grave
due
symptoms
cardiac
DENTAL
MULTIPLE
to
ABSCESS.1
BY
W. R. Ackland, M.D.S., Hon. Consulting Dental Surgeon., Bristol Royal Infirmary.
?Rt\ years ago, when I was at the Hospital, there was Very little talk of oral sepsis or pyorrhoea, and all the teaching Was Erected to the saving of teeth at all costs. Consequently,
?Wing
to the
aPproaching
fixity
of these
all those
nstinct of suspicion ^at have happened
cases
and
ITlllch
to
saving
possibly
of doubt.
I find
sepsis
myself
with
But the
an
cases
in my own practice, together with the as Dr. William Hunter and Sir William
?f such ^0rkc?cks, have made men
early impressions, attributed to oral
teeth.
me
feel that I have leaned
All the same, I
am
possibly
too
convinced that
a
?reat deal too much has been done in the other direction.
Febni^Cat^ n,ary 13th,
a
Meeting
1924.
of
the
Bristol Medico-Chirursiical Society, ' *
80
MR.
I
bringing
am
VV.
R. ACKLAND
to-night a case which 1 me, so to speak, against my
to your notice
bound to say has convinced will, that the condition of the teeth
am
heart symptoms.
to-night
The
patient
the
was
is himself
a
cause
of the
doctor, and is here
to bear out my statement of his case.
His age is 42, had never previously suffered from cardiac symptoms. On April 23rd, 1923, he had acute coryza with mild laryngitis, diagnosed as influenza, and was in bed for two weeks.
During
precordial
this illness he had occasional
these pain fluttering. to two ceased toxins?influenza and nicotine, and symptoms In spite of this, the cardiac symptoms persisted smoking. during the next two months, and increased in severity. He was easily tired, and had mild dyspnoea after slight exertionOn June 9th, 1923, he consulted a colleague, who diagnosed post-influenzal myocarditis. At 10 p.m. on June 15th he had a severe rigor, but the temperature remained normalThe next morning he had pains in both knee-joints and in the left wrist. At 11 p.m. on June 16th he had severe cramp of the recti abdominales muscles, followed bysweatingWhen he awoke on the morning of June 17th there and was considerable cardiac distress?pain, irregularity, sensations of impending dissolution. The patient was seen by Dr. Farrer Thompson, of Woburn, who found the pulse and
rate
60,
dullness
sensations
irregularly
of
He
intermittent.
The
was
Extra-systoles and
the
area
of
not increased, but the first sound
faint, and the second had fallen to
attributed
present, m.m. Hg.
were
100
patient
was
was
accentuated and and the
systolic
cardiac
was
very
reduplicated.
blood pressure
The tongue was thickly coated, perspiring. Dr. Farrer Thompson
diagnosed myocarditis, and advised the patient that pus was probably present, as the previous influenza could He advised not account for the present toxic condition. first in the that the teeth should be X-rayed place. If no toxic
ARdiac ?
ePsis
81
dental abscess. symptoms due to multiple
were
should be carefully found, the accessory sinuses
cxamined.
The teeth
were
0Sult: Four dead teeth
were
X-rayed,
with
discovered,
the
following
with three chronic
alveolaris. a certain amount of pyorrhoea cardiac symptoms began After the first extractions the clean decided to make a and the
cesses and
"
0
^appear,
s^eeP, lng
so we
July
the whole of his teeth
fitted dentures. August, and ultimately and the general symptoms have entirely gone,
and
The cardiac a
patient gradually extracted
th is better than it has been for five
or
six years.
DISCUSSION.
^r- X. (the patient) said that he wished to add something 0 the account given by Mr. Ackland. He had for over two hesuffered chronic ill-health ; quite two years ago had a severe " rheumatic attack with rigor, precordial hematuria Pain, joint and sour sweat, followed by
^ears
"
pains,
the importance swelling of the ankles. He emphasised cardiac disordered of taking a definite diagnosis in cases
ajid
Action. ^r-
P.
of Watson-Williams urged the importance sources
all possible k?nsidering ?wels, accessory nasal sinuses
of or
sepsis?teeth, tonsils, others.
Often the
Section that were least conspicuous as sources In such Pus were the most dangerous to the patient. a
difficulty
in mental concentration
foci
of visible
was
frequently
an
cases
early
an(l
important sign. ^"ERAPATH questioned the diagnosis of myocarditis. dilatation of Th no tachycardia, and no aPPearec^ *? th ^leart in the case, which did not fit in with that diagnosis. to sordered action of the heart was now thought by many k e due the heart, to influence of the nervous system on there was Often if fear were present.
sPecially probable
no i]in "less
V?L
Vt
t ^LI.
.
preceding
the disordered cardiac action. 7
No. 152.
82
REVIEWS OF BOOKS.
investigated the dental sepsis. There appeared no evidence cases that naked-eye dental sepsis commonly
Dr. Carey Coombs said that he had
importance
of
in his series of
affects the heart. Dr. X. in
reply
not to have been
said that his cardiac condition
appeared
made
was
and with extra
irregular, was not displaced. fear before
quite clear. systoles ; the
His
since the onset of his trouble.
or
especially
was
He had,
increasingly
He gave an amusing description of spa therapy> with "radium" water. In conclusion, he wished
to thank Mr.
Ackland for the remarkable
treatment, and
assisting
130,
apex beat, however, He had not observed any condition of
however, noticed that mental concentration difficult.
pulse
the
to
emphasise diagnosis.
the value of
success
of his
skiagraphy
in
due
symptoms
cardiac
DENTAL
MULTIPLE
to
ABSCESS.1
BY
W. R. Ackland, M.D.S., Hon. Consulting Dental Surgeon., Bristol Royal Infirmary.
?Rt\ years ago, when I was at the Hospital, there was Very little talk of oral sepsis or pyorrhoea, and all the teaching Was Erected to the saving of teeth at all costs. Consequently,
?Wing
to the
aPproaching
fixity
of these
all those
nstinct of suspicion ^at have happened
cases
and
ITlllch
to
saving
possibly
of doubt.
I find
sepsis
myself
with
But the
an
cases
in my own practice, together with the as Dr. William Hunter and Sir William
?f such ^0rkc?cks, have made men
early impressions, attributed to oral
teeth.
me
feel that I have leaned
All the same, I
am
possibly
too
convinced that
a
?reat deal too much has been done in the other direction.
Febni^Cat^ n,ary 13th,
a
Meeting
1924.
of
the
Bristol Medico-Chirursiical Society, ' *
80
MR.
I
bringing
am
VV.
R. ACKLAND
to-night a case which 1 me, so to speak, against my
to your notice
bound to say has convinced will, that the condition of the teeth
am
heart symptoms.
to-night
The
patient
the
was
is himself
a
cause
of the
doctor, and is here
to bear out my statement of his case.
His age is 42, had never previously suffered from cardiac symptoms. On April 23rd, 1923, he had acute coryza with mild laryngitis, diagnosed as influenza, and was in bed for two weeks.
During
precordial
this illness he had occasional
these pain fluttering. to two ceased toxins?influenza and nicotine, and symptoms In spite of this, the cardiac symptoms persisted smoking. during the next two months, and increased in severity. He was easily tired, and had mild dyspnoea after slight exertionOn June 9th, 1923, he consulted a colleague, who diagnosed post-influenzal myocarditis. At 10 p.m. on June 15th he had a severe rigor, but the temperature remained normalThe next morning he had pains in both knee-joints and in the left wrist. At 11 p.m. on June 16th he had severe cramp of the recti abdominales muscles, followed bysweatingWhen he awoke on the morning of June 17th there and was considerable cardiac distress?pain, irregularity, sensations of impending dissolution. The patient was seen by Dr. Farrer Thompson, of Woburn, who found the pulse and
rate
60,
dullness
sensations
irregularly
of
He
intermittent.
The
was
Extra-systoles and
the
area
of
not increased, but the first sound
faint, and the second had fallen to
attributed
present, m.m. Hg.
were
100
patient
was
was
accentuated and and the
systolic
cardiac
was
very
reduplicated.
blood pressure
The tongue was thickly coated, perspiring. Dr. Farrer Thompson
diagnosed myocarditis, and advised the patient that pus was probably present, as the previous influenza could He advised not account for the present toxic condition. first in the that the teeth should be X-rayed place. If no toxic
ARdiac ?
ePsis
81
dental abscess. symptoms due to multiple
were
should be carefully found, the accessory sinuses
cxamined.
The teeth
were
0Sult: Four dead teeth
were
X-rayed,
with
discovered,
the
following
with three chronic
alveolaris. a certain amount of pyorrhoea cardiac symptoms began After the first extractions the clean decided to make a and the
cesses and
"
0
^appear,
s^eeP, lng
so we
July
the whole of his teeth
fitted dentures. August, and ultimately and the general symptoms have entirely gone,
and
The cardiac a
patient gradually extracted
th is better than it has been for five
or
six years.
DISCUSSION.
^r- X. (the patient) said that he wished to add something 0 the account given by Mr. Ackland. He had for over two hesuffered chronic ill-health ; quite two years ago had a severe " rheumatic attack with rigor, precordial hematuria Pain, joint and sour sweat, followed by
^ears
"
pains,
the importance swelling of the ankles. He emphasised cardiac disordered of taking a definite diagnosis in cases
ajid
Action. ^r-
P.
of Watson-Williams urged the importance sources
all possible k?nsidering ?wels, accessory nasal sinuses
of or
sepsis?teeth, tonsils, others.
Often the
Section that were least conspicuous as sources In such Pus were the most dangerous to the patient. a
difficulty
in mental concentration
foci
of visible
was
frequently
an
cases
early
an(l
important sign. ^"ERAPATH questioned the diagnosis of myocarditis. dilatation of Th no tachycardia, and no aPPearec^ *? th ^leart in the case, which did not fit in with that diagnosis. to sordered action of the heart was now thought by many k e due the heart, to influence of the nervous system on there was Often if fear were present.
sPecially probable
no i]in "less
V?L
Vt
t ^LI.
.
preceding
the disordered cardiac action. 7
No. 152.
82
REVIEWS OF BOOKS.
investigated the dental sepsis. There appeared no evidence cases that naked-eye dental sepsis commonly
Dr. Carey Coombs said that he had
importance
of
in his series of
affects the heart. Dr. X. in
reply
not to have been
said that his cardiac condition
appeared
made
was
and with extra
irregular, was not displaced. fear before
quite clear. systoles ; the
His
since the onset of his trouble.
or
especially
was
He had,
increasingly
He gave an amusing description of spa therapy> with "radium" water. In conclusion, he wished
to thank Mr.
Ackland for the remarkable
treatment, and
assisting
130,
apex beat, however, He had not observed any condition of
however, noticed that mental concentration difficult.
pulse
the
to
emphasise diagnosis.
the value of
success
of his
skiagraphy
in
