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144 PATHOLOGY OF THE HAED TISSUES OF THE TEETH. ;
definite phase to prophylaxis as applied to dental caries. The
complete divorcement of dental practice from studies of the
pathology of dental caries, which has existed in the past, is an
anomaly in science that should not continue. It has the tendency
plainly apparent to make dentists mechanics only.
Vital Phenomena in Caeies.
ILLUSTRATIONS: FIGURES 159-161.
Because of the fact that the teeth are vital, it has heen con-
tended that vital influences play a very important part in caries.
This idea, however, has been gradually disappearing for the last
seventy-five years, and but little of it is seen in our literature of
to-day. We must not conclude from this that the teeth are not
vital, that they are not living tissue. Teeth that have lost their
pulps, the dentin of which has lost its vitality, decay the same
as teeth with living dentin. This was disputed for many years,
and the opinion asserted that the decay in teeth that had lost
their pulps was of a different character from that occurring in
teeth with living pulps. This also has been definitely given up
and has disappeared from the recent literature. To-day, the
vitality of the teeth is not regarded as influencing caries in any
considerable degree. Caries progresses the same in teeth with
living pulps as in teeth with dead pulps. Some thought decay
was more rapid in teeth with dead pulps, others have disputed it
certainly there is no difference worth contention.
Generally, caries of the teeth progresses without pain until
such a penetration of dentin bas been reached that the pulp of
the tooth becomes hypersensitive on account of irritation of
its tissue. While this is the general rule, not a few persons
complain of more or less pain or of an itching sensation almost
as soon as the enamel has been penetrated, and the examination
of such cavities with an instrument point develops the fact that
they are sensitive to any mechanical interference. Other per-
sons have no perception of anything going wrong in a decaying
tooth until they notice that a cavity has formed. There has been
no pain or other noticeable sensation because of caries of the
dentin ; this is the general rule. Sensitiveness in the early stages
of caries, without some mechanical disturbance to arouse it, is
the exception, though it is by no means rare.
The rule is, that all progressive decays in teeth with Living
pulps are sensitive to any form of mechanical interference, such
as probing with a sharp explorer, or to the use of cutting instru-