ |
| Second “ | 10 | “ |
| Canines, | 11-12 | “ |
| Second molars, | 12-13 | “ |
| Third “ or wisdom teeth, | 17-21 | “ |