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EXPOSURE AND REMOVAL OF THE DENTAL PULP. 141

capsule (always made fresh for each case), and a small pellet of
cotton saturated with this solution is placed in the cavity upon
the exposed pulp. Over this place a pellet of soft, or unvulcan-
ized, vulcanite rubber that will completely fill the orifice of the
cavity and prevent the escape of the solution. Upon this make
pressure with a broad-faced amalgam plugger. The pressure
should be gentle at first, and be gradually increased as the pain
is relieved, watching for evidence of pain in the countenance of
the patient, until very heavy pressure can be made. This should
be maintained for several minutes. Then if all has gone well
the rubber and the cotton may be removed, and the pulp will
be found insensible and its removal may be proceeded with.*
In anaesthetizing the pulp in this way notice particularly that
the cavity must be so stopped with the soft rubber as to prevent
the escape of the solution along the cavity walls, otherwise the
pressure will fail to force the drug into the pulp tissue and the
anaesthesia will fail. This is fairly easy of accomplishment in
the cavity named above and those of similar form and situation.
But in proximate cavities it is often much more difficult to so
place the rubber that it will successfully stop the orifice of the
cavity and prevent the escape of the fluid. In the molars and
bicuspids this may be successfully done by first placing a properly
formed piece of rubber against the proximating surface of the
adjacent tooth and forcing it against the gingival wall of the
cavity, and then doubling it over the occlusal portion so as to
close that also, and then applying pressure with a broad instru-
ment point selected to fit the cavity to the best advantage. As
one becomes expert in this, most cavities may be so handled as
to successfully produce anaesthesia of the pulp.
Opening the pulp chamber preparatory to removal
of the pulp.—When the pulp has been destroyed by arsenic,
the procedure when the patient has returned for the next sitting
is first to adjust the rubber dam. In proximate cavities in which
the gutta-percha filling has been placed firmly against the
proximating tooth, the filling must first be cut through with a
Koeber saw, or trimmed away with a sharp finishing knife in
order to allow the rubber dam to pass. When the dam is in
position sterilize the field of operation by mopping the teeth
included, their interproximate spaces and the adjacent rubber
* Prof. A. H. Peck's Lectures, 1899.