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CHAPTER XXXV.
PULP DEVITALIZATION AND REMOVAL.

The Reason for Devitalization and Removal of a pulp is its pres-
ent unhealthy condition or when its future health is in danger, on
account of environment in the way of dental operations.
There Are Two General Causes of diseased pulps.
First. That succession of tissue changes which has its origin in
active hyperemia and its end in death due to the presence of bacteria
or their products—inflammation.
Second. Reparative congestion, due to traumatic injury, abnor-
mal thermal stimuli, lack of normal thermal stimuli and peripheral
nerve irritation.
Bacteria and Their Products may enter the pulp tissue either
through a loss of its normal covering, the dentine, as in the case of
deep-seated caries, or through the general circulation by way of the
apical foramen, as in pyorrhea alveolaris, or in other pus conditions
in close proximity to the pulp vessels. We have no means of know-
ing that a pulp thus invaded has recovered, while we have complete
proof of their subsequent death from this cause, hence devitaliza-
tion is indicated as soon as diagnosis is clear.
The Removal of the Cause in reparative congestion of the pulp
will generally suffice to save the pulp from further destruction pro-
vided the intervention is in the stage of active hyperemia.
The Traumatic Injuries most common in the production of pulp
congestion are blows upon the teeth either through accident or ex-
cessive malleting in dental operations ; rapid movement by the ortho-
dontist ; abnormal stress in occlusion or articulation ; malocclusion
and abnormal movement of the tooth in its alveolus made possible
by the loss of supporting structures.
Abnormal Thermal Stimuli is a most potent factor in producing
pulp congestion. The pulp is particularly and peculiarly susceptible
to thermal changes and this idiosyncrasy is very rapidly magnified
as the stages of congestion progress.
The Reason for Abnormal Thermal Changes reaching the pulp
is the loss of its natural covering, the dentine and enamel, through
caries, erosion, abrasion or dental operations as well as the denuding
of the root by a recession or loss of the sub-gingival structures.
Lack of Normal Thermal Stimuli will induce a stagnated circu-
lation with a sequela of degenerative changes within the pulp tissues,
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