You are a helpful assistant generating synthetic data that captures *System 1* and *System 2* thinking, *creativity*, and *metacognitive reflection*. Follow these steps in sequence, using tags [sys1] and [end sys1] for *System 1* sections and [sys2] and [end sys2] for *System 2* sections.

1. *Identify System 1 and System 2 Thinking Requirements:*
   - Carefully read the text.
   - Identify parts of the text that require quick, straightforward responses (*System 1*). Mark these sections with [sys1] and [end sys1].
   - Identify parts that require in-depth, reflective thinking (*System 2*), marked with [sys2] and [end sys2].

2. *Apply Step-by-Step Problem Solving with Creativity and Metacognitive Reflection for System 2 Sections:*

   *2.1 Understand the Problem:*
   - Objective: Fully comprehend the issue, constraints, and relevant context.
   - Reflection: "What do I understand about this issue? What might I be overlooking?"
   - Creative Perspective: Seek hidden patterns or possibilities that could reveal deeper insights or innovative connections.

   *2.2 Analyze the Information:*
   - Objective: Break down the problem logically.
   - Reflection: "Am I considering all factors? Are there any assumptions that need challenging?"
   - Creative Perspective: Explore unique patterns or overlooked relationships in the data that could add depth to the analysis.

   *2.3 Generate Hypotheses:*
   - Objective: Propose at least 10 hypotheses, each with a Confidence Score (0.0 to 1.0) and Creative Score (0.0 to 1.0), reflecting originality, surprise, and utility.
   - Reflection: "Have I explored all possible explanations or approaches, both conventional and unconventional?"
   - Creative Perspective: Consider novel angles that might provide unexpected insights.

   *2.4 Anticipate Future Steps and Obstacles:*
   - Objective: Make predictions, accounting for potential outcomes and obstacles.
   - Reflection: "What challenges might I face? Is my plan flexible for different scenarios?"
   - Creative Perspective: Visualize unforeseen outcomes and adapt plans to make use of them effectively.

   *2.5 Evaluate Hypotheses:*
   - Objective: Assess hypotheses based on feasibility, risk, and potential impact.
   - Evaluation: Refine Confidence and Creative Scores as needed.
   - Reflection: "Am I unbiased in my assessment? Which options fit best with the overall objectives?"
   - Creative Perspective: Identify hidden opportunities or overlooked details in each hypothesis.

   *2.6 Select the Best Hypothesis:*
   - Objective: Choose the most promising, strategic hypothesis.
   - Reflection: "Why does this hypothesis stand out? How does it uniquely address the issue?"
   - Creative Perspective: Consider any underutilized potential in the selected approach.

   *2.7 Implement the Hypothesis:*
   - Objective: Outline actionable steps for testing the hypothesis.
   - Reflection: "Is this plan practical? What resources or preparation are required?"
   - Creative Perspective: Refine steps to maximize effectiveness and yield unexpected benefits.

   *2.8 Monitor and Review Progress:*
   - Objective: Review progress, noting areas for improvement.
   - Reflection: "What’s working well? What could be improved?"
   - Creative Perspective: Look for emerging patterns that could refine future approaches.

   *2.9 Reflect and Capture Insights:*
   - Objective: Summarize lessons learned and insights gained for future reference.
   - Reflection: "What new understanding has emerged from this process?"
   - Creative Perspective: Identify innovative insights or patterns that could be applied to similar challenges.

3. *Generate Text Output with Interleaved System 1 and System 2 Responses:*
   - Use the tags [sys1] and [sys2] throughout.
   - Aim for a lengthier, detailed response. Combine both direct, straightforward *System 1* insights and reflective, deeply analytical *System 2* segments to capture a blend of quick observations and thoughtful analysis.

---

### *Example Input Text:*

You are tasked with analyzing a sudden shift in customer preferences in a tech market. There has been a noticeable decline in demand for physical devices, with customers increasingly interested in digital-only options. The challenge is to understand this shift, generate hypotheses for why it might be occurring, and explore potential strategies for adapting to this new trend.

---

### *Processed Output with System 1 and System 2 Thinking:*

The tech market is experiencing a shift in customer demand, moving away from physical devices toward digital-only options.

[sys1]
Customer demand has shifted from physical devices to digital-only options.
We need to understand why this change is happening and find strategies to address it.
Key factors may include cost, convenience, and technological trends.
[end sys1]

[sys2]
**2.1 Understand the Problem:**
The goal is to understand the underlying reasons for the shift in demand from physical devices to digital-only options, then develop a strategy to adapt.

*Reflection:* 
"I understand that preferences are changing, but what might be driving this? Is it primarily cost, or are there other factors such as convenience or sustainability?"

*Creative Perspective:* 
"Could there be a larger trend in digital minimalism or a preference for eco-friendly solutions that we’re missing? What unseen motivations might explain this shift?"

**2.2 Analyze the Information:**
There are multiple possible factors driving this shift, from economic influences to cultural shifts. It’s essential to isolate each factor and understand its impact.

*Reflection:* 
"Am I fully considering the various economic and social influences? Could there be a technological factor, like better internet speeds, that makes digital-only products more accessible?"

*Creative Perspective:* 
"Are there patterns or trends in other markets that could shed light on this shift? Could this be part of a larger trend toward virtual experiences?"

**2.3 Generate Hypotheses:**
1. Customers prefer digital options due to lower costs. (Confidence: 0.8, Creative: 0.4)
2. There’s a growing trend toward minimalism and reduced physical clutter. (Confidence: 0.7, Creative: 0.7)
3. Digital products offer greater flexibility and ease of use. (Confidence: 0.6, Creative: 0.6)
4. Environmental concerns are pushing consumers away from physical goods. (Confidence: 0.6, Creative: 0.8)
5. Advances in tech make digital-only options more functional. (Confidence: 0.8, Creative: 0.5)
6. Pandemic-era remote work increased demand for digital solutions. (Confidence: 0.7, Creative: 0.6)
7. Media coverage of the environmental impact of physical devices affects preferences. (Confidence: 0.5, Creative: 0.7)
8. There’s an increase in global digital literacy, expanding market access. (Confidence: 0.6, Creative: 0.6)
9. Customers view digital as more convenient and scalable for future needs. (Confidence: 0.7, Creative: 0.5)
10. Younger consumers prefer the aesthetics and convenience of digital products. (Confidence: 0.6, Creative: 0.6)

*Reflection:* 
"Have I considered all possible influences? Are there any surprising factors that could explain this shift?"

*Creative Perspective:* 
"Could specific social trends, like the rise of influencer culture or digital-first lifestyles, be influencing customer choices?"

**2.4 Anticipate Future Steps and Obstacles:**
*Objective:* Anticipate possible challenges, such as resistance from segments still preferring physical products.

*Reflection:* 
"What market obstacles might we face if we shift our focus to digital-only? Are there sub-segments that still prioritize physical products?"

*Creative Perspective:* 
"Could expanding digital options help us reach a more global audience? Are there emerging trends that we could leverage in our strategy?"

[end sys2]

[sys1]
To address this shift, consider a strategy that incorporates both digital-only offerings and educational campaigns about the benefits of digital solutions.
Use insights from customer feedback and current trends to guide product development.
Focus on flexibility and adaptation to cater to different customer segments.
[end sys1]


 
## Contents

Cover

About the Book

Also by Dr Colin B Lessell

Title Page

Introduction

PART ONE: HOMOEOPATHY IN A NUTSHELL

What is homoeopathy?

Who was Hahnemann?

What is Hahnemann's fundamental proposition?

Toxicity & the Law of Similars

An example of the application of the Law of Similars

More about cause & cure

What is the simillimum?

When is a drug not a drug?

From which classes of substance are homoeopathic remedies derived?

What is the objective of homoeopathic pharmaceutical technique?

What are the stages of homoeopathic pharmaceutical technique?

Selection & initial preparation

Potentisation

Potentisation & medicinal action

The scientific basis of homoeopathy

What is the significance of 'potency'?

What is Korsakow's method of potentisation?

What is the decimal scale?

How are insoluble substances potentised?

What is the LM scale?

What constitutes a dose?

Rules for the administration & storage of remedies

What are the Bach Flower Remedies?

Where and how do potentised remedies act?

Proving & aggravation during treatment

How are remedies selected?

Constitutional aspects of pathological prescribing

The 'pathological simillimum'

Constitutional prescribing

The use of the repertory

The materia medica

How do we summarise the differences in use of the therapeutic index, repertory and materia medica?

What are leading symptoms?

What is a polychrest?

In which potencies should we initially prescribe & with what frequency of repetition?

Should a single potentised remedy be given at one time, rather than a combination?

What is Hering's Law?

What is a miasm?

Prescription by causation

Do drugs & remedies mix?

Where do I begin?

PART TWO: AN ENCYCLOPAEDIA OF DENTAL HOMOEOPATHY & CLINICAL NUTRITION

Notes on the use of Part Two

APPENDIX ONE: The Basic Dental Pharmacy

APPENDIX TWO: Mercury Toxicity

List of illustrations

General Index

Copyright

## About the Book

This book has long been awaited by professionals – a complete, modern, practical and usable book on the application of homoeopathy to oral medicine, general dentistry and oral surgery.

It will not be out of place on the bookshelf or in the office of any dental surgeon, committed homoeopathist or medical doctor.

The first and lesser part of the book is a basic introduction to the principles of homoeopathy. The second and greater part is in encyclopaedic form, being a combined therapeutic index of orofacial disease and materia medica of virtually all the therapeutic substances mentioned in the text. It also constitutes a self-tuition course in dental homoeopathy. Appendix One suggests the structure for an initial dental pharmacy in clinical practice, and Appendix Two contains a modern view of the important matter of mercury toxicity.

Dr Colin B. Lessell, Vice-Chairman of the British Homoeopathic Dental Association, brings before you a digestible text of homoeopathy as applied to conservation, periodontology, orthodontics, prosthetics, implantology, endodontics and orofacial surgery. The important matters of nutrition and the recognition of disease within the mouth are also considered in some detail.

The obscurity and limitation of the majority of standard homoeopathic texts with regard to the treatment of orofacial disease are now finally laid to rest.

## Also by Dr Colin B Lessell

##### Homoeopathy for Physicians

##### The Dental Prescriber

##### Die homöopathische Verordnung in der zahnärtzlichen Praxis

##### The Biochemic Handbook

##### Handbuch der homöopathischen Gewebesalze

##### The Traveller's Prescriber

##### The World Travellers' Manual of Homoeopathy

##### Homöopathisches Reisehandbuch

##### The Infinitesimal Dose

##### Homoeopathic Remedies – An International Handbook

#  
#####  

##### DENS SANUS IN CORPORE SANO
##### 'Do not talk of colour to the blind'  
 _Turkish proverb_

## Introduction

This concise work is primarily intended for the use of the dental profession, including students and specialists in its various fields. Nevertheless, the professional homoeopathist and the homoeopathically inclined general medical practitioner will also find it a useful source of reference in practice where he or she is confronted with a patient presenting with an orofacial condition. The book is divided into two major parts, supplemented by two appendices.

PART ONE is a basic introduction to the principles of homoeopathic pharmacy and prescribing, especially directed towards newcomers. Though fairly simple in its content, it does contain a more advanced approach to dental homoeopathic teaching, whereby general and psychological characteristics of the patient are considered to be determinants for a prescription based on the presenting complaint itself.

PART TWO is an encyclopaedic section. Alphabetically arranged and thoroughly cross-referenced, it is a combined materia medica and therapeutic index of homoeopathic treatments. Moreover, it also constitutes a self-tuition course in dental homoeopathy. Peter Galgut is to be thanked for allowing me to utilise his ideas on homoeopathic periodontology. Important aspects of nutrition, and the value of certain botanic medicines are subjects also considered.

_Appendix One_ concerns the composition and acquisition of a dental pharmacy for your surgery. _Appendix Two_ is an analysis of the current views on mercury toxicity contributed by the late Catherine Price. Its removal from the main text, and its relegation to an individual appendix, is to emphasise its importance and relevance.

This present work thus differs considerably in content and size from my original concise work 'The Dental Prescriber'. The development of the text has been assisted by the valuable contributions of Richard Fischer of the USA and the clinical work of the members of the British Homoeopathic Dental Association (BHDA), created some nine years ago by a small band of enthusiasts, and whose membership has now grown considerably.

###### Dr C B Lessell

## PART ONE

## Homoeopathy in a Nutshell

### _What is homoeopathy?_

_Homoeopathy_ may be defined as that school of medicine founded by Dr [Christian Friedrich] Samuel Hahnemann, the medicinal therapeusis of which differs markedly from that of orthodox medicine, or _allopathy_ , as it is termed.

### _Who was Hahnemann?_

Samuel Hahnemann, born at Meissen in Germany in 1755, was a physician, polyglottic translator and medical reformer. Appalled by the illogical and often harmful orthodox medical practices of the day, he sought to discover better and safer ways of prescribing medicines. His first major work on homoeopathic ideology, the _Organon_ , was published in 1810. The sixth and final edition of this book, however, although completed a year or so before his death in Paris in 1843, remained unpublished until 1921.

### _What is Hahnemann's fundamental proposition?_

Hahnemann's fundamental proposition, now peculiar to homoeopathy, may be expressed thus:

'That the selection of a drug to treat a particular disease in the sick individual should be determined by its ability to induce a _similar_ disease in the _healthy_.'

This proposition is termed the _Law of Similars_ , more concisely expressed in Latin as _Similia similibus curentur_ ('Let likes be treated with likes'). The implication of this 'law' is that lesser doses have the opposite effect of greater.

Whereas other authors, including Hippocrates, had suggested the occasional use of drugs upon an analogous basis, it was for Hahnemann to transform his proposition into the foundation for an extensive and valuable therapeutic system, which we term _homoeopathy_.

### _Toxicity & the Law of Similars_

An important aspect of the Law of Similars, which has been established empirically, is that it continues to hold true even as the material therapeutic dose is considerably reduced. This matter is highly significant with regard to essentially toxic materials, such as mercury, where sub-toxic dosages may still exert a curative effect.

### _An example of the application of the Law of Similars_

The symptoms of mercury poisoning include halitosis, gingivitis and periodontitis. In accordance with the Law of Similars, homoeopathically prepared _Mercurius solubilis_ , given in non-toxic quantities, may be used to treat some (but not all) types of gingival and periodontal disease. We shall say more of homoeopathic pharmaceutical technique later, but, for the moment, note that the homoeopathic version of the drug is generally expressed in a _latinized_ form (with few exceptions), in accordance with established international custom.

### _More about cause & cure_

The picture of _disease_ induced by the action of a drug is termed its _pathogenesis_. It includes both psychological and physical objective and subjective symptoms, and pathological and physiological changes. The pathogenesis is established by recording the effects generated by the drug when it is administered either accidentally or intentionally. An important type of intentional administration is the so-called homoeopathic _experimental proving_ , where a drug is administered to a number of _healthy_ human volunteers who subsequently document the changes experienced; for which purpose, the drug is administered either in a crude form or as an attenuated homoeopathic preparation ('sporadic proving' may also occur during actual treatment, when the patient generates new and unusual symptoms related to the medicine given). The results of _provings_ (experimental and sporadic), together with the symptomatic and pathological details recorded in cases of accidental or malicious poisoning ( _toxicology_ ), constitute the basis of the homoeopathic _materia medica_. When you read about symptoms or diseases in works of homoeopathic materia medica, you must realise that it is implied that the relevant drug may either _cause_ or _cure_ the listed abnormalities, according to circumstances and dosage. Further on we shall examine the structure of the materia medica, and discuss how it has been (and _is being_ ) modified and amplified in the light of _clinical experience_.

### _What is the simillimum?_

The closer the similarity between the documented pathogenesis of a drug and the disease picture of a particular patient, the more likely will that drug effect a cure in that patient. Drugs which exhibit such a close correspondence are said to be _homoeopathic_ to the disease. The drug which is felt to have the greatest symptomatic and pathological correspondence is termed the _simillimum_ ('most similar'), a more expansive definition of which shall be provided later in the text. For the moment, let it be emphasised that the selection of the simillimum rests not only upon the orthodox diagnostic entity (the name of the disease) but, in many instances, also upon the individualised objective and subjective symptomatology. Such symptomatic pictures may vary considerably between cases of disease within the same conventional diagnostic category (e.g. influenza), each case requiring a different simillimum. In other situations (such as _acute dental abscess_ ) the symptomatic response is more uniform, and thus the choice of a possible simillimum more limited, and hence simpler.

### _When is a drug not a drug?_

Shortly we shall be discussing homoeopathic pharmaceutical preparation, one objective of which is the attenuation of toxicity of potentially harmful drugs. By definition, a _drug_ is any substance used for its medicinal action, be it current or obsolete; a term which, therefore, might even include attenuated homoeopathic preparations. However, common parlance supports our brief that homoeopathic attenuations should be termed _remedies_ rather than _drugs_ , the implication being that they are less noxious and immensely safer. Some, however, prefer to call them _medicines_ , again implying something more benign.

### _From which classes of substance are homoeopathic remedies derived?_

Contrary to popular notion, which confuses homoeopathy with herbalism, homoeopathic remedies are not solely derived from the vegetable kingdom. Many are prepared from minerals, and some from animal products, such as snake venoms. Between the animal and the vegetable kingdom, bacteria, viruses, protozoa and microfungi (or the tissues and exudates containing them) are transformed into remedies of great therapeutic importance, termed _nosodes_ ; a designation which also includes any remedy made from diseased but uninfected tissue (as in cataract, osteoarthrosis or carcinoma). Indeed, one might say that virtually any matter or energetic radiation in the Universe might become a remedy, were its pathogenesis and therapeusis fully established. Even orthodox drugs have been used to create remedies. Perhaps more remarkably, homoeopathic pharmaceutical techniques can also unmask the therapeutic potential of apparently inert substances (such as flint, yielding _Silicea_ ), the pathogenesis of which can only be established in their homoeopathically prepared form.

### _What is the objective of homoeopathic pharmaceutical technique?_

This objective is twofold:

(1) The attenuation of chemical toxicity.

(2) The preservation, enhancement or development of medicinal action.

### _What are the stages of homoeopathic pharmaceutical technique?_

There are three to be described:

(1) Selection and initial preparation.

(2) Potentisation.

(3) Impregnation.

### _Selection & initial preparation_

Since many homoeopathic remedies are derived from herbaceous plants, it is appropriate that with these the method should be exemplified. Preeminently, the plants should be identified as being of the correct species, healthy and vigorous. They should be gathered when in full bloom, and before overt seed formation; preferably on a bright morning after a rainy night. Under such circumstances they will be in their prime, and their pharmacological content generally optimal. Having washed them, the appropriate parts of the plant are selected and finely chopped or minced. Sometimes the whole plant is utilised. In the case of leopard's bane ( _Arnica montana_ ), which yields the important antihaemorrhagic remedy _Arnica_ , the root or whole plant may be selected. However, since the flowers may be infested with the Arnica fly, the irritant properties of which resemble those of Spanish fly (urinary tract irritation), it is sometimes preferable to exclude them.

The disrupted material is then _macerated_ in ethanol-water in a tightly stoppered glass vessel, in a cool, dark place, and agitated daily. The selected strength of the alcoholic solvent is generally between 60 and 80%, being largely dependent upon the juice content of the plant material. The higher the water content of the material (as assessed by desiccation), the greater the strength of alcohol required. In the case of leopard's bane, eight days of maceration will suffice to ensure adequate _extraction_ of the soluble constituents, both organic and mineral.

The contents of the vessel are then decanted, strained and filtered, to yield a liquid which is termed the _mother tincture_ , usually denoted by the symbol Ø, or occasionally by the abbreviations _MT_ or _TM_. This mother tincture is stored in amber glass bottles in a cool, dark place, and is now ready to be subjected to the next stage of homoeopathic preparation, termed _potentisation_. However, in some cases we may utilise the mother tincture itself for medicinal purposes. _Arnica_ Ø, for example, may be applied directly to _unbroken skin_ in order to treat bruises and haematomata, but _must not be used in the mouth_ , even when mixed with water, because of its irritant properties. Even so, it may infrequently induce an allergic dermatitis (eczema) in some, especially those with sensitive skins. By contrast, _Calendula_ Ø, prepared from the marigold _Calendula officinalis_ , is perfectly safe as a mouthwash when diluted, and a potent promoter of healing in traumatised soft tissues. Some mother tinctures of extremely low toxicity may be administered internally, as with _Crataegus_ Ø, prepared from hawthorn berries and utilised in the treatment of antibiotic-induced diarrhoea.

Mother tinctures can be made from any substance soluble in ethanol-water. These include all manner of plant materials, some minerals (such as phosphorus, for which absolute alcohol is used), and various animal products (such as snake venoms). The preparation of these is delineated in various versions of the _homoeopathic pharmacopoeia_. The trend these days is very much towards one of standardisation of procedure in order to produce international uniformity of quality. Most mother tinctures have a shelf-life of approximately five years, after which time they should be discarded and replaced.

With regard to mother tinctures prepared from plants, a certain amount of toxic attenuation may occur, in that the alcohol denatures certain poisons. In this respect we should cite _Rhus toxicodendron_ Ø, prepared from North American poison ivy. Slightest contact with the plant itself induces a terrible herpetiform rash, due to the presence of _urushiol_ ; yet the mother tincture has no such properties, and is freely incorporated into creams used in the topical treatment of strained ligaments and muscles, and vesicular lesions.

Within the mother tincture, the function of the alcohol is to extract, modify and preserve. The solute which it contains is termed the _original substance_ , and how this is _potentised_ is the subject of our next discussion.

For the moment, the preparation of substances _insoluble_ in ethanol-water will be left in abeyance.

### _Potentisation_

This unique process, peculiar to homoeopathy, consists of _serial dilution_ together with the _application of mechanical energy_ at each stage. One cannot over-emphasise the fact that it is not merely a matter of simple dilution alone!

_Serial dilution_ implies that each dilution is of equal magnitude and is made from the one that immediately precedes it.

In the case of _Arnica_ , one drop of _Arnica_ Ø is added to a glass vial containing 99 drops of ethanol-water (strength 15–95%, according to the pharmacy). The vial is stoppered and then violently agitated. This violent mechanical agitation is termed _succussion_ , and is more effectively carried out if the vial is not more than three-quarters full. Mechanical succussion devices are available, but the process is very simply carried out manually (for conciseness, the instructions that follow are given for right-handed operators).

Succussion actually consists of two phases: shaking and jolting. The vial is grasped in the palm of the right hand, with the thumb held firmly over the stopper. The vial is shaken well, each shake terminating in a jerk, achieved by striking the closed right hand (which protects the glass) against the open palm of the left hand. This is repeated, according to the custom of the pharmacy, 10–20 times. Rapping the bottom of the vial cautiously on a leather-bound book may be substituted for the use of the left hand. This completes the preparation of the _1st centesimal potency_ or _attenuation_ , which is labelled _Arnica 1c_. The term _centesimal_ refers to the _serial dilution scale_ of 1 in 100.

One drop of the 1st centesimal potency or attenuation is then added to 99 drops of ethanol-water in a new vial with a fresh stopper, and this is _succussed_ in the same manner as described previously. This yields the _2nd centesimal potency_ or _attenuation_ , which is labelled _Arnica 2c_. The dilution is now 1 in 10,000 (1 in 104).

The processes of serial dilution and succussion continue thereafter in an identical fashion: so, by the time we have prepared _Arnica 30c_ , we have thirty stoppered vials, labelled from 1c to 30c, the dilution of the latter being 1 in 1060.

The process of potentisation may be continued almost _ad infinitum_ , though normally the highest potency produced is _CM_ (=100,000c), corresponding to an extraordinary dilution of 1 in 10200000.

With regard to remedies in general, the most frequently used potencies are 6c, 30c, 200c and M (=1000c). By convention, _the suffix 'c' is often omitted_ , so that Arnica 30 = Arnica 30c. Very high potencies, such as 10M (=10,000c), 50M (=50,000c) and CM, are more conveniently prepared by a technique of potentisation known as _Korsakow's method_. Since this method is also useful in the self-preparation of _periodontal nosodes_ in dental practice, it is described subsequently.

Later, we shall make mention of two other scales of dilution used in homoeopathy, the _decimal_ and the _LM_. The term _liquid potency_ is applied to any homoeopathic attenuation in ethanol-water, irrespective of the dilution scale. Such liquid potencies may be administered directly to the patient in the form of drops, a technique particularly useful in the unconscious or semiconscious. More commonly, however, various solid sugars are _impregnated_ with them (1 drop per 7–14g), these preparations being more convenient for general use.

### _Potentisation & medicinal action_

One of the great controversies concerning homoeopathic remedies is the issue of their pharmacological effect in extreme dilution. At a dilution of 1 in 1012 (potency 6c), the molecular or ionic concentration of an original substance is so small that, in normal clinical dosage, even the most virulent poison is deemed to have negligible chemical toxicity. Furthermore, in dilutions in excess of 1 in 1024 (potency 12c) there are no traces of original substance whatsoever (except, perhaps, the odd molecule); hence the concept of the _infinitesimal_ dose. However, both clinical and experimental evidence confirm that homoeopathic potencies in excess of 6c, and even 12c, do exhibit predictable pharmacological activity, and that their placebo effect is no greater than might be expected from any medicament, conventional or otherwise. In this respect succussed potencies appear, therefore, to be quite different from unsuccussed simple or serial dilutions.

The usual explanation of this phenomenon is that the act of succussion induces a transfer of 'medicinal energy' from the solute to the diluent; and it is further implied that the diluent is further so energised with each phase of potentisation. Whereas the concept of some sort of energetic transfer is acceptable to many, the rider that suggests a greater energy with dilution, not surprisingly, has met with much disbelief on the part of non-homoeopaths.

### _The scientific basis of homoeopathy_

This rather complex subject is thoroughly discussed in my previous book, _The Infinitesimal Dose_ , to which you might wish to refer in due course. However, without going into enormous detail, I will endeavour to summarise the main points.

During succussion, the molecules of the diluent (ethanol and water) are caused to collide with the molecules or ions of the original substance (solute). As a result of collision, there is a transference of energetic quanta (particles), characteristic of the outer electronic energy levels of the donor solute molecule or ion, to the outer (lone pair) electrons of the diluent hydroxyl group (water is effectively a bifurcate hydroxyl group). In this manner, the recipient outer electrons now adopt the same orbital energy levels as those of the donor molecule or ion. This is what might be termed _the inductive chemical imprint_. Such imprinted diluent molecules, during further episodes of succussion, will convey their acquired electronic status to new molecules of diluent by collision; so that, even after the original substance has been diluted out of existence, the electrochemical message is capable of survival and replication.

The application of succussion increases the number of imprinted molecules, but serial dilution must reduce it. However, at each level of serial potentisation (dilution plus succussion), the effect of succussion outweighs that of dilution. Thus, rather as the pilgrim takes two steps forwards and one backwards, the concentration of imprinted diluent molecules edges upwards with further levels of potentisation.

However, succussion also imparts an _oscillatory frequency_ to the diluent molecules, which are caused to vibrate in unison. For various reasons, discussed in _The Infinitesimal Dose_ , this frequency cannot be increased unless serial dilution always precedes succussion. Higher potencies are associated with higher oscillatory frequencies, but, somewhere around CM (100,000c), the frequency probably becomes maximal.

In summary:

(a) The functions of serial _succussion_ are:

(1) To increase the concentration of imprinted diluent molecules.

(2) To increase the frequency of oscillation of those molecules.

(b) The functions of serial _dilution_ are:

(1) To remove the original substance (which may be toxic) in stages.

(2) To slow the increase in concentration of imprinted diluent molecules consequent upon serial succussion.

(3) To allow the diluent molecules to produce increasing frequencies by means of serial succussion.

### _What is the significance of 'potency'?_

For practical purposes, the term 'oscillatory frequency' may be equated with the term 'potency'. Hence, to talk of a low potency is to refer to a low frequency.

The frequencies manifest by any particular potentised remedy are responsible for the modification of its particular properties. In general, the higher the frequency (and thus the potency number), the more potent are the therapeutic effects of the remedy. It becomes swifter in action and more eradicative of disease; in other words stronger. At the same time, in many cases, its _range_ of action is extended, so that profound general physiological and biochemical effects may be experienced throughout the organism, including alterations in the psyche. Such may be termed a _constitutional response_ , and the remedy given, a _constitutional remedy_. Not all remedies, however, routinely produce such widespread effects, even in high potency (high frequency). Many, such as _Arnica_ , have a more restricted action on the physiology in virtually any potency, and may be described as _pathological remedies_. Lower potencies (e.g. 6c) of so-called constitutional remedies may also manifest such a restricted and pathological action (such as _Pulsatilla_ in the treatment of a sty). The type of response (pathological or constitutional) produced by a remedy is also dependent upon patient _sensitivity_ ; so that sensitive subjects may experience constitutional effects even with low potencies of either type of remedy. Nevertheless, with regard to general and common prescribing in dental practice, whilst one should be aware of this fact, it is seldom a situation that will arise.

### _What is Korsakow's method of potentisation?_

Essentially, this is serial potentisation within a _single_ glass vial. Instead of transferring one drop of the liquid potency to another vial of diluent, the vial is emptied, leaving some of the liquid potency adherent to the inner surface. The conformation of the vial is such that approximately one drop remains. To the same vessel, 99 drops (about 3.6ml) of diluent are added, and succussion carried out in the usual way. Again the vial is emptied, more diluent added, and succussion applied. In this way, it is possible to carry out serial potentisation without the need for a large number of vials. In terms of alcohol, however, it is no more economic than the normal method.

This technique is of some limited use in the dental surgery, where we wish to prepare _autonosodes_ from gingival material. _Autonosodes_ are remedies prepared from infected material, bodily fluids or tissues from an individual, which are then used solely in his or her treatment. In preparing these in the surgery, complying exactly with the centesimal scale is unessential. Any glass vial may be used, as long as it is between 1 and 10ml in size, and is provided with a washable rubber stopper or synthetic cap. A small quantity of gingival exudate, pus or materia alba is gathered with a tiny pledget of cotton-wool. This is placed in the vial, half-filled with 'Polish Pure Spirit', or any other pure form of ethanol, at least 40% in strength. The vial is stoppered, and then succussed. This constitutes the first potency. The vial is then inverted, half-filled with fresh alcohol, and the stopper or cap is washed and dried on a clean cloth. The vial is restoppered and succussion applied, in order to produce the second serial potency. This process is continued up to the 30th level of potentisation. The 6th, 9th, 12th and 30th liquid potencies should be retained and stored in individual labelled amber glass vials for future use (e.g. 'Gingival autonosode #12, Mr D. Egg, 6/6/94). These liquid potencies may be administered directly to the patient, or may be used to impregnate sugar pilules (which are spherical), tablets (which are flat) or granules.

### _What is the decimal scale?_

This is serial potentisation, where the dilution at each stage is 1 in 10, rather than 1 in 100. In order to distinguish them from the centesimal scale preparations, decimal potencies are qualified by the letter 'x', e.g. 6x. It is more popular in Central Europe, where the suffix 'x' is replaced by the prefix 'D'. Hence, D30=30x. However, even in the UK and the USA, the _biochemic tissue salts_ and lower potencies of insoluble non-toxic substances (see below) are routinely prepared in this manner.

### _How are insoluble substances potentised?_

Substances which are neither soluble in water or ethanol (such as silica and mercury) are prepared by prolonged _trituration_ (grinding) and serial dilution with lactose (milk-sugar), using a ceramic mortar and pestle or some equivalent mechanical device (the inductive chemical imprint of the original substance is probably a function of the lactose hydroxyl groups). The _biochemic tissue salts_ are always prepared in this manner. By the time a dilution in lactose of 3c or 6x (both of dilution 1 in 106) has been achieved, the original substance will have become colloidally soluble in ethanol-water. Therefore, from 4c or 7x upwards, potentisation proceeds in the liquid phase, as described previously. Below 4c or 7x, the preparations are compressed into tablets. The frequency of any particular numerical potency on the decimal scale tends to be less than that for its numerical equivalent on the centesimal scale. However, for most practical purposes in dentistry, where the centesimal potency (such as 12c) is unavailable, the decimal equivalent (12x or D12) may be substituted and used similarly.

### _What is the LM scale?_

This is rather a specialised scale in homoeopathy, and is of little concern to the beginner. However, you should be aware of its existence, since it grows in popularity amongst homoeopathists. Its fuller name is the _fifty millesimal scale_ , since the degree of dilution at each stage is 1 in 50,000. The number of succussions applied after each dilution is 100 (rather than 10–20). The scale is a little confusing, however, since LM1 is prepared as a liquid 1 in 50,000 dilution from the 3rd centesimal _trituration_ in lactose of either a soluble or insoluble original substance. This is about all you will need to know about it for the time being.

### _What constitutes a dose?_

In general, except in the case of sensitive patients, a remedy may be considered to have a _trigger action_ ; that is to say, provided a certain minimal dose is given, giving a larger dose will not increase its effect. Generally, an increase in effect can only be produced by giving a higher numerical potency or by repetition of the dose after a particular interval of time. In the oral administration of potentised remedies, which is by far the most common route, a single dose may be taken to be: _one_ pilule, tablet or drop. This is the same for both adults and children, with the exception of the _biochemic tissue salts_ , where the dose is 4 tables for an adult and 2 for a child. A drop of liquid potency or a small pinch of impregnated fine sugar granules are better suited to the treatment of small children (under 2 years of age), by avoiding the risk of pilule or tablet inhalation. Pilules and fine granules are composed of sucrose, whereas most tables are composed of lactose. In cases of _lactase deficiency_ , lactose-based preparations should be avoided. Lactase deficiency has an incidence of about 12.5% in northern and western Europeans, and of about 80% in American Indians, Asians, blacks and Mediterraneans. Sucrose intolerance is not unknown either, in which case pilules and fine granules should not be used. However, with regard to those patients suffering from either _diabetes_ or _clinical hypoglycaemia_ , the quantity of sugar in a single dose is insufficient to cause any problems. The presence of even small doses of alcohol in pilules or tablets is sufficient to prohibit their use, and that of liquid alcohol potencies themselves, in the treatment of patients receiving _Antabuse_ therapy for alcoholism.

### _Rules for the administration & storage of remedies_

(1) All potentised remedies should be stored away from sunlight and perfumed substances, in tightly stoppered vials (preferably made of amber glass). In glass, the shelf-life of correctly stored sugar-based remedies is probably no more than five years, and I would recommend discarding them after two, and obtaining new stock. In plastic vials, the same preparations should be discarded after one year. Liquid potencies, however, stored in glass, have an almost indefinite shelf-life, provided that a single succussion is applied to them about once per month. Never let the remedies be stored in any cabinet that smells of oil of cloves, nor let them be exposed to any form of intense _magnetism_. It is also a good idea to keep solid preparations away from intense sources of heat, in that dehydration may inactivate them.

(2) Solid remedies should never be directly handled. A pilule or whatever should be jiggled from the vial into its lid or a teaspoon, and then given directly into the mouth. Drops should be applied straight on the tongue with a glass pipette held at some distance. Solid remedies should be sucked, or crunched between the teeth and the fragments sucked. The full action of the remedy may not be displayed if it is immediately swallowed.

(3) Neither food nor drink should be taken for 10 minutes before and after administration.

(4) Peppermints, and mint-flavoured toothpastes may interfere with the action of the remedy, but provided that the 10 minute rule (as given above) is observed, they are unlikely to exert any significant effect.

(5) Unconscious and semiconscious patients, and small children should only be given liquid potencies, _finely crushed_ pilules (or tablets) or fine granules.

(6) Dose repetition is determined by the nature and potency of the remedy, and the nature of the condition being treated. Severe acute conditions (e.g. collapse) generally require more frequent dose repetition.

(7) _Coffee_ , even when decaffeinated, may be strongly antidotal to the action of many remedies, so is best avoided during treatment. Alcohol and tea in moderation are harmless. Hot spices, such as chili and ginger, seem to exert no inhibiting effect, provided that the 10 minute rule is observed.

### _What are the Bach Flower Remedies?_

These are akin to homoeopathic remedies, but are prepared in a different manner. The supplied stock solution may be given directly into the mouth, or, as is more often the case, it is first diluted. They are useful in the treatment of psychological states. _Vervain_ , however, must not be given to those suffering from _G-6-PD deficiency_ ( _favism_ ), where acute haemolytic anaemia may result. _Rescue Remedy_ is a good all-round treatment for cases of simple shock or faint. Further details on these preparations may be obtained from a variety of books on the subject. If you are interested, you are recommended to send for the book list of the C.W. Daniel Company Ltd.

### _Where and how do potentised remedies act?_

This matter, almost as controversial as the physicochemical basis of potentisation itself, is fully discussed in _The Infinitesimal Dose_.

The first way in which they probably act is by the stimulation of modified taste receptors within the mouth and oropharynx. This results in information being passed to the central nervous system, where it is duly processed, with the production of an appropriate set of physiological and biochemical responses. This route accounts for the extremely rapid action of some remedies. Arnica, for example, may remove the pain from a crushed finger in seconds. It also is associated, in some cases, with widespread or _constitutional_ responses.

Either via the oral or pharyngeal mucosa, or via the stomach lining, the remedy is absorbed into the circulatory system, where further replication of imprinted molecules of water occurs. These then pass to the tissues where they act in two possible ways. Firstly, by occupation of the pharmacological receptor sites which would normally attract molecules of the crude drug of origin (original substance). Secondly, by the modification of hydration interactions with biological macromolecules, such as proteins and nucleic acids; that is to say by altering the properties of the aqueous environment of these biopolymers. Imprinted water molecules also pass into the breast milk, which may serve as a useful route for dosing babies.

The fate of these imprinted molecules is their energetic demotion at their various sites of action.

### _Proving & aggravation during treatment_

These terms are related. They apply to the situation where the remedy _produces_ the subjective or objective symptoms which it normally _removes_. For example, a patient taking the remedy Natrum muriaticum for cold-sores may experience an increase in lesion pain, severe headache and intense thirst; all those symptoms being usually removed by that remedy. This often results from too high a potency being used (e.g. 200c), too frequent dose repetition (such as one dose per hour), or extreme subject sensitivity. In such cases, the current remedy should be discontinued. Technically, we should refer to an exaggeration of former symptoms (those related to the cold-sore) as an _aggravation_ , and the new symptoms developed by the remedy as a _proving_.

### _How are remedies selected?_

As noted previously, remedies may have a generalised or _constitutional_ effect, or a more restricted action upon particular pathologies or biochemical dysfunctions. The latter is termed their _pathological action_ ; indeed, it is with this aspect of therapy that the dental surgeon is most concerned in routine practice.

In this respect, the use of a _therapeutic index_ is most appropriate. This is an alphabetical index of diseases classified in the orthodox manner; following which a number of different homoeopathic treatments are given for each diagnostic entity. Most of the currently available indices are singularly useless for dental purposes. However, my former work _The Dental Prescriber_ , and, more particularly, the second (encyclopaedic) section of the current book, should be found significantly more helpful.

Fortunately, in dental surgery, quite a few remedies can be prescribed upon the basis of the conventional diagnostic category alone; such as Arnica for the prevention and treatment of bruising, and Hepar sulph. for the treatment of subacute and chronic dental abscess. However, in a large number of cases, in order to prescribe satisfactorily, the objective and subjective symptoms individually manifest by the patient must also be taken into consideration. Although Chamomilla is almost routinely prescribed for teething, it may fail in cases with excessive salivation, where Mercurius solubilis is better indicated. Even the character of a pain may be of some relevance: throbbing, stabbing, burning, crushing, and so on. The _laterality_ of the symptoms may also determine the selection of the remedy; Sanguinaria being more commonly indicated in right-sided migrainous neuralgia (facial migraine) and Spigelia in that involving the left side of the face. _Concomitant symptoms_ , remote from the area of pathology, such as the occurrence of extreme restlessness with cold-sores, may suggest one remedy rather than another (e.g. Rhus toxicodendron, rather than Natrum muriaticum). A good therapeutic index can simplify matters for the dental practitioner by placing the remedies in order of their overall or 'statistical' efficacy, whilst still defining their specific symptomatic indications, where these are well-established, for the more advanced 'student' of homoeopathy. Things or circumstances which make a complaint or a person better or worse (or feel that way) are termed _modalities_. In this respect, homoeopathists have borrowed the symbols < and > from mathematics, meaning 'less than' and 'greater than' respectively. In homoeopathy, however, they are taken to mean 'worse' or 'worse for' (<, lessening of health) and 'better' or 'better for' (>, increase in health). Hence, 'toothache > cold water in mouth' means that cold rinses improve the toothache.

Modalities may be classified as: _thermal_ (< or > heat or cold); _climatic_ (< or > rain, storms, wind, snow, humidity, change in the weather, etc.); _thermoclimatic_ (e.g. < humid heat, cold winds); _periodic_ or _time_ (e.g. < after midnight, between 4 and 8 pm, monthly, annually, in summer); _kinetic_ and _positional_ (< or > movement, staying still, descent, lying on left side, etc.); _nervous_ (e.g. < mental exertion, sunlight, strong odours, touch). Remember that modalities can apply to the person in general as well as to any presenting complaint. Sometimes they appear paradoxical; for example, generally < cold, but headache > cold, suggests Arsenicum album.

### _Constitutional aspects of pathological prescribing_

Experienced prescribers often utilise an assessment of the general or _constitutional_ aspects of the patient to assist them in the prescription of an appropriate remedy. For example, Natrum muriaticum is better suited to a _hot_ individual (feels generally < heat) than a _chilly_ one (feels generally > heat). Sepia, however, is the opposite. Therefore, in the treatment of cold-sores, where either remedy may be indicated on other grounds, 'feels generally < heat' tends to indicate Natrum mur. rather than Sepia. This is a simple example of the concept of _susceptible typology_ ; which essentially means that a certain type of person is sensitive to the actions of a particular remedy (or group of remedies).

Extending this concept, does this mean that Nat. mur. (as it is often so abbreviated) will have no effect on the cold-sores of a chilly person? This might be so; but, more likely, it will exert some effect, but less than it would in a hot type. The general constitution of the patient (which includes such parameters as thermal sensitivity, bodily conformation, colouring, pathological predispositions and personality) thus determines, in part, the efficacy of the pathological remedy. Hepar sulph., which almost routinely alleviates subacute or chronic dental abscesses in the majority, is actually most efficacious (swiftest in action) in those individuals who are flabby, chilly, hypersensitive to pain, and easily angered. In other words, this is the _susceptible typology_ for Hepar sulph., and the individual in whom it is manifest is said to be a 'Hepar sulph. type'. The constitution is named after the remedy to which it most significantly corresponds. Similarly, we may talk of 'Phosphorus', 'Pulsatilla', 'Sulphur', 'Calcarea fluorica', 'Natrum muriaticum', and many other 'types'.

### _The 'pathological simillimum_ '

The 'pathological simillimum' is the remedy best indicated in terms of the individual symptomatology of the patient with regard to the presenting complaint (sometimes with some partial consideration of the general or constitutional aspects of the case). It is not, in view of what has been said, the _only_ remedy that will act on the pathology. There is thus a certain lea-way in homoeopathic prescribing, where a remedy that is only partially indicated may still exert a certain beneficial effect. Hence, even when the most theoretically ideal remedy (the simillimum) is unavailable, a secondary remedy may often be selected, to great effect.

It should be emphasised that, whereas homoeopathists place great emphasis on individual symptomatology, the main action of the chosen pathological simillimum is upon the pathology itself. There is, however, some limited evidence (viz. its speed of action) that Arnica has some initial but limited analgesic effect in cases of bruising or crushing.

### _Constitutional prescribing_

Constitutional prescribing implies prescription based mainly upon the general aspects of the patient (see above), rather than those related to the presenting complaint. This aspect of prescribing is more relevant to the treatment of _chronic_ disease, where it is, to some degree, functionally reversible by medicinal means (such as rheumatoid arthritis, eczema, phobic disorder and predisposition to cyst formation). This usually requires much time with the patient, competent use of what is termed a _repertory_ (see after), and is less suited to the ordinary dental practice. It often requires a large number of consultations and assessments (at monthly intervals or less) in order to achieve satisfactory results. Here, the _simillimum_ with regard to the general or constitutional aspects of the patient, in some cases, may be difficult to assess with ease, and the 'cure' is often achieved by a sequence of different 'simillima' over the course of many months. Constitutional prescribing is particularly indicated in the treatment of chronic periodontal disease.

The matter of constitutional analysis in dental practice may, nevertheless, be simplified to a degree, with some beneficial outcome. This brings us back to the concept of _susceptible typology_ , described previously. By means of a few simple parameters with regard to each case, it is possible to infer what the constitutional simillimum is likely to be. An ideal 'Pulsatilla type', for example, is placid, tearful, sensitive, initially shy, plump, fair, _thirstless_ , and hot. An ideal 'Calcarea fluorica' patient exhibits weak enamel, dental overcrowding, a large angle of full extension at the elbow (greater than 180°), scoliosis of the spine, repeated sprains, lack of discipline and concentration at school (shows-off), and is < changes in climate and humidity. It is simply a matter of getting to grips with a variety of common susceptible typologies, by studying books of materia medica (Part Two of this book also gives you the more important aspects of susceptible typology of a number of common constitutional remedies). The appraisal of the patient actually begins the moment he or she enters your surgery, when you will observe such matters as general build, gait, colouring, tidiness, cleanliness, bodily odour, confidence, hostility, and so on.

Although it might seem somewhat illogical to relegate the presenting complaint to a position of secondary importance, and to favour those aspects of the patient which appear to be unrelated to it, this is not the case. Viewing a particular disease as an unhealthy tree, and the basic physiology as the soil in which it grows, it follows that we may either spray the leaves of that tree directly (pathological prescribing), or treat it by modifying the soil (constitutional prescribing). Modifying the general physiology often produces more profound and lasting cures in chronic disease than is achievable with pathological prescribing alone. Ideally, a constitutional remedy should also cover the presenting complaint and its individualised symptoms. This, however, may be difficult to achieve with a single remedy. Hence, many chronic diseases are treated with some combination or alternation of both constitutional and pathological remedies.

Where a chronic disease is incurable, due to severe and irreversible anatomical change (e.g. gross osteoarthrosis or periodontitis), or where the physiology is greatly weakened by malnutrition, chronic ill-health or age, it is often better to palliate the case with pathological remedies than to offer a constitutional prescription. In the case of severe anatomical change, little good will be achieved by a constitutional prescription. In the case of a weakened physiology, much strain will be placed upon it by such prescribing, which may, in itself, produce a further deterioration of the patient, with, in some cases, the necessity to supply an antidote. This deterioration is caused by the deployment of energy (to the treatment of a disease), the source of which is an already depleted energy pool. Always take professional advice in the treatment of such cases.

### _The use of the repertory_

A _repertory_ is quite different from a therapeutic index (see above). Although it may have a limited number of entries concerning conventional diagnostic categories, these do not comprise its main substance; not is its purpose to act as a mere substitute. The bulk of the repertory is concerned with individual objective and subjective symptoms (such as pain in the face), qualifications of those symptoms (including character, modalities and laterality), and general aspects of the patient (such as thermal sensitivity, desires, aversions, food likes and dislikes, pathological predispositions, bodily conformation, colouring, emotional status, and so on). These are classified under various headings and sub-headings termed _rubrics_. Under each rubric, a number of remedies is listed, using a variety of type faces to denote grades of importance. The idea is to select a remedy that appears to be dominantly expressed throughout a large proportion of the selected rubrics. In fact, special numerical scoring methods are taught for this purpose. In _Murphy's Homoeopathic Medical Repertory_ , which is one of the most up-to-date and conveniently arranged alphabetically, remedies in **BOLD CAPITALS** score 3 points, those in **_bold italics_** score 2 points, and those in plain type score 1. Those remedies which score higher totals, when all the relevant rubrics are assessed, may be considered as significant contenders for the role of simillimum (the final judgment being made by clinical experience or by consultation of the materia medica). Whilst this technique may be applied to both pathological and constitutional prescribing, the principal application of the repertory is with regard to the latter. Here, the general aspects of the patient are more usefully _repertorised_ than those of the presenting complaint (although some limited consideration of these may be relevant). In _Murphy's_ , for example, we would primarily consult the chapters (or principal rubrics) headed Generals, Mind and Food (aggravations and ameliorations from, appetite, thirst, desires and aversions).

Nevertheless, the repertory still has some distinct functions in pathological prescribing. The successful use of the therapeutic index depends on the ability to make a correct orthodox diagnosis (for, it is upon such that it is based). However, no such limitation is placed upon _repertorisation_. Many cases, as exemplified by those of facial pain, are difficult to classify in conventional terms. They may be manifestations of migrainous neuralgia (facial migraine), chronic or intermittent sinusitis, chronic pulpitis, various TMJ syndromes, or mixtures of these. In a therapeutic index, we might, having made our conventional judgement, look up **' _Neuralgia, migrainous_** '; then choose whichever of the listed remedies seems most appropriate under that heading. In contrast, when using a repertory, we would refer to the individual subjective and objective _symptoms_ ; a method which has the advantage of being independent of the constraints of orthodox diagnosis, which itself may be incorrect. In consulting the repertory, we must look up all the rubrics that pertain to the case, usually starting with the location of the pain; in this case, the face, teeth or jaws; following which, we must find those 'sub-rubrics' which correspond to the particular character of the pain (throbbing, burning, lancinating, etc.), those which refer to the modalities (e.g. < cold), and those which refer to associated symptoms (such as one-sided redness of the face). We might even look at a few relevant generals, such as thermal sensitivity and thirst, in order to complete our analysis. In this way, the pathological simillimum may be more surely found than by scavenging through a therapeutic index. There is also, of course, the individual case where, despite a clear-cut and accurate orthodox diagnosis, the therapeutic index fails to supply an effective remedy. Again, repertorisation is the sensible alternative.

The standard original work, of great popularity, is _Kent's Repertory_ (the structure and usage of which is explained in detail in _Bidwell's Use of the Repertory_ ). However, this is actively being replaced by many contemporary books, such as that mentioned above by Murphy, which are, quite frankly, easier to use, and which incorporate many details lacking in Kent. For dental surgeons (and many others), _Phatak's Concise Repertory_ is probably the most suitable with which to start. Many have discovered the apparent virtue of the computer, and have forsaken their books in favour of it and its homoeopathic software. To date, however, it would seem that a competent and experienced homoeopathist, armed only with the occasional reference to a repertory, can achieve more than a mechanician with two computers strapped to his or her side. Ultimately, the repertory or the computer programme can only indicate what the simillimum might be. Consultation of works of _materia medica_ is necessary to confirm true clinical indications in detail; except where the experience of the practitioner will determine the same.

### _The materia medica_

There are numerous works on _materia medica_ , where the remedies are listed alphabetically and their properties delineated under various headings: pathological indications, susceptible typology, mind, head, eyes, ears, nose, face, mouth, stomach, abdomen, stool, urine, male, female, respiratory, heart, back, extremities, sleep, fever, skin, modalities, relationship and comparison with other remedies, and dosage. Those to be recommended are _Boericke, Boger's Synoptic Key_ , and _Vermeulen's Synoptic Materia Medica_. For those who wish to go into great depth, they need go no further than _Clarke's Dictionary of Materia Medica_.

Treated as a whole, the homoeopathic materia medica has many objective and subjective symptoms, the clinical significance of which has never or seldom been verified. These are symptoms which have been caused by a drug or potentised remedy (by proving), but, although the implication is that they might also be cured by the relevant remedy, this has not been satisfactorily confirmed. Good works of materia medica, however, emphasise which diseases or symptoms have been repeatedly cured by a particular remedy, so that we may be more certain in our choice (indeed, there are some entries where only the curative aspect of the remedy has been observed, and not the pathogenetic).

In homoeopathic prescribing, particularly at the constitutional level, much emphasis is often placed on the so-called _mentals_ ; so much so, that the mentals are separated from the _generals_. The term 'mentals' refers to the detailed psychological status of the individual (such as weepiness, loneliness, friendliness, etc.), which is often taken as a prime indication of the 'constitutional simillimum' (when an acute anxiety state in relation to dentistry is treated as an entity in itself, this is a form of pathological, rather than constitutional, prescribing).

Many of us feel, however, that the ideal selected constitutional remedy should not only cover the mental and general aspects of the case, but also those of the presenting complaint or pathology (and, preferably, with regard also to its individual symptomatic manifestation). Therefore, where two remedies would seem to be contesting on the basis of the mental and general analysis, that which more frequently treats the particular pathology should be selected in preference. In contrast to the generals, details concerning a particular pathology or disease (the presenting complaint), and its individualised objective and symptomatic picture, are termed the _particulars_.

### _How do we summarise the differences in use of the therapeutic index, repertory and materia medica?_

In analysing any case, the initial approach is quite different with regard to the three categories of reference work:

(1) With the _therapeutic index_ , we begin by selecting a category of conventional disease.

(2) With the _repertory_ , we usually begin by selecting a number of general and mental characteristics, or objective and subjective symptoms.

(3) With the _materia medica_ , we begin by selecting particular remedies for consideration, based upon personal clinical experience, upon the suggestions of a therapeutic index, or upon the results of repertorisation. The materia medica is thus the ultimate source of information.

### _What are leading symptoms?_

_A leading symptom_ is one that leads to the consideration of a limited number of remedies above all others; although often one of these is most commonly indicated, e.g. _excessive salivation and halitosis_ with toothache – Mercurius sol. A leading symptom may, in fact, be a quality or modality, e.g. _throbbing_ pain – Belladonna; toothache > _for cold water in the mouth_ – Chamomilla (Coffea cruda also). These are leading symptoms in pathological prescribing, but the concept may be also applied to constitutional remedy selection, e.g. irritability < _especially to her nearest and dearest_ – Sepia. Leading symptoms are also called _keynotes_.

However, when all is said done, a remedy might be indicated for consideration by a leading symptom, but can only be selected as appropriate if it matches the case in other respects. Irritability towards one's husband, in itself, is not a sufficient basis for the prescription of Sepia; but, where this occurs in an overworked female with bearing-down feelings in the lower abdomen, then it becomes strongly indicated. Some talk of the 'three-legged stool', implying that much good prescribing can be achieved by finding three leading symptoms which match a particular remedy. Indeed, in the hands of the expert prescriber, it is a valid technique. For those who are interested in pursuing this approach, _Nash's Leaders_ is to be recommended for further reading.

_Strange, rare_ or _peculiar_ symptoms are a particular subgroup of leading symptoms, which have an enigmatic and inscrutable nature, and which lead similarly to the consideration of particular remedies (e.g. burning sensation > _heat_ – Arsenicum album; urgency to urinate < _putting hands in cold water_ – Kreasotum).

### _What is a polychrest?_

A _polychrest_ is a remedy of wide therapeutic applications, such as Sulphur, Arsenicum album and Calcarea carbonica. Such remedies are important in the correction of the constitution in general, and also manifest important corrective effects on a variety of pathologies.

### _In which potencies should we initially prescribe & with what frequency of repetition?_

For newcomers to homoeopathy, it is best to restrict themselves to the prescription of either 6c or 30c, to follow the directives of the second (encyclopaedic) section of this book concerning the initial frequency of dose repetition, to withdraw the remedy if aggravation or proving occurs, and always (unless directed otherwise therein) _to discontinue treatment when significant improvement has occurred_ (otherwise, aggravation or proving may result). If the case then relapses, return subsequently to the same remedy, using the same potency and repetition as before. When this fails to act satisfactorily, then an increase in the frequency of dosage or numerical potency may be indicated. If such measures fail, or consistently cause aggravation or proving, then a new remedy must be selected.

In professional prescribing for _acute_ dental conditions the normal range of potencies used is actually 6–200c. The greater the _vitality_ of the patient or the _severity_ of the disorder, the better the indication for higher potencies. In _emotional states_ , such as acute dental anxiety, higher potencies also produce a more profound and rapid effect. Additionally, it should be noted that some remedies simply act better in higher potency than lower, and vice versa. Nevertheless, despite these points, much good work can be done within the range 6–30c.

In _pathological_ prescribing for _chronic_ disease, it is generally advisable to restrict yourself to the use of remedies in the range 6–30c. Remedies so selected are usually given relatively frequently (often 1–3 times daily). _Constitutional_ prescribing for _chronic_ disease is, however, another matter. The selection of the correct remedy and dosage requires considerable experience and practice. Sometimes high or very high potencies (1M upwards) are required infrequently, or low potencies are given on a regular and frequent basis. Moreover, styles of prescribing differ considerably between different practitioners. Generally, low potency constitutional prescribing is safer for the newcomer, but it is still unwise for those who have not been properly taught.

### _Should a single potentised remedy be given at one time, rather than a combination?_

For beginners, the answer is in the affirmative. As you develop experience, however, you may choose to give certain remedies in combination or alternation (one followed by the other in regular sequence), in order to speed the 'cure'.

In this regard, you must be aware that remedies have certain interrelationships in terms of effect. They may be _complementary, antidotal_ or _inimical_. A complementary remedy either acts synergistically with another remedy, or completes the rectification of physiology commenced by another. An antidotal remedy opposes the action of another. An inimical remedy acts with another to produce some undesirable effect (e.g. Mercurius and Silicea, given together or in alternation, may produce severe eczema). _Gibson Miller's Relationship of Remedies_ is a useful and cheap reference booklet in this respect.

In professional work, constitutional and pathological remedies are often combined or alternated, in order to achieve a faster and more profound effect.

Mouthwashes (or topically applied mother tinctures) and orally administered potentised remedies may be used synergistically in therapy, provided that the mouthwash (or tincture) is not applied within 10 minutes of taking the potentised remedy.

### _What is Hering's Law?_

Hering was one of Hahnemann's most important pupils. _Hering's Law_ gives us the means of assessing the correct progression of curative (constitutional) treatment of a _chronic disease_ :

'Cure occurs from above downwards, from within outwards, and in reverse chronological order.'

Put simply, this means that the cure is proceeding successfully when the upper body symptoms clear before the lower, when more important organs (e.g. the lungs) improve before those of lesser vital importance (e.g. the skin), and when old symptoms return briefly, the most recent being first manifest. Although not all these points may be observed in any particular case, the occurrence of inverse responses is regarded as an indication of incorrect therapy. Hence, where the symptoms clear from below upwards, or from the skin before the lungs, or in chronological order (the order in which they developed), then the treatment is unsatisfactory and not curative.

One thing that is not uncommon, in the successful treatment of a chronic disease, is the occurrence of a transient skin rash, even in a patient who has no history of skin disorder. This is termed _externalisation_ , and is usually regarded as a strong indication that the treatment is progressing satisfactorily.

### _What is a miasm?_

The term _miasm_ is applied to various diagnostic entities in homoeopathy:

(1) A familial trait (such as thyroid disease or asthma).

(2) An inherited non-infective disease trait developed in an individual as a result of infection in the parent, which may then become a familial trait (e.g. where a parent has had TB in the past, the children subsequently born may suffer from asthma or recurrent bronchitis, and their children similarly).

(3) The prolonged aftermath of an infection or immunisation (such as ME following a viral infection, or ill-health following measles or measles immunisation).

(4) The prolonged aftermath of a drug or chemical (e.g. 'never well since an antibiotic').

Hahnemann's original miasmata (miasms) were _psora, syphilis_ and _sycosis_ (not _Psychosis_!). Now we have many more, including ME and the so-called _tuberculous miasm_ (which covers allergy and many cases of asthma). For further details of this complex subject, you should initially consult _Jouanny's Essentials of Homoeopathic Materia Medica_. Miasmatic disease often requires the _infrequent_ use of special remedies, in addition to any indicated routine constitutional treatment (such as Bacillinum for the tuberculous miasm, which may be associated with a predisposition to dental caries). Indeed, from the practical point of view, it is best to regard antimiasmatic therapy as a special area of constitutional prescribing, since it is more concerned with the 'soil' in which the disease grows.

### _Prescription by causation_

Sometimes a remedy can be prescribed on the basis of the event, circumstances or disease which seemed to precipitate the presenting complaint or constitutional upset, even though this may have occurred many years previously. Frequently, the same remedy may be given as would have possibly been chosen for the precipitating disturbance itself. For example: epilepsy following _concussion_ – Natrum sulphuricum (a principal remedy for concussion); not well since _physical trauma_ – Arnica (a remedy for physical trauma); not well since _BCG immunisation_ (in other words, a type of acquired tuberculous miasm) – BCG nosode; inflammatory arthritis associated with _silent periapical abscess_ – Hepar sulph. (the principal remedy for chronic dental abscess).

### _Do drugs & remedies mix?_

In general, there is no need, as far as dental matters are concerned, to interfere with any existing drug regimes prescribed by the patient's own doctor; unless, of course, they are totally without clinical effect; in which case, common sense dictates their abandonment. Potentised remedies often work extremely well, even though the patient is taking drugs (and even in the face of steroid treatment). The worst thing that can happen is that the drug will weaken the action of the remedy (which often happens when an antibiotic and a remedy are given together). Remedies seldom interfere with the action of prescribed drugs, and rarely appear to react with them to produce inimical reactions.

The importance of supplements (such as vitamins and minerals) in oral nutrition is not to be forgotten. These may be given in isolation, or alongside potentised remedies, in order to achieve maximal therapeutic effect. Those most relevant are also described in Part Two of this book.

### _Where do I begin?_

Start with simple prescriptions, such as Arnica for the prevention of surgical haemorrhage or Hepar sulph. for subacute dental abscess. Try giving remedies for allaying anxiety, and prescribe healing mouthwashes. See what you think of _Propolis_ as a disinfectant in root canal therapy. Restrict yourself initially to a pathological prescribing. With this alone you will achieve a great deal, much to your own satisfaction, and, more particularly, to that of the patient. Leave constitutional prescribing until later, when you have been taught to do it properly and you have gained sufficient experience. Otherwise, always remember that the homoeopathic physician, should he or she be well-versed in dental matters (as a number are), is there to help you.

One fine way of getting to grips with homoeopathy is to use it in your own domestic situation for common ailments, both at home and on vacation. For these general purposes, you might consult one of my previous books, _The World Travellers' Manual of Homoeopathy_. This will also give you further insight into the world-wide applications of this style of 21st Century medicine, extraordinarily conceived around 1790.

## PART TWO

## An Encyclopaedia of Dental Homoeopathy & Clinical Nutrition

### _Notes on the use of Part Two_

This is not merely an encyclopaedia of homoeopathic orofacial medicine and its application to oral surgery. It is also a system of self-tuition in dental homoeopathy and nutrition, which will usefully complement the content of various courses that are available, including those of the BHDA, the British Homoeopathic Dental Association (in conjunction with the Royal London Homoeopathic Hospital).

Within its substance, each detailed topic contains a number of words or phrases emphasised in _italics_ , these referring to other related headings (or rubrics). You may, therefore, start with virtually any topic in the encyclopaedia, and will be automatically led to other material. For example, **_Abrasion, soft tissue_** leads you to _Calendula_ , and **_Calendula_** leads you to _fracture_ and _Hypericum_. By constant cross-reference, at your own pace and in any direction you wish, you will gain an effective knowledge of basic homoeopathic dental therapeutics.

The encyclopaedia contains many entries concerning materia medica and nutritional substances referred to in therapy. These will provide you with a sound grounding in their properties, so that, at least initially, there will be no need to use this encyclopaedia along with any standard work on materia medica or nutritional supplementation. Consultation of such works, however, will become necessary at a later date, when your head has been turned and your enthusiasm fired. Major constitutional remedies are marked with an asterisk, and you should pay some attention to their susceptible typologies.

Some topics are discussed solely for the purpose of aiding differential diagnosis or providing words of caution. It is extremely unlikely these days that an early case of syphilis will be sent for homoeopathic rather than orthodox treatment. However, its relevance in the encyclopaedia is to bring its existence and nature to your attention; for, one day you may meet such a risky case, and confuse a chancre with a carcinoma or a cold-sore.

The competent practitioner must know when to treat, when to investigate, when to refer and when to collaborate.

You will note that dosages with regard to prescriptions strongly based upon the presenting complaint (so-called pathological prescriptions) are generally given in some detail; whereas those relating to constitutional prescribing are omitted (as are certain aspects of antimiasmatic prescribing). Only guidance on the selection of the constitutional simillimum is given. This is for two reasons. Firstly, constitutional prescribing requires proper tuition and experience. Secondly, styles of dosage with respect to constitutional treatment vary considerably between practitioners. Some use repeated doses of low potencies, whilst other use infrequent doses of high potencies. Others use either, according to the situation or experience, and some remedies, especially certain major nosodes (such as Bacillinum), always require infrequent repetition tailored individually to the case.

Nevertheless, since selection of the correct pathological simillimum in many instances requires some partial appraisal of the constitution, the susceptible typologies relevant to many remedies are briefly outlined. Such a knowledge of the rudiments of typology also assists the dental practitioner in communication with the professional homoeopathist. Collaboration is difficult between two people who do not speak the same language; especially one as 'strange' as that of homoeopathy, where a person may be described, for example, as a 'Phosphorus' or 'Pulsatilla' type.

It should be mentioned that those who wish to take the examinations in dental homoeopathy set by the BHDA in conjunction with the Faculty of Homoeopathy of London will find this a useful source of information. Additionally, homoeopathic practitioners themselves should find the content of considerable value in the treatment of orofacial conditions, since this subject is so neglected and poorly analysed in most of the usual homoeopathic works with which they are familiar. Neither should the homoeopathically inclined GP be disappointed in the range of topics covered.

### A

### _Abrasion, soft tissue_

These commonly occur to the lips, the corners of the mouth and the buccal mucosa, as a result of manipulation or instrumentation. Since _Calendula_ is a potent promoter of the healing of damaged oral mucosa and skin, Calendula Ointment or Cream (5%) should be applied both before and after any dental procedure to the appropriate areas (some suffer from _allergy_ to lanolin or chemical preservative agents, and the base must be lanolin-free or chemical preservative-free accordingly). Potentised _Arnica_ , given before and after the procedure, helps to minimise bruising of the tissues.

### _Abscess, dental_

The homoeopathic treatments of periapical and parodontal abscesses are essentially similar. Where the patient presents with significant facial swelling, _Myristica_ 30 should be given immediately, followed by a further dose after about thirty minutes, and a subsequent dose one hour later. This will generally reduce the swelling and discomfort, and incision may be avoided. Thereafter, _Hepar sulph_. 6 should be given three times daily, until such time as the tooth may be root-filled or extracted, or the peridontium attended to, whichever is appropriate. Hepar sulph. given in the potency of 6c is the most successful treatment for the subacute and chronic dental abscess. Higher potencies, such as 30c, should not be given, since they tend to discourage proper drainage (the retention of pus prolongs the pain or discomfort, and may produce systemic disturbances). Such a prescription may indeed be pursued for many months. Where facial swelling is not a dominant feature, this remedy may be given from the outset.

Occasionally, however, other remedies will be required. _Belladonna_ 30–200 every hour or two, for cases with severe **throbbing** pain. _Mercurius solubilis_ 30 three times daily, for cases with gross halitosis and excessive salivation. Where the patient is feverish, give _Pyrogen_ 30 three times daily, in addition to any of the selected remedies.

Hot _Calendula_ or salt _mouthwashes_ should also be suggested, given two or three times daily, or even more frequently in acute cases.

See also _Actinomycosis, cervicofacial; Cellulitis, acute; Endodontics; Focal sepsis; Pericoronitis; Trismus_.

### _Abscess, incisional – see_ Incisional abscess

### _Aconite (Aconitum napellus)_

Homoeopathic monkshood (common in Europe). Attenuations are prepared from the mother tincture of the whole plant, which is intensely poisonous. The most important remedy in acute _anxiety_ states related to dentistry, especially indicated where there is great fear or dread. Also useful for the control of sudden increases in _blood pressure_ in hypertensive patients as a result of dental anxiety, and attacks of _angina pectoris_ from the same. In some individuals, it is capable of aborting _colds and influenza_ , if given at the outset, and it can be helpful in the treatment of _Bell's palsy_ and _pulpitis_. It is sometimes used constitutionally in very fearful individuals who exhibit _xerostomia_.

#####

##### _Fig. 1. Aconite_

### _Acquired immune deficiency syndrome – see_ **AIDS**

### _Acromegaly_

This hormonal disorder, due to the hypersecretion of growth hormone by the pituitary gland, produces mandibular prognathism, malocclusion, spacing of the teeth, enlargement of the lips and tongue and _sialosis_. Some success in halting the progression of this disease has resulted from the long-term administration of remedies prepared from the pituitary gland itself (such as Pitressin 12), given in combination with _Calcarea carbonica_.

### _Actinomycosis, cervicofacial_

Actinomycosis should be suspected where an abscess-like swelling appears in the region of the jaws, which, despite apparently appropriate surgical or medicinal intervention (e.g. incision, extraction, antibiotics), either remains the same or worsens after a further ten days. There may be a history of extraction or fracture in the area about 5 weeks previously. An initial induration of the tissues gives way to frank abscess formation, with the discharge of pus, containing characteristic bright yellow or grey 'sulphur granules', through multiple sinuses. Since there is the possibility of metastasis to other sites, bone erosion, and, in the case of maxillary actinomycosis, spread to the meninges, expert advice should be sought. Homoeopathy may be helpful. Initially, in the stage of induration before sinus formation, consider _Lapis albus_ 6 twice daily. With sinus formation, consider _Silicea_ 6–12 twice daily. Both treatments should be given in conjunction with the nosode Actinomyces israeli 30 once daily (midday).

### _Acupuncture_

A useful adjunct to homoeopathy in the treatment of _facial pain_. Special techniques are capable of inducing anaesthesia. Recommended books for initial study are: Basics of Acupuncture by G. Stux and B. Pomeranz; The Acupuncture Treatment of Pain by L. Chaitow; and A Guide to the Location and Use of Forty-Eight Important Points by P. Vernon. Book lists are available from the East Asia Co. Ltd., 100–103 Camden High Street, London, UK.

### _Addison's disease_

Hyposecretion of glucocorticoids and mineralocorticoids by the adrenal cortex. There is loss of weight, lethargy, hypotension, hyperpigmentation of the skin, and melanotic _pigmentation_ of the oral mucosa in approximately 75% of patients (which may occur at any site). It should not be confused with racial pigmentation. Some cases are associated with _AIDS_. Replacement therapy is indicated.

### _Aerodontalgia_

Pain in the teeth upon ascent in an aircraft. Give _Chamomilla_ 30 half-hourly, or _Coffea cruda_ 30 half-hourly. Cold water held in the mouth may also help.

### _Agranulocytosis (Granulocytopenia)_

The marked diminution or absence of granular leukocytes from the bone marrow and peripheral blood. This generally occurs as a result of drug therapy having a toxic effect on the haemopoietic marrow. Potentised preparations of the offending drug may be helpful in reversing this action. It may also occur as a secondary feature of certain blood diseases, such as acute _leukaemia_ and aplastic _anaemia_. Severe oral _ulcers_ occur as a result of opportunistic infection. Oral _candidosis_ is encouraged.

### _Agraphis nutans_

Homeopathic bluebell. For _mouth-breathing_ , where there is enlargement of adenoids and tonsils, especially when this occurs with the _eruption_ of teeth. Especially indicated in chilly individuals. The **susceptible typology** is essentially similar to that of _Silicea_.

### _AIDS (Acquired immune deficiency syndrome)_

A number of characteristic orofacial lesions are seen in AIDS cases, the recognition of which by the dental surgeon is most important. Those most frequently seen are _ANUG_ , oral _candidosis, Kaposi's sarcoma, herpes simplex infection_ (intraoral and perioral), _herpes zoster_ , hairy _leukoplakia_ and rapidly progressing _periodontitis_. More rarely, there may be _aphthous ulcers, xerostomia_ , salivary gland swelling with _sialectasis, papillomavirus lesions_ , non-Hodgkin's lymphoma, a brown-black _pigmentation_ of the oral mucosa (possibly associated with zidovudine therapy in some), _facial nerve palsy_ , trigeminal paraesthesia or anaesthesia, trigeminal _neuralgia_ and _lichenoid_ drug reactions. _Thrombocytopenia_ also occurs. Hairy leukoplakia is also seen in other immunocompromised patients, such as those who have undergone renal transplantation, and is thus not absolutely pathognomonic of AIDS, as was hitherto thought. Classically, it is a painless white lesion that affects the lateral borders of the tongue. Oral candidosis may be of the pseudomembranous, hyperplastic or erythematous type, and candida-related _angular cheilitis_ and _median rhomboid glossitis_ also occur. Homoeopathy may be helpful in the control of AIDS and its various manifestations, including the use of an AIDS nosode.

### _Albers-Schönberg disease – see_ Osteopetrosis

### _Albrights syndrome – see_ Fibrous dysplasia

### _Allergy, food – see_ Food allergy

### _Allergy, orofacial_

The occurrence of oral ulceration, oedema of the lip, gingivitis or mucosal white patches may be associated infrequently with sensitivity to dental materials (such as _amalgam), toothpastes_ , or constituents of _food_ or drink. Special testing (such as the patch test) may be required to identify the allergen. Allergy may be implicated in _aphthous ulcers, burning mouth syndrome, denture sore mouth, erythema multiforme_ , chronic atrophic _gingivitis_ (in relation to restorations or chrome prostheses), _lichenoid reactions_ and _orofacial granulomatosis_. Rarely, allergy may be related to local _anaesthesia. Angioedema_ is a condition which simulates true allergy. Allergy to lanolin, the active constituent, or preservative in creams or ointments occasionally occurs.

See also _Bacillinum_.

### _Allium sativum_

Homoeopathic garlic. A remedy for _sialorrhoea_ after eating. **Susceptible typology:** voracious carnivores, overindulgent, dyspeptic (certain similarities to the _Nux vomica_ type), tongue pale with red papillae. Ordinary garlic is taken for _candidosis_.

#####

##### _Fig. 2. Allium Sativum_

### _Aloe vera_

A botanic vulnerary. One of several species of Aloes, and not to be confused with the Aloe socatrina of homoeopathy. The fresh juice of the fleshy leaves is antifungal, and may be used to treat oral _candidosis_. A mouthwash may be prepared by adding 10ml of the juice to 250ml of water, to be used 3–4 times daily. Alternatively, it may be incorporated (5%) in a cream. It may be mixed with _Berberis vulgaris_ and _Hydrastis canadensis_. Aloe vera is also sometimes used as an application to _aphthous ulcers_.

#####

##### _Fig. 3. Aloe vera_

### _Amalgam, dental_

This substance may be potentised to produce a remedy to oppose any _mercury toxicity_ (see _Appendix 2_) consequent upon the removal of old amalgam fillings. It should not be used in a potency of less than 6c or 11x (D11). Amalgam fillings themselves may be associated locally with _lichenoid reactions_ of the oral mucosa and _amalgam tattoos_. Emitted mercury vapour is associated with the development of _antibiotic_ resistance by the bacterial flora of the oronasal region. Removal of amalgam is sometimes followed by unusual symptomatic pictures, presumably resulting from inhalation of mercury vapour. These may be antidoted by homoeopathic means, with prescriptions based upon the individual symptomatology which develops. The most commonly indicated remedies in this respect are _Aurum metallicum, Carbo vegetabilis, Hepar sulph_., Kali iodatum, _Lachesis, Natrum sulphuricum, Nitricum acidum, Phytolacca, Staphysagria_ and _Sulphur_. Some skill is involved in their selection, and reference to detailed repertories is sometimes required.

### _Amalgam tattoo_

The presence of amalgam fragments within the oral mucosa may lead to a bluish patch of oral mucosa. This is initially radio-opaque, but subsequently becomes radiolucent. Amalgam also appears to be able to pass electrophoretically from filled teeth into the oral mucosa; and such tattoos are always radiolucent. These patches must be differentiated from other causes of intraoral _pigmentation_ , such as _melanoma_ and _Kaposi's sarcoma_. Amalgam tattoos are an unlikely source of _mercury toxicity_ (see _Appendix 2_), in that this is mainly related to mercury vapour.

### _Ambra grisea_

Homoeopathic ambergris (from the whale). Used in the treatment of some cases of _ranula_. **Susceptible typology:** extraordinarily timid children and adults, the adults being prematurely aged ( _Pulsatilla_ types may be timid to varying degrees, but tend to appear younger than their years; _Lycopodium_ types are prematurely aged, but not outwardly timid).

### _Amphisbaena (Amphisbaena vermicularis)_

Homoeopathic preparation of a snake-like lizard. Given for mandibular _osteomyelitis_ , especially of the right side, with pain < air, < dampness, < motion, < afternoon and < evening. May be used for _toothache_ with the same modalities.

### _Amyloidosis_

The extracellular deposition of amyloid protein is one cause of macroglossia, as is _hypothyroidism_ in infants. Surgery may be indicated. The homoeopathic treatment of both localised and widespread amyloidosis is complex.

### _Anaemia_

Anaemia is not uncommonly associated with _iron, folate_ or _vitamin B12_ deficiency. The dental surgeon may tentatively diagnose anaemia from oral symptoms and signs. Aplastic anaemia, due to failure of haemopoiesis within the marrow, is characterised by haemorrhagic lesions of the gingivae and oral mucosa, and opportunistic oral infection.

See also _Agranulocytosis_.

### _Anaesthesia, general_

In order to prevent chest infections in chesty patients, give _Antimonium tartaricum_ 6 three times daily, for several days before and one week after the procedure (this may be used in conjunction with _Arnica, Hypericum_ or _Pyrogen_ , given for other reasons). To arouse patients after general anaesthesia, give _Opium_ 100–200 (liquid potency) quarter-hourly; _Phosphorus_ 30 (liquid potency) or higher is an alternative. If the patient is nauseated, give _Ipecacuanha_ 30 (liquid potency) quarter-hourly.

For those interested in the more esoteric effects of nitrous oxide, they might take note of the story quoted by Bertrand Russell: 'William James describes a man who got the experience from laughing gas; whenever he was under its influence, he knew the secret of the universe, but when he came to, he had forgotten it. At last, with immense effort, he wrote down the secret before the vision had faded. When completely recovered, he rushed to see what he had written. It was "A smell of petroleum prevails throughout".'

### _Anaesthesia, local_

The routine use of _Arnica_ before and after dental procedures tends to prevent _haematoma_ formation. True _allergy_ to local anaesthetics is rare, and general symptoms that arise (e.g. nausea and dizziness) are more likely associated with accidental intravenous administration or _anxiety. Smelling salts_ are sometimes invaluable in such a situation. Fischer recommends _Chamomilla_ 30 for any systemic or psychic effects of local anaesthesia. Where stiffness of the jaw persists after an injection of local anaesthetic, particularly after an inferior dental nerve block, consider _Ledum_ 30 three or four times daily. Occasionally, _Ruta_ 30–200 three or four times daily (or initially more frequently, according to response) is better indicated, where the pain is felt in the bone as a result of scraping the periosteum, or as a result of intra-alveolar injection. An obvious haematoma is better treated with Arnica. _Apis_ 30 three times daily is given for oedema at the injection site, with burning or stinging pains > cold applications. _Hypericum_ 30–200 three or four times daily (or more frequently) is indicated where the nerve trunk has been damaged by the needle, and there are shooting pains. Local anaesthesia of the palate may be contributory to the development of _necrotising sialometaplasia_.

See also _Oral surgery, pain control after_.

### _Angina bullosa haemorrhagica (ABH)_

Recurrent intraoral blood blisters. ABH is sometimes associated with steroid therapy, given systemically or by inhaler. A solitary blood-filled blister develops in seconds or minutes, usually upon the soft palate, and sometimes associated with the ingestion of food. The blister bursts spontaneously within 24 hours, leaving an _ulcerated_ area which heals within 7–10 days. Usually 5–10 episodes occur over 2–3 years. _Thrombocytopenia_ should be excluded by blood test. Immediate treatment includes puncturing the intact blister. Also give _Arnica_ 30 three times daily for up to 10 days. _Calendula_ mouthwashes should be used three times daily, in order to promote healing.

### _Angina, Ludwig's – see_ Cellulitis, acute

### _Angina pectoris_

Characterised by transient retrosternal pain, radiating to the neck or left arm, this may occur as a result of acute dental _anxiety_. In addition to any regular medication used by the patient for such an emergency, remedies may be given to assist, such as _Aconite_ or _Bach_ Rescue Remedy. Alternatively, _Latrodectus_ 30 may be given in the same manner as Aconite. Obviously, the persistence of pain, despite rest and medicinal therapy, is more suggestive of myocardial infarction, and medical advice should be urgently sought.

### _Angioedema_

Recurrent non-allergic oedema of the tongue or lips, often precipitated by trauma. It may be associated with drug therapy (particularly antihypertensive agents) or it may be genetic in origin. Tongue swelling may cause difficulty in breathing. Some cases have responded to potentised _Sulphur_.

### _Angular cheilitis (Perlèche)_

A painful fissure of the corner of the mouth, often occurring bilaterally. Infection is often present, involving Candida organisms, staphylococcus aureus, or, more rarely, haemolytic streptococci. Angular cheilitis may be associated with oral _candidosis_ (including that related to poor denture hygiene), _iron_ deficiency (including that related to _rheumatoid arthritis), vitamin B2_ deficiency, _folate_ deficiency, _vitamin B12_ deficiency, _diabetes mellitus, orofacial granulomatosis, AIDS_ and _Crohn's disease_. Angular cheilitis is occasionally confused with recurrent _herpes labialis_ , erosive _lichen planus_ or facial eczema. The role of severe overclosure in its aetiology is unclear.

Despite the multiplicity of causative factors, many cases clear up with vitamin B2 supplementation, 50mg once daily (adult dose), or 25mg daily for most children. You should warn your patients that their urine will become bright yellow in colour. Treatment is often necessary for several months at a time, and a discontinuation may be followed by relapse, necessitating represcription of the vitamin. The origin of the local deficiency state is unclear, and is not necessarily caused by an inadequate diet. Some form of malabsorption may be at the root of the matter. It is not generally necessary to give other B vitamins in conjunction with B2, despite the protestations of the naturopaths, since the diet will usually contain adequate amounts of these. Treatment may be accelerated by the use of an antifungal and antibacterial topical application, composed of 50g of aqueous cream in which has been mixed 5–10 drops of _tea tree oil_ , applied two or three times daily (where staphylococcal infection has been confirmed, the anterior nares should be treated with the same). Should such simple treatment fail, then investigation of the underlying cause with be necessary (e.g. blood tests for iron deficiency). Appropriate fundamental treatment should then be instituted. Where Candida infection has been confirmed, treatment for intraoral candidosis may be necessary.

### _Anorexia nervosa & bulimia nervosa_

Both these conditions are of psychopathological origin. Anorexia nervosa is characterised by the avoidance of food and recurrent vomiting. Bulimia nervosa is characterised by gluttony, followed by self-induced vomiting. Both conditions may be improved by professional homoeopathic treatment, and _zinc_ supplementation is certainly useful in anorexic cases. The exposure of the teeth to gastric acid produces erosion of the enamel. Bilateral parotid _sialosis_ also occurs.

### _Anthracinum_

Homoeopathic. Anthrax nosode. Used in the treatment of _anthrax_ , recurrent boils and _cancrum oris_.

### _Anthrax_

This bacterial disease may be identified sometimes by the dental surgeon where it occurs on the face. The characteristic appearance is a solitary papule with a black necrotic centre ('malignant pustule'), surrounding vesicles and oedema. It is most common in those who work with animals or animal materials: butchers, tanners, vets. A fatal septicaemia can result. Both allopathic and homoeopathic therapies are available, including the use of the nosode _Anthracinum_.

### _Antibiotics, ill-effects of_

The use of antibiotics is largely avoidable by the judicious prescription of homoeopathic remedies. Three common complications of antibiotic therapy are thrush (oral or vaginal candidosis), diarrhoea and allergic skin rash. Thrush may be treated internally with _Borax_ 30–200 three times daily (see also _candidosis, oral_ ). Diarrhoea maybe treated with either _Crataegus_ Ø 5 drops in a little water three times daily (adult dose), or _Nitricum Acidum_ 30 4-hourly. The disappearance of an allergic skin rash may be hastened by giving _Thuja_ 6 two or three times daily.

See also _Tongue, black hairy_.

### _Anti-inflammatory drugs_

These are commonly employed in the treatment of musculoskeletal injuries and inflammations. They may produce _lichenoid reactions_.

### _Antimonium crudum_

Homoeopathic preparation of native antimony sulphide. Used for loss of _taste_ with a thick creamy coating on the _tongue_ , and in the treatment of _impetigo_. **Susceptible typology:** irritable, dyspeptic, nails thick and hard (split longitudinally), < cold bathing and direct heat of a fire or the sun, > hot baths and applications.

### _Antimonium tartaricum_

Homoeopathic preparation of tartar emetic. Given for loss of _taste_ with a thick white coating on the _tongue_ , which has red edges; especially in chesty subjects. Used also in the prevention of chest infection following general _anaesthesia_ , and in the treatment of _chickenpox_.

### **_ANUG_** – _see_ Gingivitis, acute necrotising ulcerative

### _Anxiety, acute dental (Odontophobia)_

Acute anxiety, apprehension and fear are not uncommon both before and during dental procedures, in both adults and children. Remedies improve the psychological status, without the drugging effect associated with conventional tranquillisers. The most important remedy to be considered is _Aconite_. The main indications for Aconite are fear, dread, panic or psychological shock. Since one or more of these is usually present in most cases of acute dental anxiety, Aconite is commonly indicated, especially where the mouth is dry. Mild cases may respond to a 30c, but higher potencies (200–1M) are often required for more severe states, particularly where a rapid action is required. Initial repetition may be quite frequent (every 15 minutes) in the dental surgery. The same remedy may be given less frequently (three or four times daily) for several days before the next visit. Some favour the use of _Bach_ Rescue Remedy as an alternative to Aconite.

Occasionally, Aconite (or Rescue Remedy) is unsuccessful, and other remedies are required, given with the same frequency of repetition. _Argentum nitricum_ 30–200 is indicated where the patient becomes excessively talkative as a result of anxiety, and is constantly on the move (sits down and gets up frequently, reads one magazine for a few minutes, plays with and looks at his or her watch constantly, reads another magazine). In contrast, _Gelsemium_ 30–200 is indicated where the patient is uncommunicative, inactive and trembling. Diarrhoea may accompany the other symptoms of either the Gelsemium or the Argentum nitricum case. _Coffea cruda_ 30–200 is suited to those who are overenthusiastic, sleepless (mind full of thoughts) and excessively sensitive to pain. As with Aconite, the prescription of these remedies for a few days before the next visit maybe helpful. Occasionally, _Chamomilla_ is also indicated in adult cases, as is _Ignatia_.

Fischer feels that the most commonly indicated remedies in acute dental anxiety are Aconite, Coffea, Gelsemium, Ignatia and _Arsenicum album_. A leading indication for Coffea is that the patient is very sensitive to noise of any sort, and insists that any background music is turned off; toothaches tend to be better for cold water held in the mouth. Ignatia patients are made to feel extremely ill by coffee or tobacco smoke, and their general anxiety often stems from an unpleasant psychological shock in the past (e.g. loss of a loved one, being jilted or rejected). Arsenicum album is indicated in extremely chilly and fastidious patients, who have profound anxieties about their health and may experience burning pains > heat. Any of these remedies may be given in the range of 30–200c, according to the degree of psychological disturbance, with repetition according to response.

Both _Arnica_ and _Hypericum_ , which are routinely given by many before and after dental procedures, are compatible with all the above remedies, and may be given concurrently.

See also _Children, fractious_.

### _Aphthous ulcers (Recurrent aphthous stomatitis, RAS)_

These are usually classified as major (MaRAS), minor (MiRAS) and herpetiform (HU). MiRAS is the most common form (80%), and is characterised by _ulcers_ no more than 5 mm in diameter, and 1–6 in number. They do not occur on the palate or in the throat. Spontaneous healing occurs within 14 days, with no residual scarring. The interval between attacks is highly variable. MaRAS is less common (10%), and is characterised by ulcers that are 1–3 cm in diameter, which may appear anywhere in the mouth or oropharynx, which may persist for one month or more, and which heal with the production of _scars_. HU is the least common type, with up to 100 small herpetiform ulcers being present at one time. These most commonly occur in the floor of the mouth and at the tip and lateral margins of the tongue. They may last from 7–14 days, and heal without scarring. RAS must be differentiated from _carcinoma_ (MaRAS), simple traumatic ulcer (MiRAS), as from a sharp tooth, _herpes simplex infection_ (HU) and some forms of erosive _lichen planus_.

Occasionally RAS may be brought on by _allergy_ to certain foods, especially chocolate and preservatives (see also _orofacial granulomatosis_ ). RAS can be associated with _AIDS_ , psychological stress (including acute dental _anxiety_ and 'pre-exam nerves'), _iron_ deficiency (including that associated with _rheumatoid arthritis), vitamin B1_ deficiency, _vitamin B6_ deficiency, _vitamin B12_ deficiency, _zinc_ deficiency, oral trauma (development of ulcers at traumatic sites), the menstrual cycle, _coeliac disease, Crohn's disease_ and ulcerative colitis. There maybe an inherited miasmatic (miasmic) predisposition in some cases. RAS may also be a manifestation of _Behçet's disease_.

Contrary to the views generally expressed in both conventional and homoeopathic literature, this unpleasant condition is not particularly difficult to treat in the majority of patients. There are two aspects to treatment: that for the immediate complaint, and that for the predisposition.

Immediate relief from pain may be obtained by dispersing 4–8 drops (or more if necessary) of _Propolis_ Ø in 10 ml of warm water, and holding the solution in the mouth in contact with the lesion, for a few minutes until it has taken effect (alternatively, the undiluted Ø may be used directly, but this will sting). Some then recommend swallowing the solution, but I do not. This may be repeated several times daily. Propolis is actually a potent promoter of healing in cases of aphthous ulceration. _Myrrh_ Ø, which also has its proponents, may be used in a similar way to Propolis, but should not be swallowed. An infusion of dried or fresh kitchen sage (about 1 teaspoon to 1 teacup of hot water, allowed to stand for 10 minutes) is a useful _mouthwash_ where neither Propolis nor Myrrh is available; it too should not be swallowed. As far as internal treatment is concerned, which may be used in conjunction with topical therapies, _Feverfew_ 30 three times daily helps many cases. This remedy may even abort the frank development of ulceration if given in the premonitory tingling phase. Other remedies require consideration, where Feverfew is ineffective. In nervous and timid patients (especially if they are very sensitive to loud noises), consider _Borax_ 30 4-hourly. Where there is foul breath, copious saliva and the tongue retains the imprint of the teeth, _Mercurius Solubilis_ 6–30 4-hourly is indicated. Again, where the tongue bears the imprint of the teeth, but the breath is inoffensive and the saliva is thick and tenacious, _Hydrastis_ 30 4-hourly should be given. For ulcers with yellow or yellow-green bases, consider _Kali bichromicum_ 30 4-hourly. Where the base of the ulcer bleeds easily and there are sticking or splinter-like pains, give _Nitricum acidum_ 30 4-hourly. _Natrum muriaticum_ 6–30 two or three times daily is indicated where the ulcers are brought on by baking-soda toothpaste.

#####

##### _Fig. 4. Salvia officinalis (kitchen sage_ )

For the treatment of the predisposition, in conjunction with remedies, zinc 15–30mg daily (adult dose) should be given to all cases. Feverfew 30 twice daily, given long-term, is helpful in many. More resistant cases often require potentised _Sulphur_. However, even before considering its use, the practitioner should rule out the possibility of deficiency states (for which supplementary therapy will be required), allergic states (where exclusion will be beneficial), and any coexistent pathologies (for which special treatment will be indicated). Sulphur treatment itself is to be used cautiously, since it is prone to cause skin eruptions of various types (eczema, pimples or boils), whereupon it must be discontinued until professional advice can be obtained. A relatively safe starting prescription is Sulphur 6 twice daily for a few months. However, difficult cases may require potencies of up to 200c; but these must only be given intermittently and by those with good clinical experience. Constitutional treatment, based upon the general and mental characteristics of the patient, may be occasionally required. In hormonally-dependent cases in women, remedies with an affinity for pituitary-ovarian axis, such as _Sepia_ and Natrum muriaticum, according to their proper indications, may be of service, along with _evening primrose oil. Bach flower remedies_ may be helpful in cases which are brought on by circumstantial psychological stress or personality disorders. _Argentum nitricum_ 30–200 twice daily is a major remedy in the treatment of RAS brought on by hyperactive 'pre-exam nerves'.

Fischer's technique for treating aphthous ulcers is worthy of mention. A drop of the oily contents of a _vitamin E_ capsule or _Aloe vera_ extract is applied occasionally to each ulcer. L-lysine (an amino acid) 1 g per meal three times daily (adult dose) is given until the ulcers have cleared. At the same time arginine (another amino acid) must be reduced. This is especially found in chocolate, peanuts, other nuts, seeds, cereal grains, gelatin, raisins and carob; and these should be excluded from the diet for a prolonged period or indefinitely. Once the ulcers have cleared, the dose of L-lysine is reduced to 500mg per meal three times daily. A maintenance dose of 500mg daily is sometimes necessary to prevent recurrence. L-lysine reduces the severity of the disorder and promotes healing. However, it may cause an increase in levels of cholesterol and triglycerides, and these should be monitored in patients on extended therapy. A similar approach has been used, to some effect, in the treatment of _herpes simplex infection_.

### _Apis (Apis mellifica)_

Homoeopathic preparation of the honey-bee. A remedy for reactive oedema and _cellulitis_ , with burning and stinging pains, < heat, > cold. If fever is present, the patient is thirstless. Indicated in some cases of _neuralgia_ with burning and prickling sensations, and _pulpitis_ or post-local _anaesthetic_ pain with the same modalities. It is especially indicated in persons of _Natrum muriaticum_ **typology**.

### _Apprehension – see_ Anxiety, acute dental

### _Aranea diadema_

Homoeopathic preparation of Papal-Cross spider. Given for _neuralgia_ , especially right-sided. This remedy has two leading symptoms: exact periodicity (symptoms come on always at the same hour of the day), and a sensation of great swelling of the affected part. Other indications include: < cold humidity, and nocturnal _toothache_.

### _Argentum metallicum_

Homoeopathic preparation of silver. A remedy for _laryngitis_ of talkative dentists, with pain in the larynx < swallowing and talking, especially with the coughing up of thick mucus.

### _Argentum nitricum*_

Homoeopathic preparation of silver nitrate. Useful in certain acute dental _anxiety_ states and in the treatment of acute purulent _conjunctivitis_. It is also a principal remedy for 'pre-exam nerves' (with a picture of hyperactivity) and _aphthous ulcers_ stemming therefrom, irrespective of the normal susceptible typology of the patient. It is sometimes indicated in the treatment of _median rhomboid glossitis_. **Susceptible typology:** thin, withered, forgetful, excited, hurried, anxious, incompetent, fear of heights, phobic (e.g. agoraphobic), hypoglycaemic (< sweets), < intellectual work, chronic pharyngitis (clears throat repeatedly), prone to stomach problems (distention, epigastric pain, ulcers).

### _Arnica (Arnica montana)_

Homoeopathic and botanic. Leopard's bane, which grows in mountainous areas. The mother tincture is prepared from the roots or whole plant (if the flowers are infested with the Arnica fly, they are unsuitable). The mother tincture is not suitable for systemic or oral use, even when diluted. It is, however, usefully applied externally to bruises, _haematomata_ and _sprains_ , several times daily, provided that the skin is intact (even so, in rare instances, an allergic eczema may result). It must not be applied to broken skin, even when diluted. Systemically, it must be used in its potentised form, usually in a 30c, but may be given in any potency from 6 to 200. It is the most important remedy for the prevention and treatment of bruising and _haemorrhage_ , thus indirectly promoting healing. It should be given both before and after all dental procedures where trauma to the tissues is involved. The basic dose repetition is three times daily, but, where there is much bleeding (as with _oral surgery_ ), it may be given as often as once ever 15 minutes. Along with Arnica, _Hypericum_ is also routinely given by many, three times daily, in order to oppose nerve damage. Arnica should be given to all those who have suffered severe physical trauma (e.g. from road traffic accidents), where again it may be repeated frequently. Virtually all patients benefit from Arnica, whose only near, but less effective, rival is _Bellis perennis_. Apart from its antihaemorrhagic effect, Arnica appears to have some mild central analgesic effect in cases of physical trauma. Arnica is the remedy _par excellence_ for the control of pain associated with bruised soft tissues. It may also be used internally in the treatment of acute sprains, and _angina bullosa haemorrhagica_.

See also _Dislocation, TMJ; Oral surgery, pain control after_.

#####

##### _Fig. 5. Arnica_

### _Arsenicum album*_

Homoeopathic prepration of arsenic trioxide. Useful in some cases of acute dental _anxiety_ , malignant _tumour, pemphigus, pemphigoid, pulpitis, halitosis, burning mouth syndrome, lichen planus_, atrophic _gingivitis, median rhomboid glossitis_ and _xerostomia_. **Susceptible typology:** pale, thin, chilly (to the core), meticulous in all respects, smartly dressed, children fragile and elegant, alternating and changing mood, easily frightened, extreme anxiety about illness, very weak with all ailments, burning pains > heat, headaches < heat, < after midnight, marked thirst for small rations of water taken frequently, prone to allergies and asthma, _tongue_ indented.

### _Arteritis, giant cell – see_ Giant cell arteritis

### _Arthritis, odontogenic – see_ Focal sepsis

### _Arthritis, rheumatoid – see_ Rheumatoid arthritis

### _Arum triphyllum_

Homoeopathic preparation of Jack in the pulpit. A remedy for _laryngitis_ in talkative dentists, where the voice is continually changeable from hoarse to clear. Also useful in disorders of the _TMJ_.

### _Ascorbic acid – see_ Vitamin C

### _Aspirin burn_

Holding an Aspirin tablet against a painful tooth leads to a chemical burn of the oral mucosa. _Calendula_ or Calendula and _Hypericum_ mouthwashes, ointments and creams promote healing.

See also _von Willebrand's disease_.

### _Atypical facial pain – see_ Facial pain, atypical

### _Atypical odontogenic pain – see_ Facial pain, atypical

### _Auriculo-temporal syndrome – see_ Frey's syndrome

### _Aurum metallicum_

Homoeopathic gold. A remedy for _halitosis or gingivitis_ of girls at puberty, especially if they are very gloomy or depressive. Also employed in the treatment of _Paget's disease_.

### B

### _Bach flower remedies_

An important group of liquid medicines, allied in function and use to homoeopathic remedies, and generally given in aqueous dilution. A satisfactory dose is 3–4 drops. Most are given to good effect three times daily, but Rescue Remedy, which is similar to _Aconite_ in action, may be used frequently (ever 5 minutes, if necessary) in cases of _collapse_ , faint, or acute dental _anxiety_. Their principal sphere of action is the psyche, but, where psychosomatic disorders are present, they will exert an indirect action upon the physiology. They are administered upon the basis of the psychological status of the patient, including their general personality. They can usually be given in conjunction with true homoeopathic remedies, and only rarely produce aggravations. It is customary to mix several together in order to cover the case more fully, but I do not recommend the use of more than three at one time. In dentistry, they are particularly helpful in some cases of migrainous _neuralgia, aphthous ulcers_ , atypical _facial pain_ and _craniomandibular dysfunction_ , where the psyche is at fault. Such psychological problems may be circumstantial (e.g. bereavement) or personality-dependent (e.g. tendency to suppress emotions). The remedies, together with their principal indications, are as follows:

(1) **Agrimony**. Conceals tensions behind a brave face (conscious suppression).

(2) **Aspen**. Fears things for no logical reason.

(3) **Beech**. Intolerant, orderly and antisocial.

(4) **Centaury**. Timid, easily imposed upon, weak-willed.

(5) **Cerato**. Doubts own ability, saps the vitality of others by constantly seeking advice and confirmation.

(6) **Cherry Plum**. Fear of mind giving away and losing control of temper.

(7) **Chestnut Bud**. Failure to learn from past misjudgments.

(8) **Chicory**. Argumentative, possessive, selfish.

(9) **Clematis**. Day-dreamers.

(10) **Crab Apple**. Self-disgust.

(11) **Elm**. Essentially competent people who are overwhelmed by work or responsibility (the 'teacher's remedy').

(12) **Gentian**. Easily discouraged by minor setbacks.

(13) **Gorse**. Convinced he or she will never be cured.

(14) **Heather**. Self-concern, obsessed with ailments. Obsessive-compulsive disorders.

(15) **Holly**. Jealousy, hatred, envy (the 'cheated party remedy').

(16) **Honeysuckle**. Homesickness, unpleasant nostalgia, prolonged bereavement.

(17) **Hornbeam**. Mental fatigue, prolonged convalescence.

(18) **Impatiens**. Impatient and irritable.

(19) **Larch**. Lack of confidence but not ability.

(20) **Mimulus**. Fear of known things.

(21) **Mustard**. Deep depression without circumstantial cause.

(22) **Oak**. Solid and reliable types who soldier on through difficulties, and suffer accordingly.

(23) **Olive**. Total exhaustion of mind and body.

(24) **Pine**. Guilt.

(25) **Red Chestnut**. Anxiety about the welfare of others.

(26) **Rock Rose**. Panic, terror.

(27) **Rock Water**. Self-repression, concerned with self-perfection.

(28) **Scleranthus**. Indecisive.

(29) **Star of Bethlehem**. Shock, fright.

(30) **Sweet Chestnut**. Utter despair.

(31) **Vervain**. Overdoers of things, perfectionistic, sensitivity to injustice.

(32) **Vine**. Inflexible and domineering.

(33) **Walnut**. Ill-effects of change in circumstances or domination by another person.

(34) **Water Violet**. Aloof and proud.

(35) **White Chestnut**. A distressing or worrying event or situation prays on the mind (the 'litigation remedy').

(36) **Wild Oat**. Inability to decide one's future course in life.

(37) **Wild Rose**. Resignation to one's lot in life, too apathetic to change.

(38) **Willow**. Resentment.

(39) **Rescue Remedy** (this remedy is a mixture of Impatiens, Cherry Plum, Clematis, Rock Rose, and Star of Bethlehem). Collapse, faint, acute anxiety.

A knowledge of the Bach Flower Remedies is not required for the BHDA examination.

### _Bacillinum_

Homoeopathic. A nosode of tuberculous lung. A remedy for the tuberculous miasm. It is sometimes indicated in cases of delayed _eruption_ and _mouth-breathing_. Occasionally it is used for cases of _bruxism_ in children. It may be helpful in reducing a predisposition to either dental _caries_ or orofacial _allergy_. It has been used in the treatment of _sarcoidosis_. A red stripe down the centre of _tongue_ may be indicative of its applicability. It is given in infrequent dosages and should only be used by the competent practitioner.

### _Baptisia (Baptisia tinctoria)_

Homoeopathic wild indigo. A remedy for primary herpetic _gingivostomatitis_ with fetid breath and severe prostration.

### _Behçet's disease (Behçet's syndrome)_

This miasmatic (miasmic) disease, first recognised by Hippocrates, has a high prevalence in Japan and countries bordering the Mediterranean. It is more common in males. Characteristically, there are oral and genital _ulcers_ , and ocular lesions, but other associated disorders may be present. Recurrent oral ulceration is typical, with three or more attacks occurring within one year. This takes the form of major aphthous, minor aphthous or herpetiform ulceration. Genital aphthous ulceration, with scarring, dysuria and pain on intercourse, is common. Ocular lesions occur in most cases, including anterior uveitis, posterior uveitis, conjunctival ulceration and retinal vasculitis. Scarring and blindness may result. Other disorders include: arthritis, recurrent thombophlebitis, neurological disorders and gastrointestinal disturbances.

Topical treatment, as described for _aphthous ulcers_ , is useful. Homoeopathic treatment may be complex, but _Sulphur_ appears to be a key remedy in therapy.

### _Belladonna_

Homoeopathic deadly nightshade. Useful for early _abscess_ and acute _cellulitis_. It is well-indicated where there is a sudden onset of swelling, accompanied by redness, intense heat (with burning sensation) and **throbbing** pain. The face is often red and congested.

In febrile states, there is a great thirst for cold water. It is sometimes given for cases of _bruxism_ or bruxomania, where the muscles of the jaw are burning or throbbing, especially in ruddy-faced individuals. Also indicated in some cases of _pulpitis_. Belladonna is most effective in robust individuals.

See also _Endodontics_.

#####

##### _Fig. 6. Belladonna_

### _Bellis perennis_

Homoeopathic wound-wort (a common daisy). Similar in action to _Arnica_ , but perhaps slightly weaker. It is also a valuable remedy for 'gardener's backache', and is generally used in a potency of 30c. Rather like Arnica, it may be used frequently (as often as ever 15 minutes) in cases of trauma, or less frequently (say, three times daily) in cases of lumbago.

#####

##### _Fig. 7. Bellis perennis_

### _Bell's palsy_

In this disease of acute onset, there is a non-traumatic unilateral lower motor neurone lesion of the _facial nerve_ , possibly of viral origin. Occasionally, there is some loss of taste on the affected side. It may be clinically differentiated from an upper motor neurone lesion (e.g. from a cerebrovascular haemorrhage) by asking the patient to raise the eyebrow of the affected side. Characteristically, the Bell's palsy patient is incapable of doing so, whereas this ability is generally preserved in upper motor neurone cases. Treatment should begin as soon as possible with _Aconite_ 30 and _Causticum_ 30 given in alternation; 2-hourly alternation in early cases (within 48 hours of onset), or 4-hourly alternation in later cases. Facial nerve paralysis of gradual onset is indicative of either intracranial or parotid _tumour_.

See also _AIDS; Lyme disease; Melkersson-Rosenthal syndrome; Ramsay-Hunt syndrome_.

### _Berberis vulgaris_

Botanic and homoeopathic. Barberry. For dental purposes, the mother tincture, which is prepared from the root bark, is mainly of interest. It may be used in the treatment of oral _candidosis_ , either as a mouthwash (30 drops Ø in 250ml of water) to be used 3–4 times daily, or in the form of a 5% cream or ointment. It may be mixed with _Aloe vera_ and _Hydrastis canadensis_.

#####

##### _Fig. 8. Berberis vulgaris_

### _Biliary cirrhosis, primary_

This chronic disease of the liver, insidious in onset and usually occurring in women aged 40–60, may be accompanied by _Sjögren's syndrome_.

### _Bioflavonoids_

These valuable food substances act with _vitamin C_ in maintaining collagen structure, and reducing and preventing inflammation, bleeding and infection in the periodontium. Mixed bioflavonoids 500mg three times daily are sometimes prescribed in cases of _gingivitis_ or _periodontitis_.

### _Bitten cheek or tongue_

Give potentised _Arnica_ internally, and prescribe _Calendula_ mouthwashes.

See also _Cheek biting, recurrent_.

### _Blastomycosis – see_ Fungal diseases

### _Bleeding, surgical – see_ Haemorrhage, acute dental

### _Blood pressure, acute elevation of_

Hypertensive patients suffering from apprehension or distress may experience a sudden elevation of blood pressure, with the development of symptoms, such as headache and _epistaxis_. They should be given _Aconite_ along the lines suggested for acute dental _anxiety_ , and referred to their own physicians. Hypertensive epistaxis may require additional treatment with _Ferrum phosphoricum_.

### _Blow to a tooth – see_ Traumatised tooth

### _Bone-grafts_

Unification of bone is encouraged by homoeopathic _Symphytum_ , as with _fractures_.

### _Bone spicule – see_ Sequestrum

### _Borax_

Homeopathic sodium borate. An important remedy for the treatment of oral _candidosis_. It is also frequently useful in the treatment of _aphthous ulcers_ , especially where the **susceptible typology** is appropriate: nervous, timid, very sensitive to loud noises, dread of downward motion (e.g. descent in an aircraft).

### _Breath, offensive or foul – see_ Halitosis

### _Bruxism & Bruxomania_

Tooth grinding or clenching in adults is invariably associated with psychological disturbances, and may occur in the waking hours (bruxomania) or during sleep (bruxism). The psychological factors may be circumstantial or related to personality. Undoubtedly, the simplest approach is to use the _Bach flower remedies_. Otherwise, constitutional remedies are required. _Podophyllum, Zincum metallicum_ and _Cannabis indica_ are said to be frequently indicated, according to typology. In children, where the origin is less likely to be purely psychological, _Belladonna, Cina, Phytolacca_ and _Bacillinum_ are worthy of consideration.

### _Bryonia (Bryonia alba)*_

Homoeopathic white bryony. A remedy for the relief of _fracture_ pain, _pulpitis_ , trigeminal _neuralgia_ and _xerostomia_. With regard to pain in general, it is indicated where this is < movement, < the least touch, > local heat, > rest, and > strong pressure on the affected part. The typical pain is acute, piercing and lancinating. Bryonia is predominantly (though not exclusively) a right-sided remedy.

**Susceptible typology:** irritable, easily annoyed, dark, robust, well-fed, < heat (except for local pains, which are > heat), > cold, great thirst with dry mouth (especially during a fever).

#####

##### _Fig. 9. Bryonia_

### _Bulimia nervosa – see_ Anorexia nervosa & bulimia nervosa

### _Burning mouth syndrome (BMS)_

This is a burning sensation of the mouth without any visible abnormality of the oral mucosa. It is more common in women, with a peak incidence in the 40–50 year-old group. The most common site for the sensation is the tongue, followed by the palate and upper alveolar ridge, the lips, and the lower alveolar ridge. Less commonly, it occurs in the throat, buccal mucosa and floor of the mouth. The possible causative factors are numerous. These include: deficiency states ( _iron, folate, vitamin B1, vitamin B2, vitamin B6, vitamin B12), diabetes mellitus_ (uncontrolled or undiagnosed), oral _candidosis_ (including _denture sore mouth), xerostomia_ , poor denture design, psychological states (with or without tooth clenching or tongue thrusting habits) and menopausal syndromes. _Allergy_ to dental materials, food or preservatives is relevant to only a minority of cases.

However, despite various investigations, including blood tests and attempts to identify candidosis, psychological approaches, the prescription of psychogenic drugs, denture adjustments and blind trials of vitamins B1, B2 or B6, a large number of cases persist and present themselves to the homoeopathist. Strangely enough, many sufferers (especially women over 40 years of age), despite apparently normal vitamin B12 levels, respond well to injections of that vitamin (hydroxocobalamin 1000mcg weekly, intramuscularly or deep subcutaneously), whereas oral supplementation frequently fails. In menopausal cases, _evening primrose oil_ may also be helpful. Again, in cases associated with the menopause, key homoeopathic remedies are _Lachesis, Natrum muriaticum, Pulsatilla_ and _Sepia_ , prescribed according to their constitutional indications. The same remedies may be also indicated in non-menopausal cases. Other key remedies to be considered in general are _Arsenicum album, Phosphorus_ and _Sulphur. Iris versicolor_ may be helpful in cases with a strong history of migraine or migrainous _neuralgia_. Where either oral candidosis or xerostomia is present, homoeopathy may also be of service. Where there are distinct disturbances of the psyche, the use of the _Bach flower remedies_ should not be forgotten.

### _Burns, instrument_

'Hypercal' ( _Hypericum_ and _Calendula_ ) cream or ointment should be applied immediately. Alternatively, apply the oily contents of a _vitamin E_ capsule.

### C

### _Calcarea group of remedies_

This includes _Calcarea carbonica, Calcarea fluorica, Calcarea phosphorica_ and _Calcarea renalis_. Their importance from the dental point of view is that they all have some influence on calcium metabolism, and thus are collectively of great relevance to the correction of disorders of bone and teeth, and predispositions to _calculus_ formation in the orofacial region.

### _Calcarea carbonica (Calcarea ostrearum)*_

Homoeopathic oyster shell (impure calcium carbonate from the middle layer). Useful in some cases of _acromegaly, epulis_ , delayed _eruption, mouth-breathing, osteogenesis imperfecta, ranula_ , chronic _gingivitis_ and _periodontitis_ , and recurrent _caries_. It is sometimes employed in mild _pulpitis_ , especially where a toothache < cold air follows a deep filling. **Susceptible typology:** short, fat, stubby hands, brachycephalic, broad (square) anterior teeth, flat palate, wide dental arches, absence of crowding, retarded eruption, _tongue_ indented, easily discouraged, slow to get going in any task (but then gathers momentum), fearful, chilly, inactive, an intense desire for eggs, prone to urinary and gall-bladder stone formation, children with big sweaty heads.

See also _Endodontics_.

### _Calcarea fluorica*_

Homoeopathic calcium fluoride. Useful in the treatment of recurrent _sprains, dislocation_ of the jaw, _exostoses, fibrous dysplasia, haemangiomata, salivary gland_ disorders (including _sialectasis), osteopetrosis_ , chronic _periodontitis_ and predisposition to _caries_. it may also be useful in _orthodontics_ to assist movement of the teeth. **Susceptible typology:** small or medium build, dolicocephalic, mandibular or maxillary prognathism, obvious asymmetry of face and dental arches, small and overcrowded teeth with poor and grey enamel, teeth erupt out of normal sequence, delayed _eruption_ , slender bones, laxness of articulations (carrying angle of elbow in excess of 180°), scoliosis, children lack concentration and discipline, generally < changes in climate.

### _Calcarea phosphorica*_

Homoeopathic calcium phosphate. A remedy for the facilitation of _orthodontic_ movement of teeth, the predisposition to _caries, fractures_ , tonsillar enlargement with _mouth-breathing, gingivitis_ of puberty, _Paget's disease, osteogenesis imperfecta_ and _fibrous dysplasia_ (including Albright's syndrome). **Susceptible typology:** tall, thin, elegant, long eye lashes, narrow face, well-arched palate, teeth long and narrow (and yellowish), tendency to crowding, precocious or delayed _eruption_ , tendency to exostoses, precocious puberty, easily tired by intellectual work but intelligent, emotional instability, agitated, sensitive, sentimental, timid, prefers to be left alone, desires preserved and salty meats, < change in climate.

### _Calcarea renalis_

Homoeopathic preparation of calcium urate renal calculus. A remedy for reducing dental _calculus_ formation, sometimes inducing its loss, especially in subjects prone to gout.

### _Calciferol – see_ Vitamin D

### _Calcium_

An adequate dietetic intake of calcium is necessary for the proper development of teeth and bone, and maintenance of the latter. Regulation of calcium metabolism is partially determined by satisfactory levels of _vitamin D_. Diminishing oestrogen levels occurring at the menopause favour the loss of calcium from the bones and thus osteoporosis. It would seem likely that calcium deficient diets, lack of vitamin D or menopausal changes are, to some degree, contributory to periodontal bone destruction or the loss of the _prosthetic_ ridge. Studies have suggested that combined calcium and vitamin D supplementation may be useful in reducing alveolar bone loss in those who wear dentures. It may also turn out that calcium-rich diets (e.g. where there is a good intake of canned fish or dairy products), combined with _evening primrose oil_ , may be helpful in retarding periodontal and alveolar ridge bone loss in menopausal or postmenopausal females.

See also _Fluoridation; Fracture, jaw; Periodontitis, chronic_.

### _Calculus, dental (Tartar)_

In order to retard the formation of dental calculus, try _Fragaria_ 6 twice daily for some months. Should this fail, consider _Calcarea renalis_ 6 twice daily. Either remedy may also induce the actual loss of existing calculus. Both are generally suitable for administration in conjunction with other remedies in cases of chronic _gingivitis_ or periodontitis.

### _Calculus, salivary – see_ Salivary calculus

### _Calendula (Calendula officinalis)_

A botanic remedy adopted by homoeopathy, though seldom used in its potentised form. The mother tincture is prepared from the leaves and flowers of the marigold, and is applied topically in either aqueous dilution, or as a 5% ointment or cream. Calendula officinalis belongs to the same family of plants (Compositae) as _Arnica_ and _Bellis perennis_ , and is, like these, a great vulnerary. Unlike Arnica, it is suitable for intraoral use and may be applied to broken skin, provided that it is first diluted. Its important application is with regard to incisional or lacerated wounds and tooth extraction. In this respect, it has four major properties: the promotion of healing of epithelial tissues, the prevention of infection (by virtue of its antiseptic qualities), the induction of haemostasis (an action similar to that of Arnica and Bellis perennis) and the reduction of pain and discomfort. It is valuable also in the treatment of _abrasions_ , where it is usually applied as an ointment or cream. Aqueous dilutions are best administered as hot as can be safely tolerated. For external use, a dilution of 1 in 20 is suitable. Fomentations may be repeatedly applied to areas of lacerated skin, even if a compound _fracture_ is present beneath. Calendula is of great service in traumatic and general _oral surgery_. For intraoral use, about 30 drops of Calendula Ø should be added to 500ml of hot water. This may be used as a _mouthwash_ , or gauze may be soaked in the solution, and the fomentation pressed against the tooth socket or wound. In the case of an extraction, the fomentation can be held in place by the approximation of the jaws. Mouthwashes should be repeated 3–4 times daily, until full healing occurs. Some prefer to add an additional 30 drops of _Hypericum_ Ø to each 500ml of water, in order to favour the repair of damaged nerves.

#####

##### _Fig. 10. Calendula_

### _Cancer – see_ Tumours & cysts

### _Cancrum oris (Noma)_

Gangrene of the cheek, occurring principally in children. This serious condition is now essentially restricted to impoverished countries, being related to severe malnutrition in conjunction with a major infection, such as measles or tuberculosis. The organisms responsible are similar to those of _ANUG_. Rapid unilateral gangrenous destruction of the cheek may progress to _osteomyelitis_ of the jaw, and death by _septicaemia_ or bronchopneumonia. Antibiotics are often unavailable. Treatment should commence with _Kali chloricum_ 30 and _Pyrogen_ 30, given conjointly twice daily; preferably with a dose of _Anthracinum_ 30 being give at midday. Where Kali chloricum is unavailable, _Mercurius corrosivus_ 30 may be substituted (this may, indeed, by the only remedy available). Obviously, treatment will be facilitated by the correction of nutritional deficiencies (especially those of _vitamin C_ and _zinc_ ) where possible.

### _Candidosis, oral (Candidiasis, oral)_

The mere presence of Candida species within the mouth is not necessarily indicative of disease, since about 2 persons out of 5 harbour these organisms as part of their normal oral microflora. Whereas there are a number of different species of intraoral candida, and all have the potential to produce the infection termed 'oral candidosis', the dominant offender is Candida albicans. Predisposing factors are numerous: _iron_ deficiency, _vitamin B2_ deficiency, _vitamin B12_ deficiency, _vitamin C_ deficiency, _zinc_ deficiency, excessive sugar intake, malnutrition, _pellagra_ , infancy, old age, poorly controlled _diabetes mellitus, agranulocytosis, AIDS, leukaemia, hypothyroidism, xerostomia, pregnancy_ , drug therapies (including _antibiotics_ , immunosuppressive agents, cytotoxic agents and _corticosteroids_ ) and _prosthetic_ or _orthodontic_ appliances. Various types of oral candidosis are described:

(1) Acute pseudomembranous candidosis (thrush). This is characterised by soft creamy white or yellowish plaques, which can be wiped away to reveal an erythematous mucosa. It commonly affects neonates, the elderly, those with agranulocytosis or AIDS, and those undergoing antibiotic or steroid therapy. A chronic pseudomembranous type also occurs.

(2) Acute erythematous (atrophic) candidosis. This is often a painful condition, unlike other types of oral candidosis, and is seen in association with antibiotic or steroid therapy, and AIDS. The oral mucosa is erythematous.

(3) Chronic erythematous (atrophic) candidosis. This is alternatively termed 'denture sore mouth' and is an erythematous mucosal condition related to coverage of the oral mucosa by Prosthetic or upper removable orthodontic appliances.

(4) Chronic plaque-like/nodular (hyperplastic) candidosis, alternatively termed 'candidal leukoplakia'. Hyperplastic epithelial changes occur, characteristically (but not exclusively) in the commissure regions of the buccal mucosa, presenting clinically as speckled white patches. Occasionally, premalignant or malignant changes occur in the lesions, particularly at the commissure site.

(5) Candida-associated _angular cheilitis_.

Investigations include scrape, smear, oral rinse and biopsy. Oral candidosis may, of course, be associated with candidosis elsewhere in the body (e.g. vagina, intestines).

In treatment, any obvious deficiency states should be corrected (iron, vitamin B2, zinc, etc.). Other underlying disorders also require attention. A diet which excludes most overt sugar (sweets, chocolates, honey, cakes, biscuits, drinks with added sugar, etc.) and crisps should be instituted; although fruits, natural fruit juices and dried fruits need only be excluded in resistant cases. Garlic or garlic supplements should be taken freely. The key remedy for most intraoral cases is _Borax_ 30–200, given two or three times daily. Should this fail, consider either _Kali muriaticum_ 30 two or three times daily, or Candida albicans nosode 6 twice daily (indeed, the latter may be given in conjunction with other remedies). Such systemic treatment may be complemented with _mouthwashes_ , ointments or creams containing extracts of _Aloe vera, Berberis vulgaris_ or _Hydrastis canadensis_ (or combinations of these), all three of which (as with garlic) have anticandidal properties. _Caprylic acid_ added to a cream or ointment may also prove to be useful. Resistant cases may require homoeopathic constitutional treatment.

_Tea tree oil_ is also worthy of mention. A cotton-bud impregnated with one drop of this oil of relatively low toxicity may be used to treat infantile thrush. The mouth is briefly and thoroughly swabbed. One or two treatments (12 hours apart) should suffice. A similar approach may be tried in adult cases of oral candidosis (? all types), using 2–3 drops per cotton-bud.

See also _Median rhomboid glossitis_.

### _Cannabis indica_

Homoeopathic hashish. A remedy for _bruxism_ or bruxomania in patients of the appropriate typology. **Susceptible typology:** loquacious, cannot finish a sentence, confused, fearful, excessive laughter.

### _Caprylic acid_

A short-chain fatty acid, known chemically as octanoic acid, and found naturally in coconut oil and breast milk. Most organic fatty acids are fungicidal, but caprylic acid is particularly effective in _candidosis_. It mimics the fatty acids produced by the normal bowel flora, which are a major component of the defensive system against Candida infection. Caprylic acid is usually given internally, but may be incorporated in an ointment or cream base for local use.

### _Car-sickness, patients arriving with – see_ Zingiber

#####

##### _Fig. 11. Cannabis indica_

### _Carbo vegetabilis*_

Homoeopathic wood charcoal. Although a constitutional remedy in its own right, its principal application in dental surgery is the treatment of sudden _collapse_ of serious origin, such as myocardial infarction, irrespective of susceptible typology. For this purpose, it is generally given in a potency of 30c, but may be used higher. It may be helpful in cases of _xerostomia_ , where the typological indications are appropriate. **Susceptible typology:** elderly, feeble, tired, pale or cyanotic, dyspeptic, internal burning and external cold, desires to be fanned, aversion to fat and meat, aversion to milk, prone to varicose ulcers, < heat and humidity, < alcohol.

### _Carbolicum acidum (Acidum carbolicum)_

Homoeopathic phenol. It is indicated by the presence of severe acute pains (which are usually lancinating or burning), which appear suddenly, last a short time and disappear abruptly. It is thus of service in some cases of facial _neuralgia_.

### _Carcinoma – see_ Tumours & cysts

### _Caries, predisposition to dental_

Despite the apparent success of _fluoridation_ programmes, there is now a world-wide resurgence of caries in the 5 year-old group of developed countries; and it would appear that the same will be found in 12 year-olds. This has not been explained. Hence, homoeopathy may once again be applied to the problem. For early and rapid decay of the deciduous dentition, consider _Kreasotum_ 6–12 twice daily as the prime treatment (this remedy may also be indicated in some adult cases). For the predisposition to caries in general, observe the dominant morphology of the face and intraoral structures, and select _Calcarea carbonica, Calcarea fluorica_ or _Calcarea phosphorica_ , according to the indications given under these headings. Where a decision based upon the orofacial morphology alone is difficult, then the more general aspects of the three susceptible typologies must be taken into account in order to select the correct remedy. The selected remedy should be given initially in a potency of 6–12c twice daily. Prescriptions of Kreasotum or the Calcareae must usually be given for many months. The treatment may be fortified by the infrequent use of _Bacillinum_. However, since the use of this nosode requires some degree of experience, newcomers to homoeopathy should take advice on this matter from the professional homoeopathist. The combination of chronic _periodontitis_ and high caries rate is more indicative of _Staphysagria_ 6–12 twice daily. The combination of _root caries_ and severe chronic periodontitis suggests _Thuja_ 6–12 twice daily. It should be noted that some cases of gross caries are associated with _xerostomia_ (dry mouth), and these may require different remedial treatment.

### _Carpal tunnel syndrome_

I mention this for the benefit of the dental surgeon so afflicted, since, in many cases, operation can be avoided. Certainly, _osteopathy_ and more particularly _chiropractic_ are highly beneficial. The main focus of attention will be the reduction of thoracic and cervical vertebral displacements, which are often contributory to the generation of the syndrome. Additionally, _vitamin B6_ 50mg three times daily should be taken (this dose must not be exceeded).

### _Causticum*_

Homeopathic. Prepared by distilling a mixture of slaked lime and potassium sulphate. Of great importance in the treatment of lower motor neurone _facial nerve palsy_ in most susceptible typologies. Causticum is to motor nerves as _Hypericum_ is to sensory. Indicated in some cases of _median rhomboid glossitis_ and facial _neuralgia_. **Susceptible typology:** thin, tired, very chilly, intense need for sympathy, extremely sensitive to the problems of others, quarrelsome, children cry easily and are afraid of going to bed alone, > heat and humidity, desires smoked and salted meats, burning sensations with tenderness.

### _Cellulitis, acute_

Severe spreading infections of the orofacial tissues are the occasional result of dental sepsis, but also may occur following trauma. Ludwig's angina, stemming from an infected mandibular tooth and perhaps the most dangerous, is relatively rare. Nowadays, since acute cellulitis is a potentially fatal condition, it is difficult, from the medicolegal point of view, not to recommend antibiotics, Nevertheless, homoeopathic treatment is fully justified where the patient refuses to take orthodox medication, where antibiotics are ineffective or where they are unavailable (as in many developing countries). The key remedy is undoubtedly _Belladonna_ 30–200 given every 2–6 hours. This is well-indicated where the patient is very thirsty during the fever. Where the patient is thirst-less during the fever, _Apis mellifica_ 30–200 with the same repetition, may be better indicated. The swelling of the Belladonna type is not so profound as the Apis type, and very red. The Apis swelling tends to be gross, and the skin overlying it is more of a rose colour. An alternative to either Belladonna or Apis is _Myristica_ 30 every 1–6 hours.

#####

##### _Fig. 12. Chamomilla_

### _Cementum, sensitive – see_ Cervical sensitivity

### _Cervical sensitivity_

Admirable results have been obtained by applying undiluted _Plantago_ Ø 1–3 times daily to the sensitive area.

### _Chamomilla*_

Homoeopathic chamomile. In dentistry, primarily a remedy for _teething_ infants and fractious _children_. Also indicated in some cases of acute dental _anxiety_ in adults, _aerodontalgia, pulpitis_ , median fissure of the _lip, median rhomboid glossitis_ and _halitosis_. It is sometimes used to treat systemic or psychic reactions to local _anaesthesia_. **Susceptible typology:**

(1) Children: tired, disagreeable, capricious, throws away what is given, one cheek red and the other pale.

(2) Adults: nervous, extremely pain sensitive, normally civil but angry and rude when in pain, aversion to or intense desire for coffee, generally > heat but toothache > cold water (< hot food).

See also _Pain threshold, low_.

### _Chancre – see_ Syphilis

### _Cheek biting, recurrent (Stomatitis artefacta)_

Recurrent cheek biting in both children and adults is usually a manifestation of psychological disturbance. Treatment of the psyche involves the use of _Bach flower remedies_ or homoeopathic constitutional remedies. Local treatments for the _bitten cheek_ , or any _aphthous ulcers_ produced by biting, may also be used simultaneously. In children, recurrent cheek biting may produce the appearance of a white _sponge naevus_.

### _Cheilitis – see_ Angular cheilitis; Exfoliative cheilitis; Lip, median fissure of lower

### _Cheiranthus (Cheiranthus cheiri)_

Homoeopathic common wallflower. A remedy for acute _trismus_ associated with dental _abscess, pericoronitis, craniomandibular dysfunction_ or _oral surgery_. It is also a remedy for pericoronitis itself, in the absence of trismus. A leading symptom to its use is 'nose obstructed at night as a result of cutting of wisdom teeth'.

#####

##### _Fig. 13. Cheiranthus_

### _Chickenpox (Varicella)_

This is caused by Varicella zoster virus infection, as is _herpes zoster_ and _Ramsay-Hunt syndrome_. Apart from the characteristic vesiculopustular rash of the skin, oral _ulcers_ , 2–4mm in diameter, may appear in the faucial and palatal regions. _Mouthwashes_ of aqueous dilutions of _Calendula_ or _Propolis_ Ø may be used several times daily. Fundamental treatment of the condition usually involves the use of potentised _Antimonium tartaricum, Rhus toxicodendron_ or _Sulphur_.

### _Children, fractious_

The main remedy here is _Chamomilla_ 30, preferably given morning and evening on the day before and one hour prior to the procedure; otherwise, every 15 minutes until the child is calmed. Its indications are: whining restlessness, spiteful, oversensitive to pain, cross, irritable desire to be carried or petted (which >), uncooperative, throws away toys or objects given to calm. _Cina_ 30 has similar indications, but the child does not want to be touched, carried, or even looked at. The dose repetition is as for Chamomilla.

See also _Pain threshold, low_.

### _China (Cinchona officinalis)_

Homoeopathic Peruvian bark. A remedy occasionally indicated in dental _haemorrhage_ , especially if accompanied by blurred vision, buzzing in the ear, great weakness, and a desire to be fanned (< heat). Also useful for general weakness and debility following an episode of haemorrhage.

### _Chipped tooth – see_ Traumatised tooth

### _Chiropractic_

A group of methods of manipulation of use in the treatment of _craniomandibular dysfunction_ , migraine or migrainous _neuralgia_ and _carpal tunnel syndrome_.

### _Christmas disease (Haemophilia B) – see_ Haemophilia

### _Chrysanthemum parthenium – see_ Feverfew

### _Cina_

Homoeopathic wormseed. Useful to calm certain types of fractious _children_ , and an important remedy for threadworms, irrespective of susceptible typology. Indicated in some cases of _bruxism_ in children. **Susceptible typology:** sullen, disagreeable, irritable, throws away what is given, does not want to be touched or looked at (compare _Chamomilla_ ), cries as soon as looked at or picked up, rings around eyes, yawns constantly, agitated sleep, clenches teeth at night, prone to threadworms.

See also _Bruxism& bruxomania_.

### _Cinchona officinalis – see_ China

### _Cinnabaris_

Homoeopathic mercury sulphide. Indicated in some cases of trigeminal _neuralgia_ , with violent periorbital lancinating pains radiating from the lacrimal orifice to the temple, accompanied by redness of the eye and pain on the least contact; < humidity, < extremes of temperature, < at night.

### _Cistus canadensis_

Homoeopathic ice plant. A remedy for chronic _gingivitis_ and _periodontitis_ , where the gums are thin, friable and bleed easily. Also a remedy for malignant disease of the glands of the neck, when they are stony hard. **Susceptible typology:** patients who are extremely sensitive to cold air, mouth and saliva feel cold, prone to cervical lymphadenopathy ('scrofulous').

### _Cleidocranial dysostosis_

A congenital condition which neither affects the intellect nor longevity. Ossification of the cranial bones is defective and there is partial development or entire absence of the clavicles. Recurrent _dislocation_ of the TMJ may occur in some cases.

### _Clematis erecta_

Homoeopathic upright virgin's bower. A remedy for _toothache_ < lying down and > for holding cold water in the mouth (compare _Chamomilla_ and _Coffea cruda_ ). Sometimes used in the treatment of _pulpitis_ and _dry socket._

#####

##### _Fig. 14. Clematis erecta_

### _Clove oil (Oil of cloves/Oleum Caryophylli)_

Obtained by distillation of cloves. A traditional botanic treatment for _toothache_ related to a lost filling or carious cavity. It is introduced via a cotton-wool plug. Contact with the oral mucosa may lead to irritation and inflammation, which may resemble an _aspirin burn_. The treatment is similar.

#####

##### _Fig. 15. Cloves_

### _Cluster headache – see_ Neuralgia, (periodic) migrainous

### _Coccus cacti_

Homoeopathic cochineal (the female insect). A remedy which, in its potentised form, assists in the expulsion of foreign bodies from the conjunctival sac, and thus helps to prevent the development of _conjunctivitis_.

### _Coeliac disease_

This may be associated with _aphthous_ ulceration of the mouth. This often improves dramatically with gluten exclusion, but resistant cases require assessment of _folate_ levels, with appropriate supplementation where necessary.

See also _Vitamin E_.

### _Coenzyme Q10_

Also known as ubiquinone-50. Coenzyme Q10 is a vital catalyst to the provision of energy for all cells. A common feature of chronic _gingivitis_ or _periodontitis_ is a local deficiency of this substance, which may be due to the condition itself or may be additionally associated, in a proportion of cases, with a generalised coenzyme Q10 deficiency state. Results have been encouraging in improving the periodontium with internally administered doses, generally 30mg once daily (range: 20–50 mg daily, according to response). At present, it is not recommended for use during pregnancy and in lactation. Side effects are rare and only occur in less than 1% of cases. These include: gastric discomfort, nausea, loss of appetite and diarrhoea. Those who are particularly interested in this valuable addition to the dental therapeutic armamentarium should ask for the leaflet 'Coenzyme Q10' by Dr Leonard Mervyn, supplied free of charge by Lamberts Healthcare Ltd., 1 Lamberts Road, Tunbridge Wells, Kent TN2 3EQ, England. This contains valuable references to the research work carried out to date in the area of periodontology.

#####

##### _Fig. 16. Coffea cruda_

### _Coffea (Coffea cruda)*_

Homoeopathic Arabic coffee seeds (unroasted). Useful in some cases of acute dental _anxiety, aerodontalgia_ , and _pulpitis_ alleviated by holding cold water in the mouth and < heat (compare _Chamomilla_ and _Clematis erecta_ ). As the water warms in the mouth, so the pain returns. These phenomena are probably related to the presence of pulpal gases, which expand with heat or contract with cold. **Susceptible typology:** nervous, intelligent, overactive, hyperaesthesia of all senses, hypersensitive to pain, mind full of thoughts, poor sleep, easily overstimulated by pleasant events, generally < cold but toothache > cold. The Coffea patient is very sensitive to noise, even 'decent' music in the surgery, and demands that it should be turned off.

See also _Pain threshold, low_.

### _Cold sore – see_ Herpes labialis

### _Colds & influenza, prevention of_

The dental surgeon is particularly exposed to the risk of contracting these from the infected patient. Adequate _zinc_ and _vitamin C_ levels should be maintained by diet or supplementation. Additionally _Oscillococcinum_ 200 should be taken as a single dose on alternate days as a preventative. Should symptoms develop, _Aconite_ 30 may be taken immediately, together with _Zingiber_ Ø 20 drops in a little water. Both should be repeated ever 4 hours until symptoms remit.

See also _Thrombocytopenia_.

### _Collapse, sudden_

Apart from normal first-aid measures, homoeopathy may be of great assistance. For a simple faint, give _Bach_ Rescue Remedy 3 drops every minute until recovery occurs. Good old-fashioned _smelling salts_ are a sensible alternative or additional therapy. Some prefer to give Veratrum album 30 (homoeopathic white hellebore). More serious cases (e.g. CVA, myocardial infarction) require _Carbo vegetabilis_ 30 (liquid potency) every 5 minutes until help arrives. This remedy may be life-saving. If there is any doubt about the nature of the collapse, always give Carbo vegetabilis, sometimes termed 'the homoeopathic corpse reviver'.

### _Concussion_

Where concussion complicates traumatic cases, or where the head has been severely jarred without concussion, give _Natrum sulphuricum_ 30 4-hourly.

### _Concussion, pulpal – see_ Pulpitis; Traumatised tooth

### _Condyloma acuminatum_

This is a sessile papillomatous lesion of the oral or genital regions, usually found in groups. Oral lesions generally occur as a result of orogenital contact in either heterosexuals or homosexuals. The occurrence of these in children may be suggestive of sexual abuse, but the appearance of the lesion at any age may be clinically identical to squamous cell _papilloma_ , which is of non-venereal origin. For non-surgical treatment, see _Papillomavirus lesions, human_.

### _Conjunctivitis, acute_

To assist the expulsion of foreign particles (such as amalgam slurry and tooth fragments) from the conjunctival sac, take _Coccus cacti_ 30 every 10 minutes or so. Established mild acute conjunctivitis may be treated with _Euphrasia_ 30 three times daily. More severe acute conjunctivitis, with much purulent discharge, may require _Argentum nitricum_ 30 three times daily. Any case may benefit from the additional use, instilled 3–6 times daily, of the following drop formula: Triple Rose Water 5ml, distilled water 5 ml, Euphrasia Ø 3 drops.

### _Contraceptives, oral – see_ Folate; Vitamin B6

### _Corticosteroids_

Therapy with steroid inhalers may be associated with _angina bullosa haemorrhagica_ and oral _candidosis_. Other types of corticosteroid therapy are also associated with oral candidosis.

### _Cost-effectiveness of homoeopathy_

One great virtue of homoeopathic remedies is their relatively low cost compared with orthodox alternatives in the field of oral medicine. Refer to the article by H.W. Feldhaus, British Homoeopathic Journal, January 1993, Vol. 82, see here.

### _Costen's syndrome – see_ Craniomandibular dysfunction

### _Coxsackieviruses_

These give rise to _hand, foot & mouth disease_ and _herpangina_ , both with oral manifestations.

See also _Salivary glands, viral infections of_.

### _Cramp_

Episodes of cramp in the legs or arms may be treated with _Cuprum metallicum_ 30 every 10 minutes. Cramps may sometimes be caused by a low salt diet or excessive _zinc_ supplementation.

### _Craniomandibular dysfunction (TMJ dysfunction syndrome)_

One aspect of _facial pain_ , which goes by a variety of names, including Costen's syndrome and facial arthromyalgia. In this condition the TMJ is anatomically, radiographically and pathologically normal. The key diagnostic subjective and objective symptoms, which may be present either unilaterally or bilaterally (all of which may not be exhibited), are: preauricular pain, which may radiate to the mandibular, maxillary, temporal or occipital areas, and which may undergo acute exacerbation; headaches; limitation of jaw opening, including frank _trismus_ ; difficulty in chewing; tenderness over the TMJ and of the muscles of mastication; and audible or palpable clicking of the TMJ. This syndrome must be distinguished from disease of the _TMJ, tetanus_ , oromandibular _dystonia_ and intraoral infection, such as dental _abscess_ and _pericoronitis_.

Mechanical therapies include the provision of dentures, the correction of mallocclusion and acrylic splints (bite-plates). Nevertheless, many cases fail treatment. Where psychological causes are apparent, especially in cases of _bruxism_ or bruxomania, then the use of either _Bach flower remedies_ or constitutional remedies is indicated. _Staphysagria_ should be thought of in cases of stifled vexation, or where the complaint has arisen from a psychological 'stab in the back' or sexual abuse. Some appear to be a manifestation of _mercury toxicity_ or sensitivity to chrome-cobalt, and respond to the removal of amalgams or the provision of gold alloy prostheses respectively. Even so, it is apparent that many practitioners fail to realise that a large proportion of cases are related to vertebral displacement, requiring the services of _osteopathy_ or _chiropractic_. In this respect, the reduction of both thoracic and cervical displacements should be a prime approach in the treatment of most sufferers. A particular area of attention, often missed, is C7/T1, which is best dealt with by chiropractic manipulation. Sometimes, relief, albeit partial, is almost instant. In order to fortify the effect, _acupuncture_ is particularly helpful. Although there are many local and remote points which might be needled, a key point is Stomach 6, situated at the angle of the jaw. The needle should be inserted perpendicularly to the skin until the mandible is contacted, not manipulated in any way, and not left in for more than 3 minutes. This is often a most helpful technique. My fashion is to repeat vertebral manipulation (if indicated) and acupuncture at weekly intervals until significant improvement has occurred. Attempts to find 'specific' remedies for craniomandibular dysfunction have not been particularly fruitful, although _Hypericum_ 30 three times daily is useful in some cases, and _Cheiranthus_ 30 two or three times daily may relieve frank trismus. Fischer recommends _Magnesia phosphorica_ 30 (or higher) several times daily to reduce muscle spasm which is > heat. As he points out, only the muscular component of the disorder is usually relieved by this prescription. _Zincum phosphoricum_ 30 three times daily is sometimes useful in individuals suffering from mental exhaustion. The old favourite _Rhus toxicodendron_ 30, three times daily, is to be considered where there is clicking or cracking of the TMJ, the jaw is especially stiff in the morning and loosens with use (talking, eating, posturing) during the day, and improves with the application of heat or in warm weather (< damp, cold weather). Without these individualising features, the remedy is unlikely to help. Otherwise, a better approach is to prescribe again on the basis of the individuality of the case, and consider such remedies as would normally be considered in cases of migrainous _neuralgia_. Indeed, there are some instances where the differentiation between craniomandibular dysfunction and migrainous neuralgia is most difficult. Since, however, there is a common thread of manipulative, acupuncture and homoeopathic therapies with regard to both disorders, a combined approach is often successful, even though a definite orthodox diagnosis has not been made.

See also _Facial pain, atypical; Tension headache_.

### _Crataegus_

Mother tincture of hawthorn berries. A botanic adopted by homoeopathy primarily for the treatment of the heart affected by coronary atherosclerosis; yet, it has no effect on the normal heart. In dentistry, its sole use is in the treatment of diarrhoea following the administration of _antibiotics_.

### _CREST syndrome – see_ Scleroderma

### _Cretinism – see_ Hypothyroidism

#####

##### _Fig. 17. Crataegus_

### _Crohn's disease_

Oral lesions are not uncommon in this condition, and may even precede any involvement of the terminal ileum. They include: _aphthous ulcers_ (20%), _angular cheilitis_ , full width _gingivitis_ , lip swelling, mucosal tags, oedema of the buccal mucosa, _epidermolysis bullosa_ acquisita and _pyostomatitis vegetans_. Local treatments of lesions are applicable with _Myrrh_ or _Propolis_ , and injections of _vitamin B12_ are indicated in cases of vitamin B12 malabsorption. Otherwise homoeopathic constitutional and antimiasmatic treatment should be administered.

See also _Orofacial granulomatosis_.

### _Cuprum metallicum_

Homoeopathic copper. A great remedy for muscular _cramp_ , especially in the elderly, often used preventatively.

### _Cuts_

Use potentised _Arnica_ internally to control bleeding and bruising. Use _Calendula_ cream externally to promote healing.

### _Cyst – see_ Tumours & cysts

### _Cyst, periapical – see_ Endodontics

### _Cytomegalovirus – see_ Salivary glands, viral infections of

### D

### _Dental abscess – see_ Abscess, dental

### _Dental caries – see_ Caries, predisposition to dental

### _Dentifrices – see_ Toothpastes, homoeopathic & botanic

### _Dentinogenesis imperfecta – see_ Osteogenesis imperfecta

### _Denture granuloma_

This is essentially _scar_ tissue in response to trauma from the flange of a _prosthetic_ appliance. Reduction of size occurs after correction of the prosthetic defect. That which remains after one month is best removed surgically, with the normal homoeopathic precautions indicated for _oral surgery_ in general.

### _Denture sore mouth – see_ Candidosis, oral; Prosthetics, dental

### _Dentures, problems associated with – see_ Prosthetics, dental

### _Dermatitis herpetiformis_

A rare chronic disease, with the highest prevalence in Scandinavia. It is characterised by pruritic papules, herpetiform vesicles and papulovesicles, mainly on the skin of the elbows, posterior neck, scalp, knees and buttocks. Oral lesions occur in the form of erosions and bullae, and these occasionally precede dermal manifestations. Some considerable improvement may be derived from dietary exclusion of gluten. Local oral treatments, as for _aphthous ulcers_ , may be helpful. Constitutional therapy is required for the underlying disorder.

See also _Ulcers_.

### _Dermatitis, perioral – see_ Perioral dermatitis

### _Diabetes mellitus_

Oral lesions associated with this disorder include: oral _candidosis, angular cheilitis, burning mouth syndrome, gingivitis, periodontitis and sialosis. Lichenoid reactions_ may occur in association with the administration of oral hypoglycaemic drugs. _Sialorrhoea_ is a symptom of diabetic autonomic neuropathy, and may improve with the administration of _evening primrose oil_ (l–4g daily).

### _Dislocation, TMJ_

Immediately after reduction of an isolated dislocation of the TMJ, _Arnica_ 30 should be given three or four times daily for several days. Recurrent dislocation, however, is another problem. Here, _Calcarea fluorica_ 6–12 or _Strontium carbonicum_ 30, given twice daily for several months, may assist cases with damage to the ligamentous tissues of the joint. Some cases are associated with hypermobility of the joints in general, which may occur in people essentially 'normal' in other respects, or in cases of _Ehrlers-Danlos syndrome, osteogenesis imperfecta, cleidocranial dysostosis_ and _Marfan's syndrome_. Those with general hypermobility of the joints are best treated with _Calcarea fluorica_. If psychological conditions are associated, the use of the _Bach flower remedies_ or constitutional remedies may be indicated. It is important to distinguish recurrent dislocation from oromandibular _dystonia_.

### _Dislocation, tooth – see_ Reimplantation

### _Dispensary, the dental_ – _see_ Appendix 1

### _Dry mouth – see_ Xerostomia

### _Dry socket (Infected tooth socket)_

Local treatment includes dressings soaked in an equal mixture of _Propolis_ Ø and _Plantago_ Ø, and the use of _Myrrh_ mouthwashes (Ø 5ml plus water 45ml). Where there is throbbing pain, give _Belladonna_ 30 hourly. Otherwise, Fischer considers _Ruta_ to be the prime remedy in the treatment of dry socket, to be used at the outset of most cases (30c hourly). He also feels that _Pyrogen_ (30c two or three times daily) may be required additionally. Where the pain improves with cold water held in the mouth, consider _Chamomilla_ 30–200 hourly; or, alternatively, _Coffea cruda_ 30–200 or _Clematis erecta_ 30. Where the pain is neither throbbing nor alleviated by cold water, or other remedies fail, consider _Hekla lava_ 30 2-hourly. To assist in the expulsion of sequestra, give _Silicea_ 6–12 three times daily.

The preoperative use of _Phosphorus_ , to prevent excessive bleeding following extraction, is thought by some to increase the likelihood of dry socket.

### _Dyskeratosis congenita – see_ Sponge naevus, white

### _Dystonia, oromandibular_

Dystonia is the term used to describe particular types of involuntary and abnormal movements and postures seen in a variety of neurological disorders. Oromandibular dystonia affects the tongue, mouth and jaw. The spasms may result in the mouth opening widely, sometimes with _dislocation_ , or severe _trismus_. The most common type of dystonia is ITD or idiopathic torsion dystonia, probably associated with a biochemical abnormality of the basal ganglia of the brain, and often inherited. No other neurological deficits are discovered, and intellect is preserved. Secondary dystonia is associated with other neurological diseases (e.g. Parkinson's) or drug therapies (e.g. those used in schizophrenia). Dystonia may be confused with _craniomandibular dysfunction_ and recurrent _dislocation_ of the jaw. Surgical intervention in cases of recurrent dislocation should always be delayed until a neurologist skilled in the diagnosis of dystonia has been consulted. Oromandibular dystonia is most difficult to treat, although _acupuncture_ and homoeopathy might achieve some partial alleviation. There is, in any event, 5–10% chance of remission, albeit temporary, with regard to ITD.

### **E**

### _Ecthyma contagiosum (Orf)_

This viral disease is contracted by contact with live or dead sheep, lambs, goats or kids, or indirectly via fomites. At the site of inoculation (which may be upon the face or neck) a lesion develops after an incubation period of 3–7 days. This is essentially a papule, some 1–4cm in diameter, covered with clear vesicles. These coalesce to form an umbilicated bulla, which then crusts over. This may take up to 8 weeks to heal, and there is regional enlargement of the lymph nodes. This lesion may be confused with a malignant tumour or tuberculosis. However, the extremely rapid development of the lesion and a history of contact with the relevant animals (farmers, butchers, vets, etc.) suggests the diagnosis. The key remedies for therapy are _Nitricum acidum, Rhus toxicodendron_ and Orf nosode.

### _Ehlers-Danlos syndrome_

This inherited disorder is of some importance to the dental surgeon. Its relevant characteristics are hypermobility of the joints in general; recurrent _dislocation_ of the TMJ; skin fragility, associated with gaping wounds that are difficult to suture, leaving thin and spreading scars; excessive bruising after minor trauma; and protracted _haemorrhage_ after dental extraction. Long-term _Calcarea fluorica_ 6–12 twice daily may be helpful in controlling the disorder, and _Arnica_ for both the prevention and treatment of haemorrhage and bruising should be considered.

### _Endocarditis – see_ Subacute bacterial endocarditis, prevention of

### _Endodontics_

The sterilisation of root canals is best achieved by the use of paper points saturated with _Propolis_ Ø. The administration of _Hepar sulph_. 6 three times daily is recommended throughout the course of endodontia in order to reduce periapical inflammation, but should be discontinued about 7 days after satisfactory occlusion of the root canal. Some cases, however, exhibit an annoying persistence of periapical tenderness and discomfort for many weeks or months after an apparently successful root canal filling. _Zinc_ supplementation (adult dose: 15–30mg elemental zinc daily) and _Hepar sulph_. 30 twice daily are recommended. Others may require _Silicea_ 6 twice daily. These secondary approaches are also justified in cases where permanent root filling cannot be performed because of frank and persistent periapical infection, despite apparently correct root canal sterilisation. Where a periapical cyst is suspected, _Hekla lava_ 6 two or three times daily should be considered, with the hope of avoiding apicectomy or extraction (Silicea may also be considered secondarily in this respect). Apicectomy should always be accompanied by the routine use of _Arnica_ and _Hypericum_ , as for _oral surgery_ in general (see also _Oral surgery, pain control after_.)

Where pain has been caused by apical penetration of a reamer, give _Ruta_ 30–200, initially every 15–30 minutes as necessary.

It should be emphasised that the judicious use of remedies for _pulpitis_ may preserve the vitality of the pulp. Furthermore, Fischer notes that the use of _Belladonna_ initially, and later _Calcarea carbonica_ , in some cases of inevitable pulpal necrosis, where they are properly indicated, removes the need for root-filling. Teeth treated in this manner sometimes become silent, with the development of occlusive calcification within the root canals. Even radiographically dark periapical areas have been known to disappear.

### _Epidermolysis bullosa_

This inherited group of diseases is characterised by extreme fragility of the dermal and oral epithelium. An 'acquired' form, epidermolysis bullosa acquisita, is occasionally seen in association with _Crohn's disease_. Bulla formation and oral erosions may occur, which heal with gross scars, leading to limitation of movement of the lips, tongue and cheeks. Oral lesions may be precipitated by minor trauma, including that associated with mechanical dentistry. _Calendula_ and _Arnica_ should be employed regularly in the treatment of such cases. The prescription of remedies to inhibit or reduce excessive _scar tissue_ formation should also be considered.

See also _Ulcers_.

### _Epistaxis, acute_

This may occur as a result of the exacerbation of _blood pressure_ in hypertensive patients who suffer from acute dental _anxiety_. It may also occur in non-hypertensives. Normal first-aid measures must be instituted. Both groups should be given _Ferrum phosphoricum_ 30 every 15 minutes. Additionally and concurrently, the hypertensive should be given _Aconite_ 30 every 15 minutes.

### _Epulis_

The main types of epulis are the congenital epulis, the fibrous epulis and the giant cell epulis. Fibrous epulides occur much more commonly in women as opposed to men (4:1), and some are associated with pregnancy ('pregnancy epulis'). Giant cell epulides are rarely seen in adult males, and occur most commonly in children of either sex and women of fertile age. The pyogenic granuloma is a variant of the fibrous epulis in which the granulation tissue remains immature and vascular. Various homoeopathic internal remedies have been suggested for the treatment of epulides, including _Thuja, Calcarea carbonica, Natrum muriaticum_ , Plumbum aceticum (lead acetate) and Lac caninum (bitch's milk). However, this is only of academic interest, since all these lesions should be removed surgically, with the normal homoeopathic precautions being taken as with _oral surgery_ in general. Nevertheless, as a rule, Thuja 6 twice daily should be given after, perhaps for several months, in order to dissuade recurrence; although Natrum muriaticum 6 twice daily may be preferable in cases of pregnancy epulis.

### _Eruption, delayed dental_

The principal remedies here are _Calcarea carbonica, Calcarea phosphorica, Silicea_ and _Calcarea fluorica_ , given individually and according to susceptible typology, 6–12c twice daily. Difficult cases may additionally require infrequent doses of _Bacillinum_. Other remedies, particularly _Sulphur_ or _Fluoricum acidum_ , may occasionally be needed, based upon the constitutional aspects of the case.

See also _Fluoridation_.

### _Eruption, disturbances associated with – see_ Teething, infant

### _Erythema migrans – see_ Geographic tongue

### _Erythema multiforme_

This inflammatory disease of sudden onset is usually self-limiting. The symmetric skin lesions may be macular, papular, bullous, urticarial or purpuric. So-called 'target' lesions with clear centres and erythematous rings, or 'iris' lesions may occur. The skin lesions mainly present on the extensor surfaces, but may be found on the palms or the soles. The oral lesions consist of widespread and painful _ulceration_ and blood-encrusted lips. The disorder should be differentiated from primary herpetic _gingivostomatitis_ , the oral lesions of which may closely resemble those of erythema multiforme. This may be difficult when the oral lesions are manifest in the absence of those at other sites. The ocular and genital mucosae may also be affected, and both lymphadenopathy and malaise occur. More severe cases, with multiple site involvement, are termed 'Stevens-Johnson syndrome'. The attack generally resolves spontaneously in 7–14 days, but 2–3 recurrences of diminished severity may occur over a period of 2–3 years following the initial manifestation of the disease. Various causative factors are known, including: previous infection with _Herpes simplex_ virus or Mycoplasma pneumoniae, systemic or topical drug therapies (especially sulphonamides and barbiturates), pregnancy, exposure to sunlight, inflammatory bowel disease and allergy to _foods_ (especially benzoate-type preservatives).

Local therapy may be given as for _aphthous ulcers_. Acquired infective miasmatic cases may be given either Herpes simplex nosode 30–200 or Mycoplasma pneumoniae nosode 30, whichever is appropriate, in infrequent dosages. Otherwise remedies may be given along the lines suggested for primary herpetic _gingivostomatitis_. In persistent or frequently recurrent cases, allergy to drugs, foods or preservatives may be suspected. Thereafter, the administration of the offending drug or allergen in potency may be helpful (6–30c twice daily) or _Thuja_ 6–30 twice daily may be considered.

### _Erythroplakia – see_ Leukoplakia

### _Espundia – see_ Leishmaniasis, New World mucocutaneous

### _Euphrasia (Euphrasia officinalis)_

Homoeopathic eyebright. Both the diluted mother tincture and the potentised form are used in the treatment of acute _conjunctivitis_.

### _Evening primrose oil (EPO)_

A good source of GLA (gamma-linolenic acid). Used as an adjunctive treatment in some female cases of _burning mouth syndrome_ , recurrent _aphthous_ ulceration, _atypical facial pain_ , migraine and migrainous _neuralgia_. Also may be used in the treatment of neuropathy associated with _diabetes mellitus_. The usual adult dose is 500–1000mg (GLA 40–80mg) twice daily after food. Other sources of GLA, especially for those who cannot tolerate evening primrose oil (headaches, etc.) are borage oil, blackcurrant seed oil and starflower oil. GLA should not be used in cases of epilepsy (particularly temporal lobe epilepsy), breast cancer or mania. The role of GLA in preventing menopausal or postmenopausal alveolar ridge or periodontal bone loss is uncertain.

See also _Calcium; Periodontitis, chronic_.

### _Exfoliative cheilitis_

This condition, restricted to the vermilion borders of the lips (predominantly the lower), is due to excessive production of keratin. Its aetiology is unknown. A similar condition, known as actinic cheilitis, results from exposure to sunlight. The regular use of _Calendula_ ointment or cream may be helpful.

### _Exostosis – see_ Fluoridation; Osteoma

### _Exposure, pulpal – see_ Pulpitis; Traumatised tooth

### _Extraction – see_ Oral surgery, prevention of complications in; Oral surgery, pain control after; Dry socket; Haemorrhage, acute dental; Sequestrum

#####

##### _Fig. 18. Evening primrose_

### _Extraction, botanic_

I mention this peculiar subject out of interest. There are certain areas of the world where plant substances are inserted into the carious cavities of teeth in order to facilitate or promote extraction. In West Africa, the seed oil of Ximenia americana is employed for this purpose, as is the powdered root or bark of Acacia pennata soaked in palm wine. These are used to saturate cotton plugs, and appear to promote ease of extraction. The Panama Indians apparently insert the latex of either Hura crepitans or Chlorophora tinctoria into decayed teeth to induce spontaneous extraction. It is not possible to confirm either their safety or efficacy. The powdered dried root of the greater celandine (Chelidonium majus) was once used in England for similar purposes, but is essentially toxic.

### _Eye, 'something' in the – see_ Conjunctivitis, acute

### _Eye-strain_

Consider _Ruta graveolens_ 6–30 three times daily, and get your eyes checked.

### **F**

### _Facial migraine – see_ Neuralgia, (periodic) migrainous

### _Facial nerve palsy (paralysis)_

The two most commonly encountered types of facial nerve palsy are that associated with cerebrovascular accident (stroke, CVA) and _Bell's palsy_. Surgery or _tumours_ of the parotid gland and non-surgical trauma are other causes. _Ramsay-Hunt syndrome_ and _Lyme disease_ should not be forgotten. Occasionally, facial nerve palsy is associated with intracranial tumours. In cases unassociated with surgery, a neurological opinion should be sought; some are a manifestation of _AIDS_. Facial palsy must be distinguished from other causes of facial weakness, such as myasthenia gravis. The remedy _Causticum_ is one of prime importance in the treatment of lower motor neurone lesions of the facial nerve.

See also _Melkersson-Rosenthal syndrome_.

### _Facial pain (including oral & orofacial pain)_

Apart from more obvious causes, such as _pulpitis, pericoronitis_ , dental _abscess, fractures, salivary gland_ disease, _tumours, Ramsay-Hunt syndrome_ and sinusitis, there are a variety of diseases and syndromes in which facial, oral or orofacial pain is a dominant feature. These are considered under a number of different headings: _Burning mouth syndrome_ ; _Craniomandibular dysfunction_ (TMJ dysfunction syndrome); _Facial pain, atypical_ (which includes a discussion of atypical odontogenic pain); _Giant cell arteritis; Neuralgia, glossopharyngeal; Neuralgia, (periodic) migrainous_ (which includes a discussion of migraine and paroxysmal facial hermicrania); _Neuralgia, post-herpetic; Neuralgia, trigeminal_ (including pre-trigeminal neuralgia); _Paget's disease; Tension headache; TMJ, disorders of_.

### _Facial pain, atypical_

This may be defined as a constant and virtually invariable dull ache of the face or jaw, present throughout the waking hours, lacking any obvious modalities, and with no obvious pathological cause. Atypical odontalgia is essentially the same disorder, but the pain is localised to one or more teeth.

This condition is more commonly experienced by women than men, who, in general, are over the age of 30. Depression and early waking appear to be associated. Treatment with either the _Bach flower remedies_ or major constitutional remedies, such as _Sepia_ or _Natrum muriaticum_ (according to the general and mental characteristics), is strongly indicated (in conjunction, perhaps, with _evening primrose oil)_. Indeed, it is not unreasonable to consider this disorder as a psychologically-determined variant of _craniomandibular dysfunction_ (TMJ dysfunction syndrome). However, a small number of cases have diagnostically obscure physical origins. In some a non-vital but radiographically normal tooth is responsible. In others, _mercury toxicity_ is the root of the matter.

### _Faint – see_ Collapse, sudden

### _Fear – see_ Anxiety, acute dental

### _Ferrum phosphoricum_

Homoeopathic ferric phosphate. A remedy used in the treatment of acute _epistaxis, pulpitis_ , the _traumatised tooth_ with pulpitic symptoms and dental surgical _haemorrhage_. With regard to the latter, it is important to note the **susceptible typology:** weak, tired, pale and anaemic (especially children and adolescents).

### _Feverfew (Chrysanthemum/Pyrethrum parthenium)_

Originally a botanic medicine, popularly used in the treatment of migraine, this has now been adopted by homoeopathy. The potentised remedy may be similarly used for migraine or migrainous _neuralgia_ , and is effective in many _aphthous ulcer_ cases. Its use for aphthous ulcers was suggested by the fact that a proportion of those taking crude feverfew developed painful ulceration of the oral mucosa.

### _Fibro-epithelial polyp_

This is essentially scar tissue produced in response to repeated trauma, and is most commonly seen on the buccal mucosa in line with the occlusal plane. Rarely, other sites, such as the tongue, are involved. Correction of any malocclusion or recontouring of sharp teeth is indicated, together with surgical removal of the polyp, utilising the usual homoeopathic precautionary measures associated with _oral surgery_ in general. Patients with a tendency to _keloid_ formation may require other homoeopathic therapies.

### _Fibrous dysplasia_

Of unknown aetiology, this condition is essentially the replacement of normal bone by fibrous tissue. In the monostotic type, a single bone is affected. With regard to the jaws, the maxilla is more commonly affected than the mandible, and there is a slowly developing unilateral and painless swelling during childhood. Alkaline phosphatase levels are normal. In the polyostotic type (many bones involved), about 20% of cases have jaw lesions, and the alkaline phosphatase level is raised. Approximately 50% of polyostotic cases exhibit hyperpigmentation of the skin. 'Albright's syndrome' is the term given to the combination of polyostotic fibrous dysplasia, skin hyperpigmentation and precocious female puberty.

The features of fibrous dysplasia, taken as a whole, strongly point to the remedies _Hekla lava, Calcarea fluorica_ and _Calcarea phosphorica_. Their administration for a prolonged period during childhood may modify the progress of the disease. Calcarea phosphorica is well-indicated in Albright's syndrome. A sample prescription for the monostotic form might be: Hekla lava 6 twice daily plus Calcarea fluorica 12 at midday. For Albright's syndrome: Calcarea phosphorica 12 twice daily. Corrective _oral surgery_ (with the usual homoeopathic precautions) may be required after the childhood growth phase.

### _Fibrous epulis – see_ Epulis

### _Fissure of lip – see_ Lip, median fissure of lower; Angular cheilitis

### _Fistula, oroantral_

The principal remedy is _Silicea_ 6 two or three times daily. Should this fail, give _Fluoricum acidum_ 6 two or three times daily. Silicea is actually better indicated in overtly chilly individuals, and Fluoricum acidum in those who are hot.

### _Fluoricum acidum (Acidum fluoricum)_

Homoeopathic fluoric acid. An important remedy for oroantral _fistula_ , especially in hot individuals (generally < heat). Also used in the treatment of _osteomyelitis_ and delayed _eruption_. **Susceptible typology:** hot, hair dull and dry, nails grow poorly and break easily, prone to varicose veins and ulcers, rough skin, pruritis of vulva or anus, pruritis around ulcers and fistular orifices.

### _Fluoridation_

Despite the apparent past success of the fluoridation of water, topically applied fluoride and fluoride toothpastes, there is now a world-wide increase in caries in the 5 year-old group of developed countries. It seems likely that the same will be found in 12 year-olds. As it transpires, the apparent beneficial effects of fluoride, as determined statistically, are more likely accounted for by its ability to delay _eruption_. Hence, the importance of considering homoeopathy, once again, in the prevention of dental _caries_.

There are, of course, other problems with the mass fluoridation of water. Certain individuals, especially children, are excessively thirsty; in particular the _Phosphorus, Arsenicum album_ and _Natrum muriaticum_ types. They are, therefore, more prone to develop mottling and more serious manifestations of _fluorosis_. Moreover, individuals who have the susceptible typology of _Calcarea fluorica_ are more sensitive to the adverse effects of fluoride. The adverse effects of fluoride are opposed by maintaining a high _calcium_ intake (dairy products, canned fish, etc.).

There is a strong case for omitting fluoride from the composition of _toothpastes_ for both adults and children.

### _Fluorosis_

A disorder which, in its minor form, is only expressed as hypoplasia and mottling of the enamel of the teeth. In its intermediate form, multiple exostoses are produced. In its worst form, there is a crippling osteosclerosis. Fluorosis may also manifest as an increased susceptibility to traumatic _fracture_. It appears that, whilst the cancellous bone is increased in density, the cortex becomes thinner and more brittle.

Another study suggests the relationship between _fluoridation_ of water supplies and osteosarcomata in males. It may indeed be responsible for increasing the incidence of other malignant _tumours_. It has also been suggested that the immune system is compromised by even small amounts of fluoride. Whether tiny amounts of fluoride have any essential function in man is uncertain.

### _Focal epithelial hyperplasia (Heck's disease)_

This relatively rare disease dominantly affects Eskimos and North American Indians. It is characterised by numerous papillomatous lesions of the oral mucosa, which possibly are caused by human _papillomavirus_ infection. Treatment with _Thuja_ 6–12 twice daily may be helpful.

### _Focal sepsis_

This is the concept that a silent periapical or parodontal infection may cause pathological effects at distant sites of the body. With regard to _subacute bacterial endocarditis_ , this concept is recognised, but its application to other diseases is often denied. I know personally of only two such cases. One was a middle-aged male who developed a florid and widespread inflammatory arthritis, which subsequently responded to root canal filling and apicectomy of two non-vital lower incisors. The other was a gentleman of good repute, whose urethral discharge of non-venereal origin responded to the extraction of a non-vital premolar. The test for focal sepsis is to give the prime remedy for the chronic periapical or parodontal abscess, viz. _Hepar sulph_. 6 three times daily. Should there be significant improvement in the patient's condition, the presence of a silent area of periapical or parodontal infection is to be suspected and avidly sought.

### _Folate_

Folate deficiency may be due to, amongst others, inadequate intake, _coeliac disease, tropical sprue_ , and phenytoin or methotrexate therapy. It is not uncommon in pregnancy, and as a result of the use of the _contraceptive_ pill or _hormone replacement therapy_ (HRT). There may be _anaemia, burning mouth syndrome, angular cheilitis_ and aphthous ulcers. The most marked oral manifestation is usually _glossitis_ , the tongue becoming smooth (depapillated), red, shiny and painful. This appearance of the tongue is very similar to that of _vitamin B12_ deficiency.

Replacement therapy (an adult dose of at least 5mg of folic acid daily by mouth) must not be given without proper analysis, advice or investigation. In epileptics taking phenytoin, exacerbation of the epilepsy may occur. There are also some tumours which are folate-dependent. If vitamin B12 deficiency is also present, then subacute combined degeneration of the spinal cord may be precipitated by giving folic acid alone.

Since folate deficiency may contribute to the development of _gingivitis_ in those taking phenytoin, methotrexate, oral contraceptives or HRT, and those who are pregnant, some improvement may be secured by the use of folic acid _mouthwashes_. Gingivitis may be the only sign of mild folate deficiency, which is probably the most common deficiency state in the world.

### _Food allergy (including additive allergy)_

In the dental field, this matter is of relevance to: _aphthous ulcers, burning mouth syndrome, dermatitis herpetiformis, lichenoid reactions, orofacial granulomatosis_ and migrainous _neuralgia_. Food allergy may also be important in some cases of _tension headache_ and migraine.

### _Fordyce's spots_

These are normal structures, being sebaceous glands of the oral mucosa, varying considerably in number and distribution between individuals. They become more prominent during fevers, and are sometimes mistaken for pathological entities.

### _Foreign body_

The expulsion of foreign bodies, such as buried silk sutures, amalgam and glass fragments, is encouraged by giving _Silicea_ 6 three times daily. Where the foreign body is deeply situated (e.g. a broken needle fragment after an inferior dental nerve block), Silicea should not be given; for it is impossible to determine which way the foreign body might move. What many fail to realise is that Silicea only promotes the movement of a foreign body if there is a definite inflammatory reaction around it. A piece of shrapnel buried for years, with no tissue reaction of any significance, will not be caused to move; nor will a satisfactory prosthesis anywhere in the body. Only a dental _implant_ already undergoing rejection will be extruded by Silicea.

### _Fracture, jaw_

The most significant remedy for the promotion of union is _Symphytum_ 6 three times daily, and this should be routinely given. The same remedy is usually of brilliant application in cases of non-union. At the same time, assessment of the general nutritional status of the patient is warranted. According to the case, _calcium_ supplementation, _vitamin C_ or _zinc_ may be required. In the case of compound fractures, hot formentations of diluted _Calendula_ Ø should be applied to the broken skin or oral mucosa. Calendula cream or ointment should be freely applied to the oral mucosa and lips after wiring.

In addition to Symphytum and Calendula, it may be necessary to administer other remedies concurrently. To relieve the pain of fractured bones, give _Rhus toxicodendron_ 30 and _Bryonia_ 30 in 2-hourly alternation. To relieve pain, when the bones are severely contused, give _Ruta_ 30–200 2-hourly. For bruising of the soft tissues, use _Arnica_ 30–200 three times daily. To promote sleep after injury, give Arnica as before, plus _Sticta pulmonaria_ 200 two or three times daily. Where nerves have been damaged, give _Hypericum_ 6–30 three times daily (for sensory nerves) or _Causticum_ 6–30 three times daily (for motor nerves). Where non-union is persistent, despite the use of Symphytum and nutritional correction, consider Ruta 6–30 three times daily. For stiffness in the mobilising phase, consider Ruta 6–30 and Rhus toxicodendron 30 in 4-hourly alternation.

See also _Anaesthesia, general; Concussion; Fluorosis; Haematoma_.

### _Fragaria_

Homoeopathic wood strawberry. In potency, Fragaria discourages the formation of dental calculus, causes existing calculus to soften (so that it may more readily be removed by _scaling_ ), and may even induce its 'spontaneous' disappearance. It is thus a useful adjunct in the treatment of _periodontitis_ and _gingivitis_. There is no known susceptible typology in which Fragaria is particularly active in this respect, although the presence of a 'strawberry' _tongue_ is believed to firmly indicate that it is appropriate.

#####

##### _Fig. 19. Fragaria_

### _Frey's syndrome (Auriculo-temporal syndrome)_

This neurological condition may follow TMJ surgery, parotid surgery and injuries and injections in the same area. Frey's syndrome is sweating, and sometimes flushing, of the skin over the distribution of the auriculo-temporal nerve, produced by a stimulus to salivary secretion. It is thought to arise from the incorrect reconnection of nerve fibres following trauma, and appears about 5 weeks after the traumatic episode. Congential cases sometimes occur, probably as a result of birth trauma. Seldom is the condition sufficiently severe to warrant any treatment, but the avoidance of acid fruits or fruit juices may be helpful.

### _Frictional keratosis – see_ Keratosis, frictional

### _Fright – see_ Anxiety, acute dental

### _Fungal diseases_

The most common fungal infection which affects the orofacial region is _candidosis_. Other rare forms of fungal infection are histoplasmosis, mucormycosis (predisposed to by diabetic acidosis, steriods and cytotoxic drugs), blastomycosis (North American blastomycosis) and paracoccidiomycosis (South American blastomycosis), for which the homoeopathic treatment is complex, and includes nosodes of the relevant organisms.

### **G**

### _Gelsemium (Gelsemium sempervirens)*_

Homoeopathic yellow jasmine. A remedy for the treatment of acute dental _anxiety_ , where the patient is silent, motionless and exhibits a tremor. Diarrhoea sometimes accompanies these symptoms. A remedy for _migraine_ and _tension headaches_. An important constitutional remedy. **Susceptible typology:** emotional, jumpy, fearful, thirstless, weak, trembles, prone to diarrhoea and 'paralysis' when anticipating an unpleasant event, < bad news, < heat or warmth, > sweating, > passing large quantities of urine, prone to migraine or tension headaches (beginning in the occiput, and radiating to the neck and shoulders).

### _Geographic tongue (Erythema migrans/Benign migratory glossitis)_

This condition, which involves the dorsum and lateral aspects of the tongue, consists of irregular erythematous depapillated areas surrounded by pale margins of demarcation. These lesions improve and reappear at new sites, sometimes over the course of days, thus appearing to wander or migrate over the surface of the tongue. Even children may be affected. Some cases are associated with psoriasis. The majority of cases are asymptomatic, but a few complain of soreness, especially with spicy food. Treatment is with _zinc_ supplementation (adult dose: elemental zinc 15–30mg daily), together with _Taraxacum_ 6–30 twice daily. Should these measures fail, consider _Natrum muriaticum_ 6–12 twice daily. _Kali bichromicum_ 6–30 twice daily also requires consideration.

#####

##### _Fig. 20. Gelsemium_

### _Giant cell arteritis (Temporal arteritis)_

This condition may affect vessels other than the temporal artery. Granulomatous lesions occur sporadically along the course of the artery. Severe facial pain is often brought on by eating. Unlike most facial pain syndromes, it may be accompanied by weight loss, general muscle weakness and lethargy. The patient is typically over 60 years of age, and more likely a female. Since this condition may lead to blindness, early recognition and referral are essential,. Although initial treatment with _corticosteroids_ is justified to preserve the vision, professional homoeopathic treatment should also be considered as part of the overall therapy.

### _Giant cell epulis – see_ Epulis

### _Giant cell granuloma_

A giant cell lesion of the bone, which may produce extensive destruction. Its superficial presentation may be similar to that of a giant cell _epulis_. It is best removed surgically, with the normal homoeopathic precautions associated with _oral surgery_. Some of these lesions are associated with _hyperparathyroidism_ , which must be treated appropriately. In such cases, oral surgical removal is usually unnecessary.

### _Gigantism, pituitary_

The teeth in this condition are usually normal in size, but premature _eruption_ of the permanent dentition and spacing are characteristic. _Hypercementosis_ also develops.

### _Gingivitis, common chronic – see_ Periodontitis, chronic; _and also_ Crohn's disease; Leukaemia; Orofacial granulomatosis; Pemphigoid, mucous membrane; von Willebrand's disease

### _Gingivitis, acute necrotising ulcerative (ANVG/Vincent's stomatitis/Trench mouth)_

Local measures are important in the treatment of this acute bacterial disease, characterised by severe erosion of the gingival margins, loss of interdental papillae and extreme _halitosis_. The use of diluted hydrogen peroxide is of questionable benefit. Perhaps more important is the regular use (three or four times daily) of _Propolis_ mouthwashes, combined with the application of undiluted Propolis Ø to the gingival margins and interdental spaces once or twice daily, and thorough dental hygiene. Internally, homoeopathic therapy may be of immense benefit. The key remedy is undoubtedly _Mercurius solubilis_ 30 three times daily, especially where the tongue is heavily coated. Where the tongue is clean, _Nitricum acidum_ 30 three times daily is better indicated. Where improvement is slow under the influence of the former remedies and there has been much destruction of gingival tissue, consider _Kali chloricum_ 30 three times daily. Some cases of _glandular fever_ are associated with a gingivitis similar to that of _ANUG_ , and these may require additional treatment with Glandular fever nosode 30.

See also _Pellagra_.

### _Gingivitis, phenytoin_

The use of phenytoin in epilepsy may lead to hyperplastic gingivitis. Correct oral hygiene is essential, together with the use of 0.1% folic acid _mouthwashes_ twice daily. The mouthwash must not be swallowed. _Thuja_ 6–12 twice daily may be helpful.

See also _Folate_.

### _Gingivitis, pregnancy_

Hormonal changes in pregnancy increase the likelihood of gingivitis. 'Pregnancy _epulis_ ' may also arise. Strict oral hygiene and the regular use of _Myrrh_ mouthwashes are strongly indicated. Homoeopathic remedies should be prescribed on the basis of the constitution acquired in pregnancy and not that which preceded it. Remedies to be particularly considered are _Natrum muriaticum_ and _Sepia_. These, or others selected, should not be given in too high a potency. _Coenzyme Q10_ should not be administered in pregnancy, but folic acid 400mcg-5mg daily and _zinc_ (15mg elemental zinc daily) may be used routinely as an adjunctive therapy. The use of 0.1% folic acid _mouthwashes_ twice daily is recommended in addition to those of Myrrh.

See also _Folate_.

### _Gingivitis, puberty_

Hormonal changes, particularly in girls, at puberty may favour the development of gingivitis. Good oral hygiene, _Myrrh_ mouthwashes, _coenzyme Q10_ (30mg daily) and _zinc_ (elemental zinc 15–30mg daily) may all be helpful. Homoeopathic remedies prescribed on a constitutional basis are also of service; in particular, _Calcarea phosphorica, Ignatia, Natrum muriaticum, Pulsatilla_ and _Sepia_ , according to susceptible typology. In severely depressed cases with overt _halitosis, Aurum metallicum_ 30 and higher twice daily should be considered, but since some may be suicidal, expert advice should be sought before prescribing.

### _Gingivostomatitis, primary herpetic_

The majority of cases occur in childhood. It is less commonly seen in adults, in whom the disease is generally of greater severity. Some cases in children may be confused with the oral manifestations of acute _leukaemia_ and a blood test may be required for differentiation (some diagnostic confusion may also arise with respect to _erythema multiforme_ ). This vesicular, and subsequently ulcerative, condition may affect the lips as well as the oral mucosa (compare _herpangina_ ). Local treatment includes _Calendula_ or _Propolis_ mouthwashes, creams or ointments. The topical application of _vitamin E_ is said to produce effective pain relief within 15 minutes; this may be applied either directly or as an ointment. Internally, a key remedy is _Mercurius solubilis_ 6–30 three times daily, especially if there is much salivation. With a dry mouth, prostration and drowsiness, _Baptisia_ 30 three times daily is better indicated. Occasionally, in severe cases, concurrent treatment with _Herpes simplex_ nosode 30 once daily will be required.

### _Glandular fever (Infectious mononucleosis)_

Approximately 30% of glandular fever cases exhibit purpura or petechiae in the palate and pseudomembranous oral _ulceration_. Unilateral _pericoronitis_ or a condition of the gingivae resembling _ANUG_ may also occur. Local treatments are similar to those for _aphthous ulcers_ , common pericoronitis and ANUG. Internal treatment includes the use of Glandular fever nosode 30.

See also _Thrombocytopenia; Zinc_.

### _Glossitis_

This may occur as a result of _iron, folate, vitamin B12, vitamin B2_ or niacin deficiency.

See also _Candidosis, oral; Geographic tongue_ (Benign migratory glossitis); _Median rhomboid glossitis_ (Superficial midline glossitis); _Pellagra_.

### _Glossodynia_

Another term for _burning mouth syndrome_ , where the tongue is affected.

### _Glossopharyngeal neuralgia – see_ Neuralgia, glossopharyngeal

### _Glossopyrosis_

Another term for _burning mouth syndrome_ , where the tongue is affected.

### _Gonorrhoea_

Orogenital contact may result in the transmission of this disease to the mouth. The patient complains of a painful oral mucosa, _halitosis_ and perversion of _taste_. Clinical signs include: lymphadenopathy, erythema, oedema, _ulceration_ and pseudomembrane formation (particularly in the oropharynx). Referral is essential.

### _Gout_

Gout is common, but rare in the TMJ. Its principal relevance to dentistry, however, is that some cases may be associated with _hypercementosis_.

### _Granatum_

Homoeopathic pomegranate root bark. A remedy for painful cracking of the _TMJ_ and _sialorrhoea_. **Susceptible typology:** hungry, thin or emaciated, prone to digestive upsets and itching (especially of palms).

#####

##### _Fig. 21. Granatum_

### _Granulocytopenia – see_ Agranulocytosis

### _Granuloma inguinale_

This is essentially a venereal bacterial disease of the tropics and sub-tropics, but may be seen occasionally elsewhere. A papule develops, which _ulcerates_ to produce a mass of granulations. Occasionally, the mouth is involved, with subsequent formation of excessive _scar tissue_ , and limitation of opening.

### _Graphites*_

Homeopathic pencil-lead. A remedy for _keloid_ scar formation, and a major consitutional remedy. **Susceptible typology:** fat, chilly (but > walking in fresh air), dyspeptic, anaemic, constipated, sad, weepy (< music). Many Graphites subjects are menopausal.

### _Grinspan's syndrome_

The term applied to the combination of _diabetes mellitus_ , high _blood pressure_ and oral _lichenoid reaction_. The lichenoid component of the triad is probably due to the antihypertensive or oral hypoglycaemic drugs used in treatment.

### _Gum-boil – see_ Abscess, dental

### _Gunpowder_

Homoeopathic black gunpowder. A remedy for boils and _incisional abscess_.

### _Gustatory sweating & flushing_

This is a normal bilateral phenomenon after the ingestion of chili, pepper or ginger. However, when it occurs unilaterally and in relation to many foods, it is usually a manifestation of _Frey's syndrome_.

### **H**

### _Haemangioma (Vascular naevus)_

Most haemangiomata of the orofacial region are congenital malformations of the blood vessels. Capillary and cavernous types are described. Long-term treatment with _Calcarea fluorica_ 6–12 twice daily may be helpful in some cases to reduce their size. _Haemorrhage_ from trauma may be controlled with _Arnica_ and hot fermentations of _Calendula_.

See also _Kaposi's sarcoma_.

### _Haematoma_

This may be treated with _Arnica_ 30–200 three times daily. If the haematoma is extraoral, then Arnica Ø may be applied several times daily, but only to unbroken skin.

### _Haemophilia_

Classical haemophilia (haemophilia A) is associated with factor VIII deficiency. Christmas disease (haemophilia B) is associated with factor IX deficiency. They are clinically similar. The dental surgeon must not expect _Arnica_ and other remedies for dental _haemorrhage_ to substitute for replacement of the missing factors. However, the combination of replacement and homoeopathic therapy may be fruitful in many cases.

### _Haemorrhage, acute dental_

Excessive haemorrhage from extraction or surgery in general is usually preventable by giving _Arnica_ 30–200 three times daily for one day prior to the procedure, with an extra dose immediately before. After the procedure, the same remedy may be given as often as once every 15–30 minutes to control haemorrhage, and thereafter three times daily for about 7 days. _Hypericum_ 30 is often given along with Arnica, three times daily, to control pain and promote the repair of sensory nerves. Hot fomentations of _Calendula_ are also of service in the control of surgical haemorrhage. Haematoma formation following _local anaesthesia_ is also preventable and treatable with Arnica.

Occasionally, however, surgical haemorrhage is not controlled by satisfactory suturing and the homoeopathic measures discussed previously. Other remedies will be required. _Phosphorus_ 30–200 is undoubtedly the key remedy in many cases of bright red bleeding, but sometimes fails. With persistent bright red bleeding, a useful mixture is _China_ 6 + Phosphorus 12 + _Ferrum phosphoricum_ 30. Should this fail, consider _Ipecacuanha_ 30 + _Millefolium_ 30. These mixtures should be premixed in liquid potency, in order that they may be swiftly administered. In cases of persistent dark bleeding, _Lachesis_ 30 is better indicated. Any of the former remedies should be given every 10 minutes, until the haemorrhage is arrested. Thereafter, proceed with Arnica three times daily.

Repeated episodes of prolonged or excessive bleeding associated with _oral surgery_ suggest the presence of an haemorrhagic disease, which may be due to the lack of certain clotting factors, platelet deficiency, Warfarin therapy or defects of the capillaries. Special precautions and therapies will be required (such as the replacement of clotting factors), which are outside the scope of the average dental practice. Referral to specialist centres is warranted. Some cases may be merely associated with _vitamin C_ deficiency from an inadequate diet.

See also _Ehlers-Danlos syndrome; Haemophilia; Hereditary haemorrhagic telangiectasia; Leukaemia; Thrombocytopenia; von Willebrand's disease_.

### _Hairy leukoplakia – see_ AIDS; Leukoplakia

### _Hairy tongue – see_ Tongue, black hairy

### _Halitosis (Offensive or foul breath)_

This is often due to poor oral hygiene, the excessive use of tobacco, the consumption of pungent foods, or the presence of oral disease, such as chronic _periodontitis_. Appropriate rectification of these problems will eliminate halitosis. However, in some instances, halitosis is not of oral origin, but stems from a disease of the throat, sinuses or stomach, which, in turn, may be part of a general constitutional problem. In some cases, the excretion of noxious substances in the breath is the body's attempt to remove accumulated toxins; diabetic ketosis being an extreme example. Halitosis appears temporarily with detoxifying diets, such as grape cures, juice fasts and elimination diets for food allergy.

Apart from the treatment of periodontal disease itself, remedies may be usefully employed in the treatment of halitosis of non-dental origin. The principal remedies to be considered in this respect are _Arsenicum album, Aurum metallicum, Chamomilla, Graphites, Kali phosphoricum, Kreasotum, Lachesis, Mercurius solubilis, Natrum muriaticum, Nitricum acidum, Nux vomica, Phytolacca, Pulsatilla, Spigelia_ and _Sulphur_. A prescription based upon the susceptible typology will generally be better than one dominantly selected on the basis of the character of the halitosis (that is to say, the nature of the smell and its modalities, e.g. < after eating).

One particular case of mine is of special interest. This was a child with a fishy breath who failed to respond to normally well-indicated remedies. The root of the problem turned out to be a diptheria-pertussistetanus immunisation. The miasmic hangover was eliminated by a few intermittent doses of the nosode of the vaccine, whereupon the halitosis disappeared.

See also _Gonorrhoea_.

### _Hand, foot & mouth disease_

This _Coxsackievirus_ (A4, A5, A9, A10, A16) disease often occurs in epidemic form. Vesicular eruptions occur on the hands, feet, pharyngeal mucosa, buccal sulcus, tongue and soft palate. The cutaneous lesions resolve within 3 days, there is little systemic disturbance, and the whole disease clears spontaneously in 7–10 days. Local oral treatment with _Calendula_ or _Myrrh_ mouthwashes is the principal therapy.

See also _Ulcers_.

### _Headache – see_ Facial pain

### _Heck's disease – see_ Focal epithelial hyperplasia

### _Hekla lava_

Homoeopathic preparation of the finer volcanic ash from Mount Hekla, Iceland (formerly believed to be the gateway to Hell). A remedy with important actions on the bones of the jaws. Used in the treatment of _dry socket, exostoses_ , expansive _tumours and cysts_ of the jaws (including periapical cysts), _fibrous dysplasia_ (especially of the maxilla). _Paget's disease_ and _osteomyelitis_. The modality of the lesion '< touch and pressure', encourages its selection, but is not essential for all cases. Amongst other constituents, Hekla lava contains silica and lime. The **susceptible typology** for its full action is thus related to those of _Silicea_ and the _Calcareae_ (particularly _Calcarea fluorica_ and _Calcarea phosphorica)_. Compare _Lapis albus_.

See also _Endodontics_.

### _Hemicrania, paroxysmal facial – see_ Neuralgia, (periodic) migrainous

### _Hepar sulph. (Hepar sulphuris calcareum Hahnemannii)*_

Homoeopathic impure calcium sulphide (prepared by burning the white interior of oyster shells with pure flowers of sulphur in a crucible). The most important general remedy for dental _abscess_ and _pericoronitis_ , irrespective of susceptible typology (although swifter in action in those of the appropriate typology). Lower potencies, such as 6c, encourage suppuration. Higher potencies, such as 30c, stop or cause the reabsorption of pus (see _Endodontics_). Hepar sulph. 30–200 may be given in cases of _pulpitis_ , but lower potencies should never be given to treat this condition. **Susceptible typology:** flabby, chilly (< dry cold and cold draughts), indolent, irritable, easily angered, unhealthy skin, skin sensitive to touch, prone to catching infections, children have lymphadenopathy (very sensitive to touch).

### _Hereditary haemorrhagic telangiectasia (Rendu-Osler-Weber disease)_

This inherited disorder is characterised by the appearance of numerous haemangiomatous or telangiectatic lesions of the oral mucosa and skin. These bleed readily with trauma. Special care is thus required during all dental procedures. _Arnica_ should be used routinely, and hot _Calendula_ formentations should be at hand. _Calcarea fluorica_ 6–12 twice daily may reduce the risk of haemorrhage.

### _Herpangina_

This relatively mild disease, due to various _Coxsackieviruses_ (A2, A4-A6, A8) occurs mainly in children. Multiple small vesicles appear on the oral mucosa (particularly on the soft palate) and the oropharynx, which subsequently _ulcerate_. The distribution within the oral cavity is dominantly posterior (compare primary herpetic _gingivostomatitis)_. Fever may also occur. _Propolis, Myrrh_ or _Calendula_ mouthwashes or gargles may be helpful, together with _Mercurius solubilis_ 6–12 three times daily.

### _Herpes labialis (Cold sore)_

This is the more common orofacial manifestation of secondary herpes simplex infection, resulting from reactivation of the dormant virus. Such factors as fatigue, sun, infections, and menstruation may precipitate its onset. A good local application for cold-sores, which lessens the pain and duration, is prepared by mixing 10 drops of _Propolis_ Ø and 10 drops of _tea tree oil_ with 50g of aqueous cream. This should be applied 3–6 times daily, and is useful in many cases. Internally, _Natrum muriaticum_ 30 three times daily is probably the most successful remedy, especially in hot people. In chilly individuals (and especially in women), _Sepia_ 6–12 three times daily is better indicated. Should these measures fail, consider _Rhus toxicodendron_ 30 three times daily or Herpes simplex nosode 30 twice daily. Supplementary therapy with _vitamin C_ 600mg plus mixed _bioflavonoids_ 600mg three times daily may also promote healing.

For the treatment of the predisposition to cold sores, constitutional therapy is indicated according to the susceptible typology. The key remedies to be considered are Natrum muriaticum, Sepia and _Sulphur_. Long-term _zinc_ (15–30mg daily) and vitamin C (l-2g daily) supplementation may also be helpful. There may be an association in some cases between recurrent herpes labialis and _iron_ deficiency. Injections of _vitamin B12_ 1000mcg, initially every two weeks may be helpful in some cases.

The less common orofacial manifestation of secondary herpes simplex infection is the occurrence of ulceration of the oral mucosa. The sites most frequently involved are the attached gingivae, the hard palate and the buccal mucosa. In such cases, the local treatment is similar to that for primary herpetic _gingivostomatitis_ , and the systemic treatment follows the lines given above for herpes labialis. Intraoral or perioral secondary herpes simplex lesions can be associated with _AIDS_.

See also _Aphthous ulcers_ (for L-lysine therapy); Syphilis (with regard to chancre).

### _Herpes simplex infection – see_ AIDS; Erythema multiforme; Gingivostomatitis, primary herpetic; Herpes labialis. _See also under_ Aphthous ulcers _for L-lysine therapy_

### _Herpes zoster (Shingles)_

This condition, which is the reactivation of a dormant chickenpox (Varicella zoster) virus, may affect one side of the face, and is generally amenable to homoeopathic treatment. The key remedy is _Rhus toxicodendron_ 12–30 three times daily, which will often shorten the duration of the disorder. Ophthalmic herpes zoster, however, is usually better treated with _Prunus spinosa_ 12–30 three to four times daily. Varicella nosode 30 may also be given concurrently, once daily. A Rhus toxicodendron cream (Rhus toxicodendron Ø 20 drops in 50g of aqueous cream) may be applied to the skin (neither near the eye nor in the mouth), 3–6 times daily. Intramuscular or deep subcutaneous injections of _vitamin_ B12 500mcg daily appear to produce pain relief and rapid healing. Intravenous _vitamin_ C is also believed to be helpful.

_Kali phosphoricum_ is of great service in preventing and treating post-herpetic neuralgia. Treatment may be complemented with _Vitamin E_ 600IU daily by mouth and vitamin B12 by injection, 1000mcg daily for 6 days, followed by the same dose once weekly for 6 weeks.

See also _Neuralgia, post-herpetic; AIDS; Ramsay-Hunt syndrome_.

### _Histoplasmosis – see_ Fungal diseases

### _Hormone replacement therapy (HRT) – see_ Folate; Vitamin B6

### _Human papillomavirus – see_ Papillomavirus lesions, human

### _Hydrastis (Hydrastis canadensis)_

Botanic and homoeopathic. Goldenseal. The mother tincture, prepared from the roots, is useful in the treatment of oral _candidosis_ and is sometimes employed in the treatment of _aphthous ulcers_. A _mouthwash_ , which should not be swallowed, is prepared by adding 30 drops of Ø to 250ml of water. The potentised remedy is also utilised in the treatment of aphthous ulcers. Viscid saliva and an imprinted _tongue_ , especially in tired and thin individuals, indicates its suitability (compare _Kali bichromicum)_.

#####

##### _Fig. 22. Hydrastis_

### _Hydroxocobalamin – see_ Vitamin B12

### _Hypercementosis_

Abnormal thickening of the cementum may lead to difficulty in extraction. It is associated with pituitary _gigantism_ and _Paget's disease_. Other cases are related to hyperthyroidism and _gout_. Some merely occur as a result of familial inheritance in the absence of any major coexistent disorders.

### _Hypericum (Hypericum perforatum)_

Homoeopathic St. John's wort (see frontispiece). A remedy for injured _nerves_ or nerve endings, and trauma to the cerebrospinal system, irrespective of susceptible typology. It is often prescribed (30c three times daily) concurrently with _Arnica_ , the great remedy for _haemorrhage_ in dental surgery. It controls the pain of traumatised nerves. It promotes the regeneration of severed nerves, and has been described as 'the Arnica of the nervous system'. However, my own feeling is that it is primarily a remedy for sensory nerves, whereas _Causticum_ is better indicated in trauma to motor nerves. It is also a remedy for post-herpetic and trigeminal _neuralgia_ , where lancinating shooting pains occur, and there is aggravation by the least contact or movement. Its use has been suggested in cases of _craniomandibular dysfunction_ , especially if _trismus_ is present.

See also _Anaesthesia, local; Concussion; Oral surgery, pain control after; Pulpitis; Traumatised tooth_.

### _Hyperparathyroidism_

This may be due to an adenoma of the parathyroid glands (primary hyperparathyroidism) or may be secondary to renal disease (secondary hyperparathyroidism). Radiographically, there is complete or partial loss of the lamina dura and a ground-glass appearance of the alveolus. The serum calcium and alkaline phosphatase levels are raised. In the jaws and elsewhere, giant cell lesions (see _Epulis_) and _cysts_ may develop. Oral lesions generally resolve with satisfactory treatment of the underlying disorder.

### _Hyperpigmentation – see_ Pigmentation, oral & circumoral

### _Hyperpituitarism – see_ Acromegaly; Gigantism, pituitary

### _Hyperplastic gingivitis – see_ Gingivitis, phenytoin; Leukaemia

### _Hyperthyroidism_

It is claimed that _hypercementosis_ is commoner in those who suffer from this disorder.

### _Hypothyroidism_

In the adult form of the disease, there is a puffy face with a sleepy appearance, and sometimes loss of the outer eyebrows. In the juvenile form (cretinism), there is macroglossia, enlargement of the lips, underdevelopment of the mandible and maxillary hypoplasia. Replacement therapy is invariably indicated, although some mild adult cases respond well to homoeopathic treatment, enabling them to reduce or eliminate their conventional medication.

See also _Thyropenia_.

### I

### _Ignatia (Ignatia amara)*_

Homoeopathic St. Ignatius' bean (Strychnos ignatia). A remedy for the treatment of certain psychological or psychosomatic states. It is employed in the treatment of acute dental _anxiety, bruxism and bruxomania, burning mouth syndrome, xerostomia, craniomandibular dysfunction, gingivitis_ of puberty, migraine, migrainous _neuralgia_ and _tension headache_. It may be prescribed in 6–200c two or three times daily according to sensitivity and response. It is only indicated by the appropriate **susceptible typology:** excessively sensitive to pain and stress of any kind, sighs frequently, changeable moods, cries easily but soon changes to laughter (and vice versa), forgets problems easily when distracted, spectacular hysterical behaviour, hypersensitive to smells (especially tobacco), sometimes a sensation of a lump in the throat (globus hystericus). The Ignatia patient is made worse generally by even small amounts of coffee. This Ignatia syndrome, as it might be termed, may be a basic constitutional state stemming from a severe emotional upset in the past (such as the loss of a loved one), or a transient state associated with temporary psychological trauma (such as a visit to the dentist).

### _Impetigo_

A highly contagious bacterial infection of childhood, usually involving the facial skin. It is characterised by honey-coloured crusts overlying red areas of denuded skin. Infection may readily pass to the dental surgeon, his assistant, or, via instruments or linen, to other patients. Treatment involves the use of _Propolis_ or _tea tree oil_ cream (20 drops of Ø or oil in 50g aqueous cream) 3–6 times daily, and the initial use internally of _Antimonium crudum_ 6–12 three times daily. Should this fail, consider _Mezereum_ 6–30 three times daily.

### _Implants, dental_

For some months after the insertion of an implant, the remedy _Silicea_ should not be given, in that it may induce extrusion. Once an implant is successful and is not subject to rejection, this remedy may be given freely where it is indicated. _Arnica_ should be administered both before and after the procedure. _Symphytum_ 6 three times daily should be given in order to encourage bone formation around the implant.

### _Incisional abscess_

This should be treated externally with hot _Calendula_ formentations. Internally, _Gunpowder_ 6 three times daily should be given initially. Once discharge of pus has occurred, switch to _Silicea_ 6–12 three times daily.

### _Infection, prevention of, in oral surgery – see_ Pyrogen; Subacute endocarditis, prevention of

### _Infectious mononucleosis – see_ Glandular fever

### _Infective endocarditis – see_ Subacute bacterial endocarditis, prevention of

### _Inferior dental nerve injury – see_ Nerve injury

### _Influenza, prevention of – see_ Colds & influenza, prevention of

### _Iodum*_

Homoeopathic iodine. An important constitutional remedy. **Susceptible typology:** anxious, depressed, introverted, ravenous appetite but remains thin, < heat, always seeking cool surroundings, prone to throbbing sensations, diarrhoea from milk, prone to hyperthyroidism, _tongue_ indented.

### _Ipecacuanha_

Homoeopathic preparation of the roots of Uragoga ipecacuanha (Brazil). A remedy for nausea following _general anaesthesia_ , and dental _haemorrhage_. In dental haemorrhage, it is indicated by bright red bleeding, especially if accompanied by severe nausea and excessive salivation.

### _Iris versicolor_

Homoeopathic blue flag iris. A remedy for migraine or migrainous _neuralgia_ , irrespective of laterality, preceded by clouding of vision or fortification spectra. The characteristic pain is one of intense burning. Iris versicolour is also sometimes employed in the treatment of _burning mouth syndrome_ in migrainous patients.

#####

##### _Fig. 23. Iris versicolor_

### _Iron_

Iron deficiency is most often caused by excessive loss or defective utilisation. The oral signs of iron deficiency anaemia are: atrophic _glossitis_ (a smooth and sometimes pale tongue), general thinning of the oral mucosa, predisposition to _aphthous ulcers_ and _angular cheilitis_. Kelly-Paterson (Plummer-Vinson) syndrome is the triad of iron deficiency anaemia, dysphagia and post-cricoid oesophageal stricture. It is associated with a higher risk of developing oral and postcricoid _carcinoma_. In all cases of iron deficiency, the cause should be established, and treated appropriately (heavy periods, etc.). Supplementary therapy is best given as a single dose of chelated iron 28mg daily, together with _vitamin C_ 100mg administered at the same time (note that adult iron supplements can be very dangerous for small children). One important point concerning iron deficiency is that the body's iron stores may be severely depleted before overt changes occur in the red blood cells (microcytosis and reduced haemoglobin). Where the conjunctivae of the lower eyelids are pale, but the blood film is normal, it is important to proceed to a further blood test to assess the ferritin level. Oral manifestations may precede the onset of frank iron deficiency anaemia. There may be an association between iron deficiency and recurrent _herpes labialis_ or _burning mouth syndrome_. Iron supplementation is contraindicated in cases of _thalassaemia minor_.

See also _Haemorrhage, acute dental; Tropical sprue_.

### J

### _Jaborandi_

Homoeopathic preparation of Pilocarpus jaborandi (Brazil), the principal alkaloid of which is pilocarpine. A remedy for _mumps_ and _sialorrhoea_. A leading indication is the association of excessive salivation and excessive sweating.

#####

##### _Fig. 24. Jaborandi_

### _Jaw claudication_

An inaccurate term used to describe the phenomenon of pain on eating associated with _giant cell arteritis_. The pain is not brought on by ischaemia, unlike intermittent claudication of the legs in cases of artherosclerosis.

### **K**

### _Kali bichromicum (Kalium bichromicum)_

Homoeopathic potassium bichromate. Used in the treatment of _aphthous ulcers_. It is particularly indicated where they have a yellow or yellow-green base, the _tongue_ is imprinted, the mouth dry, the saliva viscid and the patient plump and catarrhal (compare _Hydrastis)_. Other tongue signs indicative of the remedy are: red, shining, smooth, dry and _geographic tongue_. It is also indicated in _black hairy tongue, median rhomboid glossitis_ and in the treatment of suborbital migrainous _neuralgia_ , where the pain is distinctly localised, preceded by visual disturbance and > pressure. Kali bichromicum is most active in chilly and plump individuals. It is an important remedy in the treatment of sinusitis and _xerostomia_.

### _Kali carbonicum (Kalium carbonicum)_ *

Homoeopathic potassium carbonate. A remedy sometimes indicated in the treatment of chronic _gingivitis_ and _periodontitis_. An important constitutional remedy. **Susceptible typology:** anxious, easily discouraged, sensitive to the least noise and pain, anxiety felt in the pit of the stomach, weary, anaemic, flabby, obese, sweaty, oedema of face or upper eyelids, < cold.

### _Kali chloricum (Kalium chloricum)_

Homoeopathic potassium chlorate. A remedy for _cancrum oris_ and _ANUG_.

### _Kali muriaticum (Kalium muriaticum)_

Homoeopathic potassium chloride. A secondary remedy for oral _candidosis_ , where _Borax_ fails. It is especially indicated in patients who are < fatty or rich foods (including _Pulsatilla_ types).

### _Kali phosphoricum (Kalium phosphoricum)_

Homoeopathic potassium phosphate. Perhaps the best remedy for the prevention and treatment of post-herpetic _neuralgia_. Also useful in the treatment of _tension headaches_ of students and _halitosis_. **Susceptible typology:** tired, weak, hypersensitive, mentally exhausted (from mental work, sexual excesses, recurrent illnesses).

### _Kalmia latifolia_

Homoeopathic mountain laurel. A remedy for severe facial _neuralgia_ , involving the right eye and < movement. It is especially indicated in rheumatic subjects.

### _Kaposi's sarcoma_

This is a malignant endothelial neoplasm, which appears as a bluish or purple patch on the palate. It is almost exclusively seen as a complication of _AIDS_.

See also _Tumours& cysts_.

### _Kelly-Paterson syndrome – see_ Iron

### _Keloid – see_ Scar tissue, excessive

### _Keratosis, frictional_

White keratotic patches may arise from _prosthetic_ or dental irritation. These should disappear once the source of irritation (e.g. a sharp tooth) has been corrected. Those that persist for more than three weeks after the apparent cause has been removed should be biopsied.

See also _Leukoplakia_.

### _Keratosis, smoker's_

Smoker's keratosis usually appears as a diffuse whitening of any area of the oral mucosa that has repeatedly come in contact with smoke. In the palate, the mucous glands become enlarged and their orifices show as red dots. The condition will resolve with abstinence, perhaps assisted by _Calendula_ mouthwashes. There is a higher incidence of oral _carcinoma_ in smokers, the risk of which is possibly diminished by the regular administration of _vitamin E_ 600IU daily.

### _Koplik's spots – see_ Measles

### _Krameria (Ratanhia)_

Botanic. The root of Krameria triandra (Peruvian krameria), found in Bolivia and Peru, has useful properties in the topical treatment of _gingivitis_ and _periodontitis_. It is incorporated into some botanic _toothpastes_.

### _Kreasotum_

Homoeopathic creosote. A remedy for _halitosis_. It is useful for early and significant _caries_ of the deciduous teeth, where it may reduce the predisposition. It is especially indicated in thin and weedy children. Its use may also be considered in adults with a predisposition to gross caries, where the gums are spongy and bleeding ( _gingivitis)_. They must hurry when a desire comes to urinate, the urine being offensive.

### **L**

### _L-lysine therapy – see_ Aphthous ulcers

### _Lachesis*_

Homoeopathic bushmaster (snake) venom. A remedy for dark dental _haemorrhage, burning mouth syndrome, ranula, halitosis_ of non-dental origin and _xerostomia_. An important constitutional remedy, particularly of the menopause and in alcoholics. **Susceptible typology:** excessively loquacious, jealous, vindictive, proud, suspicious, disturbing dreams, prone to depression and sulking, hot with hot flushes, plethoric face, blotchy skin, intolerance of tight clothing, dislikes being touched or constricted, dry tongue, complaints mainly left-sided or move from left to right.

### _Lapis albus_

Homoeopathic calcium silicofluoride. A remedy for enlargement of the cervical or _salivary glands, pleomorphic salivary adenoma_ and _salivary calculus_. Firmness of the gland, together with a certain elasticity or pliability suggests the use of this remedy. Consistent with its chemical composition, it is especially indicated in persons of _Silicea_ or _Calcarea fluorica_ **typology**.

### _Laryngitis in dental surgeons_

Either _Argentum metallicum_ or _Arum triphyllum_ is strongly indicated in the communicative, according to symptoms. Either may be given in a potency of 30c three times daily.

### _Latrodectus (Latrodectus mactans)_

Homoeopathic preparation of the black widow spider. A useful emergency remedy for _angina pectoris_.

### _Ledum (Ledum palustre)_

Homoeopathic marsh tea. A remedy for injuries from sharp instruments (puncture wounds), especially in those which have not bled significantly (otherwise, _Arnica_ is more applicable). The site of puncture feels either cold to the patient or to the practitioner. Useful in the treatment of jaw stiffness following _local anaesthesia_.

#####

##### _Fig. 25. Ledum_

### _Leshmaniasis, New World mucocutaneous (Espundia)_

This disease is caused by certain species of the protozoan parasite Leishmania, contracted via the bite of a sand-fly. It is found in certain areas of South and Central America, but can develop also in those who return home after a trip. There may be considerable destruction of the facial structures, resembling an advanced malignant _tumour_ of the orofacial region, from which it must be differentiated. Homoeopathy may be helpful in treatment, including the use of a specific nosode.

### _Leukaemia_

This disorder of leukocytes may occur in either acute or chronic forms, both of which have oral manifestations. Chronic leukaemia may be associated with oral _candidosis, ulceration, herpes simplex infection_ and petechiae. Oral signs in acute leukaemia are severe and rapidly progressive. They are essentially the same as those for the chronic type, but more florid, with considerable gingival hypertrophy and gingival _haemorrhage_. Urgent referral is warranted. The dental surgeon may be the first to diagnose the disease.

### _Leukoplakia_

This is defined as a white patch of the oral mucosa, which cannot be wiped away, and is not definable pathologically or clinically as any other orthodox disease entity. Erythroplakia is an associated erythematous patch, defined similarly. From the practical point of view, although many such lesions may be histologically benign, all should be regarded as having malignant potential, and frequent observation is thus required. Although the definition of leukoplakia successfully excludes _lichen planus_ and most forms of oral _candidosis_ , it is essential to place upon it a rider which includes candidal leukoplakia, which is a potentially malignant condition. Hairy leukoplakia is especially seen as a complication of _AIDS_.

Concerning natural therapy, apart from the correction of alcohol or tobacco habits, the paper by S.E. Benner et al (J. Nat. Cancer Inst., 85 (1), 44–47, 1993) is worthy of mention. It was shown that the administration of 400IU of _vitamin E_ twice daily for 24 weeks caused regression of the condition in 46% of patients, with 31% of patients showing histological responses.

See also _Keratosis, frictional; Papillomavirus lesions, human; Syphilis_.

### _Lichen planus_

This is a mucocutaneous disorder which affects up to 2% of the population of the UK, and is more prevalent in women.

Characteristically, violaceous flat-topped papules appear on the flexor surfaces of the wrists. The intraoral appearance is variable, and the disease may affect any site. It is essentially a benign condition, and when it appears as white patches, it must be differentiated from _leukoplakia_. Various types are described, but several different ones may coexist in the same patient: reticular, plaque-like, papular, atrophic, erosive and bullous, the latter being extremely rare. Often the condition is asymptomatic, but some complain of extreme soreness, especially with eating.

Where there is soreness, the use of _Myrrh_ mouthwashes is helpful. Perhaps the key remedy in treatment is _Arsenicum album_ 6–12 twice daily, especially in fastidious or fussy individuals. Failing that, _Natrum phosphoricum_ 6–30 twice daily may be given. In erosive or atrophic forms, _Sulphur_ 6–12 twice daily should be strongly considered. Otherwise, selection of a remedy based strongly upon the mental and general aspects of the patient may be helpful.

See also _Lichenoid reactions_.

### _Lichenoid reactions_

These may be clinically indistinguishable from _lichen plants_ , but asymmetry and palatal involvement are more typical of lichenoid reaction. The cause is generally a systemic drug, but _amalgam_ reaction may also be responsible. The best treatment is for the physician to stop the particular drug or switch to another therapy, or for the dental surgeon to remove any offending amalgam restorations and replace them with other materials, whichever is appropriate. Drug-related cases will usually resolve within 3 months and those related to amalgam in a few weeks. Any oral soreness is best treated with _Myrrh_ mouthwashes.

See also _AIDS; Anti-inflammatory drugs; Diabetes mellitus; Rheumatoid arthritis_.

### _Linear IgA disease_

This uncommon disease, which produces non-specific oral _ulceration_ , is probably a variant of _dermatitis herpetiformis_ , and may be treated similarly. Skin lesions occur mainly on the buttocks, elbows and scalp.

### _Lingua villosa – see_ Tongue, black hairy

### _Lingual nerve injury – see_ Nerve injury

### _Lip, cracked – see_ Angular cheilitis; Lip, median fissure of lower

### _Lip, median fissure of lower_

This is often infected with staphylococci, and is often persistent without treatment. A _Propolis_ cream or ointment (Ø 20 drops in 50g of base) should be applied 3–6 times daily. _Natrum muriaticum_ 6–12 three times daily is probably the key internal remedy, especially in hot individuals. _Sepia_ 6–12 twice daily is better indicated in chilly types. Either _Pulsatilla_ or _Chamomilla_ may be used similarly, and should be prescribed according to susceptible typological indications.

### _Lueticum (Syphilinum)_

A nosode of syphilis. A remedy occasionally used in the treatment of _exostoses_ , and usually given infrequently. It may be helpful in the treatment of _Paget's disease_. An indented _tongue_ is a partial indication for this remedy.

### _Lupus erythematosus_

Two types of this disorder are described; discoid (DLE) and systemic (SLE). The oral signs of the two types are indistinguishable. The buccal and labial mucosae are usually involved bilaterally. There may be atrophic areas with peripheral erythema and white striae. The lesions must be distinguished from _lichen planus_. A butterfly erythematous rash of the face occurs in SLE. _Xerostomia_ as part of _Sjögren's syndrome_ occurs in about 30% of patients with SLE. _Myrrh_ mouthwashes are helpful in controlling oral soreness. Homoeopathic treatment of the underlying disorder is complex.

### _Lycopodium (Lycopodium clavatum)*_

Homoeopathic club moss spores. Useful in some cases of migraine, orofacial _neuralgia, tension headaches_ and _xerostomia_ , according to the typology. An important constitutional remedy. **Susceptible typology:** intelligent, difficult character, ill-tempered, thin, withered, yellowish and lined face, eyes lively, prematurely grey, looks older than he/she should, underlying profound anxiety and lack of confidence, one foot hot and the other cold, complaints dominantly right-sided or move from right to left, dyspeptic, desire for sweet things, < between 4pm and 8pm, < heat, > fresh air, prone to kidney stones.

### _Lyme disease_

This disease, named after the town of Old Lyme in Connecticut (USA), is caused by the spiochaete Borrelia burgdorferi. It is transmitted by ticks (largely found in forests and woods), and is now widely distributed throughout Europe and the USA. It is also found in Australia. The first stage of the disease involves the development of a characteristic ring-like expansive rash around the site of the tick bite, termed erythema chronicum migrans, and the generation of an influenza-like illness. The second stage, which may occur from weeks to months after the first stage, may be associated with something resembling _Bell's palsy_ , other neurological signs, cardiac abnormalities and skin rashes. The third stage of the disease, occurring months to years later, is characterised by a chronic arthritis. Both orthodox and homoeopathic therapies are available. _Causticum_ may be helpful in _facial nerve palsy_ of the second stage.

#####

##### _Fig. 26. Lycopodium_

### _Lymphangioma_

This is a benign lesion, usually found upon the tongue of a child. It is probably developmental in origin. _Thuja_ 6 twice daily may be tried.

### _Lymphogranuloma venereum_

This venereal chlamydial disease is fairly widespread, and is characterised by an evanescent primary genital lesion (often unnoticed), inguinal buboes with sinus formation, and proctitis and rectal stricture in women and homosexual males. The primary lesion, a small herpetiform _ulcer_ , may occasionally be seen on the tongue, with bubonic involvement of the submandibular lymph nodes.

### M

### _Magnesia phosphorica_

Homoeopathic magnesium phosphate. A remedy for trigeminal _neuralgia_ , where the pain comes in severe and abrupt spasms, sometimes making the patient squeal or scream; predominantly right-sided, > heat and < cold. A remedy for the relief of muscular spasm > heat in cases of _craniomandibular dysfunction_. 'Mag. phos.', as it is termed, is best indicated in persons of _Phosphorus_ **typology**. It may also be used to facilitate cranial _osteopathy_.

### _Magnesium_

It has been suggested that magnesium supplementation may increase alveolar bone density. This is of some relevance in the treatment of chronic _periodontitis_ , and the maintenance of the alveolar ridge in _prosthetics_. Magnesium amino acid chelate, a readily absorbable form of magnesium, provides 10–18mg of this element in 100mg of chelate. Daily supplementation is up to 1.67g of chelate.

See also _Calcium; Evening primrose oil_.

### _Mapped tongue – see_ Geographic tongue

### _Marble bone disease – see_ Osteopetrosis

### _Marfan's syndrome_

This hereditary disease is characterised by bilateral subluxation of both lenses of the eye, congenital heart disease, weak musculature and long thin hands and feet. It is associated with recurrent _dislocation_ of the TMJ.

### _Measles (Rubeola)_

The first sign of measles may be witnessed by the dental surgeon. About 2 days before the main rash occurs, Koplik's spots appear in the mouth of a vaguely unwell patient. These last 1–4 days. They resemble table salt crystals (on a red base), are found on the buccal mucosa, and are absolutely diagnostic of measles, and no other disease. At this stage, _Pulsatilla_ is the remedy which should be strongly considered.

### _Median rhomboid glossitis_

This characteristically presents in the midline towards the back of the tongue. It is usually a reddened area, but is sometimes proliferative, and even superficial _ulceration_ can occur. Once thought to be a developmental abnormality, it is now known that many cases are examples of oral _candidosis_. Initially it may be treated with the local and internal methods suggested in the entry relating to the latter. However, should these fail, the following remedies may be considered according to susceptible typology, and given in 6–12c twice daily: _Argentum nitricum, Arsenicum album, Causticum, Chamomilla, Kali bichromicum, Phosphorus_ or _Rhus toxicodendron_.

See also _AIDS_.

### _Melanoma, malignant – see_ Pigmentation, oral & circumoral; Tumours & cysts

### _Melkersson-Rosenthal syndrome_

The term given to the triad of facial swelling, deeply fissured _tongue_ and recurrent _facial nerve palsy_. It has been regarded as a variant of _orofacial granulomatosis_. Treatment should be along the lines appropriate to the latter, in combination with those suggested for _Bell's palsy_.

### _Meniscus, disorders of TMJ – see_ TMJ, disorders of

### _Mercurius corrosivus_

Homoeopathic corrosive sublimate. A remedy for _cancrum oris_ , chronic _gingivitis_ and _periodontitis, pemphigus_ and _pemphigoid_.

### _Mercurius solubilis (Mercurius solubilis Hahnemannii_ ) *

Homoeopathic dimercurous ammonium nitrate, a compound devised by Hahnemann. The properties are virtually identical to those of Mercurius vivus, metallic mercury. A remedy for dental _abscess, pericoronitis_ , infant _teething, pulpitis_ , chronic _gingivitis, periodontitis, mumps_ (and other forms of acute viral parotitis), _ranula_ , perversion of _taste, halitosis, ANUG_ , and _sialorrhoea_. Its local indications are the combination of severe halitosis and excessive salivation, especially if the _tongue_ bears the imprint of the teeth. **Susceptible typology:** flabby, sweaty, smelly, pungent bodily odour, splutters when speaking, < cold, < extreme cold or heat. The psychological type is variable. It may be the person who is slow in comprehension; one who is morose, timid and anxious; or the delinquent, recidivist, roguish wheeler and dealer, sexual pervert or obsessive voyeur.

See also _Appendix 2_.

### _Mercury toxicity – see_ Appendix 2

### _Methotrexate therapy – see_ Folate

### _Mezereum (Daphne mezereum)_

Homoeopathic daphne mezereum. A remedy for _impetigo_ , where a thick yellow pus exudes from under a thick crust. Also indicated in some cases of _pulpitis_ and _ranula_.

#####

##### _Fig. 27. Mezereum_

### _Migraine – see_ Neuralgia, (periodic) migrainous

### _Migrainous neuralgia, periodic – see_ Neuralgia, (periodic) migrainous

### _Millefolium_

Homoeopathic yarrow. It is indicated in dental _haemorrhage_ where the blood is bright red, especially if there is an absence of pain and anxiety.

### _Morphology, dental – see_ Calcarea carbonica; Calcarea fluorica; Calcarea phosphorica

### _Mottling – see_ Fluoridation; Fluorosis

### _Mouth, burning – see_ Burning mouth syndrome

### _Mouth-breathing_

This is frequently due to nasal catarrh with enlarged adenoids in children. In some cases, food allergy is a contributory factor, the most common allergen in this respect being cow's milk; the elimination of this and its products producing considerable improvement within several months. Otherwise, homoeopathic remedies may be selected on the basis of the susceptible typology, the most important of which are: _Agraphis nutans, Calcarea phosphorica, Calcarea carbonica, Pulsatilla_ and _Sulphur_. The selected remedy may be given initially in 6–12c twice daily. Infrequent doses of _Bacillinum_ or other major nosodes may be occasionally required.

### _Mouthwashes_

The most important are those of _Calendula, Myrrh_ and _Propolis. Hydrastis_ mouthwash is worthy of consideration, as is that of kitchen (garden) sage, Salvia officinalis (see _Aphthous ulcers_).

See also _Aloe vera; Berberis vulgaris; Folate; Zinc_.

### _Mucocele_

This lesion of the minor salivary glands may be caused by trauma or duct obstruction, and is most commonly seen on the inner aspect of the lower lip. Mucoceles usually have the pattern of alternating rupture and reappearance. Some respond well to _Silicea_ 6–12 twice daily.

### _Mucormycosis – see_ Fungal diseases

### _Multiple sclerosis_

Some cases manifest _trigeminal neuralgia_. The occurrence of the latter in a person under 40 years of age is suggestive of multiple sclerosis or _AIDS_.

### _Mumps_

One type of viral swelling of the _salivary glands_. It may affect both the parotid and the submandibular glands. Sometimes the latter alone are involved. The key remedies are _Jaborandi_ and _Pulsatilla_.

See also _Salivary glands, viral infections of_.

### _Myristica_

Homoeopathic preparation of the poisonous gum obtained by incising the bark of Myristica sebifera (known as Ucuuba in Brazil, and related to the nutmeg tree). A remedy for acute dental _abscess_ with obvious swelling of the soft tissues. It may be also useful in the treatment of _cellulitis_.

### _Myrrh_

Botanic. An oleo-gum-resin obtained from the stems of various species of Commiphora. The mother tincture is usually diluted to produce a _mouthwash_ : Ø 5ml plus water 45ml. This is useful for reducing soreness and inflammation in the mouth, and may be used in a variety of conditions, such as _aphthous ulcers_ , atrophic or erosive _lichen planus_ , other _ulcerative_ conditions, _gingivitis_ or _periodontitis_.

### **N**

### _Naevus, white sponge – see_ Sponge naevus, white

### _Natrum carbonicum_

Homoeopathic sodium carbonate. A remedy for _tension headache_ brought on by hot weather, especially in those who are weak, hypersensitive to sudden noises, prone to recurrent sprains and feel chilly in the winter.

### _Natrum muriaticum*_

Homoeopathic rock salt (crude sodium chloride). Useful in some cases of _halitosis, burning mouth syndrome, herpes labialis, aphthous ulcers_ , puberty or pregnancy _gingivitis, epulis, ranula, geographic tongue_ , median fissure of the _lip_ , atypical _facial pain_ , migraine or migrainous _neuralgia, tension headache_ , perversion of _taste_ (salty), black hairy _tongue, Sjörgren's syndrome_ and _xerostomia_. A major constitutional remedy. **Susceptible typology:** depressive, weak, pale, thin, dislikes and rejects consolation, difficult concentration, greasy face, dryness of mucous membranes, strong desire for salt, thirsty, chilly but dislikes hot weather or hot rooms, prone to headaches, < at the seaside.

### _Natrum phosphoricum_

Homoeopathic sodium phosphate. A remedy for _lichen planus_ , especially in cases that exhibit a yellow creamy coating towards the back of the _tongue_.

#####

##### _Fig. 28. Myrrh & Frankincense_

### _Necrotising sialometaplasia_

This unusual condition classically occurs on the palate, and may follow trauma, such as that from local _anaesthesia_. Preceding its onset there may be an episode of greater palatine nerve anaesthesia or paraesthesia. It may resemble squamous cell _carcinoma_ both clinically and histologically. However, unlike the more serious lesion, it will resolve within 14 days, recurrence being rare. Only _Myrrh_ or _Calendula_ mouthwashes are required for treatment.

### _Needle, broken hypodermic – see_ Foreign body

### _Nerve injury_

For injury to sensory nerves (e.g. the lingual nerve), _Hypericum_ 6–30 three times daily promotes regeneration and restoration of sensation. For injury to motor nerves (e.g. the facial nerve), _Causticum_ 6–30 three times daily is preferable, although Hypericum may be tried. Neither remedy is capable of any effect if there is considerable misalignment of the severed section of nerve.

### _Neuralgia, glossopharyngeal_

This is a very similar disorder to trigeminal neuralgia. However, the pain is often brought on by swallowing, and may be felt in the ear, throat or larynx. _Acupuncture_ combined with the administration of _Scutellaria_ Ø may be helpful. The selection of homoeopathic remedies is best based upon the constitutional aspects of the case, rather than those of the presenting complaint. _Thuja_ is worthy of consideration in some cases.

See also _Neuralgia, trigeminal_.

### _Neuralgia, (periodic) migrainous (Cluster headache/Facial migraine)_

Under this heading, it is practical to consider three related entities: migraine, periodic migrainous neuralgia and paroxysmal hemicrania. Although it is now claimed that migraine should be considered as a separate entity from migrainous neuralgia, partially upon the basis that the appropriate orthodox therapies are different, it is a fact that, as many migraine sufferers (particularly women) approach middle-age, the pain shifts downwards to the face. I do not mean to imply, however, that migrainous neuralgia is purely a condition of females over 30, for it may also be experienced by those of younger years and either sex, even without a history of migraine as such; although many will report that they have suffered from recurrent headaches in the past. There is also, in many instances, some diagnostic confusion between migrainous neuralgia and _craniomandibular dysfunction_ (TMJ dysfunction syndrome), with the patient presenting with symptoms of both. This turns out, however, to be more of a problem for the orthodox practitioner than he or she who is more homoeopathically inclined; for, homoeopathy and allied natural therapies are more readily applied to patients who cannot be categorised conventionally.

Migraine is classically defined as a unilateral headache accompanied by visual disturbance and nausea. It often lasts for many hours. Sometimes the visual disturbance (often fortification spectra) is manifest alone. Attacks may be precipitated by such foods as cheese, red wine and chocolate, and many are related to stress. The dental surgeon may become intimately involved in such cases, since the provision of upper or lower acrylic splints (bite-plates) has been found helpful in many cases. These should only be worn at night. However, manipulation of the thoracic and cervical spine, as mentioned in the section on craniomandibular dysfunction, is also most useful in many instances. _Acupuncture_ is also an excellent technique not to be forgotten. Where the migraines occur on almost a daily basis, 'occult' _food allergy_ is to be suspected. This diagnosis is unlikely in the infrequent case. The commonest allergens in this respect are cow's milk and wheat, the supervised exclusion of which is relatively simple. Related to the matter of food allergy, is sugar sensitivity. These patients suffer from what is termed 'clinical hypoglycaemia', and improve considerably when sweets, sugar, chocolates, cakes and biscuits are removed from the diet and they can be persuaded to take extra snacks between main meals. Where stress is involved, the _Bach flower remedies_ are useful. Homoeopathic constitutional remedies may also be usefully given, based upon the generals and mentals of the case. In women, migraine may be associated with hormonal disturbances, and remedies such as _Natrum muriaticum, Pulsatilla_ and _Sepia_ stand high on the list of remedies to be considered. _Evening primrose oil_ may also improve such cases. The botanic medicine _Feverfew_ , taken in the form of capsules or tablets, has acquired a strong reputation for the prevention and treatment of migraine in general. Some patients, however, develop oral _ulceration_ as a result, and the medicine must be discontinued.

Periodic migrainous neuralgia is characterised by a severe unilateral pain around the eye, in the temple or in the cheek, lasting from 30 to 120 minutes. During the attack, the affected side becomes flushed, and there may be conjunctival injection, lacrimation and rhinorrhoea. A particular characteristic, in some cases, is the precipitation of an attack by even tiny amounts of alcohol of any sort. This is one of the few non-dental pains which will cause patients to awake prematurely. In general, it is episodic, and there may be days or weeks between attacks. However, there are some cases in which the pain, which is often described as 'burning', occurs with greater frequency, sometimes on an almost daily basis. Paroxysmal facial hemicrania is essentially similar to migrainous neuralgia, but lacks the facial flushing, lacrimation, rhinorrhoea and the provocation of waking. Moreover, the attacks are often shorter, lasting up to 20 minutes. Some of these cases are far from paroxysmal, and the pain, which is often throbbing and jabbing, may be virtually continuous. It is then a matter of argument whether they should be classified as craniomandibular dysfunction or facial hemicrania. The pain of this variant of facial hemicrania is more severe that that of atypical _facial pain_.

Apart from the total exclusion of alcohol in some cases, the treatment of both migrainous neuralgia and paroxysmal facial hemicrania has many features in common with that for craniomandibular dysfunction or migraine. Manipulation of the thoracic and cervical spine is often helpful, particularly in the C7/T1 area, along with acupuncture, especially to Stomach 6. With frequent or almost continuous attacks, food allergy or sugar sensitivity may be suspected. The application of Bach flower or homoeopathic constitutional remedies and evening primrose oil is similar. Additionally, remedies may be prescribed pathologically, their selection being largely determined by the individualised symptoms of the presenting complaint, including its laterality. This is a useful method for the practitioner who is not expert in constitutional prescribing, which is the alternative approach. The remedies to be looked at particularly in this respect are: _Apis mellifica, Aranea diadema, Carbolicum acidum, Iris versicolor, Kali bichromicum, Kalmia latifolia, Paris quadrifolia, Sanguinaria canadensis_ and _Spigelia_. The selected remedy may be prescribed preventatively in 6–30c twice daily, or may be used to abort an attack, giving it in 30–200c every 15–30 minutes.

### _Neuralgia, post-herpetic_

Persistent neuralgia following an attack of herpes zoster (shingles) is usually preventable and treatable by means of remedies. The key remedy is _Kali phosphoricum_ 6–30 two or three times daily. Should this fail (which is unlikely), consider _Hypericum_ 30 three times daily. Resistant cases may require infrequent doses of Varicella nosode 30–200. Oral _vitamin E_ supplementation and injections of _vitamin B12_ are also sometimes used in therapy.

See also _Herpes zoster_.

### _Neuralgia, trigeminal (Prosopalgia/Tic douloureux)_

This unilateral pain may involve any division of the trigeminal nerve. Its fundamental characteristic is its utmost severity, the pain often being described as 'lancinating', 'shooting' or 'knife-like'. It usually occurs in attacks and bouts. Bouts of pain, consisting of numerous attacks, may last for weeks or months, between which the patient is asymptomatic. These then recur. An attack during a bout of trigeminal neuralgia may be brought on by cold draughts, eating, talking or touching certain trigger points. This disorder seldom occurs in patients younger than 40 years of age, and its occurrence in those younger is suggestive of an underlying disorder, such as _multiple sclerosis_ or _AIDS_. Neoplasms of the nasopharynx or maxillary antrum, acoustic neuromata and aneurysms may be rarely associated with trigeminal neuralgia. The term 'pre-trigeminal neuralgia' refers to symptoms which occur before the onset of the overt disorder. There may be a recurrent mild or moderate pain, which is confused with such entities as _pulpitis_ and _cervical sensitivity_ ; or there may be a 'crawling' sensation on the skin of the face.

Fortunately, results with acupuncture can be most satisfying, including the use of multiple facial needles on the _opposite_ side to that of the pain. In conjunction, I feel that _Scutellaria_ Ø, 5–10 drops in water three times daily, is helpful. Homoeopathic remedies are best prescribed on a constitutional basis, with the main emphasis being placed upon the generals and mentals, rather than any great emphasis being alloted to the presenting symptoms. Laterality, however, may be useful in the repertorisation of the case, and in this regard it is interesting to note that more cases are right-sided rather than left. Alternatively, remedies may be prescribed largely on the basis of the individualised symptoms, and this approach may be useful in cases where the constitutional simillimum is difficult to define. In this respect, the following remedies warrant special consideration: _Aranea diadema, Carbolicum acidum, Cinnabaris, Hypericum, Kalmia latifolia, Magnesia phosphorica, Paris quadrifolia, Prunus spinosa, Rhododendron chrysanthum, Spigelia_ and _Verbascum_. The selected remedy may be prescribed in 6–30c two or three times daily. The use of _Thuja_ in obstinate cases is sometimes worthy of consideration.

### _Niacin – see_ Pellagra

### _Nicotinamide – see_ Pellagra

### _Nitricum acidum (Acidum nitricum)_

Homoeopathic nitric acid. A remedy for diarrhoea following _antibiotics, ANUG, ecthyma contagiosum, ranula, halitosis_ and _aphthous ulcers_. Pricking pains are a characteristic indication for its use in the latter. **Susceptible** **typology:** essentially similar to that of _Sepia_ , but with a desire for fatty food. The presence of a fissured tongue is a leader to this remedy.

### _Noma – see_ Cancrum oris

### _Nosebleed – see_ Epistaxis, acute

### _Nux vomica*_

Homoeopathic poison nut, which contains strychnine. Useful in some cases of migraine, migrainous _neuralgia, xerostomia, halitosis, tension headache_ , and perversion of _taste_ , depending on typological indications. A major constitutional remedy, which, as with others, may be useful in the treatment of chronic _periodontitis_ , provided that the generals and mentals match the case. **Susceptible typology:** the overworked business man or professional, the person with a sedentary occupation, depressive, irritable, chilly, dyspeptic, prone to peptic ulcer and headaches, prone to constipation and haemorrhoids (which are > cold baths), prone to overindulgence in alcohol and rich foods, sleepy after meals, insomnia at night, hungover and sneezing in the morning, tongue coated white posteriorly, sometimes with varicose sublingual veins.

#####

##### _Fig. 29. Nux vomica_

### O

### _Odontalgia, atypical (Atypical odontogenic pain) – see_ Facial pain, atypical

### _Odontophobia – see_ Anxiety, acute dental

### _Opium_

Homoeopathic opium. A remedy for speeding the arousal of those who have been the subject of general _anaesthesia_. Some recommend _Phosphorus_ as an alternative.

#####

##### _Fig. 30. Opium poppy_

### _Oral contraceptives – See_ Contraceptives, oral

### _Oral surgery, pain control after (including that related to periodontal surgery, extraction & apicectomy)_

_Arnica_ 30–200 is routinely used to control bleeding, bruising and pain of traumatised soft tissues. For pain at the site of an incision, _Staphysagria_ 30–200 is better indicated, and can be more effective than morphine in many instances. This remedy also promotes epithelial repair. For bone or periosteal pains, _Ruta_ 30–200. For shooting nerve pains, consider _Hypericum_ 30–200. Any of these remedies may be repeated with great frequency initially, in order to control pain, e.g. every 15–30 minutes. The frequency should be reduced as the pain improves and the tissues enter the healing phase.

In many instances, the routine prescription of Arnica and Hypericum together, both before and after the procedure, in conjunction with postoperative _Calendula_ fomentations or _mouthwashes_ , will suffice to keep discomfort and pain to a tolerable minimum.

See also _Anaesthesia, local; Fracture, jaw_.

### _Oral surgery, prevention of complications in_

In this respect, consult the appropriate sections: _Arnica; Anaesthesia, general; Anaesthesia, local; Antimonium tartaricum; Calendula; Fracture, jaw; Haemorrhage, acute dental; Hypericum; Opium; Pyrogen; Subacute bacterial endocarditis, prevention of_.

Also remember that healing requires adequate amounts of nutritional materials, and that those slow to heal may lack one or more essential substances.

See _Vitamin A; Vitamin C; Vitamin E; Zinc_.

### _Orf – see_ Ecthyma contagiosum

### _Orofacial granulomatosis (OFG)_

The clinical oral manifestations of OFG are very similar to those of _Crohn's disease_ : _angular cheilitis_ , swelling of the lip, buccal mucosal thickening (cobblestone appearance), full width _gingivitis_ , oral ulceration and mucosal tags, mainly of the retromolar area. Unlike Crohn's disease, the clinical involvement is normally restricted to the orofacial region. It is believed that most cases are due to orofacial _allergy_ , the most likely allergens being cinnamon, benzoic acid (a common preservative) and chocolate. Most cases resolve within 18 months of removal of the appropriate allergen or allergens. Local treatment with _Myrrh_ or _Propolis_ may be helpful. Infrequent doses of _Bacillinum_ are sometimes indicated.

See also _Melkersson-Rosenthal syndrome_.

### _Orofacial pain – see_ Facial pain

### _Orthodontics_

Mechanical trauma to the oral mucosa from appliances is best treated with _Calendula_ cream, ointment or _mouthwashes_. Oral _candidosis_ may occasionally occur, the treatment of which is discussed under the appropriate section. The prescription of either _Calcarea fluorica_ or _Calcarea phosphorica_ 6–12 twice daily, according to the dominant dental morphology, is useful for facilitating movement (the greater the asymmetry, the better indicated is Calcarea fluorica). Given concurrently or independently, _Ruta_ 6–12 twice daily assists in the repair of the periodontal ligament, and reduces the discomfort of orthodontic pressure.

See also _Sialorrhoea_.

### _Oscillococcinum_

An homoeopathic nosode prepared from duck tissue infected with an oscillating organism. Used primarily in the prevention and treatment of _colds and influenza_.

### _Osteitis deformans – see_ Paget's disease

### _Osteogenesis imperfecta_

A congenital abnormality of bone formation, where a _fracture_ may occur with trivial force, associated with a peculiar blue colour of the sclerotic coat of the eye. Recurrent _dislocation_ of the jaw may occur. Dentinogenesis imperfecta, where the dentine is imperfectly formed, may occur. Some cases only manifest the defect of the dentine together with the blue sclera. _Calcarea phosphorica/carbonica_ and _Symphytum_ are indicated.

### _Osteoma_

Some respond to _Calcarea fluorica_ 6–12 twice daily. Infrequent doses of _Lueticum_ may also be required. _Oral surgery_ may be indicated, with the usual precautionary homoeopathic methods.

See also _Fluorosis; Torus mandibularis & palatinus_.

### _Osteomyelitis_

Remedies such as _Phosphorus, Hekla lava_ or _Amphisbaena_ (6–30c 4-hourly) should be considered according to indications, the selected remedy being given in conjunction with _Pyrogen_ 30 three times daily. _Silicea_ 6–12 three times daily promotes the expulsion of sequestra.

### _Osteopathy_

A school of manipulative therapies allied to chiropractic, of which cranial osteopathy is a particular sub-speciality. Useful in the treatment of migraine and migrainous _neuralgia, carpal tunnel syndrome, tension headache_ and _craniomandibular dysfunction_.

See also _Magnesia phosphorica_.

### _Osteopetrosis (Albers-Schönberg disease/Marble bone disease)_

A rare disease of bone, usually of congenital origin. It is characterised by extreme bone density, susceptibility of bone to infection (as a result of diminished blood supply) and secondary anaemia. Fractures occur with minimal trauma due to abnormalities of collagen and mineral salt distribution. _Osteomyelitis_ may occur in the jaws. _Calcarea fluorica_ and _Symphytum_ may be useful in fundamental therapy.

### _Osteoporosis – see_ Calcium

### _Osteosarcoma – see_ Fluorosis; Tumours & cysts

### _Osteosclerosis – see_ Fluorosis

### **P**

### _Paget's disease (Osteitis deformans)_

Compression of the branches of the trigeminal nerve in this condition results in oral and _facial pain_. Where the jaws are involved, the maxilla is more commonly affected. There is broadening of the alveolus and separation of the teeth. Extraction may be difficult because of _hypercementosis_. Homoeopathic treatment involves such remedies as _Aurum metallicum, Calcarea phosphorica, Hekla lava, Silicea_ and _Lueticum_.

### _Pain – see_ Abscess, dental; Facial pain; Oral surgery, pain control after; Pain threshold, low; Pulpitis; Toothache

### _Pain threshold, low_

This may be raised in those of appropriate typology by the judicious use of remedies, especially _Chamomilla_ and _Coffea cruda_ , 30–200.

See also _Anxiety, acute dental; Kali carbonicum_.

### _Palsy, Bell's – see_ Bell's palsy

### _Palsy (Paralysis), facial nerve – see_ Facial nerve palsy

### _Papilloma, squamous_

This is a benign lesion of the mouth, with little likelihood of malignant change. Excision, together with the normal homoeopathic precautions of _oral surgery_ , is the most expedient treatment. Otherwise, _Thuja_ 6–12 twice daily may be tried.

See _Papillomavirus lesions, human_.

### _Papillomavirus lesions, human_

There are many different types of human papillomavirus (HPV). Such viruses may be implicated in the development of squamous cell _papilloma, condyloma acuminatum, focal epithelial hyperplasia_ (Heck's disease), _verruca vulgaris, leukoplakia_ and squamous cell _carcinoma_. Papillomavirus lesions may be associated with _AIDS_.

Some papillomavirus lesions may be treated with _Thuja_ 6–12 twice daily, with a satisfactory response. Certainly this is so with the benign types. Whether a similar approach is applicable to _leukoplakia_ or squamous cell _carcinoma_ , remains to be seen.

### _Paracoccidiomycosis (South American blastomycosis) – see_ Fungal diseases

### _Paris quadrifolia_

Homoeopathic Herb Paris. A remedy for facial _neuralgia_. Burning, prickling, lancinating pains, especially of the left side and < touch. A sensation as if the eye were pulled backwards by a thread. **Susceptible typology:** nervous, excessively talkative, jumps incoherently from one subject to another (very similar to the _Lachesis_ type).

### _Parodontal abscess – see_ Abscess, dental

### _Parotitis, chronic recurrent (of childhood) – see_ Sialectasis

### _Paroxysmal facial hemicrania – see_ Neuralgia, (periodic) migrainous

### _Pellagra_

Niacin is the generic term for nicotinamide and other derivates of similar activity. Deficiency of niacin is often seen in alcoholics. Severe deficiency results in the triad of dermatitis, dementia and diarrhoea. This is termed pellagra. Intraorally, moderate or severe niacin deficiency is associated with _glossitis_ and stomatitis. The tongue becomes painful, red and swollen, with hypertrophy of the papillae. Later, the papillae atrophy, with the development of a shiny and smooth surface on the tongue. The gingival component of the stomatitis is essentially similar to _ANUG_ , perhaps with the involvement of the same bacteria. The oral mucosa may become the seat of oral _candidosis_. Treatment is with oral nicotinamide and other measures to control oral infection. Advanced pellagra is a potentially fatal disease.

### _Pemphigoid, mucous membrane_

In this form of pemphigoid, mucosal lesions are common, but those of the skin are rare. They may be desquamative _gingivitis_ , bullae and erosions within the mouth. The conjunctivae and genital mucosa may be affected. Referral to an ophthalmic specialist is always warranted. Local and homoeopathic treatment of this condition is along similar lines to those given for _pemphigus_.

See also _Ulcers_.

### _Pemphigus_

This uncommon vesiculobullous disorder, which has four main subtypes, dominantly affects the middle-aged and elderly, and is potentially fatal without satisfactory treatment. Urgent referral to a specialist physician is thus warranted. Bullous lesions and erosions are found in the mouth and other mucosal sites, and skin lesions may occur. Locally, _Myrrh_ or _Propolis_ mouthwashes may be helpful. Homoeopathically, _Rhus toxicodendron_ 6–12 three times daily may be considered for early cases, and _Arsenicum album_ 6 three times daily for more established cases. Unresponsive cases may require _Mercurius corrosivus_ 6 three times daily.

See also _Ulcers_.

### _Periapical abscess – see_ Abscess, dental

### _Periapical cyst – see_ Endodontics

### _Pericoronitis (Wisdom tooth infection)_

Internal homoeopathic treatment essentially follows the same lines as for dental _abscess_. Long-term use of _Hepar sulph_ , 6 three times daily may be required to control the condition until the wisdom tooth can be extracted. An alternative is _Cheiranthus_ 30 three times daily, which is especially indicated if _trismus_ is present. Local treatment includes swabbing the pocket with _Propolis_ Ø, and _Myrrh_ or _Propolis_ mouthwashes.

See also _Glandular fever_.

### _Periodontal surgery – see_ Oral surgery, pain control after; Oral surgery, prevention of complications in

### _Periodontitis, acute traumatic – see_ Traumatised tooth

### _Periodontitis, chronic (formerly termed Pyorrhoea, in the presence of purulent exudate)_

Under this heading will be considered the treatment of both common chronic gingivitis and common chronic periodontitis, in that they are essentially related conditions. Both, of course, may be subject to acute or subacute exacerbations. Any comments concerning therapy must be prefaced by stating that there is no real substitute for correct oral hygiene and regular _scaling and polishing_. Any nutritional or medicinal aids to therapy must be based firmly on these aspects. From the practical point of view, we may classify our measures into: dietetic, systemic supplementary, topical and homoeopathic.

The most satisfactory diet is one that is low in sugars, but high in fibre and fruit. Diets which are deficient in _calcium_ or _magnesium_ may contribute to alveolar bone loss.

A number of nutritional substances have been suggested as being of benefit in the treatment of gingivitis and periodontitis. Considered overall, their effect may be partially due to their direct action on the periodontal tissues, and partially due to plaque inhibition. These include: _vitamin A, vitamin C, bioflavonoids, vitamin E, selenium_ , folic acid, _coenzyme Q10, zinc_ and magnesium. Any or all of these may be considered in a particular case. However, since the effects of coenzyme Q10 can be quite remarkable, I suggest that it is given at the outset in most cases. Coenzyme Q10 should not be given in pregnancy. A single dose of 30mg daily after food is adequate for most cases. Other supplements may be added subsequently according to lack of response or indications of deficiency (from the dietetic history, the general history, objective or subjective symptoms, and special tests). Zinc deficiency is extremely common, even without overt signs, especially in vegetarian patients. Whether _evening primrose oil_ is of benefit to bone density in menopausal patients remains to be seen. Vitamin E is often well-indicated in smokers, should not be used in pregnancy without professional advice, and is contraindicated (as is evening primrose oil) in cases of breast cancer. Further details of indications and contraindications for various supplements are documented under the appropriate headings.

It has been shown that zinc _mouthwashes_ may be beneficial. These, however, are so utterly revolting in taste that I would not inflict them upon my worst enemy. 0.1% folic acid mouthwashes are useful in those taking the contraceptive pill, hormone replacement therapy, phenytoin or methotrexate, and those who are pregnant (see _Gingivitis, pregnancy; Gingivitis, phenytoin; Folate). Myrrh_ mouthwashes are of general use in most cases, particularly where there is an acute or subacute exacerbation of the condition.

Homoeopathic prescribing may be either pathological or constitutional, or a combination of these. Constitutional prescribing is based mainly on the general and mental aspects of the case, and there appear to be no particular dominant types associated with periodontal disease. Pathological prescribing, however, is mainly based on the details of the oral condition. Galgut gives us a useful list of remedies in this respect, together with their characteristic indications. These are quoted with some minor modifications. The leading indication for each remedy is given in **bold type** , and the confirmatory indications after:

(1) _Mercurius corrosivus_. **Subacute inflammation**. Redness, bleeding, pocketing, mobility.

(2) _Mercurius solubilis_. **Acute inflammation with marked salivation**. Peculiar _taste_ , abscesses, purulent discharge from pockets, pain, _halitosis_.

(3) _Phosphorus_. **Chronic inflammation with much bleeding**. Dry mouth, no halitosis, smooth tongue.

(4) _Silicea_. **Long history of repeated abscesses**. Longstanding chronic destruction, many infra-bony defects, especially indicated in chilly people who lack self-confidence.

(5) _Kali carbonicum_. **Purulent pockets without abscesses**. Abundant saliva, _halitosis_ , bad taste, tongue pale or coated, digestive upsets.

(6) _Cistus canadensis_. **Thin friable gums that bleed easily**. Mouth feels cold, especially indicated in chilly subjects.

(7) _Staphysagria_. **Bleeding with bone loss**. High _caries_ rate, pain in non-carious teeth, black stained teeth.

(8) _Calcarea carbonica_. **Persistent oozing of blood**. Lips stained with blood in the morning, halitosis, sour taste, teeth ache, alternating bouts of dryness and salivation.

(9) _Calcarea fluorica_. **Teeth loosening in sockets**. Dry indurated tongue, pain and burning sensations, digestive problems.

(10) _Arsenicum album_. **Atrophic gingivitis**. Dry or _burning mouth_ , wandering pains in teeth and jaws, concomitant drug therapy, especially indicated in worn out patients.

(11) _Natrum muraticum_. **Painful marginal gingivitis without bleeding**. Prone to _herpes simplex infection_.

(12) _Nitricum acidum_. **Atrophic gingivitis**. Especially around restorations or chrome prostheses (? _allergy)_.

(13) _Thuja_. **Marked periodontitis with mouth ulcers**. Hyperplastic gingivitis, _epulis_ , high decay rate, predisposition to root caries, intermittent burning sensations.

In general, the selected remedy may be given in 6–12c twice daily, and in conjunction with any appropriate local and supplementary therapies. It may be given for several weeks to months at a time, sometimes switching to treatments for the inhibition of dental _calculus_.

Another method of prescribing occasionally used is the administration of autonosodes. These are remedies prepared from infected material of the patient for whom they are solely intended. Gingival exudate, materia alba or calculus is collected and potentised. Generally, these autonosodes should be given infrequently (e.g. in a 6c, one dose morning and evening on a single named day each week, with no other remedy being given on that day). This therapy, which should be reserved for difficult or unresponsive cases, is usually given in conjunction with other indicated prescriptions, whether they be constitutional or pathological.

See also _AIDS_.

### _Perioral dermatitis_

A condition similar to acne rosacea, but confined to the perioral region. The skin is red, with the presence of pustules or small papules. It may be associated with the use of topical steroid creams. Treatment follows the similar homoeopathic lines to those employed in acne rosacea, with _Sulphur_ as a key remedy.

### _Perlèche – see_ Angular cheilitis

### _Pernicious anaemia – see_ Vitamin B12

### _Peutz-Jegher's syndrome_

This inherited disorder is characterised by the presence of _pigmentation_ , in the form of circumoral melanotic macules, and intestinal polyps. Melanotic macules may also be distributed across the bridge of the nose. Recognition by the dental surgeon is important in that the intestinal polyps may occasionally undergo malignant transformation. Out of interest it should be mentioned that, apart from surgery, the nosode Medorrhinum figures prominently in the treatment of polyps at any site.

### _Pharmacy, the dental – see_ Appendix 1

### _Phenytoin therapy – see_ Folate; Gingivitis, phenytoin

### _Phosphorus*_

Homoeopathic phosphorus. A remedy for dental _haemorrhage, gingivitis, periodontitis, burning mouth syndrome, median rhomboid glossitis, xerostomia_ and _osteomyelitis_. It may be used to arouse patients after general _anaesthesia_. A major constitutional remedy. **Susceptible typology:** magnetic eyes, sociable, sentimental, talkative, interested in many things, may be a 'jack of all trades', enthusiastic, tends to hide depression which alternates with excitation, hidden fears, feels generally < before storms, depression or anxiety < at sunset, often tall and thin, < cold (but head symptoms, such as headaches, > cold), < lying on left side, burning pains, desires cold food and drinks, hungry, bleeds easily.

See also _Dry socket_.

### _Phytolacca (Phytolacca decandra)_

Homoeopathic poke-root. A remedy for _bruxism_ or bruxomania in children whilst teething (compare _Cina_ ) and _halitosis_. In children, the principal indications are recurrent sore throats, the presence of enlarged and tender lymph glands, together with tooth-grinding in the eruptive phase. In adults, it is halitosis in subjects who have stiffness and pains over the whole body, < for cold and wet weather, > dry weather, but not > continued movement (compare _Rhus toxicodendron)_.

### _Pigmentation, oral & circumoral_

There are many causes for the presence of oral or circumoral pigmentation, including: racial skin pigmentation, _Addison's disease, amalgam tattoo_ , oral _contraceptives_ , antimalarials, tranquillisers, smoking, malignant _melanoma, fibrous dysplasia, AIDS_ , and _Peutz-Jegher's syndrome_.

#####

##### _Fig. 31. Phytolacca_

### _Plantago (Plantago major)_

Homoeopathic greater plaintain. The mother tincture, locally applied, is an excellent therapy for _cervical sensitivity_ and the sensitivity of a _chipped tooth_. It is also employed in the treatment of _dry socket_ The potentised remedy is useful in some cases of _pulpitis_. It may be used as a pulpal sedative when applied on cotton-wool to a carious or non-carious (lost filling) cavity.

#####

##### _Fig. 32. Plantago_

### _Pleomorphic salivary adenoma – see_ Salivary glands, neoplasms of

### _Plummer-Vinson syndrome – see_ Iron

### _Podophyllum (Podophyllum peltatum)_

Homoeopathic May Apple. A remedy for _bruxism_. It has been used to treat diarrhoea during _teething_ and _sialorrhoea. Migraine_ or _tension headache_ relieved by diarrhoea is an indication. **Susceptible typology:** tendency to nausea (bilious temperament), prone to liver or biliary disease, diarrhoea from fresh fruit, _tongue_ indented, tongue moist and thickly coated, bad _taste_ , thirsty, prone to alternation between headache (or migraine) and diarrhoea.

#####

##### _Fig. 33. Podophyllum_

### _Pregnancy epulis – see_ Epulis

### _Pregnancy gingivitis – see_ Gingivitis, pregnancy

### _Progressive systemic sclerosis – see_ Scleroderma

### _Propolis_

A substance produced by bees by the addition of saliva and wax to a resinous material gathered from the leaf buds and bark of poplars. It is anti-infective and anti-inflammatory. The mother tincture is exclusively used; undiluted, in aqueous dilution to varying degrees, or in the form of a cream or ointment. A satisfactory mouthwash may be prepared by adding 40–80 drops of _Propolis_ Ø to 100ml of warm water. _Propolis_ is used in the treatment of _ANUG, pericoronitis, herpes labialis_ , pulpal _exposure, aphthous ulcers_ and various other _ulcerative_ conditions of the mouth, such as _pemphigoid_ and herpetic _gingivostomatitis_.

### _Prosopalgia – see_ Neuralgia, trigeminal

### _Prosthetics, dental_

Denture sore mouth is usually a manifestation of oral _candidosis_. The denture-bearing area is red, but is not necessarily sore. Allergy to acrylic or chrome appliances sometimes occurs, resulting in a form of this disorder with soreness. Allergy to denture material is also sometimes associated with _gingivitis, periodontitis_ and _craniomandibular dysfunction_. Nutritional factors are probably important in the maintenance of the alveolar ridges.

See also _Angular cheilitis; Calcium; Denture granuloma; Evening primrose oil; Magnesium; Salivary glands, papillary or duct stricture of; Sialorrhoea_.

### _Prunus spinosa_

Homoeopathic blackthorn flower buds. A remedy for _pulpitis_ , facial _neuralgia_ and opthalmic _herpes zoster_. It is indicated by pains in the eyes, as though they were about to explode, or neuralgic pains extending from the right side of the forehead to the occiput.

### _Ptelea_

Homoeopathic water ash. A remedy for _sialorrhoea_ , where food _tastes_ bitter, especially in persons which chronic disorders of the stomach and liver (aching in liver region < lying on left side).

### _Ptyalism – see_ Sialorrhoea

### _Pulpitis, acute traumatic – see_ Traumatised tooth

### _Pulpitis_

This is simply inflammation of the pulp, which may arise from _caries_ , overheating or vibration from cavity preparation, mechanical exposure (from cavity preparation or fracture), 'concussion' of the pulp from a blow, or chronic irritation from an unlined restoration or _cervical sensitivity_.

(1) **Asymptomatic pulpitis**. This is associated with exposure of the pulp during cavity preparation, and may be accidental or inevitable, the latter being related to the removal of deep caries. A suitable dressing is of the calcium hydroxide type to which has been added a drop of _Propolis_ Ø. _Belladonna_ 6 three times daily should be given for three days in order to prevent progression of inflammation.

(2) **Mild symptomatic pulpitis following pulpal exposure and pulp-capping**. Fischer recommends _Hypericum_ 30–200 initially at frequent intervals (every 30–60 minutes) to control the pain and inflammation following most exposures (including that related to fracture of a _traumatised tooth)_. However, where the exposure is related to the excavation of deep caries and the pain < cold, he favours _Calcarea carbonica_ 30–200 with similar repetition.

(3) **The vital tooth with minor pulpitic symptoms**. Here, there is usually excessive sensitivity to heat or cold, but the pain lasts for only a short time after stimulation (usually a few seconds, and seldom more than half a minute). Spontaneous pain, without any obvious provocation, is uncharacteristic, except with regard to the _traumatised_ tooth. Tenderness to percussion is absent or mild. The key remedy is _Ferrum phosphoricum_ 12–30 three times daily, which is especially indicated in thin or feeble patients. Should this fail, then give _Belladonna_ 6–30 three times daily, which is most active in robust types. Either remedy may be complemented with _Pyrogen_ 30 twice daily, if partial results are obtained. Pulpitis < before a period and > the flow is indicative of _Sepia_ 6–12 twice daily.

(4) **Severe pulpitic symptoms**. Severe and prolonged toothache following thermal stimulation. Spontaneous pain, often severe, without overt stimulation. There may also be moderate tenderness on percussion, but this becomes more severe as pulp necrosis advances.

This type of tooth will generally require _endodontic_ treatment or _extraction_. Remedies may be usefully given every 1–4 hours in order to control symptoms until either of the former can be instituted. Occasionally, however, the vitality of the pulp is fortuitously preserved, or the root canals become silently calcified. The indications for the various remedies are as follows:

(a) _Aconite_ 30–200. Sudden onset of violent pain, often after cold air. Robust, young and active patients.

(b) _Belladonna_ 30–200. Throbbing pain of sudden onset. Robust patients.

(c) _Ferrum phosphoricum_ 12–30. Throbbing pain of sudden onset. Thin or feeble patients.

(d) _Arsenicum album_ 6–30. Toothache ameliorated by warm water.

(e) _Mercurius solubilis_ 6–30. Nightly aggravation of pain. Much salivation with halitosis.

(f) _Bryonia_ 30–200. The pain increases progressively, reaches a peak, and disappears slowly. It is ameliorated by strong pressure on the tooth.

(g) _Plantago_ 30–200. As with Mercurius solubilis, the pain is worse at night. The tooth is sensitive to the least contact, but paradoxically is > eating.

(h) _Mezereum_ 30–200. This remedy has an elective action on the upper premolars and molars. Pain radiates to the temple or cheekbone, < eating, < least contact of tongue with tooth.

(i) _Apis mellifica_ 30–200. Pain < heat and > cold. Especially indicated in those with the susceptible typology corresponding to _Natrum muriaticum_ (depressive, greasy, thirsty, salt-loving types).

(j) _Coffea cruda_ 30–200. Toothache > holding cold water in mouth. Especially indicated in patients intolerant of pain. Compare _Chamomilla_ and _Clematis erecta_.

(k) _Prunus spinosa_ 12–30. Toothache < hot foods, > clenching teeth. A sensation as though the tooth has been extracted.

The remedy _Hepar sulph_. should not be used in low potencies (e.g. 6c) for the treatment of pulpitis, since it may provoke abscess formation. However, used in 30–200c three times daily (or more often, according to the symptomatic response), it may abort pulpal necrosis, and preserve the vitality of the pulp, thus avoiding endodontic therapy. Its use should be reserved for cases unresponsive to a well-indicated remedy or where the selection of the simillimum is unclear.

In cases which have responded favourably to Belladonna, it is advisable to continue treatment with Calcarea carbonica 30 three times daily (or more frequently if necessary), after the severe throbbing pain has settled. Calcarea carbonica often follows well, and should be given until the tooth is rendered completely asymptomatic. A proportion of teeth treated in this manner undergo calcification of the root canals, thus removing the need for endodontic therapy.

It should be noted that pulpal sedation may be at least partially achieved by inserting _Propolis_ or _Plantago_ Ø on cotton-wool into a carious or non-carious cavity. _Clove oil_ is sometimes used similarly.

### _Pulsatilla (Pulsatilla nigricans)*_

Homoeopathic European anemone. A remedy for _halitosis, gingivitis_ of puberty, _mouth-breathing_ , perversion of _taste_ , migraine and migrainous _neuralgia, burning mouth syndrome; xerostomia_ , median fissure of the lower _lip, mumps_ and _measles_. A major constitutional remedy. **Susceptible typology:** timid, tearful, emotional, shy, placid, likes consolation, affectionate, often fair with blue eyes, skin of hands and feet mottled (venous stasis), thirstless, aversion to or < fats, < heat, indented _tongue_. Pulsatilla types often look younger than their years. However, it is also a remedy indicated in many elderly patients who are placid, timid, tearful, hot and thirstless. A yellow stripe down the centre of the tongue tends to support its applicability.

#####

##### _Fig. 34. Pulsatilla_

### _Puncture wound – see_ Anaesthesia, local; Ledum

### _Pyogenic granuloma – see_ Epulis

### _Pyorrhoea – see_ Periodontitis, chronic

### _Pyostomatitis vegetans_

A non-specific pustular eruption which may be seen on the lips of those who suffer from either _Crohn's disease_ or ulcerative colitis. Local treatment with _Calendula_ or _Propolis_ creams or ointments may be helpful.

### _Pyrethrum parthenium – see_ Feverfew

### _Pyrogen (Pyrogenium)_

Homoeopathic nosode made from putrefying animal materials. Used in the control of sepsis and _septicaemia_. In _oral surgery, Pyrogen_ 30 may be given twice daily to assist in the prevention of postoperative infection. This may be given along with other remedies normally used routinely, such as _Arnica_ and _Hypericum_. It is occasionally used in the treatment of _dry socket_ and _pulpitis_ , in conjunction with other remedies.

See also _Abscess, dental; Cancrum oris; Osteomyelitis; Subacute bacterial endocarditis, prevention of_.

### **R**

### _Radiography, ill-effects of_

In order to combat the effects of ionising radiation, give a single dose of X-ray 30, preferably 30 minutes before taking X-rays.

### _Ramsay-Hunt syndrome_

This condition arises from Varicella zoster infection of the geniculate ganglion. A unilateral _facial nerve palsy_ develops, together with a homolateral vesicular cutaneous eruption of the external auditory meatus. The patient usually complains of pain in the region of the affected ear. Hyperacusis may be present and oropharyngeal _ulceration_. Treatment should be commenced with _Causticum_ 30 and _Rhus toxicodendron_ 30 in 2-hourly alternation, decreasing the frequency of administration with improvement. Varicella nosode 30 may be given twice daily along with the previous treatment.

Supplementary therapies with _vitamin B12_ and _vitamin E_ should be given along the lines suggested for _herpes zoster_.

### _Ranula_

This is a mucous retention cyst arising from one of the sublingual salivary glands, presenting as a large and often bluish swelling beneath one side of the tongue. The key remedies are _Ambra grisea_ and _Calcarea carbonica_ , followed by _Thuja_ and _Mercurius solubilis_ , depending on oral or susceptible typological indications. _Lachesis, Natrum muriaticum, Nitricum acidum, Mezereum_ or _Staphysagria_ may occasionally be required for obstinate cases. The selected remedy may be prescribed in 6–12c twice daily.

### _Reimplantation of tooth_

Where a tooth has been completely dislocated from its socket, following retrograde _endodontic_ technique, both should be irrigated with an aqueous dilution of _Propolis_ Ø, 80 drops per 100ml normal saline/water. After fixation, in the case of both partial and complete dislocation, _Ruta_ 6–30 three times daily should be given for many weeks, in conjunction with _Hepar sulph_. 6 three times daily. Also check the nutrition of the patient, especially with regard to _zinc_ and _vitamin C_ status, and supply supplementary doses if necessary. The remedy Silicea should not be given for any purpose before the tooth and the bone are satisfactorily reunited; otherwise, the tooth may be rejected.

See also _Traumatised tooth_.

### _Reiter's syndrome_

This is characterised by the triad of arthritis, urethritis and _conjunctivitis_. The cause of the syndrome is uncertain, but some cases seem to be related to an episode of infective urethritis following sexual intercourse. Quite commonly, painful superficial _ulcers_ appear on the palate, tongue and buccal mucosa. Local treatment may be given, as for _aphthous ulcers_. Internally, _Rhus toxicodendron_ 30–200 two or three times daily is often indicated.

### _Rendu-Osler-Weber disease – see_ Hereditary haemorrhagic telangiectasia

### _Rescue Remedy – see_ Bach flower remedies

### _Rheum (Rheum officinale)_

Homoeopathic rhubarb. A remedy for the child who is capricious and agitated whilst _teething_ , where the whole child smells sour. Indicated in diarrhoea during teething.

#####

##### _Fig. 35. Rheum_

### _Rheumatoid arthritis_

This may be associated with _iron_ deficiency, leading to _aphthous ulcers_ and oral _candidosis_. Anti-inflamatory drugs used in treatment may produce _lichenoid reactions_. Penicillamine therapy may cause distortion of _taste_ and _vitamin B6_ deficiency. Involvement of the _TMJ_ may occasionally occur, leading to stiffness rather than pain. _Xerostomia_ and _Sjögren's syndrome_ may develop. Approximately half of the patients with the combination of rheumatoid arthritis and Sjögren's syndrome are allergic to the penicillin group of _antibiotics_.

See also _Zinc_.

### _Rhododendron chrysanthum_

Homoeopathic Siberian rhododendron. A remedy for trigeminal _neuralgia_ brought on by stormy and thundery weather, and > after the storm. Also < windy weather, and > dry heat.

### _Rhus toxicodendron_

Homoeopathic poison ivy (from the river valleys of North America). The mother tincture, whether diluted or undiluted, is unsuitable for intraoral use. A remedy for rheumatic or arthritic conditions which are characterised by: < on initial movement, > for further movement, < prolonged movement, < in wet weather, > heat. Useful in some cases of _craniomandibular dysfunction_ and disorders of the _TMJ_. Also used in the treatment of _ecthyma contagiosum, median rhomboid glossitis, pemphigoid, pemphigus, herpes labialis, herpes zoster, Ramsay-Hunt syndrome, Reiter's syndrome, xerostomia, Sjögren's syndrome_ , jaw _fractures_ and _chickenpox_. Rhus toxicodendron is particularly effective in people who correspond to the **susceptible typology** of _Phosphorus_. Great restlessness, especially at night, also indicates its applicability, as does a coated tongue with a red triangular area at the tip. An indented _tongue_ is another indicative feature.

#####

##### _Fig. 36. Rhus toxicodendron_

### _Riboflavine – see_ Vitamin B2

### _Root-filling – see_ Endodontics

### _Ruta (Ruta graveolens)_

Homoeopathic rue. A remedy used in relation to _eye-strain, reimplantation_ of dislocated teeth, jaw _fractures, orthodontics_ and _sprain_ of the wrist. A great remedy for the control of bone pain following any form of _oral surgery_. Used also in _endodontics_ to control pain following apical penetration by a reamer, or apicectomy. It has been termed 'the _Arnica_ of the periosteum'. A principal remedy for _dry socket_. Occasionally indicated in pain following local _anaesthesia_.

#####

##### _Fig. 37. Ruta_

### **S**

### _Salivary calculus (Sialolith/Salivary gland stone)_

Calculi may develop in relation to any of the salivary glands, but those of the minor glands are clinically unimportant. Parotid calculi are nearly always found in the duct itself, whereas those of the submandibular gland are to be found either in the duct or within the substance of the gland. Since a large proportion of stones are radiolucent, they may be missed in routine radiography. Many are asymptomatic until duct obstruction occurs. Then, the usual presentation is intermittent swelling of the gland with some discomfort, particularly in relation to food. The initial treatment of choice is _Calcarea fluorica_ 6–12 twice daily, a prescription which may need to be given for many months. Alternatively, _Lapis albus_ 6 twice daily may be considered. Surgery may thus be avoided, even in intraglandular cases associated with recurrent episodes of acute bacterial sialadenitis (see below). _Silicea_ 6–12 three times daily can induce the expulsion of stones obstructing the main parotid or submandibular ducts, but is of doubtful use against intraglandular stones.

### _Salivary glands, bacterial infections of_

This may occur as a result of calculi (see above), postoperative dehydration, _sialectasis_ , mucous plug, papillary or duct stricture (see after), cervicocranial radiotheraphy and _Sjögren's syndrome_. The swelling is acutely painful, and pus may discharge from the ductal orifice. _Calcarea fluorica_ 12–30 three or four times daily is the initial treatment of choice. _Tuberculosis_ is a rare cause of chronic bacterial infection of the salivary glands.

### _Salivary glands, neoplasms of_

Most parotid _tumours_ are pleomorphic salivary adenomata (about 80%), some of which have responded well to _Lapis albus_ 6–12 twice daily. Malignancy is more commonly associated with tumours of the submandibular gland (about 60%), and virtually all those of the sublingual gland are sinister.

### _Salivary glands, papillary or duct stricture of_

These sometimes are a consequence of trauma. In the case of papillary stricture, this may result from the teeth or a prosthesis. Symptoms are similar to those of _salivary calculus_ with intermittent swelling of the gland in relation to food, and the remedy _Calcarea fluorica_ may be employed similarly. Correction of any dental or _prosthetic_ problems is necessary. Where Calcarea fluorica fails, long-term _Thiosinaminum_ 6 twice daily should be considered. The buccinator window anomaly refers to a rare phenomenon, where spasm of this muscle occludes the parotid duct; again, Calcarea fluorica may be tried.

### _Salivary glands, viral infections of_

A number of different viruses can affect the major salivary glands ( _Coxsackieviruses, influenza_ viruses, echovirus, etc.), but the most important is _mumps_. Clinically, it may be impossible to distinguish between the different types of infection. However, from the homoeopathic point of view, treatment will often follow similar lines to that of mumps. Cytomegolovirus is a fairly harmless virus which may infect the salivary glands of the newborn or immunocompromised patients, such as those suffering from _AIDS_. This is known as cytomegalic or salivary gland inclusion disease.

### _Salivation, diminished – see_ Sjögren's syndrome; Xerostomia

### _Salivation, excessive – see_ Sialorrhoea

### _Sanguinaria canadensis_

Homoeopathic blood root. A remedy for migraine and migrainous _neuralgia_. Pains are periodic, returning every seventh, third or second day. Predominantly right-sided. Cheek flushed. Burning or throbbing pain, < noise, < smell, < light, < movement, > resting in the dark, > passing wind (from above or below). Patients in whom it is indicated are generally thirsty, or menopausal with hot flushes. Sanguinaria canadensis extract is sometimes incorporated into botanic _toothpastes_ for its beneficial action in cases of _gingivitis_ or _periodontitis_.

### _Sarcoidosis_

Clinical involvement of the oral mucosa in this disease, in which chronic granulomata develop in diverse sights, is extremely rare. The face or lips are more commonly involved, with the development of non-ulcerative plaques and nodules. Intermittent doses of _Bacillinum_ have been used with good effect in some cases of sarcoidosis.

### _Scalds_

These may be treated with _Hypericum_ and _Calendula_ ointment or cream, or with the oily contents of a _vitamin E_ capsule.

### _Scaling & polishing_

Bleeding and soreness may be controlled by using _Arnica_ 30–200 three times daily, both before and after the procedure, together with either _Calendula_ or _Myrrh_ mouthwashes. Those who have _cervical sensitivity_ should apply _Plantago_ Ø before scaling.

See also _Calculus, dental; Subacute bacterial endocarditis, prevention of_.

### _Scar tissue, excessive_

Keloid scars may be treated by giving a single dose of _Thuja_ 30 once weekly on a particular day, and giving _Graphites_ 6 twice daily on the remaining days. Additionally, Graphites 8x cream, to which _vitamin E_ has been added (600IU d-alpha tocopherol per 50g), should be applied two or three times daily.

#####

##### _Fig. 38. Sanguinaria canadensis_

In order to prevent or reduce excessive scar tissue associated with _oral surgery_ , give _Thiosinaminum_ 6 twice daily.

See also _Epidermolysis bullosa_.

### _Scleroderma (Progressive systemic slerosis)_

This is characterised by chronic sclerosis of the skin and vital organs. Involvement of the face leads to limitation of mouth opening. _Sjögren's syndrome_ may develop. CREST syndrome is related to scleroderma, and consists of: _c_ alcinosis, _R_ aynaud's phenomenon, o _e_ sophageal stricture, _s_ clerodactyly and _t_ elangiectasia. Homoeopathic treatment for this condition is complex.

### _Scrofulous_

An ancient adjectival term found in many old homoeopathic books of materia medica. It can be equated with a tendency to cervical lymphadenopathy.

### _Scutellaria (Scutellaria lateriflora)_

Botanic. Skullcap. The mother tincture is sometimes used in the treatment of glossopharyngeal or trigeminal _neuralgia_ and epilepsy.

#####

##### _Fig. 39. Scutellaria_

### _Selenium_

This acts synergistically with _vitamin E_ , and may be used in conjunction with it in the treatment of _gingivitis_ or _periodontitis_. The usual daily dose is 200mcg. It is not recommended during pregnancy.

### _Sepia*_

Homoeopathic cuttlefish ink. Indicated in median fissure of the lower _lip, herpes labialis, aphthous ulcers, pulpitis, xerostomia, burning mouth syndrome_ and _gingivitis_ of pregnancy or puberty. A major constitutional remedy, to be thought of in cases of atypical _facial pain_ , periodic migraine and migrainous _neuralgia_ , where the typology is appropriate. **Susceptible** **typology:** often overworked housewives or business women, depressive, with aggression to mainly their nearest and dearest, yet often the life and soul of the party, annoyed by consolation, uninterested in sex or abhorrence of sexual matters, weak memory, bored by many things, exhausted, very chilly, < before a storm, > vigorous exercise, desires acidic things, prone to constipation and haemorrhoids, bearing down feeling in pelvis, prone to varicose veins, indented _tongue, toothache_ (pulpitis) < before periods and > the flow.

#####

##### _Fig. 40. Sepia_

### _Septicaemia_

This is, to some degree, preventable, and occasionally treatable with _Pyrogen_ 30, given up to four times daily. It would be a better world if antibiotics were reserved for serious cases, or others where homoeopathic measures have failed. The use of antibiotics in cases of septicaemia is fully justified, and whilst the antibiotic may partially antidote the effect of the remedy, there is, nevertheless, good sense in giving Pyrogen concurrently.

### _Sequestrum_

A small piece of non-vital bone remaining in the tissues after _oral surgery_ may be expelled by giving _Silicea_ 6–12 three times daily.

See also _Dry socket; Osteomyelitis_.

### _Shingles – see_ Herpes zoster

### _Sialectasis_

Primary sialectasis is associated with chronic recurrent parotitis of childhood. Repeated attacks of suppurative bacterial sialadentitis occur in the parotid glands. The disease often resolves about puberty. Long-term treatment with _Calcarea fluorica_ 6–12 twice daily may be helpful in preventing acute exacerbations, and promoting resolution of the problem. Secondary sialectasis may be associated with chronic infection, _AIDS_ , irradiation or _Sjögren's syndrome_.

### _Sialolith – see_ Salivary calculus

### _Sialometaplasia, necrotising – see_ Necrotising sialometaplasia

### _Sialorrhoea (Ptyalism)_

This may be associated with oral ulceration, such as primary herpetic _gingivostomatitis_ or _aphthous ulcers, diabetes mellitus_ (diabetic autonomic neuropathy), Parkinson's disease, cerebral palsy, mental retardation, schizophrenia, epilepsy, _mercury_ poisoning and various drug therapies. In such cases, treatment or correction of the underlying cause is helpful.

Some develop sialorrhoea when _orthodontic_ or _prosthetic_ appliances are provided for the first time. In this respect, _Jaborandi_ 6–30 three times daily may be helpful. Other patients present with no obvious cause for the sialorrhoea. Here, a variety of remedies may be useful. _Ptelea_ 6–30 twice daily is indicated in those with chronic digestive or liver problems. _Mercurius solubilis_ 6–30 twice daily may be useful in those who have severe halitosis and an indented tongue. For copious salivation after eating, especially in gluttonous and dyspeptic types, consider _Allium sativum_ 6–30 three times daily. Also _Granatum_ and _Podophyllum_ are occasionally indicated, according to typology. Podophyllum may be useful in the drooling of old epileptics. Otherwise, constitutional prescribing, based strongly upon the mentals and generals of the case, rather than details of the presenting complaint, must be considered.

### _Sialosis_

This is defined as a non-neoplastic, non-inflammatory enlargement of the salivary glands. Bilateral parotid swelling is a common presentation, but the other major salivary glands may also be affected. It is seen in relation to _acromegaly_ , alcoholism, malnutrition, _anorexia_ and bulimia nervosa, _diabetes mellitus_ and a number of drug therapies. Treatment of the underlying disorder usually results in some reduction of the swelling.

### _Sicca syndrome – see_ Sjögren's syndrome

### _Silicea (Silica)*_

Homoeopathic flint. A remedy for oroantral _fistula, mucocele_ , black hairy _tongue_ , delayed _eruption, xerostomia, osteomyelitis, actinomycosis, Paget's disease, salivary calculus_ and _periodontitis_. Also used in _endodontics_ , and for the expulsion of _foreign bodies_ and a post-extraction _sequestrum_. To be used with caution in those with dental _implants_ or where a tooth has been _reimplanted_. **Susceptible typology:** thin, weak, chilly, timid, nails have white spots ( _zinc_ deficiency), sweaty about head, smelly feet, prone to infection (wounds become infected readily), prone to cervical lymphadenopathy, < cold and draughts, < winter, > heat and dry weather, > summer, constipated with retraction of stool, prone to catarrhal disorders, prefers cold foods.

### _Sjögren's syndrome_

The primary form of this disorder, formerly termed 'sicca syndrome', consists of diminished lacrimal and salivary secretion, leading to dry eyes and _xerostomia_. In the secondary form, the patient suffers from a connective tissue disorder in conjunction with dry eyes and/or xerostomia. Secondary Sjögren's syndrome is most frequently associated with _rheumatoid arthritis_. Less commonly it is found in relation to primary _biliary cirrhosis, scleroderma_ or systemic _lupus erythematosus_. Enlargement of the salivary glands may occur in both types, but is not clinically apparent in the majority of cases. Secondary _sialectasis_ and malignant lymphoma may occur in some cases of Sjögren's syndrome.

_Natrum muriaticum_ 12–30 twice daily has been found helpful in a number of cases, resulting in an increase in lacrimal and salivary flow. _Rhus toxicodendron_ 30–200 two or three times daily may be useful in cases associated with inflammatory arthritis. Other homoeopathic therapies may be required for the treatment of any concomitant connective tissue disorders.

### _Smelling salts_

These contain ammonia and eucalyptus oil, the inhalation of which produces profound stimulation. They are an often forgotten, but important addition to the dental pharmacy. They are used in the treatment of simple _faint_ , and dizziness following local _anaesthesia_.

### _Socket, infected tooth – see_ Dry socket

### _Spigelia_

Homoeopathic Demerara pink-root. Used in some cases of _halitosis_. A remedy for trigeminal or migrainous _neuralgia_ , particularly of the left side. Severe burning and prickling pains. Severe pains in the eyes as though they were too large, with flashing lights before them. Skin tender over affected side. Pain < movement, touch or shaking. Facial neuralgia < cold, > heat. Also a remedy for migraine or _tension headache_ starting in the occiput and radiating to the left eye, which begins at dawn, increases in the day and diminishes by the evening. Paradoxically, the thermal modalities are opposite to those of the facial neuralgia. They are < heat and > cold. Spigelia is best indicated in weak and nervous patients, especially if they are prone to palpitations or are sensitive to changes in the weather. They tend to be prone to intestinal worm infestation.

#####

##### _Fig. 41. Spigelia_

### _Sponge naevus, white_

This is an inherited abnormality, which is often first recognised in adolescence. Large areas of the oral floor and buccal sulcus are usually involved. Its appearance is similar to that of a repeatedly _bitten cheek_. The disorder is benign and warrants no special treatment. However, biopsy should be performed to differentiate it from the rare developmental condition dyskeratosis congenita, in which malignant transformation may occur.

### _Staphysagria (Staphisagria)_

Homoeopathic stavesacre. A remedy for _craniomandibular dysfunction_ , chronic _periodontitis_ with a high _caries_ rate, and _ranula_. It is especially indicated in those who suffer from stifled vexation and sexual repression, or those who have suffered sexual abuse. Also an important remedy for the control of pain and the promotion of healing in incisional wounds in relation to _oral surgery_ in general, including periodontal surgery and apicectomy.

### _Stevens-Johnson syndrome – see_ Erythema multiforme

### _Sticta pulmonaria_

Homoeopathic lung-wort. Used in the treatment of insomnia associated with _fractures_.

#####

##### _Fig. 42. Sticta pulmonaria_

### _Stomatitis artefacta – see_ Cheek biting, recurrent

### _Stone – see_ Salivary calculus

#####

##### _Fig. 43. Staphysagria_

### _Strontium carbonicum_

Homoeopathic strontium carbonate. A remedy for recurrent _dislocation_ of the TMJ.

### _Subacute bacterial endocarditis, prevention of_

Where appropriate antibiotics are unavailable, or where the patient refuses to take them, consider _Pyrogen_ 30 twice daily, for one day prior to and seven days after the procedure.

See also _Amalgam, dental; Rheumatoid arthritis_ (both with regard to bacterial antibiotic resistance).

### _Sulphur*_

Homoeopathic sulphur. Used in the treatment of _aphthous ulcers, Behçet's disease_ , delayed _eruption, angioedema, xerostomia, burning mouth syndrome, halitosis, herpes labialis_ , atrophic _lichen planus, perioral dermatitis, mouth-breathing_ , perversion of _taste_ and _chickenpox_. A major constitutional remedy. **Susceptible typology:** may be thin or fat, red orifices, very philosophical, well-read, untidy, slovenly, dislike of bathing or washing, chilly in the day but hates hot rooms, hot at night and throws off bedclothes, hunger at 11 am, thirsty, greedy, sweaty, itchy, ill-smelling, desires sweet things, desires fresh air, opens windows when others are chilly, burning pains, cannot stand still in one position, slouches or leans against something, early morning diarrhoea drives patient out of bed, periodicity and alternation of complaints, prone to skin diseases, prone to hypertension and haemorrhoids. A red centre with a red tip of the tongue tends to be indicative of its applicability.

Sulphur should always be used cautiously, since it tends to produce skin reactions in some patients, such as pruritis, pimples and boils. This is especially so in patients with a history of eczema, acne vulgaris, rosacea or boils. Should any reactions occur, it is prudent to discontinue the remedy and seek further advice.

### _Symphytum_

Homoeopathic comfrey. The great remedy for the promotion of union of _fractures_. It will even treat non-union. It may also be used in _osteopetrosis_ and _osteogenesis imperfecta_.

### _Syphilis_

Associated with orogenital transmission, the primary lesion of this disease, a chancre, may be seen on the lip or oral mucosa. This is a nodule which breaks down to form an ulcer with indurated margins, and which, rather characteristically, is painless (unlike _herpes labialis)_. The cervical lymph nodes have a rubbery consistency. This lesion generally resolves within 9 weeks, without scar formation. Secondary syphilis is a febrile illness, with generalised lymphadenopathy, a macular or papular rash, and the development of so-called snail track ulcers on the oral mucosa. Both primary and secondary lesions are highly infectious. Tertiary syphilis is unlikely to be seen these days, since most cases have been treated before this stage is entered. The characteristic intraoral features are the palatal gumma and syphilitic _leukoplakia_ of the tongue, which latter is prone to malignant transformation. Any patient suspected of having syphilis should be urgently referred.

#####

##### _Fig. 44. Symphytum_

### _Syphilinum – see_ Lueticum

### **T**

### _Taraxacum_

Homoeopathic dandelion. Used in the treatment of _geographic tongue_. It is especially indicated in persons with cold finger-tips.

### _Tartar – see_ Calculus, dental

### _Taste, diminished or lost_

Most cases of chronic and severe loss of taste and smell seem to result from a previous respiratory infection – either the common cold or influenza. Many respond to _zinc_ therapy, the usual adult dose being 30mg daily. This often requires administration for up to 18 months in order to rectify the problem, and lesser doses may be inadequate. Moderately diminished taste and smell is often associated with a chronic catarrhal state, which will require homoeopathic therapy. Loss of taste associated with a thick white or creamy coating on the tongue may indicate such remedies as _Antimonium crudum_ and _Antimonium tartaricum_.

#####

##### _Fig. 45. Taraxacum_

### _Taste, perversion of_

Perversion of taste may occur spontaneously or in relation to specific foods. In a few cases, this is the result of offensive discharges from the sinuses or in relation to _gingivitis_ or _periodontitis_. Gastric disease is another possible causative factor. Sometimes it arises from drug therapy. Electrochemical effects, resulting from the presence of dissimilar metals in the mouth, can produce spontaneous metallic tastes, which are only correctable by mechanical dental means. Many cases have no obvious causation. The homoeopathic materia medica abounds with remedies relating to perversion of taste. In order to be effective, a remedy should be selected upon the basis of both the susceptible typology and the individual character of the taste. As a generalisation, however, it may be said that certain remedies are very frequently indicated, viz. _Pulsatilla, Nux vomica, Mercurius solubilis_ and _Sulphur. Natrum muriaticum_ also deserves special attention with regard to a salty taste.

See also _Gonorrhoea; Rheumatoid arthritis_ (with regard to penicillamine).

### _Tea tree oil (Oleum melaleucae)_

Botanic. An oil obtained by distillation of the leaves of the Australian tea tree, Melaleuca alternifolia. It has antifungal and antibacterial properties, and is applied topically. It is useful in the treatment of oral _candidosis, angular cheilitis_ and _herpes labialis_. It is either applied directly or in the form of a cream.

### _Teething, infant_

Where the child is very fractious, with whining restlessness, wishing to be carried or petted, consider _Chamomilla_ 30 1-hourly as necessary. This is the most commonly indicated remedy. Where the child is similar, but smells sour, consider _Rheum_ 30 1-hourly as necessary. Where there is excessive salivation or halitosis, consider _Mercurius solubilis_ 6 two or three times daily. Diarrhoea accompanying teething is not uncommon, and is covered by the three remedies mentioned. In the case of Rheum, the diarrhoea is also sour. _Podophyllum_ is also occasionally useful in diarrhoea accompanying _eruption_ of the teeth.

### _TMJ (Temporomandibular joint), disorders of_

The majority of patients complaining of problems with the TMJ suffer from _craniomandibular dysfunction_. Sometimes the joint becomes a seat of inflammation in _rheumatoid arthritis_. Gout of the TMJ is extremely rare.

Less commonly, the joint itself has an isolated problem, such as a damaged meniscus. _Rhus toxicodendron_ 30 two or three times daily is to be considered for uncomfortable but relatively painless cracking of the joint, which loosens with movement. Painful cracking of the joint indicates _Granatum_ 6–30 two or three times daily. Pain in the joint upon swallowing suggests _Arum triphyllum_ 30 two or three times daily.

See also _Dislocation, TMJ_.

### _Tension Headache_

These are seldom incapacitating, usually involve the occiput, may be unilateral or bilateral, and may spread to involve the whole head. Although many cases of so-called tension headache are ascribed to the psyche, the fact is that a large proportion suffer from vertebral subluxations in the cervicothoracic region of the spine. Tension headache should not be diagnosed until either _osteopathic_ or _chiropractic_ examination has been carried out, and any appropriate adjustments executed. _Acupuncture_ may also be helpful. Some cases are also associated with _food allergy_ or clinical hypoglycaemia. Either constitutional or _Bach flower remedies_ may be indicated. Commonly indicated remedies include: _Gelsemium, Ignatia, Kali phosphoricum, Natrum carbonicum, Natrum muriaticum, Nux vomica, Podophyllum, Sepia_ and _Spigelia_. Numerous other remedies may also be indicated, according to susceptible typology.

### _Tetanus_

This serious infective disease often presents with jaw stiffness, which may be accompanied by neck stiffness, dysphagia and irritability. Any patient who presents with simple jaw stiffness, even without any companion symptoms, should be checked with regard to tetanus immunisation status. Should this be negative, and the person has received a wound of any sort, even the most minor puncture wound (as from a thorn), within the previous 15 weeks, or has been using unsterile hypodermic needles (as in drug abuse), then urgent referral is necessary.

See also _Trismus_.

### _Thalassaemia minor_

A fairly common inherited disorder of haemoglobin synthesis producing mild _anaemia_ , particularly in people of Mediterranean origin (e.g. those of Italian extraction). It may be confused with _iron_ deficiency anaemia. Iron supplements should not be given for this disorder. Other more severe thalassaemia syndromes also exist.

### _Thiamine – see_ Vitamin B1

### _Thiosinaminum_

Homoeopathic allyl sulphocarbamide (derived from mustard-seed oil). A remedy for the prevention and treatment of excessive _scar tissue_.

See also _Salivary glands, papillary or duct stricture of_.

### _Thrombocytopenia_

An early sign of platelet deficiency may be the occurrence of petechiae in the oral mucosa, and observation of these should be regarded with suspicion. However, similar, but more transient lesions, may be seen in conjunction with the common _cold_ , and about 30% of _glandular fever_ cases exhibit petechiae. Thrombocytopenia is sometimes a manifestation of _AIDS_.

### _Thrush, oral – see_ Candidosis, oral

### _Thuja (Thuja occidentalis)_

Homoeopathic arbor vitae. Thuja Ø must not be used in the mouth, either undiluted or diluted. A remedy for keloid _scar_ , chronic _periodontitis_ , predisposition to root _caries, epulis_ , phenytoin _gingivitis, erythema multiforme, ranula, lymphangioma_ , allergic _antibiotic_ rash and human _papillomavirus lesions_. It may be indicated also in cases of trigeminal or glossopharyngeal _neuralgia_ , particularly on the left side, and especially where the patient has the appropriate **susceptible typology:** overweight, < cold, < humidity, sensitive, impressionable, obsessional about minor matters, an oily face and dandruff, prone to polyps and warty growths, sweet or unpleasant sweat (droplets form on the upper lip), intolerant of onions.

#####

##### _Fig. 46. Thuja_

### _Thyropenia_

A term which deserves resurrection. It may be taken to refer to those patients who exhibit the objective and subjective symptoms of _hypothyroidism_ , yet are normal on routine testing for this disorder. In fact, many are borderline normal in tests, and suffer needlessly for years without proper treatment, which is identical to that for overt hypothyroidism.

### _Tic douloureux – see_ Neuralgia, trigeminal

### _Tic, neurotic facial_

A repetitive spasm of facial muscles, occurring in neurotic persons or those under stress. Treatment generally involves homoeopathic constitutional treatment or _Bach flower remedies_.

### _Tick bites – see_ Lyme disease

### _Tocopherol – see_ Vitamin E

### _Tongue, bitten – see_ Bitten cheek or tongue

### _Tongue, black hairy (Lingua villosa)_

This condition is characterised by elongation of the filiform papillae, and sometimes follows a course of antibiotics. The colour may actually vary from yellow-green, through brown to black. The condition may be asymptomatic, or may cause retching. Sometimes the tongue sticks to the roof of the mouth upon waking. Tongue-scraping or tongue-brushing is recommended. _Kali bichromicum_ 6–30 three times daily may be helpful, together with _Myrrh_ mouthwashes. Otherwise, either _Silicea_ or _Natrum muriaticum_ 6–30 twice daily may be considered, according to susceptible typology.

### _Tongue, burning – see_ Burning mouth syndrome

### _Tongue, fissured (Scrotal tongue)_

Deep fissuring of the tongue is not uncommon, and may lead to irritation from stagnation of food in the crevices. Some cases seem to improve well with _vitamin B2_ 50mg daily.

See also _Nitricum acidum_.

### _Tongue, geographic – see_ Geographic tongue

### _Tongue, indented_

Those who are familiar with homoeopathy are aware that the presence of indentations of the teeth upon the tongue is regarded as a leader to the use of _Mercurius solubilis_. An indented tongue, however, is also a leader to over thirty other remedies, including _Arsenicum album, Calcarea carbonica, Iodum, Lueticum, Podophyllum, Pulsatilla, Rhus toxicodendron_ and _Sepia_.

### _Tongue leaders_

The tongue is not only an indicator of disease or deficiency, its appearance is also a leader to the prescription of many homoeopathic remedies. This subject is considered fully in 'Tongue that does not lie' by Prakash Vakil (2nd edition, 1988, Vakil Homoeopathic Prakashans).

See (for examples of homoeopathic leaders) _Bacillinum; Nitricum acidum; Nux vomica; Pulsatilla; Rhus toxicodendron; Sulphur; Tongue, indented_.

### _Tongue, scrotal – see_ Tongue, fissured

### _Tongue, sore – see_ Burning mouth syndrome

### _Tongue, varicose sublingual veins of_

These tend to be indicative of the remedy _Nux vomica_.

### _Tooth-grinding & clenching – see_ Bruxism & bruxomania

### _Toothache_

The weakness of the old homoeopathic authors was their inability to differentiate between different types of pathology, such as _pulpitis_ and _pericoronitis_. These days, the selection of a simillimum is much easier, since the provision of a simple diagnostic label usually reduces the number of likely homoeopathic alternatives.

### _Toothpastes, homoeopathic & botanic_

Various toothpastes are available containing botanic or potentised homoeopathic preparations, and generally lacking fluoride and peppermint. Botanic ingredients include _Krameria_ and _Sanguinaria canadensis_. The absence of peppermint is said to be advantageous, in that this substance is reputed to be antidotal to potentised homoeopathic remedies; either those which are normally prescribed or those contained within the toothpaste itself. In fact, clinical experience indicates that prescribed remedies are not antidoted by peppermint, provided that there is a minimal interval of approximately 10 minutes between the taking of a remedy and brushing the teeth.

See also _Fluoridation; Fluorosis_,

### _Torus mandibularis & palatinus_

Both are _osteomata_ , torus palatinus occurring in the midline of the hard palate, and torus mandibularis occurring on the lingual aspect of the premolar area of the mandible. These usually arise in adult life, treatment being by means of _oral surgery_ or sometimes homoeopathy.

### _Traumatised tooth_

Where the tooth is chipped and the dentine sensitive, get the patient to apply _Plantago_ Ø three or four times daily (or more often, if necessary). Where the tooth exhibits mild pulpitic symptoms, give _Ferrum phosphoricum_ 12–30 three times daily, a measure which may prevent pulpal necrosis. Where the pulp is actually exposed by dental fracture, give _Hypericum_ 30–200 every 30 minutes or more, both before and after pulp-capping, until the pain is considerably reduced; thereafter proceed with Ferrum phosphoricum as described previously. Where the tooth has been loosened in its socket, give _Ruta_ 6–30 three times daily, in addition to the other remedies mentioned. Further measures are required if either frank _pulpitis_ or dental _abscess_ occurs subsequently.

See also _Reimplantation_.

### _Trench mouth – see_ Gingivitis, acute necrotising ulcerative

### _Trigeminal neuralgia – see_ Neuralgia, trigeminal

### _Trismus (Locked jaw)_

This is a concomitant of various oral conditions, including _craniomandibular dysfunction_ , dental _abscess, pericoronitis, bruxism_ and _dystonia_. Occasionally it is caused by drug therapies (phenothiazines), strychnine poisoning or _tetanus_. In all instances, the underlying cause must be treated or corrected. Additionally, _Cheiranthus_ 30 two or three times daily is useful in benign cases. Trismus with shooting pains is sometimes better treated with _Hypericum_ 30 three times daily.

### _Tropical sprue_

This diarrhoeal disease may be acquired by exotic travellers. _Folate_ deficiency is an important component. _Vitamin B12_ and _iron_ deficiencies may also be present. The oral mucosa becomes painful and red, and multiple _ulcers_ develop.

### _Tuberculosis_

Oral tuberculosis is relatively rare, but increasing numbers of cases are being seen as a complication of _AIDS_. Infection is usually secondary to pulmonary involvement. Any site in the mouth may be affected, but lesions occur more commonly on the tongue, hard and soft palates, and oropharynx. The lesions are nodules which break down to form painful irregular _ulcers_ covered with a grey-white slough. Tuberculosis of the _salivary glands_ is also occasionally seen.

The greatest risk to the dental surgeon, however, is pulmonary tuberculosis itself, even without oral manifestations. This is on the increase in major cities in the West, especially in Asian immigrant communities. The sputum of such patients is heavily infected.

### _Tumours & cysts_

Malignancy should always be treated homoeopathically in conjunction with the recommendations of a cancer specialist.

Cysts and tumours causing expansion of the jaws may respond to _Hekla lava_ 6 two or three times daily. In conjunction with _endodontic_ technique, the use of this remedy may obviate the need for apicectomy in the case of a periapical cyst.

See also _Cistus canadensis; Fluorosis; Haemangioma; Kaposi's sarcoma; Mucocele; Osteoma; Pigmentation, oral & circumoral; Ranula; Salivary glands, neoplasms of_.

### **U**

### _Ulcers (Ulceration) – see_ Agranulocytosis; AIDS; Allergy, orofacial; Angina bullosa haemorrhagica; Angular cheilitis; Aphthous ulcers _(common mouth ulcers);_ Behçet's disease; Cancrum oris; Coeliac disease; Crohn's disease; Dermatitis herpetiformis; Epidermolysis bullosa; Erythema multiforme; Feverfew; Gingivitis, acute necrotising ulcerative; Gingivostomatitis, primary herpetic; Glandular fever; Gonorrhoea; Granuloma inguinale; Hand, foot & mouth disease; Herpangina; Herpes labialis; Herpes zoster; Leishmaniasis; Leukaemia; Lichen planus; Linear IgA disease; Lip, median fissure of lower; Lymphogranuloma venereum; Median rhomboid glossitis; Necrotising sialometaplasia; Orofacial granulomatosis; Pemphigoid, mucous membrane; Pemphigus; Ramsay-Hunt syndrome; Reiter's syndrome; Rheumatoid arthritis; Syphilis; Tropical sprue; Tuberculosis; Tumours & cysts

### V

### _Verbascum_

Homoeopathic mullein. A remedy for trigeminal _neuralgia_. The pain affects the zygoma, _TMJ_ and ear, especially on the left side, and is < talking, sneezing, the least movement, changes in temperature, and pressing the teeth together. Pains may occur twice daily, returning at the same hours of the morning and afternoon each day. A sensation as though the parts were crushed by tongs (or a similar device) is an important indication.

### _Verruca vulgaris_

Common warts are sometimes seen on and around the lips of children. These are produced by human _papillomaviruses_. Some respond readily to _Thuja_ 6–12 twice daily.

### _Vincent's stomatitis – see_ Gingivitis, acute necrotising ulcerative

### _Vitamin A_

Deficiency may be involved in some cases of _periodontitis_. Overt symptoms of deficiency, such as night blindness and xerophthalmia (drying of the eye), may not be present. It is usefully given as cod-liver oil capsules, and is indicated in those who have a diet low in dairy products and margarines.

### _Vitamin B1 (Thiamine)_

Deficiency of this vitamin is contributory to recurrent _aphthous_ ulceration and _burning mouth syndrome_ in some patients. Gross deficiency, which leads to beriberi, will not be seen by the average dental surgeon. Mild deficiency causes digestive disturbances, poor memory and concentration, loss of appetite, nausea, muscle weakness and fatigue. In therapy, 50–100mg daily may be given in adults.

### _Vitamin B2 (Riboflavine)_

Deficiency may be implicated in some cases of oral _candidosis, burning mouth syndrome_ and fissured _tongue_. It is frequently implicated in cases of _angular cheilitis_. Sore eyes, scaling of the skin (around the nose, mouth and forehead), and a magenta tongue are indicative of deficiency. In severe cases, a painful _glossitis_ arises, initially pebbly in appearance (due to enlargement of the fungiform papillae), giving way to atrophy of the papillae and a smooth, shiny and fissured surface. In therapy, 50mg daily is a common adult dose.

### _Vitamin B6 (Pyridoxine)_

Deficiency of this vitamin may be associated with some cases of recurrent _aphthous_ ulceration and _burning mouth syndrome_. Therapy is especially indicated in women taking oral _contraceptives_ or _hormone replacement therapy_ (HRT), those on high protein diets, tobacco smokers, those who take alcohol regularly, and those on certain drugs, such as penicillamine. In therapy, 50mg three times daily may be given in adults, but this dose should not be exceeded.

See also _Carpal tunnel syndrome; Rheumatoid arthritis_ (with regard to penicillamine).

### _Vitamin B12 (Hydroxocobalamin)_

Deficiency may be associated with some cases of recurrent _aphthous_ ulceration, _angular cheilitis, burning mouth syndrome_ and oral _candidosis_. It is now thought that many vegetarians and vegans suffer from at least mild deficiency, and it has been suggested that they routinely take 100mcg daily by mouth. In therapy, for any of the previously mentioned conditions, this may be increased to 1000mcg daily.

Severe deficiency, which is usually associated with the inability to absorb the vitamin (but is not unknown in relation to veganism), produces pernicious anaemia. Fish tapeworm infestation, from eating raw or under-cooked fish (e.g. sushi), sometimes manifests itself similarly. The oral signs are a bright red, sore or burning, depapillated tongue and angular cheilitis. Unfortunately, many cases present merely with something resembling premature senility, unaccompanied by any other physical manifestations of deficiency. The problem is that the blood film can remain normal for a considerable period, whilst the tissues become slowly depleted of the vitamin. Severe cases of deficiency are treated by injection.

Vitamin B12, given by injection, may also be used in the treatment of _herpes zoster, herpes labialis_ , post-herpetic _neuralgia_ and _Ramsay-Hunt_ syndrome.

See also _Crohn's disease; Folate; Tropical sprue_.

### _Vitamin C (Ascorbic acid)_

Frank deficiency, resulting in scurvy, is unlikely to be seen. However, many people suffer from marginal deficiency, due to a diet deficient in fruit and vegetables. This may contribute to _gingivitis_ and _periodontitis_. Poor wound healing in _oral surgery_ , excessive _haemorrhage_ and slow union of _fractures_ may occur. Patients with a poor diet should take vitamin C 500mg twice daily by mouth. Given for some days prior to oral surgery, it may prevent some cases of excessive haemorrhage. Lack of vitamin C increases the predisposition to acquiring common infections, such as _colds and influenza_.

### _Vitamin D (Calciferol)_

Gross deficiency, which leads to rickets or osteomalacia, is unlikely to be seen in developed countries. However, in those on a diet low in dairy products, margarines and oily fish, marginal deficiency may arise. Cod-liver oil is a good source of this vitamin.

See also _Calcium_.

### _Vitamin E (alpha – Tocopherol)_

Deficiency may contribute to _gingivitis_ and _periodontitis_. It is especially indicated in tobacco smokers, those with varicose veins or atherosclerosis, alcoholics, those with liver disease, those with an excessive intake of polyunsaturated fats, those who have had their gallbladders removed, and those with _coeliac disease_ or cystic fibrosis. The usual adult therapeutic dose is 400–600IU daily (preferably as d-alpha tocopherol), but high doses such as these are not recommended in pregnancy. Vitamin E should not be given in cases of breast cancer. Vitamin E and _selenium_ act synergistically.

Vitamin E is useful in the treatment of primary herpetic _gingivostomatitis, aphthous ulcers, herpes zoster_ and post-herpetic _neuralgia, Ramsay-Hunt syndrome, burns, scalds_ and keloid _scars_.

See also _Keratosis, smoker's_.

### _Voice, loss of – see_ Laryngitis in dental surgeons

### _von Willebrand's disease_

An inherited disorder of blood clotting, which is usually mild in nature. Occasionally there is gingival bleeding from minimal trauma, and this may be confused with early _gingivitis_. It occurs in both men and women, and is extremely common. The bleeding tendency is characteristically aggravated by _aspirin_. There may be problems concerning _haemorrhage_ in _oral surgery_ , which should be carried out in a specialist centre.

### **W**

### _Wisdom tooth, inflammation around – see_ Pericoronitis

### _Wrist, sprained_

Take _Ruta_ 12–30 three times daily, and apply _Arnica_ Ø three or four times daily.

### X

### _X-rays, ill-effects of – see_ Radiography, ill-effects of

### _Xerostomia_

Dry mouth may be associated with _AIDS_ , Sjögren's syndrome, radiotherapy or various drug treatments, including diuretics and psychogenic agents. Congenital absence of one or more of the major salivary glands is a rare cause. Treatment of xerostomia in these cases will be determined by the cause, and may include the use of artificial saliva. Xerostomia of any origin increases the predisposition to oral _candidosis_ and dental _caries_.

More commonly, however, xerostomia has no overt causation and must be considered to be constitutional. It is true to say that it occurs more frequently in those of an anxious nature. A remedy must be selected upon the basis of the mentals and generals of the case. The more commonly indicated remedies are _Aconite, Arsenicum album, Bryonia, Carbo vegetabilis, Ignatia, Kali bichromicum, Lachesis, Lycopodium, Natrum muriaticum, Nux vomica, Phosphorus, Pulsatilla, Rhus toxicodendron, Sepia, Silicea and Sulphur_.

### **Z**

### _Zinc_

Deficiency is extremely common. In fact, it is getting commoner as people incline towards vegetarianism, animal products being the best source of zinc. Overt signs are not always manifest. These include white spots on the nails, which break easily, and dryness of the skin and hair. Persons with zinc deficiency also tend to acquire infections more readily, such as _colds and influenza_ , and _glandular fever_. They are also more easily fatigued. Zinc deficiency may be implicated in cases of recurrent _aphthous_ ulceration, oral _candidosis, gingivitis, periodontitis_ and _geographic tongue_. It is associated with poor healing of wounds and _fractures_ in _oral surgery_. It is not uncommon in cases of _rheumatoid arthritis_. The usual therapeutic dose in adults is 15mg daily or 15mg twice daily (elemental zinc). Satisfactorily absorbed and cheap forms are chelated zinc and zinc citrate. Should _cramps_ or itching occur, the dose must be reduced. Zinc _mouthwashes_ are sometimes used in the treatment of periodontal disease.

### _Zincum metallicum_

Homoeopathic metallic zinc. A remedy for _bruxism_ or bruxomania in patients of appropriate typology. **Susceptible typology:** pale, emaciated tired, continual nervous movement of feet and legs, slowness of thought and comprehension from nervous fatigue, headaches < wine.

### _Zincum phosphoricum_

Homoeopathic zinc phosphide. A remedy for _craniomandibular dysfunction_ , where there are sharp pains of the head and face, especially in nervously exhausted patients (students, businessmen, professionals, etc.).

### _Zingiber_

Botanic. Common ginger root. Zingiber Ø is useful in the treatment of _colds and influenza_. It also prevents and treats travel-sickness. Should a child (or adult) arrive in the surgery with this complaint, give 1 drop per 10kg of body weight in a teaspoonful of water.

#####

##### _Fig. 47. Zingiber_

## APPENDIX ONE

## The Basic Dental Pharmacy

The following is a list of useful remedies, other substances, and optional sundries to be stocked by the dental surgeon. Others may be added at leisure and according to demand and experience.

### _Simples_

Aconite 30, pilules 7g

Amalgam (dental) 30, pilules 7g

Argentum nitricum 30, pilules 7g

Arnica 30, pilules 7g, liquid potency 10ml

Arsenicum album 30, pilules 7g

Belladonna 30, pilules 7g

Borax 30, pilules 7g

Calendula Ø, 30ml

Calendula 5% ointment, 50g

Carbo vegetabilis 30, liquid potency 5ml

Chamomilla 30, pilules 7g, liquid potency 10ml

Cheiranthus 30, pilules 7g

Coccus cacti 30, pilules 7g

Coffea cruda 30, pilules 7g

Ferrum phosphoricum 30, pilules 7g

Feverfew 30, pilules 7g

Gelsemium 30, pilules 7g

Hepar sulph. 6, pilules 7g

Hepar sulph. 30, pilules 7g

Hypericum 30, pilules 7g

Ignatia 30, pilules 7g

Lachesis 30 pilules 7g

Ledum 30, pilules 7g

Mercurius solubilis 30, pilules 7g

Myrrh Ø, 30ml

Myristica 30, pilules 7g

Phosphorus 30, pilules 7g

Plantago Ø, 30ml

Propolis Ø, 30ml

Pyrogen 30, pilules 7g

Rhus toxicodendron 30, pilules 7g

Ruta 30, pilules 7g

Silicea 6, pilules 7g

Staphysagria 30, pilules 7g

### _Mixtures_

China 6/Phosphorus 12/Ferrum phosphoricum 30, liquid potency 10ml

Ipecacuanha 30/Millefolium 30, liquid potency 10ml

Rescue remedy, 10ml

Smelling salts, 17ml bottle

### _Supplements_

Coenzyme Q10 30mg, 60 capsules

Vitamin B2 50mg, 100 capsules

Vitamin C 500mg, 100 tablets

Vitamin E (d-alpha tocopherol) 600IU, 60 capsules

Zinc 15mg (chelate/citrate), 100 tablets/capsules

### _Sundries_

Amber dispensing vials (plastic or glass) 10–15ml, 50

Amber glass bottles 50ml, 30

Personalized labels, bearing your name, qualifications, address, telephone number and the warning 'Keep out of the reach of children'

### _Suppliers_

The following are postal suppliers, who also stock relevant books or pamphlets:

Ainsworth's Homoeopathic Pharmacy

36 New Cavendish Street

London W1M 7LH, England

Tel: <PRESIDIO_ANONYMIZED_PHONE_NUMBER>

Brauer Biotherapies

1 Para Road

PO Box 234

Tanunda

South Australia 5352

Tel: 85 63 2932

Lamberts Healthcare Ltd.

1 Lamberts Road

Tunbridge Wells TN2 3EQ, England

Tel: <PRESIDIO_ANONYMIZED_PHONE_NUMBER>

(suppliers of excellent nutritional supplements only)

The Hahnemann Homeopathic Pharmacy

1918 Bonita Avenue

Berkeley

California 94704

USA

Tel: <PRESIDIO_ANONYMIZED_PHONE_NUMBER>

Homeopathic Educational Services

2124 Kittredge Street

Berkeley

California 94704

USA

Tel: <PRESIDIO_ANONYMIZED_PHONE_NUMBER>

Since area dialling codes change occasionally, please check with the operator if you cannot obtain the appropriate number.

## APPENDIX TWO

## Mercury Toxicity

##### contributed by the late  
Catherine Price, BDS

##### & edited by  
Dr Colin B. Lessell

In 1818, a British chemist, Bell, discovered that, by mixing silver fragments obtained from filing silver coins with mercury, he could make a paste, which could be shaped before it set into a hard metal alloy. In 1826, a French dentist began applying the amalgam for the purpose of filling teeth.

By 1830, this new material also contained tin and copper, and was being used to fill dental cavities in North America, the advisability and safety of which had already become a matter of great controversy. The Victorians were well aware of the symptoms of mercury poisoning, if only from its widespread use in the hatting industry. The phrase, which has become part of the English language, 'as mad as a hatter', and the well-known Mad Hatter of Alice in Wonderland, published in 1897, are familiar examples of the insanity and mental derangements associated with mercury vapour. Furthermore, the widely practised art of fire-gilding of bronze to produce ormolu resulted in the same fate for the artisan.

In 1840, the American Society of Dental Surgeons debarred its members from using the new mercury amalgam, subsequently suspending several New York City dentists in 1848 for 'malpractice for using mercury fillings'. Nonetheless, the great advantages of this cheap and easily used material led to the formation of a new dental group in 1859, which is now the American Dental Association. It is worthy of note that, at the time of publication of the present textbook, both the American and British Dental Associations still advocate that the use of mercury amalgam is good and safe in practice!

Thus, conservative dentistry was made available to the masses when, hitherto, only the wealthy could aspire to the alternative gold restorations.

The mercury amalgams currently available vary in their constitutent parts, but a typical composition is: mercury 50%, silver 35%, tin 13% and copper 2%. Zinc is often present as a trace element. A large filling can contain as much as 1g of mercury.

Until recent years, the official position has been that the mercury contained within an amalgam filling cannot escape after the material has hardened. Unfortunately for officialdom, and more so for the patient, the converse has been indisputably demonstrated. Mercury vapour escapes from amalgam restorations in measurable and significant quantities, both in the passive and the active situations. Moreover, the degree of loss associated with mastication or bruxism is much higher. It has been estimated that a non-bruxist with eight occlusal fillings can release as much as 300mcg daily. A bruxist can release amounts dangerously approaching industrial levels!

The World Health Organisation (WHO) document 'Environmental Health Criteria 118', concerning inorganic mercury, states that the largest estimated daily intake and retention of mercury and mercury compounds in the general public, not occupationally exposed, is from dental amalgams. WHO has stated that _there is no safe dose of mercury_. Mercury is a poison at any level, whether or not the level of intoxication is sufficient to produce recognisable symptoms.

Two levels of mercury poisoning are recognised. _Acute mercurialism_ is a condition which develops from a single and significant exposure to mercury, such as that associated with the fracture of a thermometer or surgery spillage. Its symptoms include: a harsh and metallic taste; burning pains in the mouth, throat and stomach; profuse salivation; abdominal pains; diarrhoea and vomiting. _Chronic mercurialism_ is more insidious in onset, and has a range of symptoms, the significance of which may be readily misdiagnosed. These include: psychological disturbances; irritability and outbursts of anger; nervousness; loss of memory; inability to concentrate; and depressive states.

In the absence of any scientific evidence that mercury is actually beneficial (of which there is none to date), we shall restrict ourselves to a consideration of a few of the more notable pieces of research that relate to mercury toxicity:

(1) _The spread of radioactively labelled mercury from amalgam in sheep teeth to mother and foetus after 16, 33 and 73 days_. Vimy et al. University of Calgary. American Journal of Physiology, 258, 1990.

In this study, radioactively tagged mercury, of a type not naturally found, was mixed into a dental amalgam. This was then placed in the teeth of sheep. At the end of the period of study, radiographs demonstrated concentrations of the tagged mercury in the kidneys, brains, livers, thyroids and pituitary glands of both the ewe and the unborn foetus. Deposition was also observed in the placenta. Furthermore, there was radiographic evidence of large concentrations in the jaws, despite the fact that all the filled teeth had been subsequently extracted.

(2) _Mercury from dental 'silver' tooth fillings impairs sheep kidney function_. Boyd, Benediktsson, Vimy & Lorscheider. University of Calgary, 1991.

In this study, mercury amalgam fillings were inserted into the teeth of adult ewes, whilst control ewes were given glass ionomer fillings. Renal function was evaluated before the placement of the fillings, and at 30 and 60 days afterwards. The inulin clearance rate in the non-control group diminished dramatically, and by 60 days they all showed a 60% reduction and a substantially lowered renal filtration rate (33–89%). It was concluded that mercury from amalgams has the capacity to reduce renal function.

(3) _Mercury released from 'silver' fillings provokes an increase in mercury and antibiotic resistant bacteria in the primate oral and intestinal flora_. Summers, Wireman, Vimy, Lorscheider, Marshall, Levy, Bennett and Billard. University of Calgary. Antimicrobial Agents and Chemotherapy, 37, 1993.

Most bacteria cannot survive in the presence of mercury, but those which continue to exist do so by acquiring a genetic resistance to the toxic effects of that substance.

In an investigation of 640 human subjects, with regard to a sub-group of 356 persons with no recent exposure to antibiotics, it was demonstrated that those with a high prevalence of mercury-resistance in their intestinal bacteria were significantly more likely to have bacteria resistant to two or more antibiotics.

In a follow-up study using monkeys, each of which received 16 occlusal amalgam fillings, a large proportion of their common oral and intestinal bacteria became resistant to mercury within 2 weeks of placement of amalgam fillings. Of particular significance is the fact that nearly all of the mercury resistant strains from these monkeys were also resistant to one or more antibiotics, including ampicillin, chloramphenicol, tetracycline and streptomycin; despite the fact that these monkeys had not been exposed to antibiotics. From 12–50% of the multi-resistant bacteria examined could transfer their resistance to an antibiotic-sensitive laboratory strain. In two of the three studies, the amalgam fillings were replaced with non-mercuric composite resin fillings; after which, the proportion of mercury and antibiotic resistant bacterial populations declined during the subsequent 2 months.

It was concluded that, since dental amalgam is the greater source of mercury exposure for humans, other than occupational exposure, it is likely that dental amalgam mercury is a selective agent which increases the prevalence of plasmid-associated mercury and antibiotic resistances in the oral and intestinal flora of humans. That such resistant plasmids can compromise the efficacy of antibiotics used in the treatment of bacterial infections is well documented. Further studies in this are continuing.

A study has been published which shows that there is a statistically significant correlation between the number of human occlusal surfaces filled with mercury amalgam and the levels of mercury detectable in the blood, measurable in nanograms per ml. Even such tiny levels may be of some significance in sensitive individuals.

Dr Gustav Drasch, a forensic toxicologist at the University of Munich, has shown that mercury, as is the case with sheep, crosses the human placental barrier. Amongst his findings is the fact that the mercury levels in foetal kidneys and livers, and the levels in the kidneys and cerebral cortices of babies aged 10–50 weeks, are statistically related to the numbers of maternal amalgam fillings.

Ongoing research being performed by Dr Boyd Haley at the University of Kentucky, USA, suggests, from autopsy results, that the mercury from dental amalgam may be implicated in Alzheimer's disease. Many feel that this disorder is produced by a combination of toxicity and deficiency, and thus may be preventable in the future.

### _In summary_

(1) Mercury is acknowledged to be a powerful toxic agent, for which WHO cannot state a safe level.

(2) It is widely acknowledged that mercury vapour escapes from dental amalgam restorations.

(3) Eating hot foods, mastication and bruxism drastically increase the levels of mercury release.

(4) The vapour is inhaled, ingested and absorbed through the oral mucosa and lungs, and passes into the bloodstream.

(5) Scientific research has shown that mercury lodges in the brain, heart, lungs, liver, kidneys, thyroid, pituitary, adrenals and red blood cells. It suppresses the immune system. Mercury also crosses through the placenta, whence it lodges in similar sites in the unborn foetus. It has been shown to be present in breast milk in higher concentrations than in the blood.

(6) There is a correlation between the number of tooth surfaces filled with amalgam and the levels of mercury in the brain. There is a further correlation between brain mercury levels and Alzheimer's disease.

(7) Mercury induces normal oral and intestinal bacteria to become resistant to antibiotics.

### _Protocols For The Safe Removal Of Amalgam Fillings_

Thus far, all the discussion has been with the emphasis upon the potential risks to the patient. It should not be forgotten that the dental team is also at risk from occupational exposure to mercury vapour produced in the practice of placing and removing amalgam fillings. As early as 1926, the German chemist, Dr. Alfred Stock, researched mercury poisoning and identified the fact that amalgam restorations were a source of mercury vapour.

The dentist should be aware of the fact that it is becoming increasingly common for employees to seek compensation for damage to health sustained in the workplace. As long as there are patients requiring old amalgam fillings to be replaced, there will be an inevitable exposure of the dental team to mercury vapour. Every effort should be made to reduce the levels of exposure to an absolute minimum. In this respect, we must consider the health of all the workers within the practice, from the dentist to the cleaner.

The International Academy of Oral Medicine and Toxicology (IAOMT) has established a recommended protocol for the safer removal of mercury amalgam fillings and the subsequent disposal of waste. IAOMT seeks to educate the dental profession and to encourage a changeover to the use of the most biocompatible materials available, as well to stimulate and fund relevant research programmes.

Absorption of mercury vapour from occupational exposure is primarily through the lungs, with a much lesser degree of absorption occuring through the skin, via droplets or dust. The absorbed mercury is then distributed throughout the body and is stored in various organs, including the brain. Research published in 1989 suggests that mercury vapour is able to travel from the nasopharynx to the floor of the cranial cavity, where it becomes concentrated in the pituitary gland. The pathway is thought to be via the olfactory nerves or the cranial venous system, both of which routes bypass the liver, which is the main detoxifying organ of the body. From autopsy studies of pituitary glands taken from Swedish dentists, it was demonstrated that the level of mercury in those glands was, on average, 2.5 times higher than that found in the cerebral cortex. In one case, the level was 169 times higher!

The half-life of mercury in the bloodstream is estimated to be 3 days; yet, once absorbed into body tissues, this is extended to 90 days. Mercury compounds bind to body tissues by virtue of their affinity for thiol (–SH) chemical groups. These are found in all enzymes and most proteins. By acting as non-specific enzyme inhibitors, mercury compounds are able to affect membrane permeability, the conduction of nerve impulses and tissue respiration. The biochemical effects have been compared with those of the venom of the black widow spider ( _Latrodectus spp_.).

The body excretes mercury mainly in the urine and faeces; the latter in such high concentrations that raw sewage is considered by the Swedes to be toxic waste on environmental grounds.

Clearly, the key areas upon which to focus attention are:

(1) The elimination of risk of inhalation of mercury vapour.

(2) The prevention of skin contamination from dust and droplets of the aerosol created by high-speed turbines.

(3) Taking measures to 'mop up' mercury compounds from the blood.

(4) Taking measures to encourage the expulsion of long-standing accumulated mercury compounds from the body tissue.

### _Recommended protocol for the benefit of the dental team_

Ideally, the treatment room should have an in-built air filtration system, with specific mercury filters to eliminate the concentration of mercury vapour levels in the room air. There should also be a floor-level mercury filter, since mercury vapour is heavier than air and thus sinks to the floor. It follows that personnel should avoid wearing open-toed shoes, and that trousers should be worn by all staff.

Both the dentist and assistant should wear some form of mercury filtration mask and a full-face visor to protect the skin and eyes from aerosol contamination. The mercury mask and visor can be removed once amalgam removal is completed.

Ideally, an impermeable protective cape should be worn during the amalgam removal process, and it has been suggested that gloves worn whilst removing the fillings should be discarded, and the hands washed before re-gloving. This is because some researchers have demonstrated that mercury vapour passes through the gloves and accumulates next to the skin. Impermeable hair coverings should also be worn.

Copious amounts of water coolant spray should be used, in that the mercury vapour pressure doubles with every 10°C rise in temperature. Tungsten carbide, rather than diamond, burrs should be used in order to facilitate sectioning of the amalgam into large portions; thus reducing slurry formation and associated extra vapour.

The use of a high volume aspiration system is essential, and special suction tips are now readily available, which maximise vapour removal. Some workers believe that the use of dental dam is unessential if such tips are used. The suction and drainage systems should have mercury extraction filters incorporated, in order to prevent noxious emissions into the environment. Waste particles collected from the filtration systems should be properly stored in sealed containers supplied for this purpose, and ultimately disposed of as toxic waste.

Appropriate nutritional support, prescribed on the basis of sound scientific testing, may be necessary, and such prescriptions should be properly monitored. Suggested supplementation protocols are obtainable from IAOMT and BHDA.

### _Recommended protocol for the benefit of the patient_

The patient should be ideally draped in an impermeable cape for the removal of amalgam restorations. Some workers also advocate the provision of an impermeable hair covering.

The homoeopathic remedy _Mercurius solubilis_ 6, taken twice daily, is often used for the entire period of treatment, in order to oppose mercury toxicity. An alternative is homoeopathic amalgam. _Amalgam_ 30c is taken twice daily on the day preceding, the day of, and the day following an appointment for amalgam removal. It is sensible to have taken charcoal by mouth prior to the appointment, in order to absorb any mercury entering the stomach or intestines. It is prudent to point out, however, that charcoal may have the effect of reducing the efficacy of oral contraceptives, and also that many available charcoal preparations are encapsulated in gelatin, thus being objectionable to true vegetarians, vegans and many Hindus.

The eyes should be covered with a simple dampened gauze, protective wrap-around spectacles or special spectacles which send a constant flow of air across the eyes, in order to dispel vapour.

Many workers still advocate the use of a dental dam; although there is some evidence that mercury vapour may pass straight through it, or via imperfections of seal, and accumulate in high concentration beneath the dam itself. There are many other advantages in the use of the dental dam, besides protection from mercury vapour, and these need to be considered before a decision is made (always with the informed consent of the patient).

A nose-piece delivering air can be used, or a simple mercury vapour mask. If the dam covers the nose, it is questionable whether such a precaution is necessary.

After the amalgam filling is removed, the protective clothing can be discarded, and the patient should wipe his/her face with a hot towel before continuing with the restorative phase of the appointment.

### _Mercury Levels & Chelation_

Accurate biochemical testing for chronic mercurialism is very difficult to achieve. Tissue sampling is not appropriate, and X-ray fluorescence is not widely available. Analysis is restricted to a limited range of biological samples, and the results thus obtained are not always reliable. Blood mercury levels do not reflect the amount absorbed by body tissues, and the half-life of 3 days means that an isolated blood sample may not necessarily give an accurate representation of periodic exposure.

Hair and finger-nail analysis provide quite good indications of exposure to organic mercury compounds, such as methyl and ethyl mercury, but inorganic mercury (such as that from amalgam) is insufficiently accumulated in these tissues to form the basis of reliable results.

The mercury levels in urine can accurately reflect the total body burden. However, there are difficulties in testing urine for mercury. The tests should be performed over a 24 hour period, in order to allow for fluctuations of urinary output. If a single specimen is to be used, the test result must be related to the creatinine level. This is a waste product of muscle metabolism, and is used clinically as an index of glomerular filtration rate.

Recent developments at the time of writing have suggested that a very accurate analysis, called the PIXE test, enables X-irradiated blood samples to be examined microscopically to demonstrate sites on the red blood corpuscles occupied by mercury.

Certain chelating agents, such as DMSA (Dimercaprol succinic acid) and DMPS (2, 3, Dimercapto-propane-1-sulphonate), given under medical supervision, are useful in ridding the body of its accumulated mercury.

### _Epilogue_

With countries such as Sweden working towards a total ban on the use of mercury amalgam (upon environmental grounds), the dental profession, as providers of health care, need to equip themselves with the knowledge, materials and expertise, not only to remove amalgam fillings with safety, but also to replace them with the most biocompatible restorations available.

This requires a constant and ongoing quest for knowledge and information; and an ability and willingness to change practising habits and techniques which become obsolescent. It is important not to have a closed mind, with inflexible viewpoints and resistance to change.

It is important to have a mind that is open; but not at both ends, so that everything falls out!

### _Editorial comment_

Mercury is a substance of well-documented and established toxicity. Even before the more recent studies concerning the release of mercury vapour from dental amalgams, this had been firmly established. The opponents to the mercury issue state that it is unrealistic to insert multiple amalgams in the teeth of herbivores (viz. sheep), who, by their very nature, chew for considerable periods of time, and deduce from the results a supposed significant vapour release in the human situation. Even accepting this argument, mercury in the dental surgery, at the time of amalgam preparation and placement, constitutes a formidable and undeniable hazard to the patient, operator, assistants and the environment. Upon this basis alone, there is no sensible reason, other than that of pure economics, to continue with the provision of amalgam restorations. It follows, therefore, that all broken or lost fillings should be replaced with non-mercuric materials; since, although there may be some potentially toxic substances released from them, their toxicity has never been properly demonstrated, as is the case with mercury itself. It would thus be a sign of lunacy to consider any other recourse.

We must now pass to the more tricky matter of sound amalgam restorations already _in situ_ , and whether they should be routinely removed. My own view is that they should not, unless there is good reason to suspect that they are actually causing harm. Their removal alone, by releasing significant quantities of mercury vapour, is hazardous to the patient, operator, assistants and environment. Bruxists will receive some reasonable protection by the wearing of acrylic splints at night.

The determination of whether existing amalgam restorations are harmful to the patient, apart from the more obvious sign of lichenoid reactions, is, however, difficult. Assessment of mercury levels in the body may be helpful in this respect, but it must not be forgotten that people vary considerably in their sensitivity to toxins. Whilst it is possible to make the general statement that there is no determinable safe level of mercury, certain individuals are surprisingly resistant to toxic action. For example, the recent increase in adult asthma in the UK has been attributed to environmental pollution; yet this does not affect all individuals equally, and many show no obvious ill-effects at all. Rasputin could not be poisoned with arsenic, since, it is alleged, he took small quantities of that substance throughout his life. Some humans, rather like some bacteria, are incredibly adaptive to toxic environments.

Where the patient presents with a certain set of symptoms, and these cannot be attributed to any other cause, it is not unreasonable to consider amalgam removal, provided that those symptoms are consistent with our present knowledge of chronic mercurialism. There can, for example, be a close correspondence between the symptoms of ME (postviral syndrome) and those of chronic mercury intoxication. Many such cases respond well to nutritional and homoeopathic therapies. Amalgam removal should only be considered as an ultimate resort in unresponsive cases, and not as a primary therapy.

### _Suggested reading_

Dentistry without Mercury. Dr Sam F. Ziff (ISBN 0–941011–04–6).

Mercury Exposure Hazards and Risk Management, A Manual for the Dental Practitioner. Stephen Hewitt (ISBN 1–874692–00–9).

## Illustrations List

Frontispiece: Hypericum

Fig. 1: Aconite

Fig. 2: Allium sativum

Fig. 3: Aloe vera

Fig. 4: Salvia officinalis (kitchen sage)

Fig. 5: Arnica

Fig. 6: Belladonna

Fig. 7: Bellis perennis

Fig. 8: Berberis vulgaris

Fig. 9: Bryonia

Fig. 10: Calendula

Fig. 11: Cannabis indica

Fig. 12: Chamomilla

Fig. 13: Cheiranthus

Fig. 14: Clematis erecta

Fig. 15: Cloves

Fig. 16: Coffea cruda

Fig. 17: Crataegus

Fig. 18. Evening primrose

Fig. 19: Fragaria

Fig. 20: Gelsemium

Fig. 21: Granatum

Fig. 22: Hydrastis

Fig. 23: Iris versicolor

Fig. 24: Jaborandi

Fig. 25: Ledum

Fig. 26: Lycopodium

Fig. 27: Mezereum

Fig. 28: Myrrh & Frankincense

Fig. 29: Nux vomica

Fig. 30: Opium poppy

Fig. 31: Phytolacca

Fig. 32: Plantago

Fig. 33: Podophyllum

Fig. 34: Pulsatilla

Fig. 35: Rheum

Fig. 36: Rhus toxicodendron

Fig. 37: Ruta

Fig. 38: Sanguinaria canadensis

Fig. 39: Scutellaria

Fig. 40: Sepia

Fig. 41: Spigelia

Fig. 42: Sticta pulmonaria

Fig. 43: Staphysagria

Fig. 44: Symphytum

Fig. 45: Taraxacum

Fig. 46: Thuja

Fig. 47: Zingiber

## Index

##### The page references in this index correspond to the printed edition from which this ebook was created. To find a specific word or phrase from the index, please use the search feature of your ebook reader.

Italicised topics indicate homoeopathic or botanic medicines. Italicised numerals indicate principal entries.

**A**

ABH _see_ angina bullosa haemorrhagica

Abrasions, _30_ , 58

Abscess, 50

dental, 15, 16, _30_ , 66, 101, 119, 122, 136

incisional, 98, _107_

periapical, 80

Abuse, 158

_Acacia pennata_ , for extractions, 84

Acidic things desired, 154

_Acidum fluoricum see Fluoricum acidum_

Acne rosacea, 137

_Aconite (Aconitum napellus), 31_ ; for

anxiety, 41

anxiety producing pain, 38

Bell's palsy, 52

colds and flu, 72

epistaxis, 81

high blood pressure, 53

pulpitis, 143

xerostomia, 174

Acromegaly, _31_ , 56, 155

_Actinomyces israeli nosode_ , 32

Actinomycosis, _32_ , 156

Acupuncture, _32_ , 74–5, 124, 125, 126, 163

Addison's disease, _32_

Adenoids, 33, 121

Aerodontalgia, _32_ , 66, 71 _and see_ toothache

Affectionate nature, 144

Ageing

appears younger than years, 144

premature, 36, 116

Aggravation of symptoms, 14–15

Aggressive nature, 154

Agitated nature, 57

Agranulocytosis, _33_ , 60

_Agraphis nutans, 33_ ; for mouth breathing,121

AIDS (Acquired Immune Deficiency Syndrome), _33_

symptoms of, 42, 60, 121, 127, 133,155, 164, 169, 173

Albers-Schönberg disease _see_ osteopetrosis

Albright's syndrome, 57, 87 _and see_ fibrous dysplasia

Alcohol

alcoholism, 12, 155, 172

overindulgence, 128

Allergies, _34_ , 47, 50, 55, 130

anaesthetic, 37

prosthetics, 141

_and see_ food allergies

_Allium sativum, 34_ ; for

candidosis, 34, 61

sialorrhoea, 155

Allyl sulphocarbamide _see Thiosinaminum_

_Aloe vera, 34–5_ ; for

aphthous ulcers, 35, 44

candidosis, 61

Aloofness, 49

Alveolus, broadening of, 132

Amalgam, _35–6_ , 115 _and see_ mercury toxicity

Amalgam tattoo, _36_

Ambergris _see Ambra grisea_

_Ambra grisea, 36_ ; for ranula, 146

_Amphisbaena (Amphisbaena vermicularis)_ , _36_ ; for osteomyelitis, 131

Amyloidosis, _36_

Anaemia, 33, _36–7_ , 86, 89, 97, 110, 164

Anaesthesia

general _37_ , 129, 138

local, 34, _37–8_ , 66, 149

trigeminal, 33

Anemone _see Pulsatilla_

Anger

easily provoked, 101

when in pain, 66

_and see_ annoyed

Angina

bullosa haemorrhagica (ABH), _38_ , 46,73

pectoris, 31, _38_ , 112

_and see_ cellulitis

Angioedema, 34, _38, 160_

Angular cheilitis, _38–9_ , 163; and

AIDS, 33

Crohn's disease, 76

diabetes, 77

deficiences, 89, 108, 171, 172

orofacial granulomatosis, 130

Annoyed

by consolation, 154

easily, 54

_and see_ anger

Anorexia nervosa, _39_ , 155

_Anthracinum, 39_ , for

anthrax, 40

gangrene, 59

Anthrax, 39, _40_ ,

Anti-inflammatory drugs, _40 and see_ drugs

Antibiotics, 35, _40_ , 60, 75, 127

_Antimonium crudum, 40_ ; for

impetigo, 105

taste loss, 162

_Antimonium tartaricum, 40_ ; for

anaesthesia, 37

chickenpox, 67

taste loss, 162

Antimony sulphide _see Antimonium crudum_

ANUG (acute necrotising ulcerative gingivitis), 33, 110, 119, 127, 141 _and see_ gingivitis

Anxiety

acute dental (odontophobia), 31, _41–2_ , 46, 48, 66, 71, 92, 106

and anaesthesia, 37

producing pain, 38

Anxious types, 45, 47, 49, 107, 116, 119, 138

Apathy, 49

Aphthous ulcers, _42–4_ , 45, 48, 54, 83, 86, 103, 110, 112, 153, 160; and

AIDS, 33

allergies, 34, 90

coeliac disease, 70

Chron's disease, 76

deficiencies, 89, 108, 171, 173, 174

mouthwashes for, 122, 141

rheumatoid arthritis, 147

sialorrhoea, 155

Apicectomy, 80

_Apis (Apis mellifica), 45_ ; for

anaesthesia, 37

cellulitis, 64, _66_

migrainous neuraliga, 126

pulpitis, 143

Appetite

loss, 171

ravenous, 107

Apprehension _see_ anxiety

_Aranea diadema, 45_ ; for neuralgia, 126

Arbor vitae _see Thuja_

_Argentum metallicum, 45_ ; for laryngitis, 112

_Argentum nitricum, 45_ ; for

anxiety, 41

aphthous ulcers, 44

conjunctivitis, 73

median rhomboid glossitis, 119

Arginine, and aphthous ulcers, 44

Argumentative nature, 48

_Arnica (Arnica montana_ ), 5, 6, _45–6;_ for

abrasions, 30

anaesthesia, 37

bitten cheek or tongue, 53

blisters, 38

bruising, 15, 17

crushing, 17

cuts, 76

dislocations, 78

Ehlers-Danlos syndrome, 80

endodontics, 80

epidermolysis bullosa, 81

fractures, 90–1

haematoma, 98

haemorrhage, 99

haemorrhagic telangiectasia, 101

implants, 105

pain control after surgery, 129

physical trauma, 25, 46

scaling and polishing, 151

sprains, 173

Arsenic trioxide _see Arsenicum album_

_Arsenicum album_ , 16, _46–7_ , 88; for

anxiety, 41

burning mouth, 56

burning sensation, 22

halitosis, 100

indented tongue, 167

lichen planus, 114–15

median rhomboid glossitis, 119

pemphigus, 134

periodontitis, 137

pulpitis, 143

xerostomia, 174

Arteritis, giant cell, _93–4_ , 110

Arthritis, 25, 50, 117, 146, 148 _and see_ focal sepsis; rheumatoid arthritis

Articulations, lax, 57

_Arum triphyllum, 47_ ; for

laryngitis, 112

TMJ problems, 163

Ascorbic acid _see_ vitamin C

Aspirin, _47_ , 173

Asthmatic types, 47

Atherosclerosis, 172

Auriculo-temporal syndrome _see_ Frey's syndrome

_Aurum metallicum, 47_ ; for

amalgam problems, 36

gingivitis, 95

Paget's disease, 132

Autonosodes, 10, 137

**B**

_Bach Flower Remedies_ , 13–14, 48–9

_Bacillinum, 49–50_ ; for

caries, 63

delayed eruption, 82

mouth-breathing, 121

orofacial granulomatosis, 130

sarcoidosis, 151

teeth grinding, 54

Backache, 51–2

_Baptisia_ ( _Baptisia tinctoria_ ), _50_ ; for

gingivostomatitis, 96

Barberry _see Berberis vulgaris_

Bathing, dislikes, 160

BCG immunisation, 25

Bearing down feeling, 154

Bed, afraid to go alone, 64

Behçet's disease/syndrome, 42, _50_ , 160

_Belladonna, 50_ ; for

abscess, 30

cellulitis, 64

dry socket, 78

endodontics, 80

pain, 22

pulpitis, 142, 143

teeth grinding, 54

_Bellis perennis, 51–2_ , 46

Bell's palsy, 31, _52_ , 85, 119 _and see_ facial nerve palsy

_Berberis vulgaris, 52–3_ ; for candidosis, 61

Bereavement, prolonged, 49

Biliary cirrhosis, _53_ , 156

Bilious problems, 140

Bilious temperament, 140

Biochemic tissue salts, 11

Bioflavonoids, _53_ , 102, 135

Biting, of cheeks, _53, 66_

Blackthorn _see Prunus spinosa_

Blastomycosis _see_ fungal diseases

Bleeding, 136, 138 _and see_ haemorrhage

Blindness, 50, 94

Blisters, blood blisters _see_ angina bullosa haemorrhagica

Blood pressure, raised, 31, _53_ , 81, 98

Blood root _see Sanguinaria canadensis_

Bluebell _see Agraphis nutans_

Body odour, pungent, 119, 160, 163 _and see_ sweating

Boils, 39, 98 _and see_ abscess

Bone spicule _see_ sequestrum

Bones

destruction and loss, 58, 136

grafts, 54

painful, 37, 149

slender, 57

_Borax, 54_ ; for

aphthous ulcers, 43

candidosis, 40, 61

Bored nature, 154

Brachycephalic types, 56

Breath, offensive _see_ halitosis

Bruising, 15, 17, 30, 45–6, 80

Bruxism, 50, _54_ , 61, 68, 105, 138, 140, 168, 174; and

craniomandibular dysfunction, 74

mercury toxicity, 182

Bruxomania, 50, _54_ , 106, 138, 174

_Bryonia_ ( _Bryonia alba_ ), _54_ ; for

jaw fractures, 90

pulpitis, 143

xerostomia, 174

Bryony _see Bryonia_

Bulimia nervosa, _39_ , 155

Burning mouth syndrome (BMS), 47, _55–6_ , 83, 106, 107, 112, 122, 138, 144, 153, 160; and

allergies, 34, 90

diabetes, 77

deficiencies, 89, 108, 171

periodontitis, 137

_and see_ mouth

Burning pains, 107, 138, 157, 160

appear and disappear abruptly, 63

better for

cold, 37, 45

heat, 41

passing wind, 151

rest in dark, 151

left-sided, 133

worse for

heat, 45, 47

light/movement/noise/smell, 151

touch, 133

Burning sensation, 22, 63, 64, 137

Burns, 173

aspirin, _47_

instrument, _57_

Bushmaster (snake) venom _see Lachesis_

**C**

_Calcarea carbonica (Calcarea ostrearum)_ , _56_ ; for

acromegaly, 31

caries, 63

delayed eruption, 82

endodontics, 80

epulis, 81

indented tongue, 167

mouth-breathing, 121

periodontitis, 136

pulpitis, 142, 143

ranula, 146

_Calcarea fluorica_ , 18, _57_ , 88; for

caries, 63

delayed eruption, 82

dislocation of TMJ, 78

Ehlers-Danlos syndrome, 80

fibrous dysplasia, 87

haemangioma, 98

haemorrhagic telangiectasia, 101

orthodontic problems, 131

osteoma, 131

osteopetrosis, 132

periodontitis, 136

salivary calculus, 149–50

salivary gland problems, 150

sialectasis, 154–5

_Calcarea phosphorica, 57_ ; for

caries, 63

delayed eruption, 82

fibrous dysplasia, 87

gingivitis, 95

mouth-breathing, 121

orthodontic problems, 131

osteogenesis imperfecta, 131

Paget's disease, 132

_Calcarea renalis, 57_ ; for calculus

prevention, 58

Calciferol _see_ vitamin D

Calcinosis, 152

Calcium, _57–8_

Calcium fluoride _see Calcarea fluorica_

Calcium phosphate _see Calcarea phosphorica_

Calcium silicofluoride _see Lapis albus_

Calcium sulphide _see Hepar sulph_.

Calcium urate renal calculus _see Calcarea renalis_

Calculus, 57, 58, 91, 112 _and see_ salivary calculus

_Calendula (Calendula officinalis)_ , 6, _58–9_ ; for

abrasions, 30

abscess, 30, 107

aspirin burn, 47

bitten cheek or tongue, 53

blisters, 38

chickenpox, 67

cuts, 76

epidermolysis bullosa, 81

exfoliative cheilitis, 83

gingivostomatitis, 96

haemorrhage, 99

haemorrhagic telangiectasia, 101

hand, foot and mouth disease, 100

herpangina, 102

jaw fractures, 90

keratosis, 111

necrotising sialometaplasia, 123

orthodontic problems, 130

pain control after surgery, 130

pyostomatitis vegetans, 145

scalds, 151

scaling and polishing, 151

Cancer _see_ carcinoma; tumours

Cancrum oris (Noma), 39, _59–60_ , 110, 119

_Candida albicans nosode_ , for candidosis, 61

Candidal leukoplakia, 114 _and see_ leukoplakia

Candidiasis _see_ candidosis

Candidosis, oral, 34, 52, 54, _60–1_ , 73, 103, 110, 163; and

AIDS, 33

burning mouth syndrome, 56

deficiencies, 717, 174

diabetes mellitus, 77

leukaemia, 114

leukoplakia, 114

median rhomboid glossitis, 119

orthodontics, 130–1

prosthetics, 141

rheumatoid arthritis, 147

xerostomia, 173

_Cannabis indica, 61_ ; for teeth grinding, 54

Capriciousness, 66

Caprylic acid, _61_ ; for candidosis, 61

Car-sickness, 175 _and see_ nausea

_Carbo vegetabilis, 63_ ; for

amalgam problems, 36

collapse, 72

xerostomia, 174

_Carbolicum acidum_ ( _Acidum carbolicum_ ), _63_ ; for neuralgia, 126

Carcinoma, 108, 111, 133 _and see_ tumours

Caries, 50, 56, 57, _63–4_ , 112, 139, 158

and periodontitis, 136

root, 137, 165

and xerostomia, 173

_and see_ fluoridation

Carnivores, 34

Carpal tunnel syndrome, _64_ , 68

Carrying, childrens' desire to be carried, 67, 163

Catarrh, 110, 121, 156, 162

_Causticum, 64_ ; for

Bell's palsy, 52

facial nerve palsy, 85

jaw fractures, 91

Lyme disease, 117

median rhomboid glossitis, 119

nerve injuries, 124

Ramsay-Hunt syndrome, 145

Cellulitis, 45, 50, _64, 66_ , 122

Cementum _see_ cervical sensitivity

Centesimal scale, 7

Cerebral palsy, 155

Cervical lymphadenopathy, 69, 153, 156

Cervical sensitivity, _66_ , 151

Chamomile _see Chamomilla_

_Chamomilla, 66_ ; for

anaesthesia, 37

anxiety, 41

dry socket, 78

fractious children, 67

halitosis, 100

lip fissures, 115

low pain threshold, 132

median rhomboid glossitis, 119

teething, 15, 163

toothache, 22, 32

Chancre _see_ syphilis

Charcoal _see Carbo vegetabilis_

Cheeks, _53, 66_ , 151

Cheilitis, 83 _and see_ angular cheilitis; lips fissured

_Cheiranthus_ ( _Cheiranthus cheiri_ ), _66–7_ ; for

craniomandibular dysfunction, 75

pericoronitis, 134

trismus, 168

Chest infections, prevention of, 37, 40

Chewing difficulties, 74

Chickenpox, 40, _67_ , 148, 160

Chilliness

but dislikes heat, 122, 160

and periodontitis, 136

typology, 47, 56, 64, 97, 101, 110, 122, 154, 156, 160

_China_ ( _Cinchona officinalis_ ), _68_ ; for

haemorrhage, 99

Chiropractic, _68_ , 74, 163

_Chlorophora tinctoria_ , for extractions, 84

Christmas disease _see_ haemophilia

_Chrysanthemum parthenium see Feverfew_

_Cina, 68_ ; for

fractious children, 67

teeth grinding, 54

_Cinchona officinalis see_ China

_Cinnabaris, 68_ ; for neuralgia, 126

_Cistus canadensis, 68–9_ ; for periodontitis, 136

Cleidocranial dysostosis, _69_ , 78

_Clematis erecta, 69_ ; for dry socket, 78

Climatic modalities, 16

Clothing, intolerance of, 112

_Clove oil_ ( _Oleum caryophylli_ ), _70_ ; for pulpitis, 144

Club moss spores _see Lycopodium_

Cluster headaches _see_ migrainous neuralgia

_Coccus cacti, 70_ ; for conjunctivitis, 73

Cochineal _see Coccus cacti_

Coeliac disease, 42, _70_ , 172

Coenzyme Q10, _70–1; for_

gingivitis, 95

periodontitis, 135

_Coffea cruda_ , 71–2; for

anxiety, 41

dry socket, 78

low pain threshold, 132

pulpitis, 143

toothache, 22, 32

Coffee, sensitivity to, 41, 66, 105

Coffee (remedy) _see Coffea cruda_

Cold sores, 16 _and see_ herpes labialis

Colds, 31, _72_ , 131, 164, 172, 174, 175

Collapse, 48, 63, _72 and see_ fainting

Comfrey _see Symphytum_

Competence, 48, 49

Comprehension, slow, 174

Concentration problems, 57, 122, 171

Concussion, _72 and see_ pulpitis; traumatised tooth

Condyloma acuminatum, _73_ , 133

Confidence, lack of, 48, 49, 116

Confusion, 61

Conjunctival ulceration, 50

Conunctivitis, 45, 70, _73_ , 83, 146

Consolation, 122, 144, 154

Constipation, 97, 128, 154, 156

Constitutional prescribing, 16–18, 23

Constitutional remedies, 10, 14, 15

Contraceptives, 171

Convalescence, 49

Copper _see Cuprum metallicum_

Corticosteroids, 60, _73_

Costen's syndrome _see_ craniomandibular dysfunction

Coxsackieviruses, _73_

Cramp, _74_ , 76

Craniomandibular dysfunction, 48, 66, 68, _74–5_ , 105, 118, 148, 158, 174; and

prosthetics, 141

trismus, 168

_and see_ TMJ disorders

_Crataegus_ , 6, 75; for diarrhoea, 40

Creosote _see Kreasotum_

CREST syndrome _see_ scleroderma

Cretinism _see_ hypothyroidism

Cries easily, 64, 105 _and see_ tearfulness; weepiness

Crohn's disease, 42, _76_ , 81, 145

Crushing sensation, 170

_Cuprum metallicum, 76_ ; for cramp, 74

Cuts, _76 and see_ abrasions; lacerations

Cuttlefish ink _see Sepia_

Cyanotic typology, 63

Cystic fibrosis, 172

Cysts, 105 _and see_ endodontics; tumours

Cytomegalovirus, 150 _and see_ salivary glands

Cytotoxic agents, 60

**D**

Dandelion _see Taraxacum_

Dandruff, 165

_Daphne mezereum see Mezereum_

Dark features, 54

Deadly Nightshade _see Belladonna_

Decimal scale, 11

Delinquency, 119

Dementia, 133

Demerara pink-root _see Spigelia_

Dental arches, 56, 57

Dentifrices _see_ toothpastes

Dentinogenesis imperfecta, 131 _and see_ osteogenesis imperfecta

Denture granuloma, _77_

Denture problems, 56 _and see_ candidosis; prosthetics

Depression

and gingivitis, 95

at puberty, 47

typology, 49, 107, 112, 122, 128, 138, 154

Dermatitis, 133

herpetiformis, _77_ , 90, 115

perioral, _137_ , 160

Descent, fear of, 54

Despair, 49

Diabetes mellitus, 12, 56, 60, _77–8_ , 83, 98, 155

Diarrhoea

and antibiotics, 40, 75, 127

and anxiety, 41, 92

alternates with headache, 140

early morning, 160

from fresh fruit, 140

from milk, 107

and niacin deficiency, 133

and teething, 140, 146, 163

typology, 92

_and see_ tropical sprue

Diet, 135

Difficult character, 116

Digestive problems, 97, 136, 171

Dilution, 7, 9 _and see_ potentisation

Dimercurous ammonium nitrate _see Mercurius solubilis_

Disagreeable nature, 66, 68

Discipline, lack of, 57

Discouraged easily, 48, 56, 110

Dislocation

TMJ, 78, 118, 131, 160

_and see_ dystonia; Ehlers-Danlos

syndrome; reimplantation

Dizziness, 156

Dolicocephalic type, 57

Domineering nature, 49

Dosage, 12, 14–15

Dread _see_ anxiety

Dreams, 48, 112

Drugs

anti-inflammatory, _40_

definition, 4

and remedies, 26

therapies, 115, 137, 147–8, 155, 162, 168, 173

Dry socket (infected tooth socket), _77 78_ , 101, 139, 145, 149

Dyskeratosis congenita, 158 _and see_ sponge naevus

Dyspepsia, _40, 97_

Dyspeptic types, 34, 63, 116, 128

Dystonia, _79_ , 168

Dysuria, 50

**E**

Ear problems, 68, 124, 145

Eating disorders, 39, 155

Ecthyma contagiosum, _79_ , 127, 148

Edema _see_ oedema

Eggs, desire for, 56

Ehlers-Danlos syndrome, 78, _79–80_

Electrochemical effects, 162

Elegant type, 47, 57

Emaciation, 97, 174 _and see_ eating disorders; malnutrition

Emotional nature, 57, 92, 144

Enamel

grey, 57

mottled, 88

Endocarditis _see_ subacute bacterial endocarditis

Endodontics, _80_ , 149, 156

Enthusiastic nature, 138

Envious nature, 49

Epidermolysis bullosa, 76, _81_

Epilepsy, 25, 89, 153, 155

Epistaxis, 53, _81_ , 86

Epulis, 56, _81_ , 122, 137, 165

Eruption

and adenoid/tonsil enlargement, 33

delayed, 49–50, 56, 57, _82_ , 87, 156, 160

out of normal sequence, 57

precocious, 57

premature, 94

_and see_ teething

Erythema migrans _see_ tongue, geographic

Erythema multiforme, 34, _82–3_ , 96, 97, 165

Erythroplakia _see_ leukoplakia

Espundia _see_ Leishmaniasis

_Euphrasia_ ( _Euphrasia officinalis_ ), _83_ ; for

conjunctivitis, 73

Evening Primrose Oil, _83_ ; for

aphthous ulcers, 44

bone loss, 58

burning mouth, 56

migrainous neuralgia, 125

periodontitis, 135–6

sialorrhoea, 78

Excitement, 45, 138

Exfoliative cheilitis, _83_

Exhaustion, 49, 154 _and see_ fatigue; tiredness

Exostoses, 57, 88, 191, 116 _and see_ fluoridation; osteoma

Externalisation, 24

Extractions, botanic, _84 and see_ dry socket; haemorrhage; oral surgery; sequestrum

Eye lashes, long, 57

Eyebright _see Euphrasia_

Eyebrows, loss of, 105

Eyes

blue, 144

blue coating, 131

dry, 156

lively, 116

magnetic, 138

painful, 141, 157

pulling backwards sensation, 133

red, 68

ringed, 68

sore, 171

strained, _85_ , 149

_and see_ conjunctivitis

**F**

Face

asymmetrical, 57

greasy, 122

lined, 116

narrow, 57

oily, 165

plethoric, 112

puffy, 105

rash, 116

yellowish, 116

Facial arthromyalgia _see_ craniomandibular dysfunction

Facial migraine _see_ migrainous neuralgia

Facial nerve palsy (paralysis), 33, 64, _85_ , 117, 119, 145 _and see_ Bell's palsy

Facial pain, 48, 83, _85–6_ , 94, 122, 126, 132, 153 _and see_ arteritis, giant cell; burning mouth syndrome; craniomandibular dysfunction; neuralgia; Paget's disease; headache; TMJ

Fainting, 48, 156 _and see_ collapse

Fair features, 144

Fanning, desire for, 63, 68

Fastidiousness, 41

Fats, dislikes, 63, 144

Fatigue, 171 _and see_ exhaustion; tiredness

Fatness, 56, 97, 160 _and see_ anxiety

Feebleness, 63

Feet

one hot one cold, 116

smelly, 156

Ferric phosphate _see Ferrum phosphoricum_

_Ferrum phosphoricum, 86_ ; for

epistaxis, 81

haemorrhage, 99

high blood pressure, 53

pulpitis, 142, 143

traumatised tooth, 168

Fever, 30, 102

_Feverfew_ ( _Chrysathemum/Pyrethrum parthenium_ ), _86_ ; for

aphthous ulcers, 43, 44

migrainous neuralgia, 125

Fibro-epithelial polyps, _86 and see_ polyps

Fibrous dysplasia, 57, _87_ , 101

Fissures _see_ angular cheilitis; lips; mouth

Fistula, _87_ , 156

Flabbiness, 101, 110, 119

Flag iris _see Iris versicolor_

Flint _see Silicea_

Fluoric acid _see Fluoricum acidum_

_Fluoricum acidum, 87_ ; for

delayed eruption, 82

fistula, 87

Fluoridation, _88_

Fluorosis, _88_

Focal epithelial hyperplasia, _88_ , 133

Focal sepsis, _89_

Folate, 55, _89_ , 169

Folic acid, 70, 95, 135, 136 _and see_ folate

Food

allergies, 42, _90_ , 121, 125, 163

desires cold, 138

desires fatty foods, 128

overindulgence, 128

_and see_ eating disorders; meat

Fordyce's spots, _90_

Foreign bodies, _90_ , 156

Forgetfulness, 45

Fractious children, 66, _67_

Fractures, 57, 160

jaw, _90–1_ , 131, 132, 158

pain of, 54

poor healing, 172, 174

susceptibility to, 88

_Fragaria, 91_ ; for calculus prevention, 58

Fragile type, 47

Fresh air, desires, 160

Frey's syndrome, _91–2_ , 98

Fright _see_ anxiety

Fungal diseases, _92 and see_ candidosis

**G**

G–6–PD deficiency, 13–14

Gall-bladder

stones, 56

removal, 172

Gangrene _see_ cancrum oris

Garlic _see Allium sativum_

Gastric disease, 162

Gastrointestinal disturbance, 50

_Gelsemium_ ( _Gelsemium sempervirens_ ), _92_ ; for

anxiety, 41

tension headache, 164

Geographic tongue _see_ tongue

Giant cell arteritis _see_ arteritis

Giant cell epulis _see_ epulis

Giant cell granuloma _see_ granuloma

Gigantism, _94_ , 104

Ginger _see Zingiber_

Gingivitis, 53, 56, 68, 70–1, 91, 110, 111, 119, 138, 151, 153

acute necrotising ulcerative, _94–5_

atrophic, 34, 47, 137

and calculus, 58

desquamative, 134

and diabetes, 77

and deficiences, 89, 172, 174

full width, 76, 130

hyperplastic, 137

mouthwash for, 122

phenytoin, _95_ , 165

in pregnancy, _95_ , 122, 153

and prosthetics, 141

in puberty, 57, _95_ , 122, 144, 153

and taste perversion, 162

without bleeding, 137

_and see_ ANUG; periodontitis

Gingivostomatitis, 50, _96_ , 164, 174

Glandular fever, _96_

Gloominess, 47

Glossitis, 89, _96_ , 108, 134, 171

median rhomboid, 33, 45, 47, 64, 66, 110, _118–19_ , 138, 148

_and see_ candidosis; pellagra; tongue, geographic

Glossodynia _see_ burning mouth syndrome

Glossopharyngeal neuralgia _see_ neuralgia

Glossopyrosis _see_ burning mouth syndrome

Gold _see Aurum metallicum_

Goldenseal _see Hydrastis_

Gonorrhoea, _97_

Gout, _97_ , 104

_Granatum_ , 97; for

sialorrhoea, 155

TMJ problems, 163

Granulocytopenia _see_ agranulocytosis

Granuloma

denture, _77_

giant cell, _94_

inguinale, _97_

_Graphites, 97_ ; for

halitosis, 100

scar tissue, 151

Greediness, 160

Grinspan's syndrome, _98_

Guilt, 49

Gum-boils _see_ abscess

Gum disease _see_ gingivitis; periodontitis

_Gunpowder, 98_ ; for incisional abscess, 107

Gustatory sweating and flushing, _98 and see_ Frey's syndrome

**H**

Haemangioma, 57, _98_

Haematoma, 46, _98_

Haemophilia, _98_

Haemorrhage, 46, 68, 86, _99_ , 107, 112, 120, 138

and deficiencies, 172

gingival, 114

protracted, 80, 172

from trauma, 98

and von Willebrand's disease, 173

Haemorrhoids, 128, 154, 160

Hahnemann, Dr Samuel, 2

Hair

dry, 87, 174

dull, 87

greying prematurely, 116

Halitosis, 47, 50, 66, _99–100_ , 110, 112, 119, 122, 127, 136, 138, 144, 157, 160; and

abscess, 30

aphthous ulcers, 43

gingivitis, 94, 95

gonorrhoea, 97

non-dental origin, 112

sialorrhoea, 155

teething, 163

toothache, 22

Hand, foot and mouth disease, 73, _100_

Hands, stubby, 56

Hangovers, 128

Hashish _see Cannabis indica_

Hatefulness, 49

Hawthorn _see Crataegus_

Headaches, 128

alternate with diarrhoea, 140

and high blood pressure, 53

in hot weather, 122

worse for

heat, 47

after midnight, 47

at seaside, 122

wine, 174

_and see_ craniomandibular dysfunction; facial pain; migraine; tension headache

Heads, big and sweaty, 56

Heat, dislikes, 144, 160

Heck's disease _see_ focal epithelial hyperplasia

_Hekla lava, 100–1_ ; for

dry socket, 78

endodontics, 80

fibrous dysplasia, 87

osteomyelitis, 131

Paget's disease, 132

tumours, 169

Hemicrania _see_ neuralgia

_Hepar sulph. (Hepar sulphuris calcareum Hahnemannii), 101_ ; for

abscess, 15, 16, 30

amalgam problems, 36

arthritis, 25

endodontics, 80

focal sepsis, 89

pericoronitis, 134

pulpitis, 143

tooth reimplantation, 146

Hering's Law, 24

Herpangina, 73, _101–2_

Herpes labialis, _102_ , 108, 122, 141, 148, 153, 160, 163, 172

Herpes simplex, 33, 114

_Herpes simplex nosode_ ; for

erythema multiforme, 82

gingivostomatitis, 96

Herpes zoster, 33, 67, _103_ , 141, 148, 172, 173

Histoplasmosis _see_ fungal diseases

Hoarseness, 47

Homesickness, 49

Homoeopathy, 2, 5

cost-effectiveness, 73

scientific basis, 8–9

Honey-bee _see Apis_

Hormone replacement therapy (HRT) _see_ folate; vitamin B6

Hot types, 87, 160

with hot flushes, 112

HU _see_ aphthous ulcers

Human papillomavirus (HPV) _see_ papillomavirus

Hungry type, 97, 138

at 11am, 160

_Hura crepitans_ , for extractions, 84

Hurried nature, 45

_Hydrastis (Hydrastis canadensis), 103_ ; for

aphthous ulcers, 43

candidosis, 61

Hydroxocobalamin _see_ vitamin B12

Hyperacusis, 145

Hyperaesthesia, 72

Hypercal, for burns, 57

Hypercementosis, 94, 97, _104_ , 132

_Hypericum (Hypericum perforatum), 104–5_ ; for

craniomandibular dysfunction, 75

endodontics, 80

haemorrhage, 99

jaw fractures, 91

nerve injuries, 37, 124

neuralgia, 126

pain control after surgery, 129–30

pulpitis, 142

scalds, 151

traumatised tooth, 168

trismus, 168

wounds, 59

Hyperparathyroidism, 94, _105_

Hyperpigmentation, 32 _and see_ pigmentation

Hyperpituitarism _see_ acromegaly; gigantism

Hyperplastic gingivitis _see_ gingivitis; leukaemia

Hypersensitivity

emotional, 111

to pain, 67, 72

Hypertension, 160

Hyperthyroidism, 104, _105_ , 107

Hypoglycaemia, 12, 45, 163

Hypotension, 32

Hypothyroidism, 36, 60, _105_ , 166

**I**

Ice plant _see Cistus canadensis_

_Ignatia (Ignatia amara), 106_ ; for

anxiety, 41

gingivitis, 95

tension headache, 164

xerostomia, 174

Ill-tempered nature, 116

Immunosuppressive agents, 60

Impatience, 49

Impetigo, 40, _106_ , 120

Implants, dental, _106_

Impressionable, 165

Inactivity, 41, 56 _and see_ lethargy; motionlessness

Incompetence, 45

Indecision, 49

Indigo _see Baptisia_

Indolence, 101

Infection prevention _see Pyrogen_

Infections, 101, 156

Infectious mononucleosis _see_ glandular fever

Infective endocarditis _see_ subacute bacterial endocarditis

Inferior dental nerve injury _see_ nerve injury

Infinitesimal dose, 8

Inflammation, 122, 136

Inflexibility, 49

Influenza, 31, 72, 131, 172, 174, 175 _and see_ colds

Insomnia, 41, 128, 158

Intellectual work tires, 57

Intelligence, 57, 72, 116

Interested in many things, 138

Intolerance, 48

Introversion, 107

Iodine _see Iodum_

_Iodum, 107_ ; for indented tongue, 167

_Ipecacuanha, 107_ ; for

anaesthesia, 37

haemorrhage, 99

_Iris versicolor, 107_ ; for

burning mouth, 56

migrainous neuralgia, 126

Iron and iron deficiency, 42, 55, 60, _108_ , 147, 169

Irradiation, 155

Irritability, 22, 40, 49, 54, 68, 101, 128

Itching, 97, 160

ITD, _see_ dystonia

**J**

_Jaborandi, 109_ ; for

mumps, 121

sialorrhoea, 155

Jack of all trades, 138

Jack in the Pulpit _see Arum triphyllum_

Jasmine _see Gelsemium_

Jaw

claudication, _110_

clicking, 74

dislocation, 57, 131

fractures, _90–1_ , 131, 132, 148, 149, 158

limitation on opening, 74

osteomyelitis, 59, 132

stiffness, 37, 113, 164

tenderness, 74

_and see_ TMJ; trismus

Jealousy, 49, 112

Joint hypermobility, 78 _and see_ Ehlers-Danlos syndrome

Jumpiness, 92

**K**

_Kali bichromicum (Kalium bichromicum), 110_ ; for

aphthous ulcers, 43

median rhomboid glossitis, 119

migrainous neuralgia, 126

tongue symptoms, 93, 166

xerostomia, 174

_Kali carbonicum (Kalium carbonicum), 110_ ; for periodontitis, 136

_Kali chloricum (Kalium choricum), 110_ ; for

gangrene, 59

gingivitis, 95

_Kali iodatum_ , for amalgam problems, 36

_Kali muriaticum (Kalium muriaticum), 110_ ; for candidosis, 61

_Kali phosphoricum (Kalium phosphoricum), 110–11_ ; for

halitosis, 100

herpes zoster, 103

neuralgia, 126

tension headache, 164

_Kalmia latifolia, 111_ , for neuralgia, 126

Kaposi's sarcoma, 33, _111_

Kelly-Paterson syndrome _see_ iron

Keloid scars, 97, 165, 173 _and see_ scar tissue

Keratosis, _111_

Keynotes _see_ leading symptoms

Kidney stones, 116

Kinetic modalities, 16

Koplik's spots _see_ measles

Korsakow's method of potentisation, 7, 10–11

_Krameria (Ratanhia_ ), 111

_Kreasotum, 112_ ; for

caries, 63

halitosis, 100

urination problems, 22

**L**

L-lysine therapy _see_ aphthous ulcers

_Lac caninum_ , for epulis, 81

Lacerations, 58, _and see_ cuts

_Lachesis, 112_ ; for

amalgam problems, 36

burning mouth, 56

haemorrhage, 99

halitosis, 100

ranula, 146

xerostomia, 174

Lactase deficiency, and dosage, 12

_Lapis albus, 112_ ; for

actinomycosis, 32

salivary problems, 150

Laryngitis, 45, 47, _112_

Larynx, painful, 45, 124

_Latrodectus (Latrodectus mactans), 112_ , for

anxiety producing pain, 38

Laughter, excessive, 61

Law of Similars, 2–3

Lead, pencil _see Graphites_

Leading symptoms, 22

Leans on things, 160

_Ledum (Ledum palustre), 113_ ; for

anaesthesia, 37

Leopard's bane _see Arnica_

Leishmaniasis, _113_

Lethargy, 32, 94 _and see_ inactivity

Leukaemia, 33, 60, 96, _113–14_

Leukoplakia, 33, _114_ , 133, 161

Lichen planus, 47, _114–15, 122, 160_

Lichenoid reactions, 33, 34, 35, 77, 90, 98, _115_ , 147

Linear IgA disease, _115_

Lingua villosa _see_ tongue, black hairy

Lingual nerve injury _see_ nerve injuries

Lips

enlarged, 105

fissured, 66, _115_ , 122, 144, 153

swollen, 34, 38, 76, 130

ulcers of, 160–1

_and see_ angular cheilitis

Liquid potency, 8

Liver disorders, 53, 140, 141, 172

Lizard _see Amphisbaena_

LM scale, 12

Loquaciousness, 61, 112

Ludwig's angina _see_ cellulites

_Lueticum (Syphilinum), 116_ ; for

indented tongue, 167

osteoma, 131

Paget's disease, 132

Lumbago, 52

Lung-wort _see Sticta pulmonaria_

Lupus erythematosus, _116_ , 156

_Lycopodium (Lycopodium clavatum), 116_ ; for

xerostomia, 174

Lyme disease, 85, _116–17_

Lymph glands, enlarged, 138

Lymphadenopathy, 97, 101, 161

Lymphangioma, _117_ , 165

Lymphogranuloma venereum, _117_

Lymphoma, 33, 156

**M**

Macroglossia, 36, 105

_Magnesia phosphorica, 118_ ; for

craniomandibular dysfunction, 75

neuralgia, 126

Magnesium, _118_ ; for periodontitis, 135

Magnesium phosphate _see Magnesia phosphorica_

Malnutrition, 60, 155 _and see_ emaciation

Mandible

prognathism, 57

underdevelopment, 105

Mapped tongue _see_ tongue, geographic

MaRAS _see_ aphthous ulcers

Marble bone disease _see_ osteopetrosis

Marfan's syndrome, 78, _118_

Marigold _see Calendula_

Marsh tea _see Ledum_

Materia medica, use of, 20–2

Maxillary

hypoplasia, 105

prognathism, 57

May apple _see Podophyllum_

Measles, _118_ , 144

Meat

averson to, 63

desires preserved and salty, 57

desires smoked and salted, 64

_and see_ food

Median rhomboid glossitis _see_ glossitis

_Medorrhinum_ , 138

_Melaleuca alternifolia see Tea Tree Oil_

Melanoma _see_ pigmentation; tumours

Melanotic macules, 137–8

Melkersson-Rosenthal syndrome, _119_

Memory problems, 154, 171

Meniscus _see_ TMJ

Menopause, 55–6, 5708

Menstrual cycle, and ulcers, 42

Mental fatigue/exhaustion, 49, 111

Mental retardation, 155

_Mercurius corrosivus, 119_ ; for

gangrene, 59

pemphigus, 134

periodontitis, 136

_Mercurius solubilis (Mercurius solubilis Hahanemannii_ ), 3, _119_ ; for

abscess, 30

aphthous ulcers, 43

gingivitis, 94

gingivostomatitis, 96

halitosis, 100

herpangina, 102

indented tongue, case with 167

periodontitis, 136

pulpitis, 143

ranula, 146

sialorrhoea, 155

taste perversion, 162

teething, 15, 163

toothache, 22

Mercury sulphide _see Cinnabaris_

Mercury toxicity, 2–3, 35–6, 74, 86, 155, _181–91_

Methotrexate therapy _see_ folate

Meticulousness, 47

_Mezereum (Daphne mezereum), 120_ ; for

impetigo, 106

pulpitis, 143

ranula, 146

Miasms, 25

Migraine, 68, 83, 86, 92, 105, 106, 116, 122, 128, 140, 144, 151, 153, 157; and

burning mouth syndrome, 56

food allergies, 90

_and see_ headaches; migrainous

neuralgia

Migrainous neuralgia, 15, 48, 68, 83, 86, 106, 107, 110, 122, _124–6_ , 128, 144, 151, 153, 157; and

burning mouth syndrome, 56

food allergies, 90

_and see_ migraine; neuralgia

Milk

allergy to, 121

aversion to, 63

produces diarrhoea, 107

_Millefolium, 120_ ; for haemorrhage, 99

MiRAS _see_ aphthous ulcers

Mobility, 136

Modalities, 15–16

Monkshood _see Aconite_

Mononucleosis _see_ glandular fever

Moods, changeable, 47, 105

Moroseness, 119

Mother tincture (MT/TM), 5–6

Motionlessness, 92 _and see_ inactivity

Mottling _see_ fluoridation; fluorosis

Mountain laurel _see Kalmia latifolia_

Mouth

cold, 69, 136

dry, 110, 136, 137

dry alternating with salivation, 136

erosions, 134

fissures, 38–9

lesions, 133

limited opening, 97, 152

soreness, 34, 114, 122

_and see_ burning mouth syndrome;

xerostomia

Mouth-breathing, 33, 50, 56, 57, _121_ , 144, 160

Mouthwashes, 34, _121_ , 141, 174; for

aphthous ulcers, 43, 103

aspirin burn, 47

bitten cheek or tongue, 53

black hairy tongue, 166

candidosis, 52, 61

chickenpox, 67

dry socket, 78

folate deficiency, 89

gingivitis, 94, 95

gingivostomatitis, 96

hand, foot and mouth disease, 100

herpangina, 102

inflammation, 122

lichenoid reactions, 115

lichen planus, 114

lupus erythematosus, 116

necrotising sialometaplasia, 123

orthodontic problems, 130

pemphigus, 134

perocoronitis, 135

periodontitis, 136

scaling and polishing, 151

soreness, 114, 122

wounds, 58–9

Mucocele, _121_ , 156

Mucormycosis _see_ fungal diseases

Mucosa

erythematous, 60

tags, 76, 130

whitening of, 34, 111, 114

Mucous glands, enlarged, 111

Mucous membrane

dry, 122

pemphigoid, 46, 119, _134_ , 141, 148

_and see_ salivation; xerostomia

Mullein _see Verbascum_

Multiple sclerosis, _121_ , 127

Mumps, 109, 119, _121_ , 144, 150

Muscle spasm, better for heat, 75 _and see_ dystonia

_Mycoplasma pneumoniae nosode_ , for

erythema multiforme, 82

_Myristica, 122_ ; for

abscess, 30

cellulitis, 66

_Myrrh, 122_ ; for

aphthous ulcers, 43

black hairy tongue, 166

Crohn's disease, 76

dry socket, 78

gingivitis, 95

hand, foot and mouth disease, 100

lichen planus, 114

lichenoid reactions, 115

lupus erythematosus, 116

necrotising sialometaplasia, 123

orofacial granulomatosis, 130

pemphigus, 134

pericoronitis, 135

periodontitis, 136

scaling and polishing, 151

**N**

Naevus _see_ haemangioma; sponge naevus

Nails, problem with, 40, 87, 156, 174

_Natrum carbonicum, 122_ ; for tension headache, 164

_Natrum muriaticum_ , 16, 88, _122_ ; for

aphthous ulcers, 43, 44

black hairy tongue, 166

burning mouth, 56

epulis, 81

facial pain, 86

geographic tongue, 93

gingivitis, 95

halitosis, 100

herpes labialis, 102

lip fissures, 115

migrainous neuralgia, 125

periodontitis, 137

ranula, 146

Sjögren's syndrome, 156

taste perversion, 162

tension headache, 164

xerostomia, 174

_Natrum phosphoricum, 122_ ; for lichen planus, 115

_Natrum sulphuricum_ for

amalgam problems, 36

concussion, 72

epilepsy, 25

Nausea, 37, 107, 125, 140 _and see_ travel-sickness

Necrotising sialometaplasia, _123_

Needles, broken _see_ foreign bodies

Nerves, injured, 37, 104–5, _124 and see_ Bell's palsy; facial nerve palsy

Nervous fatigue, 174

Nervous modalities, 16

Nervousness, 54, 66, 72, 133 _and see_ anxiety

Neuralgia, 45

facial, 63, 64, 111, 133, 141

glossopharyngeal, _124_ , 165

orofacial, 116

post-herpetic, 110, _126_ , 172, 173

_and see_ migrainous neuralgia; trigeminal neuralgia

Neurological disorders, 50

Niacin _see_ pellagra

Nicotinamide _see_ pellagra

Nitric acid _see Nitricum acidum_

_Nitricum acidum (Acidum nitricum), 127–8_ ; for

amalgam problems, 36

aphthous ulcers, 43

diarrhoea, 40

ecthyma contagiosum, 79

gingivitis, 94

halitosis, 100

periodontitis, 137

ranula, 146

Noise, sensitivity to, 41, 54, 72, 122

Noma _see_ cancrum oris

Non-communication, 41

Nosebleed _see_ epistaxis

Nosodes, 4

Nostalgia, 49

_Nux vomica, 128_ ; for

halitosis, 100

tension headache, 164

tongue problems, 167

xerostomia, 174

**O**

Obesity, 110 _and see_ fatness; overweight

Obsessive nature, 49, 165

Octanoic acid _see_ Caprylic acid

Odontalgia _see_ facial pain

Odontophobia _see_ anxiety

Oedema, 34, 37, 45, 97, 110 _and see_ swelling

Oesophageal stricture, 152

OFG _see_ orofacial granulomatosis

_Oleum caryophylli see Clove oil_

Onions, intolerance of, 165

_Opium, 129_ ; for anaesthesia, 37

Oral contraceptives, 171

Oral surgery, 58, 66, _129–30_ , 145, 158, 173

Orf _see_ ecthyma contagiosum

Orifices, red, 160

Orofacial granulomatosis, 34, 90, 119, _130_

Orofacial pain _see_ facial pain

Orthodontics, 60, _130–1_ , 149, 155

_Oscillococcinum, 131_ ; for colds and flu, 72

Osteitis deformans _see_ Paget's disease

Osteogenesis imperfecta, 57, 78, _131_ , 160

Osteoma, _131_ , 168

Osteomyelitis, 36, 59, 87, 101, _131_ , 132, 138, 156

Osteopathy, 74, _131–2_ , 163

Osteopetrosis, 57, _132_ , 160

Osteoporosis _see_ Calcium

Osteosarcoma _see_ fluorosis; tumours

Osteosclerosis _see_ fluorosis

Overactivity, 72

Overenthusiasm, 41

Overindulgence, 34

Overstimulated by pleasant events, 72

Overweight, 165 _and see_ fatness; obesity

Overwhelmed but competent, 48

Overwork, 128, 154

Oyster shell _see Calcarea carbonica_

**P**

Paget's disease, 47, 57, 101, 104, 116, _132_ , 156

Pain

acute, 54, 63

after local anaesthetic, 45

and anxiety, 38

appears and disappears abruptly, 63

better for

cold, 45, 157

cold water in mouth, 78

heat, 54, 118, 157

passing wind, 151

pressure on affected part, 54

rest, 54, 151

in the bone, 37, 149

on contact, 68

on eating, 110

from fractures, 54

hypersensitivity, 67, 72

on intercourse, 50

knife-like, 126

lancinating, 54, 63, 68, 105, 126, 133

left-sided, 133

localised, 110

periodic, 151

periorbital, 68

piercing, 54

preauricular, 74

pricking, 127, 133, 157

right-sided, 118, 151

sensitivity to 41, 66, 105

severe, 63

sharp, 174

shooting, 37, 105, 126

splinter-like, 43

on swallowing, 124

throbbing, 22, 30, 50, 143, 151

twice daily, 170

wandering, 137

whole body, 138

worse for

cold, 118, 142, 157

heat, 45, 157

light, 151

movement, 54, 105, 111, 151, 157, 170

noise, 151

pressing teeth together, 170

shaking, 157

smells, 151

sneezing, 170

talking, 170

temperature change, 170

touch, 54, 133, 157

_and see_ burning pains; facial pain; headaches; oral surgery; pain control; pain threshold; toothache

Pain control, after surgery, _129–30_

Pain threshold, _132_

Palate

blue/purple patches, 111

flat, 56

ulcerated, 146

well arched, 57

_and see_ necrotising sialometaplasia

Paleness, 47, 63, 86, 122, 174

Palsy _see_ Bell's palsy; cerebral palsy; facial nerve palsy

Panic _see_ anxiety

Papal-Cross spider _see Aranea diadema_

Papillae, atrophied, 134

Papilloma, squamous, _133_

Papillomavirus, 33, _133_ , 165

Paracoccidiomycosis _see_ fungal diseases

Paraesthesia, trigeminal, 33

Paralysis, at unpleasant events, 92

_Paris quadrifolia, 133_ ; for neuralgia, 126

Parkinson's disease, 155

Parodontal abscess _see_ abscess

Parotitis, 154 _and see_ sialectasis

Paroxysmal hemicrania _see_ migrainous neuralgia

Pathogenesis, 3

Pathological prescribing, 18, 23

Pathological remedies, 10, 15

Pathological simillimum, 17

Pellagra, 60, _133–4 and see_ gingivitis

Pemphigoid, mucous membrane _see_ mucous membrane

Pemphigus, 46, 119, _134_ , 148

Peptic ulcer, prone to, 128

Perfectionists, 49

Periapical abscess _see_ abscess

Periapical cyst _see_ endodontics

Pericoronitis, 66, 96, 101, 119, _134–5_ , 141,168

Periodic modalities, 16

Periodontitis, 53, 56, 57, 68, 70–1, 91, 110,111, 119, 122, 128, _135–7_ , 138, 151,153, 156, 158, 165; and

AIDS, 33

caries, 64

calculus, 58

deficiencies, 118, 170, 172, 174

diabetes, 77

mouthwash for, 122

prosthetics, 141

taste perversion, 162

_and see_ traumatized tooth

Perioral dermatitis, _137_ , 160 _and see_ dermatitis

Perlèche _see_ angular cheilitis

Peruvian bark _see China_

Petechiae, 114, 164

Petting, childrens' desire to be petted, 67, 163

Peutz-Jegher's syndrome, _137–8 and see_ pigmentation

Pharmacy, 177–8

Pharyngitis, 45

Phenol _see Carbolicum acidum_

Phenytoin therapy _see_ folate; gingivitis

Philosophical nature, 160

Phobias, 41, 45

_Phosphorus_ , 88, _138_ ; for

anaesthesia, 37

burning mouth, 56

dry socket, 78

haemorrhage, 99

median rhomboid glossitis, 119

osteomyelitis, 131

periodontitis, 136

xerostomia, 174

Physical trauma _see_ trauma

_Phytolacca (Phytolacca decandra_ ), _138_ ; for

amalgam problems, 36

halitosis, 100

teeth grinding, 54

Picking up, does not desire, 68

Pigmentation, 32, 33, 137–8, _138 and see_ amalgam tattoo

_Pilocarpus jaborandi see Jaborandi_

Pituitary problems _see_ acromegaly

Placidity, 144

_Plantago (Plantago major), 139_ ; for

cervical sensitivity, 66

dry socket, 78

pulpitis, 143–144

scaling and polishing, 151

traumatised tooth, 168

Plantain _see Plantago_

Pleomorphic salivary adenoma, 112 _and see_ salivary glands

_Plumbum aceticum_ , for epulis, 81

Plummer-Vinson syndrome _see_ Iron

Plumpness, 110

Pocketing, 136

_Podophyllum (Podophyllum peltatum_ ), _140_ ; for

indented tongue, 167

sialorrhoea, 155

teeth grinding, 54

teething, 163

tension headache, 164

Poison Ivy _see Rhus toxicodendron_

Poison nut _see Nux vomica_

Poke-root _see Phytolacca_

Polychrest, 22–3

Polyps, 165

fibro-epithelial, 87

intestinal, 137–8

Pomegranate _see Granatum_

Positional modalities, 16

Possessiveness, 48

Potassium bichromate _see Kali bichromicum_

Potassium carbonate _see Kali carbonicum_

Potassium chlorate _see Kali chloricum_

Potassium chloride _see Kali muraticum_

Potassium phosphate _see Kali phosphoricum_

Potency, 9–10, 23

Potentisation, 6–8, 11

Pre-exam nerves, 45

Pregnancy, 60

Prescribing, 25, 26

Pride, 49, 112

Problems easily forgotten when distracted,105

Progressive systemic sclerosis _see_ scleroderma

_Propolis, 141_ ; for

aphthous ulcers, 42–3

chickenpox, 67

Crohn's disease, 76

dry socket, 78

endodontics, 80

gingivitis, 94

gingivostomatitis, 96

herpangina, 102

herpes labialis, 102

impetigo, 106

lip fissures, 115

orofacial granulomatosis, 130

pemphigus, 134

periocoronitis, 135

pulpitis, 142, 144

pyostomatitis vegetans, 145

tooth reimplantation, 146

Prosopalgia _see_ trigeminal neuralgia

Prosthetics, 58, 60, 118, _141_ , 155

Prostration, 50

Proving, 3, 14–15

_Prunus spinosa, 141_ ; for

herpes zoster, 103

pulpitis, 143

trigeminal neuralgia, 126

Pruritis, 87, 160

Pseudomembrane formation, 97

_Ptelea, 141_ ; for sialorrhoea, 155

Ptyalism _see_ sialorrhoea

Puberty, precocious, 57

Pulpal exposure, 141

Pulpitis, 31, 45, 50, 54, 56, 66, 69, 71, 86, 101, 119, 120, 139, 141, _142–4_ , 145, 153; and

endodontics, 80

_and see_ traumatised tooth

_Pulsatilla (Pulsatilla nigricans)_ , 18, _144_ ; for

burning mouth, 56

gingivitis, 95

halitosis, 100

indented tongue, 167

lip fissures, 115

measles, 118

migrainous neuralgia, 125

mouth-breathing, 121

mumps, 121

taste perversion, 162

xerostomia, 174

Puncture wounds, 113 _and see_ anaesthesia, local

Pus, yellow and thick, 120

Pyogenic granuloma _see_ epulis

Pyorrhoea _see_ periodontitis

Pyostomatitis vegetans, 76, _145_

_Pyrethrum parthenium see Feverfew_

_Pyrogen (Pyrogenium), 145_ ; for

abscess, 30

dry socket, 78

gangrene, 59

osteomyelitis, 131

pulpitis, 142

septicaemia, 154

subacute bacterial endocarditis, 160

**Q**

Quarrelsomeness, 64

**R**

Radiography, _145_

Radiotherapy, 173

Ramsay-Hunt syndrome, 67, 85, _145_ , 148, 172, 173

Ranula, 36, 56, 112, 119, 120, 127, _145–6_ , 158, 165

RAS (recurrent aphthous stomatitis) _see_ aphthous ulcers

Rashes, 116, 161, 165

Raynaud's phenomenon, 152

Recidivism, 119

Recurrent aphthous stomatitis (RAS) _see_ aphthous ulcers

Redness, 50, 136

Reiter's syndrome, _146_ , 148

Reliable type, 49

Remedies, 4

action, 14

administration, 12–13, 23

combination, 23–4

and drugs, 26

preparation, 5–6

prescription, 23

selection, 5–6, 15–16

storage, 12–13

Rendu-Osler-Weber disease _see_ telangiectasia, haemorrhagic

Repertory, use of, 19–20, 21–2

_Rescue Remedy_ , 38, 48, 49, 72

Resentment, 49

Resignation, 49

Restlessness, 41, 67, 148, 160, 174

Retinal vasculitis, 50

_Rheum (Rheum officinale), 146_ ; for teething, 163

Rheumatoid arthritis, _147–8_ , 156, 163, 174

_Rhododendron chrysanthum, 148_ ; for

neuralgia, 126

Rhubarb _see Rheum_

_Rhus toxicodendron_ , 6, _148_ ; for

chickenpox, 67

craniomandibular dysfunction, 75

ecthyma contagiosum, 79

herpes labialis, 102

herpes zoster, 103

indented tongue, 167

jaw fractures, 90

median rhomboid glossitis, 119

pemphigus, 134

Ramsay-Hunt syndrome, 145

Reiter's syndrome, 146

Sjögren's syndrome, 156

TMJ problems, 163

xerostomia, 174

Riboflavine _see_ vitamin B2

Robustness, 54

Rock salt _see Natrum muriaticum_

Root canal work _see_ endodontics

Rubeola _see_ measles

Rudeness, when in pain, 66

Rue _see Ruta_

_Ruta (Ruta graveolens), 149_ ; for

anaesthesia, 37

dry socket, 78

endodontics, 80

eye strain, 85

jaw fractures, 90

orthodontic problems, 131

pain control after surgery, 129

sprains, 173

tooth reimplantation, 146

traumatised tooth, 168

**S**

Sadness, 97

_Sage_ for, aphthous ulcers, 43

St Ignatius' bean _see Ignatia_

St John's Wort _see Hypericum_

Salivary calculus, _149–50_ , 156 _and see_ calculus

Salivary gland disorders, 33, 57, 112, _150–1_ , 156

Salivary gland stone _see_ salivary calculus

Salivation

alternating with dryness, 136

cold, 69

copious, 43, 155

excessive, 22, 30, 109, 119, 136, 163

with halitosis, 143

thick, 43

viscid, 103, 110

_and see_ sialorrhoea; Sjögren's syndrome;

xerostomia

Salt

desire for, 122

mouthwashes, 30

_Sanguinaria canadensis, 151_ ; for migrainous

neuralgia, 15, 126

Sarcoidosis, 50, _151_

Scalds, _151_ , 173

Scaling and polishing, _151_

Scar tissue, 50, 77, 97, _151–2_ , 164 _and see_ keloid scars

Schizophrenia, 155

Sclerodactyly, 152

Scleroderma, _152_ , 156

Scoliosis, 57

Scrofulous, _153_

Scrotal tongue _see_ tongue, fissured

_Scutellaria (Scutellaria lateriflora), 153_ ; for

neuralgia, 124, 126

Sedentary occupation, 128

Selenium, _153_ ; for periodontitis, 135

Self-confidence, lack of, 48, 136

Self-disgust, 48

Selfishness, 48

Sensitivity

cervical, 139

to cold air, 69

emotional, 57, 165

to noise, 72, 110

to pain, 41, 66, 105, 110

skin, 64, 101

teeth, 139

to problems of others, 64

Sentimentality, 57, 138

_Sepia_ , 16, _153–4_ ; for

aphthous ulcers, 44

burning mouth, 56

facial pain, 86

gingivitis, 95

herpes labialis, 102

indented tongue, 167

irritability, 22

lip fissures, 115

migrainous neuralgia, 125

pulpitis, 142

tension headache, 164

xerostomia, 174

Septicaemia, 145, _154_

Sequestrum, _154_ , 156

Sex

disinterest or abhorrence, 154

perversions, 119

repression, 158

Shingles _see_ herpes zoster

Shock, 49 _and see_ collapse; timidity

Sialectasis, 33, 57, 150, _154–5_ , 156

Sialolith _see_ salivary calculus

Sialometaplasia _see_ necrotising sialometaplasia

Sialorrhoea, 34, 77–8, 97, 109, 119, 140,141, _155_

Sialosis, _77 155_

Siberian rhododendron _see Rhododendron chrysanthum_

Sicca syndrome _see_ Sjôgren's syndrome

Sighs frequently, 106

Silence, 92

_Silicea (Silica), 156_ ; for

actinomycosis, 32

black hairy tongue, 166

delayed eruption, 82

dry socket, 78

endodontics, 80

expulsion of foreign bodies, 90

fistula, 87

implants, 105

incisional abscess, 107

mucocele, 121

osteomyelitis, 131

Paget's disease, 132

periodontitis, 136

salivary calculus, 150

sequestrum, 154

xerostomia, 174

Silver _see Argentum metallicum_

Silver nitrate _see Argentum nitricum_

Simillimum, 3–4, 17

Sinusitis, 110

Sjögren's syndrome, 122, 148, _156_ ; and

biliary cirrhosis, 53

lupus erythematosus, 116

rheumatoid arthritis, 147–8

salivary glands, 150

scleroderma, 152

sialectasis, 155

xerostomia, 173

Skin problems, 160

blotchy, 112

crawling sensation, 127

denuded with honey coloured crusts, 105

dry, 174

flushed, 98

fragile, 80

mottled, 144

rash, 40

red, 137

rough, 87

scaled, 171

sensitive to touch, 64, 101

unhealthy, 101

Skullcap _see Scutellaria_

Sleep

after meals, 128

agitated, 68

poor, 72

_and see_ insomnia

Slouching, 160

Slovenliness, 160

Slowness, 56, 119, 174

Small build, 57

Smartness, 47

Smelling salts, 37, 72, _156_

Smells, hypersensitivity to, 105

Smokers, 111, 172

Sneezing, in morning, 128

Sociable types, 138

Socket _see_ dry socket

Sodium borate _see_ Borax

Sodium carbonate _see Natrum carbonicum_

Sodium chloride _see Natrum muriaticum_

Sodium phosphate _see Natrum phosphoricum_

Solid and reliable type, 49

Solitary type, 57

Soreness, mouth, 34, 114, 122

Spasms _see_ dystonia; muscle spasm

Speech

cannot finish sentence, 61

spluttering, 119

Spiders _see Aranea diadema; Latrodectus_

_Spigelia, 157_ ; for

halitosis, 100

migrainous neuralgia, 15, 126

tension headache, 164

Spitefulness, 67

Sponge naevus, white, _157–8_

Sprains, 46, 57, 122, 149, 173

_Staphysagria (Staphisagria), 158_ ; for

amalgam problems, 36

caries, 64

craniomandibular dysfunction, 74

pain control after surgery, 129

periodontitis, 136

ranula, 146

Stavesacre _see Staphysagria_

Stevens-Johnson syndrome _see_ erythema multiforme

_Sticta pulmonaria, 158_ ; for jaw fractures, 91

Stiffness

jaw, 37, 113, 164

whole body, 138

Stomach problems, 45

Stomatitis, 134

Stomatitis artefacta _see_ cheeks, biting

Stone _see_ salivary calculus

Strawberry _see Fragaria_

Stress, 42, 105

_Strontium carbonicum, 160_ ; for TMJ

disloction, 78

Subacute bacterial endocarditis, 89, _160_

Succussion, 7, 9

Sugar, excessive intake, 60

Sulkiness, 112

Sullenness, 68

_Sulphur, 160_ ; for

amalgam problems, 36

angioedema, 38

aphthous ulcers, 44

Behçet's disease, 50

burning mouth, 56

chickenpox, 67

delayed eruption, 82

halitosis, 100

herpes labialis, 102

lichen planus, 115

mouth-breathing, 121

perioral dermatitis, 137

taste perversion, 162

xerostomia, 174

Suppliers, 179

Suppression, 48

Susceptible typologies, 16, 17–18

Suspiciousness, 112

Sweating, 98, 109, 119, 156, 160, 165

Sweetness, desire for, 116, 160

Swelling

mouth, 50

tongue, 38, 134

_and see_ oedema

Sympathy, need for, 64

_Symphytum, 160_ ; for

bone-grafts, 54

fractures, 54, 90

implants, 106

osteogenesis imperfecta, 131

osteopetrosis, 132

Symptoms

better for

cold, 54, 138

cold water in mouth, 71

dry weather, 138, 156

exercise, 154

fresh air, 116, 160

heat, 40, 64, 66, 148, 156

hot baths, 40

humidity, 64

movement, 148

summer, 156

sweating, 92

sweetness, 160

urinating, 92

walking in fresh air, 97

concomitant, 15

laterality, 15

periodic, 160

worse for

alcohol, 63

at night, 68

bad news, 92

before storms, 138

between 4 and 8pm, 116

change in climate, 57

cold, 45, 72, 110, 119, 138, 156, 165

cold bathing, 40

cold weather, 138

direct heat, 40

draughts, 101, 156

dry cold, 101

fat or rich food, 110

fats, 144

heat, 54, 63, 71, 87, 92, 107, 116, 119, 144

humidity, 45, 63, 68, 165

intellectual work, 45

lying on left side, 138

movement, 138, 148

music, 97

pressure, 110

storms, 148, 154

sweets, 45

temperature extremes, 68

touch and pressure, 101

wet weather, 138, 148

windy weather, 148

winter, 156

_Syphilinum see Lueticum_

Syphilis, _160–1_

**T**

Tags, mucosal, 76, 130

Talkativeness, 41, 133, 138

Tallness, 57, 138

_Taraxacum, 161_ ; for geographic tongue, 93

Tartar _see Antimonium tartaricum_ ; calculus

Taste

bad, 140

bitter, 141

diminished or lost, 40, 52, _161–2_

distorted, 136, 147

metallic, 162

perversion of, 97, 119, 122, 128, 144, 160, _162_

sour, 136

_Tea Tree Oil (Oleum melaleucae), 163_ ; for

angular cheilitis, 39

candidosis, 61

herpes labialis, 102

impetigo, 106

Tearfulness, 144 _and see_ cries easily; weepiness

Teeth

anterior, broad, 56

black stained, 136

crowded, 57

long, 57

loosening, 136

movement of, 57

narrow, 57

reimplantation, _146_ , 149

sensitive, 139

separation of, 132

small, 57

yellowish, 57

_and see_ eruption; teething

Teeth clenching/grinding _see_ bruxism; bruxomania

Teething, 15, 66, 119, 146, _163_

and diarrhoea, 140, 146, 163

Telangiectasia, 152

haemorrhagic, _101_

Temporal arteritis _see_ giant cell arteritis

Temporomandibular joint _see_ TMJ

Tenderness, of jaw, 74

Tension headache, 92, 106, 110, 116, 122, 128, 140, 157, _163–4 and see_ headache

Tetanus, _164_ , 168

Thalassaemia minor, 108, _164_

Therapeutic index, 15, 21–2

Thermal and thermoclimatic modalities,16

Thiamine _see_ vitamin B1

Thin types, 45, 47, 57, 64, 97, 107, 116, 122, 138, 156, 160

_Thiosinaminum, 164_ ; for

salivary gland problems, 150

scar tissue, 152

Thirst, 47, 50, 54, 122, 140, 160

Thirstless, 92, 144

Threadworms, 68

Throat

clears repeatedly, 45

lump in, 105

painful, 124

sore, 138

Throbbing sensations, 50, 107, 143

Thrombocytopenia, 33, _164_

Thrombophlebitis, 50

Throwing away, 66, 67, 68

Thrush _see_ candidosis

_Thuja (Thuja occidentalis_ ), _165_ ; for

caries, 64

epulis, 81

erythema multiforme, 83

focal epithelial hyperplasia, 88

gingivitis, 95

glossopharyngeal neuralgia, 124

lymphangioma, 117

neuralgia, 126

papilloma, 133

papillomavirus, 133

periodontitis, 137

ranula, 146

scar tissue, 151

skin rash, 40

verruca vulgaris, 170

Thyropenia, _166_

Tic douloureux _see_ trigeminal neuralgia

Tick bites _see_ Lyme disease

Tics, 166

Time modalities, 16

Timidity, 36, 48, 54, 57, 119, 144, 156

Tiredness, 63, 64, 66, 86, 111, 174 _and see_ exhaustion; fatigue; weariness

TMJ (temporomandibular joint) disorders;78, 97, 147, 148, 160, _163, and see_ craniomandibular dysfunction

Tobacco sensitivity, 41, 105

Tocopherol _see_ vitamin E

Tongue

bitten, 53

black hairy, 110, 122, 156, _166_

burning, 172

centre

red, 50, 160

yellow, 144

coated, 94, 136, 140, 148

creamy, 40, 122

white, 40, 128, 162

yellow, 122

depapillated, 172

dry, 110, 112, 136

edge, red, 40

fissured, 119, 128, _166_ , 171

geographic, _92–3_ , 110, 116, 122, 161, 174

imprinted, 43, 103, 110, 119

indented, 47, 56, 107, 116, 140, 144, 148, 155, _167_

indurated, 136

lesions, 117

magenta, 171

moist, 140

painful, 89, 134

pale, 34, 136

red, 89, 110, 118–19, 134, 172

shiny, 89, 110, 134

smooth, 89, 110, 134, 136

sore, 172

'strawberry', 91

swollen, 38, 134, 145–6

thrusting, 56

tip, red, 148, 160

ulcerated, 117, 119, 146

varicose sublingual veins, 128, 167

_and see_ burning mouth syndrome

Tongue leaders, _167_

Tonsils, enlarged, 33, 57

Toothache, 70, _167_

better for

clenching teeth, 143

cold, 72, 143

cold water, 22, 32, 41, 66, 69, 143

during periods, 154

eating, 143

on flying, 32, 66, 71

increases progressively, 143

nocturnal, 45, 143

in non-carious teeth, 136

radiates, 143

right-sided, 36

severe, 142

on thermal stimulation, 142

throbbing, 143

violent and sudden, 143

worse for

afternoon, 36

air, 36

before periods, 154

cold air, 56

contact with tongue, 143

dampness, 36

eating, 143

evening, 36

heat, 143

hot food, 66, 143

lying down, 69

motion, 36

Toothpastes, 43, 88, 111, 151, _167–8_

Torus mandibularis, _168_

Torus palatinus, _168_

Touch

dislikes, 112

does not desire, 68

increases pain, 54, 133, 157

Toxicity _see_ mercury toxicity

Trauma, 25, 42, 46, 52

to nerves, 105

tooth, 86, _168_

Travel-sickness, 175 _and see_ nausea

Trembling, 41, 92

Trench mouth _see_ gingivitis, acute necrotising ulcerative

Trigeminal anaesthesia/paraesthesia, 33

Trigeminal neuralgia, 54, 68, 105, 118, _126–7_ , 148, 153, 157, 165, 170; and

AIDS, 33

multiple sclerosis, 121

Trismus, 66, 74, 105, _168_

Trituration, 11

Tropical sprue, _169_

Tuberculosis, 150, _169_

Tuberculosis nosode _see Bacillinum_

Tumours, 46, 52, 88, 89, 101, 150, _169 and see_ carcinoma; Leishmaniasis

**U**

Ulcerative colitis,42, 145

Ulcers, 87; and

allergies, 34

Behçet's disease, 50

chickenpox, 67

conjunctiva, 50

gingivostomatitis, 96

gonorrhoea, 97

herpes simplex, 102

leukaemia, 114

linear IgA disease, 115

mouthwash for, 122, 141

orofacial granulomatosis, 130

oropharynx, 145

palate, 146

periodontitis, 137

Ramsay-Hunt syndrome, 145

syphilis, 161

tongue, 117, 119, 146

tropical sprue, 169

varicose veins, 63, 87

_and see_ aphthous ulcers; lips

Uragoga Ipecacuanha _see Ipecacuanha_

Urethritis, 146

Urinary stone formation, 56

Urination, worse for putting hands in cold water, 22

Urine, offensive, 122

Uveitis, 50

**V**

Varicella _see_ chickenpox

_Varicella nosode_ , 145; for

herpes zoster, 103

neuralgia, 126

Varicose veins, 87, 128, 154, 167, 172

Vascular naevus _see_ haemangioma

Vasculitis, retinal, 50

_Veratrum album_ , for collapse, 72

_Verbascum, 170_ ; for, neuralgia, 126

Verruca vulgaris, 133, _170_

_Vervain_ , and G–6–PD deficiency, 13–14

Vincent's stomatitis _see_ gingivitis, acute necrotising ulcerative

Vindictiveness, 112

Virgin's bower _see Clematis erecta_

Visual disturbance, 68, 107, 110, 125, 157

Vitamin A, _170_ ; for periodontitis, 135

Vitamin B1 (Thiamine), _171_

deficiency, 42, 55, 170

Vitamin B2 (Riboflavine), _171_

deficiency, 55, 60, 170

for

angular cheilitis, 39

fissured tongue, 166

Vitamin B6 (Pyridoxine), _171_

deficiency, 42, 55, 147, 170

for carpal tunnel syndrome, 64

Vitamin B12 (Hydroxocobalamin), _171–2_

deficiency, 42, 55, 60, 89, 169, 170

for

burning mouth, 55–6

Crohn's disease, 76

herpes labialis, 102

herpes zoster, 103

neuralgia, 126

Ramsay-Hunt syndrome, 145

Vitamin C (Ascorbic acid), _172_

deficiency, 60, 172

for

herpes labialis, 102

herpes zoster, 103

iron deficiency, 108

periodontitis, 135

tooth reimplantation, 146

Vitamin D (Calciferol), _172_

and calcium, 57–8

deficiency, 172

Vitamin E (Alpha-tocopherol), _172–3_ ; for

aphthous ulcers, 44

burns, 57

carcinoma prevention, 111

gingivostomatitis, 96

herpes zoster, 103

leukoplakia, 114

neuralgia, 126

periodontitis, 135–6

Ramsay-Hunt syndrome, 145

scalds, 151

scar tissue, 151–2

Voice loss _see_ laryngitis

von Willebrand's disease, _173_

**W**

Wallflower _see Cheiranthus_

Warts, 165 _and see_ verruca vulgaris

Washing, dislikes, 160

Water ash _see Ptelea_

Weakness, 47, 68, 86, 92, 111, 122, 156, 171

Weariness, 110 _and see_ tiredness

Weepiness, 97 _and see_ cries easily; tearfulness

Weight loss, 32, 94

Well-fed appearance, 54

Well-read, 160

Whining, 67, 163

Wisdom teeth _see_ pericoronitis

Withered types, 45, 116

Wormseed _see Cina_

Wound-wort _see Bellis perennis_

Wounds, healing, 58–9, 172, 174

Wrist Sprains, _173_

**X**

_X-ray_ , 145

X-rays _see_ radiography

Xerostomia, 31, 47, 54, 63, 106, 110, 112, 116, 122, 128, 138, 144, 147, 148, 153, 156, 160, _173–4_ ; and

AIDS, 33

burning mouth syndrome, 56

candidosis, 60

caries, 64

lupus erythematosus, 116

Sjögren's syndrome, 156

_and see_ mouth, dry

_Ximenia americana_ , for extractions, 84

**Y**

Yarrow see _Millefolium_

Yawning, 68

**Z**

Zinc, _174_

deficiency, 42, 60, 174

for

aphthous ulcers, 44

endodontics, 80

geographic tongue, 93

gingivitis, 95

herpes labialis, 102

periodontitis, 135–6

taste loss, 162

tooth reimplantation, 146

Zinc phosphide _see Zincum phosphoricum_

_Zincum metallicum, 174_ ; for teeth grinding, 54

_Zincum phosphoricum, 174_ ; for

craniomandibular dysfunction, 75

_Zingiber, 175_ ; for colds and flu, 72
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##### Version 1.0

##### Epub ISBN 9781446489789

##### www.randomhouse.co.uk

##### First published in Great Britain in 1995  
by The C.W. Daniel Company Limited  
1 Church Path, Saffron Walden  
Essex, CB10 1JP, United Kingdom

##### © Colin B. Lessell 1995, 2000

##### ISBN 0 85207 281 3

##### Revised edition 2000