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EXPOSURE AND REMOVAL OF DENTAL PULP. 363

Exposure and Removal of Dental Pulp, and
Filling of Root Canals.

Exposure of the Dental Pulp.
ILLUSTRATIONS: FICUUES 419-447.
THE pulp of a tooth (1) may be found exposed by caries so
that it lies naked and in view (2) it may have been reached
;
by the extension of caries but remain covered by a softened
carious mass of dentin; (3) it may become exposed by accident
during the preparation of a carious cavity; (4) the conditions
may require that an intentional exposure be made through a
carious cavity that has nearly reached the pulp, or that an inten-
tional exposui'e be made, there being no carious cavity.
The iirst and second cases are so similar that they may
be treated of together, only noticing differences of manipulation
as they occur. In both, the supposition is that the pulp is to be
destroyed and removed. In the first procedure, the problem is
the preparation of the cavity for the treatment of the exposed
pulp, with the least pain and inconvenience to the patient. In
this writing we will not inquire into the conditions of the dental
pulp from the pathological standpoint, but will consider only
the technical procedures in pulp treatment.
The requirement is that the cavity be opened by the removal
of all overhanging enamel and that the surrounding walls be
freed from carious material, perfectly cleaned to solid dentin
and cut to a form that will certainly retain a temporary filling
for the purpose of sealing in applications that may be required
in the treatment of the pulp. It is not required here that the
cavity be cut to the full outline form, as it will be prepared to
receive the permanent filling later, nor that permanent anchor-
ages be provided; but it is required that good and sufficient
anchorage be provided for a temporary gutta-percha filling
against good, clean surrounding walls in every part. It should
be opened sufficiently wide to admit of the free and easy appli-
cation of instruments for the exposure of the pulp. In doing
this, especial care should be taken that the instruments used