1744 DISEASES OF THE MOUTH, THROAT, AND STOMACH 



Diagnosis. — The diagnosis can often be made clinically, the 

 creamy white patches being characteristic, but it should always 

 be confirmed by the microscopical examination, which will reveal 

 a large amount of mycelial threads and conidial forms. If it is 

 desired to know the setiological variety of thrush the patient is 

 suffering from, cultural methods are necessary. These are described 

 in the chapter on Bronchomycosis (see p. 1888). 



Prognosis. — Thrush ^^^^ se is not a serious affection, but its occur- 

 rence in cachectic patients is a bad omen. 



Treatment. — Glycerine of borax appHed to the patches several 

 times a day is efficacious in many cases, or an aqueous solution of 

 borax (i in 30) may be used. The addition of honey to the latter is 

 to be deprecated. In resistant cases the addition of carbolic acid 

 to the glycerine of borax, 10 minims to the ounce, will be found 

 useful. In marasmic children or adults suffering from some incur- 

 able disease any treatment may fail to bring about a complete 

 disappearance of the thrush. 



Prophylaxis. — In the case of infants there is no doubt that in 

 many cases the infection is carried by contaminated nursing bottles 

 and their rubber nipples. These should, therefore, be kept scrupu- 

 lously clean. As regards children, and more especially adults, quite 

 a number of them, although in apparent perfect health, harbour 

 thrush fungi in the mouth, and are, therefore, carriers. In them 

 the use of alkaline tooth-pastes and mouth-washes is to be re- 

 commended. 



GINGIVITIS. 



During the last few years much attention has been paid to 

 gingivitis, or inflammation of the gums, which may be divided into 

 simple gingivitis, pyorrhoea alveolaris, and ulcerative gingivitis. 

 They are all of tropical importance. 



Simple Gingivitis. 



In this disease the gums are bright red in colour, especially near 

 the margin, becoming normal when traced towards the buccal 

 mucosa. The interdental papillae are swollen, but are neither pain- 

 ful nor ulcerated. There is no odour, no pain at night, and no 

 enlargement of lymph glands, but the teeth may be covered with 

 tartar and show food debris. A carbolic rose-water mouth-wash 

 (J per cent.) will be found useful. 



Pyorrhoea Alveolaris. 



This is a chronic condition, in which there is little sign of inflam- 

 mation of the gums, but in which pus can by pressure be made to 

 exude from the peridental pockets. If it is allowed to proceed 

 unchecked it will produce ulceration of the bottom of the peridental 

 sulcus and destruction of the periodontal membrane, and will set 

 up a rarefying osteitis, which will injure the bony socket and loosen 

 the teeth. 



