Handbook for Royal Naval dental surgery attendants.

  • Great Britain. Admiralty.
Date:
1949
Catalogue details

Licence: Public Domain Mark

Credit: Handbook for Royal Naval dental surgery attendants. Source: Wellcome Collection.

    66/164 (page 52)
    In pulpitis (inflammation of the pulp) the pain may be severe, but the tooth will be firm and not tender to bite on, nor painful on percussion. Pain may be controlled by inserting a sedative dressing, such as carbolized resin, cotton-wool dipped in ‘‘ Dentalone’”’ or oil of cloves, or by placing in the cavity a paste made by mixing oil of cloves and zinc oxide—the paste should be as stiff as possible. It may not be possible to see the cavity, in which case it is probably in the side of the aching tooth and concealed by the next. In this case the dressing should be inserted between the two teeth concerned. Periodontitis (inflammation of the periodontal membrane) is usually a symptom of a more advanced condition. The pulp may have died and become septic, and the infection, progressing through the end of the root, will have resulted in an acute inflammation of the periodontal membrane. The inflammation causes great pain with tenderness on biting, and may proceed to alveolar abscess and swelling, with temperature and a general feeling of being unwell. If it is clear that the condition is of this nature and not a simple pulpitis, nothing should be inserted in the cavity, otherwise the sepsis will be bottled up and the severity of the condition may increase. Very hot mouth- washes combined with simple sedatives may bring relief. A foment, consisting of a cotton-wool roll dipped in boiling water and well squeezed out to avoid scalding, is comforting if applied to the gum in the affected area. Large external foments should not be used, however, for if abscess formation is likely there is a danger that the infection may be drawn into the deeper tissues, or that the abscess may burst externally through the cheek leaving a disfiguring scar. HAEMORRHAGE AFTER EXTRACTION Haemorrhage may prove a serious condition, especially if the blood does not appear to be clotting, and skilled treatment should be sought without delay if the bleeding is either copious, or persistent, or both. The dental surgery attendant, however, while waiting the arrival of assistance, must do what he can to alleviate the condition. His first duty is to reassure the patient, and he must therefore show no signs of alarm himself. In many cases fear and hunger are potent factors in haemorrhage. The writer remembers a case where it was discovered that the patient abstained from food for nearly twenty-four hours, because of his alarm at post-operative bleeding. He was assured that if he stopped worrying and had a good meal the haemorrhage would cease. He returned after a good lunch to report that, to his astonishment, the trouble had ceased. This case, however, must be regarded as exceptional. In treating haemorrhage a good light on the scene is essential. First, the ‘mouth should be freed from blood and any clot present, and the source of bleeding located as exactly as possible. The rate of flow should be observed, and the tendency or otherwise of the blood to clot noted. In a high percentage of cases of post-extractive haemorrhage, the bleeding does not come from the depth of the socket, but from torn tissues on the surfaces, especially where the gum has been separated from the underlying alveolar bone. Plugging of the socket in these cases is useless. If the blood appears to be pumping or pulsing out, it is a sign of arterial bleeding, and a small vessel is probably half- severed and unable to close. Gentle curettage of the site of bleeding with a suitable instrument, such as a small straight spoon excavator, should be tried first. This may complete severance of the vessel and allow it to close, when