View report page

114
die in the chair, but rather because the effect of the anaesthetic
may cause exacerbation of the disease. As all extractions can be
satisfactorily dealt with under regional and local anaesthesia without
causing any marked condition of shock there should be no
difficulty in this part of the treatment. The hyper-sensitive type
may be controlled by the use of suitable drugs to reduce shock.
It is important to limit the number of extractions to approximately
three teeth at a single sitting. Furthermore, it must not
be overlooked that the absorption of toxins following the extraction
of a number of teeth may cause serious complications, and for that
reason alone extractions should be reduced to a minimum.
It should be the aim of any scheme of treatment for tuberculous
patients to conserve the teeth as much as possible. Some
patients have a disinclination for fillings, not because they have
any real objection to conservative treatment but rather because
they are afraid of any pain that this type of treatment might cause.
This difficulty may be substantially overcome by the use of local
anaesthesia in practically all types of conservative treatment.
The use of X-rays is imperative to the Tuberculosis Officer,
and it is likewise a very necessary aid to diagnosis for the dental
officer, for many hidden roots may exist in the jaws of patients and
be a source of insidious infection. X-ray interpretation of the teeth
is invaluable in order that as many teeth as possible may be saved.
Ordinary clinical examination can reveal the presence or absence
of local dental disease, but it cannot, except in rare cases, disclose
focal infection which is often associated with dead teeth.
Without doubt the best time to treat the tuberculous patient
is when he is an inmate of a sanatorium, as he is able to rest before
and after treatment, and furthermore, he can have adequate postoperative
nursing. The majority, when they leave the sanatoria,
find it difficult to obtain employment, and even if they are in work
it is often impossible for them to secure sufficient time off for treatment,
with the consequence that in many cases only sporadic treatment
is obtained. Moreover, for a time at least their wage-earning
capacity is usually small, and the expense of the extra nourishment
which is required to build up the resistance of the patient leaves
very little margin for the cost of treatment. Most of the insur
patients are even unable to pay their contribution for dental treat
ment.
The work accomplished at C'heam during the year has well
maintained the average of previous years. It is very gratifying
observe that conservative measures have formed a great part of the
treatment.