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17S OPERATIVE DENTISTRY
hyperemia, which is the initial stage of a destructive disease, and
will respond immediately to the application of anodyne and effectual
protection from air and fluids, which is accomplished by stopping
the cavity with a non-conductor, generally cotton, or temporary stop-
ping, or an application of phenol.
If Warm Fluids Cause or Intensify the Pain and the application
of cold relieves the pain temporarily, the pulp will be found to be
well advanced in the stages of dissolution, some portion of which
has been resolved into the end products. Gaseous substances oc-
cupy portions of the pulp cavity, which is closed over the entire
coronal portion by a layer of dentine, a filling or a plug of foreign
substance. These gases are expanded by the elevation of the tem-
perature, causing increased pressure upon the remaining vital por-
tions of the pulp and intense pain results, which is further aug-
mented, many times, by the pulsations of the heart. The pulsating
symptom in this instance indicates that quite a portion of the pulp
is yet vital.
The Treatment for Relief in This Case, which is called closed
putrescence, is the removal of the obstruction for the escape of the
gas. This involves opening into the pulp chamber through the route
of the least obstruction or injury to the tooth. Necrotic portions of
the pulp should be removed, disinfectants and anodynes applied and
devitalization of the remaining vital portion effected.
If Moderately Warm Fluids Cause Pain as Avell as cold the pulp
is in the first stages of passive hyperemia or congestion. This con-
dition is generally soon followed by the symptom of being more pain-
ful upon the patient's lying down and the throbbing pains setting
in, and man}" times patients will say, "I have the jumping tooth-
ache;" or, ''It began last evening about fifteen minutes after I went
to bed."
Treatment of Passive Hyperemic Pulp for relief is sterilization
of immediate surrounding tissue at the tooth's cavity and the ap-
plication of sedatives and anodynes. If the pulp can be bled with
causing but slight pain it is beneficial ; then proceed to devitalization.
The Painting of the Gum with a revulsive is of service, especially
if the pericementum is taking on the stages of inflammation indi-
cated by slight soreness to percussion.
If the Presence of a Foreign Substance in a cavity causes pain it
may be an exposed pulp which is not very highly organized, or hyper-
sensitive dentine covered with a layer of leathery decay.
The Treatment Is the Removal of the offending object and the
prevention of its recurrence by temporary or permanent stopping.