I have a case which I am allowed to share.

A female 29 y.o. patient who has been using homoeopathy (mostly constitutional or prescribing for chronic problems) for approx. the last ten years presents with an abscess on her gum.

The abscess is located between the central and lateral incisor on the right lower side.

Earlier this year (around Jan-Feb) patient can't exactly remember she was eating a pear which was crunchy (like an apple) as she bit into it a shard of pear cut into her gum (where the abscess is now), there was some bleeding but it stopped on it's own accord, the patient cleaned out any pear that was stuck in the gum line and she found that there was a little flap of ripped gum that never healed. This flap was always there and was painless so she never went to the dentist or mentioned this incident in consultation until now.

Around six weeks ago this small gum flap swelled up into an abscess which may exude a small amount of fluid which is almost always clear, once or twice there has been a tiny drop of blood in the clear fluid. The only reason there was a clear fluid discharge is because the patient thought to put a cotton ball soaked in "Swedish Bitters" locally on the abscess to try and have it expel it's contents. (Swedish Bitters is a herbal blend of bitter herbs.) Only a small amount of fluid came out at any attempt, she tried maybe five or six times on different occasions.

The abscess is painless, patient uses an electric toothbrush and can brush right on top of abscess and it is still painless. The abscess is currently 1cm wide at the widest point (near the gum line) and 1cm high. The shape of the abscess is like that of an arrow head it tapers at the top and it lies flat against the tooth so you can't see that there is any lump until the patient pulls down her bottom lip. The color is for the most part the same as the healthy gingiva, there is a slight red tinge at the top of the abscess.

There was no trauma (either physically to the area or emotional trauma) at the time that the abscess came up i.e. six weeks ago.

The patient can floss between the teeth that the abscess is over with no pain or bleeding.

The rest of the gums are healthy. The patient has no history of any dental fillings. The patient is missing both her upper canine teeth (missing teeth run through the family.)

There is no problem with eating the lump does not interfere at all (I was hoping for a hot/ cold modality.)

I am thinking that this may be a case of gingivitis that even if the original pear shard was removed that some other food may have become lodged and caused the swelling?

The patient is otherwise well.

Any suggestions as to how to tackle this case? I am just a little bit stumped and struggling to get started as to how to tackle this one.

TIA

Carol

What are the remedies she got before ? I presume it is a sterile abcess ... ?

Normaly we think about Silicea by pushing out... May be the process is coming from the bone ... Symphytum but we need more information .

Hep sul can be useful - it tends to absorb and dissipate - also it follows Sil well . If bone is involved Hecla may be useful? .

Thank you for the replies so far. While I have been thinking about the case I had the patient on Sil 6x which did not help. The abscess has continued to increase in size without coming to a head also the patient has been experiencing headaches when meals were eaten later than normal time, this symptom was new for the patient so I figure this is a proving symptom. So I stopped the Silicea.

I decided to look at this case using Boenninghausens method. I have The Boenninghausen Repertory (TBR) by George Dimitriadis and find it priceless when I come up to cases like this one.

So focussing on Complaint with Location, Sensation, Modality, Causation and Concomittant I try and find my three legged stool (i.e. at least three of the above) and use those rubrics.

The numbering after each rubric is the rubric number found in TBR

1. Teeth and Gums - Gums #261
2. Teeth and Gums - Gums - lower #263
3. Eruptions - Abscess #1741
4. Eruptions - Painless #1793
5. Excrescences - Spongy #1898
6. From Situation and Circumstance - Injuries cuts #2390.

(The symptom Spongy I was able to get from the patient after I asked her to stop the Sil.)

I chose these rubrics b/c Gums and Gums lower describe the location. Eruptions abscess, painless and Excrescences Spongy describe the compaint. Injuries Cuts describes the causation. So I have a complaint, location, sensation and causation.

The results from the above rubrics gave me two remedies that were found in all six rubrics:

Staphysagria and Sulfur


There were no remedies that were found in five rubrics.

There were a number of remedies that were found in four rubrics: Ant-c, Conium, Merc, Nat-c, Petr, Ph-ac, Phos, Sil.

I thought Sulfur may be a possibility. In Concordant MM by Frans Vermeulen under Silicea "Followed Well By ... ... ... Sulph [if improvement ceases under Sil. a dose or two of Sulf will set up reaction and Sil will then complete the cure]. However Sil did not give any improvement in the first place.

Staphysagria has an affinity for the teeth and alveolar perisoteum and while I was studying the case (I had just finished repertizing and was doing a materia medica comparison between Sulph and Staph) I was contacted by the above patient who had remembered some more information (I asked during the initial consult if there was any major life event, change, distressing situation etc. i.e. I was looking for a mental or emotional symptom of which the patient could not remember any). The swelling probably did come up after an emotionally traumatic event which was an attempted sexual assult.

Well, well, well I thought to myself. I think this has just made my differential diagnosis between Staph and Sulph much easier.

I am giving Staph 30c to be olfacted once a day. (The patient is very sensitive and prefers taking remedies by olfaction) If required we can take the remedy orally later as it is easier to increase the dose slowly than it is trying to handle an aggravation.

The first dose will be taken tonight. I will keep you posted on any changes.

Chickhawk, what was the final outcome since it's been two months since your last post on this thread? What eventually worked, if at all?

Much appreciated!

This thread was started in 2004...so it's been over a year.

__________________
"The significance of a fact is measured by the capacity of the observer."
Carroll Dunham

Wow I forgot about this thread. Thanks for reminding me.


Well Silica did not work, neither did Staph, Sulph, or Hepar sulph.

I was at my wits end and understandably the patient was becoming frustrated as the abscess was just slowly getting larger and larger to the point that it almost covered the whole tooth that it was growing over.

I looked over the rubrics that I had chosen as it had to be there and realised that while talking to her that she had quite a lot of saliva in her mouth.

Hmmm, maybe Merc. Well, (we had tried everything else) and she had been on Merc before (many years ago) and it had worked quite well for her.

After one olfaction of Merc 30c there was a slight and sudden aggravation of the abscess where the slightly reddened part swelled but then within a few days it shrunk a little.

Due to the patients sensitivity we decided to administer the remedy by olfaction infrequently just enough to keep the case moving which in this case was about once every two months.

It took the best part of 6-8 months for the gum to clear up. There were three or four olfacted doses. It was very slow but the patient was happy with the progress.

The gum has completely healed including the original flap of gum that was there after the incident with the gum becoming damaged by the crunchy pear.

To date there have been no further gum problems in this patient.

Thanks, ChickenHawk, for remembering your final account of the situation and listing it here. Sounded like a positive outcome, and Merc 30c proved to be the remedy.

By the way, how is Merc 30c administered through the olfaction method? I'm new to all this, but is it in liquid form that is sniffed from a bottle or heated over a flame?

Hi Holistic hound,


When I have people olfact the remedy I just make up a bottle in liquid form and have them smell the bottle. If the patient is olfacting the remedy daily then I will have them throw a drop of the remedy from the bottle out i.e. into a sink that way the remedy is also changed a little after each olfaction. I also have them succuss the remedy.

hths