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218 OPERATIVE DENTISTRY
and no arsenical application should be allowed to remain until this
second attack appears, as the loss of the tooth is not beyond the pos-
sibilities of such neglect.
The Treatment of Arsenical Poisoning due to its escape from the
cavify is as follows: Remove everything from the tooth cavity.
Flood the cavity and destroyed tissues with a forceful stream of
tepid w^ater to remove all traces of the arsenic not yet absorbed.
With a sterile spoon excavator dissect and curet away all necrotic
tissue continuing until hemorrhage is produced. Again flood the
parts with warm water. Dry with a cotton ball and lightly paint
the wound with aconite and iodine, repeating the treatment every
other day until a healing is effected.
When Pulp Returns Partially Devitalized as is evidenced by sen-
sation, particularly in the apical third of the canal, it is best to open
the pulp chamber and amputate with a sharp spoon excavator only
the coronal portion. Wash chamber with warm water and dry with
warm air. Apply absolute alcohol working same towards the apex
by the side of the pulp as far as possible without causing pain, fol-
lowing this with thorough desiccation with warm air. Then seal in
a dressing of phenol and dismiss for one week or even longer and
the case will usually return with devitalization complete. This treat-
ment is particularly indicated in young teeth where the apical fora-
men is large.
The Removal of the Pulp following arsenical devitalization is
practically the same as that following anesthetization, except that in
the latter case there is danger of going beyond the apex, while with
the arsenic devitalization method, the greater danger is in not ex-
tirpating the pulp entirely to the apex through mistaking a vital
pulp stump within the canal for vital tissue beyond.
Immediate Canal Filling following arsenical devitalization is
quite universally practiced and is generally satisfactory. However,
too large a per cent is followed by mild or severe pericementitis,
v/hich might be averted by dressing the canals with a mildly anti-
septic anodyne of a stimulating nature for a few days before filling
the pulp canals.
All Treatments Above Referred To in this chapter should be
carried out with the rubber dam in place at each sitting. (See chap-
ter on "The Filling of Pulp Canals.")