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CHAPTER XXXVI.

MANAGEMENT OF PUTRESCENT PULP CANALS.

By "Putrescent Pulp Canals" is meant that condition in these
spaces resulting from putrefaction.
By "Putrefaction" is meant that serial, progressive decomposi-
tion through which albuminous substances are finally resolved into
the end-products, hydrogen sulphid (HgS), carbon dioxide (CO2),
ammonia (NH3), water (H2O), and hydrogen phosphid (PH3). A
distinguishing feature of the process is the evolution of malodorous
gases.
The Presence of Bacteria is necessary to the process of putrefac-
tion and all such cases must be approached with this fact in mind,
and antiseptic measures and precautions are paramount from the
beginning of the case to its termination, that the pericementum may
not be involved in the destructive process.
There Are Four Classes of Putrescent Pulp Canals, according to
the manner in which they are presented, symptoms present and the
method of treatment.
First. Those cases where the canals are open and exposed to
the fluids of the mouth known as "open putrescence" and which are
generally the result of the encroachment of caries.
Second. Those cases wherein the pulps die under a filling or a
layer of affected and infected dentine, the integrity of which will
not permit of the passage of fluids or gases. This is known as
"closed putrescence" and is the result of extrinsic infection.
Third. Those cases wherein the crown is integral and the bac-
teria necessary to putrefaction have entered the pulp tissue either be-
fore or after its death by way of the apical foramen, conveyed there
by the circulation of the blood. This class of cases, from the ap-
parent autopathy is termed "autogenous putrescence." Such cases
are most likely to follow suppurative processes in close proximity to
the arteries leading to the pulp, yet cases are seen where no such con-
ditions can be diagnosed, primary to the pulp symptoms, and are
generally traumatic.
Fourth. Those cases wherein the destructive processes have been
communicated to the pericementum, and are known as "complicated
putrescence." There may be pericemental inflammation in any of
its stages with or without soreness to percussion. The apical space
may harbor pus without other communication than the putrescent
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