Page 211 - My FlipBook

PROTECTION OF THE VITAL PULP 207
elimination of the vital ash is imperfect and cell metabolism is defi-
cient, protective means of conservation are more imperative, while at
the same time less risk should be taken in questionable cases.
With Robust and Particularly Plethoric Patients, all inflamma-
tory processes run a rapid and riotous course, and when the pulp
has taken on any stage of hyperemia changes towards dissolution are
of rapid succession.
In Deep-Seated Cavities it is not unlikely that the thin layer of
the dentine covering the pulp is infected and the pulp should be
protected from the invasion by the thorough disinfection of the over-
lying dentine by medication, previous to filling as well as placing
next to the dentine in question and under the filling a permanent
dressing which will exert a mildly antiseptic influence for some time
following the operation.
The Requirements of the Materials Used in Protective Pro-
cedures Are:
First—That they shall be poor conductors of heat and cold.
Second—That they shall be non-changing in character, both as to
consistency and bulk.
Third—That they have no action upon the pulp.
Fourth—That they may be introduced into deep seated cavities
without pressure.
The Materials Advocated for This Purpose Are Numerous and
the market is flooded with preparations of a secret nature which are
warranted to save the pulp in almost any stage of dissolution, but
the operator who pins his faith to such slipshod methods will sooner
or later find that he has been duped and his grief is measured by
the extent to which he has employed these cure-all methods.
There Are Four Distinct Classifications wherein success may be
expected in methods of pulp protection. The treatment of each
class is here given.
First Class. In the Progressive Stage of Caries wherein but lit-
tle dentine has been lost, yet a blast of air from the chip blower
causes a quick, sharp pain, passing off as soon as the draft of air
is checked, we find the simplest form demanding protective measures.
This is the class most often neglected by the operator and many
times irreparable injury is done a pulp by placing in such a cavity
a filling of high conductivity, such as gold or amalgam. The patient
often believes that ''cold water leaks in about the filling" and may
visit another dentist thinking that he has a poor piece of dentistry,
and the patient may be lost to an otherwise good operator, all through
the neglect of what may appear to the operator as a trivial matter.