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220 OPERATIVE DENTISTRY
pulp canal or there may be an abscess with a sinus passing through
the alveolar process and opening through the gum.
Treatment in General may be stated as involving the removal by
mechanical and chemical means of all products of putrefaction, thor-
ough sterilization of all surfaces exposed, conservation of vital tis-
sues beyond the apical foramen and the permanent closure of the
foramen to the passage of fluids and gases.
The Symptoms of Open Putrescence (Class One) are not marked
where the pulp is entirely putrescent, unless there are pericemental
complications, when the case would come under the heading of com-
plicated putrescence. When a portion of the pulp is yet vital it is
probable that the pulp is undergoing a cellular disintegration through
surface ulceration. This is usually a painless process and is re-
sponsive only to the encroachment of foreign substances which lacer-
ate its tissues or produce pressure within its substance. Such cases
call for sterilization and extirpation. However, with simple open
putrescence the symptoms are largely objective, the operator dis-
covering the conditions through instrumentation, and the noxious
gases encountered.
Treatment of Open Putrescence. Excavate the cavity to com-
plete exposure of the i)ulp chamber. Flood with a stream of water
from the syringe. Apply the rubber dam and sterilize all teeth and
surfaces exposed. For this purpose use a ten per cent solution of
formaldehyde to which has l)cen added a small amount of borax.
Another efficient sterilizing agent is bichloride of mercury, in the
proportion of one part to five-hundred of cinnamon water. Mechan-
ically remove the contents of the pulp chamber and flood the open
cavity with hydrogen dioxide, repeating the dioxogen two or three
times or until active effervescence ceases. Apply absolute alcohol
and evaporate to complete dryness. With an extra fine barbed broach
mechanically clean each root canal with hydrogen dioxide. Care
should be taken not to force any of the putrescent matter through
the foramen. Remove the contents of the canal, portion by portion.
The canals should then be dried with alcohol evaporation. Follow
this with a fifty per cent solution of sulphuric acid which is allowed
to remain three or four minutes when it should be thoroughly diluted
with water and the canals dried. Apply campho-phenique and desic-
cate to dryness. For the final dressing flood with phenol, pumping
it to the apex of said canal with a smooth broach. To this add a
paste made by mixing iodoform with phenol sufficiently stiff to be
handled to the cavity on a large spoon excavator. If crystallization
takes place add a drop of water. Avoid glycerine or alcohol. By a