Page 209 - My FlipBook

PROTECTION OF THE VITAL PULP 205
The Indications for Pulp Protection are not always clear, but will
involve a consideration of the age of the patient, extent of loss of
dentine, location of the cavity in the tooth, location in the mouth,
length of time the pulp has been exposed, the stage of hyperemia,
the general health of the patient and the possibilities of pulp infec-
tion.
The Age of the Patient has a bearing on the successful issue of a
conservative treatment, as the teeth of the young are more easily
saved from further irritation through capping than are the teeth of
those past middle age, while at the same time they demand capping
more frequently under the same conditions. Again, the pulp should
be saved if possible until the teeth are fully formed, and many times
the teeth of the younger patients are badly decayed and the pulp
in great danger before the teeth are complete, hence if the pulp can
be conserved and devitalization avoided, it is of great good to the
patient.
In Advanced Age the apical openings become smaller and many
liccome much contracted, barely accommodating the vessels with a
normal flow of blood so that a very slight congestion may cause death
fi'om strangulation or gangrene.
When a Large Amount of Dentine Has Been Lost, even though
the pulp as yet seems normal, it is safe practice to avoid the plac-
ing of the best conductors, as gold or amalgam, in close proximity
to the pulp as repeated shocks to the pulp through the filling from
thermal changes may bring on hyperemia of that organ. In the use
of phosphate of zinc cement in such cases, there should be an inter-
Acning media to prevent the irritating effect of phosphoric acid.
The Location of the Cavity is a factor in the demands for pulp
protection, as well as the probability of success in extreme cases.
The first portions of the pulp to show hyperemic conditions are those
nearest to the point of irritation. These congestions are more dan-
gerous when they appear in the body of the pulp, as they do where
decay approaches the pulp in the gingival third. Hence, when a
pulp is nearly exposed in this location it demands greater protection
and is at the same time harder to save than when the horns of the
pulp are involved.
The Location of the Tooth should be considered. Anterior teeth
are subject to greater extremes of heat and cold than are the molars,
hence the demand for preventive protection with the anterior teeth
should be remembered. At the same time their exposed position
makes pulp-capping more hazardous and it should be practiced with
great care in this location. Again, less risk should be taken in the