Page 143 - My FlipBook

EXPOSURE AND REMOVAL OF THE DENTAL PULP. 139

20-9-12, and having determined the best direction in which to
make a sweeping cut, start its edge carefully under the carious
mass close against one of the walls of the cavity and, with a strong
thrust in a curved direction, carry it across the other side, cut-
ting at once to the full depth of the softened dentin, and if pos-
sible remove the whole mass at the single cut, laying the
pulp bare. This should be carefully planned and firmly exe-
cuted. If the cut should be through the superficial portions of
the pulp, excising a portion of the tissue,
it is just as well, for
when the hemorrhage has ceased we are sure of the best condi-
tion for the absorption of remedies for destroying it, whether
this be done by the application of the arsenic or by the use of
cocaine under pressure. In some broad cavities in which it may
seem that the carious mass is too broad to be removed at a single
cut, one or more preparatory cuts may be made to either side,
avoiding the pulp, before making the principal cut for its
exposure.
An exposure of the pulp made in this way is usually not very
painful, and even if it be very sensitive, the duration of the pain
is reduced to the shortest limit.
In proximate cavities in the incisors the spoons 20-9-12 can
not generally be used for want of room. Much oftener the
spoons 15-8-12 or the discoid are applicable. In these cavities
the most desirable direction for the final cut for exposing the
pulp is from the gingival toward the incisal directly over the
pulp. In these cases the opening into the pulp is apt to be long
inciso-gingivally, and if the broad cutting edge can be placed at
right angles to this it is much safer against dropping into the
pulp chamber and producing unnecessary laceration of the sen-
sitive tissues. By proceeding carefully this position or an angle
closely proximating it can often be obtained, and then the
exposure is made with safety ; a discoid 15 is really the best
instrument for the purpose in this position. By working with
care the exposure maybe made with hatchet 12-5-12, cutting
from labial to lingual, but with much more danger of inflicting
severe pain.
Destroying the dental pulp,— When the pulp has been
fully exfjoscd, the cavity should be ready for the ap[)lication to
the pulp without further [m.-paration. If it is to be destroyed by
arsenic, cut a piece of ordinary writing paper of such size and