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214 OPERATIVE DENTISTRY

farther as possible without causing the patient pain. The drill used
should be smaller than the syringe point that a close fit to the hole
may be secured. Syringes are generally constructed so that a drill
made by flattening a No. 1-2 round bur will make a proper sized hole.
The syringe is then applied to the opening with some pressure and
its contents forced into the dentine.
It is essential that the solution be perfectly imprisoned as it re-
quires high pressure to force the anesthetic through the tubuli. Af-
ter holding the solution at high pressure in contact with the dentine
for one or two minutes it should be removed and the drill applied to
the hole to test its sensitiveness. If desensitized the hole should be
carried close to the pulp but not so far as to enter the chamber. The
syringe should be again applied and with great care, as sudden force
may cause pain by too rapid pressure upon the pulp.
Great Care Should Be Exercised when the pulp has been thus
nearly or quite exposed not to force into the pulp any considerable
amount of the anesthetic as it is carried or forced beyond the apical
foramen, from which no good can result and harm may, particularly
if the contents of an infected pulp are forced through to the tissues
of the pericementum.
Pulp Extirpation by Hypodermic Injection. Pulps may be re-
moved very quickly and Avithout pain by injecting the solution of
novocain as given for use in extracting teeth in Chapter XLI.
If Correctly Done the Pulp May Be Removed or the tooth ex-
tracted painlessly. Extreme care as to asepsis must be given. This
danger of infection makes this method unsuited for general use, but
applicable to cases where haste is imperative or where trouble is ex-
perienced in the use of pressure anesthesia or arsenic devitalization.
The Removal of an Anesthetized Pulp is accomplished by gain-
ing access to the pulp chamber from a position which will admit of
direct or nearly direct approach to each of the pulp canals, and mak-
ing the opening large enough to admit light enough to see either by
direct vision or the image in the mirror, the entire floor of the cham-
ber. First, a smooth sterile broach is passed down each canal to the
apex of the root, to test the completeness of the anesthetization. If
no sensation is found the barbed broach is then passed to the apex,
preferably an extra fine size. This should be twisted to the right
about one complete turn and then gently drawn from the cavity,
which should result in the amputation and removal of the entire
])ulp. This accomplished, the sides of the canal should be rasped
with a barbed broach of a larger size to remove any shreds which
may adhere to the sides of the canals.