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MANAGEMENT OF PUTRESCENT PULP CANALS 223
trinsic causes more or less remote from the body but the classifica-
tion of autogenous putrescence of the pulp is given, based upon
the same theories and principles as those applied in general
patholog.y, wherein the immediate cause is not at all apparent.
The Symptoms of Complicated Putrescence (Class Four) vary
from slight soreness to percussion to the symptoms accompanying
most violent and acute inflammatory processes even with general
febrile disturbances. Other cases will present themselves with an
entire absence of all the above symptoms, the only evidence of
pericemental complications being detected by observation or in-
strumentation. It is generally true that the acute cases show the
more marked symptoms, and the extremes of easy and difficult
management are encountered, whereas Avith chronic complications
the symptoms are not so marked and generally yield to stereo-
typed methods of treatment except where great destruction of tis-
sue has taken place, where such cases should come under the head
of surgery.
The Treatment in Complicated Putrescence is as varied as the
symptoms presented and the conditions found. The first order of
procedure is the removal of the cause which includes the elimina-
tion of the putrescent conditions within the pulp canal under
aseptic precautions. If the pericementum is only inflamed and the
presence of pus is not probable, the treatment is the same as that
outlined for uncomplicated putrescence, adding external applica-
tions to the gum over the affected tooth to stimulate resolution.
Painting with aconite and iodine is suggested.
In Acute Complication where pus has formed and upon broach-
ing is freely evacuated down the pulp canal, it is the best of sur-
gery to allow free drainage by this route for twenty-four or forty-
eight hours before attempting further treatment. At the end of
this time the most active symptoms will have generally subsided
and the case can be proceeded Avith. HoAvever, there have been
some cases so deeply affected bej'ond the apex of the tooth that ex-
ternal pointing on the alveolar Avail is probable and only a\'oided
by immediate extraction of the tooth. In such cases the salvage of
the tooth depends upon the ability of the patient to Avithstand the
pain fb the termination. They may be assisted in this through the
general administration of sedatives. Locally the application of re-
vulsives to the gum Avill hasten the external pointing. Evacuation
ushers in the stage of convalescence and the treatment of the pulp
canals may be proceeded with.