EXTERNAI, HEAT AND COIiD THERAPY IN ORAId SURGERY

THOMAS HKNMXSY, D.M.D., BOSTON, MASS.

I N ORA~J surgery heat and cold therapy is very important both in preoperative
and postoperative conditions. In the large majority of cases, it is practically
indispensable. The act,ual application of hot or cold compresses, of course, is
usually performed by the nursing staff; but the oral surgeon, who has assumed
the responsibility of a surgical operation, is equally responsible to prescribe the
proper procedure of the application of the heat or cold, as he would be to pre-
scribe other medication.
The theory of heat and cold therapy is not difficult to understand, although
there are some who disagree as to when heat or cold should be applied, and we
do see some cases where cold is being applied that would do better if heat were
used. This is usually due to a misunderstanding between the oral surgeon and
t.hose in charge of the care of the patient, or tho patient himself, if he is ambu-
latory and is treating himself. Heat or cold, properly applied, is very helpful
and will make the patient more comfortable.
Heat and cold therapy is used routinely for hospitalized patients in all oral
surgery cases, and, as a rule, it is quite well understood by those in charge when
heat or cold should be applied; but on account of the possibility of a misunder-
standing, the oral surgeon should check daily, and be sure that the proper treat-
ment is being carried out.
Heat and cold therapy is indicated in inflammatory and infectious processes,
which should be thoroughly understood. Inflammation is the direct result of
injury to human tissue ; it is defined as a succession of phenomena exhibited in
living tissue following trauma or bacterial invasion.
Before the advent, of the microscope, many confusing theories were ad-
vanced concerning inflammation. We all remember, and probably shall never
forget, the rational picture under the low-power microscope of the transparent
web of t,he frog’s leg. The corpuscles of the frog are larger than those of the
mammal, and, therefore, can be seen under low power. In the web of the frog’s
loot, three kinds of blood vessels can be identified: the arterioles, t,he capillaries,
and the veins. The arterioles may be recognized by their pulsation, and the
capillaries by t,heir thin walls consisting of’ endothelium only. The veins are wide
vessels and do not pulsate; their walls are not quite as thick as those of the
arterioles. The tissue between the blood ve.ssels consists of loose connective cells,
pigment cclh, and epithelial cells. The flow of blood is quite rapid and in the
wider vessels the corpuscles keep to the center of the stream.
If the web is irritated with a needle, almost immediately there is a large
increase in the number of capillaries in the microscopic field; at the same tirne,
there is a dilation of the arterioles with the result that there is a great increase
in the flow of blood to the part. This accounts for the clinical finding of redness
Visiting Oral Surgeon, Boston City Hospital, Oral Surgeon-in-Chief, Old Soldiers’ Home
Hospital, Chelsea. Mass-
Lecture clrlivered before Maswchusctts Dental Society 1941 Educational Course, P,oston
City Hospital. Roston.
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