Page 221 - My FlipBook

PULP DEVITALIZATION AND REMOVAL 217
Cement as a Retainer of arsenic has the advantage of setting
quickly, thus removing the danger, in occlusal cavities, of the pa-
tients causing themselves pain by biting on the fillings and produc-
ing pressure on the pulp. With anterior teeth it is more sightly
than amalgam or stopping. Its only disadvantage is that it some-
times sets so well that it is hard to remove and its adhering proper-
ties maj- result in dragging or lifting the application from its place-
ment, during the manipulation of introduction.
Temporary Stopping as a Retainer of arsenic has to recommend
it the ease of its removal with warmed instruments and especially
if its surface has been treated with a blast of warm air. The dan-
gers in its use lie in the difficulty in preventing pressure upon the
pulp either when applied or in mastication.
Cotton as a Retainer of arsenic should be entirely discontinued
as it has nothing to recommend it and everything to condemn it.
Caution in the Use of Arsenic about the teeth is of great impor-
tance and when used it must be sealed in the dry cavity absolutely
moisture proof and particularly when any of the cavity outline is
sub-gingival as any leakage at this point will result in great destruc-
tion to the gums and alveolar process. Such accidents are all too
frequent and the injury thus done is never fully repaired.
The Length of Time an Arsenical application should be left in
the tooth is most uncertain and there seems to be no set rule. Neither
the condition of the pulp nor the amount of dentine intervening can
be taken as certain in judging the time. However it is most com-
mon practice to see the case in about one week's time, as in this
time a majority of the cases will have become devitalized and the
natural process of exfoliation has taken place between the dead pulp
and the living tissues at the apex of the root enabling the operator
to remove the pulp without pain or hemorrhage.
Primary Soreness of the Tooth to percussion generally indicates
the death of the pulp. If an attempt is made to remove the pulp
too soon great pain will result as the pulp is yet vital, hence it is
best to wait until the pulp has been fully affected. Again during
the primary soreness and particularly during the first twenty-four
hours of this condition the patient cannot tolerate the instrumenta-
tion necessary. Such cases should be left from twenty-four to
forty-eight hours from the time pericemental soreness develops, hav-
ing applied to the gum over the afflicted tooth aconite and iodine
when it will generally permit of treatment.
Secondary Pericementitis is dangerous to the sub-dental tissues