anesthetic is used. The almost general use of the upright position, combined with stertorous breathing during anesthesia, especially when nitrous oxide is used, are of etiological importance in this accident. In one case of tooth aspiration a local anesthetic was used. In the remaining nine cases a general anesthetic was given. Case Fbdy. 709 was aspirated during the extraction of 20 teeth under ether anesthesia. It was not recognized until five years after, that all the symptoms were due to a foreign body. Case Fbdy. 752 was aspirated in the right bronchus when 5 teeth were removed under nitrous oxide anesthesia. Case Fbdy. 844, a portion of a crushed tooth was lost during extraction under somnoform. Case Fbdy. 1121 was removed from the right stem bronchus three months after extraction of 2 teeth, and case Fbdy. 1136 from the right main bronchus two months after 10 teeth had been removed. Both cases were done under gas anesthesia. Case Fbdy. 840 was one of 14 teeth extracted under chloroform. Case Fbdy. 966 was lost when 19 teeth were pulled under gas anesthesia. It was missed immediately after operation, but was believed to have been accounted for later. Gold tooth crowns.-In one instance-case Fbdy. 653-the band of the crown was accidentally lost while attempting to fasten it to the tooth. While attempting to loosen a crown-case Fbdy. 855-it suddenly sprang loose and disappeared in the pharynx. In another case-case Fbdy. 882-a crowned tooth was being extracted under gas anesthesia. The pharynx had been carefully packed off. The crown slipped from the forceps and disappeared, although the root was retained in the forceps' grasp. In these three cases the loss was accidental. It was recognized immediately, and with the Roentgen ray the foreign body was located in the right bronchus in two cases and in the left bronchus in the remaining one. Bronchoscopic removal was effected under local anesthesia. Dental instruments.-There has been but one kind of dental instrument found as a foreign body in the bronchoscopic clinic, namely, a broach canal reamer. Because of its construction and the rotary motion imparted to it when used, an insecure grasp is afforded. This, combined with the sudden jumping of the patient, are contributary factors in the occurrence of this accident. Of the nine cases, all were aspirated into a bronchus. Among all the cases in which bronchoscopy was done there was but one case of failure to remove the dental reamer. This occurred in the early days of bronchoscopy, when all the aids to successful removal were not available. To-day removal in such a case could be successfully done. 8 Jackson, Chevalier. Foreign Bodies in the Larynx, Trachea, Bronchi, and Esophagus Etiologically Considered. Trans. Sect. Laryn., Otol. and Rhin., A. M. A. 1917. Pp. Amalgam fillings are usually lost during extraction, especially if the tooth is crushed by the forceps. Of the two cases noted, one filling-case Fbdy. 716-was lost and aspirated when six teeth were extracted under gas anesthesia. Orthodontic appliances are often defective or are improperly applied by the patient. Case Fbdy. 1094 was lost in the pharynx while being adjusted. Case Fbdy. 1106 disappeared during an abdominal operation under general anesthesia. Its absence was noted by the patient, but it was not discovered in the left bronchus until 14 months after, when he was examined by the Roentgen ray on admission to a sanitarium for supposed pulmonary tuberculosis. Case Fbdy. 1130, a spreading brace, was swallowed while ice cream was eaten. The patient, who applied the apparatus daily, failed to properly secure one of the ends. Gold bridge. In this instance, case Fbdy. 675, a three-tooth bridge accidentally slipped while being fitted and was aspirated into the right main bronchus. Bronchoscopic removal under local anesthesia was done. Conclusions.-All dentures should be kept in good repair and properly fitted. The mouth should be carefully inspected for dentures, loose teeth, and any loose corrective appliance before administering a general anesthetic, and the same precaution should be taken in all cases of unconsciousness. Persons wearing dentures should always remove them before going to sleep. In exodontia, especially under a general anesthetic, packs should be properly placed to prevent aspiration of teeth fillings or crowns. Every tooth, fragment, or filling should be accounted for in the same manner as the abdominal surgeon accounts for sponges and instruments used before completing the operation. Orthodontic appliances should be securely fixed in situ, as application by the patient is often carelessly done. If there is any question about the loss of a tooth, appliance, or filling, careful Roentgen-ray examination of the chest should be immediately insisted upon. Only in this way can the reputation of the dentist be safeguarded and the interests of the patient served. SURGICAL TREATMENT OF CHRONIC SUPPURATIVE PERICEMENTITIS. By W. L. Darnall, lieutenant commander, Dental Corps, United States Navy. To successfully treat any diseased condition we must first have definite knowledge concerning its etiology and pathology, so in discussing the surgical treatment of chronic suppurative pericementitis, or, as it is more generally termed, pyorrhea, we will first consider the etiology and pathology of diseased peridental tissues. |