There are cases, especially those which have gone for years unattended, where the arch of the mouth is of such gothic shape and the defect so wide that disappointment is sure to follow in at least one of the above respects. The art of the dentist has now reached a point where plates or obturators may be constructed for unsuitable cases, which will give better functional and vocal results than any which the surgeon can produce.
Another form of palatal defect is the result of the late manifestations of syphilis, and small and large perforations may occur, usually in the hard rather than in the soft palate. They are to be dealt with surgically, but not until after the patient has been subjected to a course of antisyphilitic treatment.
THE MOUTH IN GENERAL.
The mouth more than any other part of the body is the habitat of a large fauna and flora of minute organisms. Over one hundred different kinds of bacteria from this region have been identified by Miller, and it will be easily seen how prone fresh wounds or old lesions may be to infection from these sources. Fortunately but few of these microörganisms have decided pathogenic propensities. They lurk especially in two localities—the crypts of the tonsils and along the gingival borders and alveolar processes. Along the gingival border of the teeth tartar accumulates, by a precipitation of mineral salts from the saliva, where by irritation, coupled with germ activity, the gum is loosened from the teeth beyond the level of the enamel, and the sockets thus exposed to various kinds of infection. In consequence the teeth thus undergo dental caries, become loosened in their sockets, while, at the same time, infection travels along lymph paths until the germs are filtered out in the adjoining cervical lymph nodes, which thus suffer enlargement and often suppurative destruction. An interstitial gingivitis, therefore, is always a serious menace to the integrity of the teeth. This will furnish another argument for a semi-annual inspection of the mouth by a competent dentist, that he may clean away all tartar accumulations and treat the gums in such a way as to prevent disintegration. In elderly people, especially, there is a marked tendency toward retrocession of the gums. In young or old, when this condition is noted, it may be treated by applications of zinc iodide, either of the dry, minute crystals or of a saturated solution, which may be used daily or weekly. By such precautions the teeth may be preserved to old age, the importance of which is not generally appreciated, since the teeth are necessary for suitable mastication of food which the enfeebled stomach of an aged person can more easily digest.
Infection may also occur during the period of eruption of teeth in young people, and serious trouble sometimes accompanies the appearance of temporary or permanent teeth. Gingivitis of toxic origin is not uncommon, as among the possible effects of overdosage of mercury and phosphorus.
All that has been said of the teeth and their sockets is in the main true of the tonsils, which afford numerous crypts or lacunæ in which germs may be harbored for a long time. The explanation of probably 75 per cent. of enlarged and tuberculous lymph nodes is afforded by infection spreading from the tonsils and teeth. It may not be tuberculous at first, but it becomes so later.
In the mouth may be seen expressions of actinomycosis, tuberculosis, and especially of syphilis, among the more chronic lesions, as well as of diphtheria, erysipelas, and the result of the oidium albicans of thrush. Tuberculosis is more common in the pharynx, while the syphilitic infections may appear anywhere and in any form, as chancre on the tonsil or the lip, mucous patches of the tongue, destructive lesions of bone, all of the earlier and most of the later expressions of the disease offering serious dangers of contagion.
Stomatitis is a term generally applied to the lining membrane of the mouth and indicates little regarding its nature or seriousness. It may be of traumatic origin, as when strong caustics have come in contact with the mucosa. Ulcerative stomatitis is a disease of childhood, due to the activity of the oidium albicans or some kindred microörganism, it being usually a more serious expression of the condition known as “thrush.” Washing the mouth frequently with dilute solutions of hydrogen peroxide or of tincture of iodine will usually be all that is necessary. Resistant ulcerations may be treated with 10 per cent. solution of silver nitrate. Stomatitis gangrænosa is another name for noma, or cancrum oris, which was described in the chapter on Gangrene. In these cases the surgeon should hasten the tedious separation of sloughs by use of scissors, curette, or the actual cautery ([Fig. 471]).
Blastomycetic lesions of the mouth, and especially of the lips, have been recognized. Bevan has reported extirpation of granulomas provoked by the blastomycetes, or yeast fungi, which are known to produce similar effects elsewhere ([Fig. 471]).
Fig. 470