In _too rapid healing of the orifice of the socket_, the freshly healed
surface must be separated, the socket syringed out, and a small tent of
lint allowed to remain in the orifice for about twelve hours. An
antiseptic mouth wash should also be prescribed.
In those cases _where the pus is putrid_ and there is reason to suspect
infection, the socket should be thoroughly syringed with some antiseptic
such as hyd. perchlor. 1 in 1,000, carbolic acid 1 in 40; following this
the parts should be carefully dried with cotton-wool. A small piece of
chloride of zinc should then be introduced and allowed to dissolve in
the socket, which must be subsequently kept aseptic by constant
irrigation with some antiseptic solution.
Suppuration is most frequently seen after extraction of the lower teeth
owing to the fact that drainage is less easily effected than in the
upper, owing to the dependent position of the socket. In many cases it
will be found necessary to plug the socket tightly with non-absorbent
cotton-wool dipped in an antiseptic solution; this prevents the
accumulation of _débris_ which would act as an irritant. In cases of
_suppuration occurring in patients of diminished vitality_ a tonic form
of treatment should be prescribed;[19] the dressing in the socket should
be removed two or three times a day and the socket syringed.
Care must be exercised in applying escharotics to sockets to which the
nerve may be in close proximity; this is especially necessary in dealing
with impacted lower third molars. Two cases illustrating this point have
come under my notice. In the first a second lower bicuspid with a long
standing chronic abscess had been removed. The patient complained of
pain, the socket was syringed out and a small piece of chloride of zinc
inserted. Intense agonizing pain followed which all local anodynes
failed to relieve. In the second case an impacted right lower third
molar had been removed. The socket suppurated, and the pain although
severe was not intense. Treatment similar to that used in the first case
was adopted with similar results. Since then in all cases where it is
possible that the trunk of the nerve may be in close proximity to the
socket, I have used non-irritating antiseptic injections and plugged
the socket with cotton-wool dipped in tincture of opium with much more
satisfactory results.
It is advisable to inform the patient of the possibility of pain
following the extraction of a tooth, especially after periodontitis, and
in all cases where a large number of teeth have been extracted a
mouth-wash[20] should be prescribed; for, even if there is no pain, it
will prevent the discharge from the sockets of the teeth undergoing
putrefactive changes.
Public-domain text, read in full here on John Shaqi.
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