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222 Operative dentistry
Their Removal Is Best Accomplished by saponification through
the action of sodium dioxide. This should be applied at the time of
broaching the canals, using a platinum broach. Following its use
the canals should receive a water bath.
Symptoms of Closed Putrescence (Class Two). Closed putres-
cence without complications is usually of short duration and when
they are presented for treatment before complication there generally
remains a portion of the pulp in the apical region yet vital.
The chief pathognomonic symptom is that heat produces paroxysms
of pain while cold applications bring relief.
The Treatment for Closed Putrescence is to apply the rubber dam
and with a small drill open directly to the pulp chamber when tem-
porary relief will be immediate. The opening should then be en-
larged and the necrotic pulp tissue removed. If no vital pulp tis-
sue is found the case should be proceeded with as before outlined
for cases of open putrescence. When a vital portion of the pulp re-
mains nothing will be more palliative than the phenol and iodoform
paste treatment already outlined. This paste will also devitalize the
remaining portion of the pulp. Pressure anesthesia is certainly not
indicated in such cases from the liability of infecting the pericemen-
tum. Neither is an arsenical application permissible within a pulp
canal, hence the phenol treatment is the best practice.
Autogenous Putrescence of the Pulp (Class Three) are occasion-
ally met with and may be of long standing without complications of
the apical tissues and only discovered when the dentine of the crown
is found to be non-vital. Such cases are generally of traumatic
origin primarily, the putrescent condition developing long after the
death of the pulp by the egress through the apical foramen of
facultative anaerobic bacteria. Such cases are dealt with, when
treated, as any case of closed putrescence, excepting that extra
precaution as to access must be taken as the admittance of the
air to such cases seems to render the putrescent matter most viru-
lent and the dangers of complications are most extreme. Cases pre-
sented, of recent origin, which may be classed as autogenous are
generally complicated when they come to the dentist as the com-
plication is the cause of the patient's visit, when they would be
classed as a case of closed putrescence. Their cause is the en-
trance of infection through the circulation, the bacteria having
been picked up in pus areas not far distant from the apical fora-
men. Strictly speaking there are no autogenous diseases or condi-
tions, such as auto-infection as all in this life is the result of ex-