Roentgenographic Diagnosis of Dental Infection in Systemic Disease Pp50f

ROENTGENOGRAPHIC
DIAGNOSIS OF
DENTAL INFECTION
IN SYSTEMIC DISEASES
SINCLAIR TOUSEY. A-M-. M-D-
CONSULTING SURGEON,
NEW
ST B
ARTHOLOMEW S CLINIC,
YORK
PAUL B
. HOEB
ER
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1916
NEW
YORK
PREFACE
The author has f
or many
to act in the capacity
phy
sicians,
of
not only
ears been called upon
adv
iser to dentists and
as to diagnosis but also f
treatment and prognosis. The adv
or
ice in this
book regarding treatment is not intended as a
guide to the practice of
gery
dentistry
and oral sur-
but it is hoped that it may
aid the phy
and the dentist to decide when an inf
ected tooth
sician
should be extracted and when it can be cured and
remain a saf
This v
e and usef
ul member.
olume is an elaboration of
same subj
ect read bef
ciation of
Greater New York,
ronx County
and the Medical Association of
May
Sinclair Tousey
Jan. 27,
Dental Society
New York State Dental Society
York,
15,
articles on the
ore the Roentgen Ray
Feb. 28,
May
New York,
3,
1916.

July
13,
Greater New
1916.
Asso-
1916;
the
1916;
1916;
the
CONTENTS
PAGE
I. Introduction 9
II. Inf
ections of
the Teeth and Pneumatic
Sinuses and Their X
III. Conditions f
and Py
-Ray
Diagnosis . 10
rom W hich Alv
orrhea Alv
erentiated 29
IV
. Recent B
eolar Abscess
eolaris Must B
e Dif
acteriological and Clinical
Studies 36
. Lesions and Sy
mptoms Secondary
tion Connected with the Teeth or the
Pneumatic Sinuses op the Face ... 40
I. General Conclusions 70
Author's Other Publications upon the
-Ray
in Dentistry
71

Index 73
to Inf
ec-
ROENTGENOGRAPHIC DIAG-
NOSIS OF DENTAL INFEC-
TION IN SYSTEMIC
DISEASES
CHAPTER I
IJSTTKODUCTION
^'Tlie widest publicity
should be giv
ary
act that greatly
or f
atal sy
en to the
ing and sometimes serious
stemic diseases and those af
mote organs are of
ten due to inf
ecting re-
ection connected
with the teeth or with the pneumatic sinuses of
the f
ace. The inf
by
the x-trj
by
treatment of
also autogenous v
ture f
ected f
b. Some of
oci are discov
the oral lesion and some req
an eminent j
dragged back f
the discov
rom the v
ery
uire
accination with a bacterial cul-
rom the pus in the oral lesion."
the words of
erable
these cases are cured
by
These are
urist whose wif
erge of
the :r-ray
s of
the grav
the f
e has been
e through
oci of
tion in connection with the teeth. Pernicious
anemia and general spinal sclerosis were threaten-
ing to destroy
occasion f
lif
e. The j
udge's remark is the
or these pages.

inf
ec-

ROENTGENOGRAPHIC DIAGNOSIS 27
been discharging externally
the j
aw f
or sev
the best phy
under the angle of
en y
sicians,
ears in spite of
treatment by
and I was asked to recom-
mend a good skin specialist. It seemed desirable
to introduce a probe which led up through the j
bone to the root of
aw
a tooth. And it was a simple
enough matter under a general anesthetic to ex-
tract the tooth and curette the bony
entire length of
permanently
The abov
the f
healed in ten day
e is a brief
local lesions directly
orm the f
and sy
af
some of
constitutional inf
ing v
ariety
Inf
of
ections pro-
secondary
ection Not Alway
nected W ITH the Teeth.
one in which an ey
lesions
s Con-
A case in point was
e and ear specialist had f
ears and a half
suf
and had constitutional sy
or
ered tortures f
mptoms f
ery
upper tooth extracted. The pain continuing,
ules of
bone had been cut out of
rongeur f
been suspected and no alv
graph of
the whole f
aw
radiographs
a tooth as had
eolar abscess. A radio-
ace (
Figure 14)
showed that one antrum was absolutely
Dr. Cry
er,
opaq
of

It was operated on by
spic-
the upper j
orceps. A number of
showed no retained broken root of
rom pain,
or which the
ethmoid cells had been scraped out and ev
by
the
ecting the teeth which may
mptoms.
The Focus of
two y
s.
exposition of
ocus of
ducing an amaz
socket and the
istulous tract. The latter was
howev
ue.
Philadelphia,
er,
28 ROENTGENOGRAPHIC DIAGNOSIS
who remov
ed a mass of
pus and granulation tissue
and the pain was cured. If
the x-mj
resorted to in the beginning,
of
suf
ering and the useless extraction of
upper teeth would hav
The x-raj
had been
two and a half
will rev
e been av
eal any
ears
all the
oided.
source of
inf
ection
connected with the teeth or the pneumatic sinuses
of
the f
discov
ace,
if
uences might f
av
these are present. If
ered and untreated,
ollow which could easily
erted and which may
to cure af
these were un-
the most serious conse-
ter they
hav
be exceedingly
hav
e dev
dif
e been
icult
eloped. A case in
point is described later in which the author dis-
cov
ered the cause,
but the teeth seemed perf
sound to the dentist with his usual means of
amination. The patient,
terrible neuritis,
ally
died of
a phy
sician,
high blood pressure and ev
apoplexy
apparently
e the cause in time.

to remov
himself
ectly
ex-
had
entu-
rom neglect
CHAPTER III
CONDITIONS FEOM W HICH ALV
EOLAE AB
SCESS AND
PYORRHEA ALV
EOLARIS MUST B
Pulp-stones.
These are calcareous concretions
in the pulp or "
nerv
pain,
e"
of
and the patient comes f
E DIFFERENTIATED
the tooth. They
cause
or a radiograph
which is expected to ^
show the location of
alv
an
eolar abscess. The
picture,
howev
an area of
er,
shows
density
in
what should be the per-
ectly
transparent con-
tents of
the pulp-cham-
ber. The ''nerv
e"
is
more or less irritated and there is as in Figure
15 a slight departure f
ance of
rom the normal appear-
the bone surrounding the apex of
Such cases are treated by
Malocclusion.
alv
Pain,
eolar abscess,
dications of
simply
remov
the root.
the "
similar to that of
and v
apical irritation,
the result of
al of
ery
slight radiographic in-
may
occasionally
constant pressure,
when biting or chewing. The dentist can remedy
regulating the teeth slightly

Figure 15.
be
this tooth
alone making contact with the opposing teeth
the cause by
nerv
chronic
or by
e."
gTinding the surf
ace of
this tooth or the one it
collides with. This explanation of
the case should
be accepted with more than the traditional grain
Figure 16a.
Figure 16b.
Figure 16c.
Figures 16a,
tis,
16b and 16c.
Endocarditis,
Apical Abscess in Case of
Meningitis,
Pleurisy
AND Hemiplegia.
Discomf
of
ort at f
salt. Of
irst considered due to malocclusion.
course if
the pain ceases and the
radiographic appearance becomes normal,
ut if
that is
more or less dis-

all that can be desired. B
Arthri-
Pneumonia
OF DENTAL INFECTION 31
comf
ort remains and the radiographic appearance
continues distinctly
be temporiz
by
abnormal,
ed with ev
the case should not
en though the usual tests
the dentist indicate a v
ital and healthy
Figures 16a and 16b show the progress of
tooth.
such
a case under expectant treatment. The sy
mptoms
and radiographic appearance at the start were as
described abov
e. Grinding the surf
opposing teeth did away
the discomf
the
but
ort and abnormal radiographic ap-
pearance persisted f
attack of
aces of
with their collision,
or y
ears. Then there was an
intense pain necessitating the use of
morphin and accompanied by
puration. This req
swelling and sup-
uired months of
treatment
through the root-canal. Figure 16c shows the
same tooth a y
ear later with the root f
the apex and surrounded by
prov
healthy
ed to be sterile when extracted (
The treatment of
illed to
bone. It
page 49)
ust such a case should,
cording to the author's v
iew,
into the tooth and remov
ing the dead or dy
or simply
chronically
be done bef
ery
The v
ery
the case of
consist in drilling
irritated nerv
ing
e. This should
ore its putrid decomposition has poi-
soned the alv
recov
ac-
eolus or bony
socket almost bey
ond
serious subseq
uent dev
elopments in
this patient are described at page
46.
sts.
A cy
st in either the upper or the lower

Cy
32 ROENTGENOaRAPHIC DIAGNOSIS
aw may
alv
cause sy
mptoms resembling those of
eolar abscess and the radiographer should be
caref
ul to dif
cent case (
erentiate between the two. In a re-
Figure 17a)
there was a large area of
the roots of
treated by
Dr. Clawson,
transparency
between
the lateral incisor and the canine.
Figure 17a.
Figure 17b.
oth these teeth had healthy
''nerv
contained a clear straw-colored liq
successf
ully
treated by
es."
The cy
st
uid and was
incision,
curettage and
packing without disturbing the two neighboring
teeth. Figure 17b shows a cy
presence of
a man 45 y
def
st accidentally
re-
ealed in a radiograph made to determine the
an unerupted upper canine tooth in
ears old. A large,
ined cav
is f
ten is ev
req
thin- walled,
uently
idenced by
a cy
clearly
st ;
decalcif

olar abscess of
ity
while an alv
ication
e-
OF DENTAL INFECTION
33
gradually
shading of
t*
into healthy
a distinct line of
demarcation.
A dentigerous cy
st commonly
swelling upon the j
bone without
shows as a hard
aw and is essentially
a cav
ity
in the bone wherein lies an unerupted and usu-
HH
/ '"
"
'^-^i^^B
S/M
-w4
FiGUEE ISa.
ally
supernumeraiy
tooth. Exceptionalh^
the a?
-ray
shows that
such a swelling is an Figure ISb.
odontoma,
a tumor of
almost stony
hardness and consisting of
glomeration of
nodules of
a con-
dentine cov
ered by
enamel.
Alv
eolae Abscess and Unerupted Tooth Com-
bined,
In a patient sev
ul swelling of
the lower j
enty
aw,
ears old with pain-
the dentist could
not determine whether the cause was an unerupted
tooth or an alv
Figure 18a)
eolar abscess. The radiograph
showed that both conditions were
if
ty

present. Another patient aged f
ears was
ref
erred f
or an exam-
ination to determine the
presence of
an nnerupt-
ed upper canine. The
radiograph (
18b)
Figure
showed the un-
erupted tooth and an
unsuspected alv
abscess of
eolar
an upper molar.
An IMPACTED W ISDOM TOOTH ly
ing perhaps in a
FiGUEE IDa.
Figure 19b.
Flariiig apical f
oramina of
the anterior root of
the 12-y
the 6-y
ear molar are normal. Ab-
ear molar.

scess of
horiz
ontal position concealed in the j
ing directly
against the root of
causes pain suggestiv
e of
aw and grow-
the second molar,
neuralgia or neuritis. It
is mentioned in this place because of
the misin-
terpretation that has sometimes been made of
the
radiographic appearance. The unerupted tooth
Figure 19a)
and if
lies in a natural cav
the root is not f
ully
dev
ity
in the j
eloped a trans-
parent area is seen at that end. This represents
sof
t tissue in which tooth substance is dev
eloping
and is not an abscess.
The FLARING FOEAMEN of
ay
a still gTowiug tooth in
oung person should not be mistaken f
or an
abscess. Figure 19b shows a case with both ab-

scess and this normal appearance.
aw
CHAPTER IV
KECENT B
Hartz
to v
ACTERIOLOGICAL AND CLINICAL STUDIES
ell,
Henrici and Leonard ^ hav
erif
and py
orrheal pockets both harbor streptococci
which will induce in animals inf
lammation of
heart muscle,
lammation in blood-v
oints,
inf
egetations in heart v
cular lesions and both f
tions of
e been able
the statement that ''para-apical abscesses
the kidney
the
es,
essels,
ocal and dif
s."
alv
inf
used inf
During the past y
ected
inducing v
as-
ec-
ear they
ound similar post mortem human lesions particu-
larly
of
the heart v
which they
believ
alv
e,
heart muscle and kidney
e are produced by
ganisms. The medical department of
sota Univ
cent of
suf
ersity
the Minne-
Medical School report that 12 per
the indiv
ering f
the same or-
iduals admitted to the hospital are
rom conditions due to mouth inf
ec-
tion. Their bacteriological work shows the con-
stant presence of
the streptococcus v
chronic dental abscesses and py
and a sterile condition of
ly
healthy
tic streptococci are absent f
and f
rom py
^ The report of
orrhea. The pneumococcus is absent.
The Minnesota Div
ember,
ision of
Journal of
1915.

Nov
teeth. Hemo-
rom these abscesses
dation and Kesearch Commission,
sociation,
iridans in
orrheal pockets
the Scientif
ic Foun-
National Dental As-
Their studies conv
ince them that peridental in-
lammations are primary
lesions,
the organisms
gaining access to the tissues either through the
pulp canal or at the gingiv
al margin,
ondary
ocus. Their studies of
to some other f
endameba buccalis conf
and not sec-
the
irm the statement of
ass
and others that these organisms are practically
alway
s present in diseased mouths,
but they
ind them most numerous in the deep parts of
pockets nor in the tissues. They
ind these amebae
in the pus which contains their natural f
this being bacteria and pus cells. They
able to conf
irm a causativ
the endameba and py
do not
the
ood,
are un-
e relation between
orrhea and alv
eolar ab-
scess.
In the medical wards they
cially
arthritis,
stomach,
heart lesions,
phritis and nerv
They
ne-
the neuralgic ty
orrhea as causativ
req
uently
pe.
en in cases originating f
ocus of
inf
ef
actors in these
the sole cause and
rom tonsillar or other
ection,
the presence of
or dental abscess will keep up the disease af
the large f
these f
py
orrhea
ter
ocus has been cured. All these cases
are markedly
of
the
pernicious anemia,
ind no important distinction between dental
diseases. Either is f
large f
e studied espe-
ous diseases of
abscess and py
ev
hav
acute and chronic ulcer of
improv
oci of
ed by
inf
complete extirpation
ection. To q
uote f

Leonard's report:
rom Dr.
' ' A minute examination with ev
able is necessary
caref
ul exploration,
it is still dif
means av
ail-
the x-YSij
and
icult to f
ind all
oci about the teeth. W ithout these aids it is im-
possible. W hen a phy
ery
. W ith the aid of
ering f
to come f
sician ref
ers a patient suf
rom rheumatism or other disease liable
rom dental inf
ection,
it is impossible f
or
the dentist to make a complete determination with-
out the use of
the x-y
the experience of
deal that the maj
clinical sign of
sore,
slj
. It is our experience and
others who use the x-y
ority
of
a good
e no
their existence. The teeth are not
no swelling or palpable sof
end rev
slj
dental abscesses giv
t spot at the root
eals what the radiograph shows and what
the subseq
uent operation conf
common to f
irms. It is not un-
ind abscesses shown in the radio-
graphs in cases in which there are no breaks in
continuity
of
the pulpal wall,
illings or ev
en sound teeth.
as under crowns,
'' Experience with radiography
also shows that
av
artif
ery
large proportion of
subseq
by
uently
Dr. Henry
icially
become abscessed. A study
Ulrich of
Minneapolis of
a thousand
radiographs taken at random indicated that ov
70 per cent of
the artif
icially
checked this up by
ing ov
in which,
diagnosis,
ov
er 60 per cent of
scessed. A consideration of
to do away
ery
ering f
means
place in
that this must be taken
rom sy
rare that we hav
dental f
oci in
stemic disease. It has
e extracted a tooth

been v
such were ab-
the necessary
into account in a determination of
cases suf
look-
according to our
with this condition is out of
this report. The point is,
er
illed roots were ab-
scessed. W e partially
er a hundred,
illed roots
made
which showed an abscess in the radiograph and
ailed to get streptococci when we cultured f
rom
tlie root end. Our techniq
ue is sucli that con-
tamination in making these cultures seems impos-
sible.
' ' It is amaz
ing to f
how much py
ind in well cared f
orrhea may
or mouths
exist without being ev
i-
dent except to painstaking exploration. To those
amiliar with sy
stemic results coming f
rhea in such a large proportion of
rom a slight py
ov
erlooking of
dentists,
orrhea,
rom py
cases and ev
or-
en
the careless ignoring and
such trouble on the part of
most
seems nothing less than malpractise.
^^^^^^^
''The last y
ear's work has tllro^\
on the adv
isability
of
of
the cases. There is no q
liant results f
ous v
req
accines in all
uestion but that bril-
uently
accines or ev
^l some doubt
the use of
ollow the use of
en those prepared f
lesions in other patients. A v
accine prepared
in the case of
whose case is giv
abov
e,
Miss A. F.,
was used by
other rheumatic case,
actory
giv
oci,
permanent relief
ed the recov
ery
. In most of
my
three of
al of
pericarditis. Remov
inf
ection prev
alv
er,
oci are re-
accine luill
the cases
iciently
rapid and
ented f
ocarditis and
the causativ
ular cases and general medical
measures were adopted to f
av
urther damage to

the heart in v
ev
accine was not needed. ' '
Four cases had a diagnosis of
oci of
hoiv
oci were re-
was suf
complete to indicate that v
or an-
ul in eliminat-
he expected that a v
where we were sure that all local f
mov
accines,
and until such local f
ed it can hardly
e any
en
sicians f
idence in them which is
to make the dentist less caref
ing all local f
mov
the phy
in his opinion with satis-
results. The use of
liable to create a conf
likely
one of
autogen-
or similar
or compensation.
is
CHAPTER V
LESIONS AND SYMPTOMS SECONDAEY TO INFECTION
CONNECTED W ITH THE TEETH OR THE PNEU-
MATIC SINUSES OP THE FACE
Tuberculosis.
one of
It has long been known ^ that
the common sites of
bony
inf
ection in pulmonary
and glandular tuberculosis is an alv
eolar
abscess. And the con-
tinued existence of
pus pocket is,
such a
theref
ore,
a distinct menace to lif
itself
. Figure 20 shows
such an abscess in a
patient shortly
death f
bef
ore
rom tuberculosis.
Neurasthenia.
A man
Figure 20.
Figure 21a. Figure 21b.
^ Tousey
' ' Medical Electricity
. Saunders Co.,
Eoentgen Eay
Philadelphia.

W .B
s and. Eadium. ' '

Figure 22.
thenia. Anteroposterior V
Fro^'tal Sinus Opaq
iew.
ue in a Case of
41
Neuras-


& 4H
43
in

of
powerf
was lately
ul phy
ref
siq
ue and weighing 220 pounds,
erred to me suf
thenia. He complained chief
ly
of
to stand as much business activ
ity
sibility
as one of
ering f
rom neuras-
not being able
and respon-
his apparent strength would be
M^
J^
Figure 24.
Alv
Abscess ix Digestiv
eolab Pigure 25a.
Py
orrhea in
e Spinal Arthritis.
Neurasthenia and
ueunculosis.
expected to. There had been no dental but some
nasal sy
mptoms.
The radiographs showed sev
pockets including (
eral py
Figure 21a)
lower second bicuspid due probably
rom the retained and inf
orrheal
one of
the right
to irritation
ected roots of
the f
irst
molar. An antero-posterior and also a lateral
radiograph of
to be opaq
the head showed the f
ue either f
congenital absence of

substance or because of
rontal sinus
rom pus or some other opaq
the
ue
46 ROENTGENOGEAPHIC DIAGNOSIS
rontal sinus. Dr. Culbert,
the rhinologist,
tliinks
the latter is the case.
In another case of
neurasthenia apply
author f
examination,
or x-rsij
Figure 21b)
sion of
showed an alv
eolar abscess with ero-
a considerable part of
was only
partly
ing to the
the radiograph
the root. The canal
illed and the f
oramen wide open.
Figure 25b.
Figure 25c.
Akthkitis has become known within the last
ew y
nating f
ears to be f
req
scess or py
eolar ab-
orrheal pockets. Figures 25a,
25b and
since this discov
ections in these cases. And
ery
many
chronic '' rheumatism"
Pleueisy
AND Hemiplegia.
ocus of
inf
acute or
ection.
Endocaeditis,
A patient was ref
page 30 with a lower f
Meningitis
erred to on
irst bicuspid which the
irst thought was simply
irritated by

dentist at f
a case of
has been cured in a short
treating the f
Aetheitis,
due to toxemia origi-
an alv
25c illustrate dental inf
time by
uently
rom and maintained by
striking against an uj
the f
ormation of
per tooth. This went on to
an alv
ej
olar abscess. Following
prolonged treatment through the root-canal the
tooth was f
illed.
Figure 26 shows this tooth in an apparently
cured condition. The root f
to the apical f
illing reaches about
oramen and the ^ ~
surrounding bone has regen-
erated. During the latter part
of
the summer,
the patient be-
gan to complain of
discomf
renewed
ort and wanted to hav
the tooth extracted,
but a ra-
diograph showed it to be all
right. There was a peculiar
^ ^ . Figure 2G.
appearance to the adj
acent
second bicuspid. Then f
tiv
e attacks of
ollowed a series of
arthritis,
my
Each attack lasted a week or ten day
duced v
ery
sev
ugi-
ositis and neuritis.
s and pro-
ere pain. During these two months
the patient lost twenty
pounds in weight and at
times had a slight rise in temperature. A diet
rom which sugar and meat were excluded and
medication by
licy
applications of
tra-v
aspirin,
salophen and sodium sa-
late produced little or no elf
iolet v
high f
req
ect. Finally
uency
af
currents f
acuum electrodes seemed to hav
ew
rom ul-
brought these attacks to an end. On December
howev
er,
she was seiz
ed by

5th,
sudden sev
ere
pain in the lef
t npper q
uadrant of
with great rigidity
of
pain was not reliev
ed by
and gradually
the lef
pleurisy
with ef
greatly
laxativ
usion dev
the chest,
sical signs of
eloped. The heart was
dilated and there were rasping mitral
and an ice bag ov
the sev
erity
of
the sy
sical signs.
Af
iv
ter f
e weeks of
rooks in consultation f
the clinical picture of
tuberculous pleurisy
ree diet
reduced
mptoms without much change
this acute illness,
Dr. Harlow
ound that she presented
tubercular peritonitis and
on the lef
latness at the base of
which with the onset of
constant leukocy
a purin-f
er the heart temporarily
in the phy
also f
t side of
s the phy
murmurs. Absolute rest in bed,
es and enemata
extended to the lef
where in two or three day
tlie abdomen
t rectus muscle. This
t side. There was
the right lung behind,
meningitic sy
mptoms and
tosis led to a suspicion of
scess which was disprov
en by
ab-
an exploratory
puncture.
The meningeal sy
mptoms became rapidly
worse ;
the patient was unable to speak a connected sen-
tence. There were sev
lasting f
eral sev
ere conv
rom an hour to an hour and a half
A spinal puncture showed a clear f
ulsions
each.
luid under nor-
mal pressure and containing no microorganisnls,
and negativ
e to the W assermann test. The spinal
luid contained one ly
mphocy
te to about 15 red

cells. The blood contained no microorganisms and
Figure 27.^Dilated Heaet,
Enlarged Thy
mus and Mottling
OF Lung.
Case of
arthritis,
and hemiplegia f
endocarditis,
rom dental inf
pleurisy
ection.

49
pneumonia,
meningitis

was negativ
e to the W idal and W assermann tests
and contained 25,
000 leukocy
tes per cubic milli-
meter. The urine contained albumin and casts,
radiograph of
portable outf
the chest (
the chest,
dilated heart and an
temperature 102 1/>
. Potter and his assistant. Dr. Ord-
had alway
ection,
s been suspicious of
possibly
respi-
degrees F.
way
inf
luid in
mus gland. The pulse was 120,
Dr. N. B
but mottling on the right
side. It showed a greatly
ration 34,
made with a
it showed no collection of
either side of
enlarged thy
Figure 27)
streptococcus
rom the teeth shown in my
radiographs. And it had been the plan that the
irst time the patient went out of
be to the dentist's of
doors it should
ice to hav
ond bicuspid drilled into and the q
lif
e or death of
its nerv
become ev
ident,
of
e or death of
the lif
and remov
remov
the
e decided. It had now
howev
er,
that it was a q
the patient to discov
e the source of
less it should prov
e the suspected sec-
uestion of
inf
uestion
er
ection at once un-
e to be tubercular and not
able. Dr. Henry
Sage Dunning accordingly
operated upon the patient in bed under local an-
esthesia. He extracted the originally
bicuspid without dif
iculty
the second bicuspid broke of
inf
ected f
irst
. The hooked root of
as had been antici-
pated and had to be chiseled out. The operation
took about two hours,
ement in ev
but was entirely
ery
painless.
particular began f

Improv
rom
that moment. The original tooth was f
be sterile,
but a culture of
clans was obtained f
on the f
if
the improv
iri-
rom the second bicuspid and
th day
with autogenous v
ound to
the streptococcus v
af
ter the operation inoculations
accine were begun. Af
ter this
ement was more rapid and on the
thirteenth day
af
ter the remov
respiration was 24,
pulse 74,
al of
the teeth the
temperature 98 de-
FlGUKE 28.
Figure 29.
grees F.,
daily
and the patient's strength increasing
. The phy
subseq
sical signs were clearing up. The
uent course of
this case has been remark-
able. The patient has recov
of
ered f
pneumonia and has partly
rom an attack
recov
ered f
rom
hemiplegia supposed to be due to an embolus.
She is still in bed running an irregular septic tem-
perature and the only
hav
e any
benef
a dead culture of
is believ
ed that if
ect is the inoculation with
the streptococcus v
iridans. It
her strength holds out her re-
ection will be increased to such

sistance to the inf
treatment that seems to
icial ef

Figure -"
Facial neuralgia f
^n.
Unf
or which extirpation of
khpied 'iooin in the T owek Jaw.
was planned.
53
the Gasserian ganglion

an extent as to bring about recov
ery
. The case
at present seems to be one of
endocarditis with
alv
egetations upon the heart v
sionally
produce inf
spleen and kidney
ery
es which occa-
arctions in such organs as the
s,
where the conseq
uences are
serious.
Neubitis,
neukalgta,
tic douloureux,
constitute a group of
sciatica,
cases in which one's f
irst
thought is to determine the presence or absence
of
a cause connected with the teeth or sinuses,
or no ordinary
medical agents will av
ail if
the
trouble is due to such a cause. Figure 28 is
an example of
positiv
ef
Figure 29 shows one of
ection in a case of
4y
ears in spite of
exactly
medical and hy
The x-iaj
tra-v
of
ery
pain at a f
as if
relief
through ov
sev
gienic measures.
req
uency
eeling
rom ul-
e a great deal
inal cure was accomplished
ercoming intestinal auto-intoxication,
e been the underly
The negativ
e x-raj
rom needless and inef
Figure 30 is of
T. B
aw bone.
currents f
acuum electrodes gav
but the f
al,
en into the j
which appears to hav
in-
or 3 or
ere tic douloureux
ew seconds' interv
a tack were driv
and high f
iolet ray
oci of
headache persisting f
Another patient had v
spasms of
indings in these cases.
the dental f
a case ref
indings sav
ectiv
erred by
e sacrif
ice of
the late W m.
ull. The patient had been treated by
neurolo-
and Paris

gists and electrologists in this country
ing cause.
ed the patient
his teeth.
or trigeminal neuralgia which had persisted f
three y
ears. Dr. B
operation f
glion,
or the remov
but as a f
an x-iaj
ull had arranged to perf
al of
the Gasserian gan-
inal preparatory
step sent her f
or
examination. The pictures showed an
unerupted tooth near the angle of
Dr. B
or
orm an
the j
ull operated upon with a cure of
aw,
which
the dis-
FiGUEE 31a.
FiGtTRE 31b.
ease and the patient was sav
ering and danger of
Pakoxy
smal Cough.
has recently
thor by
ed the f
ruitless suf
Such a case in a man who
become blind,
was ref
erred to the au-
Dr. Osborne. The radiographs,
them being Figures 31a and 31b,
abscess and numerous py
among
showed alv
eolar
orrheal pockets. Dental
treatment not hav
ing been beg-un,
scales are clearly
the calcareous
isible upon the root of
one of
the lower centrals.
aeteeial hy
peetension,
leading to ae-

Cases of
an intra-cranial operation.
OF DENTAL INFECTKJN
57
TERioscLERosis witli maiiy
and a prospect of
a:;
-ray
distressing sy
apoplexy
examination of
mptoms
and death,
call f
or an
the teeth and pneumatic
sinuses. Figure 32a showed extensiv
e py
orrheal
and abscess areas about the teeth. The patient
was prof
essor of
lary
ngology
and rhinology
Figure 32a.
of
our univ
ersities and had been ref
or treatment of
neuritis of
der treatment elsewhere f
which I thought was of
or high blood-pressure,
the same toxic origin as
the neuritis. Suspecting dental inf
ection,
the radiographs which showed the area of
tion. I most strongly
ound the teeth healthy
how-
according to his

ec-
applications
made through the root-canals. The dentist,
er,
I made
inf
urged treatment either by
extracting the alTected teeth or by
ev
erred to me
the arm. He was un-
in one
tests and ref
used credence to the ic-ray
It was bef
ore the general recognition of
source of
sy
stemic inf
was allowed to go f
indings.
tliis
ection and so the doctor
rom bad to worse until he was
in a desperate condition in the B
attle Creek Sani-
tarium. There he met a dentist who believ
ed the
Figure 32b.
Figure 32c.
story
told by
terribly
the radiographs. A number of
abscessed teeth were extracted with im-
mediate and marked constitutional benef
his return to New York the radiograph (
32b)
showed other inf
the upper j
aw f
only
extraction of
e,
would hav
56 y
ected areas remaining in
ew weeks he died of
all the inf
e sav
apoplexy
ected teeth,
ed this usef
ears old.

liev
but on
rom which all the teeth had been
extracted and in a f
Timely
it,
Figure
ul lif
I be-
e. He was
OF DENTAL INFECTION
59
Figure 32c is of
suEE,
a lady
with high blood-pres-
seldom lower than 220,
ibrillation and occasional sy
and with auricular
ncope
altogether
Figure 33a.
Figure 33b.
FlGURK 33c.
Figures 33a,
Mitral Iiv
33b and 33c.
SLTirFiciEX
Alv
calling f
or the immediate sacrif
teeth if
her lif
e is to be sav
Caediac lesions secondary
ice of
the inf
ed.
to dental inf
ing rheumatism,
ection
nephritis or

with its accompany
eolar Abscesses ix a Case of
CY.
ected
neuritis,
of
were endocarditis in twenty
thirty
-one of
Hartz
ell,
cases and were ev
idenced by
ally
mitral insuf
nosis of
mov
my
al of
iciency
alv
ef
ular disease,
usu-
. Four cases had a diag-
ocarditis and three of
the causativ
-three out
Henrici and Leonard's
pericarditis. Re-
oci of
urther damage to the heart in v
alv
inf
ection prev
ular cases and
general medical measures were adopted to f
av
or
compensation.
Cardiac lesions hav
and Figures 33a,
which they
inf
e already
been ref
33b and 33c are of
erred to;
a case in
are the most important result of
dental
ection. The patient has a mitral murmur,
ral regurgitation with some compensatory
largement of
the heart,
tremities or dy
mit-
en-
but no edema of
spnea. Getting up q
uickly
the ex-
rom a
reclining posture would cause him to drop back
practically
suddenly
in a f
aint and he has to av
numerous granular casts,
acid and f
ormerly
occurrence of
calcium oxalate,
a swelling of
all the teeth. Py
ound about sev
uric
contained albumin. The recent
one or two f
and one knee caused him to hav
made of
oid turning
or the same reason. The urine contains
inger j
e radiographs
orrheal pockets were
eral teeth;
and there were three
alv
eolar abscesses with considerable destruction
of
bone. The three abscessed teeth were extracted.
The f
irst two contained no pathogenic microor-
ielded a culture of

ganisms. The third y
strepto-
oints
ented
OF DENTAL INFECTION
61
coccus v
iridans f
rom which an autogenous v
ac-
cine has been prepared.
Exophthalmic Goitre.
which an ic-ray
necessary
This is a disease in
examination of
. Arising in y
it might seem unlikely
the teeth is v
outh as it of
ery
ten does,
that a dental inf
ec-
Fi3UEE 34a.
Figure 34)
tion should hav
e been present as an exciting
cause. Figure 5 (
ture of
ay
Figure 19b (
amily
hav
page 14)
howev
oung girl with an alv
page 34)
er,
is a pic-
eolar abscess,
is another. In nearly
and
ev
some case of
dental abscess can be f
e occurred during y
outh or childhood. Those
with manif
est sy
mptoms hav
more or less successf
would hav
ully
e usually
but the x-y
x-YSLj
pical dental
indings in exophthalmic goitre. In one
eolar abscesses of

case there had been alv
ound to
been treated
rj
e disclosed those with an insidious
course. Figures 34a and 34b show ty
ery
two
alone
lower molars f
or a long time. In the other case all
the upper and lower teeth except two or three iso-
lated ones had been lost through py
Ey
e Diseases.
Figure 35a.
Alv
Some of
orrhea.
the cases which were
eolar Abscesses in Case of
Tinnitus
AuRIUM.
Figure 35b. Figure 35c.
Figures 3ob and 35c.
Case of
ormerly
sy
Alv
eolar Abscesses and Py
orrhea in
Pernicious Anemia and Spinal Sclerosis.
philis hav
diagnosed as due to rheumatism or to
e been f
ound to be due to dental inf
tion. The uv
eal tract including the choroid,
iary
and the iris,
is most apt to be af

body
ec-
the cil-
ected by
this cause. Cases hav
e been known in which ev
one ey
e has been lost and this cause of
discov
ered in time to sav
tient represented by
e the other. The pa-
ect of
meningitis and at
another stage episcleritis as a direct ef
en
ection
radiograph No. Ki liad
neuroretinitis as an ef
inf
inf
ection or as a reaction f
ect of
the
rom the autogenous
accine. The patient in radiographs Figures 31a
and 31b became blind and without any
of
light shortly
ered,
bef
ore the inf
but perhaps not in conseq
Tinnitus aueium was the sy
of
by
a patient ref
perception
ection was discov
uence of
it.
mptom complained
erred to me by
Dr. Clawson.
The radiographs showed no dental lesion. Figure
35a,
on the other hand,
scesses in a phy
show^s three alv
sician with a noise as of
eolar ab-
ten thou-
sand crickets in each ear. The ringing in the ears
may
in other cases be an indirect result due to
high blood-pressure caused by
Spinal coed lesions hav
niz
the dental inf
e recently
ed to be sometimes due to inf
ection arising
rom the teeth. Figaires 35b and 35c,
tient of
Dr. SoUey
numbness and loss of
's,
ection.
been recog-
are of
a pa-
with pernicious anemia and
power in the upper and
lower extremities. She was in a desperate con-
dition with hemoglobin of
ev
ery
dence of
day
general,
ailey
not merely
ound positiv
lateral,
mptoms indicating a stage of

sclerosis with sy
33 and becoming weaker
. Dr. Pearce B
spinal
ir-
e ev
i-
64 EOENTGENOGEAPHIC DIAGNOSIS
. ritation rather than destruction of
the nerv
and cells and with a possibility
partial or com-
plete cure if
discov
alv
the source of
ered and remov
of
inf
eolar abscesses of
prepared f
ibers
ection could be
ed. The radiographs showed
sev
eral teeth. These teeth
were extracted and an autogenous v
streptococcus v
ef
accine of
the
iridans administered which was
rom the pus. The same germ had been
ound in this patient's blood. There has been im-
mediate improv
restoration of
ement in her general condition and
power in the arms but there is still
a paretic condition of
the lower extremities.
Gasteic IJLCEE.^The most surprising success
has been reported by
Hartz
ard ^ in the treatment of
ell,
Henrici and Leon-
gastric and duodenal
ulcer. Unmistakable cases were cured so
promptly
as to indicate a causativ
tween the dental inf
e relation be-
ection and the destructiv
process in the gastric wall. W e cannot tell which
of
the two f
actors is most important. There is
the irritation f
constantly
rom the inf
the hematogenous inf
of
this easily
of
many
ected matter which is
swallowed with the saliv
act of
discov
cases of
erable and remov
able cause
gastric and duodenal ulcer,
is a
great importance. Consider the number of
^Eeport of
the Minnesota Div
tion and Eesearch Committee,
Nov
ember,
ision of
Journal of
1915.

ciation,
a and there is
ection. The demonstration
the Scientif
ic Founda-
National Dental Asso
OF DENTAL INFECTION
65
these cases coming to the roentgenologist f
nosis af
ter months or y
ears of
weight and strength. Also the tendency
currence af
or diag-
pain and loss of
to re-
ter medical treatment and the tendency
to produce adliesions interf
ering with gastric and
intestinal digestion and transit. Also the danger
Figure 36a. Figure 36b.
Figures 36a and 36b.
Two Cases of
of
adhesions f
the ev
dev
Alv
orrhea in
ollowing operativ
e treatment and
er-present danger that a chronic ulcer will
elop into cancer.
Figure 36a shows alv
roots of
eolar abscesses of
a lower molar tooth as one of
in the case of
a lady
treated unsuccessf
who f
ully
or duodenal ulcer. Af
or two y
or sy
ears prev
been pain about this tooth,
ears had been
mptoms of
iously
the only
gastric
there had
treatment
counter-irritant applications.

ing been by
both
the lesions
ter seeing the radiograph
she recalled that three y
hav
eolar Abscesses and Py
Gastric Ulcer.
66 EOENTGENOGRAPHIC DIAGNOSIS
Figure 36b shows an alv
of
the three dental f
eolar abscess as one
oci of
had a large hemorrhage f
temporary
recov
FiGURE 37
Lesion Req
ery
inf
ection in a lady
who
rom the stomach with
under absolute rest and suit-
Radiograph to Determine Presence of
Gastric
uiring Operation,
able diet. Later there were f
urther gastric sy
mp-
toms and a large six-hour residue as demonstrated
by
a radiograph.
The dentist thought it wise to extract this tooth
and two others.
It seems as if
x-y
slj
examination of
the stomach
the teeth should go hand in hand in cases

and of

Figure 38.
OR Intestinal Lesion Req

Radiograph to Determine Presexce oe Gastric
67
uiring Operation.
of
suspected gastric or duodenal ulcer. Of
radiographs of
course
the stomach and intestine like Fig-
ures 37 and 38 should be made to exclude the
presence of
a lesion req
uiring an abdominal op-

eration.
CHAPTER V
GENEEAL CONCLUSIONS
The f
ollowing general conclus'ons are to be
drawn : A putrescent mass in the pulp chamber of
a tooth may
walls of
able of
exist f
the cav
or months or y
ity
ears because the
cannot collapse and are incap-
throwing out granulations and ev
illing the cav
ity
natural process of
with healthy
the body
constantly
poison the bony
the apical f
oramen suf
recogniz
tion may
not rev
tissues surrounding
iciently
to produce an ef
able in a radiograph. This condi-
be unknown ta the patient and sometimes
eal itself
to the usual tests applied by
ection secondary
grav
. This putrescent mass may
dentist. From this long-persisting source of
like the
curing an abscess in the sof
tissues of
clearly
entually
tissue,
lesions and sy
est and most div
The rr-ray
ersif
the
in-
mptoms of
the
ied character may
arise.
is to be depended upon to show
whether or not the source of
trouble is connected
with the teeth or the pneumatic sinuses,
and if
so,
whether the trouble is due to malposition and un-
natural pressure or to inf
mistake to regard ev
and proceed to sacrif
ery
ection. It would be a
case as due to the teeth
ice the latter without f
making a radiograph which may
complicity
irst
uit them of
in the matter.

any
acq
ect
AUTHOR'S PUB
LICATIONS
THE AUTI-IOR'S OTHER PUB
THE X
"
Radiotherapy
Radiography
."
Stomatology
July
"
LICATIONS UPON
-RAY IN DENTISTRY
in Py
orrhea Alv
Read bef
March 1,
1904,
1904. Interstate Dental Journ.,
Recent W ork with the A'-ray
Treatment of
Py
A"
orrhea and Cancer."
June,
- ray
rief
uency
Read bef
Oct. 17,
ore the
1905. Dental
1906.
Examination of
New York Institute of
Dental B
and High Freq
Dental Cases and in the
New York Odontological Society
"
and Dental
pp. 495-502.
Currents in the Diagnosis of
Cosmos,
eolaris,
ore the New York Institute of
the Teeth."
Dental Techniq
Philadelphia,
ue,
May
Read bef
ore the
Feb. 28,
1905.
1905;
ol. X
No. 5,
pp. 257-266.
"
A'-ray
and High Freq
nosis and Treatment of
Association,
Jersey
uf
uency
alo,
1905. Dental Cosmos,
State Dental Association,
' ' Application of
the A'-ray
rents in Dentistry
."
"
Currents in the Diag-
Dental Cases. ' ' National Dental
July
rief
Radiographs Illustrating the Topography
the Face."
tion on Lary
and Rhinology
"
ngology
Medicine,
The X
Read bef
March 24,
-ray
Dec. 18,
uency
Sept.,
of
Read bef
1905,
1905.
and High Freq
Dental B
Pneumatic Sinuses of
of
Cur-
1906.
the
ore the Sec-
New York Academy
1907.
and the Ultra- V
iolet Ray
ore Philadelphia Academy
of
1908.

71
in Dentistry
Stomatology
."
New
72 AUTHOR'S PUB
"
The X
-ray
LICATIONS
and the Ultra-V
nosis and Treatment."
tion presented bef
13,
"
iolet Ray
ore the Northern Dental Society
1909. New York Medical Journal,
A"
-ray
Age of
Measurement of
Fiv
Meeting of
May
8,
''X
-ray
Age of
ide f
the Dental Arch if
the Dental Society
or Preliminary
Req
of
uired."
Measurement of
Fiv
School of
1914. Harv
-ray
New York,
the Unerupted Teeth at the
e or Six Years to Prov
ide f
the Dental Arch if
Orthodontia,
or Preliminary
Req
uired."
Prev
ention of
Fiv
April 23,
Oct. 15,
Nasal Diseases ;
e or Six Years as a Prophy
against Spurs and Dev
iations of
the Tonsils,
matic Sinuses."
Read
the Angle
5th Annual Meeting,
ard Odontological Society
tion at the Age of
orders of
Annual
State of
ore the Eastern Association Graduates of
''X
May
1910.
1913.
Regulation of
bef
March 19,
the Unerupted Teeth at the
e or Six Years to Prov
RegTilation of
in Dental Diag-
Paper and practical demonstra-
1915.
-ray
Examina-
lactic
the Septum and Dis-
Adenoids,
and Accessory
New York Medical Journal,
Pneu-
March 13,
1915.
"
Medical Electricity
W .B
"
Sy
. Saunders Co.,
Roentgen Ray
Philadelphia,
Roentgenographic Diagnosis of
stemic Diseases."
Ray
The B
Association of
ronx County
Dental Inf
Papers read bef
Jan. 27,
Feb. 28,
May
Greater New York,

ection in
ore the Roentgen
Greater New York,
Dental Society
New York State Dental Society
Medical Association of
s and Radium."
1910 and 1915.
13,
1916,
1916,
1916,
May
15,
the
and the
1916.

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ROENTGENOGRAPHIC

SINCLAIR TOUSEY. A-M-. M-D-

Generated on 2014-12-28 09:34 GMT / http://hdl.handle.net/2027/nnc2.ark:/13960/t0gt69d18

The author has f

to act in the capacity

ears been called upon

iser to dentists and

as to diagnosis but also f

treatment and prognosis. The adv

book regarding treatment is not intended as a

guide to the practice of

and oral sur-

but it is hoped that it may

aid the phy

and the dentist to decide when an inf

should be extracted and when it can be cured and

ect read bef

Greater New York,

and the Medical Association of

New York State Dental Society

ore the Roentgen Ray

Generated on 2014-12-28 09:34 GMT / http://hdl.handle.net/2027/nnc2.ark:/13960/t0gt69d18

the Teeth and Pneumatic

Sinuses and Their X

rom W hich Alv

acteriological and Clinical

tion Connected with the Teeth or the

Pneumatic Sinuses op the Face ... 40

Author's Other Publications upon the

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NOSIS OF DENTAL INFEC-

^'Tlie widest publicity

act that greatly

ing and sometimes serious

stemic diseases and those af

mote organs are of

ten due to inf

with the teeth or with the pneumatic sinuses of

ace. The inf

oci are discov

the oral lesion and some req

accination with a bacterial cul-

rom the pus in the oral lesion."

these cases are cured

urist whose wif

tion in connection with the teeth. Pernicious

anemia and general spinal sclerosis were threaten-

udge's remark is the

Generated on 2014-12-28 09:34 GMT / http://hdl.handle.net/2027/nnc2.ark:/13960/t0gt69d18

Generated on 2014-12-28 09:34 GMT / http://hdl.handle.net/2027/nnc2.ark:/13960/t0gt69d18

been discharging externally

the best phy

under the angle of

and I was asked to recom-

mend a good skin specialist. It seemed desirable

to introduce a probe which led up through the j

bone to the root of

a tooth. And it was a simple

enough matter under a general anesthetic to ex-

tract the tooth and curette the bony

healed in ten day

local lesions directly

ection Not Alway

nected W ITH the Teeth.